August 2017

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Cover Story

Flip Flops: Biomechanical critiques resonate with clinicians and designers

It’s no secret by now that traditional flimsy flip flops are associated with gait alterations that can contribute to more serious issues, but for many patients, flip flops are a hard habit to break. A new generation of “comfort” flip flops offers an alternative, but clinicians remain wary.

By Shalmali Pal

Editor Message

Out on a Limb: Seeking a safer preseason

Anyone watching the injuries accumulate during the most recent National Football League (NFL) preseason might be en­couraged by the league’s  plans to shorten the pre­season from four weeks to three. But the medical literature suggests a much better way to reduce the incidence of preseason injuries.

Jordana Bieze Foster, Editor


Frontal plane kinematics and risk of ankle sprain

Research suggests that a simple step-down task has a strong relationship with frontal plane ankle kinematics during walking and jump landing, and may be one method of screening or assessing for increased inversion—and, in turn, increased risk of future ankle sprain—in clinical settings.

By Luke Donovan, PhD, ATC; and Mark A. Feger, PhD, ATC

AFOs and balance issues in peripheral neuropathy

At a symposium in Cape Town, South Africa, an orthotist demonstrated his technique for treating balance issues in patients with peripheral neuropathy using ankle foot orthoses (AFOs), and a team of researchers theorized about evidence-based concepts that could help explain his findings.

By Cary Groner

Biomechanics of femoral neck fractures in runners

Factors related to joint loading during running contribute to the development of stress fractures in the femoral neck and other lower extremity structures. Research suggests these loading parameters can be reduced by altering running foot strike pattern, stride length, speed, and step rate.

By Mark Riebel, PT, DSc, OCS, SCS

Clinical prediction rules: Finding a middle ground

Clinical prediction rules (CPRs) are intended to improve patient care, but critics have suggested that—for a number of reasons—the opposite may be true. Lower extremity experts interviewed by are in agreement that, ultimately, even the best CPRs should be only one piece of the clinical puzzle.

By Cary Groner


In the Moment: Ankle OA

Early warnings: Data support aggressive intervention

Osteoarthritis (OA) is commonly thought of as a disease that takes decades to manifest. But two new studies suggest some critical aspects of the ankle OA disease process actually develop quite quickly, emphasizing the importance of early intervention.

By Jordana Bieze Foster

Physical examination could help predict risk of osteoarthritis after ankle sprain

Pain, swelling, and impaired motion within a year of an ankle sprain are associated with signs of early ankle osteoarthritis (OA), according to research from the Netherlands that could help clinicians identify and intervene early in at-risk patients.

By Jordana Bieze Foster

Associations between history of injury and ankle shape have OA implications

Variations in ankle shape—some related to race—are associated with history of ankle injury, according to research from the University of North Carolina at Chapel Hill that may have implications related to risk of post-traumatic ankle osteoarthritis (OA).

By Jordana Bieze Foster

In the Moment: Diabetes

Cuboid height revisited: Study disputes link to Charcot ulcers

New research from the Temple University School of Podiatric Medicine in Philadelphia, PA, raises questions about the clinical utility of assessing cuboid height to determine risk of midfoot ulcer development in patients with Charcot neuroarthropathy.

By Keith Loria

Charcot expert underscores midtarsal correction risks as well as successes

Surgical correction of midtarsal deformities related to Charcot neuroarthropathy can have a high success rate, but patient comorbidities should be carefully considered, according to research presented in July at the annual meeting of the American Orthopaedic Foot & Ankle Society in Seattle.

By Jordana Bieze Foster

Statin users demonstrate decreased incidence of diabetic foot infection

Statin use may be protective against diabetic foot infection, according to research from Iran published in the July issue of Wounds.

By Jordana Bieze Foster

Market Mechanics

By Emily Delzell

House approves AOPA-backed legislation

The Alexandria, VA-based American Orthotic and Prosthetic Association (AOPA) reported the US House of Representatives on July 25 voted to approve a bill that includes an O&P provision recognizing the orthotist-prosthetist’s notes as part of the medical record in Medicare Medical Necessity Determinations.

BraceLab formed to market Push Braces

Occupational therapist Judy C. Colditz, OT/L, CHT, FAOTA, announced in July that she has formed a new company, Raleigh, NC-based BraceLab, and completed an agreement for it to be the exclusive US distributor of Push Braces, owned by Nea International BV in Maastricht, the Netherlands.

Vicon unveils Vertex compact camera

Oxford, UK-based Vicon in July released a new 1.3 megapixel compact camera, the Vertex.

Ottobock hosts adaptive training event

Minneapolis, MN-based Ottobock on August 2 sponsored an adaptive training event the evening before the start of the three-day Amputee Coalition National Conference, held in Louisville, KY.

Wright highlights foot and ankle systems

Wright Medical Group highlighted three new lower extremity systems at the July 12-15 American Orthopaedic Foot and Ankle Society (AOFAS) 2017 Annual Meeting in Seattle, WA.

