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White Paper: Foot Pronation

Over the past decades, pronation has been discussed as a potential risk factor for injuries or as the mechanism behind impact damping. However, little is understood about pronation. The objectives of this paper were to (a) define and differentiate between the terms of pronation and eversion, (b & c) underline the importance and problematic aspects of pronation.

By Benno Nigg, Anja-Verena Behling, and Joseph Hamill


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Understanding Pronation

By Mark Mendeszoon, DPM

As a podiatrist, athlete, coach, and independent running shoe proprietor, I have always had an interest in biomechanics and the impact on lower extremity overuse injuries and conditions. Perhaps the most well-known biomechanical term, pronation, is also the most misunderstood. In his recent article, Benno Nigg et al. (see Foot Pronation, pg 33-38)1  confirm that pronation is an integral part of the gait cycle and has a direct impact on lower extremity injuries. After a thorough review of previous studies, Nigg confirmed that pronation is appreciated by the profession but still a theory and not an absolute science. While that may be true academically for clinicians, the importance of recognizing biomechanics is imperative in treating patients. It can also play a role in building one’s practice.

In the second year of podiatric medical school, podiatrists are principally trained with Root’s Foot Morphology Theory as the foundation of biomechanics. This theory emphasizes the integral relationship between the subtalar and midtarsal joints’ anatomy and mechanics. Over the last several decades, however, Root’s theory has been challenged and proven to have inconsistencies due to the fact that pronation is still a misunderstood motion. What is certain is that pronation is a three-plane motion affecting both the subtalar and midtarsal joints  and eversion of the subtalar joint is the primary motion of pronation in the frontal plane. Many times eversion is misconstrued as pronation. As a result, more recent theories, such as Kirby’s Tissue Stress Theory and Dananberg’s Sagittal Plane Facilitation Theory, have evolved and been more accepted by the profession. The astute practitioner will combine all three theories to assess and treat their patients.

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One Claudication Question May Be Quick Screen for PAD

Peripheral Arterial Disease (PAD) affects more than 200 million adults around the world. If identified early, PAD is highly treatable and may prevent patients from suffering major adverce cardiac events (MACE) and major adverse limb events (MALE). The most important criterion for definition of PAD is an ankle-brachial index (ABI) below 0.90.

By Lynn Soban, PhD, MPH, RN

Science Meets Fun on National Biomechanics Day: April 8, 2020

National Biomechanics Day (NBD) is a worldwide celebration of biomechanics in its many forms for middle- and high-school students and their teachers. Designed to introduce biomechanics science and its applications to young minds around the world, the event seeks to teach young people about all that biomechanics contributes to society with the hope of encouraging them to pursue it as a career.

Study Shows Heel Lifts Affect Biomechanics, Muscle Function

Clinicians use a variety of in-shoe heel lifts to treat a range of musculoskeletal conditions. The mechanics of how these orthotic devices work, however, is unclear. So a group from LaTrobe University in Australia put together a study that asked this question: Do heel lifts affect lower limb biomechanics and muscle function during walking and running?

1064-nm Laser Technique Shows Positive Results for Onychocryptosis

Onychocryptosis, more commonly known as in-grown toenail, affects nearly 20% of all patients who present a foot problem to their doctor. Current treatments include incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using a carbon dioxide laser.

By Keith Loria

Custom AFO With Walking Shoes Improves Balance, Reduces Fear of Falling for Seniors

Research shows that one out of every four older Americans falls annually. Fall-related injuries continue to be a costly and debilitating health risk, costing the US healthcare system about $50 billion annually. More importantly, falling once doubles an older adult’s risk of falling again, increasing their fear of falling and negatively impacting quality of life.


Industry News & Updates

Battery-Powered Headgear Could Short-Circuit OA Joint Pain

Hyochol “Brian” Ahn, PhD, ANP-BC, an associate professor with Cizik School of Nursing at The University of Texas Health Science Center at Houston (UTHealth), believes knee pain can be stopped by administering tiny electrical charges to the brain’s primary motor cortex. The brain is an electrochemical organ that processes pain, according to Ahn, and his team is trying to desensitize the areas tied to knee pain.

Virginia Tech Researchers Developing Smart Prosthetic Socket to Improve Comfort, Performance

A Virginia Tech research team, led by Associate Professor Michael Philen, PhD, of the Kevin T. Crofton Department of Aerospace and Ocean Engineering, and Professor Michael Madigan, PhD, of the Grado Department of Industrial and Systems Engineering, has received a $400,000 National Science Foundation grant to study residual limb volume loss and develop smart prosthetic sockets to improve comfort and performance in prostheses.

CMS Adds New L-Code for 2020; Updates Therapeutic Shoe Modification Codes

The Centers for Medicare & Medicaid Services (CMS) have announced the following updates, which are effective for dates of service on or after January 1, 2020: New L-Code: A new lower extremity–related Healthcare Common Procedure Coding System (HCPCS) code has been added.

Hanger Promotes Regina Weger to SPS President

Regina Weger has been promoted to president of SPS, Alpharetta, GA; the company is a subsidiary of Hanger, Austin, TX. Weger has been with SPS for over 20 years, starting in the customer service function. She most recently served as vice president and general manager.

Ottobock Approved for €100 million in Financing for Product Development

The European Investment Bank (EIB) is providing financing of up to €100 million to Ottobock SE & Co. KGaA, Duderstadt, Germany. The company will use the funds over the next three years to fund new product development and product improvements with a focus on prosthetics, orthoses, and human mobility. The loan is backed by a guarantee from the European Fund for Strategic Investments (EFSI).

Cascade Orthopedic Supply Announces Investment by Ottobock North America

Cascade Orthopedic Supply, Chico, CA, announced an investment made in the company by Ottobock North America, Austin TX; details of the transaction were not disclosed. The investment aims to strengthen the collaboration of the two companies to further improve access to product for all orthotic and prosthetic (O&P) customers and…

Master of Science in P&O Program Approved for Kennesaw State

The Board of Regents of the University System of Georgia has approved a Master of Science in Prosthetics and Orthotics (P&O) at Kennesaw State University. It will be housed in the Department of Exercise Science and Sport Management in the WellStar College of Health and Human Services.


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