Category Archives: Feature Article

Featured Issue Article

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

July 2019

Enthesis: Unique Structure Makes Tendon-to-Bone Repairs Complicated

Formed during development, this efficient attachment system cannot be recreated during healing. Many common injuries, such as Achilles tendon and rotator cuff tears, require surgical procedures that reattach the affected tendon to the bone. Stavros Thomopoulos, PhD, director of Carroll Laboratories for Orthopedic Surgery at Columbia University in New York, compares it to trying to attach a rope to a piece of cement.

By Nicole Wetsman Continue reading

July 2019

At All Levels and Categories of Cycling: Correct Poor Crank-arm Fit to Relieve Chronic Knee (and Hip) Pain

Consider recommending installation of shorter crank arms on a bike when a cyclist complains of knee or hip pain. After years of bike-fitting, here’s why we’ve concluded that this modification is invaluable. One of the biggest problems in bicycling, I’ve found, is that pain is considered normal. I (RS) am a master bike fitter and an elite cycling coach.

By Rick Schultz, MBA, DBA, and Amy Schultz, PT, DPT, CSCS Continue reading

July 2019

A Common Class of Antibiotics Can Lead to Tendon Rupture

Despite Black Box warning for risk of tendinitis and tendon rupture, clinicians continue to prescribe fluoroquinolones. Half of the musculoskeletal injuries in the United States each year involve tendons and ligaments, and of the tendon injuries that can occur, those that strike the Achilles tendon are the most common. Higher rates of participation in…

By Nicole Wetsman Continue reading

June 2019

Patient Perspective – Beyond Bunions: Feeling Footloose and Fancy Free 6 Years After Surgery

I’ve never been one to gaze admiringly at my toes while lounging at the beach – or heaven forbid, take pictures of them with a tropical sea background to post on Instagram. I was cursed with ugly feet – wide and stubby (thanks Dad!) – and because of that, I’ve never bothered to try and adorn them with pedicures and polish.

By Karen Bakar Continue reading

June 2019

Inclusion In the Exam Room, In the Locker Room, On the Field

What does an athlete look like? There was a time when the answer to this question was largely homogenous, but today’s athletes have broken every mold and stereotype. They can be tall, short, lean, thick, strong, nimble, brawny, brainy, quick, or deliberate.

By Sarah Kogod Continue reading

June 2019

Bike Fitting Will Come Out From the Shadows and Into Rehab Armamentarium

Many readers may not have heard of it yet, but by the time LER turns 20, I predict it will be a common prescription…at least I hope it will be. I’m talking about bike fitting, of course. The number of individuals choosing cycling as transportation, hobby, sport, or community activity—whether it’s competitive or recreational—is increasing annually—up from around 43 million in 2014 to 47.5 million in 2017.

By Happy Freedman Continue reading

June 2019

Growing Awareness of Unicity Will Drive Sport Science

Like the athletes we study, the field of sport science is always in motion. When combined with medicine, it is a rich and growing environment in which the interaction between daily practice and clinical research contributes to an overall progression in understanding of human performance and biological adaptations.

By Antonio Robustelli, MSc, CSCS Continue reading

June 2019

What’s the Point of 3D Printing Orthotics? Options!

Recently, on the Facebook page of Craig Payne, creator of Podiatryarena.com, there was discussion about a published study that compared running biomechanics and perceived comfort between a 3D-printed orthotic and a traditionally manufactured orthotic. The study showed there were no differences between the two devices.

By Bruce E. Williams, DPM Continue reading

June 2019

Complimentary Approach Grows, But Some Challenges Remain

Lower Extremity Review can be both proud and excited about its 10th anniversary and its participation in all aspects of sports medicine and podiatry, rehab, fitness, and wellness. As for what the next decade holds, I predict implementing the input and expertise from all the medical specialties, along with educators, trainers, and therapists of all backgrounds, will continue to grow.

By Robert A. Weil, DPM Continue reading