September 2012

Cover Story

Triple threat: The female athlete triad and injury risk

The Triad’s new definition specifies low energy availability, menstrual irregularity, and low bone mineral density as predictors of future health risks, including lower extremity injuries. This broader definition means far more female athletes may be at risk than previously thought, particularly in the high school setting.

By Jill Thein-Nissenbaum, PT, DSc, SCS, ATC

Editor Message

Out on a limb: Surviving the Triad

I set foot in a gym this summer for the first time in 14 years. I was nervous, but not for the reasons you might think. I wasn’t worried about not knowing how to use the equipment, or being less fit than other members, or the possibility of running into someone I knew.

Jordana Bieze Foster, Editor


Patient Perspective: Communication takes edge off pain of recovery

When I first entered my podiatrist’s office for treatment of a moderately painful case of plantar fasciitis, I never thought that healthcare for my feet could get complicated. I subsequently developed sesamoiditis and my podiatrist prescribed custom orthotics for both my foot conditions. But then came the clincher: one night, I fell down a short flight of stairs and unfortunately landed on my foot.

By Barbara Boughton

Rethinking device design to improve compliance

Reducing the shaft height of a removable cast walker, which results in a lighter device and may also help improve postural stability, can help improve compliance in patients at risk for diabetic foot ulcers without compromising the device’s offloading capability.

By Sai Vikas Yalla, PhD, and Ryan T. Crews, MS, CCRP

Effects of minimalist shoes on running gait

Research suggests that when transitioning to a minimalist running shoe, foot strike pat­tern is key to preventing lower extrem­ity injuries. A transitional minimalist shoe, with slightly thicker and softer soles, may help prevent certain injuries in some runners.

By Everett B. Lohman III, DSc, PT, OCS

Knee OA interventions: A look at value for money

Even if an intervention results in a positive clinical outcome in patients with knee oste­o­­arthritis, another important factor to consider is whether that treatment’s benefits justify its costs. Increasingly, cost effectiveness studies are comparing OA interventions to determine value.

By Daniel Pinto, PT, PhD

Clinical assessment of ankle joint laxity

Ankle joint laxity can be a complicating factor in patients with acute ankle sprains or chronic instability, and testing for excessive laxity can help practitioners choose an appropriate method of treatment. However, not all tests for ankle joint laxity are created equal.

By Theodore Croy, PhD, PT, OCS, and Jay Hertel, PhD, ATC, FNATA


In the Moment: Sports medicine

By Emily Delzell and Jordana Bieze Foster #17088385
Lost in transition: Minimalist shoes don’t always alter gait

Barefoot-simulating and minimalist shoes are capturing the imagination of runners who hope to avoid injury and increase performance by adopting a forefoot or midfoot strike pattern, but recent research suggests runners don’t necessarily convert their gait simply by switching shoes.

Lower extremity work contributes to golf swing velocity, performance

Lower extremity work during a golf swing is positively correlated with both club head velocity and golfer skill level, according to research from the Ohio State University in Columbus, OH.

Soccer study explores factors that may link limb dominance to ACL injury risk

Kinematic and kinetic differences between dominant and nondominant limbs during cutting in soccer players could help explain previous findings regarding limb dominance and anterior cruciate ligament (ACL) injury risk, according to research from Ball State University in Muncie, IN.

In the Moment: Retraining

By Jordana Bieze Foster #21149286
Ambling modifiers: Finding a patient-friendly gait for knee OA

In the interest of improving compliance, studies of gait modifications to reduce moments and forces at the knee in patients with knee osteoarthritis (OA) are increasingly focusing on gait alterations that will not make patients self-conscious.

Kinetic biofeedback training reduces knee abduction moment on landing

Real-time biofeedback training can help female athletes reduce knee abduction moments (KAM) during landing, which may in turn reduce risk of anterior cruciate ligament injury, according to preliminary research from Cincinnati Children’s Hospital.

