Lower Extremity Review
Outcomes of revascularization in patients with lower extremity critical limb ischemia should be defined according to patient goals and functional criteria rather than more traditional, physician-oriented variables such as limb salvage and graft patency.
By Ginger L. Manos, MD, John W. York, MD, FACS, and Brent L. Johnson, MS
In the surgical management of ankle fractures, post-traumatic arthritis is the outcome that practitioners and patients would most like to avoid. But given the sensitivity of joint cartilage to even the slightest malalignment or pressure shift, that can be easier said than done.
By Cary Groner
Amputees lack the lower extremity muscles responsible for maintaining kinematic stability under increasing load carriage conditions, and would benefit from a more versatile prosthetic foot design that could adapt dynamically to changing loads.
By Kurt Collier, CP
In sports, the concept of “affordance perception” can mean sensing an opponent’s next move, which has implications not just for performance but also for reducing injury risk. An understanding of affordance perception also can improve the effectiveness of training.
By Julie A. Weast-Knapp, MA, and Kevin Shockley, PhD
Study findings suggest that rocker soles effectively reduce peak plantar pressures in patients at risk for diabetic foot ulceration, particularly when paired with custom orthoses. Whether or not rocker soles can play a role in healing active neuropathic ulcers, however, remains unclear.
By Emily Delzell
Research supports the use of balance training to improve physiological and clinical outcome measures in patients with chronic ankle instability. Now researchers and clinicians must use that knowledge to optimize the incorporation of balance training into CAI rehabilitation protocols.
By JoEllen M. Sefton, PhD, ATC, CMT, and Kenneth E. Games, MEd, ATC
There’s little question that dynamic pressure data have benefit for designing foot orthoses, particularly for diabetic patients, but recent focus on the technology’s limitations has clinicians wondering about cost justification. And what about those ubiquitous drugstore kiosks?
By Cary Groner
Instrumented gait analysis can help characterize abnormal gait patterns in patients with cerebral palsy, which improves clinical decision making. Early interventions based on gait analysis can help minimize the long-term adverse effects of poor biomechanics.
By Frank M. Chang, MD, Jason T. Rhodes, MD, MS, Katherine M. Davies, BA, and James J. Carollo, PhD, PE
Functional electrical stimulation of the ankle dorsiflexor muscles effectively reduces foot drop in stroke patients, but also is associated with limitations. Now researchers are looking to address those limitations by adding plantar flexor stimulation to the mix.
By Emily Delzell
The prevalence of leg ulceration in adults, either active or healed, is 1% to 2%, and the majority have chronic venous insufficiency.1 Although CVI has received less attention than arterial insufficiency, estimates suggest it is 10 times more common. Despite the prevalence of venous ulcers, they are often neglected or managed inadequately.
By Steven E. Zimmet, MD, RVT, FACPh
In the ongoing battle against inversion ankle sprains in basketball and other sports, high tops are old news. But shoe designers have begun to investigate other ways that shoes might play a role in preventing sprains rather than contributing to the problem.
By Cary Groner
The medical literature generally supports the use of foot orthoses for management of plantar fasciitis symptoms, but evidence regarding specific orthotic designs is inconclusive. Early research suggests a temporary custom foot orthosis may be an effective treatment option.
By Caryn Doggett, DPT, Michelle Drake, DPT, and Robert Boyles, PT, DSc, OCS
Previous research has identified superior balance in professional golfers compared with controls as well as associations between balance and skill level in amateur golfers. This study compared standing balance characteristics between professional and highly skilled amateur golfers.
By Robert Donatelli, PT, PhD; Kenji Carp, PT, ATC, OCS; Guido Pagnacco, PhD; and John Adam, ATC
New England Baptist Hospital’s multidisciplinary prehabilitation program is grounded in research suggesting that outcomes after total joint replacement can be positively influenced by preoperative care that includes management of patient expectations as well as exercise.
By Claire E. Robbins, PT, DPT, MS, GCS, James V. Bono, MD, and Carl T. Talmo, MD
Pronation is a necessary component of normal running biomechanics, facilitating shock absorption and stabilization. But abnormal levels of pronation, whether restricted or excessive, can alter gait patterns in ways that can potentially increase the risk of running-related injuries.
By Tracy A. Dierks, PhD
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