October 2012

Cover Story


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Battlefield injuries: Saving lives and limbs throughout history

By understanding how military medicine has evolved and adapted over time, modern practitioners can better appreciate the need to question convention, advance research, and rapidly integrate beneficial new technologies into medical care.

By Christine Miller, DPM, FACCWS, Ashley Finn, and Emily Delzell

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London bridges: Clinicians and athletes connect at the 2012 Paralympic Games

There were no medals for the orthotists, prosthetists, and other lower extremity specialists in attendance at the 2012 games in London. But thousands of world-class athletes couldn’t have succeeded without them.

By Emily Delzell

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Editor Message


Jordana
Out on a limb: Beyond offloading

Lower extremity practitioners are constantly being reminded that what they think they know about injury prevention is only part of a bigger picture. This time it’s the diabetic foot care community’s turn to wonder just how much they have yet to learn about the mechanisms underlying ulceration.

Jordana Bieze Foster, Editor

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Jordana
Out on a limb: Fit vs quit

If you treat overweight patients with hip or knee osteoarthritis, you’ve undoubtedly counseled them about the benefits of exercise and maintaining a healthy weight. They’ve probably told you how much they really would like to exercise, if only the pain weren’t so bad.

Jordana Bieze Foster, Editor

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Special Report


KID STUFF 2012: Pediatric clinical news update

Click to download the complete PDF

In our second annual pediatric special section, LER updates you on the latest research and clinical news to help optimize management of your littlest lower extremity patients. Topics include cerebral palsy, clubfoot, juvenile idiopathic arthritis, ACL injury, footwear, obesity, and the pros and cons of foot screening.

Sponsored by an educational grant from…


Photo courtesy of Cascade DAFO.
Energy efficiency with AFO use varies in cerebral palsy patients

Longer strides lead to increased work
Ankle foot orthoses (AFOs) are regularly prescribed to children with walking disabilities resulting from cerebral palsy, yet the effects of AFOs on energy recovery and work during gait are still unclear.

By Samantha Rosenblum

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The surrogate biomodel undergoes testing in An- drew DiMeo's lab. Photo courtesy of Andrew Di- Meo, PhD.
Biomodel could help researchers optimize clubfoot brace design

Method includes complex rotations
A surrogate biomodel of a child’s lower extremities, in particular the ability to model movement along multiple axes of rotation, could help improve researchers’ biomechanical understanding of bracing for clubfoot.

By Emily Delzell

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Photo by Vincent Giordano/Trinacria Photography (www.trinacriaphotography.com), courtesy of Clinical Prosthetics & Orthotics.
Juvenile idiopathic arthritis study reveals footcare information gap

Issues involve custom foot orthoses
A Scottish study suggests foot care in children with juvenile idiopathic arthritis (JIA) falls short because of poor access to care and negative perceptions about custom foot orthoses. Experts say those issues may be less prevalent in the US but emphasize the need to educate patients, parents, and referring clinicians about the benefits of lower extremity care.

By Larry Hand

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Early ACL surgery could lower risk of associated knee damage

Patterns mirror those seen in adults
Timing of reconstruction surgery after pediatric anterior cruciate ligament (ACL) injuries seems to be related to the prevalence of meniscal and chondral injuries discovered during those surgeries, according to new research published in the September issue of The American Journal of Sports Medicine.

By Cary Groner

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Wearing athletic shoes affects some performance measures

Standing long jump distance improves
Research has recently begun to clarify footwear’s effects on gait and functional performance in children, but the broader implications of the findings remain a matter of debate.

By Cary Groner

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Dynamic data in obese children may suggest gait compensation

Low force values surprise researchers
An Austrian study exploring the role of genu valgum and flatfoot in obese and normal weight children found obesity was associated with higher peak plantar pres­sures, but lower maximum force while walking, when forces were normalized to body weight.

By Christina Hall Nettles

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Experts debate relative benefits of screening feet for risk factors

Most question emphasis on flatfoot
The value of screening programs for pediatric foot problems—primarily flatfoot—was recently challenged in a commentary by Australian podiatrist Angela Evans, PhD, a researcher and lecturer in the Division of Health Sciences at the University of Adelaide.

