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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

September 2016

Management of athletes with early-stage PTTD

Posterior tibial tendon dysfunction (PTTD), known also as tibialis posterior tendon dysfunction, is one of the leading causes of acquired flatfoot in adults, but the…

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

September 2016

Support for dry needling builds among clinicians

Dry needling is gaining momentum as an alternative therapy for myofascial pain, and is supported by a small but growing body of research as well as anecdotal evidence. But the training and expertise required to perform the procedure has become a topic of debate.

By P.K. Daniel Continue reading

September 2016

Chronic ankle instability, gait, and muscle activity

New research suggests lower extremity clinicians should consider implementing gait training in combination with targeted strengthening of the peroneus longus and gluteus medius muscles to help restore normal gait patterns in patients with chronic ankle instability.

By Rachel Koldenhoven, MEd, ATC Continue reading

September 2016

Reducing postoperative thromboembolism risk

Preventing deep venous thrombosis and pulmonary embolism after lower extremity surgery can involve pharmaceutical therapies or mechanical interventions. The type of prophylaxis used depends on the type of surgery, pre-existing risk factors, and patient preference.

By Barbara Boughton Continue reading

September 2016

Step-rate manipulation and foot-strike pattern

In distance runners, step-rate manipulation of at least 10% above a runner’s preferred rate may be an effective clinical gait retraining method to decrease the severity of foot inclination angle at heel strike and…

By Darrell J. Allen, PT, DPT, MS, SCS, CSCS; Hollie Heisler, PT, DPT; and Jennifer Mooney, PT, DPT  Continue reading

August 2016

Pregnancy and gait: From foot pain to fall prevention

Researchers are investigating how changes during pregnancy may affect the lower extremities in the long term, as well as ways to treat and prevent these issues.

By Lori Roniger Continue reading

August 2016

Management of Achilles tendinopathy in runners

Achilles tendinopathy is a common lower extremity injury in athletes as well as nonathletes. The Achilles tendon is often a site of injury in runners and is the second most common running-related musculo­skeletal injury, after medial tibial stress syndrome, with an…

By Howard Kashefsky, DPM Continue reading

August 2016

Uneven terrain: Tactics for orthotic-device users

Helping patients manage an orthotic device can be challenging, but doing so in the face of uneven terrain is a balancing act between stability, mobility, and strength. Device adjustments and rehabilitation pro­tocols can help patients avoid asymmetries and reduce the risk of falling.

By Shalmali Pal Continue reading

August 2016

Foot strike while running and patellofemoral pain

Recent research supports the idea that increased patellofemoral stress is a contributing factor in runners with patello­femoral pain, and that gait retraining to promote a…

By Jenevieve L. Roper, PhD; Deborah L. Doerfler, PT, DPT, PhD; Christine M. Mermier, PhD; and Janet S. Dufek, PhD Continue reading

August 2016

Foot rotation during gait in patients with knee OA

Rotating the foot in or out during gait is associated with significant decreases in frontal plane knee load during early or late stance, respectively, and can be effective for reducing pain and potentially slowing the progression of…

By Kevin Alan Valenzuela, ABD, CSCS; and Hunter Jared Bennett, PhD Continue reading

August 2016

Radiofrequency-based arthroscopy in the ankle

The results of a retrospective chart review suggest that the use of plasma-mediated bipolar radiofrequency-based arthroscopic microdebridement is associated with notable decreases…

By Renato Giorgini, DPM, FACFAS; Stephanie Giles, DPM; Omer Aci, DPM; and Christopher Japour, DPM, MS  Continue reading

July 2016

Blood Flow Restriction Training: The slow-flow movement is fast becoming rehab’s hottest trend

Partially occluding blood flow to the limbs, in com­bin­ation with low-load resistance exercise, appears to facilitate hypertrophy and strength gains in athletes and others while protecting the joints from damaging stresses.

By Cary Groner Continue reading