Lower Extremity Review
Decisions related to the stiffness of an ankle foot orthosis (AFO)—whether they involve device design or the materials from which it’s fabricated—can help lower extremity clinicians customize stability, biomechanics, and muscle function to meet individual patients’ needs.
By Lori Roniger
Professional football players are enduring higher levels of force than ever, and foot and ankle injury rates are increasing as a result. Advances in surgery and rehabilitation have helped get players back on the field more quickly, but injury prevention remains a significant challenge.
By Will Carroll
Altered biomechanics after ankle arthrodesis often increase stress on the adjacent joints in the foot, which can cause or exacerbate osteoarthritic degeneration in those joints. Clinicians and researchers are working to better understand this process and how to minimize patients’ risk.
By Cary Groner
The ability to identify and treat patients at risk for mental health issues after anterior cruciate ligament (ACL) injury may help improve psychological readiness for reconstructive surgery, attitudes toward postoperative rehabilitation, and successful surgical and rehabilitation outcomes.
By John Reaume, MD, MHSA; Dana Reaume, PsyD; and Melissa A. Christino, MD
Pronation is a triplanar movement and is the combination of rearfoot eversion, midfoot abduction, and talocrural dorsiflexion.1 Pronation in normal gait allows flexible, adaptive changes to varying types of terrain; it dissipates ground reaction forces; and encourages lower extremity internal rotation.
By Frank Layman, PT, DPT, EdD, MT; and April Wilson, PTA, BS, CI, CKTP, IASTM
Weight loss following bariatric surgery can have biomechanical and symptomatic benefits for obese patients with knee osteoarthritis (OA). But it’s less certain whether that weight loss can also reduce the risk of obesity-related complications following total knee arthroplasty.
By Shalmali Pal
The mechanisms underlying the so-called crossover effect—when a unilateral intervention results in bilateral changes—are still unclear, but clinical applications related to lower extremity strengthening, fatigue, and stretching are already being explored by rehabilitation specialists.
By Cary Groner
A growing body of evidence suggests that foot orthoses may be a helpful addition to other therapies for improving balance and potentially reducing the risk of falls. The findings have been mixed, however, and clinical enthusiasm for this type of insole intervention also varies.
By Hank Black
Posterior tibial tendon dysfunction (PTTD), known also as tibialis posterior tendon dysfunction, is one of the leading causes of acquired flatfoot in adults, but the…
By By Frank Layman, PT, DPT, EdD, MT; and April Wilson, PTA, BS, CI, CKTP, IASTM
Dry needling is gaining momentum as an alternative therapy for myofascial pain, and is supported by a small but growing body of research as well as anecdotal evidence. But the training and expertise required to perform the procedure has become a topic of debate.
By P.K. Daniel
New research suggests lower extremity clinicians should consider implementing gait training in combination with targeted strengthening of the peroneus longus and gluteus medius muscles to help restore normal gait patterns in patients with chronic ankle instability.
By Rachel Koldenhoven, MEd, ATC
Preventing deep venous thrombosis and pulmonary embolism after lower extremity surgery can involve pharmaceutical therapies or mechanical interventions. The type of prophylaxis used depends on the type of surgery, pre-existing risk factors, and patient preference.
By Barbara Boughton
In distance runners, step-rate manipulation of at least 10% above a runner’s preferred rate may be an effective clinical gait retraining method to decrease the severity of foot inclination angle at heel strike and…
By Darrell J. Allen, PT, DPT, MS, SCS, CSCS; Hollie Heisler, PT, DPT; and Jennifer Mooney, PT, DPT
Achilles tendinopathy is a common lower extremity injury in athletes as well as nonathletes. The Achilles tendon is often a site of injury in runners and is the second most common running-related musculoskeletal injury, after medial tibial stress syndrome, with an…
By Howard Kashefsky, DPM
Helping patients manage an orthotic device can be challenging, but doing so in the face of uneven terrain is a balancing act between stability, mobility, and strength. Device adjustments and rehabilitation protocols can help patients avoid asymmetries and reduce the risk of falling.
By Shalmali Pal
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