July 2011

Cover Story


EXERCISE AND NEUROPATHY:  Not mutually exclusive
EXERCISE AND NEUROPATHY: Not mutually exclusive
Exercise is a cornerstone of treatment for diabetes, but for years patients with peripheral neuropathy have been dis­couraged from weight-bearing exercise for fear of further increasing ulceration risks. Now new research is turning that advice on its head. By Cary Groner

Publisher’s Memo


Publisher’s memo: Our second year
Publisher’s memo: Our second year
Another year has virtually flown by, and I am so happy to share with you LER’s progress as an organization in the past year. Thanks in no small part to you, our readers, we have experienced a lot of exciting accomplishments and achieved some key goals that I had set when I started the magazine. Richard ...

Editor Message


Out on a limb: Subtle distinctions
Out on a limb: Subtle distinctions
Those investigating alleged improprieties associated with a 2007 study on hip protectors will tell you their efforts are all about ethics. But the way I see it, the more important lesson to be learned from this situation is one of biomechanics, specifically the clinical importance of the subtleties of asymmetry. Jordana Bieze Foster, Editor

Special Section:


KID STUFF: Pediatric clinical news update

In this special section, LER updates you on the latest research and clinical news to help optimize management of your littlest lower extremity patients. Topics include pediatric flexible flatfoot, cerebral palsy, ACL injury, clubfoot, Charcot-Marie- Tooth disease, gait patterns in autism, and footwear for early walkers.

Sponsored with educational grants from…


New papers revisit, rekindle flexible flatfoot controversy
New papers revisit, rekindle flexible flatfoot controversy
“Other considerations” spark debate In January 2010, when LER first covered the controversy, Australian podiatrist and researcher Angela Evans, PhD, had recently published a paper in the Journal of the American Podiatric Medical Association suggesting that children whose feet were flatter than expected, but asymptomatic, should be monitored rather than automatically treated with orthoses. By Cary Groner
CP experts assess evidence for use of orthotic devices
CP experts assess evidence for use of orthotic devices
Despite progress, research gaps remain The January publication in NeuroRehabili­tation of the recommendations from a consensus conference held in 2008 paints a less-than-perfect picture of the evidence underlying orthotic management of cerebral palsy (CP). By Larry Hand
ACL injury prevention training focuses on younger athletes
ACL injury prevention training focuses on younger athletes
Age-specific protocols are key to success Training programs aimed at preventing anterior cruciate ligament injuries have been used for many years, but injury rates remain high. Injury prevention experts suggest such programs may be more effective if implemented before children reach the ages associated with highest injury risk and if the programs utilize age-specific protocols. By Emily ...
Not all practitioners embrace soft soles for novice walkers
Not all practitioners embrace soft soles for novice walkers
Barefoot-like isn’t necessarily best Barefoot is a biomechanics buzzword these days, but not all practitioners believe soft-soled shoes are best for very young children, even if such shoes do approx­imate the barefoot walking experience. By Shalmali Pal
Charcot-Marie-Tooth patients respond to AFO management
Charcot-Marie-Tooth patients respond to AFO management
But recognizing device limits is key Muscle weakness and instability associated with Charcot-Marie-Tooth disease in children can be addressed with ankle foot orthoses, research suggests, but practi­tioners should be aware of the limitations of AFOs in this patient population as well as the ever-present challenge of compliance. By Shalmali Pal
French study favors Ponseti over compatriots’ technique
French study favors Ponseti over compatriots’ technique
Casting simplifies clubfoot management In a comparative study published in the April/May issue of the Journal of Pediatric Orthopaedics, French researchers found that Ponseti casting compared favorably to French physiotherapy for initial treatment of idiopathic clubfoot. By Emily Delzell
Early research characterizes gait associated with autism
Early research characterizes gait associated with autism
Results could have clinical implications Little research has been published about gait patterns in children with autism, but that could be changing. One recently published study, although small, appears to lay the foundation for more focused research and could have clinical implications as well. By Larry Hand

Departments


Ankle sprain prevention revisits shoes as solution
Ankle sprain prevention revisits shoes as solution
In the ongoing battle against inversion ankle sprains in basketball and other sports, high tops are old news. But shoe designers have begun to investigate other ways that shoes might play a role in preventing sprains rather than contributing to the problem. By Cary Groner
Plantar fasciitis: A new take on custom orthoses
Plantar fasciitis: A new take on custom orthoses
The medical literature generally supports the use of foot orthoses for management of plantar fasciitis symptoms, but evi­dence regarding specific orthotic designs is inconclusive. Early research suggests a temporary custom foot orthosis may be an effective treatment option. By Caryn Doggett, DPT, Michelle Drake, DPT, and Robert Boyles, PT, DSc, OCS       
Original research: Skill level and balance in golf
Original research: Skill level and balance in golf
Previous research has identified superior balance in professional golfers compared with controls as well as associations between balance and skill level in amateur golfers. This study compared standing balance characteristics between profes­sion­al and highly skilled amateur golfers. By Robert Donatelli, PT, PhD; Kenji Carp, PT, ATC, OCS; Guido Pagnacco, PhD; and John Adam, ATC      
Prehabilitation for TJA: More than just exercise
Prehabilitation for TJA: More than just exercise
New England Baptist Hospital’s multi­disciplinary prehabilitation program is grounded in research suggesting that outcomes after total joint replacement can be positively influenced by preoperative care that includes management of patient expectations as well as exercise. By Claire E. Robbins, PT, DPT, MS, GCS, James V. Bono, MD, and Carl T. Talmo, MD