By Cary Groner

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Departments


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Debating the complexities of partial foot amputation

Partial foot amputations may not offer a biomechanical advantage over transtibial amputations if the metatarsal heads cannot be retained, and some experts suggest amputation level should be selected based on probability of wound healing instead. But others disagree.

By Cary Groner

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Ankle arthroplasty makes strides, but issues remain

Study findings and anecdotal reports suggest that newer-generation total ankle replacement can match or exceed ankle arthrodesis when it comes to gait and range of motion, but neither procedure returns gait to normal. Implant survival has also improved, but continues to be a challenge.

By Barbara Boughton

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Total hip arthroplasty: Obesity and outcomes

Total hip arthroplasty can significantly improve quality of life in obese patients, but high body mass index is also associated with higher rates of complications and re­admissions than in normal-weight patients. The emerging subgroup of super-obese patients poses additional challenges.

By Raghav Rajgopal, MD, and James L. Howard, MD, MSc, FRCSC

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Biofilms: Diabetic foot ulcer care gets personal

Opportunistic microorganisms called bio­films constitute an age-old diabetic wound care problem that defies traditional anti­microbial therapies. Experts believe interventions customized to individual patients based on molecular diagnostics may be the best line of defense.

By Larry Hand

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Platelet-rich plasma: An option for tendinopathy

Patients with chronic refractory lower extremity tendinopathies often continue to have symptoms after exhausting most of their therapeutic options. Preliminary evidence supports the use of platelet-rich plasma in these patients, though higher-level research is needed.

By Ricardo E. Colberg, MD, and Kenneth Mautner, MD

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Healthcare reform: What it means for your specialty

Despite being upheld by the Supreme Court, the Affordable Care Act remains a subject of debate heading into next month’s presidential election. Meanwhile, government affairs experts are working to determine just how the ACA will affect lower extremity practitioners.

By Shalmali Pal

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Ankle bracing: Exploring effects on proximal joints

Research suggests that the ankle’s ability to absorb its share of energy during landing from a jump is altered with the use of an ankle brace. The extent to which this effect might influence risk of injury to other lower extremity joints or soft tissues, however, remains unclear.

By Jacob K. Gardner, MS

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Despite few solid studies, ulcer debridement thrives

There are few high-quality studies and no randomized controlled trials documenting its effectiveness, but debridement—from surgical to larval—remains a mainstay of diabetic ulcer care in many practices, and new twists on conventional techniques continue to evolve.

By Cary Groner

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Prehabilitation for TKA: Preop and postop benefits

Prehabilitation, particularly in the form of exercise, has the potential to significantly improve preoperative and postoperative outcomes in patients with knee osteo­arthritis who are undergoing total knee arthroplasty. Both physiological and psychological outcomes can be positively impacted.

By Carly McKay, PhD, and Harry Prapavessis, PhD

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News


In the Moment: Sports medicine

By Jordana Bieze Foster

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Location, location: High pressures don’t predict all ulcers

Practitioners often deem all areas of elevated peak plantar pressure in patients with diabetes at some risk for ulceration. A study published in September, how­ever, suggests this risk varies with the specific location of pressure, and investigators say findings highlight the importance of monitoring plantar pressure as part of preventive care.

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Neuropathy results in less sensory loss at fifth metatarsal than hallux

Clinicians should carry out quantitative vibration testing for sensory loss in patients at risk for diabetic neuropathy at the hallux, according to research that confirms the hallux undergoes greater sensory loss than the fifth metatarsal, an alternate location for vibration testing.

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Imaging reveals intrinsic muscle deterioration in neuropathic feet

Diabetic neuropathy is associated with increased levels of intrinsic foot muscle deterioration, which may contribute to foot deformity and ulceration, according to research presented in September at the annual meeting of the American Society of Biomechanics in Omaha, NE.

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10ITMknee-iStock24183345sm
Investigating OA: Studies revisit underlying variables

Knee osteoarthritis researchers are taking a closer look at the factors that influence knee adduction moment (KAM) and also considering the contributions of sagittal plane variables, as illustrated by studies presented in September at the American Society of Biomechanics (ASB) annual meeting in Omaha, NE.

