March 2012

Cover Story


Finding a formula for the optimal AFO

Quantitative research from The Nether­lands suggests that for every ankle foot orthosis, there is an optimal stiffness associated with the lowest energy cost of walking for a given set of gait-related impairments. Achieving this optimal device stiffness in practice, however, may require clinicians to rethink conventional ap­proaches to AFO prescription.

By Daan J.J. Bregman, PhD

Editor Message


Out on a limb: Game theory

There are plenty of reasons you might be thinking about seeing Moneyball. Maybe you’re wondering how anyone could have turned that book into a movie. Maybe you’re curious about how Angelina’s better half and the kid from Superbad ended up with Oscar nominations. Maybe you just need to forget about the snow on your lawn and try to get in the mood for Opening Day.

Jordana Bieze Foster, Editor

 

Departments


ACTIVE STANCE: Barefoot balance training for runners

Barefoot training and balance training have each been effective in studies of runners, but combining the methods could lead to even better results.

By Emily Splichal, DPM, MS, CPT

The role of proprioception in knee OA management

Demonstrated associations between im­paired proprioception and knee osteo­arthritis suggest some interventions that help relieve painful symptoms in patients with knee osteoarthritis , such as exercise and bracing, do so by positively affecting joint position sense.

By Barbara Boughton

Lower extremity focus helps cut risk of falls

Falls are common, disabling and costly. Causes are multifactorial but include foot disorders, ill-fitting footwear, and poor bal­ance. Recent research supports a multi­dis­ci­plinary approach to falls prevention and indicates that lower extremity practi­tioners can play an important role.

By Hylton B. Menz, PhD, and Martin J. Spink, BPod(Hons)

Taking a team approach to diabetic limb salvage

Hospitals with multidisciplinary diabetic foot care programs have found that adding vascular surgeons to the team makes their amputation prevention efforts more effective, but also adds an extra layer of challenges in terms of coordinat­ion and communication.

By Cary Groner

Connecting instability and ankle osteoarthritis

Not all patients with chronic ankle in­stability develop ankle osteoarthritis, but evidence suggests the two con­ditions are related, which in turn sug­gests that ankle sprain prevention and management could help reduce ankle replacement rates.

By Larry Hand

Compartment syndrome following tibia fracture

Acute compartment syndrome can devel­op after open or closed tibial fractures, even those that appear to be benign. Early diagnosis of increased compart­mental pres­­sure and timely surgical intervention can prevent adverse out­comes including nerve injury and muscle necrosis.

By Langdon A. Hartsock, MD, and William R. Barfield, PhD

News


In the Moment: O&P

By Emily Delzell

Ply trap: Prosthetic sock thickness varies
Recent research from the University of Washington in Seattle confirms what many practitioners have already learned from treating patients with lower limb amputat­ions: Sock thickness varies among dif­ferent sock products of the same ply and is also affected by biomechanical ...
Dose response for OA brace wear includes hamstring strengthening
Research from Canadian investigators suggests brace wear may positively affect activity level without decreasing muscle strength in patients with medial compartment knee osteoarthritis (OA). Investigators from Dalhousie University in Nova Scotia followed 24 patients (four women) who wore a valgus unloader ...
Study suggests rocker sole shoes help reduce circulatory calf pain
Researchers at the University of Salford in Manchester, UK, reported in March that a pilot study comparing two therapeutic shoe soles in eight individuals with claudication showed a reduction in calf pain with rocker sole wear. The investigators asked study volunteers, ...

In the Moment: Surgery

By Emily Delzell

MIS adventures: Minimal approach rivals standard TKA
Several studies presented in February found few differences in outcomes for minimally invasive total knee arthroplasty (TKA) and traditional TKA. By Emily Delzell
Surgical, nonsurgical Achilles care lead to similar one-year outcomes
In a study of acute Achilles tendon rupture published this month in the Clinical Journal of Sport Medicine, some strength and endurance measures improved earlier in those who underwent surgical versus nonsurgical care, but rerupture rates and patient-reported function were ...
Study finds no restoration of proximal kinematics after hallux valgus surgery
Surgical hallux valgus correction significantly improves foot geometry and hallux kinematics but does not significantly change proximal kinematics, according to research from Marquette University in Milwaukee, WI. In a study published in the February issue of Foot & Ankle International, investigators ...

