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Charcot Orthosis™ Introducing EXOS ® functional inserts featuring our proprietary carbon nano-tube shell for easier reform-ability. ÌÜV >}iÌ iÜ>ÞÞÕwÌÞÕÀ«>ÌiÌÃLiV>ÕÃiÌÃvÌiÃÜÌ `iÀ>Ìi i>Ì}vÀ>iÝÌ iÀV«>ÌV ]>Ü}ÞÕÌ>i>`ÕÃÌiÌÃvÀÌ vÞÕÀ«>ÌiÌLivÀiÌ >À`iÃL>VÌ>V>ÀL}À>« ÌiiÃÌ>ÌiÜ iVi`° ÀiÃi`}ÃiÀÌÃL>VÌÌ i>Õv>VÌÕÀiÀÀÀiÃV i`Õ} «>ÌiÌð̽ÃÌ iÌiV }ÞÞÕiÝ«iVÌvÀÌ ii>`iÀÌ iÀ>«iÕÌV vÌÜi>À° Ì>VÌ\ (877) 728-9917 À drcomfort.com/exos2 29 37 43 VOLUME 8 NUMBER 3 LERMAGAZINE.COM March 201 6 fea tures 26 ORTHOTIC DEVICES FOR THE WIN Plantar fasciitis: Clinical concerns in basketball Highly visible elite athletes with plantar fasciitis are in the news, but healthcare practitioners need to also focus on those who play recreation - ally for health benefits. By Patricia Pande, MClScPT, CSCS, CPed COVER STORY 29 Running modifications 18 and reducing injury risk Evidence suggests that no one foot strike style can be expected to Outcomes after ACL surgery: decrease injury risk in all runners, and that switching foot strike patterns can have unintended consequences. Using a shorter stride THE IMPORTANCE OF GRAFT TYPE length, however, can be an effective alternative for some runners. In an attempt to decrease the risk of re-rupture and revision surgery after anterior By Elizabeth Boyer, PhD, and Tim Derrick, PhD cruciate ligament reconstruction, practitioners are refining the decision process regarding which procedure is best for which patient. 37 Strength training: Bone By Cary Groner health benefits for men IN THE MOMENT Men with low bone mass are much less likely than their female counter - running /13 parts to receive treatment. But research suggests that resistance exercise is a safe and effective way to improve bone mineral density in men and, Benefits of balance: YBT is associated with history of injury in turn, reduce the risk of fracture and related complications. Test for lower extremity asymmetry identifies risk in recreational runners By Pamela S. Hinton, PhD Clinically useful 2D measurements predict patellofemoral joint force OA /15 43 Ankle instability rehab emphasizes individuality PFOA prognostication: Sagittal plane factors predict worsening Years after Achilles tear, injured limb demonstrates elevated knee loading Research presented at the most recent International Ankle Symposium indicates that rehabilitation for chronic ankle instability is evolving from Clinical single-leg hop tests can help estimate risk of OA after ACL injury a one-size-fits-all approach to an increased focus on matching specific interventions to the patients who are most likely to benefit. By Lori Roniger plus ... 49 Flexible flat foot: Effects of orthoses during gait OUT ON A LIMB / 9 NEW PRODUCTS / 58 In this original investigation, researchers analyzed the biomechanical An analgesic assist The latest in lower extremity devices and technologies effects of a foot orthosis in patients with flexible flat foot during walking The type of analgesia used in ACL surgery and the extent to which those functional effects are consistent with can affect patients' quadriceps strength, MARKET MECHANICS /61 proposed theories about the device’s mechanism of action. which could influence functional outcomes. News from lower extremity companies and organizations By Bruce Elliott, PT, DPT, COMT, and Juan Garbalosa, PhD, PT By Jordana Bieze Foster By Emily Delzell Custom AFO Gauntlets _ _ _ _ _ _______ _ _ _ _ _ _______ ____ ________ _ _ _ _ _ _______ ____________ ____________ ____________ Mad e in the USA SStandardtandard FFeatureseatures z So PORON ®®-padded-padded ccollarollar z MMoldedolded ppolypropyleneolypropylene iinnernner sshellhell with PORON ® ppaddingadding tthroughouthroughout z LLinedined wwithith lleathereather oorr optionaloptional XX-Static®-lined-Static®-lined NNeoSponge™eoSponge™ z PORON ® + MMulticork™ulticork™ oorthoticrthotic z In-houseIn-house tturnaroundurnaround timetime ofof 77-10-10 business days z * PDACPDAC LettersLetters availableavailable at:at: www.acor.com/PDAC-Sadmerc.phpwww.acor.com/PDAC-Sadmerc.php L L L L (G) G* G* A AFO G aun tlets ar e a vailable with y our choic e of thr ee polypr op ylene r einf or cemen ts . Full Heel Open H eel Leaf H eel G* G G G* Standard Flexure Joint Dorsi-Assist Chopart Toe Articulating Articulating Filler 18 Color Options! Multiple Closure Options (natural leather - colors may vary) black brown bone white taupe navy blue oak sand pink red orange yellow purple royal kelly light medium sky G* G* G* G* G* G* blue green grey grey blue Lace Boot Hooks Speed Lacer Velcro Lace/Velcro Navicular Strap Scan this barcode with your smartphone QR reader or visit: www.acor.com/downloads.php www.acor.com to download our new catalogs 800 -237-2267 Look for us: You [email protected] (option 2) Tube out on a limb: An analgesic assist When it comes to improving Given the obvious downsides to the conventional FNB approach, outcomes after anterior surgeons and their anesthesiologist colleagues have been looking cruciate ligament (ACL) for alternatives. These include the adductor canal block (ACB), a recon struction, lower more distal block of the femoral nerve, positioned in the midthigh extrem ity practitioners need to preserve quadriceps femoris strength. all the help they can get. Early studies on ACB use in total knee arthroplasty patients have Fortunately, a recent study been positive. And, in a study epublished in early March by Anes - suggests they might be able thesiology , researchers from the University of Toronto in Canada to get some valuable assis - found that an ACB administered prior to ACL reconstruction was tance from their colleagues associated with significantly less quadriceps strength loss than a in anesthesiology. preoperative FNB, while providing equal or better pain relief. Increasing numbers of studies have underscored the importance of quadriceps strength—and, in particular, quadriceps strength symmetry between limbs—in determining functional outcomes after ACL surgery. In fact, a number of orthopedic surgeons say The type of analgesia used in ACL surgery the need to maximize quadriceps strength after ACL reconstruc - can affect patients' quadriceps strength, tion is an important consideration in their choice of graft type, which could influence functional outcomes. surgical technique, and rehabilitation protocols (see “Outcomes after ACL surgery: The importance of graft type,” page 18). But a smaller body of literature is starting to indicate the type of analgesia used in ACL reconstruction procedures also affects Granted, the findings are preliminary, and we can’t connect all the postoperative quadriceps strength—which could, in turn, affect dots yet. The Toronto study only assessed strength loss preopera - functional outcomes. tively, so we can’t assume those effects would be evident postop - eratively. The Mayo Clinic results suggest they might, but we can’t Femoral nerve blocks, for example, have been widely reported to yet assume the findings of that study can be extrapolated beyond cause immediate postoperative quadriceps weakness, particularly six months, or that they would have any impact on rerupture rates in patients undergoing total joint arthroplasty, but also in those or cartilage degeneration. undergoing ACL reconstruction. One might not think analgesia- induced weakness in the first day or two after surgery would have Still, the findings are intriguing enough that lower extremity practi - longer-term implications, especially in athletes, but research from tioners should at least be asking questions about analgesia when the Mayo Clinic in Rochester, MN, suggests it might. planning an ACL reconstruction or a postoperative rehab protocol. The Mayo Clinic team reported last February in the Journal of And, when facing a clinical challenge as complicated as an ACL Knee Surgery that ACL reconstruction patients who received a injury, lower extremity practitioners should also be encouraged to postoperative femoral nerve block (FNB) had significantly weaker know that it’s a battle being fought on multiple fronts. quadriceps at six months than patients who did not receive a . FNB. Vertical jump and single-leg hop performance was also significantly poorer in the FNB group. 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Corp., Fort Worth, TX 76106 USA MKL-619, REV-1, 0913 GET INVOLVED AND STAY CONNECTED WITH THE GROWING LER SOCIAL Publisher Richard Dubin | [email protected] MEDIA NETWORK ! Editor Visit lermagazine.com today to stay up to date on critical lower Jordana Bieze Foster | [email protected] extremity information, subscribe to our monthly e-newsletter, and join Senior editor the conversation on our vast, ever-expanding social media network. Emily Delzell | [email protected] Associate editor P.K. Daniel | [email protected] facebook.com/LowerExtremityReview Operations coordinator M Melissa Rosenthal-Dubin | [email protected] 76,000 post views Social media consultant per month Kaleb S. Dubin | [email protected] New products editor Rikki Lee Travolta | [email protected] Graphic design & production Christine Silva | MoonlightDesignsNC.com Website development @lowerextremity Anthony Palmeri | PopStart Web Dev [email protected] 2,849 Followers M Circulation Christopher Wees | Media Automation, Inc Editorial advisors Craig R. Bottoni, MD, Jonathan L. Chang, MD, Sarah Curran, PhD, FCPodMed, Stefania Fatone, PhD, BPO, Timothy E.
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