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December 2011

PET/CT for PFP: Not ready for prime time

The latest research on patellofemoral pain (PFP) syndrome suggests that different mechanisms are responsible and treatments must be tailored accordingly. A new imaging study has drilled down into the source of PFP, offering evidence of a link between the syndrome, bone metabolic activity, and increased mechanical stress.

By Shalmali Pal

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December 2011

Stretching out plantar fasciitis

Tight hamstrings play an important role in plantar fasciitis, according to a study published in the June issue of Foot and Ankle Specialist. “These findings show that while we always consider the tightness of the gastrocnemius/soleus complex and the subsequent restricted ankle motion from this equinus, we also need to consider the role of the hamstrings,” said Jonathan Labovitz, DPM, lead author and associate professor at Western University of Health Sciences, Pomona, CA.

By Katie Bell

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December 2011

Orthotic CAD-CAM workflow management

A customized CAD-CAM system can streamline each step of creating custom foot orthoses. Experts say proper preparation is the key to managing this technology’s workflow. Philip Wells, BSc (Hons) Podiatry, technical support manager for Stepahead and Salts Techstep in Birmingham, UK, emphasized the way in which creating a more efficient workflow improves profitability for a practice.

By Stephanie Zultanky Pavlou

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December 2011

Shoe stiffness and pressure patterns

Pressure measurement technology can differentiate between the impact forces of a stability shoe and a flexible shoe during gait, according to a preliminary study presented in August at the annual meeting of the American Society of Biomechanics in Long Beach, CA.

By Katie Bell

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November 2011

Pretty pathways to pain: Muscle activation in high-heeled shoes

Researchers from New York University have found that wearing high heels increases muscle activation, which can have painful ramifications throughout the kinetic chain. Some individuals, however, seem to adapt to high heels more effectively than others.

By Smita Rao, PT, PhD, and Renata Ripa, MA

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November 2011

Evidence-based orthotic management of PTTD

The medical literature supports the use of orthotic devices in patients with pos­terior tibial tendon dysfunction, especially those in the early stages. Demonstrated benefits include improvements in foot and ankle alignment, clinical symptoms, and functional outcomes.

By Holly Olszewski, CPO

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November 2011

Experts stress selectivity in advanced ulcer care

Despite the expense associated with advanced wound care technologies, evidence suggests that switching from standard care makes both clinical and economic sense if a diabetic foot ulcer has not experienced a 50 percent reduction in wound area after four weeks.

By Emily Delzell

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November 2011

Role of physical therapy in patients with hip OA

Some studies support the effectiveness of physical therapy for reducing pain and improving function in patients with hip osteoarthritis, but evidence on the topic is limited and contradictory—suggesting that perhaps PT is most effective in a specific subgroup of patients.

By Alexis A. Wright, PT, PhD, DPT, and Garrett S. Naze, PT, DPT

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November 2011

Bracing and rotation, part 2: ACL injuries

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 second installment examines rotation as a contributor to anterior cruciate ligament injury.

By Cary Groner

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November 2011

Preventing wrong-site foot and ankle surgery

Wrong-site surgery can have significant financial and professional conse­quences, which is why surgeons’ or­gan­iza­tions are promoting protocols speci­­fi­cally designed to reduce such errors. A recent survey of foot and ankle surgeons suggests those efforts are paying off.

By Donald E. Fowler III, MD; Karl M. Schweitzer Jr, MD; Olubusola Brimmo, MD; Ryan May, BS; and Selene G. Parekh, MD, MBA         

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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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