October/November 2018

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Cover Story

Vexing Question: How Soon Should Patients Drive After Lower-Extremity Surgery?

The answer doesn’t come easily; official guidelines are lacking. Ultimately, patients bear responsibility for the decision, but you can still offer them valuable advice for keeping safe. “Doctor, when can I start driving again?”  That’s a common question patients ask when they’re headed for lower-extremity surgery. But it’s not always an easy one to answer.

By Keith Loria


Guest Editorial

Patellofemoral Pain: An Ongoing Orthopedic Enigma

Patellofemoral pain (PFP), also known as anterior knee pain, is one of the most common but complex knee problems to manage. PFP affects approximately 23% of the general population and 29% of adolescents. Moreover, females are twice as likely to develop PFP as males.

By Lori A Bolgla, PT, PhD, MAcc, ATC, and Michelle C Boling, PhD, LAT, ATC

THANK YOU…and Onward to 2019!

Lower Extremity Review extends heartfelt thanks to our readers, advertisers, countless medical experts, and—listed below—our many authors and the members of the LER Editorial Advisory Board. Without the support of all of you, LER would not be possible. Thank you for your encouragement, involvement, and loyalty during 2018—a year of transition for the publication, for sure.

We look forward to 2019: to hearing your ideas and to delivering clinical reviews, news, and opinion to keep you informed of best practices and help you improve outcomes. We encourage you to let us know what we’re doing right (and to tell us when you disagree or when we just plain get it wrong). Our mission is always to help you help your patients.

Here’s to a happy, healthy 2019!

Rich Dubin, Publisher + Janice T. Radak, Editor


  • Marianne Adams, MA, MFA
  • Thomas Gus Almonroeder, PT, DPT, PhD
  • Andrea Baellow, MS
  • Hank Black
  • Lori A. Bolgla, PT, PhD, MAcc, ATC
  • Michelle C. Boling, PhD, LAT, ATC
  • Benn Jason Scott Boshell, MSc, BSc (Hons)
  • Barbara Boughton
  • Uli Brüderlin
  • Andrew K. Buldt, BPod(Hons), PhD
  • Kathleen Cameron, MPH
  • Nicholas A. Campitelli, DPM, FACFAS
  • Nachiappan Chockalingam, PhD
  • Ralf Colin
  • D. Chris Cothern PT, CES, PES
  • Tyler Coye, BA
  • Sally Crawford, MS
  • Patrick A. DeHeer, DPM, FACFAS, FASPS, FFPM RCPS (Glasg)
  • Paul DeVita, PhD
  • Matthew Dilnot, DPM
  • Jill R. Dorson
  • Ian Engelman, MS, CPO
  • Vicki Foerster, MD, MSc
  • Kathrin Freyler
  • Neal R. Glaviano, PhD, AT, ATC
  • Albert Gollhofer
  • Cary Groner
  • Terry P. Haines
  • Laura Hochnadel
  • Jonathan L. Hook, DPM, MHA
  • Ken Johnson, PT
  • Anne Krause
  • Jonathan Labovitz, DPM, FACFAS, CHCQM
  • Keith Loria
  • Curt Martini, DPM
  • James McGuire, DPM, PT, LPed, FAPWHc
  • Hylton B. Menz, BPod(Hons), PhD, DSc
  • Tom Michaud, DC
  • Karen Mickle, BSc (Hons), PhD
  • Joseph M. Mozena
  • Harry L. Penny, DPM, DABPM, FAPWHc
  • Elizabeth W. Peterson, PhD, OTR/L, FAOTA
  • Donald C. Pompan, MD
  • Ramona Ritzmann
  • J. Kim Ross, DC, PhD
  • Gary M. Rothenberg, DPM, CDE, CWS
  • Susan Saliba, PhD, MPT, Med
  • Susan Sanford, PT, LAc, C.SMA
  • Jay Segel, DPM
  • Richard Schilling, DPM, FACFAS
  • Jarrod Shapiro, DPM, FACFAS, FACFAOM
  • William Smith, MSPT, CPed
  • Scott A. Spencer, DPM
  • Emily Splichal, DPM
  • Phil Stevens, MEd, CPO, FAAOP
  • Thomas Stocker
  • Rene Stolwyk
  • Audris Tien, DPM
  • Sarah Marie Tighe, SPT
  • Harald Töpfer
  • Robert A. Weil, DPM
  • Nicole Wetsman
  • Bruce Williams, DPM, DABPS
  • Cylie M. Williams
  • Joseph G. Wilson, DPM
  • T. Craig Wirt, DPM, PhD
  • Mariana Wingood, DPT, PT, GCS, CEEAA
  • Lori Yarrow, DC, BPE
  • Julia Yuncken

