Category Archives: Feature Article

Featured Issue Article

October 2016

Role of bariatric surgery in patients with knee OA

Weight loss following bariatric surgery can have biomechanical and symptomatic benefits for obese patients with knee osteo­arthritis (OA). But it’s less certain whether that weight loss can also reduce the risk of obesity-related complications following total knee arthroplasty.

By Shalmali Pal Continue reading

October 2016

Crossover consequences of unilateral treatments

The mechanisms underlying the so-called crossover effect—when a unilateral intervention results in bilateral changes—are still unclear, but clinical applications related to lower extremity strengthening, fatigue, and stretching are already being explored by rehabilitation specialists.

By Cary Groner Continue reading

October 2016

Insole research explores postural control effects

A growing body of evidence suggests that foot orthoses may be a helpful addition to other therapies for improving balance and potentially reducing the risk of falls. The findings have been mixed, however, and clinical enthusiasm for this type of insole intervention also varies.

By Hank Black Continue reading

September 2016

Management of athletes with early-stage PTTD

Posterior tibial tendon dysfunction (PTTD), known also as tibialis posterior tendon dysfunction, is one of the leading causes of acquired flatfoot in adults, but the…

By By Frank Layman, PT, DPT, EdD, MT; and April Wilson, PTA, BS, CI, CKTP, IASTM Continue reading

September 2016

Support for dry needling builds among clinicians

Dry needling is gaining momentum as an alternative therapy for myofascial pain, and is supported by a small but growing body of research as well as anecdotal evidence. But the training and expertise required to perform the procedure has become a topic of debate.

By P.K. Daniel Continue reading

September 2016

Chronic ankle instability, gait, and muscle activity

New research suggests lower extremity clinicians should consider implementing gait training in combination with targeted strengthening of the peroneus longus and gluteus medius muscles to help restore normal gait patterns in patients with chronic ankle instability.

By Rachel Koldenhoven, MEd, ATC Continue reading

September 2016

Reducing postoperative thromboembolism risk

Preventing deep venous thrombosis and pulmonary embolism after lower extremity surgery can involve pharmaceutical therapies or mechanical interventions. The type of prophylaxis used depends on the type of surgery, pre-existing risk factors, and patient preference.

By Barbara Boughton Continue reading

September 2016

Step-rate manipulation and foot-strike pattern

In distance runners, step-rate manipulation of at least 10% above a runner’s preferred rate may be an effective clinical gait retraining method to decrease the severity of foot inclination angle at heel strike and…

By Darrell J. Allen, PT, DPT, MS, SCS, CSCS; Hollie Heisler, PT, DPT; and Jennifer Mooney, PT, DPT  Continue reading

August 2016

Management of Achilles tendinopathy in runners

Achilles tendinopathy is a common lower extremity injury in athletes as well as nonathletes. The Achilles tendon is often a site of injury in runners and is the second most common running-related musculo­skeletal injury, after medial tibial stress syndrome, with an…

By Howard Kashefsky, DPM Continue reading

August 2016

Uneven terrain: Tactics for orthotic-device users

Helping patients manage an orthotic device can be challenging, but doing so in the face of uneven terrain is a balancing act between stability, mobility, and strength. Device adjustments and rehabilitation pro­tocols can help patients avoid asymmetries and reduce the risk of falling.

By Shalmali Pal Continue reading

August 2016

Foot strike while running and patellofemoral pain

Recent research supports the idea that increased patellofemoral stress is a contributing factor in runners with patello­femoral pain, and that gait retraining to promote a…

By Jenevieve L. Roper, PhD; Deborah L. Doerfler, PT, DPT, PhD; Christine M. Mermier, PhD; and Janet S. Dufek, PhD Continue reading

August 2016

Foot rotation during gait in patients with knee OA

Rotating the foot in or out during gait is associated with significant decreases in frontal plane knee load during early or late stance, respectively, and can be effective for reducing pain and potentially slowing the progression of…

By Kevin Alan Valenzuela, ABD, CSCS; and Hunter Jared Bennett, PhD Continue reading

August 2016

Radiofrequency-based arthroscopy in the ankle

The results of a retrospective chart review suggest that the use of plasma-mediated bipolar radiofrequency-based arthroscopic microdebridement is associated with notable decreases…

