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March 2014

The ideal running shoe: An elusive, evolving concept

The body of research that has evaluated running shoe prescription and injury suggests the most important factors to consider when selecting a running shoe are that it fits the foot perfectly and that the midsole is comfortable and appropriate for the individual athlete’s running style.

By Thomas C. Michaud, DC

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February 2014

TKA in obese patients: Weighing the risks vs the benefits

Total knee arthroplasty significantly improves functional outcomes in obese patients, but is also riskier than in normal-weight patients. As the number of obese patients with knee osteoarthritis continues to rise, clinicians are being challenged to find a balance between the risks and the benefits.

By Susan M. Odum, PhD, and Bryan D. Springer, MD

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February 2014

Charcot-Marie-Tooth: AFO mechanics and gait patterns

Patients with Charcot-Marie-Tooth disease showing the greatest increase in speed appear to respond to and utilize the energy storing and releasing properties of a carbon fiber composite ankle foot orthosis differently from those who had smaller increases in walking speed.

By Janet S. Dufek, PhD; Edward S. Neumann, PhD, PE, CP; M. Cameron Hawkins, PhD; and Brendan J. O’Toole, PhD

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February 2014

Exploring treatment options for intermittent claudication

Despite the documented benefits of supervised exercise in patients with claudication, its effect on actual clinical practice has been disappointing due to a lack of reimbursement. But practitioners and research­ers have been investigating other options, with encouraging preliminary results.

By Cary Groner

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February 2014

The brain: A new frontier in ankle instability research

Transcranial magnetic stimulation research suggests cortical excitability may be able to help differentiate healthy, previously injured, and functionally unstable ankle joints, and underscores the need to clinically target both mechanical and proprioceptive deficits in patients with FAI.

By Alan R. Needle, PhD

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February 2014

Variable amputation rates in patients with diabetes

Studies show that lower extremity amputation rates in patients with diabetes vary widely, sometimes even within individual healthcare systems. What’s more difficult to determine is why these variations exist and what can be done to improve access to care for all patients.

By Larry Hand

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February 2014

Epidemiology of Achilles tendon rupture in the US

The etiology of Achilles tendon rupture is multifactorial, but the injury occurs most frequently in the athletic population. Clini­cians still miss 24% of ruptures acutely, particularly in older patients, those in whom sports was not the causative mechanism, and those with high BMIs.

By Steven M. Raikin, MD

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January 2014

Foot Orthoses: A distal twist on low back pain management

Increasing numbers of patients are finding relief from chronic low back pain with the use of foot orthoses, but the mechanism underlying the positive outcomes is largely unknown.

By Larry Hand

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January 2014

Knee injury prevention: Hip and ankle strategies

Many knee injury prevention programs do not focus on ankle dorsiflexion range of motion and hip adductor activation, but research suggests both distal and proximal variables contribute to alterations in frontal plane knee biomechanics and could affect injury risk.

By Darin A. Padua, PhD, ATC, and Micheal A. Clark, DPT, MS, PES, CES   

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January 2014

Nerve decompression and diabetic neuropathy

Advocates of surgical nerve decompression in a subset of patients with diabetic neuropathy have published some impressive outcomes, but critics of the procedure point to the conspicuous absence of randomized trials. The issue has become one of the most contentious in diabetes care.

By Cary Groner

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January 2014

Painful hip impingement: Functional implications

Physical impairments associated with femoroacetabular impingement include limited range of motion, muscle weakness, and altered biomechanics. Attention to these areas during rehabilitation can improve surgical outcomes and may even reduce the risk of osteoarthritis.

By Jerrad R. Guenther, BSc, Michael K. Gilbart MD, FRCS(C), MEd, and Michael A. Hunt PT, PhD

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January 2014

Achilles tendinopathy and body mass index

Research suggests that obesity influences the development of Achilles tendi­no­pathy to a greater degree than other types of foot and ankle pain. This phenomenon will become increasingly important to lower extremity practitioners as global obesity rates continue to rise.

By Ryan T. Scott, DPM, AACFAS, and Christopher F. Hyer, DPM, MS, FACFAS

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January 2014

A proximal perspective on patellofemoral pain

Hip strengthening can improve short-term outcomes related to patel­lo­­femoral pain syndrome, but further research is needed to determine the underlying mechanism and whether the same approach will also prove effective in managing patello­femoral osteoarthritis.

