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November 2011

Chronic ankle instability affects postural control

Research suggests that individuals with chronic ankle instability use different movement strategies to maintain postural control than individuals with healthy ankles. These changes may be related to alterations in movement variability associated with ankle instability.

By Lisa Chinn, MS, ATC, and C. Collin Herb, MEd, ATC

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October 2011

Vascular Viewpoint: Improving superficial thrombophlebitis care

Superficial thrombophlebitis (STP) is a common and controversial condition largely overshadowed by its big brother, deep vein thrombosis (DVT).1 Frequent reports of concomitant STP and DVT, with or without pulmonary embolus, align the two pathophysiologies closely.

By Marlin W. Schul, MD, MBA, RVT

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October 2011

FUTURE SHOCK: Youth sports and osteoarthritis risk

There’s no question that exercise is good for kids. But the trauma asso­ciated with some youth sports can dramatically increase the risk that those kids will develop knee or ankle oste­oarthritis by the time they reach adult­hood. The key next step is to determine what can be done about it.

By Yvonne M. Golightly, PT, PhD, Stephen W. Marshall, PhD, and Dennis J. Caine, PhD

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October 2011

Rotational mechanics: Bracing’s next frontier

This two-part series explores the role of rotational forces in athletic injuries and the extent to which bracing can help control those forces and, in turn, prevent those injuries. This first installment ex­amines ankle sprains, PTTD, patello­femoral pain, and osteoarthritis.

By Cary Groner

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October 2011

Orthotic management of the pes cavus foot

Published studies on pes cavus are in short supply, making evidence-based orthotic management a challenge. This author proposes a theory of pes cavus etiology based on muscle imbalances and reactions, which may support the concept of early orthotic intervention.

By Paul R. Scherer, DPM

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October 2011

Conference coverage: 2nd PFP research retreat

Two years after their inaugural event, experts on patellofemoral pain syndrome congregated in Belgium to once again dissect and analyze the latest research on the mechanisms underlying PFP and the effectiveness of such interventions as bracing, foot orthoses, and exercise.

By Cary Groner

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October 2011

Better nutrition boosts diabetic foot outcomes

The evidence documenting the role of nutrition in improving wound healing and neuropathy symptoms hasn’t been widely publicized, particularly among lower extremity healthcare practitioners. But getting that information to your diabetic patients could help save their feet.

By Larry Hand

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September 2011

Keeping O&P compliance in check

A recent paper suggests that a checklist system can help practitioners educate caregivers about orthotic device use in children with CP, which could improve compliance. But experts differ as to whether such checklists make sense in the complex world of O&P devices.

By Larry Hand

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September 2011

Strategies for rehab after Achilles tendon surgery

At the Palo Alto Foundation Medical Group, rehabilitation following operative repair of Achilles tendon ruptures is based on three key evidence-based criteria for return to activity and selective use of an anti-gravity treadmill to accelerate that return.

By Amol Saxena, DPM, FACFAS

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September 2011

A patient-first approach to critical limb ischemia

Outcomes of revascularization in pa­tients with lower extremity  critical limb ischemia should be defined according to patient goals and functional criteria rather than more traditional, physician-oriented variables such as limb salvage and graft patency.

By Ginger L. Manos, MD, John W. York, MD, FACS, and Brent L. Johnson, MS

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September 2011

OA after ankle fracture: Surgery’s complex role

In the surgical management of ankle fractures, post-traumatic arthritis is the outcome that practitioners and patients would most like to avoid. But given the sensitivity of joint cartilage to even the slightest malalignment or pressure shift, that can be easier said than done.

By Cary Groner

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September 2011

Effects of load carriage on amputee ambulation

Amputees lack the lower extremity muscles responsible for maintaining kinematic stability under increasing load carriage conditions, and would benefit from a more versatile prosthetic foot design that could adapt dynam­ically to changing loads.

By Kurt Collier, CP

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September 2011

Factors affecting athletes’ perception of movement

In sports, the concept of “affordance perception” can mean sensing an op­po­nent’s next move, which has implica­tions not just for performance but also for reducing injury risk.  An understanding of affordance perception also can improve the effectiveness of training.