In the Moment: Sports medicine

By Jordana Bieze Foster

Loading lessons: Select exercises carefully for ACL rehab
Exercises prescribed for rehabilitation after anterior cruciate ligament (ACL) reconstruction should be designed to protect the healing graft from excessive strain in addition to rebuilding muscle strength and activation, according to evidence-based recommendations from a multicenter team of experts. By Jordana ...
Barefoot running offers no metabolic advantage over lightweight footwear
The metabolic cost of running increases with heavier footwear, but barefoot running is no more metabolically efficient than running in a lightweight shoe, according to research from the University of Colorado at Boulder. In 12 men experienced in barefoot running, investigators ...
Custom brace outperforms others for inversion control during cutting
A custom-molded hinged ankle brace more effectively controls inversion during cutting maneuvers than two other brace designs tested by researchers from the Hong Kong Polytechnic University, a finding with potential implications regarding ankle sprain prevention. Eight individuals with a history of ...

Market Mechanics


South Dakota passes bill capping patients’ copays for physical therapy
On February 27 South Dakota Gov Dennis Daugaard signed House Bill 1183, legislation promoted by the South Dakota Physical Therapy Association (SDPTA) that reduces out-of-pocket expenses for patients. HB 1183 limits the amount health insurers can charge patients for out-of-pocket copayments ...
Surgeons pioneer first remote-control internal limb lengthening system
Orthopedic surgeons at Sinai Hospital in Baltimore, MD, recently performed the first tibial implantation in North America using a novel externally controllable internal limb lengthening system. Shawn Standard, MD, head of pediatric orthopedics at Sinai’s International Center for Limb Lengthening (ICLL), ...
Book focuses on female athletes
Warren Potash’s recently released book, They’re Not Boys: Safely Training the Adolescent Female Athlete, is designed to help teenaged female athletes and their parents understand that young women who participate in athletics have a higher risk of injury. Potash also delves ...
PFA has new address, phone numbers
As of March 1, the Pedorthic Footcare Association (PFA) office address is: Pedorthic Footcare Association, 8400 Westpark Drive, second floor, McLean, VA 22102. The PFA’s new phone number is 703/610-9035 or 800/ 673-8447. The new fax number is 703/995-4456. The organization can ...
Corflex finalizes soft goods contract
Manchester, NH-based Corflex, a veteran-owned manufacturer of orthopedic rehabilitation products, has won a supplier diversity agreement with Irving, TX-based Novation for orthopedic soft goods. The three-year deal offers market competitive pricing. Novation established a supplier diversity program committed to supporting minority ...
DJO Global establishes fellowship award
Vista, CA-based DJO Global, a global provider of medical devices for musculoskeletal health, vascular health, and pain management, established in February the DJO Cross Fellowship Award program in honor of recently retired Chief Executive Officer Les Cross. DJO Global will fund ...
Amniox launches amniotic membrane technology in lower extremity markets
Marietta, GA-based Amniox Medical has introduced Neox products, cryopreserved human amniotic membrane grafts that maintain their innate biological and healing potential, to lower extremity practitioners. Amniox premiered the grafts at the 2012 Annual Scientific Conference of the American College of Foot ...
Maddak sponsors networking, education program for occupational therapists
Pequannock, NJ-based Maddak launched a program in February designed to create a partnership between occupational therapists and the company, which manufactures products that simplify tasks of daily living, including eating, drinking, dressing, grooming, bathing, and toileting. According to Maddak, the goals ...
Foundation supporting disabled calls for 2012 grant applications
The nonprofit Dralla Foundation, established last year by Rockaway, NJ-based Allard USA, has set a May 1 deadline for 2012 grant requests. The foundation awarded 13 inaugural grants in 2001, its first year. Awardees further the foundation’s mission of providing ...
PDAC assigns reimbursement codes for Active Innovations ankle braces
Active Innovation, the medical division of Gardner, KN-based company Active Ankle, has secured pricing, data analysis, and coding (PDAC)-approved reimbursement codes for its product line. The approved billing code for the CF Pro is L1971. The CF Pro is a professional ...
Sydney will host global shoe congress
The Australian Pedorthic Medical Grade Footwear Association will hold the 18th World Congress of Orthopaedic Shoe Technicians and Pedorthists in Sydney, Australia, March 29-31. The program will feature topical keynote speakers, discussion groups, and presentations focusing on the congress theme, “Extending ...
NYCPM presents biomechanics seminars
The New York College of Podiatric Medicine is presenting a se- ries of one-day courses for foot health practitioners. Mastering Biomechanics topics include patient biomechanical assessment, prescription writing, practice management pearls, and billing, coding, and compliance review. Presentations will be held ...

