Category Archives: Feature Article

Featured Issue Article

December 2009

CPO seeks central fab: Finding a match

Charles Kuffel, CPO, of Blaine, MN, knows his limitations. If the clinician and father of four is going to keep his referrals happy, get products to his patients on time and have a life outside the office, it means outsourcing some orthotic orders to a central fabricator.

By L.W. Barnes

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December 2009

For those about to rock, we caution you

Shoes with rocker-bottom soles have long been used to alleviate plantar pressures in diabetes patients and others susceptible to forefoot pain or ulceration. The soles move the apex of the toe rocker behind the metatarsal heads, reducing pressure as the patient’s weight transfers forward over the ball of the foot.

by Cary Groner

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December 2009

Shear Madness: Beyond plantar pressure

Clinicians have known for many years that uneven plantar pressures, combined with the loss of sensitivity caused by peripheral neuropathy, are associated with foot ulcers in diabetes patients. Ulcers often occur in different areas than peak pressures do, however. Shear forces, caused by pressure differentials in the foot, may be more to blame than plantar pressures per se.

by Cary Groner

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December 2009

Drop foot mechanics outweigh etiology

Conditions associated with drop foot are as varied as post-stroke hemiplegia, brain or spinal cord injury, and neuromuscular disorders including multiple sclerosis (MS). Patients with drop foot are unable to use the dorsiflexor muscles to lift the foot clear of the ground during the gait’s swing phase, nor can they control plantar flexion during heel strike. The result is an awkward, unstable gait and a tendency to trip when the toes brush the ground.

by Cary Groner

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December 2009

Finding—and breaking—the ACL-OA link

In recent years, scientific studies have shown that anterior cruciate ligament (ACL) injury in athletes can lead to later osteoarthritis in a large proportion of cases. In fact, some studies have documented osteoarthritis rates of 50% to 100% in former athletes who have experienced ACL injury, when followed for 15 to 20 years.

By Barbara Boughton

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December 2009

The Home Stretch: Paths to pain relief

Stretching and splinting have long been treatment strategies for plantar fasciitis. However, new research and ongoing clinical experience are calling into question older methodologies and providing evidence for some new approaches.

by Cary Groner

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December 2009

Underuse, overuse both can lead to PTTD

Ongoing research into posterior tibial tendon dysfunction (PTTD) has revealed risk factors that include female sex, increasing age, overweight, unsupportive footwear, and even metabolic syndromes such as diabetes. Although typically associated with older, inactive patients, PTTD is also seen more rarely in young athletes.

by Cary Groner

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December 2009

CP gait studies document AFO efficacy

Clinicians who treat ambulatory cerebral palsy patients rely heavily on ankle-foot orthoses, which are the most effective treatment option for improving gait mechanics. But because CP encompasses such a wide range of symptoms, selecting the most appropriate corrective brace for a patient’s specific gait abnormality or abnormalities can present clinical challenges. Recent studies that shed light on ankle-foot orthoses’ impact on gait are characteristic of crucial ongoing research.

By Linda Weber

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December 2009

Sport-specific advances benefit all amputees

Whether it’s rock climbing, triathalons, cycling, running or the high jump, advances in prosthetic design have made high-caliber athletic competition a reality for some amputees. One such athlete testified in the September issue of Prosthetics and Orthotics International, “Snowboarding with the new prosthesis is like it was before the amputation!”

by Barbara Boughton

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December 2009

Early, active ACL rehab maximizes ROM

Achieving full range of motion is a key outcome of any rehabilitation program after ACL reconstruction. But what are the ingredients of a rehabilitation program that produces the best outcomes in terms of ROM?

By Barbara Boughton

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November 2009

Managing turf toe in football players

Grade 1 and 2 turf toe hyperextension injuries have good outcomes when treated non-operatively, but the optimal treatment for grade 3 is unclear.

By Seth C. Gamradt, MD, and Robert H. Brophy, MD

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November 2009

Kinematics of PTTD dictate management

Researchers are only starting to examine how orthotic management of PTTD affects foot and ankle kinematics.

By Jeff Houck, PT, PhD, Christopher G. Neville, PT, MS, and Adolph Flemister, MD

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November 2009

Feedback-based rehab could lower risk of OA

Feedback-based gait retraining may help reduce rates of loading by improving joint kinematics and proprioception.

By Jody L. Riskowski, PhD

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November 2009

Diabetes: Offloading difficult wounds

If foot pressures are to be reduced, healing to progress, and prevention of ulceration to be a realistic
goal, offloading is imperative. Part one of two.

By Robert J. Snyder, DPM, FACFAS, CWS, and Karen K. Lanier, CPed

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November 2009

Achilles tendinopathy: A four-part approach

Treatment program includes patient education, deep friction massage, eccentric exercise, and Mulligan taping.

By Russell Woodman, FSOM,OCS,MCTA, DPT, and Juan C. Garbalosa, PhD, PT

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October 2009

Practice Tactics: Assess, then exceed patient expectations

As patients pay more for healthcare, they will expect more from the patient experience. The most successful practices will be those that are best able to meet — and exceed — those expectations.

By Jason Kraus

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October 2009

Controlling drop foot: Beyond standard AFOs

The basic goal is to improve toe clearance during swing and provide stability during stance, but new orthotic technologies do much more.

By Jeremy Farley, CPO/L

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October 2009

Orthoses: Alternatives for midfoot arthritis pain

Full-length carbon graphite orthoses may improve outcomes through load redistribution and forefoot motion control.

By Smita Rao, PT, PhD

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October 2009

Balancing risks, rewards of athletic shoe traction

Research suggests that traction on modern artificial turf can vary depending on cutting angle.

By Michelle Sabick, PhD; Benjamin Cooper, MS; Seth Kuhlman, MS; and Ronald Pfeiffer, EdD, LAT, ATC

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October 2009

Functional hallux limitus: Diagnosis and treatment

Once identified, functional hallux limitus can be effectively managed with orthotic devices.

By James G. Clough, DPM Continue reading

October 2009

Diabetes: Improving foot care compliance

More favorable diabetic foot ulcer outcomes will require a better understanding of why patients don’t comply.

By Ryan Crews, MS, CCRP

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September 2009

Diabetes: Pressure data guide offloading efforts

Pinpoint problem areas, compare orthotic devices and improve consistency in fabrication.
By Georgeanne Botek, DPM, and Tammy M. Owings, DEng.

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September 2009

Stroke: The evidence for orthotic treatment

The literature on use of AFOs for stroke management could—and should—change your practice. By Stefania Fatone, PhD, BPO(Hons)

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September 2009

Fifth met stress fracture: Load-based risk factors

Male gender, athletic task, foot type, and shoe design may all contribute to lateral forefoot loading.
By Robin M. Queen, PhD, and James A. Nunley II, MD

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September 2009

Ankle balance training targets recurrent injury

Reducing sprain recurrence in turn reduces the risk of chronic ankle instability and osteoarthritis. By Erik A. Wikstrom, PhD, ATC, and Mitchell L. Cordova, PhD, ATC

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