Category Archives: Feature Article

Featured Issue Article

January 2018

Can minimalist shoes protect against injury by increasing foot-muscle thickness?

Improvement in abductor hallucis muscle size associated with a gradual transition to minimalist running shoes suggests that this type of strength-based approach can help improve foot structure and stability, which may…

By Nicholas A. Campitelli, DPM, FACFAS; and Scott A. Spencer, DPM Continue reading

November 2017

BRAINS, SPRAINS, AND CHRONIC PAIN: Concussion consequences may include osteoarthritis

As a growing number of studies report associa­tions between concussion and musculoskeletal injury risk, new research suggests concussed athletes may also have an increased risk of osteoarthritis later in life.

By Robert C. Lynall, PhD, ATC; Timothy C. Mauntel, PhD, ATC; David R. Howell, PhD, ATC; and Thomas A. Buckley, EdD, ATC Continue reading

November 2017

From barefoot running to diabetic neuropathy

Because footwear alters sensory perception, research examining the role of cutaneous feedback in barefoot running may provide important insight related to some of the gait changes that occur in patients with…

By Melissa Thompson, PhD, and Kristine Hoffman, DPM, FACFAS Continue reading

November 2017

Focus on biomechanics helps treat claudication

Lower extremity clinicians say ankle foot orthoses, rocker-soled shoes, and other orthotic interventions can benefit patients with peripheral arterial disease and intermittent claudication by making it easier for them to exercise, and research is starting to demonstrate these benefits.

By Shalmali Pal Continue reading

November 2017

Assessing runners’ gait using wearable sensors

Wearable sensors allow for the collection of running biomechanics data outside the laboratory in natural training environments, enabling clinicians to collect a large volume of information in a relatively short time to help identify and manage individuals who may be at risk for running-related injuries.

By Rachel Koldenhoven, MEd, ATC; and Alex DeJong, MEd, ATC Continue reading

November 2017

When a longtime patient dies: How clinicians cope

It’s not unusual for any practitioner to experience complicated emotions when a death or a terminal diagnosis disrupts the personal bond forged with a patient over many years, but experts say lower extremity clinicians often are not well equipped to deal with these emotions.

By Emily Delzell Continue reading

October 2017

Lower extremity clinicians absorb hurricanes’ impact

Clinicians in areas affected by hurricanes Harvey and Irma were prepared for issues involving preexisting lower extremity concerns, but were surprised by the number of cases they saw in the storm’s aftermath involving healthy people trying to function under extraordinary conditions.

By Nancy Shohet West Continue reading

October 2017

Implications of high ankle sprains in college athletes

High ankle sprains in collegiate athletes differ from lateral or medial ankle sprains in multiple clinically relevant ways. These include loss of sports participation time, mechanism of injury, rates of injury during competition versus practices, and the possible long-term risk of osteoarthritis.

By Timothy C. Mauntel, PhD, ATC; and Zachary Y. Kerr, PhD, MPH Continue reading

October 2017

Orthotic management tactics for hallux limitus

Orthotic devices for hallux limitus are designed to limit first metatarsophalangeal joint motion while providing cushioning and plantar pressure distribution. A lack of quality research on conservative treatment of the disorder, however, forces clinicians to rely on their own experience.

By Hank Black Continue reading

October 2017

Return-to-play concerns following Achilles tears

Achilles tendon ruptures are severe injuries that are associated with a long recovery and significantly affect an athlete’s ability to function at a high level. In devising strategies for rehabilitation and return to play, the goal of clinicians and athletes alike is to try to minimize this impact.

By J. Turner Vosseller, MD Continue reading

September 2017

Hemophilia, ankle pain, and orthotic management

The ankle is a frequent site of arthropathy  in patients with hemophilia, but orthotic devices and orthopedic shoes can help relieve this pain. New research suggests that…

By David Oleson, PT, PCS; Katherine Stribling, PT, DPT, PCS; Jamie Beckwith, PT, DPT; Laura Fox, PT, DPT, PCS; Felicity Case, PT, DPT, PCS; Nancy Durben, MSPT, PCS; and Michael Recht, MD, PhD      Continue reading

September 2017

Soft braces: Experts hunt for potential mechanisms

Soft braces are not designed to change lower extremity alignment or joint forces, but research suggests they may influence knee and ankle biomechanics in other ways, including by enhancing proprioception. This line of investigation could open the door to new therapeutic opportunities.

