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Evaluation, management and prevention of lower extremity youth ice hockey injuries

hockey-557219_1280Ice hockey is a fast-paced sport played by increasing numbers of children and adolescents in North America and around the world. Requiring a unique blend of skill, finesse, power and teamwork, ice hockey can become a lifelong recreational activity. Despite the rising popularity of the sport, there is ongoing concern about the high frequency of musculoskeletal injury associated with participation in ice hockey. Injury rates in ice hockey are among the highest in all competitive sports. Numerous research studies have been implemented to better understand the risks of injury. As a result, rule changes were adopted by the USA Hockey and Hockey Canada to raise the minimum age at which body checking is permitted to 13–14 years (Bantam level) from 11–12 years (Pee Wee). Continuing the education of coaches, parents and players on rules of safe play, and emphasizing the standards for proper equipment use are other strategies being implemented to make the game safer to play. The objective of this article was to review the evaluation, management and prevention of common lower extremity youth hockey injuries.

Journal of Sports Medicine, Click here for full Study

There’s more than one way to lace your running shoes – and it matters which you use

October 18—- Printed in the Washington Post

You’ve visited your favorite running store, analyzed your gait and found the perfect shoe for you.

Now you’re all set to go on a run, right?

Not so fast.

How you lace your shoes can affect your performance and overall running experience, experts say.

“I’ve had runners slip on a pair of running shoes and say they feel great, but when they stand up or jog around the store or on the treadmill, they’ll tell me something just doesn’t seem right,” said Rob Voigt, who manages the Georgetown Running Company in the District.

“I’ll relace their shoes and ask them to take another jog around the store, and I already know by their smile that the lacing made all the difference.”

In fact, according to podiatrist Adam Spector, of Foot and Ankle Specialists of the Mid-Atlantic in Wheaton and Rockville, if you don’t lace your shoes appropriately, your performance may suffer and you may have a less-than-pleasant experience. Spector is co-founder of the Montgomery County Road Runners Club’s Stride Clinic to evaluate runners. He was a national-level swimmer on scholarship at George Washington University and ran for cross-training. Now, running is the centerpiece of Spector’s daily exercise regimen.

Runners can suffer minor and major injuries if they do not lace their shoes optimally, Spector said.

And that’s because correctly lacing your perfect shoes can keep them perfect while you run.

“Your foot and shoe need to become one,” Spector said. “The key is to make sure the shoe fits well and then to lace your shoes so that your foot stays stable.”

For example, excess side-to-side motion of your foot as you run can create irritation and sheer that may result in blisters, tendinitis or other overuse injuries, according to Spector. If your foot moves from front to back, you risk experiencing a burning sensation on the bottom of your forefoot or bruising your toes, which can become increasingly painful. When the toes get irritated, possibly traumatizing the nail bed and causing bleeding under it, the nails can turn black and blue.

“It’s a myth that you’re not a real runner unless your toenails turn black,” Spector said. “They shouldn’t.”

The goal is for your foot to be stable as you run — or even as you walk — said Voigt, a recreational runner who played lacrosse at the State University of New York at Canton. He said a number of lacing strategies are designed to secure your foot while accommodating such common issues as bunions, or bony joints at the base of your big toe; a cavus foot, or a foot with a high arch; flat-footedness, or when the sole of your foot comes in contact with the ground when you stand or run; narrow heels; and heel spurs, or calcaneal spurs, which are buildups of calcium on your heels.

In addition, some lacing techniques can be used to adapt a running shoe if, for whatever reason, you don’t have access to a variety of shoes.

“Overseas, I didn’t have the luxury of going and trying on lots of different pairs of shoes, so I had to make do with what I had,” said Steve Royster, a Foreign Service officer who just finished his ninth marathon and is working in Washington. “I noticed that if I laced them with different levels of tension or skipping certain eyelets, I would get different and sometimes helpful effects.”

Royster said he has flat feet, so he’s benefited from lacing his shoes through all of the eyelets but then tying them pulled to the outsole, away from the arch.

“This helps to adjust shoes that don’t fit as well to give me more support,” Royster said.

Voigt also noted that it’s a good idea to ensure that your laces are flat and not twisted as you tie them. “This is another way to avoid chafing and irritating any of the nerves on the top of your feet as you run.”

While it’s important for runners to be properly fitted for shoes that are comfortable, support their foot type and gait, and are appropriately laced, runners experiencing pain, skin issues or numbness in their feet that does not resolve quickly should be evaluated by a podiatrist to rule out more serious local or systemic problems, Spector said.

“Our feet are attached to our bodies,” he said. “So optimizing their biomechanics and function will improve how the rest of our body works.”

Voigt says that most running stores can show you how to lace your shoes if any of the techniques are confusing or if you don’t know which ones would work best.

