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Type 2 Diabetes in Youth: A 21st Century Disorder

As obesity and overweight affect more adolescents, this disease, once attributed to middle age and older, is striking an aggressive course that all clinicians will need to address. With the increasing prevalence of overweight and obesity and with 18.5% (or 13.7 million) of youth already being obese,1 type 2 diabetes (T2D) in youth is becoming an important part of every healthcare practitioner’s daily practice.

By Neil H. White, MD


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Special Features

The Power Forward and the Exploding Shoe

Nowadays, when we see a headline about an “exploding shoe,” we instinctively think of an alarming situation involving the Transportation Security Administration—the TSA.

Thankfully, that was not the case at a memorable February 20 Atlantic Coast Conference basketball game between Duke and North Carolina.

Early on, Duke’s star power forward, Zion Williamson, was the victim of a wardrobe malfunction, you could say. Pivoting with his back to the basket, the 6-foot-7, 280-pound athlete planted his left foot and found himself in a compromised position. He quickly got unshod as his foot forcefully broke through the lateral aspect of a Nike Paul George-PG 2.5 basketball shoe. At the same time, Williamson’s right knee collapsed medially into a grade-1 sprain.

The star player’s injury isn’t serious, but the incident has raised a great deal of speculation. Was the shoe faulty? Close-up replay of Williamson’s move showed that it failed at the interface of midsole and outsole. Or was it just the wrong shoe for this athlete?

By Robert M. Conenello, DPM

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3 Can Be Better Than 6 When It Comes to Weber B Fractures

In medical school, we were taught that Weber B ankle fractures required the 6-week cast immobilization protocol. But for many of us, that protocol has felt excessive due to concerns of increased ankle stiffness, decreased ankle strength, and the possibility of a thrombotic event. However, the thought of possible suboptimal healing of the fracture [malunion or nonunion] with less than 6 weeks of immobilization or use of less rigid forms of immobilization provided anxiety to many of us treating physicians. Despite the anxiety, there has been a trend among foot and ankle physicians toward earlier mobilization for this common fracture subset.

And now, a recent article1 in the British Medical Journal has arrived to soothe that anxiety. The Finnish study reported on the comparison of immobilization techniques for stable unimalleolar Weber B ankle fractures.

This well designed, randomized, blinded, and high patient number clinical trial provides excellent clinical evidence for the decision to treat stable unimalleolar Weber B ankle fractures with options other than long-term immobilization of up to 6 weeks. In the study, patients were randomized into 3 groups: a 6-week cast group (84), a 3-week cast group (83), and a 3-week orthosis group (80). The 6-week cast group served as a control group and the authors compared the 3-week cast group to the 6-week cast group and the orthosis group to the 6-week cast group. The authors were looking to see if treatment of these fractures with immobilization in a cast for 3 weeks or immobilization with the use of an orthosis for 3 weeks produced non-inferior results as compared to 6 weeks of cast immobilization. Study participants were seen at 3 weeks, 6 weeks, 12 weeks, and 52 weeks. The study results showed that 3 weeks of cast immobilization or 3 weeks of immobilization with the use of a prefabricated ankle-foot orthosis provide the same clinical outcome as immobilization of 6 weeks with a cast for these fractures. This is the result of enhancement of fracture healing with early mechanical stimulation.

By Jeffrey R. Baker, DPM, FACFAS

Anterior Femoral Ligament Thickening Seen 3 Years Post-ACL Surgery

Osteoarthritis (OA) affects nearly 50% of patients who undergo anterior cruciate ligament reconstruction (ACLR) within 2 decades after surgery. The mechanism of OA development has been elusive; many experts theorize that disruption of knee–joint tissue homeostasis is key. Now, researchers, using ultrasonography (US), have found an increase in the thickness of the anterior femoral cartilage and cross-sectional area 3 years postoperatively.

Compression in Lymphedema

In a narrative review of old and innovative concepts concerning pressure and stiffness in lymphedema therapy, the authors of a study just published in Phlebology found that the current literature does not appear to be in sync with the array of options available today.

Diabetes Updates:  Amputations Increasing; Insomnia as Risk Factor

Amputations on the Rise – After decades of decline, diabetes-related lower-extremity amputations appear to be on the rise in the United States, according to new data from the Nationwide Inpatient Sample of the US Healthcare Cost and Utilization Project and the National Health Interview Survey of the National Center for Health Statistics, part of the US Centers for Disease Control and Prevention.

Bringing Medical Cannabis Into Skilled Nursing Facilities

When New York state legalized medical cannabis, geriatrician Zachary Palace, MD, CMD, realized that many of the conditions that qualified for the drug were those that he saw regularly in the elderly—like  chronic or neuropathic pain, Parkinson’s disease, and multiple sclerosis.

By Nicole Wetsman 

The Power of a ‘Sit to Stand’: An Infographic

Infographic by Chris Tuckett, Physiotherapist BSc MCSP. Tuckett is based in The Princess Alexandra Hospital NHS Trust, based in Harlow, Essex, UK. Based on: Harvey JA, Chastin SFM, Skelton DA. Breaking sedentary behaviour has the potential to increase/maintain function in frail older adults. J Frailty Sarcopenia Falls. 2018;3(1):26-34. doi: 10.22540/JFSF-03-026.

FDA Adds Boxed Warning to Uloric

The U.S. Food and Drug Administration (FDA) has concluded there is an increased risk of death with Uloric (febuxostat) compared to another gout medicine, allopurinol. This conclusion is based on its review of results from a safety clinical trial that found an increased risk of heart-related death and death from all causes with Uloric.

Book Review: Pedorthic Footwear: Assessment and Treatment

Pedorthic Footwear: Assessment and Treatment, a 578-page resource with 550 illustrations, is the result of an ambitious and unique collaboration of international authors and is edited by Klaas Postema, Karl-Heinz Schott, Dennis Janisse, and Gerardus M. Rommers. In total, 54 authors (physiatrists, pedorthists, movement scientists, and physiotherapists) from 7 countries contributed.


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