November 2011

Cover Story

Pretty pathways to pain: Muscle activation in high-heeled shoes

Researchers from New York University have found that wearing high heels increases muscle activation, which can have painful ramifications throughout the kinetic chain. Some individuals, however, seem to adapt to high heels more effectively than others.

By Smita Rao, PT, PhD, and Renata Ripa, MA

Editor Message

Out on a limb: High on heels

A week after this magazine goes to press, I’ll be in Puerto Rico with my in-laws for a beach wedding. I’m sure the scenery will be spectacular. But I also know that once the ceremony is over, I’ll be counting the minutes until I can put my heels back on.

Jordana Bieze Foster, Editor


Evidence-based orthotic management of PTTD

The medical literature supports the use of orthotic devices in patients with pos­terior tibial tendon dysfunction, especially those in the early stages. Demonstrated benefits include improvements in foot and ankle alignment, clinical symptoms, and functional outcomes.

By Holly Olszewski, CPO

Experts stress selectivity in advanced ulcer care

Despite the expense associated with advanced wound care technologies, evidence suggests that switching from standard care makes both clinical and economic sense if a diabetic foot ulcer has not experienced a 50 percent reduction in wound area after four weeks.

By Emily Delzell

Role of physical therapy in patients with hip OA

Some studies support the effectiveness of physical therapy for reducing pain and improving function in patients with hip osteoarthritis, but evidence on the topic is limited and contradictory—suggesting that perhaps PT is most effective in a specific subgroup of patients.

By Alexis A. Wright, PT, PhD, DPT, and Garrett S. Naze, PT, DPT

Bracing and rotation, part 2: ACL injuries

This two-part series explores the role of rotational forces in athletic injuries and the  extent to which bracing can help control those forces and, in turn, prevent those  injuries. This second installment examines rotation as a contributor to anterior cruciate ligament injury.

By Cary Groner

Preventing wrong-site foot and ankle surgery

Wrong-site surgery can have significant financial and professional conse­quences, which is why surgeons’ or­gan­iza­tions are promoting protocols speci­­fi­cally designed to reduce such errors. A recent survey of foot and ankle surgeons suggests those efforts are paying off.

By Donald E. Fowler III, MD; Karl M. Schweitzer Jr, MD; Olubusola Brimmo, MD; Ryan May, BS; and Selene G. Parekh, MD, MBA         

Chronic ankle instability affects postural control

Research suggests that individuals with chronic ankle instability use different movement strategies to maintain postural control than individuals with healthy ankles. These changes may be related to alterations in movement variability associated with ankle instability.

By Lisa Chinn, MS, ATC, and C. Collin Herb, MEd, ATC


In the Moment: Footwear

By Emily Delzell

Bespoke for stroke: Temporary custom shoe improves gait
Recent research from the Netherlands suggests that a custom-made orthopedic shoe designed for temporary use can enhance early mobilization after stroke, improving functional mobility, walking speed, and gait. By Emily Delzell
Study links poor footwear choices to impairment in patients with gout
Research from the Auckland University of Technology suggests use of poor footwear is a major problem in patients with gout, finding that 42% of individuals studied wore shoes with inadequate cushioning, support, stability, or motion control. The New Zealand investigators, who ...
Jazz shoes restrict plantar flexion, may also impair muscle activation
Girls who take part in recreational jazz dancing may be wearing dance shoes that adversely affect muscle activation and restrict their ability to attain the optimal pointed, or plantar flexed, position while dancing, according to Australian researchers. Investigators from the University ...

In the Moment: Sports Medicine

By Jordana Bieze Foster

Lockout lessons: NFL Achilles injuries spark debate
Achilles injuries in the National Football League appear to be occurring earlier, more frequently, and in younger players than in previous seasons. Whether that apparent trend is related to the labor dispute and lockout that shortened the preseason is a ...
Bone data support return to play six months after hip resurfacing
Patients experience significant increases in femoral neck bone density six months after undergoing hip resurfacing, which suggests it is safe for them to return to high-impact sports at that time, according to research from Washington University School of Medicine in ...
Rearfoot landing could reduce ACL injury risk during cutting, pivoting
Landing on the rearfoot instead of the forefoot during cutting and pivoting tasks can decrease knee loading and theoretically reduce the risk of anterior cruciate ligament injury, according to a study from George Mason and Old Dominion universities. Researchers assessed knee ...
Early stage rearfoot eversion effects bolster theory of PTTD progression
Two measures of pronation typically associated with later stages of posterior tibial tendon dysfunction are also apparent in its earliest stage, according to University of Calgary research with possible implications for early intervention. Investigators analyzed static anatomical foot structure, ankle invertor ...

