March 2013

LER03-13Cover-smCover Story

Kickboxing: A creative approach to improving balance in patients with MS

Kickboxing isn’t just for elite martial artists. In fact, preliminary research suggests the kicks, punches, and knee movements associated with the sport can improve balance and mobility in patients with multiple sclerosis. And as an added bonus, it’s also fun.

By Kurt Jackson PT, PhD, GCS, and Kimberly Edginton-Bigelow, PhD

Editor Message

Out on a limb: Well heeled

It’s widely believed that women persist in wearing high-heeled shoes, despite what can be considerable discomfort, for aesthetic reasons. But what if, on some level, we’re attracted to high-heeled shoes because we associate them with social status?

Jordana Bieze Foster, Editor


Special Section

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Click to download the complete PDF

Teachings from the East

Researchers and practitioners from across the globe came together in Hyderabad, India, in February for the World Congress of the International Society of Prosthetics & Orthotics (ISPO). LER’s exclusive coverage of the 2013 World Congress, held in India for the first time, explores the evidence-based use of lower extremity devices for conditions ranging from stroke to cerebral palsy to diabetes.

By Jordana Bieze Foster

Sponsored by an educational grant from…


CEREBRAL PALSY: Dynamic devices facilitate compliance, outcomes in children with cerebral palsy

Brace wear time, not torque, is key – Dynamic orthoses offer an effective alternative to static devices for management of tip-toe gait and knee flexion contracture in children with cerebral palsy (CP), particularly because the dynamic devices are associated with greater compliance, according to separate studies from Sweden and France.

OSTEOARTHRITIS: Knee braces and wedged insoles both alter gait in patients with knee OA

A Taiwanese study offers more evidence that offloading knee braces and wedged foot orthoses are both associated with significant biomechanical improvements in patients with knee osteoarthritis (OA).

SPORTS MEDICINE: Proximal rocker bar on shoe can relieve tension on Achilles tendon in runners

A rocker bar proximally positioned on a running shoe can relieve tension on the Achilles tendon as well as reduce the force required of the calf muscles during walking and slow running, according to research from the Netherlands.

DIABETES: More results support use of foot orthoses to significantly decrease plantar pressures

Swedes also find low ulceration rate – Research from Sweden and Egypt provides more evidence that foot orthoses can significantly decrease plantar pressures in patients with diabetes, theoretically reducing the risk of foot ulcers and lower extremity amputation.

FLAT FOOT: Arch structure in children with talipes planovalgus improves with shoe inserts

Orthotic management of pediatric talipes planovalgus starting at an early age is associated with significant improvement in weightbearing arch structure, according to research from Saga University in Japan.

OFFLOADING: Walkers’ effect on proximal biomechanics varies depending on design characteristics

Tibial inclination appears significant – Orthotic walkers have significant effects on proximal joint mechanics during gait, the extent of which appear to depend on individual device design, according to research from the University of Central Lancashire in the UK.

PEDIATRICS: In hyperpronators, functional scoliosis responds to distal orthotic treatment

What appears to be idiopathic scoliosis may actually be functional scoliosis that can be effectively treated with foot orthoses in children who are hyperpronators, according to research from Chungnam National University in Daejeon, South Korea.

STROKE: Eight weeks of early AFO use significantly enhances benefits of stroke rehabilitation

Functional balance test scores rise – Use of an ankle foot orthosis (AFO) within six weeks of stroke results in better balance outcomes and earlier independent ambulation than if AFO use is delayed, according to research from the Netherlands.


Active Stance: Rethinking the concept of excessive pronation

Anterior knee pain is one of the most common injuries affecting runners, accounting for 25% of all running injuries.1 The etiology of anterior knee pain is multifactorial in nature,2 but one of the most commonly cited biomechanical risk factors is excessive rearfoot pronation.

