LER Cover Story:
lerEXPO Highlights: Fibular Nails–Fad or New Standard?
This article synthesizes the key findings, surgical techniques, and clinical insights from a lerEXPO’s 2025 Gait Keepers Journal Club regarding the use of intramedullary fibular nails for distal fibula fractures. The primary focus is on a retrospective multi-center study published in the Journal of Foot & Ankle Surgery (JFAS) in 2023, which represents the largest cohort of its kind to date.
By Brian Burgess, DPM with Brad Abicht, DPM, FACFAS and Jeff Dikis, DPM
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Feature Articles
The Effects of Exercise on the Geometry and Bone Mineral Density of Femoral Neck Strength
Physical exercise induces spatially heterogeneous adaptation in bone. However, it remains unclear where the changes in bone mineral density (BMD) and geometry have the greatest impact on femoral neck strength.
By Dermot O’Rourke, Belinda R. Beck, Amy T. Harding, Steven L. Watson, Peter Pivonka, Saulo Martelli
Stingray Injuries of the Lower Extremity Treated at United States Emergency Departments
Stingrays are cartilaginous fish related to sharks with round, flattened bodies and whip-like tails. Stingrays are common to shallow intertidal areas of tropical and subtropical oceans around the world, although some rays inhabit cooler waters and freshwater. While there are approximately 150 species of ray worldwide, one to two dozen stingray species are…
By Mathias B. Forrester, BS
Book Excerpt Practical Biomechanics: Treating Asymmetry
One of the most perplexing issues I deal with in biomechanics is trying to take asymmetrical functioning bodies and make them more symmetrical when I think it will help the patient’s symptoms and function. However, asymmetry is part of who we are as people, so some thought has to be put into deciding exactly what needs to be changed because…
By Richard Blake, DPM
The Utility of Pentoxifylline to Treat a Chronic Venous Leg Ulcer: A Case Report
The relationship between calf-pump insufficiency and ulceration has long been established.1 The accompanying venous hypertension is associated with histologic and hemodynamic alterations in capillary and lymphatic microcirculation that result in pathophysiologic changes in the tissues.
By Windy Cole, DPM, CWSP
A Scoping Review of Heel Fat Pad Syndrome
Clinical commentaries and expert opinions have suggested that aging, injury, repetitive or prolonged overloading (eg, endurance runners), overweight, improper footwear, steroid injection, and comorbidities (eg, diabetes, rheumatic diseases) may negatively impact the structure and function of the heel fat pad.
By Alison H. Chang, Steven Zartov Rasmussen, Asger Emil Jensen, Thomas Sørensen, and Michael Skovdal Rathleff
International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines
The human aging process is universal, ubiquitous, and inevitable. Every physiological function is being continuously diminished. Aging and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning.
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ShortTakes From the Literature
Major Adverse Foot Events Prevalent in DPN and Nephropathy
Peripheral neuropathy affects millions of individuals worldwide. The lifetime...
ROM & Dynamic Stability in Athletes with Lateral Ankle Sprain
Ankle sprains are the most common lower-leg musculoskeletal injuries,...
Meta-Analysis Shows ESWT Is Safe & Efficacious for Plantar Fasciitis
Based on findings from a systematic review and meta-analysis, researchers from...
Can Short-Term Weight Loss Programs Work?
Long-term lifestyle change programs can be effective at achieving weight loss...
Operative VS Nonoperative Management of Achilles Tendon Ruptures
Orthopedic researchers from the University of Michigan and the Toledo (Ohio)...
Collaborative Care Builds Better Outcomes: Care Fragmentation Impacts LE Amputation Outcomes
Care fragmentation (CF) is a known risk factor for unplanned readmission,...
Re The Gut-Brain Axis: Genetic Link Between Parkinson’s Disease and Inflammatory Bowel Disease Found
Researchers at the Icahn School of Medicine at Mount Sinai have identified...
Initiating BP Meds Increases Fall Risk in Nursing Home Residents
Initiating a new prescription for blood pressure medications may serve to more...