News


In the Moment: Sports medicine

By Jordana Bieze Foster

Meniscal misadventures
Meniscal misadventures
Some surgeries may predict AC lesions Research presented this month at the annual meeting of the American Ortho­paedic Society for Sports Medicine spelled more bad news for advocates of menis­cectomy, potentially linking the embattled procedure to the development of articular cartilage ...
Soccer hamstring injury data suggest need for gender-specific intervention
Gender appears to affect patterns of hamstring injury in soccer, suggesting that different prevention strategies may be in order for male and female players, according to a study presented in June at the National Athletic Trainers Association meeting. Researchers from the ...
Low vitamin D levels plague NFL players, possibly increasing risk of muscle injury
A preseason evaluation of the New York Giants football team found that nearly all players suffered from vitamin D insufficiency, a factor that may have contributed to muscle injuries, according to a study presented this month at the AOSSM meeting. Researchers ...
Anterior stiffness differentiates chronic ankle instability from ‘potential copers’
Anterior stiffness may be a key differentiator between people who develop chronic instability following an ankle sprain and those who recover fully, according to research presented in June at the annual meeting of the National Athletic Trainers Association. Investigators from the ...

In the Moment: Footcare

By Jordana Bieze Foster

A coup for pes cavus
A coup for pes cavus
New approach supports orthotic care In contrast with previous findings based on peak pressure values, an abstract presented at July’s International Society of Biomechanics (ISB) meeting in Brussels used a new method of measuring dynamic plantar pressure distribution to confirm that ...
Shear associated with heel height could increase shoe-related risks
Posterolateral shear stress increases with heel height and could play a key role in high-heeled shoe-related foot disorders, according to a study in the June issue of the Journal of Biomechanics. Investigators from Hong Kong Polytechnic University used in-shoe triaxial force ...
Inexpensive intervention reduces falls in older adults with severe foot pain
A multifaceted fall-prevention program introduced in a group of community dwelling older adults reduced falls by 36% compared with a control group, according to a June British Medical Journal study. Investigators at La Trobe University in Bundoora, Australia, randomized 305 adults ...

Market Mechanics


Products


Double Depth From Dr. Comfort
Double Depth From Dr. Comfort
Offering patients appealing styles of diabetic shoes can improve compliance and outcomes. Dr. Comfort’s new Double Depth Collection adds four new style options to its two classic designs; all come in several colors. This collection works for hard-to-fit patients, including ...
Direct-milled Polypro Orthotics
Direct-milled Polypro Orthotics
Amfit introduces direct-milled polypropylene functional orthotics (FOs). This addition to Amfit’s central fabrication facility allows practitioners to specify and dispense polypro FOs with the same ease as its ethyl vinyl acetate (EVA) functional orthotics. Amfit Polypro FOs offer adjustable rigidity, ...
Apis Mt. Emey Medical Footwear
Apis Mt. Emey Medical Footwear
Apis’s Mt. Emey Medical Collection shoes are designed for hard-to-fit feet as well as those with more challenging orthotic needs. These shoes offer a variety of closures for adjustability and accommodate mild or severe foot deformities, including those caused by ...
QuikStride-Plus Prefab Insole
QuikStride-Plus Prefab Insole
FootStride Technology’s custom orthotic lab offers an improved version of its QuikStride prefabricated insole. The insole’s full-length cover provides a shock-absorbing cushion that molds to patients’ feet while its combination of Dri-Lex Eco antimicrobial material and perforated EVA wicks away ...
Handcrafted  Leather Orthotics
Handcrafted Leather Orthotics
ComfortFit Labs’ Classic Leather Collection’s trio of handcrafted orthotics includes the Leather Balancer, Leather Shaffer, and Leather Laminate. The Leather Balancer’s deep heel cup provides rearfoot control and minimizes mediolateral instability. The Leather Shaffer’s medial flange offers firm arch support, ...
Aquatic Access Pool Lifts
Aquatic Access Pool Lifts
Aquatic Access’s redesigned line of IGAT (in-ground automatic turn) pool lifts is compliant with 2010 Standards for Accessible Design, which require public recreational facilities to be handicapped accessible. Easily removable Aquatic Access lifts, for aquatic therapy patients who are unable ...
Pro-Tec Gel-Force Knee Support
Pro-Tec Gel-Force Knee Support
Pro-Tec’s Gel-Force Knee Support is designed to alleviate knee pain and provide moderate knee joint stability for patients with patellofemoral pain syndrome, patellar maltracking, chondromalacia, and minor meniscus and ligament tears. It provides patellar compression and offers stability on the medial ...
Hot & Cold Foot Massager
Hot & Cold Foot Massager
Health Enterprises’ Therapeutic Hot & Cold Foot Massager provides three massage options to help relieve pain and reduce stress. The over-the-counter massager can be filled with warm water or ice or cold water and offers alternate pressures for relaxing or ...
Hersco Low Profile Ankle Gauntlet
Hersco Low Profile Ankle Gauntlet
Hersco Ortho Labs introduces the extra low profile Butterfly brace, a lightweight, flexible, custom-made ankle gauntlet designed to fit in almost any shoe. The Butterfly is a slim version of the traditional plastic-in-leather ankle support and is an option for ...