By Michael B. Pohl, PhD

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November 2013

Energetics of landing: Effects of ankle instability

A diminished capability for energy dissipation at the knee after ground impact during landing in patients with chronic ankle instability may result in greater demands on the ankle joint. Modifying landing strategies could potentially reduce the risk of musculoskeletal injury.

By Masafumi Terada, MS, ATC, and Phillip A. Gribble, PhD, ATC, FNATA   

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November 2013

Conference coverage: 3rd PFP research retreat

The third International Patellofemoral Pain Research Retreat picked up where previous retreats had left off in examining proximal and distal factors related to PFP and subgroups of patients who might respond to targeted interventions. But this retreat broke some new ground as well.

By Jordana Bieze Foster

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November 2013

Plantar plate repair: New approach to metatarsalgia

Plantar plate pathology in conjunction with metatarsalgia occurs more often than is commonly appreciated, but can be addressed using a combined procedure that involves a dorsal approach to anatomic plantar plate repair and metatarsal realignment.

By Lowell Weil Jr, DPM, FACFAS, and Erin E. Klein, DPM, MS

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November 2013

Studies examine ways to optimize OA bracing

Research continues to suggest that bracing has the ability to improve pain and function in patients with knee osteoarthritis in a controlled setting, but researchers are now working to identify factors that affect bracing outcomes in the real world. Patient expectations are at the top of that list.

By Larry Hand

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November 2013

Achilles tendon rupture: The influence of gender

The literature suggests that women are less likely than men to experience an Achilles tendon rupture. This may be because women are less capable of generating the large eccentric contractions necessary for rupturing the tendon. Estrogen may also play a protective role.

By Joseph L. Laratta, MD, and J. Turner Vosseller, MD

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November 2013

Limited hip flexibility: Mutability and mobility

Myofascial or joint-focused stretches can increase passive hip range of motion in young adult men with limited hip flexibility, but this will not necessarily result in more hip motion actually being utilized during functional activity unless old movement patterns can be unlearned.

By Janice Moreside, PhD

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November 2013

Hamstring strain: Issues facing collegiate athletes

Collegiate athletes who participate in sports associated with sprinting have an increased risk of hamstring strain. Investigators have identified flexibility, strength, and fatigue as potential contributing factors that can be addressed through sport-specific training and rehabilitation.

By Kevin M. Cross, PhD, ATC, PT, Susan Saliba, PhD, ATC, PT, and Jay Hertel, PhD, ATC

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October 2013

Battlefield injuries: Saving lives and limbs throughout history

By understanding how military medicine has evolved and adapted over time, modern practitioners can better appreciate the need to question convention, advance research, and rapidly integrate beneficial new technologies into medical care.

By Christine Miller, DPM, FACCWS, Ashley Finn, and Emily Delzell

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October 2013

Debating the complexities of partial foot amputation

Partial foot amputations may not offer a biomechanical advantage over transtibial amputations if the metatarsal heads cannot be retained, and some experts suggest amputation level should be selected based on probability of wound healing instead. But others disagree.

By Cary Groner

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October 2013

Ankle arthroplasty makes strides, but issues remain

Study findings and anecdotal reports suggest that newer-generation total ankle replacement can match or exceed ankle arthrodesis when it comes to gait and range of motion, but neither procedure returns gait to normal. Implant survival has also improved, but continues to be a challenge.

By Barbara Boughton

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October 2013

Total hip arthroplasty: Obesity and outcomes

Total hip arthroplasty can significantly improve quality of life in obese patients, but high body mass index is also associated with higher rates of complications and re­admissions than in normal-weight patients. The emerging subgroup of super-obese patients poses additional challenges.

By Raghav Rajgopal, MD, and James L. Howard, MD, MSc, FRCSC

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October 2013

Biofilms: Diabetic foot ulcer care gets personal

Opportunistic microorganisms called bio­films constitute an age-old diabetic wound care problem that defies traditional anti­microbial therapies. Experts believe interventions customized to individual patients based on molecular diagnostics may be the best line of defense.

By Larry Hand

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