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March 2017

Foot posture, orthoses, and patellofemoral pain

Prescription of foot orthoses for runners with patellofemoral pain (PFP) is often based on the premise that individuals with excessive pronation are among those most likely to have a positive response. However, preliminary analyses indicate this may not be the case.

By Thomas Gus Almonroeder, DPT; and John Willson, PT, PhD Continue reading

March 2017

Putting prehab to the test highlights inconsistencies

The growing popularity of prehabilitation contrasts with mixed findings in the lower extremity literature: Specifically, the approach seems to be more effective in patients undergoing anterior cruciate ligament (ACL) reconstruction than those undergoing hip or knee replacement.

By Cary Groner Continue reading

March 2017

March LER Issue Flipbook is live!

Check out the latest issue of LER as a digital flipbook. Continue reading

February 2017

3D PRINTING OF FOOT ORTHOSES: Clinical feasibility and cost-benefit analyses

Several technical issues currently limit the cost effectiveness of 3D-printing custom foot orthoses, but these will likely be addressed in the near future with the emergence of larger and faster 3D printers.

By Steven Hoeffner, PhD; Timothy Pruett; Breanne Przestrzelski, MS; Brian Kaluf, CP; Nikki Hooks, CO; Katelyn Ragland; Shannon Hall; Kyle Walker; Dan Ballard, CPed; and John DesJardins, PhD Continue reading

February 2017

Does history of running protect against knee OA?

Running may increase the risk of knee osteoarthritis (OA) onset or progression for some people, but in many others the knees will be safe during running; in such individuals, the benefits of physical activity can positively affect weight management and other means of reducing OA risk.

By Nicole M. Cattano, PhD, LAT, ATC; and Jeffrey B. Driban, PhD, ATC, CSCS Continue reading

February 2017

Managing O&P patients who are hard on devices

Even patients who obediently wear their O&P devices can pose a clinical challenge if they wear their devices past the point of breakdown. Experts offer suggestions for dealing with patients who are hard on devices—including those who are very large, very active, or very frugal.

By Shalmali Pal Continue reading

February 2017

Basketball shoe trends favor fashion over feet

Several confounding factors make it difficult to determine statistical associations between footwear and injuries in basketball, but attitudes toward shoes among National Basketball Association (NBA) players suggest both positive and negative trends with regard to potential injury risk.

By Will Carroll Continue reading

February 2017

Jump mechanics and risk of patellar tendinopathy

To understand the association between jumping biomechanics and transmission of forces through the patellar tendon, practitioners must have a working knowledge of the anatomy of the knee, as well as the biomechanical factors that determine force transmission through the knee.

By Rob Halle, PT, DPT, OCS, CSCS Continue reading

January 2017

Patellofemoral pain subgroups: A critical first step toward personalized clinical intervention

Researchers from the UK have identified three subgroups of individuals with patellofemoral pain (PFP) that can be determined using simple evidence-based clinical tests—a key first step toward developing targeted treatment strategies as part of the ongoing effort to improve PFP outcomes.

By Jessie Janssen, PhD; James Selfe, DSc; Michael Callaghan, PhD; Chris Sutton, PhD; Paola Dey, PhD; and Jim Richards, PhD Continue reading

January 2017

Influence of mental health on diabetic foot outcomes

As evidence accumulates suggesting negative effects of depression, dementia, and other mental health issues on gait and foot-related outcomes in people with diabetes, researchers are looking at ways to screen for risk factors and psychosocial issues earlier in the continuum of care.

By Hank Black Continue reading

January 2017

The role of hip extensor strength during cutting

Although most clinicians tend to emphasize hip abductor and external rotator muscle  strengthening in injury prevention and rehabilitation, recent research suggests exercises to increase explosive hip extensor strength may be critical for controlling frontal plane motion during cutting tasks.

By Marc Norcross, PhD, ATC, and Sam Johnson, PhD, ATC Continue reading

January 2017

Using wearable sensors to characterize CP gait

Inertial measurement units (IMUs) facilitate the creation of a gait analysis system that is portable and suited for use in the clinic. Research suggests IMUs can be used to measure clinically important gait metrics in children with cerebral palsy, which may improve patient outcomes.

