LER Cover Story:
lerEXPO Highlights: 5 Surprising Lessons from the Frontlines of Limb Preservation
In the relentless landscape of diabetic limb preservation, the clock is the surgeon’s most formidable adversary. Every 20 seconds, a lower limb is lost to amputation somewhere on the globe. For those of us operating out of high-volume centers like the University of Maryland, these aren’t just figures in a journal–they are the visceral realities of a Tuesday-to-Thursday phenomenon.
Imagine a patient walking into your clinic on a Tuesday, seemingly stable. By Thursday, they are in the emergency department (ED) with a white cell count of 35,000–a systemic alarm bell signaling a limb in total crisis.
By Jake Wynes, DPM, MS, FACFAS
lerEXPO Upcoming Events
Feature Articles
Unilateral Drop Foot in a Patient with Diabetic Neuropathy
This case study documents the functional impact of the Trulife A-Pace Anterior Lateral Strut Carbon Fibre AFO in a 62-year-old female with longstanding type 2 diabetes, established peripheral neuropathy, and a new unilateral left-sided drop foot presentation. The etiology was a common peroneal mononeuropathy, confirmed on electrodiagnostic study, with an indeterminate trigger but presumed multifactorial in the setting of underlying diabetic microvascular disease and mechanical compression from prolonged cross-legged sitting.
lerEXPO Highlights: 5 Insights That Are Changing How We Treat Flatfoot
Flatfoot is frequently marginalized in clinical conversations as a mere structural quirk–a low arch that requires little more than an orthotic. Yet, for patients, it represents a progressive biomechanical failure and a source of chronic, lifestyle-altering pain. For the surgical community, it has long been a battlefield of competing philosophies. How do 15 of the world’s leading orthopedic minds find common ground on a condition so riddled with nuance?
By Jeff Dikis, DPM, Brad Abicht, DPM, FACFAS and Julio Ortiz, DPM, FACFAS
Insurance Prior Authorization Reform: Why It Matters for Podiatrists
There’s a quiet but meaningful shift happening in the way insurance companies handle prior authorizations. For those of us in podiatry, it has the potential to change how we deliver care in very practical ways. Starting (it has been reported) January 1, several of the country’s largest insurers, such as UnitedHealthcare, Humana, and Aetna are planning to adopt a single, standardized approach for pre-treatment reviews.
By Mikel D. Daniels, DPM, MBA, President and Chief Medical Officer, WeTreatFeet Podiatry
Dirty Truth #10: Bottom Up and Top Down
Dirty Truth #10 is grounded in the old saying, “where the rubber meets the road.” When your foot strikes the ground, the ground hits you back. The foot goes from an unloaded state (swing phase) to a weight-bearing, interactive body, getting pushback during every step you take on that road. The equal and opposite force Newton promised us. This bottom-up view changes everything.
By Jay Segel, DPM; Sally Crawford, MS
Biointegrative Implants Reshape Foot and Ankle Surgery
For decades, metal hardware has been the standard in foot and ankle surgery. Screws, plates and pins have provided reliable fixation, enabling surgeons to stabilize bones and joints during healing. While effective, these materials often remain in the body permanently, and in some cases, require secondary procedures for removal due to irritation or complications.
By Keith Loria
Rock Climbing-Related Lower Extremity Injuries Treated at Hospital Emergency Departments
Rock climbing includes different disciplines such as traditional climbing (temporary rope anchoring placed during the climb), top rope or speed climbing (rope anchoring at the top of the wall, indoor only), sport climbing (ropes anchored at multiple fixed points while ascending), and bouldering (short distance climbing without ropes). It can be performed outdoors on natural terrain or outdoors and…
By Mathias B. Forrester, BS
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Lower Extremity Review
ShortTakes From the Literature
K Tape Effects on Static Plantar Pressure and Force in Young Females with Flexible Flatfoot
Flatfoot is a condition brought on by trauma, persistent foot stress, obesity,...
Pre- and Post-operative Physical and Mechanical Rehab in Hallux Valgus
Approximately one-third of the adult population is affected by hallux valgus...
Effectiveness of Sandals and PT vs PT Alone on Pain and Function in Plantar Fasciitis
Recent evidence suggests that appropriate footwear can facilitate recovery in...
Anatomy Changes, Signaling Pathways, and Clinical Treatment After Ankle Sprain
Ankle sprain (AS), a prevalent sports injury, often progresses to chronic...