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Altered landings suggest link between neurocognitive scores, ACL injury risk

Female athletes with low neurocognitive scores are more likely than those with higher scores to demonstrate altered landing mechanics consistent with elevated anterior cruciate ligament (ACL) injury risk, according to findings that could have implications for concussion management.

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Limited arch excursion characterizes individuals with patellofemoral pain

Patients with patellofemoral pain (PFP) have less medial longitudinal arch excursion during stair descent than healthy individuals, according to a Brazilian study that may help explain the effects of foot orthoses in patients with PFP.

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shutterstock.com #98925422
Brains and sprains: Is there an extremity-concussion link?

The sports medicine community is demonstrating increasing interest in the possibility that neurocognitive impairment and musculoskeletal injury may be related, as evidenced most recently by an exchange in the letter to the editor section of the September issue of The American Journal of Sports Medicine (AJSM).

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Achilles tendon in runners maintains stiffness despite stress of marathon

Running a marathon does not significantly affect Achilles tendon stiffness, suggesting that overuse may not explain Achil­les ruptures in runners, according to a Finnish study published in the October issue of the Journal of Experimental Biology.

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NFL study finds higher rates of sprains on artificial turf than on grass surfaces

Knee and ankle sprains in National Football League (NFL) players occurred more frequently on artificial turf than on grass between 2000 and 2009, according to a study commissioned by the NFL Injury and Safety Panel e-published in September by The American Journal of Sports Medicine.

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In the Moment: Surgery

By Jordana Bieze Foster

10ITM-diabetes-iStock24843
Location, location: High pressures don’t predict all ulcers

Practitioners often deem all areas of elevated peak plantar pressure in patients with diabetes at some risk for ulceration. A study published in September, how­ever, suggests this risk varies with the specific location of pressure, and investigators say findings highlight the importance of monitoring plantar pressure as part of preventive care.

Continue reading

Neuropathy results in less sensory loss at fifth metatarsal than hallux

Clinicians should carry out quantitative vibration testing for sensory loss in patients at risk for diabetic neuropathy at the hallux, according to research that confirms the hallux undergoes greater sensory loss than the fifth metatarsal, an alternate location for vibration testing.

Continue reading

Imaging reveals intrinsic muscle deterioration in neuropathic feet

Diabetic neuropathy is associated with increased levels of intrinsic foot muscle deterioration, which may contribute to foot deformity and ulceration, according to research presented in September at the annual meeting of the American Society of Biomechanics in Omaha, NE.

Continue reading

10ITMknee-iStock24183345sm
Investigating OA: Studies revisit underlying variables

Knee osteoarthritis researchers are taking a closer look at the factors that influence knee adduction moment (KAM) and also considering the contributions of sagittal plane variables, as illustrated by studies presented in September at the American Society of Biomechanics (ASB) annual meeting in Omaha, NE.

Continue reading

Altered landings suggest link between neurocognitive scores, ACL injury risk

Female athletes with low neurocognitive scores are more likely than those with higher scores to demonstrate altered landing mechanics consistent with elevated anterior cruciate ligament (ACL) injury risk, according to findings that could have implications for concussion management.

Continue reading

Limited arch excursion characterizes individuals with patellofemoral pain

Patients with patellofemoral pain (PFP) have less medial longitudinal arch excursion during stair descent than healthy individuals, according to a Brazilian study that may help explain the effects of foot orthoses in patients with PFP.

Continue reading

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Weighty issues after TJA: Many put on pounds despite pain relief

Contrary to expectations, total joint arthroplasty (TJA) for hip or knee osteoarthritis does not necessarily lead to weight loss, according to a systematic review performed by researchers in San Diego.

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ACL reconstruction fails to improve return-to-sport rates after one year

Athletes who undergo surgical reconstruction after anterior cruciate ligament (ACL) injury are no more likely to return to sports one year later than those treated nonoperatively, according to a Norwegian study.

