November 2012

Cover Story


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Energetics of landing: Effects of ankle instability

A diminished capability for energy dissipation at the knee after ground impact during landing in patients with chronic ankle instability may result in greater demands on the ankle joint. Modifying landing strategies could potentially reduce the risk of musculoskeletal injury.

By Masafumi Terada, MS, ATC, and Phillip A. Gribble, PhD, ATC, FNATA   

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Genetics: The future of injury prevention

Evidence is linking genetic mutations to Achilles tendon and anterior cruciate ligament injuries as researchers try to connect complex motor control processes to small segments of DNA. But genetic testing is still a long way from becoming a clinical tool.

By Larry Hand

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Editor Message


Jordana
out on a limb: Parsing the pain

You know that saying about how a man with a hammer sees everything as a nail? That’s something those who specialize in biomechanics might want to remember when considering patients with chronic pain.

By Jordana Bieze Foster, Editor

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Jordana
Out on a Limb: The whys of compliance

If you think your patients have compliance issues, be glad you’re not treating clubfoot in a place like India, Egypt, Mexico, or Bangladesh.

By, Jordana Bieze Foster, Editor

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Special Report


CONFERENCE COVERAGE: International Clubfoot Symposium

Click to download the complete PDF

The Ponseti method of clubfoot management has achieved worldwide 
acceptance, but practitioners and researchers are still working to identify the best ways to optimize clinical outcomes while remaining sensitive to issues of cost effectiveness and cultural differences. Clinicians from around the globe gathered in October at the second International Clubfoot Symposium to 
discuss their successes and challenges.

Sponsored by an educational grant from…


Another infant wears what Oyoun said is the “best locally made brace available” in the Assiut region in southern Egypt. She bent the bar manually when she fitted the baby with the brace. (Photo courtesy of Nariman Abol Oyoun, MD.)
Resource-poor areas benefit from global outreach efforts

Treatment of children with clubfoot has evolved considerably in the five years that have elapsed since the inaugural International Clubfoot Symposium, and the benefits of this evolution are particularly evident in resource-poor nations—home to about 80% of the 200,000 children born each year with clubfoot. But practitioners who treat patients in these areas still face financial, cultural, and logistical challenges.

By Emily Delzell

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Benefits of Ponseti method extend to older children

Clubfoot correction ideally should be performed during infancy, before children learn to walk, but experts agree that the Ponseti treatment method can also be effective in older children. Speakers at the International Clubfoot Symposium in October presented successful outcomes for Ponseti treatment of neglected clubfoot in patients aged up to 21 years.

By Jordana Bieze Foster

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TATT in relapsed clubfeet can affect plantar flexion

Tibialis anterior tendon transfer (TATT) is known to be associated with limited ankle dorsiflexion, but practitioners should be aware that plantar flexion also can be negatively affected, according to research presented in October at the International Clubfoot Symposium.

By Jordana Bieze Foster

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Departments


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Conference coverage: 3rd PFP research retreat

The third International Patellofemoral Pain Research Retreat picked up where previous retreats had left off in examining proximal and distal factors related to PFP and subgroups of patients who might respond to targeted interventions. But this retreat broke some new ground as well.

By Jordana Bieze Foster

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Plantar plate repair: New approach to metatarsalgia

Plantar plate pathology in conjunction with metatarsalgia occurs more often than is commonly appreciated, but can be addressed using a combined procedure that involves a dorsal approach to anatomic plantar plate repair and metatarsal realignment.

By Lowell Weil Jr, DPM, FACFAS, and Erin E. Klein, DPM, MS

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Studies examine ways to optimize OA bracing

Research continues to suggest that bracing has the ability to improve pain and function in patients with knee osteoarthritis in a controlled setting, but researchers are now working to identify factors that affect bracing outcomes in the real world. Patient expectations are at the top of that list.