A Foot Forward for Optimum Health
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Industry News & Updates
UD Researchers Developing Force-sensing Devices for Prosthetic Legs
John Horne lost his right leg to bone cancer when he was a freshman in high...
Micro-massaging Artificial Muscles Help Fractured Leg Bones Heal Better
An interdisciplinary team of medical specialists, engineers, and computer...
Seams in Clothing Can Capture Body Movement
Everyday clothing may soon be able to capture and record body movements...
Prosthesis Driven by Nervous System Allows Natural Gait
Using a new type of surgical intervention and neuroprosthetic interface,...
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OSTEOARTHRITIS: Orthotic options for knee OA focus on compliance issues
By Jordana Bieze Foster New research presented in June at the 2015 ISPO Congress underscored the...
PROSTHETICS: Foot strike pattern can affect load in amputee runners too
By Jordana Bieze Foster Foot strike pattern during running affects loading in unilateral lower...
The future of footwear and orthoses is here. Now what?
By Jordana Bieze Foster A shift in tone was apparent at this year’s Ortho Technology Forum (OTF),...
The argument for library-based orthotic prescription
By Jordana Bieze Foster Much of the discussion at the 2015 Ortho Technology Forum (OTF) focused on...
Pluses and minuses of additive and subtractive approaches
By Emily Delzell Practitioners and orthotic laboratory owners at the fourth annual Orthotics...
A Message From the Publisher
Welcome to Lower Extremity Review or LER as we call it. This long awaited magazine fills the lower extremity information gap for practitioners in the fields of Podiatry, Physical Therapy, O&P Pedorthics, and Orthopedics. With over 20 years experience in multi-disciplinary editorial development and publishing, the collaboration of this incredible team has made this publication possible
Rich Dubin
Publisher and Chief Executive Officer
Featured Products
Lower Extremity Review
No-Show Comfort Socks
Nekkid Comfort® no-show socks leverage a superior hypoallergenic silicone oval that grips the back of the heel and y-gore construction that firmly hugs the bottom of the heel, so they stay in place, even during vigorous exercise. In addition to exceptional staying...
Minimal Oxford Men’s Shoes
The Hamilton minimal tuxedo-toe Oxfo is designed to keep feet healthy, balanced, and moving comfortably. The shoe is not without compromises such as omitting a raised heel, potentially excluding it from certain formal venues. However, the overall profile of the shoe...
Microneedling Device for Ankle Joint Preservation
The SmartShot® microneedling device is a new option for ankle joint preservation that is shown to be 67% less disruptive to subchondral bone and provide improved healing compared to traditional marrow stimulation techniques. This marrow access device was designed...
Motion Capture Tool
BioMech Lab™ enables clinicians to capture relevant motion metrics necessary to rapidly evaluate, design, and monitor physical, surgical, pharmaco, and cognitive therapies. Coupling advanced sensor technology with powerful artificial intelligence and machine learning...
TUT Trainer Microgym
The TUT system offers anyone, including elite athletes, a way to elevate their game in record time, across all the key areas. The system builds and recruits all the major muscle groups, adding progressive resistance across multiple planes of motion. Plus it’s...
Lifestyle Sandal Collection
Tread Labs, a performance insole brand established by Chaco founder Mark Paigen, is debuting its premium lifestyle sandal collection for men and women. This line is built upon the brand’s “Your Support Group” system, providing unprecedented levels of comfort, pain...
byACRE Carbon Fiber Rollator
Medline has expanded its portfolio of mobility products with the inclusion of the new byACRE Overland Carbon Fiber Rollator, a lightweight assistive walking device that is durable and agile enough to operate in snow, sand, and mud, as well as on sidewalks, curbs,...
Children’s Workbook to Understanding Pain
Ouch! Why Do I Hurt? is a workbook and guide that provides a fun, interactive way to teach children about how pain works and what to do about it. Studies show that when kids understand how pain works, they fear it less and are more able to return to school and the...
TheraScoop Lateral Trainer
Helix has launched TheraScoop, a professional upgrade to its bestselling Scoop Lateral Trainer, a therapeutic device designed to address chronic knee and hip pain at home. This compact lateral trainer was designed specifically for physical and occupational therapists...
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