February 2014

LER02-14CoverCover Story

TKA in obese patients: Weighing the risks vs the benefits

Total knee arthroplasty significantly improves functional outcomes in obese patients, but is also riskier than in normal-weight patients. As the number of obese patients with knee osteoarthritis continues to rise, clinicians are being challenged to find a balance between the risks and the benefits.

By Susan M. Odum, PhD, and Bryan D. Springer, MD

Editor Message

Out on a limb: Independent variables

When more conventional approaches lead to inconsistent or inexplicable findings, researchers sometimes find that assessing the variability of an outcome can provide a valuable perspective. But researchers still have a great deal to learn about how much variability is too much, or too little, with regard to lower extremity issues.

Jordana Bieze Foster, Editor

Special Educational Series: Pediatrics

 Shaping the future

One of the most rewarding aspects of pediatric lower extremity care is the knowledge that early intervention can have a positive effect on a child’s entire adult life—a theme that is repeated throughout this special publication dedicated to lower extremity pediatrics.

Continue Reading →


Charcot-Marie-Tooth: AFO mechanics and gait patterns

Patients with Charcot-Marie-Tooth disease showing the greatest increase in speed appear to respond to and utilize the energy storing and releasing properties of a carbon fiber composite ankle foot orthosis differently from those who had smaller increases in walking speed.

By Janet S. Dufek, PhD; Edward S. Neumann, PhD, PE, CP; M. Cameron Hawkins, PhD; and Brendan J. O’Toole, PhD

Exploring treatment options for intermittent claudication

Despite the documented benefits of supervised exercise in patients with claudication, its effect on actual clinical practice has been disappointing due to a lack of reimbursement. But practitioners and research­ers have been investigating other options, with encouraging preliminary results.

By Cary Groner

The brain: A new frontier in ankle instability research

Transcranial magnetic stimulation research suggests cortical excitability may be able to help differentiate healthy, previously injured, and functionally unstable ankle joints, and underscores the need to clinically target both mechanical and proprioceptive deficits in patients with FAI.

By Alan R. Needle, PhD

Variable amputation rates in patients with diabetes

Studies show that lower extremity amputation rates in patients with diabetes vary widely, sometimes even within individual healthcare systems. What’s more difficult to determine is why these variations exist and what can be done to improve access to care for all patients.

By Larry Hand

Epidemiology of Achilles tendon rupture in the US

The etiology of Achilles tendon rupture is multifactorial, but the injury occurs most frequently in the athletic population. Clini­cians still miss 24% of ruptures acutely, particularly in older patients, those in whom sports was not the causative mechanism, and those with high BMIs.

By Steven M. Raikin, MD


In the Moment: Sports medicine

By Emily Delzell

Platelet-rich progress: Data support PRP use for heel pain

Two studies published early this year found platelet-rich plasma (PRP) injection improved pain and function in patients with chronic severe plantar fasci­itis who hadn’t responded to conservative treatments.

Neuromuscular training in young girls boosts skills, may reduce future risks

Researchers reported in February that integrative neuromuscular training (INT) enhances motor skills in girls, improving fitness and offering potential protection from development of risk factors for anterior cruciate ligament tears and other musculoskeletal injuries.

Soccer players have strength deficits upon returning from hamstring injury

Researchers from Qatar reported in February that soccer players who sustain a hamstring injury are likely to have isokinetic strength deficits when they return to play, but the effect of those deficits on reinjury rates is unknown.

Market Mechanics

By Emily Delzell

High error rates compel PDAC contractor to continue widespread claims review

Based on the high error rates found in its most recent quarterly review, Noridian Healthcare Solutions, Medicare’s durable medical equipment pricing, data analysis, and coding (PDAC) contractor, announced in January that it will continue its prepayment widespread review of claims for therapeutic…

FDA approves US trial of Celution System

The US Food and Drug Administration (FDA) granted San Diego-based Cytori Therapeutics an IDE (investigational device exemption) in January, allowing the company to begin a prospective safety and feasibility trial of its system for bedside extraction, processing, and reinfusion of autologous adipose-derived…

Liventa, Cryoport ally for direct delivery

Philadelphia-based Liventa Bioscience and Cryoport, based in Lake Forest, CA, partnered in February to deliver Liventa’s cell-based biologics tissue forms directly to orthopedic care providers using Cryoport’s purpose-built cold chain logistics solutions, which extend the shelf life of live tissue cells.

