August 2011

Cover Story

Momentous adaptations: Offloading the knee through gait modification

Changing the way people walk can significantly decrease knee external adduction moments, which in turn appears to relieve pain and possibly slow the progression of osteoarthritis. The challenge, however, is finding a gait modification that feels and appears natural to patients.

By Lydia Caldwell, BS, and Joaquin Barrios, PT, DPT, PhD

Editor Message

Out on a limb: A thin disguise

It’s hard to remember sometimes that being thin was once undesirable, a sign of poverty, poor nutrition, and low social status. These days, Hollywood-style thinness is associated with wealth—the kind of wealth that might buy the services of a personal dietitian, personal chef, and personal trainer.

By Jordana Bieze Foster, Editor


The role of rocker soles in reducing ulcer risk

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

Effects of balance training in individuals with CAI

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

Pros, cons of pressure in foot orthosis design

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

Gait analysis influences care of children with CP

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       

Next step for FES focuses on plantar flexor muscles

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


In the Moment: Footcare

By Emily Delzell

Handicapping hallux valgus
Predictive variables include race, age Research presented in July at the annual meeting of the American Podi­atric Medical Association in Boston adds to knowledge of risk factors for and prevalence of hallux valgus. Older age, African American race, high heel use, ...
Orthoses relieve metatarsal pressure with or without met pad modification
Foot orthoses modified with metatarsal pads, the current standard of care for metatarsalgia, don’t significantly reduce plantar pressure compared with orthoses alone, according to a study presented in July at the annual APMA meeting in Boston.
Mild compression socks reduce edema, maintain flow in patients with diabetes
Mild compression socks can reduce lower extremity edema in patients with diabetes without compromising vascularity, according to research presented in July at the annual APMA meeting in Boston.

In the Moment: Sports medicine

By Jordana Bieze Foster

PFP: Vasti revisited
Other factors may warrant focus Research presented in August at the annual meeting of the American Society of Biomechanics in Long Beach, CA, adds support to the increasingly popular idea that patellofemoral pain syndrome arises from different mech­anisms—and therefore should be ...
Foot strike patterns do not predict impact loading rates while running
Just because a runner’s foot strike pattern changes as a result of switching from shod to barefoot running doesn’t necessarily mean that runner will experience lower impact loading rates, according to research from the University of Oregon presented in August ...
Athletes of both genders risk asymmetry in landing kinetics after surgery on ACL
Female athletes may have a greater risk of a primary anterior cruciate ligament injury than their male counterparts, but following ACL reconstruction both genders are equally prone to asymmetrical landing kinetics that could lead to a second injury, according to ...

In the Moment: O&P

By Jordana Bieze Foster

Upshots of ankle bracing
Proximal effects could put knees at risk Bracing the ankle has kinetic effects at the more proximal joints that could increase the risk of anterior cruciate ligament injury, according to research from Iowa State University presented in August at the annual ...
Gait data suggest ESAR prosthetic feet sacrifice stability to improve propulsion
Decreasing the stiffness of an energy storage and return prosthetic foot improves propulsion but does so at the cost of stability, according to research from the University of Texas at Austin presented in August at the ASB meeting.
Ankle foot orthoses assist conservative treatment of retrocalcaneal heel pain
Nonoperative treatment of retrocalcaneal heel pain with stretching and ankle foot orthoses has had an 83% success rate at the University of Tennessee, researchers from that institution reported in July at the annual meeting of the American Orthopaedic Foot & ...

