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
CAGA 101: The 12 Dirty Truths of Foot Mechanics
We all know we will not live forever, but perhaps a good goal would be to not outlive your health. We also know that there are elements of our health we can control and those we can’t. Aging is a simple fact, though we often don’t consider it at the functional microscopic level. We can’t do much about the ending, but we have much to say and…
By Jay Segel, DPM; Sally Crawford, MS
3D Scanning vs. Plaster Casting–Evolving Techniques in Orthotic Capture
Over the last few decades, clinicians have debated the merits of traditional plaster casting versus modern 3D scanning in orthotic capture. Amid continuing discourse, 1 principle holds: the clinician’s grasp of anatomical data and its impact on device design is critical to success. Equally as vital is the orthotic lab’s role in translating clinical intent into design.
By Dr. Dean Hartley (Podiatrist & Adjunct Engineering Fellow–University of Queensland)
Melted Boundaries: Regenerative Orthobiologics in Lower Extremity Medicine–The Rise of Orthokine® (Autologous Conditioned Serum) and Enhanced PRP Therapy for Joint Pain
Orthokine® is the proprietary name for a German-developed autologous conditioned serum (ACS) therapy now advanced in musculoskeletal medicine for joint pain. In scientific literature and clinical contexts, Orthokine is used interchangeably with the generic designation autologous conditioned serum (ACS), with…
By Dr. Hooman Mir, DPM, MSci, FAPWCA
UTRGV, School of Podiatric Medicine
Department of Podiatric Medicine, Surgery & Biomechanics
CAGA 101: The 12 Dirty Truths of Foot Mechanics
Each one of these so-called “Dirty Truths” has its specific reason, or reasons, for making the list. This one gets most of its “dirtiness” educationally and clinically. Many patients are familiar with the term “pronation,” though their understanding may vary. A clear explanation of body planes and planes of motion is important for an accurate understanding of this concept.
By Jay Segel, DPM; Sally Crawford, MS
lerEXPO Highlights: AFO Coding Compliance and Documentation Best Practices
Ankle-Foot Orthoses (AFOs) play an essential role in the management of various lower extremity conditions. Coding and compliance accuracy and proper documentation can pose a challenge. Providers must accurately explain why the specific AFO is needed. This is not just a box-ticking exercise but a fundamental element to avoid audit failures.
Leading the Shift: How We Made 3D Printed Polypropylene a Reality
I am regularly asked, “Why 3D printed?” There are obvious environmental and manufacturing benefits, although speaking from my clinical perspective–it is the design freedom that is most important. The ability to have an unrestricted design envelope, being able to design and manufacture devices lighter, thinner, fully-custom and quicker are just a few of the benefits.
By Dean Hartley (Podiatrist & Adjunct Engineering Fellow–University of Queensland)
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Lower Extremity Review
ShortTakes From the Literature
Exergame Program Improves Gait in People with Parkinson’s Disease
Gait impairments are among the most common and disabling symptoms of...
Diagnostic Musculoskeletal Ultrasound for Plantar Fascia
The plantar fascia is composed of fibrous connective tissue that forms a band...
Ozone Successful Treatment of Venous Leg Ulcers and Diabetic Foot Ulcers
Venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs) are chronic wounds...
Achilles Tendon Stiffness and Jumping: Comparative Study of Soccer and Basketball Athletes
Tendon properties influence athletic performance, and Achilles tendon (AT)...
Plantar Pressure in Recreational Athletes Running in Maximal and Traditional Shoes
Running is a popular competitive and recreational activity with numerous...
Is Local Steroid Injection Predictive of Patient Response to Endoscopic Plantar Fascia Release
Plantar fasciitis is a very common issue with many treatment options. The...
Indoor VS. Regular Custom-Made Footwear for Diabetics at High Risk Of Foot Ulceration
Custom-made footwear designed specifically for indoor use increases footwear...
Partial Nail Avulsion With or Without Phenolization for Ingrown Toenails
Ingrown toenails, a common and often painful condition, frequently require...
