May 2012

Cover Story #30496210
Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

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Medial shin pain in runners: Evidence for orthosis use

Studies of the kinematic variables associated with medial tibial stress syndrome suggest possible targets for prevention and intervention, including the use of foot orthoses.

By Janice K. Loudon, PT, PhD, SCS, ATC, and Michael P. Reiman, PT, DPT, OCS, SCS, ATC, FAAOMPT, CSCS

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Healing in the dark: Night use of orthoses

Night splinting for plantar fasciitis gets the lion’s share of attention, but lower extrem­ity practitioners are also seeing positive results with night use of orthoses for conditions ranging from cerebral palsy to AIDS.

By Larry Hand

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Editor Message #30496210
Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

Continue reading

Out on a limb: Yes, treat the symptoms

In the healthcare community there’s a lot of talk about the importance of treating the underlying cause of a disease rather than just the symptoms. But sometimes treating the symptoms can be pretty darned important too.

Jordana Bieze Foster, Editor

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Out On a Limb: Class act

When I was in journalism school in Los Angeles, securing a spot in the reporting class taught by Pulitzer Prize-winning LA Times writer George Ramos was a coup. It was also terrifying.

Jordana Bieze Foster, Editor

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Special Report

STEPS AHEAD: Advances in foot and ankle biomechanics

Foot and ankle experts from across the globe gathered in Sydney, Australia, in April for the third International Foot & Ankle Biomechanics (i-FAB) congress. LER’s exclusive coverage of this event starts with the ever-controversial topic of barefoot running and goes on to examine clinical and scientific progress related to plantar pressures, diabetes, pediatrics, unstable shoes, and osteoarthritis.

By Jordana Bieze Foster

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Departments #30496210
Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

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Orthotic management of Charcot-Marie-Tooth

Ankle foot orthoses can help compensate for muscle weakness and accommodate related structural deformities in patients with Charcot-Marie-Tooth disease, but practitioners are constantly looking for ways to improve suboptimal compliance rates.

By Cary Groner

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Diabetes and altered gait: The role of neuropathy

Researchers have identified gait alterations in patients with diabetic peripheral neuropathy but also in diabetic patients with normal sensation, raising questions about the extent to which factors other than neuropathy might also be affecting gait.

By Cary Groner

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Concussion assessment: Neuromuscular concerns

Balance testing is already recommended for concussion assessment in athletes, but research suggests the connections between concussion and neuromuscular variables are even more complex, and the opportunities for intervention more numerous.

By Brent Harper, PT, DPT, DSc, OCS, FAAOMPT

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Artificial surfaces evolve, but safety debate persists

Artificial turf technology has advanced significantly, and some research suggests newer surfaces are as safe as grass, if not safer. But in other reports, including a high-profile NFL study, turf has been associated with higher rates of lower extremity injury.

By P.K. Daniel

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Active Stance: Minimalist footwear: A risky switch for runners?

For the majority of evolutionary history, runners were either barefoot or wore minimalist footwear lacking the cushioning of today’s running shoes. Barefoot or minimally shod runners demonstrate differences1 in kinematics and impact forces compared with those wearing modern running shoes, and some research suggests barefoot running may confer biomechanical advantages over more cushioned footwear.

By Erik M. Haniuk, BS; LTC Steven J. Svoboda, MD; Karen Y. Peck, MEd, ATC; Kenneth L. Cameron, PhD, MPH, ATC; and LTC Brett D. Owens, MD

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Preventing hamstring injuries on the gridiron

Hamstring injuries that occur during sprinting are a significant concern in football, not just because of the frequency with which they occur, but also because they are notoriously difficult to rehabilitate, which underscores the need for effective prevention through targeted exercise programs.

By Charles D. Kenyon, MS, RSCC, and Marcus C.C.W. Elliott, MD

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Selection of amputation level in diabetic patients

Not all patients with diabetes and not all ulcerated limbs are amenable to salvage. When salvage is not an option, amputa­tion can help improve patient function, but a number of factors should be considered when deciding how much of the foot—if any—should be retained.