By Pedro Rodrigues, MS, PT, PhD, Trampas TenBroek, PhD, and Joseph Hamill, PhD

Foot ulcer experts weigh use of hyperbaric oxygen

Two February publications sum up the polarizing nature of hyperbaric oxygen therapy (HBOT) for treating recalcitrant diabetic foot ulcers. A meta-analysis supported use of HBOT, while a large cohort study found a lack of effectiveness in community-care settings.

By Larry Hand

Exercise helps reduce claudication symptoms

Research suggests that exercise therapy can help reverse the ambulatory impairments associated with lower extremity pain in patients with peripheral arterial disease. The next step is to determine the methods of exercise therapy most likely to result in optimal outcomes.

By Ana I. Casanegra, MD, Omar L. Esponda, MD, and Andrew W. Gardner, PhD

The role of varus thrust in knee osteoarthritis

Varus thrust is a characteristic of dynamic alignment that has been shown to be predictive of medial tibiofemoral structural progression. Treatments aimed at minimizing varus thrust may reduce structural progression and symptoms related to knee osteoarthritis.

By Grace Hsiao-Wei Lo, MD, MSc

Foot orthoses and injury prevention in football

Team practitioners at the United States Naval Academy designed an orthotic intervention to prevent turf toe and Lisfranc sprains in football linemen and gained valuable insights about how players’ preferences and predispositions can affect compliance.

By CAPT Jeff Fair, EdD, ATC, LAT; CAPT David Keblish, MD; and LCDR Anthony Rabaiotti, DPM


In the Moment: Sports Medicine

By Emily Delzell

Bad breaks: Fifth met fractures can curtail NFL careers

Jones and proximal diaphyseal fifth meta­tarsal fractures are common among football players and may shorten their athletic careers, according to a February study that found players with fractures were significantly more likely than players without the injuries to have played in fewer than 10 National Football League (NFL) games.

Even gradual transition to minimalist running leads to signs of stress in feet

Investigators at Brigham Young University in Provo, UT, reported that runners who transitioned from traditional running shoes to zero-drop shoes meant to mimic barefoot running had evidence of bone marrow edema, a marker for stress on the foot, after gradual transition from conventional to minimalist shoes.

Girls, football players face highest risk of knee injury in high school athletics

The highest knee injury rates in US high school sports are associated with football, followed by girl’s soccer and gymnastics, according to an epidemiological study from The Ohio State University in Columbus and Colorado State University in Aurora.

Market Mechanics

Pistorius’s next court date set for June
Oscar Pistorius, the 26-year-old South African double amputee and Olympic and Paralympic sprinter, is free on bail and awaiting his next court hearing on June 4 on a charge of premeditated murder. Pistorius maintains that the fatal February 14 shooting ...
Florida aims for amputation prevention
The state of Florida is funding the Diabetic Amputation Prevention Project (DAPP) at Barry University’s School of Podiatric Medicine in Miami Shores. The project will provide preventive care for people with high-risk diabetic feet, and its leaders hope to save limbs ...
ComfortFit owner appears in HBO biopic
Tom Calagna, founder, co-owner, and president of Roselle, NJ-based ComfortFit Labs, will appear in a small role in a new HBO movie, “Phil Spector,” written and directed by playwright and filmmaker David Mamet. The movie focuses on the relationship between Spector, ...
AP adds definition of athletic trainer
The addition of an athletic trainer definition to the upcoming edition of the Associated Press (AP) stylebook will school reporters in the field’s nomenclature, differentiating athletic trainers from personal trainers, and improve on how the profession is referenced in print ...
Delcam takes orthotic forum to Atlanta
UK CAD-CAM developer Delcam will host its 2013 Orthotics Technology Forum in the US this year. The event is set for May 29-31 at the Georgia Institute of Technology in Atlanta. The forum will feature current and emerging equipment, software, and ...
OPAF welcomes returning sponsors
Troy, MI-based Becker Orthopedic and the Board of Certification/Accreditation (BOC) are returning as Orthotic and Pros­thetic Activities Foundation (OPAF) bronze-level sponsors, according to OPAF, which noted that both companies have been sponsors for many years. “OPAF appreciates all of our donors ...
Game Ready releases amputee cold wrap
Concord, CA-based Game Ready debuted its Amputee Wrap line in February with a below-knee wrap that delivers cold therapy and is designed specifically for traumatic amputees. The wrap is designed to be used in the immediate postoperative period to speed healing ...
WillowWood wins VA innovation contract
The US Department of Veterans Affairs (VA) announced in February that Mt. Sterling, OH-based WillowWood, in partnership with The Ohio State University in Columbus and The University of Akron, have secured a new contract to develop a more comfortable and ...