By Stephanie Kramer Continue reading

September 2017

SEBT scores and injury risk in collegiate athletes

Anterior-direction Star Excursion Balance Test performance may most appropriately discriminate between collegiate athletes who are and are not at risk for lower extremity injury, though…

By Mikel R. Stiffler-Joachim, MS; David R. Bell, ATC, PhD; and Bryan C. Heiderscheit, PT, PhD Continue reading

September 2017

Surgery and ulcer healing in patients with equinus

Achilles tendon lengthening and gastrocnemius recession both increase ankle joint dorsiflexion and reduce plantar forefoot pressures in patients with diabetes and equinus deformity, but experts continue to debate which is best for managing forefoot ulcers and minimizing reulceration.

By Barbara Boughton Continue reading

August 2017

Frontal plane kinematics and risk of ankle sprain

Research suggests that a simple step-down task has a strong relationship with frontal plane ankle kinematics during walking and jump landing, and may be one method of screening or assessing for increased inversion—and, in turn, increased risk of future ankle sprain—in clinical settings.

By Luke Donovan, PhD, ATC; and Mark A. Feger, PhD, ATC Continue reading

August 2017

AFOs and balance issues in peripheral neuropathy

At a symposium in Cape Town, South Africa, an orthotist demonstrated his technique for treating balance issues in patients with peripheral neuropathy using ankle foot orthoses (AFOs), and a team of researchers theorized about evidence-based concepts that could help explain his findings.

By Cary Groner Continue reading

August 2017

Biomechanics of femoral neck fractures in runners

Factors related to joint loading during running contribute to the development of stress fractures in the femoral neck and other lower extremity structures. Research suggests these loading parameters can be reduced by altering running foot strike pattern, stride length, speed, and step rate.

By Mark Riebel, PT, DSc, OCS, SCS Continue reading

August 2017

Clinical prediction rules: Finding a middle ground

Clinical prediction rules (CPRs) are intended to improve patient care, but critics have suggested that—for a number of reasons—the opposite may be true. Lower extremity experts interviewed by are in agreement that, ultimately, even the best CPRs should be only one piece of the clinical puzzle.

By Cary Groner Continue reading

July 2017

Recent trends favor use of bracing for knee OA

Experts say new research underscoring the clinical benefits of bracing for patients with knee osteoarthritis (OA), along with more comfortable device designs aimed at improving patient compliance, may help boost the historically low rates of brace utilization in this patient population.

By Barbara Boughton  Continue reading

July 2017

An interdisciplinary take on diabetic limb salvage

Developing a multidisciplinary team dedicated to diabetic limb salvage allows for immediate referral, lessens the burdens on individual practitioners, helps remove structural barriers that can delay patient care, and offers a framework in which to organize inpatient care for these patients.

By Brian M. Schmidt, DPM, AACFAS Continue reading

June 2017

Study challenging Root concepts reignites debate

The latest paper to challenge biomechanics-based foot orthotic management concepts developed decades ago has revital­ized a long-running discussion among foot specialists about how to define normal structure and function and which assessments should be used in prescribing foot orthoses.

By Cary Groner Continue reading

June 2017

Minimalist shoes: Risks and benefits for runners

Although there may be benefits to a change in running footwear, there are also risks associated with a switch to minimalist running shoes. Alterations in anatomy, physiology, and biomechanics associated with transitioning to minimalist footwear are likely to be unique to each runner.

By J. Todd Walker, MD; Donna Moxley Scarborough, PT, MS; Eric M. Berkson, MD; and Matthew J. Salzler, MD Continue reading

June 2017

Management of painful plantar fat pad atrophy

Aging and a number of medical conditions can lead to atrophy of the fat pads under the heel and forefoot, which often causes considerable pain. Cushioned footwear and orthoses are mainstays of treatment, but research also supports the use of fat grafting in recalcitrant cases.

By Barbara Boughton  Continue reading

May 2017

National Biomechanics Day thrills kids worldwide

National Biomechanics Day continued to build momentum in its second year, as scientists from Delaware to New Zealand got a jump on recruiting the next generation of biomechanists by demonstrating a wide range of applications—not to mention just how much fun the field can be.

By Hank Black Continue reading

May 2017

Stress fractures: Lessons from military research

Lower extremity stress fractures are not limited to members of the armed forces, but have been studied extensively in military populations. That body of evidence has important implications for stress fracture prevention and management in runners, other athletes, and even nonathletes.

By Baris K. Gun, DO; Andrew C. McCoy, DPM; Kevin C. Wang, BS; and Brian R. Waterman, MD Continue reading