By Cary Groner

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Peroneal latency’s role in inversion ankle sprain

A delay in the activation of the peroneus longus and peroneus brevis muscles is thought to contribute to the risk of inver­sion ankle sprain. New research suggests that ankle taping, in addition to providing mechanical stability, also helps reduce this peroneal latency.

By Adam Knight, PhD, and Wendi Weimar, PhD         

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Patient race contributes to burden of knee OA

Evidence suggests that the prevalence and symptom severity of knee osteo­arthritis are greater in African-American pa­tients, underscoring the need for lower extremity practitioners to implement effec­tive strategies for disease prevention and management in this patient population.

By Kelli D. Allen, PhD

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In the Moment: Knee OA

By Emily Delzel #30496210
Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

Continue reading

Photo courtesy of Townsend Design
Benefits of bracing: Studies find improvement in pain, gait

Studies presented at the 2013 World Congress on Osteoarthritis, held in April in Philadelphia, provide more evidence that knee bracing can improve pain and gait mechanics in patients with knee osteo­arthritis (OA)—improvements that are magnified with increased wear time.

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Nonoperated knee remains vulnerable after unilateral total joint arthroplasty

Unilateral total knee arthroplasty (TKA) does not reduce loading in the nonoperated knee, and the resulting asymmetry may help explain why many patients end up undergoing TKA in the contralateral knee within 10 years of the initial procedure, according to an Israeli study presented at the 2013 World Congress on Osteoarthritis.

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Medial meniscal damage corresponds to decreased proprioceptive accuracy

Severity of meniscal abnormality in patients with knee OA is significantly associated with severity of proprioceptive impairment, according to research from the Netherlands presented at the 2013 World Congress on Osteoarthritis.

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Adding exercise to diet improves pain, function in overweight knee OA patients

Adding exercise to a dietary program does not significantly increase weight loss or reduce loading in overweight patients with knee osteoarthritis (OA) compared to diet alone, but the addition of exercise is associated with significant improvements in pain and function, according to preliminary results of a large 18-month trial presented in April at the 2013 World Congress on Osteoarthritis.

Continue reading #5980593
Weight watching: Ten percent gain or loss affects symptoms

Education about weight loss—including why it’s important and how to achieve it—should be “front and center” of any clinical encounter involving patients with knee osteoarthritis (OA), said a researcher who recently published findings on the effects of weight change over time on OA-related pain and functional limitations.

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Hatha yoga outperforms traditional exercise for relief of OA-related pain

A study e-published in April by the Journal of Alternative and Complementary Medicine suggests hatha yoga is superior to therapeutic exercises in reducing osteoarthritis-related walking pain. Investigators from Ebnezar Orthopedic Center in Bangalore, India, randomized 250 outpatients with radiographic knee OA…

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Patellofemoral cartilage damage tends to be medial, even in most valgus knees

Medial cartilage damage, not lateral damage, is the more prevalent pattern of cartilage morphology in patellofemoral knee osteoarthritis in all but the most severely involved knees, according to research from Boston University School of Medicine.

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In the Moment: Sports medicine

By Emily Delzell #30496210
Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

Continue reading

Study participant undergoes testing for cortical excitability and inhibition measures. (Image courtesy of Alan Needle, MS, ATC, CSCS.)
Loose links Cortical data distinguish unstable ankles

A small study points to a “decoupling” effect between neurological and mechanical aspects of the ankle joint among some people with recurrent sprains and resultant functional ankle instability (FAI), reported investigators in a Journal of Sport Rehabilitation paper e-published on April 9.

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Barefoot running with nonrearfoot strike pattern may put Achilles at risk

Women who run barefoot with a midfoot or forefoot strike pattern have higher Achilles tendon (AT) loads—and, potentially, a higher risk of tendinopathy—than rearfoot strikers, according to research e-published May 3 in the Annals of Biomedical Engineering.

