Category Archives: Feature Article

Featured Issue Article

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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January 2013

Trends and techniques in materials, part I: O&P

This two-part series examines trends in materials development and fabrication. This first installment focuses on how material strength, stiffness, and other variables affect the structural properties and design of orthotic and prosthetic devices.

By Cary Groner

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January 2013

Choosing children’s shoes: Mechanical considerations

Children’s shoes often are designed to look like adult shoes but lack the same structural components. Perhaps not surprisingly, research has dem­on­strated that running kinematics and kinetics differ significantly between seemingly similar child and adult shoes.

By Janet S. Dufek, PhD, Dana Forrest, MS, and John A. Mercer, PhD

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January 2013

Ankle instability treatment focuses on postural control

Interventions to improve postural control in patients with functional ankle instability include strength training, balance training, taping, bracing, and foot orthoses, but further research is needed to determine which therapeutic approaches work best in which patients.

By Janet Simon, MS, ATC, Emily Hall, MS, ATC, and Carrie Docherty, PhD, ATC

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January 2013

Whole body vibration for knee osteoarthritis

Whole body vibration may help improve strength and function in patients with knee osteoarthritis and may even slow disease progression. But contradictory findings, a lack of consensus on optimal parameters, and safety issues have even WBV advocates proceeding with caution.

By Cary Groner

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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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