February 2024

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Cover Story


Sandal Stack Height, Gait, and Stability
Stack height is the amount of material between one’s foot and the ground. As stack height, by definition, speaks to the amount of organized material between a 3-dimensional foot of limited mass and the relatively unlimited mass of any 2-dimensional support surface on which it functions, it will have... By Jay Segel, DPM, & Sally Crawford, MS

Guest Perspective


Guest Perspective: Effective Analogies to Improve Patient Understanding
There are any number of quotes we can use that pokes at the perpetual issue of clinicians using overly complex terminology when communicating with patients about their health. “One good analogy is worth three hours discussion” - Dudley Field Malone By Talysha Reeve

Features


Severe Work-Related Lower Extremity Injuries Reported to the Occupational Safety and Health Administration
Background: Between two and three million work-related injuries occur in the United States (US) each year. A portion of these injuries involve the lower extremity. The US Department of Labor Occupational Safety and Health Administration (OSHA) collects information on work-related injuries and provides the information in several data sources. By Mathias B. Forrester, BS
lerEXPO Conversation: Use Material Science to Optimize Clinical Device Performance and Reimbursement
Falls and falls-related injuries are a problem in individuals with chronic ankle symptoms. At last year’s Academy meeting, there was a great paper that talked about how they’re now developing outcome measures for lower limb orthotics, something we’ve had for a while in prosthetics. The author looked at his data and also data from the... By Gary Bedard, CO, FAAOP(D)
Falls Prevention Interventions for People with Multiple Sclerosis, Parkinson’s Disease, and Stroke
Research has shown that more than half of people with multiple sclerosis and Parkinson’s disease will fall within a 3- or 6-month period, respectively, while nearly 75% of stroke survivors fall within a year of the stroke occurring. Clinical trials evaluating the effectiveness of falls prevention interventions for... By Nicola O’Malley, Susan Coote, Fiona McCullough Staunton, Eileen O’Connor, and Amanda M. Clifford

ShortTakes From the Literature


Exercise Training Modes Lower Resting Blood Pressure
In an effort to establish an optimal antihypertensive exercise prescription, researchers from Kent, England, conducted a large-scale pairwise and network meta-analysis on the effects of various exercise modes on resting blood pressure. They looked at 270 randomized controlled trials with more than 15,800 patients.
Inflammatory Markers in Diabetic Foot Infections
This meta-analysis of 10 studies with 785 patients confirmed the significant association between diabetic foot infection and 3 inflammatory markers: white blood cell (WBC) count, C-reactive protein (CRP) level, and procalcitonin (PCT) level. The meta-analysis indicated that mean WBC count (standardized mean differences...
Use of Removable Boot vs Cast After Ankle Surgery: Cost-Effectiveness vs QoL   
In a unique combined study, researchers from multiple institutions across the United Kingdom compared a removable boot with plaster cast for the treatment of ankle fractures 2 weeks after surgery with weight bearing as able. They used data from 243 trial participants and reviewed medical notes to estimate costs from both the National Health Service (NHS) and...
TAA in Patients Age <50: Midterm Outcomes
In a chart review that spanned 2000-2017, researchers from Duke University looked at 58 patients who underwent primary total ankle arthroplasty (TAA) (average age at surgery 43.3 years) and had minimum clinical follow-up of 5 years. They found that 11 required additional surgery related to the TAA; 6 patients (10.3%) required bone grafting of peri-implant...
Prediabetes Patients Prefer Lifestyle Interventions
In the age of personalized medicine, clinicians are trying to better understand not only patient preferences and values, but expectations as well. This systematic review examined 18 studies involving 17,240 patients with prediabetes to spot trends to facilitate clinical decision-making about how best to prevent disease progression.
Caprini Risk Score & Varicose Vein Ablation
The incidence of venous thromboembolism after ablation of superficial varicose veins is 3.4%, predominantly due to asymptomatic endovenous heat-induced thrombosis (EHIT) and deep vein thrombosis (DVT), and significantly correlates with the Caprini Risk Score.