Multimodal adaptive rehab improves propulsive impulse in stroke patients

Gait training on a dual-belt treadmill in an adaptive virtual environment can help improve propulsive impulse in the paretic limbs of individuals with hemiparesis following stroke, according to research from the University of North Carolina at Chapel Hill.

Market Mechanics

Wound care market sees slow growth, NPWT and biologics are strong areas

A new study by market analysis company Espicom, headquartered in Chichester, UK, suggests advanced wound care products are not reaching their potential value or audience and that their use is constrained by tightened healthcare spending and slow clinical adoption, particularly in Asia.

The report, “The Global Advanced Wound Care Market to 2017,” noted that while the international market saw double-digit growth before 2008, the market has slowed more recently, with growth ...

Foot and ankle group names new VP, receives funds for educational mission

The American College of Foot and Ankle Pediatrics (ACFAP) appointed Louis J. DeCaro, DPM, West Hatfield, MA, vice president at the American Podiatric Medical Association’s (APMA) national convention, held last month in Washington DC.

Decaro, who is medical director and co-owner of Middlebury, CT-based Nolaro24, told LER the office of vice president had gone unfilled for a number of years and his role will be to help ACFAP President Ron Raducanu, ...

Register for “Innovative to the Bone”

On October 29 and 30 the Cleveland Clinic will hold its 10th annual Medical Innovation Summit, which this year focuses on advances in orthopedic technology, including those in concussion detection, joint replacement, and regenerative medicine.

More than 1000 executives, investors, entrepreneurs, and clinicians are expected to gather for the meeting, which will be capped by a “Top 10 Innovations” presentation, advances summit experts believe will have a breakthrough impact on healthcare ...

Ski country hosts bootfitting courses

Jackson Hole Boot Camp, based in Jackson Hole, WY, is a fitting and medical education program that blends pedorthics and sports medicine to help medical professionals and gear industry employees learn biomechanics and advanced ski boot fitting skills for sports that require a rigid stance. Attendees can earn 16.25 continuing education units at the camp, scheduled for December 6-8. For more information, go to

MasterFit University is ...

PFA plans for Little Rock symposium

The Pedorthic Footcare Association will hold its 53rd annual symposium November 1-3 in Little Rock, AR. Symposium guests can earn continuing education credits while checking out more than 100 exhibitors between educational sessions covering topics from wound care to running a successful pedorthic practice. For more information or register, go to and click on the button for the symposium.

Össur Americas partners with OPIE

Gainesville, FL-based OPIE Software announced in September that Össur Americas, based in Foothill Ranch, CA, has agreed to be an integrated supplier within the OPIE Software system and on the website The integration will allow OPIE Software users and website visitors to view Össur’s digital prosthetics catalog, configure product orders based on specific patient parameters, and place electronic orders for Össur’s prosthetic products. To access these functions you’ll need ...

German group grows compression division

Bayreuth, Germany-based medi, a medical device company that produces a variety of products, has bought San Diego-based CircAid to expand its compression therapy division.

CircAid specializes in compression garments for treatment of lymphedema, venous disease, and other edema-related disorders while medi produces more than 320 products for conditions related to venous disease, lymphedema, musculoskeletal injury, rehabilitation, and lower extremity amputation.

CircAid’s manufacturing and logistical operations will remain in San Diego and medi ...

Symposium highlights Ponseti method

The University of Iowa in Iowa City will host the Ponseti International Association’s 2012 International Clubfoot Symposium, which focuses on approaches, treatment, and outcomes of the Ponseti method and promotes community building among healthcare providers involved in the treatment of children with clubfoot.

A preconference workshop on October 3 that includes an overview of clubfoot treatment and a patient casting session will kick off the main event, which takes places October ...

ComfortFit offers flat-rate repair prices

Roselle, NJ-based ComfortFit Labs new single flat-rate repair price of $30 includes repair and refurbishing of foot orthoses made by any lab with all work guaranteed for six months.