FDA clears foot/ankle In2Bones systems

Memphis, TN-based In2Bones USA reported in July it has received US Food and Drug Administration clearance for its new fracture repair and correction systems.

APTA reaches 100K-member mark

The Alexandria, VA-based American Physical Therapy Association (APTA) in August reported it has achieved a major membership milestone: 100,000 members.

Össur brace mimics native ACL function

The Orthopaedic Journal of Sports Medicine on July 6 epublished study data showing support with an Össur dynamic force anterior cruciate ligament (ACL) brace better matches the angle-dependent forces of a native ACL than a static force ACL brace.

Orthotic designer John Sabolich dies

John Alan Sabolich, CPO, owner and clinical director of Scott Sabolich Prosthetics & Research in Oklahoma City, OK, died July 23. He was 68.

AOFAS launches awareness campaign

The Rosemont, IL-based American Orthopaedic Foot & Ankle Society (AOFAS) in July launched a consumer awareness campaign and website to help the public recognize the value of seeking a foot and ankle orthopedic surgeon for foot and ankle care.

APMA contributes ‘Choosing Wisely’ list

The American Board of Internal Medicine (ABIM) on August 1 published a “Choosing Wisely” list from the Bethesda, MD-based American Podiatric Medical Association (APMA).

Pacira’s Exparel cuts post-TKA opioid use

The Journal of Arthroplasty in August published data showing local infiltration analgesia (LIA) with liposomal bupivacaine (LB) made by Parsippany, NJ-based Pacira Pharmaceuticals improves pain scores and reduces opioid use after total knee arthroplasty (TKA) compared with LIA alone.

CIHR MSK institute names Kahn director

The Ottawa, Ontario-based Canadian Institutes of Health Research (CIHR) in July appointed Karim Khan, PhD, scientific director of its Institute of Musculoskeletal Health and Arthritis, effective October 1.

Cleveland Clinic to host wound care event

The Cleveland Clinic announced in July that it plants to host the 2017 Limb Salvage and Woundcare Symposium October 6-7 in Independence, OH. The continuing medical education event will feature lectures, panel discussion, and case studies focused on limb revascularization and wound care for patients with diabetes.


Genesis XPS Pedorthic Shoes

Xelero introduces Genesis XPS pedorthic shoes for men and women. The shoes, which have a narrower outsole than the company’s Matrix models for a less-bulky appearance, feature an XPS propulsion…

RunScribe Wearable Sensors

RunScribe is a new wearable sensor system for data-driven runners, coaches, and clinicians to analyze stride. By capturing every foot strike, RunScribe provides a comprehensive view of a runner’s mechanics over the…

ProSelfCare Bum Wrap

The Bum Wrap from ProSelfCare is a fanny-pack style wrap that fits around the hips. It combines a hot/cold compress with therapy balls in an adjustable wrap to target and relieve muscle knots and trigger point pain in the…

Quadrastep E+ Orthoses

Nolaro24 introduces the Quad­ra­step E+ orthotic device to its Quadrastep System line, which provides custom-to-foot-type prefabricated foot orthoses as a state of the art alternative to traditional custom orthotic management.

Easy Walk Experience Shoes

New from Arcopedico USA is the Easy Walk Experience Collection of Portuguese-made comfort and travel footwear for active lifestyles, with a lower price point and new fabric technology.

MediCordz Lower Body Kit

Responding to customer requests, NZ Manufacturing now offers the MediCordz Core Stabilization Lower Body kit. Designed in conjunction with therapists from multiple disciplines, the Lower Body kit provides a…

Instavit Vitamin D Spray

Instavit now offers supplemental vitamin D in a spray delivery system to help improve lower extremity bone health in patients who have difficulty taking supplements in pill form. Referred to informally by the company as the…

BRD Sport G18 Knee Brace

The new BRD Sport G18 Knee Brace, with anatomically contoured 3D knit construction, now is even more comfortable and easier to apply. The knee sleeve is intended to aid recovery and reduce pain and…

Pro-Select Ankle Brace

New from Elite Orthopaedics is the Pro-Select Lace Up Ankle Brace, which retails for $12. The brace is intended for patients with chronic weak ankles, post ankle trauma, postop ankle…

Performance Protein Powder

Designer Protein’s Essential 10 Performance Protein supplement provides nutrients to aid postworkout recovery, alleviate muscle aches, and replenish electrolytes.

Sigvaris Accutab Compression Wraps

Sigvaris now offers three inelastic compression wraps, all featuring an Accutab system that allows clinicians to prescribe a compression level for their patients and allows patients to easily set the correct initial compression…

Copper Cloud Diabetic Socks

Apex now offers the new Copper Cloud Heavenly Diabetic Socks, designed to provide “heavenly” comfort while helping to reduce the risk of foot ulcers. The socks feature copper yarn, known for its antibacterial, antifungal, and…