Lower Extremity Review
Orthotic devices for hallux limitus are designed to limit first metatarsophalangeal joint motion while providing cushioning and plantar pressure distribution. A lack of quality research on conservative treatment of the disorder, however, forces clinicians to rely on their own experience.
By Hank Black
Achilles tendon ruptures are severe injuries that are associated with a long recovery and significantly affect an athlete’s ability to function at a high level. In devising strategies for rehabilitation and return to play, the goal of clinicians and athletes alike is to try to minimize this impact.
By J. Turner Vosseller, MD
The ankle is a frequent site of arthropathy in patients with hemophilia, but orthotic devices and orthopedic shoes can help relieve this pain. New research suggests that…
By David Oleson, PT, PCS; Katherine Stribling, PT, DPT, PCS; Jamie Beckwith, PT, DPT; Laura Fox, PT, DPT, PCS; Felicity Case, PT, DPT, PCS; Nancy Durben, MSPT, PCS; and Michael Recht, MD, PhD
Soft braces are not designed to change lower extremity alignment or joint forces, but research suggests they may influence knee and ankle biomechanics in other ways, including by enhancing proprioception. This line of investigation could open the door to new therapeutic opportunities.
By Stephanie Kramer
Anterior-direction Star Excursion Balance Test performance may most appropriately discriminate between collegiate athletes who are and are not at risk for lower extremity injury, though…
By Mikel R. Stiffler-Joachim, MS; David R. Bell, ATC, PhD; and Bryan C. Heiderscheit, PT, PhD
Achilles tendon lengthening and gastrocnemius recession both increase ankle joint dorsiflexion and reduce plantar forefoot pressures in patients with diabetes and equinus deformity, but experts continue to debate which is best for managing forefoot ulcers and minimizing reulceration.
By Barbara Boughton
Research suggests that a simple step-down task has a strong relationship with frontal plane ankle kinematics during walking and jump landing, and may be one method of screening or assessing for increased inversion—and, in turn, increased risk of future ankle sprain—in clinical settings.
By Luke Donovan, PhD, ATC; and Mark A. Feger, PhD, ATC
At a symposium in Cape Town, South Africa, an orthotist demonstrated his technique for treating balance issues in patients with peripheral neuropathy using ankle foot orthoses (AFOs), and a team of researchers theorized about evidence-based concepts that could help explain his findings.
By Cary Groner
Factors related to joint loading during running contribute to the development of stress fractures in the femoral neck and other lower extremity structures. Research suggests these loading parameters can be reduced by altering running foot strike pattern, stride length, speed, and step rate.
By Mark Riebel, PT, DSc, OCS, SCS
Clinical prediction rules (CPRs) are intended to improve patient care, but critics have suggested that—for a number of reasons—the opposite may be true. Lower extremity experts interviewed by are in agreement that, ultimately, even the best CPRs should be only one piece of the clinical puzzle.
By Cary Groner
Experts say new research underscoring the clinical benefits of bracing for patients with knee osteoarthritis (OA), along with more comfortable device designs aimed at improving patient compliance, may help boost the historically low rates of brace utilization in this patient population.
By Barbara Boughton
Developing a multidisciplinary team dedicated to diabetic limb salvage allows for immediate referral, lessens the burdens on individual practitioners, helps remove structural barriers that can delay patient care, and offers a framework in which to organize inpatient care for these patients.
By Brian M. Schmidt, DPM, AACFAS
The latest paper to challenge biomechanics-based foot orthotic management concepts developed decades ago has revitalized a long-running discussion among foot specialists about how to define normal structure and function and which assessments should be used in prescribing foot orthoses.
By Cary Groner
Although there may be benefits to a change in running footwear, there are also risks associated with a switch to minimalist running shoes. Alterations in anatomy, physiology, and biomechanics associated with transitioning to minimalist footwear are likely to be unique to each runner.
By J. Todd Walker, MD; Donna Moxley Scarborough, PT, MS; Eric M. Berkson, MD; and Matthew J. Salzler, MD
Aging and a number of medical conditions can lead to atrophy of the fat pads under the heel and forefoot, which often causes considerable pain. Cushioned footwear and orthoses are mainstays of treatment, but research also supports the use of fat grafting in recalcitrant cases.
By Barbara Boughton
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