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Study links concussion to increased incidence of lower extremity injury

College athletes who sustain a concussion are almost four times as likely as their counterparts who avoid the brain injury to subsequently injure lower extremity muscles, according to research presented at the 2013 American Medical Society for Sports Medicine conference held in April in San Diego.

Continue reading #78926533, Gregory Johnston /
Direction change: Backward running may reduce PF pain

Backward running involves lower patellofemoral joint compression forces than forward running and is a viable strategy for rehabilitation of patellofemoral pain syndrome in runners, allowing them to continue exercise without increasing these forces, according to UK research e-published in April in the Journal of Biomechanics.

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Physical examination outperforms MRI for diagnosing Achilles tendon rupture

A retrospective analysis e-published in April in Clinical Orthopaedics and Related Research found physical examination is superior to magnetic resonance imaging (MRI) for diagnosis of acute Achilles tendon ruptures. Investigators at Thomas Jefferson University Hospital in Philadelphia compared 66 patients…

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Rigid footwear affects jump landing mechanics in female soccer players

Interactions between gender and footwear type affect landing mechanics in soccer players, according to research e-published in April in the Scandinavian Journal of Medicine & Science in Sports. Investigators at Duke University in Durham, NC, conducted motion analysis on 28…

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In the Moment: Surgery

By Samantha Rosenblum and Jordana Bieze Foster #30496210
Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

Continue reading #2375800
Flying can be trying: Most hip implants trigger security delays

Researchers in Baltimore reported that patients who have undergone total hip arthroplasty may experience greater inconvenience than other passengers when going through airport security.

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ACL reconstruction delays increase risk of meniscal, chondral injuries

Research from the University of Hong Kong provides further evidence that delaying anterior cruciate ligament surgery increases the risk of meniscal injury and articular cartilage lesions, both of which are associated with increased long-term risk of knee osteoarthritis. Investigators analyzed…

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Study finds no decrease in BMI after ankle surgery despite functional gains

Overweight and obese patients with end-stage ankle arthritis may think that having surgery will inspire them to lose weight, but research from the University of British Columbia suggests that in reality this doesn’t happen. Investigators retrospectively assessed 145 patients who…

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Market Mechanics #30496210
Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

Continue reading

Study finds Dr. Comfort mobility shoe helps reduce knee adduction moment

Flat, flexible footwear sold by Mequon, WI-based Dr. Comfort is associated with significant reductions in knee adduction moment (KAM) in patients with knee osteoarthritis (OA), according to a small proof-of-principle study e-published on April 23 by Arthritis & Rheumatism. In … Continue reading

Deal with OHI grows Frazier Healthcare

Seattle-based Frazier Healthcare announced last month its acquisition of Orthotic Holdings Inc (OHI), which is headquartered in Markham, Ontario. OHI is a holding company of Langer Biomechanics, based in Ronkonkoma, NY; Arizona AFO, located in Mesa; and The Orthotic Group … Continue reading

OSU plans major sports medicine facility

A multimillion-dollar donation from a local family to The Ohio State University (OSU) in Columbus will fund construction of the largest dedicated sports medicine complex in the country, according to an April release from the university. The 140,000-square-foot facility will … Continue reading

Campaign highlights Huntington patients

In recognition of May as Huntington Disease Awareness Month the Huntington’s Disease Society of America (HDSA) has launched the Faces of Huntington’s Disease campaign. Each day in May, the campaign presents a different story from patients, caregivers, scientists, clinicians, advocates, … Continue reading

Foundation taps new board members

The Pedorthic Foundation in May named two pedorthists to its board of directors, Matthew Mirones, CPed, CPO, and Anne Brussok, CPed. Mirones, a former president of the Pedorthic Footcare Association, has practiced orthopedic rehabilitation for more than 35 years, and … Continue reading