Editorial Advisory Board

  • Craig R. Bottoni, MD
  • Jonathan L. Chang, MD
  • Sarah Curran, PhD, FCPodMed
  • Stefania Fatone, PhD, BPO
  • Timothy E. Hewett, PhD
  • Robert S. Lin, CPO
  • Jeffrey A. Ross, DPM, MD
  • Erin D. Ward, DPM
  • Bruce E. Williams, PDM

Feature Articles

Exploring Stability and Freedom with the GYROKINESIS® Method

New somatic practice uses repeated movements, breath awareness and rhythmic patterns to loosen joints and ease muscle tension. The GYROKINESIS® Method* is a unique form of somatic practice that is gaining popularity around the world. The Gyrokinesis Method promotes a holistic approach to health and well-being that could be useful to a variety of populations.

By Marianne Adams, MA, MFA

Stylish Prosthetic Limbs Boost Amputees’ Quality of Life

Aesthetic devices respond to emotional needs and can lead to “positive conversations”. In the early 1900s in the United Kingdom, the National Health Service considered glasses and spectacles medical devices—designed to be functional, but without any consideration of style and experience.1 As a result, said Stefania Sansoni, PhD, companies that made eyeglasses didn’t think about their appearance. “They were thinking about not attracting attention,” she said.

By Nicole Wetsman

National Biomechanics Day 2018: Opening Young Minds to a Burgeoning Field

National Biomechanics Day (NBD) 2018—April 11, 2018—continued building excitement for the field by engaging 11,000 young students across 150-plus sites around the globe. The home-grown events allow high school (and younger) students to experience first-hand a field that underlies orthopedics, exercise physiology science, physical therapy, and countless other fields that involve human movement and performance.

The PodPAD Project: A Podiatry-led Integrated Pathway for People with Peripheral Arterial Disease in the UK – a Pilot Study

Clinical evidence suggests that this intervention (foot care plus advice on diet, exercise & smoking) is highly effective at reducing the progression into acute care and can reduce the incidence of amputation by 60%.

By Lisa Farndon, John Stephenson, Oliver Binns-Hall, Kayleigh Knight, and Sally Fowler-Davis

From the Literature

New NATA Recommendations Address Patellofemoral Pain

Patellofemoral pain (PFP), one of the most common knee problems in active people, is also one of the most challenging conditions to manage, due to its complex nature. To support athletic trainers and other healthcare providers who treat the problem, the National Athletic Trainers’ Association (NATA) has published recommendations and a framework for identifying risk factors and managing patients who experience PFP.

Poor Balance Tied to Visual Acuity–Peripheral Vascular Disease Interaction

Poor vision has long been known as a risk factor for poor balance. This is particularly true in older adults as they perform complex balancing tasks, such as standing on 1 foot. A team of Canadian researchers wanted to determine whether poor vision would be more strongly related to standing balance in older adults who had peripheral vascular disease (PVD) or diabetes.

ADA Issues New Guidelines for Youth with T2D

Youth-onset type 2 diabetes (T2D), defined as T2D that develops before 20 years of age, is a growing medical challenge in the United States. A national study reported a 4.8% increase in newly diagnosed cases of T2D in this age group from 2002 to 2012.

VA Reports Downward Trend in Surgical Adverse Events

In an 8-year quality improvement follow-up study of reported surgical adverse events (AEs) at the US Veterans Health Administration (VHA), researchers found 277 AEs and 206 “close calls.” The data show a continuing of the downward trend from 1.74 to 0.47 AEs with harm for every 100,000 procedures, compared to the previous similar VHA studies (the periods 2001-2006 and 2006-2009).

HIPAA Violations Can Be Costly

A Connecticut allergy practice has agreed to pay $125,000 and enter a corrective action plan to settle an alleged Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule violation. According to the US Department of Health and Human Services (HHS), the violation occurred when one of the practice’s physicians disclosed a patient’s protected health information to a member of the media.

New Products

36″ x 4″ Pro-Roller Foam Rollers

OPTP has added a new 4″ diameter foam roller to its elite Pro-Roller line, available in standard and soft densities. The 36″ x 4″ roller is closer to the ground than the regular 36″ x 6″ diameter roller, for a safer, more stable feeling. They are well suited for the elderly, beginners, or individuals with a compromised sense of balance and are easier to control while using for massage.

