Friday, December 18, 2009

X1 Blade Turf Toe Insert - 2009

Zanesville, OH "Called Clyde 800-253-6217 to order" 12/17/09 (Hiker model/podiatrist office order/diagnosis unknown) - Central Point, OR "Online order" 12/16/09 (Hiker model/hallux rigidus/carpet installer,bowling) - Bromball, PA "Online order" 12/16/09 (Hiker model/turf toe/walking) - Marietta, GA "Online order" 12/16/09 (Hiker model/nondisplaced fx @ proximal phalanx of great toe/Army training) - Newark, DE "Called Clyde 800.253.6217 to order" 12/16/09 (Hiker model/hallux rigidus/walking) - Voorhes, NJ "Online order" 12/15/09 (Pro model/turf toe/ volley ball) - Los Angeles, CA "Online order" 12/11/09 (turf toe/softball) - Indianapolis, IN VA Hospital "Fax order" 12/09/09 (hallux rigidus) - Morganton, NC "Called Clyde "800-253-6217 to order"12/10/11 (hallux rigidus/golf) - Winnepeg, Manitoba Canada "Called Clyde 800-253-6217 to or der"12/07/09 (turf toe/hallux rigidus) -Hampstead,MD "Online order"12/06/09 (great toe pain/soccer) -Tufts Medical Center/Surgeon "Online order"12/06/09 (turf toe/tennis) - Winona, MN "Called Clyde 800-253-6217 to order"12/03/09 (cheilectomy bilateral) - Honolulu, HI "Called Clyde 800-253-6217 to order"12/02/09 (turf toe/basketball) - Watsonville, CA "Called Clyde 800-253-6217 to order"12/01/09 (Morton's Syndrome) - Mountain Center, CA "Called Clyde 800-253-6217 to order"12/01/09 (turf toe/pro tennis) - Marietta, GA "Online order" 11/30/09 (turf toe/football) - Chapel Hill, NC "Called Clyde 800-253-6217 to order"11/30/09 (hallux rigidus/runner) - New York City "Online order"11/30/09 (turf toe/soccer) -Des Moines, IA"Online order"11/28/09 (turf toe/cross country skiing)- University of Texas Football"Called Clyde 1-800-253-6217 to order"11/27/09 (turf toe/football) - Wesley Chapel, FL "Online order"11/26/09 (turf toe/ tennis) - Stalowa Wola, Poland "Called Clyde to order"11/25/09 (professional basketball/turf toe) - North Charleston, SC"Online order" 11/24/09 (bilateral turf toe) - Ambler, PA "Online order"11/23/09 (great toe arthritis) - Stillwell, KS "Online order" 11/19/09 (hallux rigidus/golf) -Hockessin, DE "Online order"11/19/09 (halluxrigidus) - Teutopolis, IL "Online order"11/18/09 (hallux rigidus/golf) - Livermore, CA "Online order"11/18/09 (turf toe/soccer) -Los Angeles, CA "Online order" 11/18/09 (turf toe/football) - Dublin, Ireland"Online order"11/18/09 (turf toe/rugby) - Warrenton, VA "Online order"11/17/09 (turf toe/dogtrainer) - Eastern Wyoming College"Online order" 11/17/09 (recurring turf toe bilateral) - New York City "Called Clyde 800-253-6217 to order"11/17/09 (bilateral hallux rigidus) - Los Altos, CA"Called Clyde 800-253-6217 then ordered"11/16/09 (turf toe) - Motara, CA"Online order"11/12/09 (turf toe) - Indianapolis, IN "Called Clyde 800-253-6217 to order"11/12/09 (great to arthritis bilateral) -Terre Haute, IN "Fax order 317-255-7535"11/11/09 (sesamoiditis) - Fulda, MN"Online order" 11/11/09 (hallux limitus) - Ft. Wayne, IN "Online order"11/10/09 (bilateral turf toe/H.S. basketball) - Danville, CA "Online order" 11/10/09(bilateral great toe pain/3rd order) - Kenley, Surrey United Kingdom "Online order"11/10/09 (hallux rigidus) - Allentown, PA "Online order"11/09/09 (hallux rigidus) - Victor, NY"Online order"11/07/09 (turf toe) - Washington, DC/Georgetown Running Company "Called Clyde 800-253-6217 to order"11/07/09 (turf toe/marathoner) -Garden City, NY "Online order"11/07/09 (turf toe) - Central Michigan Football "Called Clyde 800-253-6217"11/06/09 (turf toe/receiver) -Derthoud, CO"Called Clyde 800-253-6217 to order"11/05/09 (hallux rigidus/turf toe) - Miami, FL "Online order"11/04/09 (hallux rigidus) - Johnson City, TN "Called Clyde 800-253-6217 to order" 11/03/09 (bilateral hallux rigidus) - Delaware, OH "Online order"11/03/09 (turf toe) - Austin, TX"Online order" 11/03/09 (turf toe) - United Kingdom"Online order" 11/03/09 (hallux rigidus) - University of Texas Football Austin, TX"Called Clyde 800-253-6217 to order"11/02/09 (turf toe) - USC FootballLos Angeles, CA"Online order"11/01/09 (turf toe) - Lebam, WA "Online order" 10/30/09 (turf toe) - Newark, DE "Called Clyde 800-253-6217 to order" 10/30/09 (morton's neuroma) - Midlothian, VA "Online order"10/29/09 (turf toe) - Wheeling, WV "Online order"10/29/09 (turf toe) - Washington, IL "Online order"10/29/09 (turf toe) - Cary, IL "Called Clyde to order" 10/29/09(turf toe/ H.S. O-lineman) - Wyoming, DE "Online order" 10/29/09 (hallux rigidus) - Bellevue, WA "Online order"10/29/09 (turf toe) - Alexandria, NSW, Australia -"Called Clyde to order"10/28/09 (turf toe/surfer) - Houston, TX"Online order" 10/28/09 (turf toe) - Duluth, GA "Called Clyde 800-253-6217 to order"10/28/09 (bilateral turf toe/QB H.S. Football) - Tulsa, OK "Called Clyde 800-253-6217 to order"10/28/09 (turf toe) - Lonestar Orthopedic / Cincinnati, OH10/28/09-(bilateral hallux rigidus) -Cal Poly Football"Called Clyde 800-253-6217 to order" 10/26/09 (turf toe) -Saint Ambrose Football"Called Clyde 800-253-6217 to order"10/26/09 (bilateral turf toe) - Chillicothe, IL "Called Clyde 800-253-6217 to order"10/26/09 (turf toe) - McHenry, IL "Online order"10/25/09 (turf toe) - Denver, CO "Online order"10/24/09 (bunion pain) - Tulsa, OK "Online order"10/22/09 (hallux limitus) - Sycamore, OH "Online order" 10/22/09 (turf toe/H.S. Football) - West Virginia University "Online order"10/22/09 (turf toe) - Doylestown, PA "Online order"10/22/09 (hallux rigidus) - Franklin Park, NJ "Online order" 10/21/09 (turf toe) - Clyde, TX "Online order"10/20/09 (turf toe/H.S. football) - Rochester, MN "Online order"10/20/09 (turf toe) - Zanesville, OH "Online order"10/20/09 (turf toe) - DeWitt, IA "Online order" 10/19/09 (turf toe) - Jacksonville, FL "Online order" 10/16/09 (bilateral turf toe) - Pasadena, CA Turning Point Physical Therapy"Call Clyde to order 800-253-6217"1/16/09 (turf toe/pole vaulter) - 10/16/09 - Richmond, VA "Online order"10/16/09 (turf toe) - Beachwood, OH "Called Clyde to order 800-253-6217"10/14/09 (turf toe/runner) - Knoxville, TN"Online order" 10/13/09 (turf toe) -McLean, VA"Call Clyde to order 800-253-6217"10/13/09 (turf toe/runner) - Wellington, FL "Online order" 10/12/09 (turf toe/reorder H.S. football) - Oakland, CA"Online order" 10/11/09 (bilateral turf toe/H.S. football)Dulles, VA"Online order "10/09/09 (hallux rigidus) -Lafayette, CO"Online order" 10/09/09 (hallux limitus) -Troy, NC "Online order" 10/08/09 (turf toe/H.S. football) - Manhattan, KS "Online order" 10/07/09 (turf toe) -Waynesboro, VA "Online order" 10/07/09 (Great toe pain) - McCloud, OK "Online order / talk to Clyde 800-253-6217"10/07/09 ( turf toe/ H.S. softball) -Waterbury, CT"Online order / talk to Clyde 800-253-6217"10/07/09 (turf toe/H.S. football) -Atlanta, GA"Online order / talk to Clyde 800-253-6217" 10/07/09 (bilateral turf toe/NBA basketball) -Cincinnati, OHLone Star Orthopedic -10/07/09 (turf toe) -Chicago, IL Lifestyle Physical Therapy 10/06/09 (turf toe/H.S. football) - Jamul, CA"Online order" 10/05/09 (hallux limitus) - Chicago, IL "Online order" 1/05/09 (turf toe) - Watergate Bay, England "Online order" 10/05/09 (turf toe/ reorder) - Bentonville, AR, "Online order" 10/03/09 (turf toe) - Lexington, SC "Online order" 10/03/09 (turf toe) -Wellington, FL"800-253-6217 call Clyde"10/02/09 (turf toe/H.S. football) - Limerick, Ireland"Online order"10/02/09 (turf toe)- Las Vegas Locomotives/UFL "Online order"10/02/09 (turf toe/running back) -Gainesville, FL"Online order"10/01/09 (bilateral turf toe) - Notre Dame Football"Online order" 10/1/09 (sesimoiditis/offensive lineman) - Bellevue, WA"800-253-6217 call Clyde" 10/1/09 (hallux rigidus) -Howe, TX"800-253-6217 call Clyde" 10/1/09 (turf toe.H.S. basketball) -Green Bay Packers"800-253-6217 call Clyde" 10/1/09 (turf toe/running back) - Ashville, NC"Online order" 9/30/09 (turf toe) - Columbus, OH"800-253-6217 call Clyde" 9/30/09 (turf toe/soccer) - Minneapolis, MN"Online order"9/29/09 (hallux rigidus) - San Diego, CA "800-253-6217 call Clyde" 9/29/09 (turf toe) - Columbia, MO "800-253-6217 call Clyde" 9/28/09 (turf toe/soccer) - Terre Haute, IN Hanger Prosthetics 9/28/09 (sesimoiditis) - Columbus, OH OrthoNeuro 9/25/09 (turf toe) Houston, TX "Online order" 9/25/09 (turf toe) - Honolulu, HI "800# call Clyde" 9/25/09 (broken great toe/ H.S. soccer) - Mountaiview, CA "Online order"9/24/09 (hallux rigidus/runner) - Greenville, SC Foothills Footcare Center 9/24/09 (turf toe/H.S. football) - Cincinnati, OH Lone Star Orthopedic 9/24/09 (turf toe/hallux rigidus) - Ironton, OH "Online order" 9/23/09 (turf toe/ H.S. football) - St. John, ND "800# talk to Clyde" 9/23/09 (turf toe/H.S. football) - New York City, NY "Online order" 9/21/09 (hallux rigidus bilateral) - Notre Dame, INNotre Dame Football 9/21/09 (turf toe/D1 football) - Cambridge, MA "800# talked to Clyde"9/21/09 (turf toe) - Wallace, ID "Online order" 9/19/09 (turf toe) - Seattle, WA "Online order" 9/19/09 (turf toe) - Abilene, TX "Online order" 9/19/09" (hallux rigidus bilateral) - Dahlonega, GA "Online order" 9/17/09 { turf toe) - Chesnee, SC "Online order" 9/17/09 (turf toe/H.S. football) - Lafayette, CA "Online order" 9/17/09 (turf toe) - Berthoud, CO "800# talk to Clyde" 9/16/09 (turf toe/H.S. football) -Gastin, IN "Online order" 9/15/09 (turf toe) - Austin, TX University of Texas Football "800# talk to Clyde" 9/15/09 (turf toe) - Newton, MA"800# call Clyde"9/14/09 (hallux rigidus) - Austin, TX Lone Star Podiatry "Online order" 9/14/09 (turf