By Larry Hand

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Achilles tendon rupture: The influence of gender

The literature suggests that women are less likely than men to experience an Achilles tendon rupture. This may be because women are less capable of generating the large eccentric contractions necessary for rupturing the tendon. Estrogen may also play a protective role.

By Joseph L. Laratta, MD, and J. Turner Vosseller, MD

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Limited hip flexibility: Mutability and mobility

Myofascial or joint-focused stretches can increase passive hip range of motion in young adult men with limited hip flexibility, but this will not necessarily result in more hip motion actually being utilized during functional activity unless old movement patterns can be unlearned.

By Janice Moreside, PhD

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Hamstring strain: Issues facing collegiate athletes

Collegiate athletes who participate in sports associated with sprinting have an increased risk of hamstring strain. Investigators have identified flexibility, strength, and fatigue as potential contributing factors that can be addressed through sport-specific training and rehabilitation.

By Kevin M. Cross, PhD, ATC, PT, Susan Saliba, PhD, ATC, PT, and Jay Hertel, PhD, ATC

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Charcot neuroarthropathy and bone mineral density

Research indicates that in diabetic patients with Charcot neuroarthropathy, peripheral bone mineral density decreases over time, which can contribute to risks of hardware failure, loss of correction, delayed union, and nonunion in patients with advanced disease.

By Rachel H. Jung, DPM, MHA, MPH; Robert M. Greenhagen, DPM; Dane K. Wukich, MD; Vassilios Vardaxis, PhD; and Robert  M. Yoho, DPM, MS

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OA knee braces face off against wedged insoles

Two separate studies directly compared valgus knee bracing and wedged foot orthoses for reducing knee adduction moment in patients with osteoarthritis, but came to opposite conclusions. A third study suggests combining the two interventions may be the best solution.

By Barbara Boughton

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Self-selected gait speed: A critical clinical outcome

When treating patients who are going through rehabilitation, clinicians may be overemphasizing gait distance and over­looking the importance of gait speed. Clinical assessment of gait speed is sim­ple and inexpensive but can be a signifi­cant indicator of functional recovery.

By Heather Braden, PT, MPT, PhD, GCS

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Intramuscular manual therapy for heel pain

Intramuscular manual therapy, also known as dry needling, is hypothesized to relieve pain by modifying tension in connective tissue. Limited evidence supports the use of IMT for plantar fasciitis, although further research is needed to rule out a placebo effect.

By Brent Harper, PT, DPT, DSc, OCS, FAAOMPT

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News


In the Moment: O&P

By Jordana Bieze Foster

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Prepare for landing: Bladed cleats may put fifth met at risk

Bladed soccer cleats were associated with increased forefoot loading during a jump-landing task, which may lead to a higher risk of fifth metatarsal stress fractures, according to a study published in the September-October issue of the Journal of Athletic Training.

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Leg mechanics, training conditions may predict Achilles pain in runners

Investigators at the University of Tuebingen in Germany have identified alterations in lower leg mechanics and higher impacts caused by “fast” training conditions (e.g., interval training sessions, competitions) as potential risk factors for Achilles tendon pain in runners.

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Anterolateral knee ligament ‘discovery’ makes headlines, but is not really new

The media buzz over the apparent discovery of a new knee ligament announced in early November faded quickly as experts pointed out that the finding was not exactly new.

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Photo courtesy of David Misener, CPO, of Clinical Prosthetics & Orthotics.
Drop foot fix for CMT: AFOs work both proximally and distally

The mechanism by which ankle foot orthoses (AFOs) reduce drop foot in patients with Charcot-Marie-Tooth disease (CMT) involves proximal effects as well as the distal changes with which clinicians are more familiar, according to research from the UK.

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Personalized data make a difference in additive manufacturing of insoles

Personalized insoles created using additive manufacturing technology are associated with improved biomechanics and comfort during running, according to research from Loughborough University in the UK.

