Airshift™ OA Knee Brace
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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 ´,·PVRKDSS\ P\GRFWRU RUGHUHGWKHEHVW EUDFHIRUPHµ ´ 6LQFHLQVXUDQFHSD\VWKHVDPHIRUD TXDOLW\EUDFHFRPSDUHGWRDFKHDSNQRFNRII LW·VUHDVVXULQJWKDWP\GRFWRURUGHUHG WKH5LFKLH%UDFH²WKHJROGVWDQGDUGDQG EHVWEUDFHDYDLODEOHµ Your patient deserves the best. Your patient expects the best technology available. The Richie Brace® is the most trusted and prescribed brace in the industry. Prescribing an unproven knock-o can jeopardize a positive patient outcome. 7RWDO&RPIRUW 7RWDO&RPSOLDQFHIRUD%HWWHU3DWLHQW2XWFRPH )RUPRUHLQIRUPDWLRQYLVLWXVDW ZZZULFKLHEUDFHFRP 11 33 41 VOLUME 7 NUMBER 6 LERMAGAZINE.COM June 201 5 fea tures 29 SPECIAL SECTION 18 COVER STORY Footwear and risk of knee OA: THE SEARCH FOR MEANING IN MOMENTS Although footwear may in fact play a role in Conference Coverage: the development of knee osteoarthritis and Ortho Technology Forum 2015 its clinical management, those relation - ships are turning out to be much more complicated than once thought. 33 Adapted tango: Bringing By Cary Groner artistry to rehabilitation Adapted tango, a version of traditional Argentine tango modified to IN THE MOMENT address motor impairments, has been shown to improve balance, Sports medicine /11 mobility, and cognition in older adults and patients with Parkinson disease, with better compliance than conventional rehabilitation. Concussion chronicity: Balance deficits persist long term By Madeleine E. Hackney, PhD Patients with ankle instability respond to auditory feedback by changing gait One workshop prepares youth coaches to implement knee injury prevention 41 Total ankle arthroplasty: Defining its clinical niche Foot function /13 Research generally upholds total ankle arthroplasty as a viable alternative Running shoe reveal: Study links max cushioning, higher load to the traditional first-line surgical treatment, ankle arthrodesis, for Balance data suggest somatosensory benefit of minimalist footwear design correctly selected patients with end-stage ankle arthritis. But complica - tion rates associated with ankle arthroplasty remain an area of concern. Dynamic arch height in runners differs significantly from static measurement By Hank Black 51 Hip strength, balance, and risk of ACL injury plus ... Hip strength is associated with performance on the Star Excursion Balance Test in female collegiate athletes, a finding that adds to the OUT ON A LIMB / 9 NEW PRODUCTS / 62 evidence that hip strengthening programs can help reduce the risk of 3DP’s material needs The latest in lower extremity devices and technologies anterior cruciate ligament injuries in that patient population. We can’t assume that anything we know By Jatin P. Ambegaonkar, PhD, ATC, OT, CSCS; Lindsey M. Mettinger, MS, ATC; Shane V. about the material properties of orthotic MARKET MECHANICS /65 Caswell, PhD, ATC; Andrea Burtt, MS, ATC; Shruti J. Ambegaonkar, PT, PhD; and Nelson devices will be true for 3D-printed devices. News from lower extremity companies and organizations Cortes, PhD By Jordana Bieze Foster By Emily Delzell CAPTURE PRESCRIBE PRINT REPEAT A NEW PERSPECTIVE ON MOVEMENT 3D printed orthotics created using advanced data capture and modeling technology. That means SOLS are custom-engineered for your patient’s foot morphology, body, and lifestyle. _ WWW.SOLS.COM/MOVE Questions, or comments? 855 932 7765 Follow our adventures @WEARSOLS JOIN 10,000 OF YOUR COLLEAGUES IN THE LER ONLINE COMMUNITY. Publisher Visit lermagazine.com today to stay up to date on critical lower Richard Dubin | [email protected] extremity information, subscribe to our monthly e-newsletter, and join Editor the conversation on our vast, ever-expanding social media network. Jordana Bieze Foster | [email protected] Senior editor Emily Delzell | [email protected] Associate editor P.K. Daniel | [email protected] M Social media consultant Kaleb S. Dubin | [email protected] New products editor Rikki Lee Travolta | [email protected] Graphic design & production Christine Silva | MoonlightDesignsNC.com M Website development Anthony Palmeri | PopStart Web Dev [email protected] 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. Hewett, PhD, Robert S. Lin, CPO, Jeffrey A. Ross, DPM, MD, Paul R. Scherer, DPM, Erin D. Ward, DPM, Bruce E. Williams, DPM Our Mission: Lower Extremity Review informs healthcare practitioners on current developments in the diagnosis, treatment, and prevention of lower extremity injuries. LER encourages a collaborative