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Musculoskeletal Examination of the Foot and Ankle: Making the Complex Simple

S.  R. Hurwitz, S. G. Parekh pp. 243 Thorofare: SLACK Incorporated, 2012 ISBN: 978-1-55642919-4

SLACK Incorporated’s Making the complex simple series covers all areas of the body, including this text, Musculoskeletal examination of the foot and ankle. Editors Dr Shepard Hurwitz and Selene Parekh, and an array of prominent American foot and ankle surgeons, have produced a most informative text, bringing together examination techniques and most importantly relating them to common clinical foot and ankle conditions.

The target audience is stated by the authors to be surgical trainees, consultants, allied health professionals and medical students. As a practising consultant dedicated to foot and ankle problems, I found the information a useful refresher, but the majority of the content did not add to my knowledge base. I would suggest that the content is best directed at enthusiastic medical students with an orthopaedic career interest, all levels of surgical trainees, including those wishing to specialise in foot and ankle surgery and allied health professionals such as physiotherapists wishing to gain more information about conditions that they treat on a daily basis.

The book is divided into three main sections. First, we are provided with a thorough overview of physical examination and gait analysis. Secondly, there is a dedicated section on Imaging of the foot and ankle. And finally, the third section covers nine common foot and ankle conditions. Simple and specialist physical examination techniques are described with respect to each condition and treatment is also covered, adding to the strength and depth of the book.

In some ways the title of the book does not reflect the amount of useful information available to the reader beyond simple physical examination. Whilst the first section on general physical examination covers conditions such as ankle instability and posterior tibial tendon dysfunction, which are again covered in detail later in the book, a degree of repetition of common and important signs in my opinion is useful and drives home the principles of a thorough history and physical examination.

I was pleased to see reference to medial ankle instability, which is increasingly recognised and underappreciated. Peroneal tendon pathology was well covered, including the modern technique for fibular groove deepening, and management of the fortunately rare situation of irreparable longus and brevis tendons. Pes cavus is covered in some detail and provides a wealth of information for the orthopaedic trainee with an interest in the foot and ankle. The concepts of bony and soft-tissue balancing are highlighted, and summarised in a very readable format.

Caution is required in reading some of the treatment sections. Foot and ankle problems often have multiple solutions and some treatments available in the United States are not common place in the United Kingdom, such as radiofrequency treatment for resistant plantar fasciitis. Nevertheless, the reader should use an open mind on reading any text which describes treatment options, as variation in practice is commonplace throughout the world.

In summary I would thoroughly recommend this book to students and in particular orthopaedic trainees wishing to gain a better understanding of how to diagnose and treat common foot and ankle problems.

A. Amin

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