Lower Extremity Review
Los pacientes con diabetes que han sido objeto de una amputación parcial del pie son los más vulnerables a la re- ulceración. El calzado, las platillas, las prótesis parciales de pie, las ortesis de pie y tobillo pueden ayudar a reducir ese riesgo al mismo tiempo que mejoran la función.
Por: Erick Janisse, CPed, CO y Dennis Janisse, CPed
The J. Peterman Company is probably best known as the erstwhile employer of Elaine Benes on “Seinfeld.” But the company and its distinctive catalogs made a lasting impression on me when I first came across them years earlier.
Jordana Bieze Foster, Editor
An increasing number of patients with diabetes are taking advantage of a Medicare benefit for therapeutic shoes, but more could make use of the preventive measure to avoid further complications and possible amputation, practitioners say. Posing an obstacle, however, are the increased paperwork demands and looming fee cuts to physicians by the Centers for Medicare and Medicaid Services (CMS).
With so much emphasis placed on proper diabetic footwear, especially for those who suffer from peripheral neuropathy, patients with diabetes may not realize how crucial the size, fit, fiber, and construction of socks also are. Since socks are an integral part of treatment, the following do’s and don’ts may help practitioners educate patients about proper sock selection and wear.
When a new material comes on the scene, industry experts say that training and common-sense techniques go a long way toward understanding how best to handle it—whether the issue is safety or the durability of the finished device.
Children’s feet grow so irregularly and so fast. As every parent can attest, their children seem to outgrow sneakers and maryjanes in lightspeed. But this headache isn’t the only problem. According to two recent European studies, children’s ill-fitting shoes can pose a health dilemma as well.
Selecting the right prosthetic liner for an amputee patient is a complex problem that clinicians grapple with daily. They find themselves constantly weighing trade-offs between liner features. Cushioning and comfort inevitably must be balanced with durability. More cushioning decreases how long the liner will maintain its shape and protective properties before deteriorating.
The explosive growth in research and clinical applications for plantar pressure measurement devices (PMDs) has led to efforts to standardize protocols so that data can be more easily interpreted and compared by scientists and clinicians.
Despite research suggesting diabetic foot orthoses may need replacing only once a year, practitioners say there are a number of clinical reasons why an individual patient might need new insoles more often.
Numerous studies, and significant clinical experience, suggest that ankle foot orthoses help increase gait speed in post-stroke patients with hemiplegia or drop foot. Not all research supports this conclusion, however…
Despite the awareness among researchers that patients with knee osteoarthritis (OA) have impaired proprioception, the clinical implications of these deficits remain unresolved. Some scientific evidence indicates that impaired proprioception is linked to increased pain in knee OA, but whether impaired proprioceptive acuity results in progression of the disease remains uncertain.
The extent to which stretching and strengthening exercises successfully address plantar fasciitis continues to be a matter of debate among practitioners. Variables known to be associated with the condition include obesity, reduced ankle dorsiflexion, and work-related weight-bearing.
Posterior tibial tendon dysfunction (PTTD) continues to bedevil clinicians treating patients for whom a conservative, nonsurgical approach is indicated. Although extensive research has supported treatment with AFOs, few controlled trials have been conducted, and the choice between articulated and solid designs has largely remained a matter of individual preference.
Recent published studies suggest that patient-reported outcomes after total knee arthroplasty (TKA) don’t actually reflect performance on functional tests. So, although patients may be reporting significant improvement in their ability to walk, climb stairs, and function overall, their Timed Up and Go Test results may actually tell a different story.
Athletes, coaches, and trainers have long known that ankle sprains—the most common athletic injury—seem more likely as games wear on and players become tired. Only recently, however, have researchers begun to quantify how fatigue affects biomechanics and what those changes may imply for injury risk and prevention.
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