Market Mechanics

Wisconsin Medicaid, Medicare fraud cases focus on orthotic device sales
Recent legal actions in Wisconsin have targeted millions of dollars in Medicare and Medicaid fraud associated with the sales of orthotic devices. On October 24 Wisconsin Attorney General J.B. Van Hollen announced that his office had charged seven Milwaukee residents with ...
ACFAS seeks investigative sites for study on subtalar arthroereisis
The American College of Foot and Ankle Surgeons (ACFAS) is seeking members to serve as investigators as part of a research initiative on subtalar joint arthroereisis. The study’s principal investigator, Adam E. Fleischer, DPM, MPH, FACFAS, and colleagues are recruiting ...
EOS 3D system compares well with CT
Cambridge, MA-based EOS Imaging’s 3D modeling system compares well with computed tomography (CT) scanning for measuring femoral torsion, according to a study presented October 24 at the Journées Françaises de Radiologie in Paris. Results demonstrated no significant differences between the two ...
Össur site emphasizes active life
Foothill Ranch, CA-based Össur launched its online forum, ÖssurActive, at the September American Orthotic & Prosthetic Association National Assembly in Las Vegas. The site offers discussion boards and training programs for above-knee and below-knee amputees. Spearheaded by Paralympic track star Marlon ...
ISPO announces PacRim 2012 dates
The U.S. National Member Society of the International Society for Prosthetics and Orthotics is sponsoring A Pacific Forum for Physical Rehab, also known as PacRim 2012, January 22-24 in Honolulu. PacRim 2012’s plenary sessions and workshops on progressive treatment options and ...
Cascade distributes Incrediwear line
Chico, CA-based Cascade Orthopedic Supply is now carrying Star Nutrition’s line of Incrediwear products, including the Incredibrace and Incredisocks lines, which use anion technology to help increase circulation and regulate temperature. Star Nutrition, also based in California, has more than ...
AliMed teams with GHX for e-commerce
A partnership between Dedham, MA-based AliMed and technology company Global Healthcare Exchange (GHX) opens the door for 3900 GHX hospital members to select and purchase products from AliMed through the GHX exchange. GHX’s cloud computing technology increases efficiencies for hospitals and ...


KidZerts Wear-moldable Insole
KidZerts has released the first wear-moldable arch support insole that shapes itself to match the unique contours of the bottom of a child’s foot. The ethyl vinyl acetate (EVA) moldable sublayer molds slowly to the plantar surface during wear; other ...
Foot/Ankle E-Module
PhysioTools’s new Foot and Ankle Strengthening module installs easily on Mac or PC computers, and includes exercise sequences and educational information as well as advice notes on a number of common foot and ankle disorders. The software helps podiatrists and ...
Seattle LP Low Profile Foot
Trulife introduces its first low profile prosthetic foot for community ambulators and high activity amputees – the Seattle LP. Designed of carbon fiber and titanium, this low profile foot is ideally used with long residual limbs. The Seattle LP’s multi-axial ...
AliMed Bariatric Positioners
AliMed has added to its products a line of bed positioning devices engineered to withstand the compressive weight of bariatric patients and help prevent pressure ulcers. The positioners, made from a closed-cell foam that resists compression better than standard foam, ...
Ipocon Gel Sheets
Comfort Products Ipocon Gel Sheets are made by Uniprox and constructed of silicone gel. The viscoelastic properties of the material provides partial pressure relief to feet. The sheets are free of Lycra coating and are suited for individuals who need ...
Otto Bock Triton Foot
Otto Bock HealthCare introduces its 1C60 Triton prosthetic foot. Developed with input from amputees and with an emphasis on full mobility and natural anatomy, the Triton is suitable for everyday use and helps wearers live an active lifestyle. Its flexible ...
Cartigel Joint Supplement
Nutra-C M&D’s Cartigel, a dry powder food supplement that promotes joint pain relief and joint cartilage, is designed for patients wishing to alleviate chronic joint pain and pursue a more active lifestyle. Cartigel is available over the counter, mixes with ...
Star Nutrition Incrediwear
Star Nutrition announces four new products in their Incrediwear line of apparel for the lower extremity, which now includes cycling socks, snowboarding, and skiing socks and shorts. All products are woven with ingredients that release negatively charged anions that help ...
Stratiform Foot Orthosis
Earthwalk Orthotics introduces the Stratiform multilayered orthotic device, designed for patients with diabetes and other at-risk patients requiring passive support. Construction of the orthosis begins with a high-density EVA (ethylene vinyl acetate) formable. A traditional plaster positive is created from ...
Pro-Tec Pre-Cut Tape
Pro-Tec Athletics’ new Pre-Cut Kinesiology Tape is intended to help relieve muscle tightness, knee pain, iliotibial band syndrome, shin splints, hamstring tears, plantar fasciitis, epicondylitis, wrist pain, and most soft tissue injuries. The tape is designed to promote circulation and ...
Tekscan Datalogger
Tekscan has released the F-Scan Datalogger for use with its F-Scan System, which captures dynamic in-shoe pressure and force information. The Datalogger collects and stores sensor data in its internal memory for uploading to a computer at a later time, ...
Bauerfeind Professional Heel
Bauerfeind USA has introduced a heel-focused over-the-counter foot orthosis for the management of plantar fasciitis and heel pain. The Bauerfeind professional heel is an anatomically designed device configured with moderate arch support to provide pain relief and redistribute pressure away ...