Category Archives: Feature Article

Featured Issue Article

January 2013

Exploring mechanisms of diabetic foot ulceration

Prevention and treatment of foot ulcers in patients with diabetes requires an understanding of the various factors that contribute to increased risk, including anatomical deformity, poor vascular function, and di­min­ished capacity for healing at a microscopic level.

By Allyson Berglund, DPM, Matthew Juriga, DPM, Aristidis Veves, MD, DSc, and Thanh Dinh, DPM

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November 2012

Charcot neuroarthropathy and bone mineral density

Research indicates that in diabetic patients with Charcot neuroarthropathy, peripheral bone mineral density decreases over time, which can contribute to risks of hardware failure, loss of correction, delayed union, and nonunion in patients with advanced disease.

By Rachel H. Jung, DPM, MHA, MPH; Robert M. Greenhagen, DPM; Dane K. Wukich, MD; Vassilios Vardaxis, PhD; and Robert  M. Yoho, DPM, MS

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November 2012

OA knee braces face off against wedged insoles

Two separate studies directly compared valgus knee bracing and wedged foot orthoses for reducing knee adduction moment in patients with osteoarthritis, but came to opposite conclusions. A third study suggests combining the two interventions may be the best solution.

By Barbara Boughton

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November 2012

Self-selected gait speed: A critical clinical outcome

When treating patients who are going through rehabilitation, clinicians may be overemphasizing gait distance and over­looking the importance of gait speed. Clinical assessment of gait speed is sim­ple and inexpensive but can be a signifi­cant indicator of functional recovery.

By Heather Braden, PT, MPT, PhD, GCS

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November 2012

Intramuscular manual therapy for heel pain

Intramuscular manual therapy, also known as dry needling, is hypothesized to relieve pain by modifying tension in connective tissue. Limited evidence supports the use of IMT for plantar fasciitis, although further research is needed to rule out a placebo effect.

By Brent Harper, PT, DPT, DSc, OCS, FAAOMPT

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October 2012

Healthcare reform: What it means for your specialty

Despite being upheld by the Supreme Court, the Affordable Care Act remains a subject of debate heading into next month’s presidential election. Meanwhile, government affairs experts are working to determine just how the ACA will affect lower extremity practitioners.

By Shalmali Pal

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October 2012

Ankle bracing: Exploring effects on proximal joints

Research suggests that the ankle’s ability to absorb its share of energy during landing from a jump is altered with the use of an ankle brace. The extent to which this effect might influence risk of injury to other lower extremity joints or soft tissues, however, remains unclear.

By Jacob K. Gardner, MS

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October 2012

Despite few solid studies, ulcer debridement thrives

There are few high-quality studies and no randomized controlled trials documenting its effectiveness, but debridement—from surgical to larval—remains a mainstay of diabetic ulcer care in many practices, and new twists on conventional techniques continue to evolve.

By Cary Groner

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October 2012

Prehabilitation for TKA: Preop and postop benefits

Prehabilitation, particularly in the form of exercise, has the potential to significantly improve preoperative and postoperative outcomes in patients with knee osteo­arthritis who are undergoing total knee arthroplasty. Both physiological and psychological outcomes can be positively impacted.

By Carly McKay, PhD, and Harry Prapavessis, PhD

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September 2012

Patient Perspective: Communication takes edge off pain of recovery

When I first entered my podiatrist’s office for treatment of a moderately painful case of plantar fasciitis, I never thought that healthcare for my feet could get complicated. I subsequently developed sesamoiditis and my podiatrist prescribed custom orthotics for both my foot conditions. But then came the clincher: one night, I fell down a short flight of stairs and unfortunately landed on my foot.

By Barbara Boughton

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September 2012

Rethinking device design to improve compliance

Reducing the shaft height of a removable cast walker, which results in a lighter device and may also help improve postural stability, can help improve compliance in patients at risk for diabetic foot ulcers without compromising the device’s offloading capability.

By Sai Vikas Yalla, PhD, and Ryan T. Crews, MS, CCRP

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September 2012

Effects of minimalist shoes on running gait

Research suggests that when transitioning to a minimalist running shoe, foot strike pat­tern is key to preventing lower extrem­ity injuries. A transitional minimalist shoe, with slightly thicker and softer soles, may help prevent certain injuries in some runners.