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Midfoot index of load differentiates postarthrodesis gait from normal

Swiss researchers have found that pedobarographic differentiation between ankle arthrodesis patients and healthy volunteers can be narrowed down to a single variable, midfoot index of load—a finding that could make the technology much more accessible to the average clinician.

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Market Mechanics


Study finds certified providers receive only a third of Medicare O&P payments

Unlicensed providers continue to receive unauthorized payments for O&P services from the Centers for Medicare & Medicaid Services (CMS), according to a study released in September.

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Freedom Innovations refines robotic leg

Irvine, CA-based Freedom Innovations announced in October that it will partner with Vanderbilt University in Nashville, TN, and the Rehabilitation Institute of Chicago to commercialize a first-generation prosthesis that uses control systems that mimic the human leg’s power and gait.

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OSU hosts ACL prevention, rehab course

The Sports Health and Performance Institute at the Ohio State University (OSU) in Columbus is scheduled to host the 11th annual workshop on anterior cruciate ligament (ACL) injury prevention and rehabilitation on November 9.

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Implantable device prices decline

The Washington DC-based Advanced Medical Technology Association (AdvaMed) released a study on its website on September 23 showing significant declines in average prices for major implantable medical devices.

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ABC accredits Arizona AFO central fab

The American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) has granted a Five-Year Central Fabrication Accreditation to Arizona AFO, the Mesa, AZ-based company announced on October 1.

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Ultramarathoner re-ups with Pro-Tec

Redmond, WA-based Pro-Tec Athletics announced in September that it has re-signed Scott Jurek for an additional two years to its team of professional athletes. Jurek, a champion ultramarathoner who has been on the Pro-Tec team for more than seven years and is author of the New York Times bestseller Eat & Run, will work closely with Pro-Tec to help educate runners about recovery and performance.

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iQube facilitates insoles for children

A Russian orthopedist at the Saint Petersburg State Paediatric Medical University combined data from Delcam’s iQube scanner with 3D spine and posture analyses and then used the company’s software to create custom orthotic insoles for children with locomotor disorders, Birmingham, UK-based Delcam announced in October.

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Amy Purdy and Daniel Gale competed in the current season of Amazing Race. Photo courtesy of CBS.
Amputee Amazing Race contender meets personal goals despite elimination

Among the 22 competitors on the 21st season of CBS’s Amazing Race was bilateral amputee Amy Purdy, a medalled snowboarder and cofounder of Adaptive Action Sports, a Lummi Island, WA-based company aimed at giving youths and young adults with disabilities … Continue reading

Medi-Dyne acquires Cho-Pat

Colleyville, TX-based Medi-Dyne Healthcare in September bought pain prevention product company Cho-Pat, which is head-quartered in Hainesport, NJ. The acquisition of Cho-Pat is consistent with Medi-Dyne’s strategy of providing pain relief and prevention solutions along the entire length of the … Continue reading

Foundation funds PT referral research

The Foundation for Physical Therapy in Alexandria, VA, has awarded Georgetown University economist and Professor of Public Policy Jean Mitchell, PhD, a $300,000 high-impact research grant to study the influence of physical therapy referral characteristics and practices on quality, cost … Continue reading

Knit-Rite facilities earn ISO certification

Kansas City, KS-based Knit-Rite, a global manufacturer and distributor of orthotics and prosthetics, compression hosiery, and general medical textiles, received International Organization for Standardization(ISO)13485:2003 certification in September for both its manufacturing facilities, located in Kansas City and Ellerbe, NC. ISO … Continue reading

Project fills clinical gaps with free shoes

Durham, NC-based continuing education company FootCentric, the University of North Carolina (UNC) at Chapel Hill Division of Physical Therapy Faculty Clinic, and the North Carolina Physical Therapy Association are collaborating on the “Free Your Feet Project.” The group will hold … Continue reading

Products


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Raptor-12 Motion Camera

Motion Analysis Corporation announces a new camera to its lineup: the Raptor-12, with a maximum resolution of 12 megapixels (MP). Resolutions include 150 fps with 12MP, 200 fps with 9.4MP, 300 fps with 6.3MP, 500 fps with 3.8MP, and 900 … Continue reading

