November 2016

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Cover Story

Mouthguard mysteries: Can wearing one really improve athletic performance?

Multiple studies suggest that mouthguards, designed to protect athletes from dental injuries during contact sports, may also help improve muscle force and power. But plenty of other studies have found no such ben­efits, and even the experts aren’t sure what to believe.

By Cary Groner

Editor Message

Out on a limb: Strike pattern revisited

The concept of foot-strike pattern during running—something rarely discussed a decade ago, even in research circles—is now pervasive among runners as well as biomechanics experts and lower extremity clinicians. But that’s not necessarily a good thing.

By Jordana Bieze Foster, Editor

LER Pediatrics

Making it personal

Personalized medicine, holistic care, and patient-centered management can all imply slightly different things, but beneath the differences one central tenet is the same—the importance of tailoring treatment to individual patients’ unique conditions, needs, and goals.

In this issue several articles discuss some of the varied ways in which lower extremity practitioners are taking an individualized approach to orthotic management of young patients, who are undergoing rapid physical changes, developing interests, and facing other childhood challenges.

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Peroneal tendinopathy management in tennis

Although not as common as Achilles tendinitis, peroneal tendinitis is seen in a certain group of patients with chronic ankle instability or with a cavovarus foot.1 Peroneal tendinitis presents as lateral foot pain and may also be of unknown etiology or associated with an acute inversion injury.

By Patricia Pande, MClScPT, CSCS, CPed

AFO stiffness can help optimize patient function

Decisions related to the stiffness of an ankle foot orthosis (AFO)—whether they involve device design or the materials from which it’s fabricated—can help lower extremity clinicians customize stability, biomechanics, and muscle function to meet individual patients’ needs.

By Lori Roniger

How foot and ankle injury trends reflect today’s NFL

Professional football players are enduring higher levels of force than ever, and foot and ankle injury rates are increasing as a result. Advances in surgery and rehabili­tation have helped get players back on the field more quickly, but injury prevention remains a significant challenge.

By Will Carroll

Adjacent-joint arthritis after ankle arthrodesis

Altered biomechanics after ankle arthro­desis often increase stress on the adjacent joints in the foot, which can cause or exacerbate osteoarthritic degeneration in those joints. Clinicians and researchers are working to better understand this process and how to minimize patients’ risk.

By Cary Groner

Psychological aspects of ACL rehabilitation

The ability to identify and treat patients at risk for mental health issues after anterior cruciate ligament (ACL) injury may help improve psychological readiness for reconstructive surgery, attitudes toward postoperative rehabilitation, and successful surgical and rehabilitation outcomes.

By John Reaume, MD, MHSA; Dana Reaume, PsyD; and Melissa A. Christino, MD


In the Moment: Running

ITBS intrigue: Fatigue leads to decreased hip adduction

Women with iliotibial band syndrome (ITBS) independently modify their running gait when fatigued to decrease hip adduction, potentially as a result of pain, according to research from Rutgers University in Newark, NJ, that may have implications for gait retraining.

By Katie Bell

Step rate, length differentiate trained from untrained long distance runners

Trained long distance runners have a higher step rate and a shorter step length during running than untrained participants—characteristics that may represent adaptations to reduce injury and improve running economy, according to research from Spain.

By Jordana Bieze Foster

Runners with chronic ankle instability demonstrate altered kinetics in study

Chronic ankle instability (CAI) is associated with altered vertical ground reaction forces (vGRF) and loading rates during running, which may be related to altered landing patterns designed to protect the ankle joint, according to research from Indiana University in Bloomington.

By Jordana Bieze Foster

In the Moment: Rehabilitation

Sex and BFR: Too many studies exclude young women

The problematic trend of physiological studies in which young women are underrepresented now extends to research on blood flow restriction (BFR) training, according to a paper epublished in October by Clinical Physiology and Functional Imaging.

By Cary Groner

Foot-specific training in older adults helps improve strength and balance

Foot-focused progressive resistance training helps improve toe flexor strength and balance in older adults, which may help reduce the risk of falls, according to research from the University of Wollongong in Australia.

By Jordana Bieze Foster

Foam rolling outperforms stretching for quadriceps, hamstring flexibility

Foam rolling is associated with greater acute improvement in quadriceps and hamstrings flexibility compared with static or dynamic stretching, according to research from Taiwan.

By Jordana Bieze Foster

Market Mechanics

By Emily Delzell

Hanger foundation funds 2016 grants

The Austin, TX-based Hanger Charitable Foundation in October awarded $17,500 to four grant recipients, concluding its third round of 2016 grants.

biodesigns socket ups walking distance

Westlake Village, CA-based biodesigns in November reported a recent 13-patient study showed its alternative transfemoral socket outperformed a standard-of-care socket in improving amputees’ balance confidence and walking capacity.

Spenco sends shoes to disaster victims

Waco, TX-based Spenco Foot­wear donated 1000 pairs of shoes, sandals, and slippers to Haitian victims of Hurricane Matthew, which devastated the island nation in early October.

NBA, AT orgs join to grow youth access

The New York, NY-based National Basketball Strength and Conditioning Coaches Association (NBSCA) in October announced it would form a scientific advisory panel of four experts from various fields within the strength and conditioning community to provide continuing education and sharing of best practices to its members.

