September 2015

Download the Complete issue as a PDF (12mb)

Download the Complete issue as a PDF (12mb)

Cover Story

Health literacy: the challenge of making clinical information accessible to patients

Healthcare education materials for patients are consistently written at a reading level too advanced for a significant number of people–a trend that affects all aspects of lower extremity care and can adversely affect clinical outcomes.

By Hank Black

Editor Message

Out on a limb: Reading lessons

The Internet and social media have transformed health advocates’ ability to disseminate educational information, which has the potential to substantially improve outcomes across all healthcare disciplines.

By Jordana Bieze Foster


Knee OA, biomechanics, and progression to TKA

The frontal and sagittal plane gait bio­mechanics associated with progression to total joint replacement in patients with knee osteoarthritis, particularly variables related to sustained loading, may be promising…

By Cheryl Hubley-Kozey, PhD, and Gillian Hatfield, PT, PhD

Tibial stress fractures: an evidence-based approach

Study findings suggest that increased loading rates and tibial acceleration are associated with an increased risk of sustaining a tibial stress fracture. Interventions directed at reducing these impact…

By CPT Jamie B. Morris, DPT, OCS, CSCS, and LTC Donald L. Goss, PT, PhD, OCS, ATC

Fifth met fractures and osteoporosis in women

Given that older women are at increased risk for osteoporosis, an increased incidence of fifth metatarsal fractures with increasing age in women suggests that such injuries could serve as an early point of entry into osteoporosis treatment and fracture prevention.

By David Beck, MD, Justin Kane, MD, and David Pedowitz, MD   

Cryotherapy and muscle recovery after exercise

Research utilizing contrast-enhanced ultrasound suggests that, although cryo­therapy effectively decreases the pain associated with exercise-related muscle damage, those symptomatic effects are not associated with decreased blood flow in the affected skeletal muscle.

By Noelle M. Selkow, PhD, ATC, and Susan A. Saliba, PhD, MPT, ATC

Surface EMG: A how-to guide for practitioners

With evidence-based protocols in hand, practitioners can feel more comfortable clinically integrating surface electromyography (sEMG) assessment, creating more sophisticated sEMG treatment protocols, and demonstrating the effectiveness of interventions.

By Rachelle Bordlee, sDPT, and Christopher Kevin Wong, PT, PhD


In the Moment: Sports Medicine

By P.K. Daniel

Profiling for ACL injury prevention: Biomechanics identify risk subtypes

Although existing anterior cruciate ligament (ACL) injury prevention programs have been successful at reducing the incidence of ACL injury, a new study suggests that tailoring interventions based on four risk profile subtypes could be more effective.

Femoroacetabular impingement alters motion at both foot and hip during gait

Individuals with femoroacetabular impingement (FAI) demonstrate alterations in foot mechanics as well as hip mechanics, a finding that may have implications for orthotic management of this population, according to an Israeli study.

MRI after hamstring injury does not help predict timing of return to sport

Magnetic resonance imaging (MRI) has no added value for predicting how soon athletes can return to sport after acute hamstring injury compared with predictions based only on patient history and clinical examination, according to a recent study.

In the Moment: Diabetes

By Emily Delzell

Partial hallux amputation in a patient with hallux rigidus. Image courtesy of Noah Oliver, DPM.
Risks of rigidus: Arthritis boosts hallux reamputation rates

Patients with diabetic neuropathy and hallux rigidus (HR) undergoing partial amputation of the hallux are 7.7 times more likely to need reamputation than their counterparts without HR, according to research from Georgetown University in Washington, DC.

Two in three patients with diabetic foot osteomyelitis heal with nonsurgical care

Nearly two thirds of patients with diabetic foot osteomyelitis heal with medical management alone, with patients with metatarsal site infection most likely to require amputation, according to research from the UK.

Annual emergency care for DFUs tops $8B, complications plague rural poor

Diabetic foot ulcers (DFUs) cost $8.78 billion per year in emergency department (ED) care and subsequent inpatient admissions, with the rural poor at particularly high risk for serious complications, according to…

Market Mechanics

By Emily Delzell

Opposition to Medicare prosthetic care draft grows; experts, amputees join fight

Scientists disavowing the use of their research by Medicare officials to justify proposed prosthetic limb reimbursement changes, the social media campaign #not­aluxury, and protests led by amputee rights groups and professional O&P organizations are among the voices protesting the proposed rule change.

NICE updates three diabetes guidelines

The UK’s National Institute for Health and Care Excellence on August 26 published three updated guidelines for the management of diabetes that emphasize prevention and rapid care of diabetic foot problems and tight glucose control for adults and children.

AMP 1 team wins at stand-up basketball

The Freedom Innovation-sponsored AMP 1 national team of amputee basketball players in August competed in Los Angeles at the Nike 3on3 Tournament, winning three games of stand-up basketball against able-bodied players in the street basketball and fan festival.

ASU installs $500K virtual reality gait lab

Alabama State University’s (ASU) Biomechanics and Motor Control Laboratory in Montgomery in August installed an advanced gait analysis device that places patients in virtual reality simulations.

Bulldog joins Opie as integrated supplier

Gainesville, FL-based Opie Software and Bulldog Tools, of Lewisburg, OH, reported in August that Bulldog is now an integrated supplier within the Opie Purchasing & Inventory System and at Bulldog designs, engineers, and manufactures certified O&P tools and products.