The art of lacing

Gap lacing: Lace your shoes normally but skip any areas that are sensitive, especially if you have high arches, wider feet or bunions. (By Carolee Belkin Walker)
Side lacing: Securing your shoes by lacing them on the side of your foot can accommodate high arches and flat-footedness. (By Carolee Belkin Walker)
Loop lock lacing: This style is designed for when you get the right fit but your heel still wants to slip. You’re basically lacing the shoe and going back to last eyelet to pull everything tight. (By Carolee Belkin Walker)
Skip lacing: This style can accommodate greater blood flow at the neck of the foot and bunions. (By Carolee Belkin Walker)
Speed lacing: Some shoes come out of the box with speed laces, but you can buy them at most running stores. Speed laces are popular among triathletes because you can slip your feet quickly into your shoes and simply pull the laces to tighten them. Most speed laces come with a simple locking mechanism. (By Carolee Belkin Walker)
Straight lacing: This style can help relieve pressure on the top of your foot. You’re creating more space between eyelets without skipping eyelets. (By Carolee Belkin Walker)

Join Us At the OPMA Conference Sept 12-14

WCapturee Are proud to be exhibiting for the 13th year, at the annual Ontario Podiatric Medical conference.  Please stop by our booth and say hello!  We have new products and technologies that can make you practice not only run smoother, but can save you considerable time and resources.

Shin Splints in 500 to 800 year old skeleton

Medial tibial stress syndrome: A skeleton from medieval Rhodes demonstrates the appearance of the bone surface – a case report
Posted online on July 18, 2014. (doi:10.3109/17453674.2014.942587

Photo credit, Wikipedia

Photo credit, Wikipedia

1Museum of Anthropology
2Laboratory of Histology and Embryology
3Laboratory for Research of the Musculoskeletal System, National and Kapodistrian University of Athens,

School of Medicine, Athens, Greece

We present a case of bilateral medial tibia stress syndrome (MTSS) in a 500- to 800-year-old male skeleton with an estimated age at death of between 20 and 30 years. The skeleton came from a Byzantine graveyard in Rhodes, Greece, which was in use between the thirteenth and fifteenth centuries AD.

The tibiae exhibit symmetrically developed surface lesions along the posterior-medial aspects involving the middle and distal thirds of diaphyses, in accordance with the pattern of symptom distribution in MTSS. The lesions comprise longitudinal striation and associated pitting, mainly affecting the mid-diaphyses and posterior-medial borders and in finely porous, diffuse tissue predominantly over the distal diaphyses

Read More: for full pdf version click here


Economic costs of diabetes

The total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced Diabetic patient doing glucose level blood testproductivity. The largest components of medical expenditures are hospital inpatient care (43% of the total medical cost), prescription medications to treat the complications of diabetes (18%), antidiabetic agents and diabetes supplies (12%), physician office visits (9%), and nursing/residential facility stays (8%). People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes. For the cost categories analyzed, care for people with diagnosed diabetes accounts for more than 1 in 5 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes


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Mechanism of orthotic therapy for the painful cavus foot deformity.

By: Najafi B1, Wrobel JS, Burns J.Abstract



People who have extremely high arched feet or pes cavus often suffer from substantial
foot pain. Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear. It is generally thought that one of the primary functions of CFO is redistributing abnormal plantar pressures. This study sought to identify variables associated with pain relief after CFO intervention.


Plantar pressure data from a randomized controlled trial of 154 participants with painful pes cavus were retrospectively re-analyzed at baseline and three month post CFO intervention. The participants were randomized to a treatment group given CFO or a control group given sham orthoses.


No relationship between change in pressure magnitude and change in symptoms was found in either group. However, redistribution of plantar pressure, measured with the Dynamic Plantar Loading Index, had a significant effect on pain relief (p = 0.001). Our final model predicted 73% of the variance in pain relief from CFO and consisted of initial pain level, BMI, foot alignment, and changes in both Dynamic Plantar Loading Index and pressure-time integral.


Our data suggest that a primary function of effective orthotic therapy with CFO is redistribution of abnormal plantar pressures. Results of this study add to the growing body of literature providing mechanistic support for CFO providing pain relief in painful foot conditions. The proposed model may assist in better designing and assessing orthotic therapy for pain relief in patients suffering painful cavus foot deformity.

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3D printing gives disabled duck Dudley a new limb

Yet another disabled wee duckie has been given a new lease on life thanks to the magic of 3D printing.

(Credit: 3 Pillar Designs)

At long last, 3D printing has found its niche: providing replacement limbs — for ducks. Poor Dudley of K9-1-1 Animal and Rescue Services in Sicamous, Canada, lost his leg when he was just a baby to a vicious attack from a chicken kept in the same pen — but now he can walk again, thanks to 3D printing.