PT group raises $3M for research center

The Foundation for Physical Therapy announced January 24 that it has reached its goal of raising $3 million to fund a Center of Excellence for training physical therapists in health services research. The mission of the Center of Excellence for Health Services/Health Policy…

AMA names Wrobel to work group

The American Podiatric Medical Association (APMA) announced in January that the American Medical Association (AMA) has selected APMA nominee James Wrobel, DPM, to serve on the AMA’s Endocrine Clinical Work Group, part of its Physician Consortium for Performance Improvement (AMA–PCPI).

Orpyx wearable sensor enters US market

Orpyx Medical Technologies, a supplier of wearable sensor-based technologies headquartered in Calgary, Canada, in January launched its flagship product, the SurroSense Rx System, into the US market. The system, which collects plantar pressure data through…

Study of cell therapy for muscle injury meets primary safety, efficacy endpoints

Pluristem Therapeutics, a developer of placenta-based cell therapies based in Haifa, Israel, released on January 21 positive results from its phase I/II safety and efficacy trial of its PLX-PAD (placental expanded) cells for treatment of muscle injury. PLX-PAD cells, which release therapeutic proteins…

Bulls’ Tedeschi is NBATA Trainer of the Year

The National Basketball Athletic Trainers Association (NBATA) awarded Chicago Bulls Head Athletic Trainer Fred Tedeschi, ATC, with its 2012-2013 Joe O’Toole Athletic Trainer of the Year honor at the January 27 faceoff between the Bulls and the Minnesota Timberwolves.

ACSM taps new editor for flagship journal

L. Bruce Gladden, PhD, FACSM, began his tenure on January 1 as editor-in-chief of Medicine & Science in Sports & Exercise, the flagship journal of the American College of Sports Medicine. Gladden is professor in the School of Kinesiology and Humana-Germany-Sherman Distinguished Professor in Education at Auburn University in Alabama.

Orthofeet partners with diabetes educators

Northvale, NJ-based Orthofeet joined with the American Association of Diabetes Educators (AADE) in January to begin a grassroots effort to bring foot health education to patients with diabetes in key US markets. The Orthofeet team will partner with the AADE network…

Apis plans Hands-on-Foot seminar

Therapeutic footwear supplier Apis, based in South El Monte, CA, is sponsoring a “Hands-on-Foot Seminar” in Columbus, OH, on March 24. Rich Rusche, CO, CPed, will lead the seminar, which will focus on management of the neuropathic limb and offer 9.75 CEUs (continuing education units).

Lamey Wellehan celebrates centennial

Auburn, ME-based shoe seller Lamey Wellehan, which has six retail locations in the state, will mark the 100th anniversary of the opening of its first store on March 17, St. Patrick’s Day, in Lewiston. The company will celebrate its centennial with a yearlong schedule of events, including door prizes, vendor days, and sales.

2014 Paralympian is Ottobock ambassador

Ottobock in February named international snowboarding cham­pi­on Keith Gabel of Ogden, UT, its newest Ottobock Ambassador. In this role, Ogden, a below knee amputee, will serve as role model for individuals with disabilities and showcase the technology he uses in daily life and in competition.