toe) - Tuscon, AZ "Online order" 9/14/09 (turf toe) - Spring, TX "Online order" 9/13/09 (turf toe) - Philadelphia, PA "800# talk to Clyde" 9/11/09 (hallux rigidus) - Denison, TX "800# talk to Clyde"9/11/09 (turf toe- H.S. football) - Bloomington, MN "800# call Clyde" 9/10/09 (turf toe) - Eugene, OR "800# call Clyde" 9/08/09 (hallux rigidus) - Gloucester, MA "Online order"9/07/09 (hallux rigidus) - Katy, TX"Online order" 9/07/09 (turf toe) - Sunland Park, NM "Online order" 9/7/09 (turf toe) - Radlett, England "Call Clyde to order" 9/7/09 (turf toe/rugby) - Floosmoor, IL "Online order" 9/6/09 (Morton's Foot - 2nd ray pain & sesimoiditis)) - San Diego, CA "Online order" 9/5/09 (turf toe) - Aiken, SC "Online order" 9/5/09 (turf toe) - Belmont, MA "800# call Clyde" 9/4/09 (3rd met fx) - Geneva College"800# call Clyde" 9/3/09 (turf toe / football) - Franklin College "800# call Clyde" 9/3/09 (turf toe/football) - Zanesville, OH "Online order" 9/3/09 (turf toe/H.S. Football) - Overland Park, KS "800# talk to Clyde"9/2/09 (turf toe/H.S. football) - Pendleton, IN"Online order" 9/2/09 (4th met fx) - Winnepeg, Manitoba Canada Performance Healthware 9/2/09 (great toe injuries) -Sherman, TX North Texas Foot Care"800# talk to Clyde" 9/2/09 (turf toe/H.S. football) - Lumberton, TX "Online order" 9/1/09 (turf toe) - Austin, TX Lone Star Podiatry "Onlineorder" 9/1/09 (turf toe) - Portland State U."800# talk to Clyde" 9/1/09 (turf toe/ football & soccer) - Zanesville, OH "Online order" 9/1/09 Podiatric Associates ( turf toe/ h.s.QB football) - Clinton, TN "800# talk to Clyde" 9/1/09 (hallux rigidus) - Brooklyn, NY "Online order" 9/1/09 (functional hallux limitus) - Waldorf College"800# talk to Clyde" 8/31/09 (turf toe/football) -Portland State U."800# tallk to Clyde" 8/31/09 (turf toe / D1 football) - Niagra Falls, NY "800# talk to Clyde" 8/31/09 (turf toe / - Lanoka Harbor, NJ "800# talk to Clyde" 8/31/09 (bilateral hallux rigidus) - Midlothian, TX "Online order" 8/31/09 (turf toe/ h.s. football) - Tulsa, OK "Online order" 8/30/09 (hallux rigidus) - Medicine Hat, Alberta Canada "Online order" 8/30/09 (hallux rigidus - sesimoiditis) - Payson, UT "Online order" 8/28/09 (turf toe) - Los Gatos, CA "Onlineorder" 8/28/09 (turf toe) - Beachwood, OH "Online order" 8/28/09 (turf toe) - Tigard, OR "Online order" 8/28/09 (turf toe bilateral) - Eastlake, OH "Online order" 8/27/09 (turf toe) - Hartford, WI "800# talk to Clyde" 8/27/09 (hallux rigidus) - Lander, WY "800# talk to Clyde" 8/27/09 (turf toe/football) - Bethesda, MD "800# talk to Clyde" 8/27/09 (hallux rigidus/runner) - Hampsted, MD "Online order" 8/26/09 (turf toe) - Macalester College"Online order" 8/26/09 (turf toe) - Green Bay Packers"800# talk to Clyde" 8/26/09 (turf toe) - Grenada, MS "800# talk to Clyde" 8/26/09 (turf toe/football) - Navarre, FL "800# talk to Clyde" 8/25/09 (sesimoiditis) - Manchester, TN "Online order" 8/24/09 (sesimoiditis) - Aliso Viejo, CA "Online order" 8/24/09 (turf toe) -Butler University"800# order" 8/24/09 (turf toe-soccer) - Franklin College"800# order" 8/24/09 (turf toe-football) Agoura Hills, CA "Online order" 8/23/09 (turf toe) - Chicago, IL "Online