August 2014

LER08-14cvr-SMCover Story

Incline walking: An offloading option for patients with knee OA

Incline walking on a treadmill results in less frontal plane knee loading and more gluteus, hamstrings, quadriceps, and triceps surae muscle activation than level walking, and therefore may benefit patients with knee osteoarthritis or those who have undergone knee replacement.

By Henry Wang, PhD, Mason Haggerty, MS, Clark Dickin, PhD, and Jennifer Popps, PhD

Editor Message

Out on a limb: Taking on Tommy John

Baseball’s approach to preventing arm injuries so far has been to try to limit loads on the arm itself. But more and more evidence seems to suggest some of the prevention efforts should be focused further down the kinetic chain.

By Jordana Bieze Foster, Editor

Special Education Series: Pediatric Hypotonia

Mobility and More

At the most basic level, mobility is about getting from point A to point B. But, for many children with hypotonia, it’s about so much more.

It’s about independence. It’s about confidence. It’s about maintaining strength, fitness, and healthy bones. It’s about not being excluded from activities enjoyed by their typically developing peers.

Sponsored by an educational grant from SureStep.



Special Educational Series: Pediatrics

A matter of timing

If an intervention has the potential to treat or prevent lower extremity issues in a child, clinicians and parents are naturally inclined to implement it as early as possible. It makes sense intuitively, and in many cases early intervention is supported by published evidence. But in other cases the picture is less clear.

Continue Reading →


Patient Perspective: The long struggle to get a knee back in the game

It happened about two years ago while I was playing a friendly game of basketball with my teenage sons and friends. I was 49 years old and never felt like slowing down. Like most guys, while playing ball, we would imitate our favorite players.

By Joseph Hayward

AFO tuning: Balancing function and satisfaction

Tuning of ankle foot orthoses (AFOs) and AFO-footwear combinations can significantly improve gait in patients with neuromuscular impairments. Even so, some pa- t­ients still prefer their untuned devices, which has led researchers and clinicians to reexamine their approach to intervention.

By Cary Groner

Return of strength after Achilles tendon surgery

Despite excellent subjective outcomes following Achilles tendon repair, significant plantar flexion and dorsiflexion strength deficits often persist. However, modern trends in postoperative rehabilitation represent a progression toward a more functional strength recovery.

By David A. Porter, MD, PhD, Kirk Cleland, MD, and Angela M. Rund, MEd, ATC

Flexible flatfoot: Foot orthoses and outcomes

Many studies have shown an effect of foot orthoses on biomechanical function in patients with flexible flatfoot, but few studies have focused on patient-centered outcomes. There is a need to investigate the effect of foot orthoses on pain and fatigue in these individuals over time.

By Sarah A. Curran, PhD

Running shoe mass: Can feet tell any difference?

Research suggests that when trying on athletic shoes in a retail store, an individual’s perceptions of shoe mass primarily come from handling the shoes and less (if at all) from test-wearing them. In addition, the foot’s perception of shoe mass does not appear to improve with practice.

By Joel G. Greenya, BS, Stephen J. Slade, BS, Christopher L. Kliethermes, PhD, and David S. Senchina, PhD

Dynamic compression for recovery in athletes

US Olympic Committee researchers have found that peristaltic pulse compression of the lower extremities may provide a means of enhancing the rheological properties of the lower extremities without resorting to extreme temperatures, expensive body work, or stretching.

By William A Sands, PhD, FACSM, CSCS


In the Moment: O&P

By Samantha Rosenblum and Emily Delzell

Making history: Nurse is first US osseointegrated amputee

It was a first for Las Vegas physical therapist Edward Dolegowski, PT: An amputee reported that her prosthesis felt like her leg.

By Samantha Rosenblum

Weight-bearing casts for Achilles tear keep pace with nonweight-bearing

Use of a weight-bearing cast for the nonoperative treatment of acute Achilles tendon rupture produces outcomes that are at least equivalent to traditional nonweight-bearing casts, according to a randomized controlled trial from researchers in Auckland, New Zealand.

By Emily Delzell

AFO users retain deficits in function, blood flow many years after stroke

People who use an ankle foot orthosis (AFO) after a stroke retain significant deficits in neuromuscular function and blood flow many years later, according to research from the University of Oklahoma in Oklahoma City.

By Emily Delzell

Market Mechanics

By Emily Delzell

Analysts predict sluggish market for robotic orthopedic surgery systems

London, UK-based market information firm GlobalData reported in July that computer-assisted and robotic surgery are expected to remain the reserve of top-tier hospitals, mostly in developed countries, and that the technology has been slow to gain general acceptance.

Pedorthic groups announce symposium

The Pedorthic Association of Canada (PAC) and the Pre­scription Foot Orthotic Laboratory Association (PFOLA) announced in July the two organizations will partner for the annual PAC Symposium in 2015.

