July 2014

Out on a limb: Five-year milestones

1Limb-JordanaJordana Bieze Foster, Editor

In the five years since the launch of Lower Extremity Review, some things about lower extremity healthcare haven’t changed much. Diabetes is still an epidemic. Stem cells are still the next big thing. Management of pediatric flexible flatfoot is still controversial. Too many coaches still haven’t bought into sports injury prevention. But there have also been a number of significant developments in those
five years.

Five years ago, we knew that foot orthoses could alter plantar pressure patterns, but researchers hadn’t been able to demonstrate any effect on diabetic foot ulceration rates. Now we have evidence that foot orthoses can in fact reduce ulcer recurrence in high-risk patients.

Five years ago, the medical literature supported operative repair of Achilles tendon rupture over nonoperative treatment, primarily because surgery was associated with lower rerupture rates. Now, research suggests that rerupture rates for operative and nonoperative approaches are similar as long as rehabilitation protocols include early mobilization.

Five years ago, fusion was the only option for most patients with end-stage ankle osteoarthritis. Now total ankle arthroplasty is becoming a viable alternative, and a growing body of research suggests it offers functional advantages over conventional arthrodesis procedures.

Five years ago, video games were just a guilty pleasure. Now video game technology is making rehabilitation more engaging for a range of patient populations—including senior citizens—and studies are documenting the effectiveness of “exer-gaming” protocols.

Five years ago, researchers had documented gait variables associated with increased knee loading in patients with knee osteoarthritis or patellofemoral pain, but had just begun to look at ways of using that information clinically. Now clinical gait retraining is taking off, and the next wave of research is focusing on which specific gait retraining strategies are most effective in particular subgroups of patients.

Five years ago, all concussion-related sessions at sports medicine conferences were focused on the anatomy above the neck. Now the effects of concussion on postural control and the apparent connection between concussion and musculoskeletal injuries are increasingly becoming part of the concussion discussion.

Lower extremity healthcare can be frustrating. At times it may seem like you’re seeing the same clinical issues over and over again, in one patient after another, day after day. It may seem like each new study you read raises more questions than it answers, and even the answers amount to only one small piece of a huge clinical puzzle that may never be solved. Trust me, as a medical journalist, sometimes I feel the same way.

But when you stop and think about it, there really have been a number of tangible advancements in the last five years. And given the maddeningly slow rate at which high-level scientific studies can realistically be conducted, published, and disseminated into clinical practice, that’s pretty impressive.

In our first five years, LER has brought you detailed coverage of all the developments listed above, as well as many more, and we have no plans to stop now. I for one can’t wait to see what the next five years will bring.

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