By Julie A. Weast-Knapp, MA, and Kevin Shockley, PhD

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DPM interviews Lower Extremity Review editor Jordana Bieze Foster

Robert Weil, DPM interviews Lower Extremity Review editor Jordana Bieze Foster for his radio show; The Sports Doctor. The Sports Doctor Show covers all aspects of sports medicine including treatment & prevention of injuries, current events and health and fitness topics. The interview aired on August 4th. Click here to listen to the exciting interview.

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July 2011

EXERCISE AND NEUROPATHY: Not mutually exclusive

Exercise is a cornerstone of treatment for diabetes, but for years patients with peripheral neuropathy have been dis­couraged from weight-bearing exercise for fear of further increasing ulceration risks. Now new research is turning that advice on its head.

By Cary Groner

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Venous ulcers: The role of compression therapy

The prevalence of leg ulceration in adults, either active or healed, is 1% to 2%, and the majority have chronic venous insufficiency.1 Although CVI has received less attention than arterial insufficiency, estimates suggest it is 10 times more common. Despite the prevalence of venous ulcers, they are often neglected or managed inadequately.

By Steven E. Zimmet, MD, RVT, FACPh

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July 2011

Ankle sprain prevention revisits shoes as solution

In the ongoing battle against inversion ankle sprains in basketball and other sports, high tops are old news. But shoe designers have begun to investigate other ways that shoes might play a role in preventing sprains rather than contributing to the problem.

By Cary Groner

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July 2011

Plantar fasciitis: A new take on custom orthoses

The medical literature generally supports the use of foot orthoses for management of plantar fasciitis symptoms, but evi­dence regarding specific orthotic designs is inconclusive. Early research suggests a temporary custom foot orthosis may be an effective treatment option.

By Caryn Doggett, DPT, Michelle Drake, DPT, and Robert Boyles, PT, DSc, OCS       

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July 2011

Original research: Skill level and balance in golf

Previous research has identified superior balance in professional golfers compared with controls as well as associations between balance and skill level in amateur golfers. This study compared standing balance characteristics between profes­sion­al and highly skilled amateur golfers.

By Robert Donatelli, PT, PhD; Kenji Carp, PT, ATC, OCS; Guido Pagnacco, PhD; and John Adam, ATC      

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July 2011

Prehabilitation for TJA: More than just exercise

New England Baptist Hospital’s multi­disciplinary prehabilitation program is grounded in research suggesting that outcomes after total joint replacement can be positively influenced by preoperative care that includes management of patient expectations as well as exercise.

By Claire E. Robbins, PT, DPT, MS, GCS, James V. Bono, MD, and Carl T. Talmo, MD

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June 2011

Pronation in runners: Implications for injury

Pronation is a necessary component of normal running biomechanics, facilitating shock absorption and stabilization. But abnormal levels of pronation, whether restricted or excessive, can alter gait patterns in ways that can potentially increase the risk of running-related injuries.

By Tracy A. Dierks, PhD

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June 2011

Mysteries of O&P devices and energy expenditure

Ankle foot orthoses and other O&P devices allow patients to walk faster, for longer periods of time, with a more biomechanically efficient gait. It seems logical that energy costs would decrease as a result. But that’s been surprisingly difficult for researchers to prove.

By Cary Groner

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June 2011

Global lessons improve amputation prevention

Interdisciplinary foot screening and limb salvage programs in this country and around the world have successfully reduced diabetic foot ulceration and amputation rates, and in doing so have inspired others to initiate similar prevention programs in their own countries.

By Emily Delzell

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June 2011

Functional knee bracing and athletic performance

Functional knee braces can’t be effective if athletes won’t wear them, and many athletes won’t wear them because they fear their athletic performance will be negatively affected. But early research suggests that athletes accommodate to knee brace wear almost immediately.

By Neetu Rishiraj, ATC, PhD, Jack E. Taunton, MSc, MD, Robert Lloyd-Smith, MD, William Regan, MD, and Navin Prasad, MSc, MD

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June 2011

Powering the Windmill: Lower body mechanics of softball pitching

Injuries in softball pitchers typically occur in the upper extremities, but focusing rehabilitation and prevention efforts on the upper body alone ignores the essential supporting roles played by the pelvis and lower extremities in providing a stable base for the pitching motion.

By Gretchen D. Oliver, PhD, ATC, LAT

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