Bauerfeind partners with NBA trainers

Tampa, FL-based Bauerfeind on July 19 announced a partnership with the National Basketball Athletic Trainers Association (NBATA).

Allied OSI Labs introduces DME crutches

Indianapolis, IN-based Allied OSI Labs noted in August that it is expanding its over-the-counter and durable medical equipment (DME) line by offering Medicare-reimbursable crutches for in-office dispensing.

Integra’s membrane speeds DFU healing, company inks deal to sell Tornier ankles

Wound Repair & Regeneration on August 22 epublished results from a pivotal clinical trial showing Integra LifeSciences’s bilayer membrane skin regeneration system closed nonhealing diabetic foot ulcers (DFUs) faster than standard care.

WillowWood exec Joe Arbogast dies

Joseph “Joe” Arbogast, former co-owner and executive vice president of Mt. Sterling, OH-based prosthetic manufacturer WillowWood, died on August 10.

Insurance issues slow prosthetic market

The global market value for prosthetics will rise slowly in the next few years, from just over $1 billion in 2014 to approximately $1.21 billion by 2021, hindered by reimbursement difficulties, according to an August 25 report by London, UK-based research and consulting firm GlobalData.

FDA fast-tracks Flexion’s OA injectable

Burlington, MA-based Flexion Therapeutics reported on September 1 that the US Food and Drug Administration (FDA) has granted Fast Track designation for FX006, Flexion’s late-stage lead drug candidate for osteoarthritis (OA) of the knee.

Grant will fund study of Cadence device

The Physiotherapy Foundation of Canada and the Quebec Rehabilitation Research Network in August awarded a CA$20,000 grant to Cadence Biomedical’s research collaborators for study of the Seattle-based company’s Kickstart device for stroke recovery.

Ottobock starts orthotic business unit

Austin, TX-based Ottobock in August announced the creation of a business unit focused on off-the-shelf orthoses, fbracing, and supports. The Activity & Sports Medicine (ASM) unit combines products from Ottobock acquisitions Ortho Rehab, Bio Cybernetics International, and Cybertech and its global portfolio of orthotic solutions.

Sigvaris lobbys for lymphedema act

Peachtree City, GA-based Sigvaris sponsored an August 8 meeting between a Tennessee congressman and a wound care specialist and other stakeholders who support the Lymphdema Treatment Act. The act would amend the current Medicare statute to allow for coverage of compression supplies.


Becker Ankle Joint

Becker Orthopedic now offers the new Compact Double Action Ankle Joint (Model 725) for orthotic devices, designed to provide a variety of options in one complete small package. The Compact Double Action Ankle Joint comes optimized with…

Helli Dynamic Walking Shoe

The Helli Dynamic Walking Shoe from Waldlaufer USA is designed for people suffering from plantar fasciitis, heel spurs, hallux limitus, or metatarsal pain. The mild rocker sole supports the arch while gently propelling the foot through the gait cycle…

OA Reaction Web Brace

DJO Global’s DonJoy brand offers the new OA Reaction Web brace as a discreet solution for knee osteoarthritis pain. The brace frame features lightweight silicone hexagonal webbing, with a soft silicone condylar pad and air pockets that…

Coral Chewables Supplements

The new Coral Chewables supplement has a Bavarian cream flavor and delivers 500 mg of bioavailable coral calcium in addition to 73 other minerals. The above-sea coral calcium is intended to help patients reduce the risk of osteoporosis and…

Arcopedico Boots and Flats

Arcopedico USA offers new comfort boots and flats for fall and winter 2015. Claire is a classic riding boot with a 14″ soft leather shaft, a wide toe box, detailed stitching, two adjus­table calf buckles, a 1″ heel, and an antimicrobial, cushioned insole.

Therafirm Ease Hosiery

Ease gradient compression hosiery from Therafirm is designed to promote better blood flow, prevent swelling, and relieve tired, achy legs and feet and to be donned with ease by people with limited mobility or dexterity. The soft, breathable…

KLM Ankle Brace

The new KLM Brace from KLM Laboratories is a custom-molded gauntlet-style ankle foot orthosis (AFO) specifically designed to stabilize the lower extremity, improve mobility, reduce pain, and decrease the risk of falls in patients with instability…

APS-500 Polyethylene

The new APS-500 material from Allied O&P Supply is a flesh tone colored, high-strength polyethylene that can be used in place of Sureform and Subortholen when making custom foot orthoses. It is suitable for deep draws and embossing.

Mephisto Mobils Ergonomic Shoes

The Mobils Ergonomic Collection of all-over padded shoes by Mephisto includes three advanced technological features. All-over soft padding between the lining and the natural leather upper cushions the entire foot. The anatomic removable foot­bed…

LP EmbioZ Socks

La Pointique International offers the new LP EmbioZ Ankle Stabilizer Socks in regular (pictured) and calf lengths. The sock design features a Heel Lock strap to support and stabilize the ankle joint, helping to reduce the risk of ankle sprain.

Standard Cyborg Water Leg

The Standard Cyborg Water Leg is a 3D-printed, waterproof leg that a transtibial amputee can use in the shower, at the beach, or in the pool with no need to worry about damaging his or her primary prosthesis. The 30-minute scanning process can be…

Stabilized Heel Cup

Sols has released a new orthotic design with the company’s signature Stabilized Heel Cup. The Stabilized Heel Cup feature, intended for patients who overpronate or underpronate, helps improve ankle stability and alignment by…