order" 8/20/09 (hallux rigidus) - Rehoboth, DE "Online order" 8/19/09 (bunion) - Hornel. NY "Online order" 8/19/'09 (hallux rigidus bilateral) Dublin, Ireland "Reorder online" 8/18/08 (arthritis great toe) -San Jose, CA "Online order" 8/18/09 (turf toe) - Rutland, VT "Online order" 8/18/09 (turf toe) - Carmel, IN Hanger Prosthetics 8/18/09 (2nd met fx) - Folsom, CA "Online order" 8/17/09 (turf toe) - Belmont, OH "Onlineorder" 8/17/09 (turf toe) - McCordsville, IN "Online order" 8/17/09 (turf toe) - Smyrna, TN "Online order"8/15/09 (turf toe) - Laguna Niguel, CA "Online order" 8/14/09 (turf toe) - Austin, TX "Online order" 8/14/09 (turf toe) - Pembroke Pines, FL"800# reorder" 8/13/09 (turf toe) - Brookfield, CT "Online order" 8/13/09 (turf toe) - Wilson, WY "800# order" 8/10/09 (turf toe) - Juneau, AK"800# reorder" 8/10/09 (turf toe) - Medford, OR "Online order" 8/10/09 (turf toe) - Palo Alto, CA "Online order" 8/8/09 (turf toe) - South Burlington, VT"800# order" 8/7/09 (hallux limitus) - North Royalton, OH "800# order" 8/6/09 (turf toe) - Calgary, Alberta Canada "800# order" 8/6/09 (hallux limitus) - Arlington, VA "800# order" 8/4/09 (turf toe) Terre Haute, IN Hanger Prosthetics 8/3/09 (great toe amputation) - Naugatuck, CN "800# Order" 8/3/09 (bilateral hallux limitus) - Malmo, Sweden"Online order"8/2/09 (hallux limitus) - Sioux Falls,SD "Online order" 8/1/09 (hallux limitus) - Asheville, NC "Online order"7/31/09 (bilateralhallux valgus) - Keswick, VA "800# Order" 7/31/09 (turf toe) - Butler U. Basketball "800# order" 7/31/09 (turf toe) - Morgantown, NC "800# order" 7/30/09 (hallux limitus) - Los Angeles, CA "800# Order" 7/30/09 (turf toe) - Edmonton, Alberta Canada - "800# Order" 7/30/09 (turf toe) - Mahwah, NJ "Online order" 7/29/09 (turf toe) - Palo, Alto, CA "Online order" 7/28/09 (turf toe) - Plymouth, MI "Online order" 727/09 (great toe pain) - Tuscon, AZ "Online order" 7/27/09 Broadway Podiatry (sesimoiditis) - St Augustine, FL "Online order" 7/22/09 (turf toe) - Los Angeles, CA "Online order" 7/21/09 (turf toe) - New Market, VA "Online order" 7/21/09 (turf toe) - Escondido, CA "800# order" 7/20/09 ( hallux rigidus) - Rocky River, OH "Online order" 7/19/09 (turf toe) - Pembroke, MA"Online order"7/19/09 (turf toe) - Dublin, Ireland "Online order" 7/17/09 (great toe arthritis) - Duluth, GA "Online order" 7/17/09 (turf toe) - Houston, TX "Online order" 7/17/09 (turf toe) - Zionsville, IN "800# Order" 7/13/09 (turf toe) - Midlothian, TX "Online order" 7/12/09 (turf toe) - Tuscon, AZ "Online order" 7/11/09 (hallux rigidus) - Raleigh, NC "Online order" 7/10/09 (hallux rigidus) - Rutland, VT "800# order" 7/10/09 (hallux rigidus) - Honolulu, HI "Online order" 7/10/09 (bilateral hallux rigidus) - Mason, OH "Online order" 7/9/09 (bilateral hallux rigidus) - Prairie Village, KS "Online order" 7/8/09 (turf toe) - Durham, NC "Online order" 7/8/09 (great toe arthritis) - Del Mar, CA "800# order" 7/8/09 (turf toe) - Cumming, GA "Online order" 7/8/09 (turf toe) - Livermore, CA "800# order" 7/7/09 (turf toe) - Peoria, IL "On-site pick-up" Peoria AAU Basketball 7/7/09 (turf toe) - Ft Lauderdale, FL "Online order" 7/6/09 (turf