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Cover Story

Clinical Applications of Custom 3D Printed Implants in Complex Lower Extremity Reconstruction

The authors present four cases of complex lower extremity reconstruction involving segmental bone loss and deformity – failed total ankle arthroplasty, talus avascular necrosis, ballistic trauma, and nonunion of a tibial osteotomy.

By Rishin J. Kadakia, MD, Colleen M. Wixted, Nicholas B. Allen, Andrew E. Hanselman, MD, and Samuel B. Adams, MD


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Special Features

2020: The Year That Was!

By Phil Maffetone, DC

Some years it’s hard to say good-bye…and then there’s 2020. We’re sure we’re not the only ones happy to see it in the rearview mirror. But to just drive away is to ignore the words of Socrates, who rightfully said,

“The secret of change is to focus all of your energy not on fighting the old, but on building the new.”

We want to take this opportunity to express our appreciation for all those who have supported Lower Extremity Review this past year in oh, so many ways. And we want to thank those who have supported lerExpert, and now, lerEXPO. We’re focused on building the new and are glad to have you with us.

2020 obviously saw a much-curtailed schedule for in-person visits, but we still want to thank our hosts:

  • NY Podiatric Clinical Conference (NYC)
  • American Academy of Orthotists and Prosthetists (Chicago)
  • No-Nonsense Seminar (North Central Academy of Podiatric Medicine, Cleveland—ok, this didn’t actually happen, but we made some good friends so that still counts)

While travel was curtailed, lerEXPO had the opportunity to launch and we want to acknowledge the sponsors for those events (check out lerEXPO.com for follow-ups):

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Transverse Arch Importance Overstated

By Kevin A. Kirby, DPM

I write in response to the September 2020 LER article, “Overlooked Arch in the Foot Is Key to its Evolution and Function,” by William Weir, which discusses the article, “Stiffness of the Human Foot and Evolution of the Transverse Arch,” by Venkadesan et al, published in Nature in early 2020.1

The article by Venkadesan et al discussed the possible importance of the transverse arch of the midfoot to the stiffness of the longitudinal arch of the foot. Unfortunately, both articles overestimate the biomechanical influence of the transverse arch on foot stiffness and whether Venkadesan et al’s ideas truly “have not been studied previously.”

For many years, the longitudinal arch was thought to provide most of the stiffness to the foot to improve the mechanical efficiency of human bipedal gait. In their paper in Nature, Venkadesan et al make claims that the transverse arch of the midfoot contributes “more than 40% of the longitudinal stiffness of the foot.” While the authors have done their homework in modelling the transverse arch of the midfoot to estimate its contribution to longitudinal arch stiffness, the authors omitted important factors regarding the biomechanical importance of the longitudinal arch in increasing the mechanical efficiency of gait within the human bipedal animal. In other words, the estimate made by these authors that the midfoot transverse arch contributes “more than 40% of the longitudinal stiffness of the foot” appears to be wishful thinking on the part of these researchers.

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Hematoma Algorithm May Improve Outcomes

Researchers at the Kent State University College of Podiatric Medicine observed a specific subset of patients was frequently coming to their clinic with complications after mismanagement or misdiagnosis of initial blunt trauma soft tissue injuries to the lower extremity.

Measuring Topical Oxygen Therapy Result with NIRS

Chronic wounds are defined as those not proceeding through the orderly phase of tissue repair with 30 days; incidence of these wounds continue to rise, creating a burden not only on patients, but the healthcare system as well.

Gellable Fiber Dressing in Chronic Venous Leg Ulcers

This investigational product case series looked the use of gellable fiber dressing technology in the setting of heavily exudating venous leg wounds in a series of 5 patients. Exudate management is key to healing this type of ulcer.

Hydroxychloroquine Does Not Prevent Death in COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of COVID-19, emerged from a zoonotic source in China in late 2019. Its transmission has been ineffectively controlled and the world has been immersed in a COVID-19 pandemic since early 1st quarter of 2020.

3D Printed Insoles Offers New Hope for Patients with Diabetes

Scientists from Staffordshire University, England, claim that their new 3D-printed insoles can improve the foot health of people suffering with diabetes. Their study is said to present the first quantitative evidence in support of optimized cushioning in diabetic footwear as…

Low Energy Increases Fall Risk in Older Adults

Declines in feelings of energy can lead to balance problems in older adults, according to Clarkson University research published in the journal Physical & Occupational Therapy in Geriatrics. “We wanted to see whether increases in feelings of fatigue or…

Don’t Try This for Ankle Stability

While ankle sprain is perhaps the most common of sporting injuries, there remains no one-size-fits-all solution. But there is one solution that’s losing ground based on new evidence from the Institute of Motion Analysis & Research (IMAR) at the University of Dundee in the United Kingdom.


Industry News & Updates

A New Product for the Treatment of Post-Traumatic OA

A team of investigators at Boston Children’s Hospital and Rhode Island Hospital received a Military Medical Research and Development Award from the Joint Warfighter Medical Research Program (JWMRP) in 2016 to advance the development of a novel treatment for…

American Limb Preservation Society is Established

The American Limb Preservation Society (ALPS) has been established to advance the science and clinical care surrounding limb preservation as well as support year-round efforts to advocate for best practices that champion prevention and lead to better health…

Researchers Develop Smart Suit to Monitor Physiological Data

The current technology used to monitor an athlete’s performance ranges from small wearable fitness trackers to elaborate clinical monitoring equipment. Fitness trackers are compact and lightweight but can only collect data from a single point, which is…

Prophylactic Dressing Standards Initiative is Launched

The National Pressure Injury Advisory Panel (NPIAP) and the European Pressure Ulcer Advisory Panel (EPUAP) have announced the launch of the Prophylactic Dressing Standards Initiative (PDSI) and the establishment of a dedicated international task force to lead…

NYCPM to Join Touro College & University System and NY Medical College

New York College of Podiatric Medicine (NYCPM) will join the Touro College & University System and New York Medical College. Touro President Alan Kadish, MD, and NYCPM President Louis Levine signed a Membership Agreement in an…

Texas’ First Podiatry School to Open in 2021

Texas’ first school of podiatry could potentially open in fall 2021 at University of Texas Rio Grande Valley (UTRGV) after being approved by the University of Texas System board of regents. The school of podiatry will be housed within the Division of Health Affairs…


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