The first iteration of Dudley’s foot.
(Credit: 3 Pillars Designs)

Unlike Buttercup’s new foot, which was created using a 3D-printed mould to cast a limb in silicone, creating Dudley’s foot was a more elaborate affair.

It was created by Terence Loring of 3 Pillar Designs, a company that specialises in 3D printing architectural prototypes. Loring heard of Dudley’s plight through a friend and — Buttercup’s story undoubtedly echoing in his head — decided to see what he could do to help.

The first limb Loring designed has a jointed construction, and was fully 3D-printed in plastic byProto3000 in Canada. When Dudley put it on, the limb broke and Dudley fell over, so Loring went back to the drawing board for a one-piece model with no joints, printed in a softer plastic.

When the new foot was put on Dudley, he started walking straight away, no hesitation. However, the plastic causes friction sores — a problem Buttercup’s owner, Mike Garey, solved with a silicone sock and prosthetic gel liner.

We’ve no doubt Loring will come up with a solution. Meanwhile, Dudley is happy as a duck in a pond.

(Credit: K9-1-1 Animal and Rescue Services)

(Source: CNET Australia)


A new app for intelligent glasses, such as Google Glass, will soon make it possible to improve the gait of patients suffering from Parkinson’s disease and to decrease their risk of falling. Researchers at the University of Twente’s MIRA Institute have received a grant from the NutsOhra fund for the development of the app.google glass

The gait of Parkinson’s patients is often disturbed: sometimes this presents as a shuffling movement with the patient taking small steps, or it may result in the patient constantly looking for additional support. Gait disturbance also increases the chance of a fall, despite the progress made in terms of medication. Researchers have established that the gait of patients improves when they regularly see or hear a pattern. Examples might include stripes on the floor, or the regular ticking of a metronome.

The researchers, working under the leadership of Prof. Richard van Wezel, who is professor of Neurophysiology at the UT and is also attached to the Donders Institute in Nijmegen, are now looking at exploring the possibility of using the intelligent glasses, such as Google Glass, that are now coming on to the consumer market.

Intelligent glasses would be able to provide patients with the regular visual or audible patterns required. These patterns may take the form of moving stripes or shapes which the patient sees through the glasses, flashing shapes, or music with varying tempos. The latest intelligent glasses already have inbuilt cameras and accelerometers. By using these, it will be possible to determine which approach works best for each individual patient.

The MIRA Institute for Biomedical Technology and Technical Medicine is working on the project together with the Donders Institute for Brain, Cognition and Behaviour (Nijmegen), the Medisch Spectrum Twente hospital and the VUmc University Medical Centre in Amsterdam.

“Fonds NutsOhra”, a fund that provides financial support for healthcare projects, has granted the sum of € 94,000 to the project.

Contact: Wiebe van der Veen – University of Twente
Source: University of Twente press release

The Craziest High Heels Shoes You Will Ever See

As for fashion I cannot comment however, the literature on the damage that high heels do the lower extremity is plentiful, from osteoarthritis of the knee, plantar fasciitis and low back pain to hagluds deformity and clawed toes, just to name a few.  Is this art of fashion?



Plantar fasciitis – to jab or to support? A systematic review of the current best evidence

Background: Plantar fasciitis is a common condition routinely managed by podiatrists in
the community and is widely treated conservatively. Two commonly used treatments for plantar fasciitis are customized functional foot orthoses and cortisone-shot-side-effectscorticosteroid injections. While common to clinical practice, the evidence base underpinning these treatment strategies is unknown.Therefore, the aim of this systematic review was to assess the effectiveness and safety of customized functional foot orthoses and corticosteroid injections in the treatment of plantar fasciitis.

Methods: A systematic literature search was conducted. Experimental studies, in English,from 1998 to 2010 were accepted for inclusion in this review. The PEDro quality assessment tool and the National Health and Medical Research Council’s hierarchy of evidence were used to assess the quality of the included studies.

Results: Six randomized controlled trials which met the selection criteria were included in thisreview. Four reported on customized functional foot orthoses and 2 on corticosteroid injections.Current best available evidence highlights that both customized functional foot orthoses and corticosteroid injections can lead to a decrease in pain associated with plantar fasciitis.  Additionally, customized functional foot orthoses may also provide an additional benefit in terms of increased functional ability in patients with plantar fasciitis. Corticosteroid injections may have side effects, especially pain (from the injection).

Conclusion: Both customized functional foot orthoses and corticosteroid injections can lead to reduction in pain associated with plantar fasciitis. While customized functional foot orthoses may increase the functional outcomes in patients with plantar fasciitis, corticosteroid injections may have side effects (especially pain as a result of the injection), which may limit its acceptability.

Click here for the full study in pdf JMDH-20053-plantar-fasciitis—–to-jab-or-to-support–a-systematic-rev_052411