toe) - Loveland, CO "Online order" 7/6/09 (turf toe) - Atlanta, GA "Online order" 7/3/09 (great toe arthritis) - Edgartown, MA "Online order" 7/7/09 (great toe pain) - Fairfield, CT "Online order" 7/7/09 Chiropractic Sports Practice (turf toe) - Terre Haute, IN "800# order" Hanger Prosthetics (turf toe) - Portland, TN "Online order" 7/1/09 (sesimoiditis) - Fremont, CA "Online order" 6/29/09 (Sesimoiditis) - Newark, DE "800# order"Independence Orthotics (stock order) - Lake Worth, FL "Online order" 6/29/09 (turf toe) - Pen Argyl, PA "Online order" 6/29/09 (turf toe) - Winston-Salem, NC "Paypal order"6/27/09 (hallux rigidus) - Flagstaff, AZ "Online order" 6/24/09 (hallux rigidus) - Lima, OH"Online order" 6/24/09 (turf toe) - Dallas, TX"Online order" 6/23/09 (turf toe) Yardley, PA "Online order" 6/22/09 (turf toe) - Spotswood, NJ "Online order"6/20/09 (turf toe) - Lawai, HI "800# Sale" 6/19/09 (turf toe) - Vancouver, WA "Apple Medical" 6/19/09 (turf toe) - Canberra, Australia"Online order" 6/19/09 (hallux rigidus) - Dayton, OH "Online order" 6/17/09 {hallux rigidus) - Flanagan, IL "Online order" 6/16/09 (painful big toe) - Lincoln, NE "Online order" 6/16/09 (turf toe) - Los Gatos, CA "Online order"6/16/09 (sesimoiditis) - Frankfort, KY "Online order"6/15/09 (turf toe) - Lexington, KY "Online order" 6/15/09 (turf toe) - Marietta, GA "Online order" 6/15/09 (turf toe) - Sacramento, CA "Online Order"6/14/09 ( hallux limitus) - Tampa, FL "Online order"6/13/09 (turf toe) - Easton, MD "The Orthopedic Center"6/11/09 (turf toe) - Opp, AL" Online sale"6/10/09 (turf toe) - University of Illinois Football 6/9/09 "On-site order" 6/9/09 (turf toe) - Danville, PA "Online order" 6/9/09 (turf toe) - Bedford, MA "Online order" 6/8/09 (bilateral turf toe) - Rexburg, ID "Online order" 6/8/09 (turf toe) - Tallahassee, FL "Online order" 6/6/09 (turf toe) - Olympia, WA "Online order" 6/6/09 (turf toe) - Oklahoma City, OK "Online order" 6/5/09 (turf toe) - Norcross, GA "Online order" 6/5/09 (sesimoiditis) - San Antonio, TX "Online order" 6/5/09 (great toe sprain) - Brooklyn, NY "Online order" 6/4/09 (turf toe) - Loveland, CO"Online order" 6/4/09 (turf toe)- Coplay, PA"800# Order"6/3/09 (turf toe) - Knoxville, TN "Internet order"6/2/09 (turf toe) - Terre Haute, IN"800# Order" 6/2/09 (turf toe) - Sana Cruz, CA "800# order" 6/1/09 (hallux limitus) - Freehold,NJ "Online order" 5/31/09 (turf toe) -Albany, NY "Online order" 5/31/09 (great toe arthritis) - Plattsburgh, NY "Online order" 5/30/09 (hallux rigidus) - Green Bay, WI "Online order" 5/29/09 (turf toe) - West Salem, OH "Online order" 5/29/09 (turf toe) -Fishers, IN "Online order" 5/29/09 (sesimoiditis) - Medford, OR "Online order" 5/28/09 (turf toe) - Las Vegas, NV "Online order" 5/27/09 (great toe pain) - Bridgeport, CT "Online order" 5/27/09 (turf toe) Pittsburg, CA "Online order" 5/26/09 (turf toe) - Austin, TX "Online order" 5/25/09 (turf toe) - Harrisburg, PA "Online order" 5/25/09 (hallux rigidus) - Fredericksburg, VA "Online order"5/25/09(turf toe) - Minneapolis,MN"Online order" 5/25/09 (turf toe) - Mesa, AZ "800# order" 5/22/09 (turf toe) - Madison, CT 5/21/09 "Online order" (Bilateral