By Mahmoud El-Gohary, PhD; Sean Pearson, BS; Paul Vasilyev, BS; James McNames, PhD; and James Carollo, PhD, PE Continue reading

January 2017

Fluoroquinolones and risk of tendon damage

As ciprofloxacin and other fluoroquino­lones are prescribed more frequently, tendon-related adverse effects are also becoming more common. Experts often do not recommend these drugs, particularly for athletes or elderly patients, and emphasize that all patients should know the risks.

By Barbara Boughton Continue reading

November 2016

Mouthguard mysteries: Can wearing one really improve athletic performance?

Multiple studies suggest that mouthguards, designed to protect athletes from dental injuries during contact sports, may also help improve muscle force and power. But plenty of other studies have found no such ben­efits, and even the experts aren’t sure what to believe.

By Cary Groner Continue reading

November 2016

Peroneal tendinopathy management in tennis

Although not as common as Achilles tendinitis, peroneal tendinitis is seen in a certain group of patients with chronic ankle instability or with a cavovarus foot.1 Peroneal tendinitis presents as lateral foot pain and may also be of unknown etiology or associated with an acute inversion injury.

By Patricia Pande, MClScPT, CSCS, CPed Continue reading

November 2016

AFO stiffness can help optimize patient function

Decisions related to the stiffness of an ankle foot orthosis (AFO)—whether they involve device design or the materials from which it’s fabricated—can help lower extremity clinicians customize stability, biomechanics, and muscle function to meet individual patients’ needs.

By Lori Roniger Continue reading

November 2016

How foot and ankle injury trends reflect today’s NFL

Professional football players are enduring higher levels of force than ever, and foot and ankle injury rates are increasing as a result. Advances in surgery and rehabili­tation have helped get players back on the field more quickly, but injury prevention remains a significant challenge.

By Will Carroll Continue reading

November 2016

Adjacent-joint arthritis after ankle arthrodesis

Altered biomechanics after ankle arthro­desis often increase stress on the adjacent joints in the foot, which can cause or exacerbate osteoarthritic degeneration in those joints. Clinicians and researchers are working to better understand this process and how to minimize patients’ risk.

By Cary Groner Continue reading

November 2016

Psychological aspects of ACL rehabilitation

The ability to identify and treat patients at risk for mental health issues after anterior cruciate ligament (ACL) injury may help improve psychological readiness for reconstructive surgery, attitudes toward postoperative rehabilitation, and successful surgical and rehabilitation outcomes.

By John Reaume, MD, MHSA; Dana Reaume, PsyD; and Melissa A. Christino, MD Continue reading

October 2016

Women’s Work: Overcoming gender barriers in lower extremity specialties

In lower extremity healthcare, as in politics, it hasn’t been easy for women to succeed in traditionally male-dominated roles. The gender demographics have shifted toward parity over time—in some specialties more than others—but challenges still remain.

By Emily Delzell Continue reading

October 2016

Management of athletes with excessive pronation

Pronation is a triplanar movement and is the combination of rearfoot eversion, midfoot abduction, and talocrural dorsiflexion.1 Pronation in normal gait allows flexible, adaptive changes to varying types of terrain; it dissipates ground reaction forces; and encourages lower extremity internal rotation.

By Frank Layman, PT, DPT, EdD, MT; and April Wilson, PTA, BS, CI, CKTP, IASTM Continue reading

October 2016

Role of bariatric surgery in patients with knee OA

Weight loss following bariatric surgery can have biomechanical and symptomatic benefits for obese patients with knee osteo­arthritis (OA). But it’s less certain whether that weight loss can also reduce the risk of obesity-related complications following total knee arthroplasty.

By Shalmali Pal Continue reading

October 2016

Crossover consequences of unilateral treatments

The mechanisms underlying the so-called crossover effect—when a unilateral intervention results in bilateral changes—are still unclear, but clinical applications related to lower extremity strengthening, fatigue, and stretching are already being explored by rehabilitation specialists.

By Cary Groner Continue reading

October 2016

Insole research explores postural control effects

A growing body of evidence suggests that foot orthoses may be a helpful addition to other therapies for improving balance and potentially reducing the risk of falls. The findings have been mixed, however, and clinical enthusiasm for this type of insole intervention also varies.

By Hank Black Continue reading

September 2016

Clinician-patient communication: How personal connections can improve outcomes

Increasingly, lower extremity practitioners are realizing the clinical importance of patient communication. They’re also starting to realize that effective communication requires more than just using the right words.

By Hank Black Continue reading