Category Archives: Feature Article

Featured Issue Article

May 2020

Bike Fit Unplugged

This Bike Fit specialist explains his process for fitting the cyclist, not the bike, to address the individual needs of the rider. He provided commentary to LER Editor Janice T. Radak for the photographs taken at a recent bike fitting clinic and displayed in this story. Bike Fit Unplugged is the technique I developed…

By Happy Freedman Continue reading

May 2020

Wound Care Update: The Role of Topical Oxygen Therapy in the Treatment of Wounds

When you think back to your early studies in General Biology you may recall memorizing the steps of the Krebs Cycle. It is through this process of aerobic respiration that most living things generate energy. In aerobic organisms, cells utilize oxygen (O2) as a final electron acceptor to synthesize high-energy…

By Windy Cole, DPM Continue reading

May 2020

CRITICAL ANALYSIS: Prefab or Custom: Which Foot Orthosis Is Better for Plantar Heel Pain?

Recent analysis of the podiatric literature concludes that custom foot orthoses aren’t superior to prefab inserts—an account one expert rejects. It’s a matter of who does the custom work, he says.

By Stanley Beekman, DPM Continue reading

April 2020

A Summary of Potential Pharmacotherapy for COVID-19: A Review of the Available Literature.

At the time of this writing, we as lower extremity providers are in the midst of a COVID-19 pandemic.  Per the World Health Organization (WHO), there is no current evidence to recommend any specific anti-COVID-19 supportive or antiviral treatment for patients with confirmed COVID-19.

By Robert G. Smith, DPM, MSc, RPh Continue reading

April 2020

Early Orthotic Intervention in Pediatric Patients, Part 3: Muscular Dystrophy

Improving patient care includes questioning traditional treatment approaches; in this case, it’s also about developing ways to enhance and augment those techniques. The first two articles in this series looked, respectively, at early orthotic intervention in children with cerebral palsy (CP) and in those with Down syndrome and other neurological conditions.

By Cary Groner Continue reading

April 2020

The Role of Exercise Therapies for the Management of Posterior Tibial Tendon Dysfunction

Clinicians may find the EdUReP theoretical framework provides helpful guidance for exercise prescription and load management for patients with this potentially disabling condition. Despite the substantial gains in knowledge and understanding of lower extremity tendinopathies in recent years..

By Talysha Reeve, B.App.Sc.(Podiatry), GradCertClinRehab Continue reading

March 2020

Lower Extremity Noninvasive Vascular Testing Update

Peripheral arterial disease may be a common finding among those over 50, but it remains underdiagnosed. Choosing the right diagnostic test is key. Eight million men and women in the United States have lower extremity peripheral arterial disease (PAD).1 PAD is a common finding among patients over age 50, yet it is frequently underdiagnosed.

By Brittany Mammano, DPM, PGY-1, and Saba Sadra, DPM, MSc Continue reading

March 2020

CLINICAL PERSPECTIVE: Assessing Relaxed Standing Alignment and Posture in Autism Spectrum Disorder

Use the scale provided here to help you assess standing posture, including the nature and extent of deviation from normal, in children with a developmental disability. Proper standing alignment requires that muscles, bones, and joints are in correct relation to each other, creating elongation and symmetry while counteracting the detrimental force of gravity.

By Dalia Zwick, PT, PHD Continue reading

March 2020

Rx for Diabetic Foot Ulcers: Optimize Your Communication With Patients

Communication, education, and empathy—combined with a solid knowledge base of the disease—are key components of successful management of these damaging, even life-threatening, lesions. Diabetic foot ulcers (DFUs) can be concerning to patients and providers for multiple reasons. From the patient’s perspective, DFUs can be uncomfortable, even painful, and a source of embarrassment from a…

By Angela Kelley, PA-C Continue reading

February 2020

Tech Takes On Diabetic Foot Ulcers

DFCON2019* showcased new technologies coming online to aid in the treatment and prevention of diabetic foot ulcers. Diabetic foot ulcers (DFUs) are the most common complication of diabetes. Up to a quarter of patients with diabetes will suffer at least one DFU in their lifetime which can lead to amputation or death.

By Lynn Soban, PhD, MPH, RN Continue reading

February 2020

Expert Commentary: Lymphedema of the Lower Extremities

Often overlooked, lymphedema of the lower extremities is becoming more common as aging, obesity, and cancer therapies all take their toll. Detection is key to getting appropriate treatment. Lymphedema of the lower limbs is a common, complex, and highly treatable disease that begs recognition by healthcare providers.

By Stanley G. Rockson, MD Continue reading

February 2020

Patient Presentations Improve Communications, Increase Efficiency

A legal encounter with a patient led this podiatrist to rethink how and what he communicates with patients. Many of us are increasingly pushed to provide a greater amount of care along with reducing costs or increasing the value of each patient office visit.

By Donald Pelto, DPM Continue reading

January 2020

A Guide to Individualized Management of Foot Drop

Most patients benefit from nonsurgical care of foot drop. Your task is to identify the optimal bracing options and work closely with the patient to understand their personal treatment expectations and goals.

By Jason Wright, DPM, PGY-2, And Marshall G. Solomon, DPM, FACPM, FACAS Continue reading

January 2020

A Role for Arthroscopy in Managing Ankle Trauma?