Market Mechanics

Study supports Heelift to lower risk of pressure ulcers after hip fracture
The Heelift Suspension Boot from Evanston, IL-based DM Systems can significantly reduce the risk of pressure ulcers in patients recovering from hip fracture, according to a study from Northern Ireland published in the July issue of the Journal of Wound ...
Masterfit University courses hone snowsports boot fitting expertise
Lower extremity practitioners who are involved or interested in snowsports boot fitting can learn the relevant skills while earning continuing education credits through Briarcliff Manor, NY-based Masterfit University. Designed and taught by certified pedorthists with more than 225 years of experience ...
Charcot-Marie-Tooth Association marks September for awareness
The Charcot-Marie-Tooth Association (CMTA) has announced plans for National Charcot-Marie-Tooth disorder Awareness Month in September 2011. The CMTA will host local, national, and global events to raise awareness of this degenerative neuromuscular disease. CMT Global Day is scheduled for September 24th, ...
PAL updates XtremityOne software for diabetic orthotic management
Pekin, IL-based PAL Health Technologies announced in August the release of Version 3 of its XtremityOne software for computer-assisted orthotic management of diabetic foot ulcers. XtremityOne is a portable, integrated unit that captures scanned foot images, allows for image manipulation in ...
littleSteps orthosis line expands to include larger children’s sizes
Middlebury, CT-based Nolaro24 has added new sizes to its littleSteps product line of pediatric orthotic devices. littleSteps now come in sizes 6 and 7, so the entire line now accommodates shoes ranging from toddler size 8.5 to children’s size 6. littleSteps ...
CastCooler extends global reach with distribution in Middle East
CastCooler is now bringing relief to some of the hottest places on the planet. The Colorado Springs, CO-based company announced in July its plans to begin distribution in Saudi Arabia, United Arab Emirates, Oman, Kuwait, Qatar, Lebanon, and Turkey—starting with a ...


OPTP Foam Roller Techniques
Orthopedic Physical Therapy Products has released the updated second edition of Foam Roller Techniques. The edition offers full-color images, new anatomical diagrams, 47 pages of descriptive instructions, and clear photo demonstrations of self-massage techniques for each muscle group. Self-massage with ...
REL-K Microprocessor Knee
The REL-K (Rizzoli Electronic Knee), distributed by Fillauer, is the latest generation of microprocessor knees, giving patients who have undergone amputation the ability to easily navigate their environment. With six modes of control, patients can walk, run, negotiate slopes, climb ...
TheraFlix Online Exercise System’s exercise prescription software provides patients and providers with an online library of physical therapy exercise videos. Each exercise is featured in a high-definition video, still image, and full-text description with verbal cueing. Exercises can be organized into protocols or ...
Arcopédico Travel Shoes
Arcopédico’s Portuguese-made women’s shoes are designed for frequent travelers. The anatomically designed shoes have arch-supporting soles and nonbinding uppers and are engineered for comfort. The lightweight, packable shoes have moisture-wicking and antimicrobial insoles. The Shawna leather line has a flexible ...
Therapy Motions Exercise Cycle
Therapy Motions’ second-generation eVO System is a stationary, motorized dual-motion therapy cycle with reciprocating handlebars and foot pedals that are interlinked to provide coordinated movement. Its motion provides simultaneous physical and rehabilitative therapy to both the upper and lower extremities. ...
Low-profile Insole
Spenco Medical introduces the PolySorb ProForm, an insole that provides cushion and support for tight-fitting shoes. The ProForm, an ultra-thin insert, is designed to provide comfort in shoe styles that typically do not have room for an insole. Its four-way ...
MedEfficiency TCC-EZ Boot
MedEfficiency has released an improved TCC-EZ Boot for diabetic foot ulcer healing. The updated TCC-EZ Boot, designed for use with the TCC-EZ Total Contact Cast System, features a Velcro closure, side paddles that grip the TCC-EZ cast, and a new sole ...
Insightful Products Step-Smart Brace
Insightful Products’ new Step-Smart brace for foot drop pushes the foot into gentle dorsiflexion during swing phase and then decelerates the foot during heel strike. The brace is designed to provide correct timing of shock absorption and the appropriate level ...
Össur Re-Flex Rotate Foot
Össur’s Re-Flex Rotate with energy vector optimization is a durable high performance foot that provides both vertical and rotational shock absorption as well as smoother rollover for increased stability in stance. The combination is appropriate for very active or moderately ...
Euro International Therapeutic Shoes
Euro International introduces a new therapeutic shoe line, and now offers an assortment of surgical and foot-relief shoes, including the Mars, Saturn, Jupiter, Venus, Merkur, Uranus, and Neptune models. The new line features high-quality craftsmanship and material selection to accommodate ...
Pedifix GelSmart Toe Spacer
PediFix introduces the GelSmart gel toe spacer, which is equipped with a gel loop to fix the device in place. The toe spacer with stretchable gel loop, made from a comfortable, durable gel material, separates the hallux and second toe ...
Foot Foundation Balance System
The Foot Foundation’s new Sports Balance System measures and controls pronation with archless, custom-angled, full-foot foundations that can be used in almost any shoe, including athletic shoes. The SBS measurements correspond with one of 12 custom angled foundations that are designed to quickly and ...