Foot drop team gets into competition

Allard USA’s TeamUP—the first national team of people with foot drop—took part in its inaugural event in April at the BB&T Gate City Half Marathon and 8K in Greensboro, NC. Allard USA, headquartered in Rockaway, NJ, formed the eight-person team … Continue reading

Hanger continues support of First Clinics

Hanger Clinic has signed on as a 2013 Bronze-level sponsor of the Orthotic & Prosthetic Activities Foundation (OPAF), the foundation announced in April. OPAF noted this sponsorship carries on a long tradition of support by Hanger since OPAF’s inception in … Continue reading

Orthofix inks agreement to sell Breg to private equity firm for $140 million

Lewisville, TX-based Orthofix International signed an agreement on April 24 to sell Breg, its sports medicine business, to Chicago-based Water Street Healthcare Partners, a strategic private equity firm focused on the healthcare industry. Water Street is expected to close on … Continue reading

Preliminary research supports use of advanced wound care product

The AutoloGel System, made by Gaithersburg, MD-based Cytomedix, shows efficacy for healing chronic wounds, according to three posters presented at the Symposium on Advanced Wound Care (SAWC), held in Atlanta in April. The system uses an individual’s own blood to … Continue reading

Arthritis Foundation recognizes on-the-move orthopedic surgeon

At its April Women on the Move Luncheon in New York City the Arthritis Foundation honored Alexis Chiang Colvin, MD, assistant professor of sports medicine in the Leni and Peter W. May Department of Orthopaedic Surgery at Mount Sinai School … Continue reading

Cyclist with CMT begins ride across US on elliptical bike to benefit foundation

Last month Andreas Johansson, a Swedish cyclist with Charcot-Marie-Tooth disease (CMT) began a nearly 6000-mile cross-country journey on an ElliptiGo 8C elliptical bike that will take him from New York City to Seattle and then down to his finishing point … Continue reading

Biomedix earns best company nod

Minnesota Business magazine has named Saint Paul, MN-based BioMedix one of its “100 Best Companies to Work For,” a list that recognizes businesses that make an impact and set a standard of excellence for others to follow. BioMedix, a medical … Continue reading

ABC announces changes for assistants

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) announced last month that requirements for its certified orthotic/ prosthetic assistant designation will change as of January 1, 2013. Individuals seeking ABC assistant certification have until September 30 to … Continue reading

DM Systems goes green, reduces environmental impact, saves dollars

Evanston, IL-based DM Systems made a series of environmental efforts in 2011, including upgrading its lighting to reduce carbon dioxide emissions and implementing a bicycle-friendly commuter policy for employees, according to its first environmental sustainability report, released last month. DM, … Continue reading

Rehab center demos new exoskeleton that helps paralyzed patients walk again

In April, Rancho Los Amigos National Rehabilitation Center in Downey, CA, debuted the ReWalk exoskeleton robot, which can help people with lower-limb paralysis walk again. As the crowd of spinal cord injury patients, their families, and press watched, 36-year-old Agnes … Continue reading

Trigger point author speaks at June events

Author and continuing education instructor Valerie DeLaune will lecture on trigger points at two June conferences. DeLaune has written books on trigger point therapy for foot, ankle, leg, and knee pain and for repetitive strain injuries. She is scheduled to … Continue reading

Nonprofit group partners with Allard

In April the Charcot-Marie-Tooth Association (CMTA) announced a new patient-focused partnership with orthotic device manufacturers and distributors Allard International, based in Helsingborg, Sweden, and Allard USA, based in Rockaway, NJ. The partnership embodies the philanthropic spirit of the Allard companies … Continue reading

AOPA annual meeting set for September

The American Orthotic & Prosthetic Association will hold its 95th National Assembly and New England Chapter Combined Meeting September 6-9 in Boston, MA. Practitioners can attend spe­­ci­alty sessions to earn up to 30 continuing education credits and view the latest … Continue reading

