Category Archives: Special Section

September 2013

Understanding Hypotonia

Diagnostic challenges should not delay clinical intervention
Hypotonia, or abnormally low muscle tone, is by itself not a disorder but a symptom of an enormous array of issues—many of which can be difficult to diagnose accurately. Even in the absence of a specific underlying diagnosis, however, children with hypotonia can benefit from clinical intervention.

By Christina Hall Nettles

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September 2013

Gait: The Cornerstone of Intervention

Quantifying the effects of hypotonia starts in the clinic
Effective management of children with hypotonia requires an understanding of how the condition affects gait. Clinicians typically rely on their professional experience when discussing the effects of hypotonia on gait in pediatric patients, partly because they trust that experience, but also because so little research has actually elucidated these effects.

By Cary Groner

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September 2013

Orthotic Solutions for Children with Hypotonia

New research underscores years of positive clinical results
When it comes to orthotic management of pediatric patients with hypotonia, the medical literature is only beginning to document the effectiveness that clinicians have been reporting anecdotally for years.

By Cary Groner

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September 2013

Orthotic success stories: Four cases in a series

Each child in this case series was assessed every other week for 16 weeks to determine mastery of items 23, 26-28, 30-39, and 41 (ranging from “pull to stand” to “walk fast”) on the Peabody Developmental Motor Scale. Test instructions were modified as needed for children to understand them. Parents were included in each session and encouraged to play with the child in order to demonstrate the targeted skills. Graphs illustrate age of mastery for each item number for the hypotonic child compared to a “typical” child, with linear trend lines illustrating rate of change, and demonstrate the improved mastery of skills after prescription of supramalleolar orthoses (SMOs). The cases will be presented in September at the O&P World Congress in Orlando, FL.

By Megan Smith, CO

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CONFERENCE COVERAGE: Orthotics Technology Forum 2013

In late May lower extremity clinicians, orthotic lab owners and managers, and technology experts gathered at the Georgia Institute of Technology in Atlanta for a discussion of digital technology in orthotic application, design, and manufacture. By Emily Delzell

July 2013

High-tech path leads to the future of improved orthotic prescription

One of the most-talked-about images from the 2013 Orthotics Technology Forum (OTF) depicted 11 custom foot orthoses made by 11 experienced orthotists and podiatrists for a single patient. All 11 practitioners had been given the same information about the patient’s condition, yet all 11 orthoses were distinctly different.

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July 2013

3D printing: The shape of things to come

The Orthotics Technology Forum presentation given by Ben Boyer, CPed, was as much about what the speaker was wearing as what he was saying. Boyer, who is the lab manager at Kintec in Vancouver, Canada, wore a product he thinks may represent part of the future of orthotic design and manufacture—orthoses he’d printed with a hobbyist-level desktop 3D printer.

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July 2013

Lean manufacturing transforms orthotic fabrication

The need to replace entrenched processes and thinking with fluid, fast-moving orthotic design and manufacture that minimizes errors and maximizes resources was highlighted by several speakers at the Orthotics Technology Forum, including Jarret Eschenburg, CPed, director of operations at Coral Springs, FL-based SureFit, a subsidiary of Hanger.

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May 2013

Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

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March 2013

CEREBRAL PALSY: Dynamic devices facilitate compliance, outcomes in children with cerebral palsy

Brace wear time, not torque, is key – Dynamic orthoses offer an effective alternative to static devices for management of tip-toe gait and knee flexion contracture in children with cerebral palsy (CP), particularly because the dynamic devices are associated with greater compliance, according to separate studies from Sweden and France.

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March 2013

OSTEOARTHRITIS: Knee braces and wedged insoles both alter gait in patients with knee OA

A Taiwanese study offers more evidence that offloading knee braces and wedged foot orthoses are both associated with significant biomechanical improvements in patients with knee osteoarthritis (OA).

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March 2013

SPORTS MEDICINE: Proximal rocker bar on shoe can relieve tension on Achilles tendon in runners

A rocker bar proximally positioned on a running shoe can relieve tension on the Achilles tendon as well as reduce the force required of the calf muscles during walking and slow running, according to research from the Netherlands.