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Tibial bone health asymmetries persist in stroke survivors despite use of AFOs

Tibial bone mineral density in stroke survivors who use ankle foot orthoses (AFOs) remains significantly higher in the unaffected limb than the affected limb after more than a decade, according to research from the University of Oklahoma in Oklahoma City.

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In the Moment: Osteoarthritis

By Emily Delzell

11ITM-sports-iStock24930208v2
Prepare for landing: Bladed cleats may put fifth met at risk

Bladed soccer cleats were associated with increased forefoot loading during a jump-landing task, which may lead to a higher risk of fifth metatarsal stress fractures, according to a study published in the September-October issue of the Journal of Athletic Training.

Continue reading

Leg mechanics, training conditions may predict Achilles pain in runners

Investigators at the University of Tuebingen in Germany have identified alterations in lower leg mechanics and higher impacts caused by “fast” training conditions (e.g., interval training sessions, competitions) as potential risk factors for Achilles tendon pain in runners.

Continue reading

Anterolateral knee ligament ‘discovery’ makes headlines, but is not really new

The media buzz over the apparent discovery of a new knee ligament announced in early November faded quickly as experts pointed out that the finding was not exactly new.

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E-education for TJR: Emails help manage patient expectations

An email-based education and communication service is helping patients understand what to expect as they get ready to undergo or recover from total joint replacement (TJR) surgery.

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Study finds both vitamin D deficiency and knee OA symptoms vary by race

Vitamin D deficiency may underlie race-specific pain patterns in patients with osteoarthritis (OA), according to researchers from the University of Florida in Gainesville.

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Motion-control footwear features fail to decrease knee adduction moment

Two studies e-published in October found medial arch supports and motion control shoes have no significant effect on knee adduction moment (KAM), regarded as a surrogate measure of medial knee compression.

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Market Mechanics


ACA may improve preventive O&P care

The Affordable Care Act (ACA), which went into effect on October 1 and has a strong emphasis on preventive care, may help O&P practitioners offer their patients devices that prevent serious sequelae, including drop foot, foot ulcers, and amputation, said William DeToro, LO, CO, CEO of Poland, OH-based Anatomical Concepts Inc (ACI).

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DJO Global signs Olympic gold medalist

Vista, CA-based DJO Global announced on October 30 that Megan Rapinoe, Olympic gold medalist for the US Women’s Soccer Team and a National Women’s Soccer League player for the Seattle Reign FC, is partnering with them to help educate young athletes about the value of bracing in injury prevention and returning to play.

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O&P site makes user-friendly updates

O&P Social relaunched its website, oandpsocial.com, in November. The newly designed site gives O&P clinicians and other allied health professionals easy-to-use navigation, an educational forum with Medi­care updates and tips for a more effective practice, a list of national and international O&P events, and a forum for interaction among O&P professionals.

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Steadman organizations name CEO

J. Richard Steadman, MD, managing partner and founder of The Steadman Clinic, and Marc Philippon, MD, managing partner of Steadman Philippon Research Institute (SPRI), announced on October 16 that Tom Mars, a former Walmart executive and SPRI board member, is new chief executive officer of both organizations, located in Vail, CO.

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Combination therapy eases OA pain

Combining Irving, CA-based VQ OrthoCare’s BioniCare transcutaneous electrical joint stimulator with an unloading knee brace improves OA symptoms significantly more than electrical stimulation alone, according to a multicenter study published in October in The American Journal of Orthopedics.

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Pedors launches 24/7 B2B portal

Hiram, GA-based Pedors launched pedors247.com, its new 24/7 business-to-business portal where practitioners can place, review, and track orders, invoice balances, and order history, at the 54th Pedorthic Footcare Association Symposium held in Boston October 31-November 2.

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Ankle sprain trial supports Traumeel

A multicenter randomized controlled noninferiority trial published in October in The International Journal of Clinical Practice found a topical homeopathic gel and ointment made by Albuquerque, NM-based Heel Inc are as effective as the current standard of care for reducing pain and improving function in patients with acute ankle sprains.