Zimmer launches app for OA patients

Warsaw, IN-based Zimmer has developed Arthritis 411, an iPad application designed to help individuals with knee and hip osteoarthritis learn more about their condition and treatment options. The app offers a library of simple animations and videos as well as … Continue reading

PT course focuses on kinesiology tape

Boise, ID-based Spider Tech will work with Canadian digital education development company Collarborans to offer educational courses for physical therapists interested in learning more about the company’s precut, apply-by-the-numbers kinesiology tape. Toronto-based Collaborans offers interactive digital education and seminars for … Continue reading

Bike-a-thon supports disabled kids

Edward Glaser, DPM, of Lyles, TN-based Sole Supports has partnered with Charles C. Southerland, DPM, professor in the School of Podiatric Medicine at Barry University in Miami, FL, to support the Yucatan Crippled Children’s Project, the medical mission Southerland founded … Continue reading


DDP Yoga Exercise Program

DDPYoga is designed by Diamond Dallas Page (DDP), a three-time professional wrestling heavyweight champion who entered the ring at 35, an age when most pro athletes are in retirement. DDPYoga is a hybrid workout that incorporates some traditional yoga movements … Continue reading #30496210
Clinicians come to aid of marathon victims

Lower extremity practitioners were among the first responders after two explosions ravaged the Boston Marathon last month, and are continuing to help heal the hundreds of victims who lost limbs or experienced other traumatic lower extremity injuries.

By Emily Delzell

Continue reading

Lease-to-own Foot Scanner

ComfortFit Labs announces a new low-cost lease-to-own program for the company’s Tom-Cat in-office scanning systems. The Tom-Cat system provides an easy nine-second scan per foot, on-screen prescription form and data, and a no-mess casting system, with no need to send … Continue reading

Locking Knees

Trulife introduces the new PC (polycentric) Friction Control Knee with Lock. The new SSK602L and SSK604L are Trulife’s latest locking knees. Lightweight and durable, they can be used either in a locked position or in free motion. Both prosthetic knees … Continue reading

Ultra High-5 Ankle Brace

Breg has released a new ankle brace named the Ultra High-5, which features a lightweight, semi-rigid, heat-moldable shell designed for anti-rotation and anti-inversion to help patients or athletes recover from high or low ankle injuries. This brace moves with the … Continue reading

Total Support Siesta Shoe

Spenco Medical Corporation has unveiled its first full shoe, the Total Support Siesta, as part of its spring 2012 footwear line. The slip-on Siesta features the same footbed contour as the Total Support insole, with a metatarsal bump to offload … Continue reading

Universal Plantar Fasciitis Support

The Universal Plantar Fasciitis Support from Corflex is designed to provide pressure and continuous support to help reduce the pain caused by plantar fasciitis. The 1½” elastic tension strap applies pressure over the medial calcaneal tubercle and plantar fascia. This … Continue reading

Reflective PattStrap

Fabrifoam Products introduces an improved version of its Reflective PattStrap with continuous reflective stripes for increased visibility and greater leg-hugging power. This multi-purpose strap can be used to treat iliotibial band syndrome (ITBS), patellar tendinitis, Osgood-Schlatter disease, chondromalacia, and for … Continue reading

Children’s AFO Socks

KeepingPace offers SuperMax Children’s AFO Socks, incorporating 92% CoolMax polyester to wick moisture away from the foot when worn under ankle foot orthoses. Construction features 2% Lycra content to ensure stretch and eliminate bunching. A 6% exterior plated nylon content … Continue reading

Air-Gel Ankle Brace

Elite Orthopaedics introduces the Advantage Air-Gel Ankle Brace. The brace, designed for patients in acute to active phases of ankle recovery and rehabilitation, is available in a universal size to either the left or right ankle and may be dispensed … Continue reading

Trigger Point Grid Roller

The Grid from Trigger Point Performance is a self-therapy tool that can be used to massages aches and pains in the muscles or to achieve a total body strength workout. The design of this self-therapy tool features “distrodensity” zones that … Continue reading