Turf Toe) - Durham, NC 5/21/09 "Online order" (hallux rigidus) - Bronxville, NY 5/20/09"800# order" (turf toe) - Whitewater, WI 5/20/09 "800# order" (turf toe) - Westbury, NY 5/19/09 "800# order" (turf toe) - New York, NY 5/19/09 "Online order" (bilateral hallux rigidus) - Aurora, IN 5/19/09 "call clyde order"(turf toe) - Austin, TX 5/18/09"secure fax order" - University of Texas Football (turf toe) - South Lyon, MI 5/18/09 (turf toe) - Austin, TX 5/17/09 (turf toe) - Carlsbad, CA 5/14/09 (turf toe) - Madisonville, LA 5/14/09 (turf toe) - Proctor, CO 5/12/09 (turf toe) - Hopkinton, MA 5/11/09 (bilateral turf toe) - Egg Harbor City, NJ 5/11/09 (turf toe) - Santa Cruz, CA5/11/09 (hallux rigidus) - Vail, CO 5/11/09 (great toe pain) - Plymouth, MN 5/9/09 (hallux rigidus) - Wamego, KS 5/9/09 (turf toe) - Rogers, MN 5/08/09 (turf toe) - Terre Haute, IN 5/8/09 (Hanger Orthotics - Dealer) - Rome, GA 5/6/09 (Rome Orthopedic Clinic- turf toe) - York, PA 5/6/09 (FX 1st MTP) - Eau Claire, WI 5/6/09 (Paulsrud Chiropractic - turf toe) - Newark, NJ 5/5/09 (hallux limitus) - New York, NY 5/5/09 (turf toe) - Plain City, OH 5/5/09 (turf toe) - Plainfield, IN 5/5/09 (hallux rigidus) - Indianapolis, IN 5/5/09 (Active Podiatry - X1 Dealer) - Cedar Park, TX 5/5/09 (turf toe) - Chicago, IL 5/04/09 (turf toe) - Jackman, ME 5/03/09 (turf toe) - University of Texas Sports Medicine - Austin 5/1/09 (turf toe-football - reorder) - Cincinnati, OH 5/1/09(turf toe) - Randwick, NSW Australia (turf toe) - Menominee, MI 4/29/09 (turf toe) - University of Wisconsin Sports Medicine - Madison4/29/09 (turf toe-reorder) - Boston, MA 4/28/09 (turf toe bilateral)- London, UK 4/28/09 (sesimoiditis) - Kingston, TN 4/28/09 (turf toe - reorder) - Mesa, AZ 4/28/09 (plantar fasciitis/stress fracture) - Glen Ellyn, IL 4/27/09 (great toe arthritis) - Williamstown, NJ 4/25/09 (sesimoiditis) - Chicago, IL 425/09 (bilateral hallux rigidus) - Croton-On-Hudson, NY 4/25/09 (bilateral hallux rigidus - reorder) - Murrels Inlet, SC 4/24/09 (turf toe-soccer) -Indiana University Sports Medicine - Bloomington 4/24/09 (turf toe-soccer) - University of Wisconsin Athletics - Madison 4/22/09 (turf toe-soccer) - Morgantown, NC 4/22/09 (hallux limitus) - Brandon, FL 4/22/09 (hallux rigidus) - Keene, NY 4/22/09 (hallux limitus) - McCook, NE 4/21/09 (High Plains Podiatry - X1Dealer) - San Francisco, CA 4/19/09 (turf toe) - Carlsbad, CA 4/18/09 (bilateral turf toe) - Mesa, AZ 4/18/09Coralville, IA 4/18/089 (hallux rigidus) - Vancouver, BC 4/17/09 (turf toe) - Watsonville, CA 4/16/09 (hallux limitus) - Knoxville, TN 4/15/09 (turf toe) - Boise, ID 4/14/09 (turf toe) - Denver, CO 4/14/09 (hallux rigidus) - Pittsburgh, PA 4/14/09 (hallux rigidus) (hallux limitus) - - Crimora, VA 4/13/09 (turf toe) - Durham, NC4/13/09 (great toe arthritis) - Minneapolis, MN 4/13/09 (bilateral hallux rigidus) - :Lossiemouth, Scotland 4/13/09 (bilateral hallux rigidus) - Atarfe, Spain 4/13/09 (bilateral hallux rigidus) - Broomfield, CO 80020 4/12/09 (turf toe) - Sioux Falls, SD 4/12/09 (turf toe - reorder) -Denham Springs, LA 4/10/09 (hallux rigidus) - Springfield, IL 4/10/09(Hanger Prosthetics - X1 