A Foot Forward for Optimum Health
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Industry News & Updates
Cleveland Researchers Launch First Major Study to Address Onychomycosis
Athletes are 2.5 times more likely than the general public to develop nail...
Researchers Explore AFOs for Treating Achilles Tendinopathy
In Elisa Arch’s Orthotics and Prosthetics for Enhanced Mobility Lab, at the...
AI “Digital Twins” Help Patients Make Smarter Decisions About Knee Surgery
An artificial intelligence (AI)–powered tool helped patients make more...
DME MACs Expand Coverage for OA Knee Braces
The Centers for Medicare & Medicaid Services and the Durable Medical...
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Additive Manufacturing Is Here to Stay
By reducing weight, lead times, and costs, 3-D printing or additive manufacturing (AM) offers...
Post-Processing Tech Personalizes to Each User’s Needs
While 3D printing has dramatically accelerated the customization process for manufacturing...
Manitoba P&O Users Endorse Certified Care…Want More
A recent survey found that experienced orthotic and prosthetic (O&P) device users with a...
Pseudo-Prosthesis Appears Accurate As Teaching Tool
Prosthetic device users have a wide range of needs and prosthetists need to be aware of varying...
The Importance of Interface Materials
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
Achilles Repair System
Medline UNITE Foot & Ankle’s new FORCECORD™ Midsubstance Achilles Repair System is constructed from a densely woven, tubular, synthetic, non-resorbable polyester. The implant features flat tapered ends and uses a specially designed probe for ease of passing. When...
Premium Insoles for Everyday Use and High-Performance Activities
Northwest Podiatric Laboratory, a manufacturer of custom orthotics since 1964, has introduced StepCraft® premium insoles–a culmination of 6 decades of biomechanical expertise. The insoles are said to transform movement with unmatched support, stability, and...
Microprocessor-Controlled Knee Joint for KAFOs
The NEURO HiTRONIC system knee joint is suitable for custom-made knee-ankle-foot orthoses (KAFOs) with microprocessor-controlled swing phase and stance phase control. Patented microhydraulics make the joint small and light. The slim, anatomically shaped controller...
AI-Powered Patient-Matched Lapidus System
The VIRTUGUIDE™ System is an artificial intelligence (AI)–powered, patient-matched solution designed to support Lapidus procedures, which help realign the foot by joining the first metatarsal bone and the medial cuneiform. The system uses pre-operative planning...
Red Light Therapy for Joint Pain Relief
MOVE+ is an at-home, highly-targeted laser red light therapy device that was developed for individuals who struggle with chronic joint pain, helping them recover more quickly by restoring damaged tissue. The device uses LED lights and medical-grade laser technology to...
Bioresorbable Wick for Tendon Repairs
ROTIUM® is a fully resorbable, synthetic-nanofiber scaffold designed to optimize the healing environment, promote tissue remodeling, and improve long-term outcomes. Driven by surgeon demand and clinical success in over 12,000 rotator cuff cases, ROTIUM is now being...
Compression Socks
ZenToes recently launched its latest innovation, next-generation Compression Socks. They are available in 3 styles, Basic, Anti-Slip, and Gel Padded, and 3 colorways, grey, blue frost, and lilac. Designed to promote lasting comfort, ZenToes is delivering everyday...
Rapid Relief Rx Balm Relieves with Hemp CBD
Xtreme Rapid Relief Rx Balm is a concentrated topical formula created for targeted application in clinical and active recovery settings. With 1,000 mg of hemp-derived cannabidiol (hemp CBD) and a trusted blend of ingredients including arnica, turmeric oil, bromelain,...
Mushroom-Based Roll-On for Muscle Relief
Xtreme Roll-On, part of the Xtreme Wellness product line, mixes a blend of reishi mushroom peptides with its proprietary BioHeat Matrix to help improve circulation to calm inflammation, and accelerate localized muscle relief in smaller/harder-to-reach areas. The...
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