DME admins to reject claims with errors

Beginning September 1, paper claims that are billed with incorrect modifiers will be returned as “unprocessable,” according to Nash­ville, TN-based CGS Administrators, the Jurisdiction C Durable Medical Equipment Medicare Administrative Contractor (DME MAC).

O&P Social launches new platform

O&P Social, a social media site for O&P, pedorthic, and allied health professionals, in July revamped its site,, with new functions and features.

Insoles decrease sensitivity to pain

A study epublished on July 16 reported that shock-absorbing insoles (SAIs) made by Otto Bock Scandinavia in Norrköping, Sweden, reduce pain sensitivity and perception in young soccer players playing on artificial turf.

Self-adapting dressing reduces costs

Santa Clara, CA-based Osnovative Systems reported in July that a study of its self-adaptive wound dressing showed the product reduced wound care costs by 30%.

Sigvaris offers education, marks 150 years

Peachtree City, GA-based Sigvaris North America is offering several educational opportunities to practitioners who fit compression hose and stockings, the company announced in July.

US district court dismisses AOPA suit

In August the US District Court for the District of Columbia issued a decision granting the government’s motion to dismiss the case the American Orthotic and Prosthetic Association (AOPA) filed in May 2013 challenging the Medicare…

Tekscan demos devices at biomech event

Tekscan introduced attendees of the seventh World Congress of Biomechanics, held in Boston July 6-11, to a variety of its lab based biomechanical assessment and application technology solutions.

ACFAP installs DeCaro as new president

The American College of Foot and Ankle Pediatrics (ACFAP) installed Louis J. DeCaro, DPM, on July 25 as its new president. DeCaro, who is currently in private practice in West Hatfield, MA, and directs several adult and pediatric biomechanics clinics, specializes in podopediatrics.

Bacterin filler effective for talar defects

Patients with osteochondral defects of the talus and previously failed microfractures who underwent malleolar osteotomy and implantation of Belgrade, MT-based Bacterin’s allograft bone graft material had positive outcomes at two-year follow-up, according to a study epublished in July by The Journal of Foot & Ankle Surgery.

Down syndrome group honors Veldman

The National Down Syndrome Congress (NDSC) on July 12 presented SureStep CEO Bernie Veldman, CO, with its 2014 Exceptional Meritorious Service at its annual conference in Indianapolis.

Diabetic shoes cut lower extremity risks

Milwaukee, WI-based Dr. Comfort released results in July of a study showing people with type 2 diabetes who wear therapeutic shoes lower their likelihood of developing foot ulcers and undergoing lower limb amputations.

CaerVision appoints new director

Frederick, MD-based CaerVision, in July appointed Sarah Brey­meier senior director of its Podiatry Network, which provides educational and marketing content for televisions and monitors in practitioners’ waiting and exam rooms.

APMA gives Amniox seal of approval

The American Podiatric Medical Association (APMA) in July gave its Seal of Approval to Amniox’s Neox Wound Matrix and Clarix Regenerative Matrix product lines.


Comfortmaxx Orthoses

New from Footmaxx is the Comfortmaxx hand-crafted custom orthosis line featuring 100% merino wool and designed with comfort in mind. Merino wool helps keep feet warm in cold months and cool in hot months…

Coral Joint Supplement

Coral introduces Coral Joint & Collagen Support, a supplement engineered to help maintain bone health and joint flexibility. Ingredients include above-the-sea EcoSafe coral minerals and vitamins D3, K1, and…

EVO Quatro Ankle Stabilizer

The new EVO Quatro Ankle Stabilizer from Med Spec is a low-profile version of the EVO Ankle Stabilizer. The Quatro’s boot design has been modified to reduce the coverage around the midfoot and allow for…

Impacto Ergo Mates

Among the newest additions to the Impacto Protective Products foot protection line are Ergo Mates. Ergo Mates are designed to reduce fatigue, pain, and discomfort when walking or standing for long periods.

Ironman Insoles

Spenco introduces new Ironman insoles, specifically engineered to help endurance athletes conquer challenges. Available in Ironman Race and Ironman Train configurations, the insoles offer a combination of cushioning…

Orthoflex Thermoplastic

Orthoflex, new from Allied O&P Supply, is a flexible, formable thermoplastic material designed for below-knee socket liners, above-knee socket liners, ankle foot orthosis cushioning, inner booties, shock absorption…

Square Toe Post-Op Shoe

Powerstep’s new Square Toe Post-Op Shoe is designed to provide protection for the foot following surgery or trauma. A rigid heel counter and ankle strap hold the foot securely in place to control motion in the shoe.

Arcopedico Cork Sandals

Arcopedico USA takes a refreshing look at women’s comfort footwear with its cork sandals. The sandals feature bright hues, flirty wedges, leather and knit straps, anti-slip thermal rubber, and lightweight soles made…