July 2013

LER07-13cvrsmCover Story

Glycemic control and postoperative healing

Researchers have established that elevated levels of glycated hemoglobin in patients with diabetes are associated with poor outcomes after foot and ankle surgery. Now the challenge is to identify an “acceptable” glycated hemoglobin level below which the benefits of surgery outweigh the risk of complications.

By Naohiro Shibuya, DPM, MS, FACFAS, Jon M. Humphers, DPM, and Daniel C. Jupiter, PhD

Publisher Message

Rich Dubin, Publisher
Publisher’s memo: A healthier approach

As we celebrate LER’s fourth anniversary, I feel that I would be remiss if I didn’t take this opportunity to share what I have personally experienced this past year. Last July, my wife decided to go back to school to become a certified health coach. Little did I know then that this would bring profound changes in my life both personally and professionally.

Richard Dubin, Publisher

Editor Message

Out on a limb: Sins of expertness

In journalism, as in much of healthcare, we tend to focus our attention on what is new. But every once in a while we’re reminded that words and ideas published more than a decade ago still have the power to challenge the way we think.

Jordana Bieze Foster, Editor

CONFERENCE COVERAGE: Orthotics Technology Forum 2013

Click image to download PDF (6.7mb)

Click image to download PDF (6.7mb)

In late May lower extremity clinicians, orthotic lab owners and managers, and technology experts gathered at the Georgia Institute of Technology in Atlanta for a discussion of digital technology in orthotic application, design, and manufacture.

By Emily Delzell

Sponsored by an educational grant from…


High-tech path leads to the future of improved orthotic prescription

One of the most-talked-about images from the 2013 Orthotics Technology Forum (OTF) depicted 11 custom foot orthoses made by 11 experienced orthotists and podiatrists for a single patient. All 11 practitioners had been given the same information about the patient’s condition, yet all 11 orthoses were distinctly different.

3D printing: The shape of things to come

The Orthotics Technology Forum presentation given by Ben Boyer, CPed, was as much about what the speaker was wearing as what he was saying. Boyer, who is the lab manager at Kintec in Vancouver, Canada, wore a product he thinks may represent part of the future of orthotic design and manufacture—orthoses he’d printed with a hobbyist-level desktop 3D printer.

Lean manufacturing transforms orthotic fabrication

The need to replace entrenched processes and thinking with fluid, fast-moving orthotic design and manufacture that minimizes errors and maximizes resources was highlighted by several speakers at the Orthotics Technology Forum, including Jarret Eschenburg, CPed, director of operations at Coral Springs, FL-based SureFit, a subsidiary of Hanger.


Patient Perspective: Bunionectomy recovery is more than just healing

I can’t recall exactly when the bunion on my left foot started causing discomfort, but it was probably when I was about 40. I waited some time to get a referral to a podiatrist, and when I finally saw one, life with two kids and a full-time job stalled my pursuit of treatment for another three and half years.

By Karen Bakar

Post-traumatic OA: Unique implications for the military

Military populations experience high rates of disability related to post-traumatic osteo­arthritis (PTOA), which does not always originate from combat injury. But military researchers are also uniquely posi­tion­ed to explore therapeutic options to minimize the effect of PTOA.

By Jessica C. Rivera, MD, Joseph C. Wenke, PhD, James R. Ficke, MD, and Anthony E. Johnson, MD

A new approach to iliotibial band syndrome in runners

Variables related to iliotibial band strain appear to be important risk factors for development of iliotibial band syndrome (ITBS) in runners, a finding that is beginning to change the way researchers assess the effectiveness of gait retraining interventions to treat or prevent ITBS.

By Stacey Meardon, PT, PhD, ATC, CSCS, and Ross H. Miller, PhD

Kicking biomechanics: Importance of balance

Kicking is a whole-body movement that is responsive to a wide range of constraints related to the task, the environment, and the athlete. Preliminary research also suggests that balance control in the support leg plays a key role in athletes’ kicking performance.

By David I. Anderson, PhD, and Ben Sidaway, PT, PhD


In the Moment: Ankle

By Jordana Bieze Foster

Brace relations: Complex effects are not only mechanical

Research presented in late June at the annual National Athletic Trainers Association (NATA) meeting in Las Vegas added to the body of evidence suggesting that the effects of ankle bracing are not solely mechanical, and that even the mechanical effects may be more complicated than they seem.

CAI patients with poorest sensation report more sprains in their history

Decreased plantar cutaneous sensation in patients with chronic ankle instability (CAI) is associated with number of prior ankle sprains, according to research from Old Dominion University in Norfolk, VA.

Balance deficits persist after sprain despite clearance to return to sports

Athletes with a history of severe ankle sprain still demonstrate postural control deficits and report functional impairment even after being medically cleared for full sports participation, according to two studies from A.T. Still University in Mesa, AZ.

In the Moment: Knee

By Jordana Bieze Foster

Positives for PFP: Benefits of six-week rehab are retained

Six weeks of lower extremity strengthening in runners with patellofemoral pain (PFP) leads to improvements in pain and function that are retained six months later, regardless of whether the rehabilitation focuses on the knee or the hip, according to research presented in late June at the National Athletic Trainers Association (NATA) annual meeting in Las Vegas.

Self-reported function corresponds to bone bruise radiographic severity

Self-reported functional scores in patients with bone bruise lesions associated with anterior cruciate ligament (ACL) injury are consistent with severity classifications based on radiographic presentation, according to findings presented in late June at the NATA meeting.

Knee brace use alters lower extremity muscle activation during jump landing

Wearing a functional knee brace significantly alters activation characteristics in several lower extremity muscles, according to research from the University of Virginia in Charlottesville presented in late June at the NATA meeting.