By Everett B. Lohman III, DSc, PT, OCS

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September 2012

Knee OA interventions: A look at value for money

Even if an intervention results in a positive clinical outcome in patients with knee oste­o­­arthritis, another important factor to consider is whether that treatment’s benefits justify its costs. Increasingly, cost effectiveness studies are comparing OA interventions to determine value.

By Daniel Pinto, PT, PhD

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September 2012

Clinical assessment of ankle joint laxity

Ankle joint laxity can be a complicating factor in patients with acute ankle sprains or chronic instability, and testing for excessive laxity can help practitioners choose an appropriate method of treatment. However, not all tests for ankle joint laxity are created equal.

By Theodore Croy, PhD, PT, OCS, and Jay Hertel, PhD, ATC, FNATA

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August 2012

Load cells enhance study of prosthetic foot rollover

A new technology, the load cell, can be used to assess rollover characteristics of prosthetic feet in a variety of walking envi­ronments. Load cell analysis can help identify premature foot-flat and dead spots and determine the effects of energy stor­age and return designs on amputee gait.

By Edward S. Neumann, PhD, PE, CP, FAAOP; Justin Brink, MSE, EI; Kartheek Yalamanchili, MSE, EI; and Joon S. Lee, PhD

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August 2012

Idiopathic toe walking: Insights on intervention

As researchers explore the possibility that idiopathic toe walking has an underlying neurologic cause, clinicians continue to refine treatment strategies to keep ITW patients off their toes. Orthotic devices play a key role, with lower-profile devices growing in popularity.

By Emily Delzell

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August 2012

Gait alterations associated with diabetic neuropathy

Inconsistent findings from laboratory stud­­ies have made it difficult to deter­mine which gait alterations are specific to diabetic peripheral neuropathy and which also affect diabetic patients with­out neuropathy. Body-worn sensor tech­nol­ogy may help clarify the distinctions.

By Tahir Khan, DPM, and Ron Guberman, DPM, DABPS

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August 2012

Acute stretching debate approaches a consensus

Experts still disagree about whether stretch­­ing prior to athletic activity can prevent injury and, if so, whether those ben­e­fits offset any negative performance effects. But they do tend to agree that some form of stretching is probably a good idea for most athletes.

By Cary Groner

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August 2012

OA bracing: Longer use does not impair strength

Dose-response research refutes the com­mon perception that increasing brace wear time leads to muscle atrophy in patients with knee osteoarthritis. In fact, longer bracing duration appears to im­prove hamstring strength as well as in­creas­ing patients’ physical activity levels.

By Cheryl L. Hubley-Kozey, PhD, and Gillian Hatfield Murdock, PT, MSc

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July 2012

Pediatric obesity weighs on growing bones, joints

Exercise is the standard prescription for obesity. But alterations to joint biome­chan­ics, gait, and anatomical structure in overweight children and teens mean that physical activity comes with its own risks, which practitioners must factor into any clinical recommendations.

By Christina Hall Nettles

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July 2012

Development of the arch: Functional implications

Contrary to the conclusions of early research, recent studies suggest that arch height does indeed affect lower extremity function. The biomechanics associated with different arch heights may provide a basis for treatment and prevention of related injuries.

By Thomas C. Michaud, DC

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July 2012

The evidence for use of gauntlet-style AFOs

Gauntlet-style ankle foot orthoses offer an alternative to a larger rigid therm­oplastic AFO for foot and ankle pathol­ogies requir­ing more stability or im­mo­bili­za­tion than a foot orthosis provides. Materials, trim lines, and fabrication techniques can vary to meet different patients’ needs.

By Holly Tuchscherer Olszewski MS, CPO 

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July 2012

Dialysis treatment takes toll on diabetic foot care

A convergence of comorbidities means diabetic patients on dialysis have an even higher risk of foot ulcers and amputation than those without renal disease. The potential for preventing these complica­tions at dialysis centers is too often underappreciated by practitioners.

By Larry Hand

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July 2012

ACL reconstruction and risk of knee OA, part 2

This two-part series examines the link between ACL injury and the later development of osteoarthritis (OA) and how surgery may strengthen or weaken that link. This second installment explores meniscal damage, proprioception, and what MRI can add to the discussion.

By Cary Groner

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June 2012

Diabetic foot infections: Progress meets pitfalls

New evidence-based guidelines on the management of diabetic foot infections reflect significant advances by research­ers and clinicians, but the recent emer­gence of regulatory hurdles has slowed the development of new antibiotic drugs for treating those infections.

By Emily Delzell

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