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Sprained Ankle Software

PhysioTools’ Sprained Ankle training module is an easy-to-use tool, with 120 illustrations and informative text on the management of a sprained ankle, including acute care, taping, and rehabilitation…

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Antibacterial Silosheath

Silipos introduces the Antibacterial Silosheath, which offers the same benefits as the Silosheath Original along with the added benefits of antimicrobial protection and odor control. The interior lining of the Antibacterial Silosheath is coated with a mineral oil gel specifically … Continue reading

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Easy Out Ribbon

Brand new from ComfortFit Orthotic Labs is the Easy Out pull-out ribbon. The ribbon—a loop attached to the underside of an insole but accessible when the device is positioned inside a shoe—allows patients to quickly and easily remove foot orthoses from their shoes.

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Powerstep Wide Fit Orthotic

Powerstep introduces the Wide Fit Full Length Orthotic, a new wider profile orthotic specifically designed for use with wide-width footwear. This functional device features a semirigid polypropylene support shell calibrated for arch support with flexibility, a deep and wider heel … Continue reading

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Lycra Mary Janes

Apis Footwear offers the new 9205-L women’s Lycra Mary Jane comfort shoes as a part of its Mt. Emey Therapeutic Line. Three pairs of heat mold- able inserts are included with every order. The new Lycra Mary Jane shoes feature … Continue reading

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Amerigel Wound Wash

Amerx Health Care has introduced its new and improved Amerigel Wound Wash for painless and effective wound cleansing. The product is a sterile, pH neutral, nonlactated Ringer’s solution containing sodium chloride, calcium chloride, and potassium chloride in purified water. Amerigel … Continue reading

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Foot Drop Splint, Platinum Sound

The Platinum Sound AFO and the Foot Drop Splint from PAL Health Technologies follow PAL’s new approach to drop foot and equinus treatment. The noncustom Foot Drop Splint (from PAL’s Transition Ankle line) is a lightweight injection-molded polypropylene brace with … Continue reading

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G&W Sprained Ankle Orthosis

The Sprained Ankle Orthosis (SAO) from G&W Heel Lift is designed to reduce the healing time of common ankle sprains and protect weak ankles from inversion sprains. The SAO is a firm heel cup…

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Sandalwalk Foot Orthoses

Earthwalk Orthotics introduces Sandalwalk prescription foot orthoses designed to replace the removable footbed in Dr. Comfort’s Open Comfort Collection. The prescription orthoses are discreet…

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Rapid Zap Ankle Brace

Hely & Weber offers the Rapid Zap figure-8 style ankle brace. Wide open spaces provide easy access for the foot to facilitate application. Tri-Lace-Pod straps are designed for a quick and accurate fit and security. The top strap aligner…

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Thorlo Padded Socks

Thorlo introduces Thorlos Padds—clinically tested padded socks for people with low to moderate foot pain and people with diabetes whose feet are not at immediate risk for ulceration and who want nonactivity-specific foot protection. The padding is designed to reduce … Continue reading

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PeroSupport.Pro Ankle Foot Orthosis

As a step up from its successful PeroSupport.tec ankle foot orthosis, Euro International presents a newer revamped version: the PeroSupport.Pro from Streifeneder ortho.production. The PeroSupport.Pro prevents lateral twisting as well as lateral slipping. It is intended for management of peroneal … Continue reading

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Aline Systems RTS Insole

Aline Systems announces new RTS foot technology. RTS combines the patented technology from the company’s RT insole with a new memory foam and technical fabric top sheet. The Aline RTS includes a softer feel…

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OA Restore Knee Brace

The OA Restore knee brace from Ottobock utilizes a rigid frame and unique hinging to help stabilize the knee, relieve symptoms, and delay more aggressive treatment for patients with mild to moderate medial or lateral knee osteoarthritis, ligament or cartilage damage…

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Spark Pro Motion Analysis

Spark Motion, maker of portable motion analysis software for use in authentic sports performance and rehabilitation environments, announces a rebranding (formerly Kinesio Capture). The company’s Spark Pro…

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