Lower Extremity Review
This two-part series examines trends in materials development and fabrication. This first installment focuses on how material strength, stiffness, and other variables affect the structural properties and design of orthotic and prosthetic devices.
By Cary Groner
Children’s shoes often are designed to look like adult shoes but lack the same structural components. Perhaps not surprisingly, research has demonstrated that running kinematics and kinetics differ significantly between seemingly similar child and adult shoes.
By Janet S. Dufek, PhD, Dana Forrest, MS, and John A. Mercer, PhD
Interventions to improve postural control in patients with functional ankle instability include strength training, balance training, taping, bracing, and foot orthoses, but further research is needed to determine which therapeutic approaches work best in which patients.
By Janet Simon, MS, ATC, Emily Hall, MS, ATC, and Carrie Docherty, PhD, ATC
Whole body vibration may help improve strength and function in patients with knee osteoarthritis and may even slow disease progression. But contradictory findings, a lack of consensus on optimal parameters, and safety issues have even WBV advocates proceeding with caution.
By Cary Groner
Prevention and treatment of foot ulcers in patients with diabetes requires an understanding of the various factors that contribute to increased risk, including anatomical deformity, poor vascular function, and diminished capacity for healing at a microscopic level.
By Allyson Berglund, DPM, Matthew Juriga, DPM, Aristidis Veves, MD, DSc, and Thanh Dinh, DPM
Research indicates that in diabetic patients with Charcot neuroarthropathy, peripheral bone mineral density decreases over time, which can contribute to risks of hardware failure, loss of correction, delayed union, and nonunion in patients with advanced disease.
By Rachel H. Jung, DPM, MHA, MPH; Robert M. Greenhagen, DPM; Dane K. Wukich, MD; Vassilios Vardaxis, PhD; and Robert M. Yoho, DPM, MS
Two separate studies directly compared valgus knee bracing and wedged foot orthoses for reducing knee adduction moment in patients with osteoarthritis, but came to opposite conclusions. A third study suggests combining the two interventions may be the best solution.
By Barbara Boughton
When treating patients who are going through rehabilitation, clinicians may be overemphasizing gait distance and overlooking the importance of gait speed. Clinical assessment of gait speed is simple and inexpensive but can be a significant indicator of functional recovery.
By Heather Braden, PT, MPT, PhD, GCS
Intramuscular manual therapy, also known as dry needling, is hypothesized to relieve pain by modifying tension in connective tissue. Limited evidence supports the use of IMT for plantar fasciitis, although further research is needed to rule out a placebo effect.
By Brent Harper, PT, DPT, DSc, OCS, FAAOMPT
Despite being upheld by the Supreme Court, the Affordable Care Act remains a subject of debate heading into next month’s presidential election. Meanwhile, government affairs experts are working to determine just how the ACA will affect lower extremity practitioners.
By Shalmali Pal
Research suggests that the ankle’s ability to absorb its share of energy during landing from a jump is altered with the use of an ankle brace. The extent to which this effect might influence risk of injury to other lower extremity joints or soft tissues, however, remains unclear.
By Jacob K. Gardner, MS
There are few high-quality studies and no randomized controlled trials documenting its effectiveness, but debridement—from surgical to larval—remains a mainstay of diabetic ulcer care in many practices, and new twists on conventional techniques continue to evolve.
By Cary Groner
Prehabilitation, particularly in the form of exercise, has the potential to significantly improve preoperative and postoperative outcomes in patients with knee osteoarthritis who are undergoing total knee arthroplasty. Both physiological and psychological outcomes can be positively impacted.
By Carly McKay, PhD, and Harry Prapavessis, PhD
When I first entered my podiatrist’s office for treatment of a moderately painful case of plantar fasciitis, I never thought that healthcare for my feet could get complicated. I subsequently developed sesamoiditis and my podiatrist prescribed custom orthotics for both my foot conditions. But then came the clincher: one night, I fell down a short flight of stairs and unfortunately landed on my foot.
By Barbara Boughton
Reducing the shaft height of a removable cast walker, which results in a lighter device and may also help improve postural stability, can help improve compliance in patients at risk for diabetic foot ulcers without compromising the device’s offloading capability.
By Sai Vikas Yalla, PhD, and Ryan T. Crews, MS, CCRP
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