Lower Extremity Review
Experts continue to debate the relative merits of the Semmes-Weinstein monofilament for assessing diabetic foot ulcer risk, including how many sites on the foot should be tested, and which ones. But it’s tough to argue with the technique’s cost-effectiveness.
By Cary Groner
Preliminary research suggests that impaired balance in patients with diabetic peripheral neuropathy (DPN) may improve with proprioceptive stimulation from foot orthoses. Postural instability is common in patients with diabetic neuropathy, said David Levine, DPM, CPed, who is in private practice in Frederick, MD.
By Katie Bell
Every day, people willingly trade good foot health for stylish shoes—think stilettos, platforms, and pointy toeboxes. For some time, however, patients who wore diabetic footwear didn’t have the option of worrying about style versus substance.
By Shalmali Pal
Myths abound in discussions about healthcare (just think chicken soup). But when it comes to the use of compression hosiery, some tales can be debunked easily. The benefits of compression hosiery include improved blood circulation for patients with varicose veins, or achy swollen feet—especially helpful for those with diabetes.
By Larry Hand
Any time a practitioner applies an orthotic device, such as an ankle foot orthosis (AFO) to offload a diabetic foot ulcer, he or she also has to make sure pressure is not redistributed to the point that a new ulcer is created elsewhere on the foot. Devices have to be constructed with the correct materials and properly fitted to the foot, which leaves a lot of leeway for practitioners.
By Larry Hand
Outsourcing has become integral to streamlined manufacturing and, in the O&P world, central fabrication services fit the bill. Yet, for practitioners dealing with a customer service rep in a different time zone or an employee in a far-off land, communication isn’t always easy to achieve. Lower Extremity Review checked in with O&P experts on effective ways to communicate with central fab facilities.
By Shalmali Pal
In patients affected by both diabetes and drop foot, ankle foot orthoses (AFOs) can help restore a more normal gait pattern and reduce the mechanical risks of ulceration. But microtrauma caused by irritation and elevated pressure is also a significant concern in these patients, making device selection and fit critical concerns.
By Larry Hand
Research indicates that primary care physicians are underprescribing exercise as a treatment for knee osteoarthritis, and experts suggest the same can be said about bracing. “I think primary care physicians probably don’t know much about braces. Being primarily internists, primary care physicians may turn to what they know best, and that’s pharmacological therapy, because that’s what they’re accustomed to doing,” said Nicholas Giori, MD, PhD, an orthopedic surgeon at Stanford University School of Medicine in Palo Alto, CA.
By Larry Hand
Many studies of posterior tibial tendon dysfunction (PTTD), or adult acquired flatfoot disorder, have focused on foot kinematics and benefits of bracing for pain relief and increased ambulation. But new findings from the University of Southern California in Los Angeles suggest clinicians also look higher along the kinetic chain when determining an effective treatment.
By Christina Hall Nettles
Finding shoes that fit over ankle foot orthoses (AFOs) is a challenge for thousands of children with neuromuscular disorders that affect walking ability. Parents have waited patiently while custom AFOs were molded and fitted, only to find themselves at wit’s end when trying to finish the morning dress routine.
By Christina Hall Nettles
After amputation patients and practitioners tend to focus on the affected side. But the intact limb, or “sound side,” is also worth watching as long-term shifts occur in weight distribution between limbs during gait. This stress can often lead to knee osteoarthritis (OA) in the intact limb.
By Shalmali Pal
Chronic ankle instability (CAI) has been linked to development of early ankle osteoarthritis (OA), but questions remain as to how and why the degeneration occurs and how bracing and other interventions might slow the process.
By Larry Hand
Research suggests foot orthoses can affect frontal and transverse plane motion in proximal joints during landing from a jump, which could help decrease the risk of anterior cruciate ligament injury, especially in female athletes.
By Katie Bell
The latest research on patellofemoral pain (PFP) syndrome suggests that different mechanisms are responsible and treatments must be tailored accordingly. A new imaging study has drilled down into the source of PFP, offering evidence of a link between the syndrome, bone metabolic activity, and increased mechanical stress.
By Shalmali Pal
Tight hamstrings play an important role in plantar fasciitis, according to a study published in the June issue of Foot and Ankle Specialist. “These findings show that while we always consider the tightness of the gastrocnemius/soleus complex and the subsequent restricted ankle motion from this equinus, we also need to consider the role of the hamstrings,” said Jonathan Labovitz, DPM, lead author and associate professor at Western University of Health Sciences, Pomona, CA.
By Katie Bell
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