Category Archives: Feature Article

Featured Issue Article

September 2020

Expert Opinion: Quantification of Arch Height in a Foot Orthotic: Defining A Standardized Methodology

Science and quantification are long overdue in the orthotic work that we do on a daily basis. The process of capturing the anatomical arch, creating a positive model, and managing arch fill has been solely a decision of those trained in the art.

By Ian Engelman Continue reading

September 2020

Overlooked Arch In The Foot Is Key To Its Evolution And Function

A long-overlooked part of the human foot is key to how the foot works, how it evolved, and how we walk and run, according to a Yale-led team of researchers. The discovery upends nearly a century of conventional thinking about the human foot and could open new avenues to explore in evolutionary biology as well as guide new designs for robotic and prosthetic feet, said the study team.

By William Weir Continue reading

September 2020

An Update on Peripheral Artery Disease (PAD): Part II

This 2-part series examines the current state of peripheral artery disease. Part 1, which appeared in the August issue, focused on disease burden, risk factors, and clinical presentation. This article reviews diagnostic tools and current management recommendations.

By Aisha Cobbs, PhD Continue reading

August 2020

Evaluation and Treatment of Osteosarcopenia in Older Adults

Bone loss (osteopenia/osteoporosis) and loss of muscle mass and function (sarcopenia) are two of the most prevalent chronic conditions among aging adults. However, the mention of osteosarcopenia might garner a few puzzled looks. This relatively new term describes a geriatric syndrome in which osteopenia/osteoporosis and sarcopenia overlap in the same individual.

By Aisha Cobbs, PhD Continue reading

August 2020

Office-Based Advanced Wound Care Therapy

As diabetic foot ulcers plague more patients, wound care management—including a host of new technologies—are driving an increase in office visits. Diabetes mellitus is the leading cause for nontraumatic amputation. Since 1980, the number of people with diabetes around the world has nearly quadrupled, from 108 million to nearly 422 million in 2014—and it continues to rise.

By Michael Flores, DPM,  and Marshall G. Solomon, DPM, FACPM, FACFAS, FFPM RCPS (qlas) Continue reading

August 2020

Bike Fitting as a Diagnostic Tool

Like a good medical exam, a medical bike fit starts before the patient ever gets on the bike. Talking with cycling patients before any assessments can facilitate the diagnostic process. Bike fitting is a service that has been offered in bike shops and studios for decades. Bike fitting is also a medical service offered by physicians, physical therapists, chiropractors, and other qualified health care providers.

By Andrea Myers, PT, DPT Continue reading

July 2020

Young Children Can Benefit From Articulating Knee Prosthesis

Children using new flexible knee prosthetic, which costs the same as the traditional stiff prosthetic, do not show adaptations in gait kinematics. A new study shows that young children with limb loss will use and benefit from prosthetic knee flexion and extension, if it is available to them. The study counters the current standard of care that uses a…

By Dave Shelles Continue reading

July 2020

Wound Care Update Theragnostic Imaging: Beyond Standard Photographs

Implementation of these new, highly sophisticated devices can help prevent, diagnose, treat, and monitor wound progress. As a medical director in a wound care clinic and the director of wound research for a podiatric medical school, I’ve seen a lot wound imaging in my time. Recently, I have seen some new and exciting imaging innovations enter the wound care space that…

By Windy Cole, DPM Continue reading

July 2020

A Review of Nonsurgical Treatment of Hypertrophic Scars

Managing patients with hypertrophic scars can be challenging, with a variety of conservative treatment options suggested in the medical literature. This review summarizes conservative treatment options for hypertrophic scars, focusing on the mechanisms of action, risks, complications, and efficacy of various options.

By Laura-Ashley O’Connell, DPM; Adrienne Estes, DPM, MS, AACFAS, FAPWHc; and David Shofler, DPM, MSHS Continue reading

June 2020

Peroneal Tendonitis: Workup and Nonsurgical Treatment

More than “just a sprain,” accurately diagnosing peroneal tendonitis in a timely manner helps patients recover faster and avoid long-term sequelae from this painful condition. Peroneal tendon disorders have traditionally been considered a rare source of ankle symptoms.

By Kevin Haag, DPM, PGY-3, and Marshall Solomon, DPM Continue reading

June 2020

A Multifactorial Perspective on Lower-Extremity Amputee Rehabilitation

Limb loss alters pain, touch, and proprioception in countless ways that are not yet fully understood. Understanding how to more realistically evaluate the efficacy of both proactive and reactive interventions meant to address these alterations will improve outcomes and quality of life for those living with lower-extremity amputation.

By Austin Davids, MSOP, CPO, and Jeffrey Yau, PhD  Continue reading

June 2020

Recovery and Regeneration Strategies for Foot Performance: Part I

These 2 complex processes are necessary components of quality training programs for athletes at all levels. This article, which covers fundamentals, is the first in a 2-part series. Taking care of the recovery and regeneration of the foot is an integral part of a well-rounded approach to high performance development.

By Antonio Robustelli, MSc CSCS Continue reading

June 2020

Using Functional Movement Assessments to Prevent Lower Extremity Injuries

It seems like every time sports analysts talk about the most recent game—whether it’s football, basketball, baseball, college, or professional—they’re discussing another athlete’s season-ending injury. While the spectrum for the severity of injuries varies, athletes—individuals who we…

By Sami Ahmed, DPT, CES, SFMA, CMTPT Continue reading

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