Lower Extremity Review
Many knee injury prevention programs do not focus on ankle dorsiflexion range of motion and hip adductor activation, but research suggests both distal and proximal variables contribute to alterations in frontal plane knee biomechanics and could affect injury risk.
By Darin A. Padua, PhD, ATC, and Micheal A. Clark, DPT, MS, PES, CES
Advocates of surgical nerve decompression in a subset of patients with diabetic neuropathy have published some impressive outcomes, but critics of the procedure point to the conspicuous absence of randomized trials. The issue has become one of the most contentious in diabetes care.
By Cary Groner
Physical impairments associated with femoroacetabular impingement include limited range of motion, muscle weakness, and altered biomechanics. Attention to these areas during rehabilitation can improve surgical outcomes and may even reduce the risk of osteoarthritis.
By Jerrad R. Guenther, BSc, Michael K. Gilbart MD, FRCS(C), MEd, and Michael A. Hunt PT, PhD
Research suggests that obesity influences the development of Achilles tendinopathy to a greater degree than other types of foot and ankle pain. This phenomenon will become increasingly important to lower extremity practitioners as global obesity rates continue to rise.
By Ryan T. Scott, DPM, AACFAS, and Christopher F. Hyer, DPM, MS, FACFAS
Hip strengthening can improve short-term outcomes related to patellofemoral pain syndrome, but further research is needed to determine the underlying mechanism and whether the same approach will also prove effective in managing patellofemoral osteoarthritis.
By Michael B. Pohl, PhD
The third International Patellofemoral Pain Research Retreat picked up where previous retreats had left off in examining proximal and distal factors related to PFP and subgroups of patients who might respond to targeted interventions. But this retreat broke some new ground as well.
By Jordana Bieze Foster
Plantar plate pathology in conjunction with metatarsalgia occurs more often than is commonly appreciated, but can be addressed using a combined procedure that involves a dorsal approach to anatomic plantar plate repair and metatarsal realignment.
By Lowell Weil Jr, DPM, FACFAS, and Erin E. Klein, DPM, MS
Research continues to suggest that bracing has the ability to improve pain and function in patients with knee osteoarthritis in a controlled setting, but researchers are now working to identify factors that affect bracing outcomes in the real world. Patient expectations are at the top of that list.
By Larry Hand
The literature suggests that women are less likely than men to experience an Achilles tendon rupture. This may be because women are less capable of generating the large eccentric contractions necessary for rupturing the tendon. Estrogen may also play a protective role.
By Joseph L. Laratta, MD, and J. Turner Vosseller, MD
Myofascial or joint-focused stretches can increase passive hip range of motion in young adult men with limited hip flexibility, but this will not necessarily result in more hip motion actually being utilized during functional activity unless old movement patterns can be unlearned.
By Janice Moreside, PhD
Collegiate athletes who participate in sports associated with sprinting have an increased risk of hamstring strain. Investigators have identified flexibility, strength, and fatigue as potential contributing factors that can be addressed through sport-specific training and rehabilitation.
By Kevin M. Cross, PhD, ATC, PT, Susan Saliba, PhD, ATC, PT, and Jay Hertel, PhD, ATC
Partial foot amputations may not offer a biomechanical advantage over transtibial amputations if the metatarsal heads cannot be retained, and some experts suggest amputation level should be selected based on probability of wound healing instead. But others disagree.
By Cary Groner
Study findings and anecdotal reports suggest that newer-generation total ankle replacement can match or exceed ankle arthrodesis when it comes to gait and range of motion, but neither procedure returns gait to normal. Implant survival has also improved, but continues to be a challenge.
By Barbara Boughton
Total hip arthroplasty can significantly improve quality of life in obese patients, but high body mass index is also associated with higher rates of complications and readmissions than in normal-weight patients. The emerging subgroup of super-obese patients poses additional challenges.
By Raghav Rajgopal, MD, and James L. Howard, MD, MSc, FRCSC
Opportunistic microorganisms called biofilms constitute an age-old diabetic wound care problem that defies traditional antimicrobial therapies. Experts believe interventions customized to individual patients based on molecular diagnostics may be the best line of defense.
By Larry Hand
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