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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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May 2011

BATTLES OF ACHILLES: The operative vs nonoperative treatment debate

Early mobilization techniques have revolutionized both surgical and nonsurgical management of Achilles ruptures, but the resulting improved outcomes have ignited a heated discussion among practitioners as to which approach is best.

by Cary Groner

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May 2011

Consider mental health in patients with diabetes

Many lower extremity practitioners are not aware of the risks of distress, depression, and cognitive impairment in patients with diabetes. But screening for mental health issues and adjusting patient management accordingly can significantly improve diabetic foot care outcomes.

By Larry Hand

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May 2011

Effects of knee bracing on patellofemoral pain

Research suggests that different bracing designs may have different mechanisms of action for relief of patellofemoral pain syndrome, which is consistent with the heterogeneous nature of the condition and underscores the need to understand each design’s function prior to treatment.

By Song Joo Lee, MS, Yupeng Ren, MS, Nicole A. Wilson, PhD, Sang Hoon Kang, PhD, and Li-Qun Zhang, PhD

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May 2011

Prefab-custom orthoses debate mellows with age

Not so long ago, the effectiveness of prefabricated foot orthoses relative to their custom brethren was a bitterly divisive topic. But the vitriol has dissipated over time, as practitioners have turned their focus to the appropriate selective use of each type of device.

by Cary Groner

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May 2011

Osseous implications of ACL reconstruction

The loss of bone integrity that accompanies ACL injury persists after reconstructive surgery, even with aggressive rehabilitation. Improved interventions may help decrease patients’ risk for low bone mineral density and osteoarthrosis.

By John Nyland DPT, SCS, EdD, ATC, CSCS, FACSM

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May 2011

Platelet-rich plasma: More than a last resort?

Findings from studies of PRP can be conflicting and confusing, but lower extremity practitioners remain cautiously optimistic about the trendy treatment’s clinical potential to accelerate healing of soft tissues, bone, and diabetic wounds.

by Cary Groner

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April 2011

Sprain in the Forecast: Epidemiology and risk factors for ankle sprain

Analysis of the epidemiology of ankle sprain has revealed modifiable and non-modifiable risk factors. Understanding these will allow practitioners to help athletes minimize their risk of acute injury and chronic sequelae.

By CPT Brian R. Waterman, MD; Joseph R. Langston, BS; Kenneth L. Cameron, PhD, ATC; LTC Philip J. Belmont, Jr, MD; and LTC Brett D. Owens, MD

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April 2011

In search of a mechanism for foot orthoses’ effects

The seemingly endless quest to discover why foot orthoses relieve symptoms is veering away from skeletal alignment and toward somatosensory variables, though some still insist that kinematics play a role as well.

by Cary Groner

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April 2011

Differential diagnosis of Charcot arthropathy

Early detection of Charcot neuroarthropathy is critical for preventing the bone and joint destruction associated with later stages, but symptoms that mimic other conditions can make a differential diagnosis difficult.

By Georgeanne Botek, DPM, and Gina Hild, DPM

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April 2011

Sensitivity to self image boosts O&P outcomes

O&P devices are all-too-public indicators of an infirmity, and often limit clothing and footwear options—all of which contributes to poor self image. But a little empathy can keep self image issues from sabotaging patient compliance.

By Emily Delzell

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