Lower Extremity Review
Assessing device alignment is a key aspect of prosthetic practice, but when it comes to lower extremity orthotics the process is less common. That’s changing, however, as researchers begin to document the effects of alignment on gait biomechanics.
by Cary Groner
Obesity not only increases the risk of knee osteoarthritis but also makes it more difficult to treat, as typical exercise recommendations often are simply not practical. Gait researchers, however, are working to identify new potential therapeutic approaches.
by Elizabeth M. Russell, MS, and Joseph Hamill, PhD
The practitioner’s objective in treating flexible flatfoot is to realign the foot and eliminate pain. Multiple nonsurgical therapeutic options are available, but if those are unsuccessful, surgical interventions can be effective.
by Neal M. Blitz, DPM, FACFAS, and Pawel Hanulewicz, MD
Research has elucidated new information about the disease processes that contribute to Achilles tendinopathy and the relative effectiveness of therapies such as heavy-load eccentric exercise and injections of corticosteroids, dextrose, and other solutions.
by Michael Ryan PhD, CPed(C)
The importance of glycemic control in patients with diabetes is well known. But neurological studies suggest that dyslipidemia is actually a more significant contributor to the development of peripheral neuropathy in the same patient population.
by Andrea M. Vincent, PhD, Lucy M. Hinder, PhD, and Eva L. Feldman, MD, PhD
As a growing body of research supports the idea that fatigue contributes to sports-related injury, investigators are now working to identify those athletes who may be most vulnerable to the effects of fatigue and interventions that could counteract those effects.
Ulcer prevention is the key to amputation prevention in patients with Charcot arthropathy, according to research from Chicago that raises the question of whether pre-emptive surgical correction of deformities is warranted in Charcot patients.
Women who are so accustomed to high heels that they feel uncomfortable in flat shoes demonstrate musculotendinous changes compared to those who prefer flats, according to research from Manchester Metropolitan University in the U.K. Investigators recruited 11 women...
A study from the University of Tennessee supports the use of a three-quarter length custom orthosis for patients with hallux valgus deformity. The study compared custom orthoses of full, three-quarter, and sulcus lengths. The orthoses were worn by 25 patients (38 feet...
Even in the absence of impaired joint laxity, chronically unstable ankles demonstrate a reduced ability to detect afferent signals in response to applied loads, according to research from the University of Delaware. In 19 healthy ankles and 10 ankles with chronic...
Closed kinetic chain exercises vary considerably with respect to quadriceps-hamstrings co-contraction, which may have significant implications for rehabilitation, according to research from the University of North Carolina in Chapel Hill. Investigators analyzed...
AFOs must find energy balance – The extent to which carbon composite ankle foot orthoses improve gait efficiency in stroke patients may be a function of walking speed, according to a Swedish study. And despite the fact that the devices are known for their energy storage, research from the Netherlands suggests that the relationship between energy storage and energy cost may be complicated.
Is earlier intervention needed? Researchers and clinicians are only beginning to understand the relationship between pediatric flexible flatfoot and obesity, which becomes even more complicated in the context of orthotic treatment. Findings from Hong Kong appear to throw another wrinkle into the mix, suggesting that obese children are significantly slower to respond to orthotic therapy than their normal-weight counterparts.
Biomechanics may offer clues – Too often, by the time Charcot neuroarthropathy is diagnosed, it is too late to do much more than accommodate the resulting deformity. That’s why researchers from Germany and the U.K. are working to find ways of screening for patients at risk for Charcot, which would facilitate earlier and more effective intervention.
But placebo findings raise questions – Three German studies presented at the ISPO meeting in Leipzig confirm that bracing for knee osteoarthritis is associated with both symptom improvement and biomechanical effects. But the findings also suggest that the relationship between those two sets of outcome measures is more complicated than one might think.
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