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Ottobock wins communications award

German prosthetics company Ottobock, headquartered in Dusseldorf, announced on October 29 that it had won the 2013 Econ Award for excellence in public relations for its London 2012 “Passion for Paralympics” campaign.

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Expert group recommends “chronic disease” approach to OA management

Spurred by conclusions from the Chronic Osteoarthritis Management Initiative (COAMI) Work Group, which met earlier this year to assess current practice in OA management, healthcare providers from more than 20 professional societies are proposing significant changes in management of osteoarthritis … Continue reading

LE professionals get active for veterans

Commerce City, CO-based Mile High Orthotics Lab and Mequon, WI-based Dr. Comfort joined forces in October to raise money for recovering US service members and veterans. On October 7, a team of Mile High manufacturers and clinicians participated in the … Continue reading

PTs laud proposed Medicare agreement

On October 24 American Physical Therapy Association president Paul A. Rockar Jr, PT, DPT, MS, issued a statement applauding the proposed legal settlement of Glenda Jimmo, et al vs Kathleen Sebelius, a national class action lawsuit. Plaintiffs alleged that the … Continue reading

Societies respond to GAO report on self-referral rates for imaging

In late October professional societies penned official responses to a report from the US Government Accountability Office (GAO) that found self-referral rates for magnetic resonance imaging (MRI) and computed tomography (CT) have skyrocketed in recent years, with MRI self-referral rates … Continue reading

Lucknow hosts 2013 CP conference

The International Conference on Cerebral Palsy and Developmental Medicine and the seventh annual Meeting of the Indian Academy of Cerebral Palsy will convene in Lucknow, India, March 6-10, 2013, for a 1500-plus delegate meeting on the state of care for … Continue reading

Annual ACSM survey highlights fitness and health trends for 2013

The American College of Sports Medicine’s (ACSM) seventh annual international survey of fitness trends finds traditional exercises poised for popularity in 2013. Body-weight training, which includes back-to-basics exercises such as push-ups, planks, pull-ups, and squats, appears in the top 10 … Continue reading

Healthline launches online surgical guide for total knee replacement

San Francisco-based Healthline Networks introduced a new online consumer health resource in October, the Surgical Procedure Guide for Total Knee Replacement Surgery. The guide is aimed at individuals who are considering or have undergone total knee replacement surgery (TKR). It … Continue reading

Products


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Alli-Flex Black Plastic

Alli-Flex from Allied Plastic Supply is a soft black, flexible plastic used for prosthetic liners. A cost-effective alternative to black Northvane, Alli-Flex is easy to clean and resists staining. A benefit of a black liner is its ability to mask … Continue reading

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Postoperative Mesh Top Shoe

Elite Orthopaedics introduces a new postoperative shoe: the Mesh Top Post Operative Shoe. The new shoe is designed for use on a postoperative, traumatized, diabetic, or insensitive foot. Features of the Mesh Top Post Operative Shoe include an open-toe design … Continue reading

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Prosthetic Swim Joint

The new swim joint by Swim Again is designed to give lower limb amputees the freedom of swimming without the hassle of specialized prosthetics. The joint can be released with a pull pin, allowing the user to walk to and … Continue reading

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Dynamic AFO Padding

Beginning late this year, all Dynamic Ankle Foot Orthoses from Cascade Dafo will feature improved internal padding. The new contoured modular pad-ding will be applied in areas of each brace design where elevated pressure is anticipated. Ortho-engineered to conform to … Continue reading

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Arch Suspender AFO Modification

Hersco announces availability of the Arch Suspender from Richie Labs as an ankle foot orthosis modification to control the midtarsal joint and hindfoot. The Medial Arch Suspender is an adjustable lifting strap under the talonavicular joint to resist collapse of the medial arch as well as eversion of the ankle and hindfoot.