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March 2013

DIABETES: More results support use of foot orthoses to significantly decrease plantar pressures

Swedes also find low ulceration rate – Research from Sweden and Egypt provides more evidence that foot orthoses can significantly decrease plantar pressures in patients with diabetes, theoretically reducing the risk of foot ulcers and lower extremity amputation.

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March 2013

FLAT FOOT: Arch structure in children with talipes planovalgus improves with shoe inserts

Orthotic management of pediatric talipes planovalgus starting at an early age is associated with significant improvement in weightbearing arch structure, according to research from Saga University in Japan.

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March 2013

OFFLOADING: Walkers’ effect on proximal biomechanics varies depending on design characteristics

Tibial inclination appears significant – Orthotic walkers have significant effects on proximal joint mechanics during gait, the extent of which appear to depend on individual device design, according to research from the University of Central Lancashire in the UK.

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March 2013

PEDIATRICS: In hyperpronators, functional scoliosis responds to distal orthotic treatment

What appears to be idiopathic scoliosis may actually be functional scoliosis that can be effectively treated with foot orthoses in children who are hyperpronators, according to research from Chungnam National University in Daejeon, South Korea.

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March 2013

STROKE: Eight weeks of early AFO use significantly enhances benefits of stroke rehabilitation

Functional balance test scores rise – Use of an ankle foot orthosis (AFO) within six weeks of stroke results in better balance outcomes and earlier independent ambulation than if AFO use is delayed, according to research from the Netherlands.

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November 2012

CONFERENCE COVERAGE: International Clubfoot Symposium

The Ponseti method of clubfoot management has achieved worldwide 
acceptance, but practitioners and researchers are still working to identify the best ways to optimize clinical outcomes while remaining sensitive to issues of cost effectiveness and cultural differences. Clinicians from around … Continue reading

November 2012

Resource-poor areas benefit from global outreach efforts

Treatment of children with clubfoot has evolved considerably in the five years that have elapsed since the inaugural International Clubfoot Symposium, and the benefits of this evolution are particularly evident in resource-poor nations—home to about 80% of the 200,000 children born each year with clubfoot. But practitioners who treat patients in these areas still face financial, cultural, and logistical challenges.

By Emily Delzell

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November 2012

Benefits of Ponseti method extend to older children

Clubfoot correction ideally should be performed during infancy, before children learn to walk, but experts agree that the Ponseti treatment method can also be effective in older children. Speakers at the International Clubfoot Symposium in October presented successful outcomes for Ponseti treatment of neglected clubfoot in patients aged up to 21 years.

By Jordana Bieze Foster

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November 2012

TATT in relapsed clubfeet can affect plantar flexion

Tibialis anterior tendon transfer (TATT) is known to be associated with limited ankle dorsiflexion, but practitioners should be aware that plantar flexion also can be negatively affected, according to research presented in October at the International Clubfoot Symposium.

By Jordana Bieze Foster

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October 2012

Energy efficiency with AFO use varies in cerebral palsy patients

Longer strides lead to increased work
Ankle foot orthoses (AFOs) are regularly prescribed to children with walking disabilities resulting from cerebral palsy, yet the effects of AFOs on energy recovery and work during gait are still unclear.

By Samantha Rosenblum

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October 2012

Biomodel could help researchers optimize clubfoot brace design

Method includes complex rotations
A surrogate biomodel of a child’s lower extremities, in particular the ability to model movement along multiple axes of rotation, could help improve researchers’ biomechanical understanding of bracing for clubfoot.

By Emily Delzell

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October 2012

Juvenile idiopathic arthritis study reveals footcare information gap

Issues involve custom foot orthoses
A Scottish study suggests foot care in children with juvenile idiopathic arthritis (JIA) falls short because of poor access to care and negative perceptions about custom foot orthoses. Experts say those issues may be less prevalent in the US but emphasize the need to educate patients, parents, and referring clinicians about the benefits of lower extremity care.

By Larry Hand

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October 2012

Early ACL surgery could lower risk of associated knee damage

Patterns mirror those seen in adults
Timing of reconstruction surgery after pediatric anterior cruciate ligament (ACL) injuries seems to be related to the prevalence of meniscal and chondral injuries discovered during those surgeries, according to new research published in the September issue of The American Journal of Sports Medicine.

By Cary Groner

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