A Prospective Study on Arch Supports, Plantar Fasciitis and Patient-Reported Outcomes
Arch-support insoles are used to reduce symptoms in patients with plantar...
Changes in Lower Extremity Tendon Thickness After Stroke Rehab (Balance and Outcomes)
Peripheral musculoskeletal structures may undergo secondary changes after...
Pulsed Radiofrequency Promising Strategy for Morton’s Neuroma Pain
Morton’s neuroma is a prevalent cause of forefoot pain, often proving...
Daily Steps and Health Outcomes: A Systematic Review
Despite evidence from the past decade on daily steps and health-related...
A Foot Forward for Optimum Health
Questions, Answers & Commentaries About AFOs
I would like to thank the reader for acknowledging my expertise. I want to reiterate that the literature supports functional context as a focus of rehabilitation as opposed to just impairment-based interventions. We must treat the person as a whole entity (person: mental, emotional, physical, spiritual, intellectual) of who they are in their lived spaces (environment) and what they do in that space (tasks).
By Dr. Jennifaye V. Brown
Industry News & Updates
Heat Aids Antibiotics’ Effectiveness Against Prosthetic Infections
Heat generated by alternating magnetic fields (AMF) helps common antibiotics...
AI Research Helping to Mitigate Prosthetic Limb Side Effects
Veterans who wear prosthetic lower legs could experience healthier and more...
SHP Protein Found to Protect Cartilage
Current treatments for osteoarthritis (OA) mainly focus on alleviating pain...
Central Nervous System a Key Player in Diabetes Pain
Changes within the central nervous system, including the brain and spinal...
Emerging Developments in AFOs
A Three Part Series
Carbon composite ankle foot orthoses are reshaping how podiatrists approach bracing. Lighter, lower-profile, and easier to fit into everyday footwear, these devices are moving from specialty use to everyday practice. This three-part series covers what you need to know, which patients benefit most, and how to put carbon composite AFOs to work, backed by clinical case studies.
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
Ventilated Toe Caps Reduce Maceration Risk
PediFix is introducing an assortment of ventilated digital devices for protection with better skin health. The firm’s Visco-GEL® line provides pain relief for a variety of foot and toe ailments with a proprietary, U.S.-made gel that cushions, protects, and hydrates...
Sneaker Built Around a Custom Orthotic
The Surefoot footwear collection was engineered entirely around a patient’s custom orthotic. Powered by Amfit® full-contact foot-scanning technology, the collection represents a fundamental shift in how supportive footwear is designed, prescribed, and worn. The result...
Fungal Nail Renewal
Kerasal® Advanced Clear & Defend Fungal Nail Renewal is a new formula designed to instantly transform the look of damaged nails while helping protect against future surface damage. This beauty-forward approach fits seamlessly into today’s nail care routines and is...
Patient-Specific 3D-Printed Foot and Ankle Fixation Plates
MedCAD’s AccuStride fixation plates–with U.S. Food & Drug Administration (FDA) 510(k) clearance–is part of a patient-specific solution available to surgeons as a complete foot and ankle (F&A) system. The AccuStride implant and surgical guide system coupled...
Knee Brace with Stability, Guidance System
The Dr. Flexa knee brace is built around AxisControl™ stabilizers, tri-weave neoprene, an open-patella cutout, and a silicone interior grip system. AxisControl is the brand’s proprietary lateral stabilizer system, integrated into the brace structure. It is designed to...
Microgravity Treadmill
The Boost 3 is a next-generation microgravity treadmill. It utilizes differential air pressure technology originally developed by NASA. By creating a pressurized air chamber around the user’s lower body, the system provides precise, controllable reduction in...
Pickleball Footwear
The All Court Vehicle (ACV) Pro delivers all-court performance with every move, while providing the comfort, support, and confidence players need to dominate a match. The breathable Aero-Step™ insert technology provides targeted airflow to keep feet cool and dry...
Performance Socks
Revitalign® Performance Socks are designed to meet the demands of a dynamic lifestyle. Recognizing that support shouldn’t end with shoes, the company developed a sock that incorporates biomechanical technology to enhance foot wellness throughout the day. Each pair is...
Clog Built Around a Custom Orthotic
The Surefoot footwear collection was engineered entirely around a patient’s custom orthotic. Powered by Amfit® full-contact foot-scanning technology, the collection represents a fundamental shift in how supportive footwear is designed, prescribed, and worn. The result...



