Market Mechanics

NATA’s ankle sprain guidelines focus on best practices, assessment, prevention
Partners to advance pressure mapping
Volunteers fit children’s feet in record time
Collaboration targets sports performance
Foundation launches health initiative
Adidas adds “blades” for energy return
Mr. Edge writes book on skating injuries


Gel Pediatric Suspension Sleeve

Silipos’ Gel Pediatric Suspension Sleeve is designed to work with pediatric below-knee sockets as well as pediatric and adult upper extremity sockets. The sleeve is fully lined with medical grade mineral oil gel to maximize comfort and skin protection. The gel is engineered to reduce friction, abrasion, and pressure on the residual limb. It moves with the skin to avoid bunching behind the knee, protects the skin, and helps facilitate ...

WalkJoy Gait Restoration

Worn discreetly and comfortably below the knee, the compact, lightweight WalkJoy product aids in the restoration of gait and balance in patients with peripheral neuropathy. Its advanced telemetry provides precise information about a patient’s walking dynamics and activates vibrotactors upon heel strike. This immediate signal frequency is optimized for physical transmission and response, helping restore pro­prioception and kinesthesia. WalkJoy’s telemetry, combined with its WalkingHealth software, facilitates documentation of patients’ baseline ...

SureStep Sandals

SureStep Sandals are designed with custom features for children who wear orthotic devices. A flexible sole allows for intrinsic movement, while the added height and longer straps provide the support necessary to be worn with an orthotic device. A special cutline on the sole has been added for easy custom modifications. SureStep Sandals provide a breathable, cooler alternative to shoes while maintaining children’s function and encouraging proper development. The sandals ...

SportFit Flex Orthosis

ComfortFit Labs has added a new orthotic device to its SportFit collection. The SportFit Flex is similar to the company’s SportFit device, but is designed for patients who cannot tolerate a semirigid shell. This new device is listed in the company’s 2013 Custom Orthotic Prescription Order Form. The new SportFit Flex has a semiflexible (Santoprene rubberized/plastic) shell, and offers moderate control and shock absorption. SportFit orthotic devices are intended for ...

Plantar F3 Foot Roller

Swede-O has launched the Plantar F3 Foot Roller, designed to relieve heel and foot pain in three ways: stretching, cold therapy, and heat therapy. The design of the Plantar F3 has three distinct contact surfaces to isolate the plantar fascia and facilitate stretching for feet of any size or shape. The Sorbothane material is anti­microbial, latex-free, and designed to feel comfortable against the skin. Developed by a certified athletic trainer ...

Peapod Pediatric Orthotics

Peapod Pediatric Orthotics (by Podotech, available from Algeos USA) offer a versatile, cost-effective alternative to custom foot orthoses for clinicians with pediatric patients. The Peapod Dinky is a medium density ethylene vinyl acetate (EVA) device, with a deep heel cup for medial calcaneus support and stability. The Peapod Junior combines a thermoplastic shell with supersoft poly­urethane and an attractive brushed nylon cover. Customizable Peapod foot orthotics fit discreetly into the ...

Paperless Clinic Software

Kiwi Software Solutions has developed a web-based program that allows medical orthotic providers to run a paperless clinic. Kiwi software can be used on a tablet device to replace a clipboard for clinical note taking, and can also be used on a desktop to book appointments, enter patient information, and generate reports. Users can efficiently schedule patients, perform a clinical assessment, prepare billing forms, and report back to the patient ...

Ovation Hybrid Night Splint

Ovation Medical introduces the Ovation Hybrid Night Splint to provide the convenience of the company’s Dorsal Night Splint and the structured support and adjustability of the original Posterior Night Splint. The shell design of the Hybrid positions the foot securely while the nonskid sole facilitates improved ambulation. The articulating hinge design allows for adjustment of settings throughout rehabilitation, while an adjustable tension strap accommodates individual patient tolerances. Additional padding increases ...

Orthotronic C-Brace

Ottobock announces the debut of the C-Brace orthotronic mobility system for patients with neurological conditions affecting the lower limbs. The orthotronic system, which combines electronic and me­ch- an­ical technologies, helps the wearer to descend stairs, change speeds, and walk with controlled knee flexion; it also helps prevent wear and tear on the sound side while providing support throughout the gait cycle. Measurements of knee angle direction and velocity, including knee ...

Compression Hosiery

Sigvaris announces the launch of its medical-grade compression level Allure product line. The Allure sheer medical compression hosiery line, featuring a diamond-dot pattern, has the look and soft feel of designer fashion hosiery with the health benefits of medical compression hosiery. The breathable construction makes Allure hosiery suitable year-round for work, dress, or travel. Allure closed-toe hosiery is available as thigh-highs or pantyhose, with 15-20 mm Hg or 20-30 mm ...

Compression Anklet in Black

PediFix introduces its Pedi-Smart Black Compression Anklet. This medical-grade product provides graduated Grade III (30-40 mm Hg) compression from the metatarsals to the calf, which helps increase venous activity, minimizes swelling, eases pain, and speeds healing, especially after injury or surgery. The lightweight Black Compression Anklet offers fashion-conscious patients an alternative to the existing beige version, which has been popular for more than 15 years. Both anklets are toeless, can ...

BRD Plantar Fasciitis Brace

BRD Sport is now offering a Plantar Fasciitis Brace to relieve acute arch and heel pain. Three-dimensional knitting offers a four-way stretch, and anatomically contoured silicone pads on the medial and lateral sides give support and intermittent massage to help improve circulation. An adjustable arch strap helps customize the amount of support provided and position the ankle in proper anatomical alignment. The brace is designed to fit comfortably into any ...