Category Archives: Feature Article

Featured Issue Article

June 2013

Inserts improve symmetry, velocity in stroke patients

Learned disuse of the affected limb can lead to weight-bearing asymmetries in patients with stroke-related hemiparesis. Compelled body-weight shift therapy, using shoe inserts to force loading of the affected limb, can help patients achieve a more symmetrical gait.

By Alexander S. Aruin, PhD

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June 2013

Retraining fixes faulty gait in injured runners

Although the technique is still in its infancy, early research suggests gait retraining can be used to address medial collapse, primarily in runners with patello­femoral pain (PFP) syndrome, and to reduce impact loading in runners with PFP or tibial stress fracture.

By Ashlin Miller, BS, and Richard W. Willy, PhD, PT, OCS

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June 2013

Rockers and rollovers: Implications for AFOs

Practitioners and researchers are redefining rocking and rolling as key components of gait, and designing ankle foot orthoses and other orthotic and prosthetic devices to specifically address impairments in the way certain patients rock and roll.

By Cary Groner

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June 2013

Soft tissue composition and bone injury risk

Documenting how shock propagates through the leg and is attenuated by the soft tissues appears to be a critical step toward advancing practitioners’ and researchers’ understanding of lower extremity injury mechanisms related to running and landing activities.

By Timothy A. Burkhart, PhD, EIT, Alison Schinkel-Ivy, MHK, and David M. Andrews, PhD Continue reading

June 2013

Relieving pain in patients with diabetic neuropathy

Given the limitations of pharmacotherapy options for treating painful diabetic peripheral neuropathy, practitioners are also considering the merits of cognitive therapy, orthotic management, and combination therapies to relieve patients’ pain.

By Larry Hand

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May 2013

Orthotic management of Charcot-Marie-Tooth

Ankle foot orthoses can help compensate for muscle weakness and accommodate related structural deformities in patients with Charcot-Marie-Tooth disease, but practitioners are constantly looking for ways to improve suboptimal compliance rates.

By Cary Groner

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May 2013

Diabetes and altered gait: The role of neuropathy

Researchers have identified gait alterations in patients with diabetic peripheral neuropathy but also in diabetic patients with normal sensation, raising questions about the extent to which factors other than neuropathy might also be affecting gait.

By Cary Groner

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May 2013

Concussion assessment: Neuromuscular concerns

Balance testing is already recommended for concussion assessment in athletes, but research suggests the connections between concussion and neuromuscular variables are even more complex, and the opportunities for intervention more numerous.

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

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May 2013

Artificial surfaces evolve, but safety debate persists

Artificial turf technology has advanced significantly, and some research suggests newer surfaces are as safe as grass, if not safer. But in other reports, including a high-profile NFL study, turf has been associated with higher rates of lower extremity injury.

By P.K. Daniel

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April 2013

Microfracture surprises tarnish the experience

US orthopedic surgeons perform more than 25,000 microfractures annually, making the procedure the most common marrow-­stimulating technique used for repair of the cartilage defects that often affect active individuals.1 Although microfracture is a single-stage, low-cost intervention that requires only surgical time and common surgical tools, it requires…

By Emily Delzell

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April 2013

Orthosis use in children with Down syndrome

The literature on preschool-aged and older children with Down syndrome tends to be consistent with conventional understanding of orthotic principles, but in very young children clinical decision-making about orthoses must also encompass  neuromotor implications.

By Julia Looper, PT, PhD

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April 2013

Diabetic ankle fractures: Surgical considerations

Pittsburgh researchers found that patients with diabetes have higher complication rates than nondiabetic patients following open surgical management of ankle fractures, but also that the rate of major complications in the diabetic patients was relatively low.

By Robert W. Mendicino, DPM, FACFAS; Alan R. Catanzariti, DPM, FACFAS; Brian Dix, DPM; and Phillip Richardson, DPM Continue reading

April 2013

Bone bruises and risk of knee osteoarthritis

Bone bruises are commonly associated with anterior cruciate ligament (ACL) tears, but researchers are only beginning to understand the potential clinical significance of these chondral lesions with regard to knee osteoarthritis (OA) and preventing ACL injury recurrence.