Improved Conformity Control
South West Orthopedic Designs unveils its ICC (improved conformity control) technology for gauntlets and ankle foot orthoses (AFOs). The ICC system utilizes innovations in nyglass/carbon fiber/resin laminations to facilitate a variety of flexible to rigid support options for foot and ...
Pool Aqua Stretch Band
StrechCordz introduces a new exercise and training stretch-band: the Pool Aqua Band. The Pool Aqua Band was developed with input from Ann Anthony, a certified aquatic trainer and inventor of Hydro-Pilates. It features exercise tubing with a cuff attached to ...
Memopur 20/50 Insole
The Memopur 20/50 insole is a new Euro International product made exclusively in Germany and constructed from reinforced Memopur, an open-cell polyurethane foam, that was developed solely for the fabrication of orthotic insoles. This material provides a 96% rebound rate, ...
Signature Series Sockets
The new Signature Series of APOPPS (Adjustable PostOperative Preparatory Prosthetic System) sockets features combined sizing for better inventory management. Rather than seven sizes, the new series includes four sizes: #1416, #1618, #1821, and #2124. The new Signature Series sockets are ...
Gait Plate for Intoeing
Nolaro 24 offers the new littlesteps Gait Plate for kids, semirigid prefabricated orthoses that limit in-toeing gait caused by rotational deformities of the lower limb while simultaneously addressing overpronation, which is often associated with in-toeing. A semirigid shell extends laterally ...
Thermoflux Material
UCO International introduces Thermoflux, the newest in the company’s line of quality reinforcement materials. Reinforcement materials are popular for their ability to serve as the framework for foot orthoses by adding strength without adding thickness. Thermoflux is a lightweight, fibrous ...
Small Cuff for Bioness L300
Bioness has received 510(k) clearance from the US Food and Drug Administration to market a smaller leg cuff for use with its L300 Foot Drop System, which uses neuromodulation technology to treat foot drop. The leg cuff, wrapped just below ...
Bio-Kil Socks
St. Justine introduces antibacterial socks to help relieve the itchy, annoying symptoms of fungal infection or athlete’s foot. Bio-Kil Anti-Bacteria Socks feature the Bio-Kil biocide formula—which is designed to target bacteria, fungi, molds, and viruses—integrated in a sock material made ...
Morton’s Extension Modification
ComfortFit Labs now offers a rigid carbon Morton’s Extension option for any of the company’s graphlite composite orthotic devices. Thinner and lighter than the company’s other orthotic shells, the graphlite composite shells are designed for semiactive to active patients needing ...
OrthoticSelector Software
Delcam has added a new program to software options for the design and manufacture of custom orthotic insoles. OrthoticSelector provides a lower-cost solution for practitioners and laboratories by allowing them to identify, from a library of existing designs, the prefabricated ...
HiFi Prosthetic Interface
biodesigns now offers the High-Fidelity (HiFi) Interface System with OsseoSync Technology for lower extremity amputees. The HiFi Interface is designed to offer the benefits of osseointegration without the surgery that would attach the prosthesis directly to the residual limb. The ...
SlenderFit Orthotics
Powerstep introduces SlenderFit Fashion Orthotics, new sulcus-length orthoses specifically designed for use in women’s fashion footwear to help relieve foot pain and discomfort. The S (or cobra) shape cradles the heel and provides arch support. The built-in metatarsal cushion with ...