Lower Extremity Review
Too many knee braces just won’t stay put, which can affect compliance and possibly even device effectiveness. Research on the topic is scarce, but experts say the key to minimizing knee brace migration is making sure the device fits the patient’s anatomy as closely as possible.
By Shalmali Pal
A growing body of research suggests that footwear comfort can improve movement performance and, in particular, neuromuscular control of balance. These findings could have significant implications for rehabilitation of older adults and patients with lower extremity disorders.
By M. Owen Papuga, PhD, and Jeanmarie R. Burke, PhD
Ankle braces help prevent injury by restricting motion, but those restrictions don’t necessarily result in negative effects on athletic performance. Evidence suggests that while agility may be affected with use of an ankle brace, vertical jump and balance skills may not.
By Jatin P. Ambegaonkar, PhD, ATC, OT, CSCS; Nelson Cortes, PhD; and Shruti J. Ambegaonkar, MS, PT
Studies assessing the relative functional benefits of limb salvage and amputation for lower extremity bone and soft tissue tumors have produced inconsistent results, but the range of subjective and objective tests used in those studies may have influenced the findings.
By Lucy Kupersmith, BA, and Jeremy S. Somerson, MD
For the majority of evolutionary history, runners were either barefoot or wore minimalist footwear lacking the cushioning of today’s running shoes. Barefoot or minimally shod runners demonstrate differences1 in kinematics and impact forces compared with those wearing modern running shoes, and some research suggests barefoot running may confer biomechanical advantages over more cushioned footwear.
By Erik M. Haniuk, BS; LTC Steven J. Svoboda, MD; Karen Y. Peck, MEd, ATC; Kenneth L. Cameron, PhD, MPH, ATC; and LTC Brett D. Owens, MD
Hamstring injuries that occur during sprinting are a significant concern in football, not just because of the frequency with which they occur, but also because they are notoriously difficult to rehabilitate, which underscores the need for effective prevention through targeted exercise programs.
By Charles D. Kenyon, MS, RSCC, and Marcus C.C.W. Elliott, MD
Not all patients with diabetes and not all ulcerated limbs are amenable to salvage. When salvage is not an option, amputation can help improve patient function, but a number of factors should be considered when deciding how much of the foot—if any—should be retained.
By Cary Groner
A delay in the activation of the peroneus longus and peroneus brevis muscles is thought to contribute to the risk of inversion ankle sprain. New research suggests that ankle taping, in addition to providing mechanical stability, also helps reduce this peroneal latency.
By Adam Knight, PhD, and Wendi Weimar, PhD
Evidence suggests that the prevalence and symptom severity of knee osteoarthritis are greater in African-American patients, underscoring the need for lower extremity practitioners to implement effective strategies for disease prevention and management in this patient population.
By Kelli D. Allen, PhD
A patient presenting with both end-stage knee osteoarthritis and a painful foot-ankle deformity is not uncommon, but the medical literature offers practitioners little guidance as to which condition should be managed first or whether they should be addressed simultaneously.
by Michael S. Pinzur, MD, and William Hopkinson, MD
Advances in communications technology now make it possible for an expert in one location to assess a diabetic foot ulcer in a patient who is miles away. But telehealth efforts face a number of hurdles, the most daunting of which may be patient privacy.
By Emily Delzell
When prescribing an ankle foot orthosis or neuroprosthesis for a patient with acute drop foot following stroke, lower extremity practitioners should consider the device’s potential effects on neural plasticity and motor relearning in addition to its potential effects on gait.
By Chad Lairamore, PhD, PT, CBISt
Newly published proceedings of an interdisciplinary osteoarthritis summit hosted by the Hospital for Special Surgery explore how researchers are working to understand the complexities of the disease and break down the barriers facing the development of new interventions.
By Cary Groner
Indications for operative versus nonoperative treatment of tarsometatarsal joint injuries depend on the specific injury pattern and disruption of normal anatomy, which may be evident on physical examination or radiographs but may also present more subtly.
By Andrew Rosenbaum, MD, John DiPreta, MD, and Richard Uhl, MD
Barefoot training and balance training have each been effective in studies of runners, but combining the methods could lead to even better results.
By Emily Splichal, DPM, MS, CPT
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