Category Archives: Feature Article

Featured Issue Article

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

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