Meeting Highlights 2023 UIP World Congress & AVLS 37th Annual Congress

This international event devoted to venous and lymphatic medicine was sponsored by the American Vein & Lymphatic Society together with the American Venous Forum, Canadian Society of Phlebology, Mexican Academy of Phlebology & Lymphology, and Union of International Phlebotomy. Lower Extremity Review thanks the combined organizations and the authors for granting reuse permissions for this information. Please note minor editing has occurred for clarity and/or brevity.


Venous Leg Ulcers and Concomitant Lymphedema
To achieve the best outcomes for patients with venous leg ulcers (VLU), a definitive and accurate diagnosis must be achieved. Many papers regarding VLU management assume a simplicity in the diagnosis given the relative commonality, neglecting the associated lymphatic... By M. Mark Melin, Caroline Fife, Marlin Shul, Monika Gloviczki, Adelaide Herbert, Heather Barnhart (Hettrick), Amy Kaufman, Karen Andrews, Sandra Rosenberg
Natural Zinc Ion Based Technology for Next Generation Compression and Wound Care Devices
Material selection can strongly impact medical device performance and patient experience. Selection of the optimum materials in combination with the design, will influence how the device performs in promoting recovery, increasing lymphatic fluid, regulating moisture and... By Cristina Acevedo, PhD; Ian Crane; Rohit Kankaliya; Rajib Mondal, PhD; Albert Ortega; Kevin Urman, PhD
Chronic Lipodermatosclerosis in a Patient with Functional Venous Disease
Case Report: 70-year-old man with a BMI of 57.1 presenting with bilateral symptomatic tributary varicose veins, chronic lipodermatosclerosis and venous ulcers of both lower limbs. There was no history of DVT or PE. He has central obesity with overhanging anterior abdominal wall. By Preshy Varghese, MBBS, MMed, FRCS, FRACGP
Innovative Compression Technology May Reduce Hospital Visits and Improves Self-Care in Venous Leg Ulcer Patients
The cost of treatment, such as nursing time required for application of products and the number of clinical visits, is a significant expense in venous leg ulcer (VLU) care. Objectives: This study aimed to evaluate the efficacy of an innovative compression technology that delivers a well-defined pressure, invariant of applier skills, leg shape, and without the need for reapplications due to edema reduction. By Andreas Nilsson and Josefin Damm

Industry News & Updates


Self-Sensing Electric Artificial Muscles has Implications for Rehabilitation Training
Muscle contraction hardening is essential for enhancing strength and also enables rapid reactions in living organisms. Taking inspiration from nature, researchers at Queen Mary’s School of Engineering and Materials Science in London have successfully created an artificial muscle that seamlessly transitions between soft and hard states while also...
Algorithm Measures Quality of Gait Through Smart Watches
An algorithm written by researchers from Neuroscience Research Australia (NeuRA) and University of New South Wales (UNSW), Sydney, Australia, could help promote health in older people and at-risk populations. The Watch Walk algorithm works by measuring gait with a smart watch’s built in accelerometer.
OSU Receives Research Funds to Treat Diabetic Neuropathy
The National Institutes of Health has awarded $3.6 million to a team of neurosurgical, neurology, and neuroscience researchers at The Ohio State University (OSU) Wexner Medical Center and College of Medicine to test a novel diagnosis and treatment combination for painful diabetic neuropathy. The approach combines spinal cord stimulation (SCS) with measurement of...
NATA Receives APHA Public Service Award
The National Athletic Trainers’ Association (NATA) received the American Public Health Association Injury Control and Emergency Health Services (APHA ICEHS) Section’s 2023 Institutional Public Service Award in November during APHA’s Annual Meeting and Expo in Atlanta.
Robert Weil, DPM, Inducted into National Fitness Hall of Fame
The National Fitness Hall of Fame (NFHOF), a member-based educational organization that was founded to recognize the efforts individuals and organizations make to practice and promote healthy living, announced that Robert Weil, DPM, has been inducted into its 2023 Hall of Fame. Weil is a longtime sports podiatrist, having treated many...
AOPA Introduces 2024 Board of Directors
The American Orthotic and Prosthetic Association (AOPA) recently introduced its 2024 board of directors. The Executive Committee will consist of Mitchell Dobson, CPO, FAAOP, who assumes the role of president, along with, Teri Kuffel, JD, who moves into the role of immediate past president and Rick Riley who was appointed to be president-elect after...

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