By Cary Groner

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April 2013

Poststroke bone changes in patients who use AFOs

The medical literature suggests that changes in bone density and other bone characteristics after stroke persist after patients have regained ambulatorystatus. Whether ankle foot orthoses have a shielding effect on bone remodeling, however, remains unclear.

By Kyle Sherk, MS, CPO

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March 2013

Active Stance: Rethinking the concept of excessive pronation

Anterior knee pain is one of the most common injuries affecting runners, accounting for 25% of all running injuries.1 The etiology of anterior knee pain is multifactorial in nature,2 but one of the most commonly cited biomechanical risk factors is excessive rearfoot pronation.

By Pedro Rodrigues, MS, PT, PhD, Trampas TenBroek, PhD, and Joseph Hamill, PhD

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March 2013

Foot ulcer experts weigh use of hyperbaric oxygen

Two February publications sum up the polarizing nature of hyperbaric oxygen therapy (HBOT) for treating recalcitrant diabetic foot ulcers. A meta-analysis supported use of HBOT, while a large cohort study found a lack of effectiveness in community-care settings.

By Larry Hand

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March 2013

Exercise helps reduce claudication symptoms

Research suggests that exercise therapy can help reverse the ambulatory impairments associated with lower extremity pain in patients with peripheral arterial disease. The next step is to determine the methods of exercise therapy most likely to result in optimal outcomes.

By Ana I. Casanegra, MD, Omar L. Esponda, MD, and Andrew W. Gardner, PhD

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March 2013

The role of varus thrust in knee osteoarthritis

Varus thrust is a characteristic of dynamic alignment that has been shown to be predictive of medial tibiofemoral structural progression. Treatments aimed at minimizing varus thrust may reduce structural progression and symptoms related to knee osteoarthritis.

By Grace Hsiao-Wei Lo, MD, MSc

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March 2013

Foot orthoses and injury prevention in football

Team practitioners at the United States Naval Academy designed an orthotic intervention to prevent turf toe and Lisfranc sprains in football linemen and gained valuable insights about how players’ preferences and predispositions can affect compliance.

By CAPT Jeff Fair, EdD, ATC, LAT; CAPT David Keblish, MD; and LCDR Anthony Rabaiotti, DPM

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February 2013

Assessing alternatives to first MTP joint fusion

Arthrodesis remains effective for most patients with end-stage hallux rigidus, but finding an alternative that allows more range of motion can be challenging. Faced with disappointing arthroplasty outcomes, surgeons have had to get creative.

By Cary Groner

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February 2013

Hemiplegic CP: Effects in the uninvolved limb

In patients with spastic hemiplegic CP, practitioners and researchers tend to focus primarily on the hemiplegic limb. But hemiplegia also leads to impairments in the uninvolved limb, which are important to consider when designing a therapeutic approach.

By Julieanne P. Sees, DO, and Freeman Miller, MD

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February 2013

Footwear properties and football injuries

Excessive rotational traction that occurs at the interface between the shoe and the playing surface, as well as shoe properties such as rotational stiffness, may have the potential to influence the high incidence of lower extremity injuries in athletes.

By Feng Wei, PhD, and Eric G. Meyer, PhD

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February 2013

Trends in materials, part II: Foot orthoses

This two-part series examines trends and techniques in materials development and fabrication. This second installation focuses on technological advances that are likely to affect the structural properties and manufac­­ture of in-shoe foot orthoses.

By Cary Groner

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February 2013

The influence of obesity on ankle fracture risk

Obese patients are more likely than nonobese individuals to sustain an ankle fracture, particularly a severe ankle fracture. Contributing factors may include increased torque on the ankle or low bone mineral density relative to body weight.

By Christy King, DPM, AACFAS
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January 2013

Lower extremity effects of detraining in athletes

Evidence suggests that when an athlete stops or tapers his or her training, the resulting effects on endurance, strength, balance, and lower extremity biomechanics may increase the risk of injury. Understanding these effects can help prac­ti­tioners minimize injury risks.

By Boyi Dai, PhD, and Jason C. Gillette, PhD

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