Lower Extremity Review
Although it has not been shown to be a risk factor for stress fracture in traditional running, the presence of Morton’s foot (a second metatarsal longer than the first) alters running mechanics in ways that may exacerbate the risks of forefoot injury associated with alternative running styles.
By Brian E Stoltenberg, DPT, OCS, CSCS; and Donald L Goss, PT, PhD, OCS, ATC
Uncontrolled deformity, deep infection, and ischemia-hypoxia make up the troublesome triad of confounders associated with healing challenges in patients with diabetic foot ulcers. Clinical examination and intervention in nonhealing patients should focus on these three elements.
By Anna Maria M. Tan, DPM; Michael B. Strauss, MD; and Lientra Q. Lu, BS
Footwear with rocker soles are best known for helping to redistribute plantar pressures during gait in patients with diabetes, but research suggests they also have clinically relevant effects on balance and gait that can be beneficial for some populations but potentially dangerous for others.
By Greg Gargiulo
Using patient-reported outcome tools can give lower extremity clinicians insight into the disability experienced by patients with chronic ankle instability. A combination of instruments may be necessary, as different assessments may capture different aspects of the condition.
By Adam B. Rosen PhD, ATC; and Cathleen N. Brown PhD, ATC
Prescription of foot orthoses for runners with patellofemoral pain (PFP) is often based on the premise that individuals with excessive pronation are among those most likely to have a positive response. However, preliminary analyses indicate this may not be the case.
By Thomas Gus Almonroeder, DPT; and John Willson, PT, PhD
The growing popularity of prehabilitation contrasts with mixed findings in the lower extremity literature: Specifically, the approach seems to be more effective in patients undergoing anterior cruciate ligament (ACL) reconstruction than those undergoing hip or knee replacement.
By Cary Groner
Running may increase the risk of knee osteoarthritis (OA) onset or progression for some people, but in many others the knees will be safe during running; in such individuals, the benefits of physical activity can positively affect weight management and other means of reducing OA risk.
By Nicole M. Cattano, PhD, LAT, ATC; and Jeffrey B. Driban, PhD, ATC, CSCS
Even patients who obediently wear their O&P devices can pose a clinical challenge if they wear their devices past the point of breakdown. Experts offer suggestions for dealing with patients who are hard on devices—including those who are very large, very active, or very frugal.
By Shalmali Pal
Several confounding factors make it difficult to determine statistical associations between footwear and injuries in basketball, but attitudes toward shoes among National Basketball Association (NBA) players suggest both positive and negative trends with regard to potential injury risk.
By Will Carroll
To understand the association between jumping biomechanics and transmission of forces through the patellar tendon, practitioners must have a working knowledge of the anatomy of the knee, as well as the biomechanical factors that determine force transmission through the knee.
By Rob Halle, PT, DPT, OCS, CSCS
As evidence accumulates suggesting negative effects of depression, dementia, and other mental health issues on gait and foot-related outcomes in people with diabetes, researchers are looking at ways to screen for risk factors and psychosocial issues earlier in the continuum of care.
By Hank Black
Although most clinicians tend to emphasize hip abductor and external rotator muscle strengthening in injury prevention and rehabilitation, recent research suggests exercises to increase explosive hip extensor strength may be critical for controlling frontal plane motion during cutting tasks.
By Marc Norcross, PhD, ATC, and Sam Johnson, PhD, ATC
Inertial measurement units (IMUs) facilitate the creation of a gait analysis system that is portable and suited for use in the clinic. Research suggests IMUs can be used to measure clinically important gait metrics in children with cerebral palsy, which may improve patient outcomes.
By Mahmoud El-Gohary, PhD; Sean Pearson, BS; Paul Vasilyev, BS; James McNames, PhD; and James Carollo, PhD, PE
As ciprofloxacin and other fluoroquinolones are prescribed more frequently, tendon-related adverse effects are also becoming more common. Experts often do not recommend these drugs, particularly for athletes or elderly patients, and emphasize that all patients should know the risks.
By Barbara Boughton
Although not as common as Achilles tendinitis, peroneal tendinitis is seen in a certain group of patients with chronic ankle instability or with a cavovarus foot.1 Peroneal tendinitis presents as lateral foot pain and may also be of unknown etiology or associated with an acute inversion injury.
By Patricia Pande, MClScPT, CSCS, CPed
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