November 2012

Cover Story

Genetics: The future of injury prevention

Evidence is linking genetic mutations to Achilles tendon and anterior cruciate ligament injuries as researchers try to connect complex motor control processes to small segments of DNA. But genetic testing is still a long way from becoming a clinical tool.

By Larry Hand

Editor Message

Out on a Limb: The whys of compliance

If you think your patients have compliance issues, be glad you’re not treating clubfoot in a place like India, Egypt, Mexico, or Bangladesh.

By, Jordana Bieze Foster, Editor


Special Report

CONFERENCE COVERAGE: International Clubfoot Symposium

Click to download the complete PDF

The Ponseti method of clubfoot management has achieved worldwide 
acceptance, but practitioners and researchers are still working to identify the best ways to optimize clinical outcomes while remaining sensitive to issues of cost effectiveness and cultural differences. Clinicians from around the globe gathered in October at the second International Clubfoot Symposium to 
discuss their successes and challenges.

Sponsored by an educational grant from…

CONFERENCE COVERAGE: International Clubfoot Symposium

The Ponseti method of clubfoot management has achieved worldwide 
acceptance, but practitioners and researchers are still working to identify the best ways to optimize clinical outcomes while remaining sensitive to issues of cost effectiveness and cultural differences. Clinicians from around the globe gathered in October at the second International Clubfoot Symposium to 
discuss their successes and challenges.

Resource-poor areas benefit from global outreach efforts

Treatment of children with clubfoot has evolved considerably in the five years that have elapsed since the inaugural International Clubfoot Symposium, and the benefits of this evolution are particularly evident in resource-poor nations—home to about 80% of the 200,000 children born each year with clubfoot. But practitioners who treat patients in these areas still face financial, cultural, and logistical challenges.

By Emily Delzell

Benefits of Ponseti method extend to older children

Clubfoot correction ideally should be performed during infancy, before children learn to walk, but experts agree that the Ponseti treatment method can also be effective in older children. Speakers at the International Clubfoot Symposium in October presented successful outcomes for Ponseti treatment of neglected clubfoot in patients aged up to 21 years.

By Jordana Bieze Foster

TATT in relapsed clubfeet can affect plantar flexion

Tibialis anterior tendon transfer (TATT) is known to be associated with limited ankle dorsiflexion, but practitioners should be aware that plantar flexion also can be negatively affected, according to research presented in October at the International Clubfoot Symposium.

By Jordana Bieze Foster


Charcot neuroarthropathy and bone mineral density

Research indicates that in diabetic patients with Charcot neuroarthropathy, peripheral bone mineral density decreases over time, which can contribute to risks of hardware failure, loss of correction, delayed union, and nonunion in patients with advanced disease.

By Rachel H. Jung, DPM, MHA, MPH; Robert M. Greenhagen, DPM; Dane K. Wukich, MD; Vassilios Vardaxis, PhD; and Robert  M. Yoho, DPM, MS

OA knee braces face off against wedged insoles

Two separate studies directly compared valgus knee bracing and wedged foot orthoses for reducing knee adduction moment in patients with osteoarthritis, but came to opposite conclusions. A third study suggests combining the two interventions may be the best solution.

By Barbara Boughton

Self-selected gait speed: A critical clinical outcome

When treating patients who are going through rehabilitation, clinicians may be overemphasizing gait distance and over­looking the importance of gait speed. Clinical assessment of gait speed is sim­ple and inexpensive but can be a signifi­cant indicator of functional recovery.

By Heather Braden, PT, MPT, PhD, GCS

Intramuscular manual therapy for heel pain

Intramuscular manual therapy, also known as dry needling, is hypothesized to relieve pain by modifying tension in connective tissue. Limited evidence supports the use of IMT for plantar fasciitis, although further research is needed to rule out a placebo effect.

By Brent Harper, PT, DPT, DSc, OCS, FAAOMPT


In the Moment: O&P

By Jordana Bieze Foster

Drop foot fix for CMT: AFOs work both proximally and distally

The mechanism by which ankle foot orthoses (AFOs) reduce drop foot in patients with Charcot-Marie-Tooth disease (CMT) involves proximal effects as well as the distal changes with which clinicians are more familiar, according to research from the UK.

Personalized data make a difference in additive manufacturing of insoles

Personalized insoles created using additive manufacturing technology are associated with improved biomechanics and comfort during running, according to research from Loughborough University in the UK.

Tibial bone health asymmetries persist in stroke survivors despite use of AFOs

Tibial bone mineral density in stroke survivors who use ankle foot orthoses (AFOs) remains significantly higher in the unaffected limb than the affected limb after more than a decade, according to research from the University of Oklahoma in Oklahoma City.