Products


BioSculptor AFO Scanning Table
The new AFO Scanning Table from BioSculptor Corporation allows users to scan the plantar and dorsal surfaces of a patient’s foot while maintaining the lower leg in a neutral position. This scanning table has acrylic lasting boards of three different heights ...
Hot and Cold Foot Therapy
Health Enterprises offers two new hot and cold therapy products: TheraToes and TheraPed, which have been awarded the American Podiatric Medical Association (APMA) Seal of Acceptance. Either Therma gel product can be heated in the microwave for targeted heat therapy ...
Webly Zap Ankle Brace
The Webly Zap ankle brace from Hely & Weber features a construction of supportive ballistic nylon with non-stretch and non-fraying straps that is designed to replicate taping. Uses include play, rehabilitation, and competitive athletics.  Ankle control is provided by figure-8 ...
Excel Lace-up Ankle Brace
For athletes looking for the best of both worlds, the Excel lace-up brace from Active Ankle provides the comfort and mobility of a lace-up with support and security of a “tape job” at an inexpensive price point.  A circumferential strap ...
Sani-Cast Hygiene Kit
MD Americas offers a new hygiene product designed to help sanitize and deodorize the skin wrapped in an orthopedic cast. The Sani-Cast kit includes a reusable medical-grade 21” easy-reach applicator and 36 premoistened disposable cleansing pads. Patients simply attach one ...
CosySoles Warming Slippers
CosySoles offers microwaveable slippers to relieve cold feet in patients whose circulation is compromised by conditions such as arthritis, muscular dystrophy, Charcot-Marie-Tooth disease, Raynaud’s disease, scleroderma, lupus, diabetes, multiple sclerosis, cerebral palsy, fibromyalgia, reflex sympathetic dystrophy, and other peripheral neuropathies. ...
Microprocessor Raize Foot
The new Raize Ankle/Foot system from Hosmer utilizes dual microprocessors to control a hydraulic ankle coupled to a composite foot platform. The Raize constantly monitors data from multiple sensors in the ankle to maintain stability in changing environments, including the ...
Heat-Moldable Ultimate Insole
Archmolds has introduced the Ultimate, a new heat-moldable custom insole offering up to twice the support of the company’s other heat moldable insoles. The Ultimate is designed to prevent foot, leg, hip, or back pain while enhancing comfort and performance ...
Topical BioMedics Gift Sets
Topical BioMedics offers health and wellness gift sets featuring Topricin pain relief and health cream or Topricin Foot Therapy Cream. The gift sets, designed for a variety of budgets and lifestyles, also feature natural soaps, handmade candles, foot reflexology rollers, ...
ProTech Custom Post
The Powerstep ProTech Custom Post from Stable Step allows for quick and simple adjustments with heel posts or heel lifts to easily create a customized orthotic product. Each full length polypropylene orthotic shell with an EVA base, Poron top layer, ...
Ultra Zoom Ankle Brace
Breg has released the Ultra Zoom, a full season performance ankle brace that is lightweight and flexible for daily wear yet sturdy enough to reinforce, support, and protect during athletic activities. The Ultra Zoom is designed for prevention of ankle ...
Neoprene Hinged Knee Brace
The Advantage Neoprene Hinged Knee Brace provides support for patients with weak or injured knees that require medial and lateral support without restricting mobility. This product is now available in sizes small through extra-large and may be dispensed by orthopedic ...