Össur users sweep medals in Cybathlon

Reykjavik, Iceland-based Össur reported in October that amputees wearing its technologies dominated the lower limb competition at the inaugural Cybathlon games in Zurich, Switzerland, claiming all three medals in the leg prosthesis race. The Cybathlon is the first global competition…

Curbell names Airlite vendor of the year

Orchard Park, NY-based Curbell Plastics in October named Airlite Plastics its 2015 Vendor of the Year. Omaha, NE-based Airlite  makes plastic packaging as well as a variety of extruded plastic sheet materials for the O&P industry.

Phoenix launches to sell molded devices

Lake Placid, FL-based Phoenix Molded Shoes, Inserts, and Braces opened its doors on September 12. The manufacturer is emphasizing communication with its practitioner customers about its services and lower extremity custom devices, which include accommodative and functional orthoses.


Dalco Premium Air Walker

Dalco International’s new Premium Air Walker, the company’s most advanced walker, immobilizes and protects the leg and foot following injury or surgery. Similar to Dalco’s traditional Air Walker, the boot utilizes an inflatable bladder to ensure compression and fit.

Spenco Styles For Professionals

Spenco introduces its Professional Collection of attractive footwear for people whose professions require long hours of standing or walking. The new styles incorporate Spenco’s Total Support Contour and orthotic-grade arch support, along with…

Arizona Mezzo Brace

Arizona AFO introduces the Arizona Mezzo brace. Developed by Wisconsin-based Wilson Janisse Group, the Arizona Mezzo is a happy medium between a UCBL (University of California Biomechanics Laboratory) orthosis and the original Arizona AFO (ankle foot orthosis).

Tread Labs Stride Insoles

Tread Labs introduces Stride orthotic insoles. The two-part system features a molded poly­propylene arch support and a replaceable topcover, which attaches to the arch support with low-profile Velcro to make replacement or modification fast and easy.

ProTech Control Met Orthosis

Powerstep’s new ProTech Control Met orthosis offers the stability, support, and comfort of its ProTech Control Full Length, but has the added benefit of a built-in metatarsal pad. The Poron met pad helps to spread and cushion the metatarsal heads to…

RevoFit Lanyard

Click Medical introduces the RevoFit Lanyard, a simple-to-use system that allows amputees to easily draw and lock their residual limb into a prosthetic socket. Unlike traditional lanyards, the RevoFit Lanyard can be used with suction and seal-in systems.

AF7 Ankle Bracing Sleeve

New from Allied OSI Labs is the AF7 Ankle Bracing Sleeve, a flexible two-in-one ankle brace for treating acute ankle sprains and Achilles tendinitis or peroneal tendinopathy. The AF7 combines elements of a compression sleeve and an ankle brace, designed to stabilize the ankle without…

Customizable Tensitube Shrinker

Paceline introduces the new customizable Tensitube Blue Shrinker, an elastic postoperative residual limb shrinker that applies controlled compression to help provide pain relief and reduce hypertrophic scarring and edema in lower extremity amputees.

Swede-O Ankle Foot Stabilizer

Swede-O announces the launch of the Ankle Foot Stabilizer (AFS), the newest addition to the MVT2 (Micro Ventilated Thermal) Technology line of products. The AFS includes medial and lateral stabilizers, an adjustable closure strap for greater support, and a nonslip safety sole to help prevent slipping.

Orfitrans Medium Soft

Orfit Industries introduces Orfitrans Medium Soft, made of a stronger thermoplastic material for optimal patient comfort. Orfitrans Medium Soft can be used for transtibial check sockets as well as for lower limb orthoses.

Little Feet For Children

TRS has responded to requests from the O&P profession by introducing two new sizes (14 cm and 15 cm) of its Little Feet for infants and young children. Little Feet are functional, economical prosthetic feet in sizes now ranging in 1-cm increments from 10 cm to 15 cm.

BiowaveHome Neurostimulation

Biowave prescription neuro­stimulation is now available in a system that can be used at home or while traveling. Bio­waveHome delivers therapeutic high frequency electrical signals through the skin to the surface of nociceptive pain fibers, blocking the transmission of pain…

Footmaxx MyFit Orthoses

The vast majority of Footmaxx orthotic devices are custom, carefully crafted based on a patient’s unique prescription. Now Footmaxx also offers the MyFit line of nonprescription foot orthoses as an economical solution to foot, arch, and heel pain.

Össur Pro-Flex Prosthetic Foot

Össur has launched Pro-Flex, a new foot designed to help reduce joint pain among amputees who engage in low-to-moderate impact activities. Pro-Flex is designed to address many comorbidities often found in lower limb amputees, including altered gait dynamics that can…

Pain Posters From OPTP

OPTP has partnered with Adriaan Louw, PT, PhD, CSMT, to create a new set of posters focused on neuroscience pain education. The Pain Neuroscience Posters are now available as a set of four 17.75″ x 24″ posters suitable for display in therapy clinics or rehabilitation centers.

Darco Pro Term Walker

Darco International announces the addition of the Body Armor Pro Term Walker to its product line. The Pro Term Walker is an interim orthosis for conservative follow-up treatment following Chopart and Lisfranc amputations, among other indications.