Category Archives: Feature Article

Featured Issue Article

September 2019

Autism Linked to Between-Limb Asymmetries Across the Gait Cycle

Recent findings from the University of Nevada, Las Vegas (UNLV), add to a growing body of evidence that autism spectrum disorder (ASD) is associated with significant gait asymmetry, suggesting movement quality should be part of the diagnostic and treatment processes for ASD.

By Keith Loria Continue reading

September 2019

Quantitative Gait Assessment in Children With 16p11.2 Syndrome

Neurodevelopmental disorders are frequently associated with motor impairments including locomotion. These study findings highlight the importance of using precise measures to differentiate motor dysfunction in neurodevelopmental disorders.

By Sylvie Goldman, Aston K. McCullough, Sally Dunaway Young, Carly Mueller, Adrianna Stahl, Audrey Zoeller, Laurel Daniels Abbruzzese, Ashwini K. Rao, and Jacqueline Montes. Continue reading

September 2019

Early Orthotic Intervention in Pediatric Patients, Part 2: Down Syndrome, other neurological conditions, and toe walking

Down Syndrome is associated with a long list of compensatory gait symptoms due to hypotonia, triplanar foot and ankle misalignments, sagittal and coronal compensation at the knee, proximal weakness, and equinus contractures, all of which need to be treated. How early depends on the individual child.

By Cary Groner Continue reading

August 2019

Early Orthotic Intervention in Pediatric Patients, Part I: Cerebral Palsy

Children with cerebral palsy (CP) typically encounter a host of gait- and balance-related issues associated with spasticity, dyskinesia, and weakness. How severe these are depends on CP type and the individual case. As a result, experts have long debated how early to intervene with bracing strategies that include ankle-foot orthoses (AFOs), and how long to maintain those interventions.

By Cary Groner Continue reading

August 2019

Healthcare Provider-Implemented Foot Evaluations for Walking Exercise Programs

Encouraging exercise and appropriate footwear selection may be key in helping patients maintain healthy activity levels. Exercise is recommended for the majority of patients regardless of age, gender, or physical disability. The 2008 Physical Activity Guidelines for Americans1 recommended that all adults perform 150 minutes…

By Audris Tien, DPM, Brad Franklin, DNP, RN, FNP-C, FAANP, and Jarrod Shapiro, DPM, FACFAOM, FACFAS Continue reading

August 2019

Chronic Ankle Pain? Put Os Trigonum Fracture in the Differential

This overlooked, often-left-undiagnosed ankle pathology causes long-term pain and instability. Appropriate treatment protocols, applied in a timely manner, can get patients back on their feet. The ankle presents an interesting dichotomy of strength and frailty: Whereas the ankle supports body weight, makes sharp twists and turns, and keeps the body from falling…

By Scott Pensivy, PT, LAT, ATC Continue reading

July 2019

Enthesis: Unique Structure Makes Tendon-to-Bone Repairs Complicated

Formed during development, this efficient attachment system cannot be recreated during healing. Many common injuries, such as Achilles tendon and rotator cuff tears, require surgical procedures that reattach the affected tendon to the bone. Stavros Thomopoulos, PhD, director of Carroll Laboratories for Orthopedic Surgery at Columbia University in New York, compares it to trying to attach a rope to a piece of cement.

By Nicole Wetsman Continue reading

July 2019

At All Levels and Categories of Cycling: Correct Poor Crank-arm Fit to Relieve Chronic Knee (and Hip) Pain

Consider recommending installation of shorter crank arms on a bike when a cyclist complains of knee or hip pain. After years of bike-fitting, here’s why we’ve concluded that this modification is invaluable. One of the biggest problems in bicycling, I’ve found, is that pain is considered normal. I (RS) am a master bike fitter and an elite cycling coach.

By Rick Schultz, MBA, DBA, and Amy Schultz, PT, DPT, CSCS Continue reading

July 2019

A Common Class of Antibiotics Can Lead to Tendon Rupture

Despite Black Box warning for risk of tendinitis and tendon rupture, clinicians continue to prescribe fluoroquinolones. Half of the musculoskeletal injuries in the United States each year involve tendons and ligaments, and of the tendon injuries that can occur, those that strike the Achilles tendon are the most common. Higher rates of participation in…

By Nicole Wetsman Continue reading

June 2019

Patient Perspective – Beyond Bunions: Feeling Footloose and Fancy Free 6 Years After Surgery

I’ve never been one to gaze admiringly at my toes while lounging at the beach – or heaven forbid, take pictures of them with a tropical sea background to post on Instagram. I was cursed with ugly feet – wide and stubby (thanks Dad!) – and because of that, I’ve never bothered to try and adorn them with pedicures and polish.

By Karen Bakar Continue reading

June 2019

Inclusion In the Exam Room, In the Locker Room, On the Field

What does an athlete look like? There was a time when the answer to this question was largely homogenous, but today’s athletes have broken every mold and stereotype. They can be tall, short, lean, thick, strong, nimble, brawny, brainy, quick, or deliberate.

