Category Archives: Feature Article
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
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
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
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
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
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
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
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
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
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
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
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
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
The field of Sports Medicine has undergone exponential growth over the last few years, but still remains in its infancy. So much research and technology have been added to clinical practice since the simple days of “RICE” (Rest-Ice-Compression-Elevation). The catch phrase for some of this phenomenon is “analytics” and it covers a variety of topics. This is where I believe Sports Medicine is going in the future.
By Howard Osterman, DPM Continue reading
Devices and patient care have changed dramatically through the history of the O & P profession. At first, devices were carved of wood, based on visual inspection, then sewn with leather and bent metal; today, we cast in plaster and pull plastic. If history tells us anything, it’s that, first, newer technology will continuously become…
By Jacob Praga, MSBME Continue reading
The future isn’t coming—it’s arriving at an incredible pace! Technology and the data it can supply have reshaped the planet and those who fail to adopt it will be left in the dust. The need for objective data in treatment decisions will become mandatory both by payers and patients alike.
By Kendon Howard Continue reading
In a recent article in the Philadelphia Inquirer, reporter Stacey Burling wrote, “Amputation rates among people with diabetes in the United States dropped for about 15 years, but recent reports issued by the U.S. Centers for Disease Control and Prevention highlight a disturbing trend: Amputation rates have been rising in people under 65 with diabetes since 2009.
By Mark Hinkes, DPM Continue reading
Although it’s difficult to predict future developments, one might extrapolate, to some extent, large changes to a specialty of medicine by looking back on the history of the field and combining it with recent developments and trends.
By Jarrod M. Shapiro, DPM Continue reading
Mobility and balance deficits in patients with lower extremity impairments are significant factors for decreased quality of life. To improve outcomes for these patients, clinicians need measures that are evidence-based and scientifically validated; in other words, there is a need to measure things that matter.
By Michael Rowling, BS Continue reading
Before pronouncing what I predict will be the single most significant change in foot and ankle surgery in coming years, it’s essential to look back. I asked an orthopedic colleague what he thought the most significant change in orthopedics was over the past 25 years, and he replied, “locking plate technology.” I agree.
By Patrick A. DeHeer, DPM Continue reading
My perspective on the future reflects my professional interest in lower-extremity injuries and conditions that can be treated by knee braces and by ankle-foot and knee-ankle-foot orthoses. An aging population and other market demographics seem to indicate there is an increasing need for braces; new manufacturing methods, including interesting composite materials and 3D printing, seem to point toward a future of technical innovation.
By Rick Riley Continue reading
Georgia Institute of Technology initiated its Masters of Science in Prosthetics and Orthotics (MSPO) program in 2002, knowing that considerable advances in the profession would be possible if research was an emphasis in clinical education. Students entering the program came with added bases of knowledge, dominated by…
By Geza F. Kogler, PHD Continue reading
Modern day times not only see us living longer, but enjoying a wide array of advances in lifestyle, medicine, health, and social care, as well as the fast-paced changes in technology. Currently, 13% of the global population is over age 60, a figure which is increasing by 3% each year.1
By Sarah A. Curran, PhD Continue reading
Harnessing Emerging Technologies to Standardize Prosthetic and Orthotic Clinical Care Into the Future
Prosthetic and orthotic clinical care involves using custom-made devices to assist in the rehabilitation of people with physical impairments and disabilities. As such, it has long relied on the craftsmanship of prosthetists and orthotists. Although the results of such craftsmanship can be of tremendous benefit to the patient…
By Stefania Fatone, PhD, Ryan Caldwell, CP, FAAOP, and Julia Quinlan, PhD Continue reading
The foot ranks high among the most ill-constructed elements of the modern human musculoskeletal system—an observation that necessarily begs the question: Why is this so? Upright, bipedal gait is the defining characteristic of our lineage; humans and our immediate ancestors have been practicing it for at least 5 million years. Why hasn’t evolution perfected this hallmark adaptation?
By Bruce Latimer, PhD Continue reading