Repair services include new top and bottom covers, new posting, arch fill, poron extensions, poron padding, and replacement of most standard accommodations.

Levy & Rappel launches new website

Saddle Brook, NJ-based Levy & Rappel’s new website went live the first week of September. Its new features include an easily navigable design, a section on the use of its foam impression product, LevyFoam, and a mechanism for submitting e-mail questions that are answered by a certified practitioner. Visit the revamped site at

ABC creates new accreditation program

The American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) has developed the first comprehensive accreditation program for central fabrication facilities in the orthotic, prosthetic, and pedorthic professions.

The new program will follow the same model as ABC’s current accreditation programs, with an onsite survey and re-accreditation every three years. Central fabrication facilities will be measured against 60 standards that correlate with best business practices and process improvement.

ABC reported the ...

Dralla announces awards for 2012

The Rockaway, NJ-based Dralla Foundation in August awarded its third round of grants to nonprofits that share the foundation’s mission of supporting the aspirations of children and adults with disabilities.

Dralla will provide $35,000 in funds to 23 US organizations to support a variety of programs and individuals, including sports events that encourage physically challenged individuals to try new activities, a team competing in the National Junior Disability Championships, and sailing ...

ACL workshop scheduled for November

The Sports Medicine Biodynamics Center at Cincinnati Children’s Hospital and The Ohio State University Sports Medicine program are scheduled to hold their 10th annual workshop on prevention, training, and rehabilitation for athletes at risk for anterior cruciate ligament injuries on November 10 at Cincinnati Children’s.

Workshop instruction will include the use of 3D motion analysis to teach athlete screening techniques and neuromuscular training methods that focus on proper core and knee ...

University adds advanced biomech lab

High Point University in NC is creating an advanced biomechanics and human physiology/ performance lab. The 13,150 square-foot lab is under construction and will facilitate study of injury prevention and rehabilitation methods as well as methods to improve human physiologic response to activity and overall physical performance. Kevin Ford, PhD, associate professor of physical therapy, is lab director. In the future, the university reported, the lab will be used to ...

Medical device conference seeks papers

University of Minnesota organizers of the Design of Medical Devices Conference, scheduled for April 9-11, 2013, in Minneapolis, are seeking original two-page papers that demonstrate new technologies and applications in medical device design from academic and industry researchers, clinicians, and practitioners.

The Journal of Medical Devices will publish all accepted papers as two-page technical briefs. Conference registration and participation in the conference poster session is required for publication.

Preliminary papers have a ...


Pediatric Walkers

Otto Bock offers the Yogi Anterior Walker and Walk Star Posterior Walker pediatric mobility products. The light, functional Yogi features caster swivel locks and a friction brake for gait stability and extra-low hand grips for young children, while its two sizes, adjustability, and accessories help it fit a range of needs. The Walk Star is a folding gait trainer that comes in five sizes and three colors and fits kids ...

Lower Limb Ultrasound DVD

Primal Pictures introduces a new DVD-ROM, “3D Anatomy for MSK Ultrasound: Lower Limb,” a training or reference tool for practitioners who use ultrasound to diagnose and treat conditions of the hip, knee and foot. Detailed, interactive 3D anatomical images are linked to corresponding ultrasound scans for specific transducer positions to provide a practical guide and daily reference for interpretation and orientation. More than 50 clinical topics are covered, including bursitis, ...

Corganics Shave Gel

Corganics offers Smooth Shave Gel, which can be used to shave patients’ lower extremities prior to medical procedures. The therapeutic formula includes essential oils, vitamins, antioxidants, and aloe vera. Appropriate for any skin type, including sensitive skin, the shave gel facilitates a clean, close shave and reduces skin irritation, razor burn, ingrown hairs, and minor nicks. Because it can be used without water, Smooth Shave Gel is convenient and quick ...