In the Moment: Osteoarthritis

By Emily Delzell

Market Mechanics

Expert group recommends “chronic disease” approach to OA management
Spurred by conclusions from the Chronic Osteoarthritis Management Initiative (COAMI) Work Group, which met earlier this year to assess current practice in OA management, healthcare providers from more than 20 professional societies are proposing significant changes in management of osteoarthritis ...
LE professionals get active for veterans
Commerce City, CO-based Mile High Orthotics Lab and Mequon, WI-based Dr. Comfort joined forces in October to raise money for recovering US service members and veterans. On October 7, a team of Mile High manufacturers and clinicians participated in the Tough ...
PTs laud proposed Medicare agreement
On October 24 American Physical Therapy Association president Paul A. Rockar Jr, PT, DPT, MS, issued a statement applauding the proposed legal settlement of Glenda Jimmo, et al vs Kathleen Sebelius, a national class action lawsuit. Plaintiffs alleged that the US ...
Societies respond to GAO report on self-referral rates for imaging
In late October professional societies penned official responses to a report from the US Government Accountability Office (GAO) that found self-referral rates for magnetic resonance imaging (MRI) and computed tomography (CT) have skyrocketed in recent years, with MRI self-referral rates ...
Lucknow hosts 2013 CP conference
The International Conference on Cerebral Palsy and Developmental Medicine and the seventh annual Meeting of the Indian Academy of Cerebral Palsy will convene in Lucknow, India, March 6-10, 2013, for a 1500-plus delegate meeting on the state of care for ...
Annual ACSM survey highlights fitness and health trends for 2013
The American College of Sports Medicine’s (ACSM) seventh annual international survey of fitness trends finds traditional exercises poised for popularity in 2013. Body-weight training, which includes back-to-basics exercises such as push-ups, planks, pull-ups, and squats, appears in the top 10 ...
Healthline launches online surgical guide for total knee replacement
San Francisco-based Healthline Networks introduced a new online consumer health resource in October, the Surgical Procedure Guide for Total Knee Replacement Surgery. The guide is aimed at individuals who are considering or have undergone total knee replacement surgery (TKR). It offers ...


Warming Insoles
Spenco Medical Corporation offers Spenco PolySorb Flow Warm performance insoles for walkers, runners, and joggers seeking support and comfort in a warm foot environment. A reflective thermal barrier, a foil layer beneath the topcloth, retains natural body heat. The topcloth ...
Low Profile Triton Foot
New from Ottobock, the multi-axial Triton Low Profile (LP) foot is designed for active above- or below-knee amputees with clearances as small as 2.5 inches, particularly those with longer residual limbs. In addition to its reduced structural height, the Triton ...
Remote Triggering
Tekscan has introduced new remote triggering products that improve the flexibility of its VersaTek Wireless and Datalogger systems. The Trigger Transmitter (TT-1) and Trigger Receiver (TR-1) allow users to synchronize F-Scan Wireless and Data-logger recordings with transmissions from other measurement ...
Tibion Bionic Leg
Tibion, a venture backed robotics technology company, has introduced the Tibion Bionic Leg: a wearable lower limb robotic trainer activated by the patient’s intent to move. The Tibion Bionic Leg is designed to strengthen stance, improve gait, and enhance active ...
Footmaxx Metascan
Footmaxx has released an updated and improved version of its diagnostic system, Meta­scan. Metascan analyzes a foot in motion to help practitioners predetermine the need for foot orthoses and optimize orthotic fit. Options for diagnosing abnormal foot function and balance ...
Breathable Knee Support
Active Innovations introduces the Targeted Breathable Support (TBS) knee support crafted with VentiPrene, a durable, lightweight, 1/8-inch thick perforated neoprene. The material differs from standard neoprene in that it allows skin to breathe while providing compression and warmth without overheating. ...
Postoperative Mesh Top Shoe
Elite Orthopaedics introduces a new postoperative shoe: the Mesh Top Post Operative Shoe. The new shoe is designed for use on a postoperative, traumatized, diabetic, or insensitive foot. Features of the Mesh Top Post Operative Shoe include an open-toe design ...
Alli-Flex Black Plastic
Alli-Flex from Allied Plastic Supply is a soft black, flexible plastic used for prosthetic liners. A cost-effective alternative to black Northvane, Alli-Flex is easy to clean and resists staining. A benefit of a black liner is its ability to mask ...
Arcopedico Knit Shocks
Arcopedico’s top-selling LS shoe line has been rebranded with the nickname “Shocks” (shoes as comfortable as wearing socks) and introduced in two bright new colors, fuschia and orange. As the name implies, Shocks offer the coziness of a pair of ...
Prosthetic Swim Joint
The new swim joint by Swim Again is designed to give lower limb amputees the freedom of swimming without the hassle of specialized prosthetics. The joint can be released with a pull pin, allowing the user to walk to and ...
Dynamic AFO Padding
Beginning late this year, all Dynamic Ankle Foot Orthoses from Cascade Dafo will feature improved internal padding. The new contoured modular pad-ding will be applied in areas of each brace design where elevated pressure is anticipated. Ortho-engineered to conform to ...
Tarso Clubfoot AFO
M.J. Markell Shoe Company offers the Tarso Clubfoot AFO, a semirigid ankle foot orthosis for use with the Ponseti method of clubfoot treatment. The Tarso Clubfoot AFO has a symmetrical shape for use on either the left or right foot. ...