By Renato Giorgini, DPM, FACFAS; Stephanie Giles, DPM; Omer Aci, DPM; and Christopher Japour, DPM, MS  Continue reading

July 2016

Understanding turf toe: The role of foot orthoses

Turf toe is a common injury in football players competing on artificial turf, but it also occurs in soccer and baseball players on natural grass and other playing surfaces. Turf toe is a sprain of the capsule of the first metatarsophalangeal (MTP) joint; increasing grades of injury may include…

By Patricia Pande, MClScPT, CSCS, CPed Continue reading

July 2016

New healing factors take ulcer care to the next level

Support is growing, in the medical literature and in clinical practice, for the use of skin substitutes and other advanced biologic therapies in chronic diabetic foot ulcers. But researchers and practitioners remain uncertain as to which of these advanced products are best for…

By Hank Black Continue reading

July 2016

Lower extremity strength and injury risk in runners

Study findings regarding strengthening interventions in runners with patello­femoral pain syndrome have been inconsis­tent, perhaps because specific subgroups are more responsive than others. Preliminary research suggests high school runners may make up…

By Lace Luedke, PT, DPT, PhD, OCS, CSCS Continue reading

July 2016

Limb length discrepancy: When, how to intervene?

Limb length discrepancies (LLDs) as small as 1.5 cm can significantly affect gait, and some clinicians choose to intervene in cases of even smaller discrepancies. Many LLDs can be addressed orthotically, but surgical techniques are becoming less invasive and more effective.

By Cary Groner Continue reading

June 2016

Golf swing biomechanics: Footwear considerations

With the rise of a new crop of young stars and the anticipation of its Olympic debut this year, golf continues to be immensely popular for players and spectators alike. Golfing is a highly coordinated sport that, by its nature, is associated with risk of…

By Patricia Pande, MClScPT, CSCS, CPed Continue reading

June 2016

When knee OA research becomes legal testimony

In worker’s compensation cases, including those involving knee osteoarthritis, an expert witness often will be asked to use his or her knowledge of biomechanics to provide an opinion supporting or refuting a causal relationship between work conditions and an overuse injury.

By Steven T. McCaw, PhD

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June 2016

Stroke rehab: Strategies to improve gait velocity

Multiple techniques can help improve gait speed after stroke, from therapeutic exercise to task-specific training to orthotic devices. Despite a growing body of research in this area, however, it is still not clear which intervention is most appropriate for which patients.

By Hank Black

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June 2016

Posture-specific strength and landing mechanics

Recent research suggests that training designed to maximize strength at deeper knee flexion angles during landing may be warranted, especially in female athletes, to help reduce the risk of anterior cruciate ligament injury without inadvertently compromising jump height.

By Boyi Dai, PhD; Jacob S. Layer; and Taylour J. Hinshaw

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June 2016

Treatment of distal toe calluses and ulcerations

When calluses or ulcers develop on the distal aspect of the lesser toes, offloading pressure from the distal end of the digit is essential for healing to occur. Research suggests that toe crest pads offer an inexpensive but effective means of offloading and healing these distal wounds.   

By Monica Melo, DNP, RN, ACNS-BC, CWOCN, CFCN

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May 2016

Managing metatarsalgia in athletic populations

Metatarsalgia is a common foot disorder. The term metatarsalgia refers to a pain syndrome in the forefoot and not to a specific diagnosis. Pain is confined to the area across the plantar forefoot, including the second through fourth metatarsal heads.

By Howard Kashefsky, DPM, FACFAS Continue reading

May 2016

Skin-care issues related to orthotic device wear

The care and prevention of skin issues may not get as much attention in orthotics as in prosthetics, but such issues can significantly affect patient outcomes. Here, lower extremity experts share the tips and tricks they use to manage dermatological challenges related to orthotic devices.

By Lori Roniger Continue reading

May 2016

Using subsensory noise to improve balance, gait

Using specially designed insoles to deliver stochastic resonance to the plantar surface of the feet has the potential to significantly improve static balance, dynamic balance, and gait mechanics in healthy…

By Daniel Miranda, PhD; Wen-Hao Hsu, ScD; and James Niemi, MS Continue reading