Lower Extremity Review
Each one of these so-called “Dirty Truths” has its specific reason, or reasons, for making the list. This one gets most of its “dirtiness” educationally and clinically. Many patients are familiar with the term “pronation,” though their understanding may vary. A clear explanation of body planes and planes of motion is important for an accurate understanding of this concept.
By Jay Segel, DPM; Sally Crawford, MS
Ankle-Foot Orthoses (AFOs) play an essential role in the management of various lower extremity conditions. Coding and compliance accuracy and proper documentation can pose a challenge. Providers must accurately explain why the specific AFO is needed. This is not just a box-ticking exercise but a fundamental element to avoid audit failures.
I am regularly asked, “Why 3D printed?” There are obvious environmental and manufacturing benefits, although speaking from my clinical perspective–it is the design freedom that is most important. The ability to have an unrestricted design envelope, being able to design and manufacture devices lighter, thinner, fully-custom and quicker are just a few of the benefits.
By Dean Hartley (Podiatrist & Adjunct Engineering Fellow–University of Queensland)
Orthobiologics is the science of harnessing and concentrating substances (substrates) that occur naturally in the body. It is theorized that in higher concentrations, biologics may help to enhance (or) improve the healing process. Orthobiologics and bone substitutes represent groundbreaking advancements in regenerative medicine.
By Asim Raja, DPM, FACFAS
Millions of families in the United States (US) own dogs, and with these dogs comes an assortment of dog items (gates, beds, toys, etc.). Tens of thousands of falls associated with dogs are treated at US hospital emergency departments (EDs) each year, a portion of which involve dog items. The objective of this study is to describe dog-item-related…
By Mathias B. Forrester, BS
Assessing the clinical efficacy of different therapeutic options for KOA will aid clinicians in treating patients. While clinicians recognize the positive role of physical therapy in improving symptoms and functionality in knee osteoarthritis (KOA) patients, these methods may differ in mechanisms of action, applicability, and efficacy variances.
By Xiao Chen, Yuanhe Fan, Hongliang Tu, and Yuan Luo
I used to think documentation was the easy part. Write what you saw, describe what you did, keep it clear and detailed. I was trained well. I took pride in good notes—organized, clinical, complete. The kind you’d feel confident handing off to a colleague.
By Cassandre Voltaire, DO, ABWMS
The biomechanics of the diabetic foot are an intricate interplay of physiological and mechanical challenges that necessitate specialized care strategies. Diabetes often triggers changes in foot structure and function as a result of complications including peripheral neuropathy, vascular issues, and obesity.
By James McGuire, DPM, LPT, LPed, FAPWHc
This study highlights the importance of a user-centered design in enhancing adherence to and satisfaction with AFOs. Ankle-foot orthoses (AFOs) are essential in pediatric rehabilitation particularly for children with conditions such as cerebral palsy, drop foot, or neuromuscular impairments.
By Peter Dabnichki and Toh Yen Pang
Dirty Truth #4: Shock Absorption is Energy Loss–Understanding Loading in Gait Analysis
Perhaps the most surprising and unintuitive of all the dirty truths is number four, “Shock absorption via cushion is energy loss.” At first blush, cushion seems like a no-brainer benefit. When we delve into this idea a bit deeper, applying our structure, the forces acting on the lower limbs, and applying the physics that we talked about in the last three dirty truths, the truth of number four becomes clear.
By Jay Segel, DPM; Sally Crawford, MS
Integrating targeted exercises focused on AH strengthening, both pre- and post-surgery, offers a comprehensive approach to HV management. The abductor hallucis (AH) is the most important muscle in the…
By Giacomo Farì, Laura Dell’Anna, Francesco Paolo Bianchi, Rachele Mancini, Enrica Chiaia Noya, Carlo De Serio, Riccardo Marvulli, Luisa De Palma, Danilo Donati, Roberto Tedeschi, Maurizio Ranieri, Marisa Megna, and Andrea Bernetti
Emergency medical services (EMS) calls accounted for 65.2% of all incidents to which United States (US) fire departments responded in 2023. A portion of fire department EMS calls are likely to involve lower extremity injuries. The objective of this study was to describe the pattern of these lower extremity injuries.
By Mathias B. Forrester, BS
Chronic, hard-to-heal wounds are a major aspect of care in most podiatric offices, which is why antimicrobial resistance (AMR) is an escalating concern for healthcare practitioners. AMR is not only a growing concern for patient health but also poses potential legal and economic ramifications for healthcare providers.
By Windy Cole, DPM, CWSP, FAPWH
Hind foot non-unions are a complex orthopedic challenge that clinicians face, particularly due to the unique anatomy and weight-bearing responsibilities of this part of the foot. Non-unions occur when a fracture fails to heal nine months after injury or shows no radiographic improvement over a consecutive 3-month period. This condition is not only painful but can also severely impact mobility and quality of life.
By Zeeshan Husain, DPM, FACFAS, FASPS
Dirty Truth #3: What We Can’t See Is Key. In the last 2 installments, we talked about our problematic foot anatomy and what happens to the structure during weight bearing and activity. Much like how a mousetrap precisely captures its target, analyzed computer-aided gait analysis (CAGA) reports accurately “mousetrap” and track the unseeable, providing valuable insights and objective data.
By Jay Segel, DPM; Sally Crawford, MS
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