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April 2018

Limb Salvage or Amputation of the Diabetic Foot?

The decision often hinges on how a given inter­vention will affect the patient’s quality of life. How, then, to define optimal QoL for your patient, and to agree on the means to achieve it? As clinicians well know, diabetes puts patients at risk of foot ulcers that can lead to poor outcomes, evidenced by the 40% 5-year mortality in patients with newly diagnosed diabetic foot ulcers (DFUs).

By Cary Groner Continue reading

March 2018

What role for eccentric exercises in conservative treatment of achilles tendinopathy

The authors seek answers to clinical questions regarding the optimal program of eccentric exercises: Does type of tendinopathy predict success? What modifications to exercise duration and repetitions make sense? What is the likelihood of long-term pain relief afforded by such a program of exercise?

By Jonathan L. Hook, DPM, MHA, and Curt Martini, DPM Continue reading

February 2018

Assessing Limb Length Discrepancy

Leg-length discrepancy and its sequelae are best considered a syndrome affecting many regions of the body through the closed kinetic chain. Most cases require comprehensive, cross-disciplinary treatment. The authors present a novel scoring system for diagnosis.

By Jay Segel, DPM; Susan Sanford, PT, L.Ac, C.SMA; Sally Crawford, MS; and Lori Yarrow, DC, BPE Continue reading

January 2018

Patellofemoral pain: More activity means more pain — and then less activity?

People with PFP are less physically active than healthy controls, with regard to both steps per day and minutes of mild, moderate, and intense activity. Increases in activity-related pain may cause…

By Neal R. Glaviano, PhD, AT, ATC; Andrea Baellow, MS; and Susan Saliba, PhD, MPT, Med 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

HANDLE WITH CARE: How sports equipment affects biomechanics and injury risk

Clinicians know that handling a lacrosse stick or other types of sport-specific equipment can affect an athlete’s movement patterns in potentially harmful ways. Now researchers are beginning to quantify these types of effects and explore their clinical implications.

By Jill R. Dorson 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

Running shoes and injury risk: Rethinking the importance of cushioning and pronation

In spite of advancements in research and subsequent modifications to running footwear design, rates of running-related injuries have not decreased. That may be because researchers and designers have been focusing on the wrong variables.

By Joseph Hamill, PhD, and Gillian Weir, PhD 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

August 2017

Flip Flops: Biomechanical critiques resonate with clinicians and designers

It’s no secret by now that traditional flimsy flip flops are associated with gait alterations that can contribute to more serious issues, but for many patients, flip flops are a hard habit to break. A new generation of “comfort” flip flops offers an alternative, but clinicians remain wary.

By Shalmali Pal Continue reading

July 2017

Tactical athletes: Maximizing their ability to protect and serve

Increasingly, clinicians and researchers are focusing on tactical athletes—including warfighters, firefighters, law enforcement officers, and other professionals—as a unique population with regard to lower extremity injuries.

By Hank Black Continue reading