multidisciplinary clinical approach with an emphasis on functional outcomes and evidence-based medicine. LER is published monthly, with the exception of M a combined November/ December issue and an additional special issue in December, by Lower Extremity Review, LLC. Subscriptions may be obtained for $38 domestic. and $72 international by writing to: LER, PO Box 390418, Minneapolis, MN, 55439-0418. Copyright©2015 Lower Extremity Review, LLC. All rights reserved. The publication may not be reproduced in any fashion, including electronically, in part or whole, without written consent. LER is a registered trademark of Lower Extremity Review, LLC. POSTMASTER: Please send address changes to LER, PO Box 390418, Minneapolis, MN, 55439-0418. Lower Extremity Review 292 Washington Ave. Ext. #105, Albany, NY 12203 518/452-6898 lermagazine.com 06.15 7 PRESENTS: extre me impact prot ection PORON® XRD® XRD® Extreme Impact Protection i s a lightweight, thin and breathable material that’s engineered for repeated impact and shock absorption, absorbing more than 90% of energy when impacted at high strain rates! Available in Sheets 2mm or 3mm thicknesses Infused with Microban® Antimicrobial Protection, it helps prevent the growth of bacteria that causes stains and odors. • Breathable, open-cell technology • Soft to the touch, yet rm on impact. • Outperforms the competition • M emory-like foam provides a contoured t for each user Sole Defense® EZ-Fit Tri-Layer Orthotics SD-3001L Sole Defense® EZ-Fit Premium Orthotics SD-4003L Sole Defense® Cushioned Insoles XS-XRD Look for us: You www.acor.com Tube Toll-free: 800 -237-2267 out on a limb: 3DP’s material needs 3D printing is no longer Even in cases in which traditional orthotic materials actually do some futuristic concept lend themselves to 3D printing, another hurdle to overcome is that might someday affect that the manufacturing process itself can change the properties lower extremity healthcare. of the material. It’s here, and it’s already One challenging aspect of additive manufacturing is that products changing the landscape are typically composed of numerous micron-scale beads piled on more quickly than many top of one another, according to a recent statement from the had expected. But, as Defense Advanced Research Projects Agency announcing its anyone who follows Open Manufacturing program. “Even when well-known and journalists on Twitter can trusted alloys are used, the additive process produces a material attest, the battle to be at with a much different ‘microstructure,’ endowing the manufac - the forefront of something tured part with different properties and behaviors than would be new often leads to critical expected if the same part were made by conventional manufac - details being overlooked. turing,” the statement read. At the recent Ortho Technology Forum (see “Conference So, essentially, we can’t assume that anything we know about Coverage: Ortho Technology Forum 2015,” page 29) and at the the material properties of traditional orthotic devices will be joint meeting of the Pedorthic Association of Canada and the true for 3D-printed orthotic devices. Clinically, that seems like a Prescription Foot Orthotic Laboratory Association that followed, big problem. much of the discussion about 3D printing involved concerns that the technology will encourage the emergence of entrepreneurial orthotics companies with business strategies that emphasize cost over quality. And, certainly, that’s a legitimate concern. We can’t assume that anything we know But to me, the bigger issue with 3D printing is that even about the material properties of orthotic companies or clinicians who want to create quality orthotic devices will be true for 3D-printed devices. products using the technology may not be able to do it. That’s because the types of materials that are amenable to 3D printing, and the way those materials behave once they’ve gone through I do believe that 3D printing has the potential to take orthotic therapy the additive manufacturing process, could end up being to the next level. But it will take extensive research to develop any completely different from the subtractive manufacturing world. type of clinical confidence in 3D-printed orthotic materials—research For starters, many of the materials that have traditionally been that, as far as I can tell, is only in its earliest stages. used for orthotic devices simply can’t be used in a 3D printer. In the meantime, jumping on the 3D printing bandwagon may be Research and development departments