Consider the benefit of arthroscopy for addressing intraarticular pathology at the time initial surgical repair of high-grade ankle fracture is performed. Ankle fractures are a common orthopedic injury. Although surgical repair often yields good results, many cases are nonetheless associated with poor clinical outcome after repair.  

By Kevin Burke, DPM and Jonathan Hook, DPM Continue reading

January 2020

EXCERPT: Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining, Part 1

These authors tap unusual but useful historic data sets to enlighten the search for the mechanisms that cause exercise-associated muscle cramps. Few athletes escape the painful experience of muscle cramps. Cramps that occur during or soon after a bout of physical activity have been termed exercise-associated muscle cramps (EAMC), and these are commonly experienced as a “painful, spasmodic contraction of the…

By Ronald J. Maughan and Susan M. Shirreffs Continue reading

October 2019

Plantar fasciitis: A New Approach to An Old Problem

Introducing the kineticokinematic approach to treating plantar fasciitis. This approach focuses not only on the position of the foot but also on the forces that may be contributing to this highly prevalent foot condition. Heel pain is one of the most common complaints treated by lower extremity specialists, affecting an estimated 10% of the population.

By Pedro Aldape-Esquivel, DPM and Jarrod Shapiro, DPM, FACPM, FACFAS Continue reading

October 2019

Medial Tibial Stress Syndrome Remains a Challenge for Clinicians, Painful for Patients

While most agree it is an overuse injury, treating MTSS (aka shin splints) should involve rest, proper diet, and sometimes avoiding NSAIDS. It’s been decades since I had a case of shin splints, but I remember vividly how painful it was. I was 20 years old and overtraining—especially given the sorry state of my running shoes—and I felt as if I had a burning coal lodged along the medial side of my left shank. Every step hurt.

By Cary Groner Continue reading

October 2019

IS CHANGE ON THE HORIZON? Congress Proposes Reforms to the Stark Law

Podiatrists are among the providers targeted by efforts to revise regulation of referral for Medicare services. The goal? Modernize governance of a changing healthcare industry. The federal Physician Self-Referral Law (known commonly as the “Stark Law” or, simply, “Stark”) and its regulations generally prohibit physician referrals of Medicare patients for certain designated healthcare services when the physician has a…

By Daniel F. Shay, Esq. Continue reading

September 2019

Understanding the ‘odd gait’ of autism

Children with autism spectrum disorder are often described as “uncoordinated” or “clumsy” and many have clear motor control impairments. Early intervention to address motor deficits may improve physical skills and the difficulties with social functioning that are the hallmark of the disorder. Research among children with autism spectrum disorder (ASD) has traditionally focused on impairments in social skills, the condition’s core deficit.

By Keith Loria Continue reading

September 2019

Autism Linked to Between-Limb Asymmetries Across the Gait Cycle

Recent findings from the University of Nevada, Las Vegas (UNLV), add to a growing body of evidence that autism spectrum disorder (ASD) is associated with significant gait asymmetry, suggesting movement quality should be part of the diagnostic and treatment processes for ASD.

By Keith Loria Continue reading

September 2019

Quantitative Gait Assessment in Children With 16p11.2 Syndrome

Neurodevelopmental disorders are frequently associated with motor impairments including locomotion. These study findings highlight the importance of using precise measures to differentiate motor dysfunction in neurodevelopmental disorders.

By Sylvie Goldman, Aston K. McCullough, Sally Dunaway Young, Carly Mueller, Adrianna Stahl, Audrey Zoeller, Laurel Daniels Abbruzzese, Ashwini K. Rao, and Jacqueline Montes. Continue reading

September 2019

Early Orthotic Intervention in Pediatric Patients, Part 2: Down Syndrome, other neurological conditions, and toe walking

Down Syndrome is associated with a long list of compensatory gait symptoms due to hypotonia, triplanar foot and ankle misalignments, sagittal and coronal compensation at the knee, proximal weakness, and equinus contractures, all of which need to be treated. How early depends on the individual child.

By Cary Groner Continue reading

August 2019

Early Orthotic Intervention in Pediatric Patients, Part I: Cerebral Palsy

Children with cerebral palsy (CP) typically encounter a host of gait- and balance-related issues associated with spasticity, dyskinesia, and weakness. How severe these are depends on CP type and the individual case. As a result, experts have long debated how early to intervene with bracing strategies that include ankle-foot orthoses (AFOs), and how long to maintain those interventions.

By Cary Groner Continue reading

August 2019

Healthcare Provider-Implemented Foot Evaluations for Walking Exercise Programs

Encouraging exercise and appropriate footwear selection may be key in helping patients maintain healthy activity levels. Exercise is recommended for the majority of patients regardless of age, gender, or physical disability. The 2008 Physical Activity Guidelines for Americans1 recommended that all adults perform 150 minutes…

By Audris Tien, DPM, Brad Franklin, DNP, RN, FNP-C, FAANP, and Jarrod Shapiro, DPM, FACFAOM, FACFAS Continue reading

August 2019

Chronic Ankle Pain? Put Os Trigonum Fracture in the Differential

This overlooked, often-left-undiagnosed ankle pathology causes long-term pain and instability. Appropriate treatment protocols, applied in a timely manner, can get patients back on their feet. The ankle presents an interesting dichotomy of strength and frailty: Whereas the ankle supports body weight, makes sharp twists and turns, and keeps the body from falling…

By Scott Pensivy, PT, LAT, ATC Continue reading