Supportive Shock-Absorbing Orthotics

Cadence Insoles introduces a new model to its line of exclusive, retail-only, over-the-counter orthotics. The EX MP provides semi-rigid support, durable high-rebound/low-compression set polyurethane foam, and an antimicrobial, low-friction CoolMax top cover with a built-in metatarsal pad. The EX MP is only available for purchase from physicians’ offices and select retailers; it is not available for online sales.

Posted CP-3300 Orthotic Shell

KLM Laboratories continues to help practitioners meet the ever-changing needs of each patient. The Posted CP-3300 orthotic shell is the newest addition to the KLM prefabricated product family. This semi-flexible polypropylene shell has a 2-degree inverted rear foot post that is lightweight and low bulk. The design of the horseshoe shape will allow for heel lift attachments, which are under development.

Ottobock C-Brace Lower-Limb Orthosis

The new C-Brace by Ottobock HealthCare uses the world’s first mechatronic stance and swing phase control orthosis (SSCO) system, introduced with the original C-Brace, to control stance and swing phase with microprocessor sensor technology. Building upon the features of the first-generation C-Brace, the new C-Brace is smaller and lighter, allowing it to be worn under clothing.

Waldlaufer Extra-Wide Women’s Lace-up

German comfort footwear company Waldlaufer introduces the stylish new Kagan lace-up, a therapeutic shoe without the therapeutic look, designed to accommodate the footwear needs of women with extra-wide feet, bunions, and hammertoes. Like every Waldlaufer shoe, the Kagan is handcrafted in Europe using the finest leathers and super-light, air cushion soles.

X-Large Therafirm Ease Compression Hosiery

Therafim’s Ease line of compression hosiery debuted in 2014, growing in popularity and expanding ever since. Now, Therafirm has expanded the line with the introduction of X-Large sizes. Compression knee highs are sized by ankle and calf circumferences. With new sizing including X-Large, Ease knee highs now fit ankle and calf circumferences up to 15” and 23”, respectively.

Foot Orientation Apparatus for 3D Foot Scanning

New from PAL Heath Technologies is the Foot Orientation Apparatus (patent pending, serial number 62/739,962) to be used with PAL’s Xtremity 3D foot scanner. The lightweight and portable apparatus was developed to obtain subtalar neutral positioning of the foot, ensuring foot scans are more accurate for the physician and more comfortable for the patient.

Z-CoiL Relieves Foot, Leg, and Back Pain Immediately

Z-CoiL shoes feature an innovative spring in the heel. Like shock-absorbers for the body, Z-CoiL’s reduce impact by 50%, enabling the wearer to walk, run, and stand for hours in comfort. Now those suffering from foot, leg, and back pain can reduce pain and injury without pills, shots, or surgery. It sounds too good to be true – but it’s not!

Tread Labs Insoles Improve Patient Outcomes and Your Bottom Line

Some of your patients need custom orthotics. Others will achieve equal outcomes, at lower cost, with pre-fabricated insoles. Tread Labs offers semi-custom insoles that provide excellent relief from plantar fasciitis and other foot ailments. They are the perfect solution for customers who do not need, or cannot afford, custom devices.

Orthofeet Tie-Less Lacing System

Orthofeet therapeutic shoes offer unique functional features: Tie-Less Lacing System offers an easy way of fastening the shoe without the need for lacing up – and ideal solution for patients who have difficulty tying laces. Two-Way Fasting uses straps on both the medial and lateral sides of the shoe. Heel-Strap enables adjusting the grip around the heel, eliminating slippage, and accommodating braces and wide feet…

The Neuropathic Walker is your solution

The Neuropathic Walker is a more advanced and comfortable solution to the CROW Walker. The Neuropathic Walker is integrated with custom molded 3/16” solid polypropylene and 1/4” Aliplast lining with the same trim lines as a CROW Walker. We use high-quality leather that is molded over the solid polypropylene.

Control Pronation with New Fast Fit Bug Prefabricated Shoe Inserts

Cascade Dafo, creator of the original DAFO (Dynamic Ankle Foot Orthosis), has added the Fast Fit Bug to its line of prefabricated shoe inserts. This low-profile foot orthosis is designed to control mild to moderate pronation with an optimal amount of support and comfort, yet minimal volume in the shoe.

Industry Snapshot

Noteworthy products, association news, and market updates