Dr Jack’s Skin Cream

Active Feet offers Dr. Jack’s Extra Strength Skin Care Crème for use on dry and cracked skin, including feet, heels, and knees. The cream is both a keratolytic and an emollient, engineered with ingredients that are similar to the natural moisturizers and antioxidants present in healthy, young skin. Urea penetrates the skin to attract, absorb, and hold moisture. Alpha hydroxy and malic acids remove the dead skin. Pure silk protein ...

Alignment Socks

My-Happy Feet offers Foot Alignment Socks, featuring dividers that separate the toes to improve alignment and help relieve foot pain. Designed to be worn while sleeping, the socks stretch the foot muscles, spread the metatarsals, and encourage circulation. Initially the socks are worn with the dividers at the tips of the toes for 15 to 20 minutes per day. The dividers are gradually moved down between the toes and worn ...

OA Nano Knee Brace

DJO Global has launched the OA Nano, the company’s lightest off-loading knee brace, for patients with mild-to-moderate osteoarthritis. Sold under the DonJoy brand, the 14.2-oz brace is manufactured using nanoMag, a metal as light as magnesium with the strength of aircraft-grade aluminum. The OA Nano incorporates DonJoy Adjuster off-loading technology to decrease pressure on the affected areas of the knee, allowing patients to enjoy physical activities with less pain and ...

ArtAssist Compression

The ArtAssist, a home-use device for treating peripheral arterial disease (PAD), applies intermittent pneumatic compression to the foot, ankle, and calf. The compression regimen is designed to simulate the vascular benefits of brisk walking, but without pain. The arterial pump technology increases distal blood flow mechanically and by promoting arteriogenesis, the opening of collateral vessels that bypass obstructed arteries. The device is intended for patients with PAD, ischemic diabetic foot ...

Intelligent Ice Cold Therapy

Intelligent Ice is a temperature controlled cooling solution from Intelligent Inventions. Intelligent Ice can be used for up to four hours at a safe temperature of 7°-8° C to minimize tissue and nerve damage. Each reusable, solution-filled pad comes with a protective pocket equipped with straps to attach the pad to affected anatomical areas; extension straps can help accommodate large patients or hard-to-wrap areas. Refreezing time is only 1.5 hours. ...

Black Tamarack Flexure Joint

With the recent growth in the use of black thermoplastic and carbon fiber materials for ankle foot orthoses (AFOs), Becker Orthopedic offers a new matching thermoformable joint option: the Black Tamarack Flexure Joint. Tamarack Flexure Joints self co-align the medial and lateral joint axes. The unique high strength inner filament core prevents elongation and ensures precise hinging action. The joints provide the motion assist power of metal joints but without ...

Travel Size Roller Massager

Pro-Tec Athletics offers the new Pro-Tec Travel Size Roller Massager with Trigger Point Release Grips, the newest addition to the company’s full line of sports medicine products. The travel size roller massager is designed to reduce muscle tightness, soreness, and pain. Features include raised Vynafoam sections that sink into soft tissues to roll out tightness and rounded grip ends to provide precision trigger-point release. At 17.5” long, the travel size ...

Total Support Thin and Max

Building on the success of its original Total Support insoles, Spenco Medical Corporation now debuts the Total Support Thin and Total Support Max insoles. The insoles are designed to provide advanced support for the heel and arch, combined with increased shock absorption and motion control, for athletes at all levels. The Total Support Thin is designed for athletes who need semi-flexible arch support and stability in a low-profile insole. The ...

Ultra Zoom in White

Understated and high performing, the Ultra Zoom ankle brace is now available in white. At the request of customers, Breg is offering this popular brace in a color that won’t stand out when worn with team uniforms—just in time for volleyball, girls’ basketball, soccer, and football season. On the field or on the court, the Ultra Zoom is designed to help prevent ankle injuries. Performathane technology enables the brace to ...