StrechCordz Dual Strap

StrechCordz from NZ Manufacturing now include a new dual stretch strap. The Stretch and Mobility Strap, with one strap made of nylon webbing connected to a stretch elastic strap, is designed for stretching that uses isometric contractions to improve flexibility. … Continue reading

Turf Toe Steel Insoles

Aetna Felt Corporation offers Turf Toe Steel Insoles, for prevention and management of turf toe and other metatarsophalangeal joint injuries. The Turf Toe Steel Insoles are available in standard sizes, in half and full steel. The insoles are laser-cut spring … Continue reading

Sport Firm Foot Orthosis

The EZFit Sport Firm premolded foot orthosis, made in the USA, offers comfort and pain relief for many patients. The full-length design offers immediate support for pes planus and plantar fasciitis, and is also suitable for athletes who play high-impact … Continue reading

YogaToes Gems

YogaPro has introduced YogaToes Gems, a “lite” version of its original YogaToes footcare product. Like the original Yoga­Toes, the Gems exercise and stretch foot muscles, which in turn helps improve foot posture. YogaToes Gems feature an under-toe lift bar that … Continue reading

Grip-Top Compression

The Sigvaris Cotton Series closed-toe calf compression products will now be available with a grip-top in two color options, black and crispa (a medium brown), for men and women. For patients with edema in the knee area, the new grip-top … Continue reading

Visco-Gel Toe Buddy

PediFix introduces the newest Visco-Gel foot protection product, the Toe Buddy, which gently separates and aligns crooked toes. Visco-Gel is the company’s proprietary Gel poly­mer material that cushions, protects, and conforms to foot contours. Designed like a “buddy splint,” the … Continue reading

3D Camera System

Apis Footwear offers the cutting-edge Mt. Emey 3D camera system to help customers save time and money on custom foot orthosis fabrication. The Mt. Emey 3D camera system can send 3D data about the patient’s foot with a click of … Continue reading

New Spenco Footwear

Spenco Medical Corporation has updated its Total Support footwear line and added two Siesta styles. The Siesta Vented features breathable air weave mesh panels and a suede heel pull; the Siesta Slide has a low-profile back so the shoe can … Continue reading

Poly/Lycra Knee Casting Sleeve

The STS Company of Mill Valley, CA, announces the re-introduction of a new and improved polyester/ Lycra Knee/KAFO Casting Sleeve. The new casting material provides a more detailed, accurate, and precise negative lower extremity mold for custom knee braces or … Continue reading

ProMed Ankle Brace

New from Active Innovations, a division of Active Ankle Systems, the ProMed brace provides the comfort and mobility of a lace-up with added support for controlling both the heel and the forefoot, starting with its Y-shaped vertical stabilization straps. Total … Continue reading

Original Levy Dynamic AFO

Levy & Rappel has finally introduced the Original Levy Dynamic AFO. This biomechanically correct and dynamic ankle foot orthosis is fully custom manufactured from the practitioner’s cast and delivered in seven days. A Tamarack ankle joints (dorsiflexion assist or free … Continue reading

Nova Precision Podiatry Drill

Algeos USA is proud to announce the launch of the Nova Precision A300xp Podiatry Drill in the US. The Nova Precision A300xp drill has a variable speed of up to 30,000 rpm and three memory storage settings for preferred revolution … Continue reading

Triton VS Foot For Active Users

Developed with input from amputees, Otto Bock’s new 1C61 Triton VS (Vertical Shock) prosthetic foot combines the function of the Triton foot with additional vertical shock and rotation compliance and is suitable for everyday use as well as an active … Continue reading

Ultraviolet Shoe Deodorizer

Using UV technology, the shUVee Ultraviolet Shoe Deodorizer is proven to destroy odor causing germs and bacteria, including MRSA (Methicillin Resistant Staphylococcus Aureus), and T. Rubruna, the parent strain of the fungus commonly known as athlete’s foot. The deodorizer is … Continue reading