Congress adds $10M for O&P research

The American Orthotic & Prosthetic Association (AOPA) lobbied successfully to secure funds for O&P outcomes research as part of the 2014 congressional appropriations package, the organization announced in January. Congress accepted a proposal by Sen. Dick Durbin (D-IL)…


MVI Footcare Catalog

MVI Footcare, a division of Med-Vet International, is pleased to announce that its new product catalog is now available to the foot and ankle healthcare community. Built on the foundation of Med-Vet International’s 30 years of experience in the medical community, the MVI Footcare catalog is dedicated to the foot and ankle healthcare professional.

FuseForce Fixation System – Solana Surgical

Solana Surgical announces the launch of the FuseForce SuperElastic Fixation System, an implant system for fusing the small joints in the foot and ankle. The FuseForce System is a complete, sterile kit containing superelastic nitinol (memory metal) staples and all the instruments required for implantation.

Sole Supports EVA Orthotics

Sole Supports now offers new EVA (ethylene vinyl acetate) Orthotics. Constructed using Sole Supports’ newly designed optical calibration process, the EVA Orthotics are an alternative to more rigid plastic devices and are suitable for geriatric patients or patients with diabetes. The softer material combines compression with flexion…

Tru-Mold Advanced CROW

The new Advanced CROW (Charcot restraint orthotic walker) from Tru-Mold Shoes combines the comfort and mobility features of a custom-molded boot with the healing characteristics and offloading of a traditional CROW device. A TM Pressure Relief System provides recesses on the insert and removable base material…

AdaptaStep from Propét

Propét introduces the Adapta­Step recovery shoe, under its Propét Preferred therapeutic foot care line. AdaptaStep is designed to help alleviate fluid build up, speed healing, and promote a quicker return to normal gait. The Variable Flex Technology system features removable inserts in the forefoot to allow for…

Rocktape Active-Recovery

Rocktape’s Active-Recovery series of athletic tapes is available in more than 55 designs and colors, including Tattoo, Pink Camouflage, Biohazard, Argyle, U.K. Flag, Pink Skull, and Tiger. Rocktape kinesiology tape works by lifting the skin away from the soft tissue underneath, which allows more blood to move into an injured area to accelerate healing and recovery.

Dr Jill’s Orthotics

Dr. Jill’s Foot Pads now offers Dr. Jill’s Orthotics—customizable, ready-to-dispense foot orthoses. Designed by a podiatrist, the thin, lightweight, durable devices come with a lifetime guarantee that they will never break, crack, or bottom out.

WalkOn Reaction AFO

Ottobock announces the launch of the WalkOn Reaction AFO. Fabricated from a prepreg advanced carbon composite, the Reaction is lightweight, low profile, and extremely tough. It is designed for patients with weak dorsiflexion, poststroke impairment, traumatic brain injury, multiple sclerosis, neuromuscular atrophy, peroneal paralysis, and partial foot amputation.

OPTP Star Roller

OPTP introduces its newest star, the new Star Roller, designed for therapeutic self-massage, relaxation techniques, body alignment, and core strengthening exercises. Designed and patented by a physical therapist, it features deep ridges running the length of the foam roller, alternately compressing and releasing tense or rigid…

Aetrex Petals and Stretchables

Aetrex Worldwide offers two new lines of shoes: Apex Petals and Apex Stretchables. Apex Petals offers fashion-forward styles designed to provide maximum comfort and protection. The lightweight shoes have removable double depth insoles and slip-resistant soles made from injected EVA (ethylene vinyl acetate).

ClotrimazOil Antifungal

The PediFix Footcare Company announces the first antifungal with the broad-spectrum killing power of clotrimazole, in an exclusive essential oils carrier formula. ClotrimazOil is an alternative to tolnaftate and unde­- cylenic acid. Clotrimazole kills six types of fungi, yeasts, and molds that traditional antifungals don’t.

BRD Sport Achilles Brace

The BRD Sport Achilles Ankle brace is designed to provide reliable relief of pain due to Achilles tendinitis, achillobursitis, or post-traumatic irritation. Three-dimensional knitting offers a four-way stretch to improve fit and comfort. An anatomically contoured silicone tendon pad aids with increased joint stabilization and recovery.