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Warming Insoles

Spenco Medical Corporation offers Spenco PolySorb Flow Warm performance insoles for walkers, runners, and joggers seeking support and comfort in a warm foot environment. A reflective thermal barrier, a foil layer beneath the topcloth, retains natural body heat. The topcloth … Continue reading

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Arcopedico Knit Shocks

Arcopedico’s top-selling LS shoe line has been rebranded with the nickname “Shocks” (shoes as comfortable as wearing socks) and introduced in two bright new colors, fuschia and orange. As the name implies, Shocks offer the coziness of a pair of … Continue reading

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New Options OA Brace

The New Option OA is a pull-up, buttressed, “soft” brace for patients with mild to moderate knee osteoarthritis. The buttressed sleeve aids in knee alignment, provides compression, and is easy to apply.

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Low Profile Triton Foot

New from Ottobock, the multi-axial Triton Low Profile (LP) foot is designed for active above- or below-knee amputees with clearances as small as 2.5 inches, particularly those with longer residual limbs. In addition to its reduced structural height, the Triton … Continue reading

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Tibion Bionic Leg

Tibion, a venture backed robotics technology company, has introduced the Tibion Bionic Leg: a wearable lower limb robotic trainer activated by the patient’s intent to move. The Tibion Bionic Leg is designed to strengthen stance, improve gait, and enhance active … Continue reading

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bodyblock Limb Support

The bodyblock is a light, comfortable multipurpose support block that can be used to elevate a limb or as a spacer between the knees. Made of polyurethane, it weighs just 300 g and can be easily cleaned and disinfected between patients.

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Remote Triggering

Tekscan has introduced new remote triggering products that improve the flexibility of its VersaTek Wireless and Datalogger systems. The Trigger Transmitter (TT-1) and Trigger Receiver (TR-1) allow users to synchronize F-Scan Wireless and Data-logger recordings with transmissions from other measurement … Continue reading

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Footmaxx Metascan

Footmaxx has released an updated and improved version of its diagnostic system, Meta­scan. Metascan analyzes a foot in motion to help practitioners predetermine the need for foot orthoses and optimize orthotic fit. Options for diagnosing abnormal foot function and balance … Continue reading

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Contender Post-op Brace

Corflex announces the release of its Contender Post-Operative Knee Brace. The ZipTrak, X-Flex, and QuikZip systems work together to ensure the Contender knee brace stays in place, which maximizes its ability to control range of motion to aid in healing and rehabilitation following an injury or a surgical procedure.

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Tarso Clubfoot AFO

M.J. Markell Shoe Company offers the Tarso Clubfoot AFO, a semirigid ankle foot orthosis for use with the Ponseti method of clubfoot treatment. The Tarso Clubfoot AFO has a symmetrical shape for use on either the left or right foot. … Continue reading

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MaxxLife Custom Orthosis

Footmaxx offers the MaxxLife premium custom-made foot orthosis for comfort and stability. The MaxxLife features a natural leather topcover, a low-profile Duramaxx semirigid orthotic module, a polyurethane mid-layer reinforced with a suede bottom, and a polyurethane heel cushion and cap.

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PressureGuardian Data Collector

PressureGuardian, developed by Tillges Technologies, is a compact portable pressure sensor device with a compatible data-collecting app. The information can be used to adjust orthotic and prosthetic devices to offload pressure on a diabetic wound or inside a prosthetic socket.

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Topical Gear ACL Tube

Topical Gear has released the ACL Tube. Inventor Bill Bue and his team developed the light- weight (2 oz) brace that applies topical pressure on the medial quadriceps and hamstring muscles.

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Breathable Knee Support

Active Innovations introduces the Targeted Breathable Support (TBS) knee support crafted with VentiPrene, a durable, lightweight, 1/8-inch thick perforated neoprene. The material differs from standard neoprene in that it allows skin to breathe while providing compression and warmth without overheating. … Continue reading

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MxXpress Software

ModulaRx Orthotics Corp has introduced a new computer technology, MxXpress, to facilitate the accurate design and manufacture of customized foot orthoses based on plantar pressure measurements.

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