Category Archives: Feature Article
September 2017
Hemophilia, ankle pain, and orthotic management
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 Continue reading
September 2017
Soft braces: Experts hunt for potential mechanisms
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 Continue reading
September 2017
SEBT scores and injury risk in collegiate athletes
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 Continue reading
September 2017
Surgery and ulcer healing in patients with equinus
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 Continue reading
August 2017
Frontal plane kinematics and risk of ankle sprain
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 Continue reading
August 2017
AFOs and balance issues in peripheral neuropathy
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 Continue reading
August 2017
Biomechanics of femoral neck fractures in runners
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 Continue reading
August 2017
Clinical prediction rules: Finding a middle ground
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 Continue reading
July 2017
Recent trends favor use of bracing for knee OA
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 Continue reading
July 2017
An interdisciplinary take on diabetic limb salvage
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 Continue reading
June 2017
Study challenging Root concepts reignites debate
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 Continue reading
June 2017
Minimalist shoes: Risks and benefits for runners
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 Continue reading
June 2017
Management of painful plantar fat pad atrophy
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 Continue reading
May 2017
National Biomechanics Day thrills kids worldwide
National Biomechanics Day continued to build momentum in its second year, as scientists from Delaware to New Zealand got a jump on recruiting the next generation of biomechanists by demonstrating a wide range of applications—not to mention just how much fun the field can be.
By Hank Black Continue reading
May 2017
Stress fractures: Lessons from military research
Lower extremity stress fractures are not limited to members of the armed forces, but have been studied extensively in military populations. That body of evidence has important implications for stress fracture prevention and management in runners, other athletes, and even nonathletes.
By Baris K. Gun, DO; Andrew C. McCoy, DPM; Kevin C. Wang, BS; and Brian R. Waterman, MD Continue reading
May 2017
Somatosensory deficits following ACL surgery
Research suggests light touch sensation in the foot and ankle may be negatively affected several years after anterior cruciate ligament (ACL) reconstruction—a finding consistent with studies that have reported decreased somatosensation in patients with other lower extremity conditions.
By Matthew Hoch, PhD, LAT; Steven Morrison, PhD; and Johanna Hoch, PhD, LAT Continue reading
May 2017
Unique orthotic strategies for low-volume footwear
The low-volume shoes worn by cyclists, figure skaters, and others can make orthotic management of these patients challenging. So, lower extremity practitioners have had to develop creative strategies for achieving the desired biomechanical effects while working within a limited space.
By Jill R. Dorson Continue reading
April 2017
Protocol helps improve TKA outcomes, cut costs
A multidisciplinary joint replacement program is improving patient outcomes, decreasing complications, and shortening hospital stays, which helps to lessen clinical anguish following total knee arthroplasty as well as the financial burden on patients and the healthcare system.
By Katie Mullen, SPT; Jon R. Cook, PT, DPT; Meghan Warren, PT, MPH, PhD; and Tarang Jain, PT, PhD, DPT Continue reading
April 2017
Metatarsal morphology and injury risk in runners
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 Continue reading
April 2017
The troublesome triad of diabetic ulcer healing
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 Continue reading
March 2017
Rocker-bottom footwear: effects on balance, gait
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 Continue reading
March 2017
Chronic ankle instability and self-reported function
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 Continue reading
March 2017
Foot posture, orthoses, and patellofemoral pain
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 Continue reading
March 2017
Putting prehab to the test highlights inconsistencies
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 Continue reading
February 2017
Does history of running protect against knee OA?
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 Continue reading