By Sarah Kogod Continue reading

June 2019

Bike Fitting Will Come Out From the Shadows and Into Rehab Armamentarium

Many readers may not have heard of it yet, but by the time LER turns 20, I predict it will be a common prescription…at least I hope it will be. I’m talking about bike fitting, of course. The number of individuals choosing cycling as transportation, hobby, sport, or community activity—whether it’s competitive or recreational—is increasing annually—up from around 43 million in 2014 to 47.5 million in 2017.

By Happy Freedman Continue reading

June 2019

Growing Awareness of Unicity Will Drive Sport Science

Like the athletes we study, the field of sport science is always in motion. When combined with medicine, it is a rich and growing environment in which the interaction between daily practice and clinical research contributes to an overall progression in understanding of human performance and biological adaptations.

By Antonio Robustelli, MSc, CSCS Continue reading

June 2019

What’s the Point of 3D Printing Orthotics? Options!

Recently, on the Facebook page of Craig Payne, creator of, there was discussion about a published study that compared running biomechanics and perceived comfort between a 3D-printed orthotic and a traditionally manufactured orthotic. The study showed there were no differences between the two devices.

By Bruce E. Williams, DPM Continue reading

June 2019

Complimentary Approach Grows, But Some Challenges Remain

Lower Extremity Review can be both proud and excited about its 10th anniversary and its participation in all aspects of sports medicine and podiatry, rehab, fitness, and wellness. As for what the next decade holds, I predict implementing the input and expertise from all the medical specialties, along with educators, trainers, and therapists of all backgrounds, will continue to grow.

By Robert A. Weil, DPM Continue reading

June 2019

Explosion of Analytics Will Fuel Growth of Sports Medicine

The field of Sports Medicine has undergone exponential growth over the last few years, but still remains in its infancy. So much research and technology have been added to clinical practice since the simple days of “RICE” (Rest-Ice-Compression-Elevation). The catch phrase for some of this phenomenon is “analytics” and it covers a variety of topics. This is where I believe Sports Medicine is going in the future.

By Howard Osterman, DPM Continue reading

June 2019

Technology Is Inevitably Reinventing Orthotics and Prosthetics

Devices and patient care have changed dramatically through the history of the O & P profession. At first, devices were carved of wood, based on visual inspection, then sewn with leather and bent metal; today, we cast in plaster and pull plastic. If history tells us anything, it’s that, first, newer technology will continuously become…

By Jacob Praga, MSBME Continue reading

June 2019

Objective Data Will Lead the Transformation of Treatment

The future isn’t coming—it’s arriving at an incredible pace! Technology and the data it can supply have reshaped the planet and those who fail to adopt it will be left in the dust. The need for objective data in treatment decisions will become mandatory both by payers and patients alike.

By Kendon Howard Continue reading

June 2019

Proper Diabetes Care Can Reduce Rising Lower Extremity Amputation Rates

In a recent article in the Philadelphia Inquirer, reporter Stacey Burling wrote, “Amputation rates among people with diabetes in the United States dropped for about 15 years, but recent reports issued by the U.S. Centers for Disease Control and Prevention highlight a disturbing trend: Amputation rates have been rising in people under 65 with diabetes since 2009.

By Mark Hinkes, DPM Continue reading

June 2019

Tech Innovation Has Nudged Podiatry Forward More Than Any Other Force

Although it’s difficult to predict future developments, one might extrapolate, to some extent, large changes to a specialty of medicine by looking back on the history of the field and combining it with recent developments and trends.

By Jarrod M. Shapiro, DPM Continue reading

June 2019

To Improve Patient Outcomes, Measure What Matters

Mobility and balance deficits in patients with lower extremity impairments are significant factors for decreased quality of life. To improve outcomes for these patients, clinicians need measures that are evidence-based and scientifically validated; in other words, there is a need to measure things that matter.

By Michael Rowling, BS Continue reading

June 2019

Foot and Ankle Surgery: A “Minimal” Future

Before pronouncing what I predict will be the single most significant change in foot and ankle surgery in coming years, it’s essential to look back. I asked an orthopedic colleague what he thought the most significant change in orthopedics was over the past 25 years, and he replied, “locking plate technology.” I agree.

By Patrick A. DeHeer, DPM Continue reading

June 2019

OUTCOMES COULD BE AFFECTED: Is Reimbursement Reduction Imminent for Most Off-the-Shelf Braces?

My perspective on the future reflects my professional interest in lower-extremity injuries and conditions that can be treated by knee braces and by ankle-foot and knee-ankle-foot orthoses. An aging population and other market demographics seem to indicate there is an increasing need for braces; new manufacturing methods, including interesting composite materials and 3D printing, seem to point toward a future of technical innovation.

By Rick Riley Continue reading

June 2019

“Capstone” Research Has Great Value to Orthotics and Prosthetics

Georgia Institute of Technology initiated its Masters of Science in Prosthetics and Orthotics (MSPO) program in 2002, knowing that considerable advances in the profession would be possible if research was an emphasis in clinical education. Students entering the program came with added bases of knowledge, dominated by…

By Geza F. Kogler, PHD Continue reading

June 2019

Embrace Mobile Technology to Meet Challenges of a Growing Older Population

Modern day times not only see us living longer, but enjoying a wide array of advances in lifestyle, medicine, health, and social care, as well as the fast-paced changes in technology. Currently, 13% of the global population is over age 60, a figure which is increasing by 3% each year.1

By Sarah A. Curran, PhD Continue reading