Category Archives: Feature Article
When treating patients who are going through rehabilitation, clinicians may be overemphasizing gait distance and overlooking the importance of gait speed. Clinical assessment of gait speed is simple and inexpensive but can be a significant indicator of functional recovery.
By Heather Braden, PT, MPT, PhD, GCS
Intramuscular manual therapy, also known as dry needling, is hypothesized to relieve pain by modifying tension in connective tissue. Limited evidence supports the use of IMT for plantar fasciitis, although further research is needed to rule out a placebo effect.
By Brent Harper, PT, DPT, DSc, OCS, FAAOMPT
Despite being upheld by the Supreme Court, the Affordable Care Act remains a subject of debate heading into next month’s presidential election. Meanwhile, government affairs experts are working to determine just how the ACA will affect lower extremity practitioners.
By Shalmali Pal
Research suggests that the ankle’s ability to absorb its share of energy during landing from a jump is altered with the use of an ankle brace. The extent to which this effect might influence risk of injury to other lower extremity joints or soft tissues, however, remains unclear.
By Jacob K. Gardner, MS
There are few high-quality studies and no randomized controlled trials documenting its effectiveness, but debridement—from surgical to larval—remains a mainstay of diabetic ulcer care in many practices, and new twists on conventional techniques continue to evolve.
By Cary Groner
Prehabilitation, particularly in the form of exercise, has the potential to significantly improve preoperative and postoperative outcomes in patients with knee osteoarthritis who are undergoing total knee arthroplasty. Both physiological and psychological outcomes can be positively impacted.
By Carly McKay, PhD, and Harry Prapavessis, PhD
Reducing the shaft height of a removable cast walker, which results in a lighter device and may also help improve postural stability, can help improve compliance in patients at risk for diabetic foot ulcers without compromising the device’s offloading capability.
By Sai Vikas Yalla, PhD, and Ryan T. Crews, MS, CCRP
Research suggests that when transitioning to a minimalist running shoe, foot strike pattern is key to preventing lower extremity injuries. A transitional minimalist shoe, with slightly thicker and softer soles, may help prevent certain injuries in some runners.
By Everett B. Lohman III, DSc, PT, OCS
Even if an intervention results in a positive clinical outcome in patients with knee osteoarthritis, another important factor to consider is whether that treatment’s benefits justify its costs. Increasingly, cost effectiveness studies are comparing OA interventions to determine value.
By Daniel Pinto, PT, PhD
Ankle joint laxity can be a complicating factor in patients with acute ankle sprains or chronic instability, and testing for excessive laxity can help practitioners choose an appropriate method of treatment. However, not all tests for ankle joint laxity are created equal.
By Theodore Croy, PhD, PT, OCS, and Jay Hertel, PhD, ATC, FNATA
A new technology, the load cell, can be used to assess rollover characteristics of prosthetic feet in a variety of walking environments. Load cell analysis can help identify premature foot-flat and dead spots and determine the effects of energy storage and return designs on amputee gait.
By Edward S. Neumann, PhD, PE, CP, FAAOP; Justin Brink, MSE, EI; Kartheek Yalamanchili, MSE, EI; and Joon S. Lee, PhD
As researchers explore the possibility that idiopathic toe walking has an underlying neurologic cause, clinicians continue to refine treatment strategies to keep ITW patients off their toes. Orthotic devices play a key role, with lower-profile devices growing in popularity.
By Emily Delzell
Inconsistent findings from laboratory studies have made it difficult to determine which gait alterations are specific to diabetic peripheral neuropathy and which also affect diabetic patients without neuropathy. Body-worn sensor technology may help clarify the distinctions.
By Tahir Khan, DPM, and Ron Guberman, DPM, DABPS
Experts still disagree about whether stretching prior to athletic activity can prevent injury and, if so, whether those benefits offset any negative performance effects. But they do tend to agree that some form of stretching is probably a good idea for most athletes.
By Cary Groner
Dose-response research refutes the common perception that increasing brace wear time leads to muscle atrophy in patients with knee osteoarthritis. In fact, longer bracing duration appears to improve hamstring strength as well as increasing patients’ physical activity levels.
By Cheryl L. Hubley-Kozey, PhD, and Gillian Hatfield Murdock, PT, MSc
Exercise is the standard prescription for obesity. But alterations to joint biomechanics, gait, and anatomical structure in overweight children and teens mean that physical activity comes with its own risks, which practitioners must factor into any clinical recommendations.
By Christina Hall Nettles
Contrary to the conclusions of early research, recent studies suggest that arch height does indeed affect lower extremity function. The biomechanics associated with different arch heights may provide a basis for treatment and prevention of related injuries.
By Thomas C. Michaud, DC
Gauntlet-style ankle foot orthoses offer an alternative to a larger rigid thermoplastic AFO for foot and ankle pathologies requiring more stability or immobilization than a foot orthosis provides. Materials, trim lines, and fabrication techniques can vary to meet different patients’ needs.
By Holly Tuchscherer Olszewski MS, CPO
A convergence of comorbidities means diabetic patients on dialysis have an even higher risk of foot ulcers and amputation than those without renal disease. The potential for preventing these complications at dialysis centers is too often underappreciated by practitioners.
By Larry Hand
This two-part series examines the link between ACL injury and the later development of osteoarthritis (OA) and how surgery may strengthen or weaken that link. This second installment explores meniscal damage, proprioception, and what MRI can add to the discussion.
By Cary Groner
New evidence-based guidelines on the management of diabetic foot infections reflect significant advances by researchers and clinicians, but the recent emergence of regulatory hurdles has slowed the development of new antibiotic drugs for treating those infections.
By Emily Delzell
Different foot strike patterns are associated with different means of attenuating and redistributing forces during running, which may have implications for injury risk and rehabilitation. Researchers, however, have yet to fully examine and understand those implications.
By Peter Larson, PhD
Too many knee braces just won’t stay put, which can affect compliance and possibly even device effectiveness. Research on the topic is scarce, but experts say the key to minimizing knee brace migration is making sure the device fits the patient’s anatomy as closely as possible.
By Shalmali Pal
A growing body of research suggests that footwear comfort can improve movement performance and, in particular, neuromuscular control of balance. These findings could have significant implications for rehabilitation of older adults and patients with lower extremity disorders.
By M. Owen Papuga, PhD, and Jeanmarie R. Burke, PhD