July 2011

Cover Story

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

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 Dubin, Publisher

Editor Message

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

“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

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

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 Delzell

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

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

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

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


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

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

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

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


In the Moment: Sports medicine

By Jordana Bieze Foster

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
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

Delcam opens orthotic demo center, updates design/manufacture software
Fort Myers, FL-based Delcam’s new demonstration center in Windsor, Ontario, will allow the company’s application engineers to reproduce client problems to find quick solutions, provide a venue for demonstrating applications of its digital technology, which covers a range of products ...
JMS Plastics Supply broadens scope with Orthofeet insoles, shoes, socks
On July 1 Neptune, NJ-based JMS Plastics Supply began selling Orthofeet’s therapeutic shoes, diabetic insoles, and therapeutic socks. Orthofeet’s shoes and orthotics are approved by Medicare and meet the requirements of the Therapeutic Shoe Bill. The shoe line is appropriate ...
Medco to carry Progressive Health Innovation’s Ankle Foot maXimizer
Progressive Health Innovations, the Port Moody, B.C.-based manufacturer of the Ankle Foot maXimizer (AFX), has reached a distribution agreement with Medco Sports Medicine, a division of Patterson Medical and the largest supplier of medical products to athletic trainers in the ...
Art de Cure event raises $25,000 for American Diabetes Association
Art de Cure’s Albany, NY, board members presenteda $25,000 check to the American Diabetes Association (ADA) on June 3 at the Tour de Cure VIP Awards Dinner. The money was raised at a benefit held in the Art de Cure ...
Ballet dancers say Muscle Angel massagers keep them on their toes
Boston Ballet Company dancers and physical therapists recently endorsed the hand-held massagers from Muscle Angels, part of Brookline, MA-based Norbis Innovations. Kelsey Hellebuyck, corps de ballet member, said she uses two Muscle Angels to work both sides of her body ...
Shavelson gets patent for foot typing system, foot-type specific orthotics
Dennis Shavelson, DPM, recently received a U.S. patent for his Functional Foot Typing (FFT) method, FFT Pre-Orthotic Padding system, and Foot Centring orthotics. Shavelson’s FFT system identifies four possible types for both the rearfoot and the forefoot: rigid, stable, flexible, and ...
PMD consensus document available for online feedback through July 31
Efforts to standardize protocols for plantar pressure measurement devices (PMDs) so data can be more easily interpreted and compared by scientists and clinicians have produced a draft consensus document, “Agreement on PMD hardware performance assessment,” that is open for comment ...
Maddak launches new website
Pequannock, NJ-based Maddak’s new website at www.maddak.com features more than 400 Ableware self-help products. The company calls it a complete resource for ADL (aids for daily living) for home medical equipment distributors, health care professionals, and end users. The website ...
ACFAOM announces October dates for 2011 annual conference in Orlando
The annual American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) conference, scheduled for October 27 through 30 at the Hilton Orlando Bonnet Creek in Orlando, FL, will feature the latest information for clinicians involved in the nonsurgical care ...
AOPA reveals plans for U.S.-based World Congress of O&P in 2013
The American Orthotic & Prosthetic Association (AOPA) announces the 2013 World Congress of Orthotics & Prosthetics, which will take place September 18 through 21, 2013, at the Gaylord Palm Resort in Orlando. For more information or to learn how to present ...


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 ...
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 ...
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
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 ...
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 ...
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, ...
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 ...
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 ...
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, ...