Lower Extremity Review
By understanding how military medicine has evolved and adapted over time, modern practitioners can better appreciate the need to question convention, advance research, and rapidly integrate beneficial new technologies into medical care.
By Christine Miller, DPM, FACCWS, Ashley Finn, and Emily Delzell
Partial foot amputations may not offer a biomechanical advantage over transtibial amputations if the metatarsal heads cannot be retained, and some experts suggest amputation level should be selected based on probability of wound healing instead. But others disagree.
By Cary Groner
Study findings and anecdotal reports suggest that newer-generation total ankle replacement can match or exceed ankle arthrodesis when it comes to gait and range of motion, but neither procedure returns gait to normal. Implant survival has also improved, but continues to be a challenge.
By Barbara Boughton
Total hip arthroplasty can significantly improve quality of life in obese patients, but high body mass index is also associated with higher rates of complications and readmissions than in normal-weight patients. The emerging subgroup of super-obese patients poses additional challenges.
By Raghav Rajgopal, MD, and James L. Howard, MD, MSc, FRCSC
Opportunistic microorganisms called biofilms constitute an age-old diabetic wound care problem that defies traditional antimicrobial therapies. Experts believe interventions customized to individual patients based on molecular diagnostics may be the best line of defense.
By Larry Hand
Patients with chronic refractory lower extremity tendinopathies often continue to have symptoms after exhausting most of their therapeutic options. Preliminary evidence supports the use of platelet-rich plasma in these patients, though higher-level research is needed.
By Ricardo E. Colberg, MD, and Kenneth Mautner, MD
SureStep HEKO Hinge, SureStep DA Hinge, SureStop, SureStep Free Motion Hinge & SureStep Dorsiflexion Assist Band
SureStep shoes have been custom designed specifically for children who wear orthoses. Their wider, deeper heel, toe box and instep allow for adequate room and a comfortable fit. The unique tread promotes intrinsic movement and flexibility while a special “cut-line” allows for easy shoe modifications.
The SureStep TLSO has redefined spinal management. The soft, flexible plastic serves well to create improved upright positioning, while still allowing for slight movement in all planes.
The first and only device developed to discourage w-sitting, Criss Crossers use a unique audio cue to remind children to change their position.
SureStep HEKO is the first and only pediatric hyper extension knee orthosis to incorporate a 4-axis knee hinge, for smooth, anatomically correct flexion and extension. This exceptional device provides localized control of the knee, preventing hyperextension, valgus and varus, while allowing full flexion and extension. With adjustable extension stops, the HEKO offers up to 30 degrees of adjustability.
The SureStep PullOver is an amazing tool that not only facilitates improved stability of the foot and ankle complex using a SureStep SMO, but it is also the only SMO that incorporates a true dorsiflexion assist through the use of a removable proximal strut.
A uniquely designed orthosis developed to help children reach their potential. This exceptional “orthosis within an orthosis” allows for the SureStep SMO to be utilized independent of the AFO. Children can work through a variety of transitional skills without impeding normal muscle function.
A growing child means eventually outgrowing the original SureStep SMO. The BigShot and BigShot Lite are the perfect solutions for older children who still need the stability of SureStep.
The SureStep SMO remains the most advanced method of controlling excessive pronation and providing stability to the hypotonic population. Suitable for patients up to 80 lbs.
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