Dealer) - Knoxville, TN 4/8/09 (turf toe) - Sault Saint Marie, Ontario 4/7/09 (Motion Specialties - X1 Dealer)- Moundville, AL 4/7/09 (turf toe) - Chardon, OH 4/7/09 (turf toe) - Thibodaux, LA 4/7/09 (turf toe) - Fishers, IN 4/5/09 (turf toe) - Danville, CA 4/5/09 (turf toe) - Hagen, Germany 4/5/09 (turf toe) - Snohomish, WA 4/5/09 (great toe arthritis) - Wales, WI 4/5/09 (Footwork Orthotics - X1 Dealer) - Los Angeles, CA 4/3/09 (hallux rigidus) - Dover, DE 4/2/09 (Kent Foot & Ankle - X1 Dealer) - Waldorf, MD 4/2/09 (turf toe) - Middle River, MD 4/2/09(turf toe) - Bloomington, IN 4/1/09 (Southern Indiana Orthopedic - X1 Dealer) - Surrey, BC Canada 4/1/09 (turf toe) -Garner, NC 4/1/09 (arthritis great toe)- Lexington, KY 4/1//09 (turf toe) - Monmouth, ME 4/1/09 (turf toe) - Williamstown, NJ 4/1/09 (turf toe) - Terre Haute, IN 3/30/09 (Hanger Prosthetics - X1 Dealer ) - Irving,TX 3/28/09 (turf toe) - New York, NY 3/27/09 (turf toe) - Cincinnati, OH 3/26/09 (turf toe) - Walnut Port, PA 3/25/09 (turf toe) - Clifton Springs, NY 3/25/09 (turf toe) - Austin, TX 3/23/09 (hallux rigidus) -Bel Air, MD 3/21/09 (turf toe) Columbus, OH 3/20/09 (turf toe) - Lutherville, MD 3/20/09 (turf toe) - San Diego, CA 3/20/09 (turf toe)- Staten Island, NY 3/19/09 (turf toe) - Indianapolis, IN3/19/09 (VA Medical Center - X1 Dealer) - Carmel, IN 3/18/09 (great toe pain) - Vista, CA 3/18/09 (turf toe)- Long Beach, CA 3/16/09 (Great Toe Arthritis) - Falling Waters, WV 3/16/09 (bunion pain bilateral) - Grain Valley, MO 3/16/09 (turf toe) - St. Petersburg, FL 3/14/09 (hallux rigidus), Karma, Sweden 3/13/09 (hallux rigidus) - Indianapolis, IN 3/12/09 (VA Medical Center reorder x 48) - Brownstown, MI 3/12/09 (sesmoiditis and hallux limitus bilateral) - Newark, DE 3/11/09(Independence Prosthetics - X1 Dealer) - Monrovia, CA 3/11/09 (turf toe) - Hinckley, OH 3/11/09 (Millenium Rehab - X1 Dealer) - Hendersonville, NC 3/11/09 (Hendersonville Podiatry - X1 Dealer) - Ville Platte, LA 3/11/09 (turf toe) -Solana Beach, CA 3/11/09 (great toe pain) - Raton, NM 3/3/09 (turf toe) - Newark, NJ 3/3/09 (Independence P&O - X1 Dealer) - Irwin, PA 3/2/09 (turf toe/soccer) - St. Charles, IL 2/24/09 (reorder x2 turf toe) - Tucson, AZ 2/24/09 (turf toe) - La Jolla, CA 2/24/09 (turf toe) - Wall Township, NJ 2/24/09 (turf toe) - Terre Haute, IN 2/243/09 (reorder) Atherton, CA 2/19/09 (turf toe) - Wales, WI 2/18/09 (local pedorthist - inventory) Pembroke Pines, FL 2/17/09 (turf toe) - St.Charles, IL 2/16/09 (reorder- turf toe) - Halifax, Nova Scotia 2/11/09 (turf toe) -Purdue Universtiy Sports Medicine 2/11/09 (stocking order)- Pittsburgh, PA 2/11/09 (hallux rigidus) - Silver Spring, MD 2/11/09 (turf toe) - Parkland, FL 2/11/09 (turf toe) - Bloomington, IN 2/11/09 (Orthopaedics of Southern Indiana - X1 reorder) -New York City 2/10/09 (dx:turf toe) - Valley, WA 2/09/09 (dx:turf toe) - Hayes Center, NE 02/09/09 (great toe pain) - Waynesboro, VA 02/09/09 (dx:hallux rigidus) St. Charles, IL 02/08/09 (dx:turf toe) - Buford, GA 2/08/09 (dx:hallux rigidus) - Washington, DC 02/06/09 (dx: turf toe) - Chicago, IL 2/05/09 (dx:turf toe)- Weston, FL 2/2/09 (dx:unknown) Ft Morgan, CO 2/2/09 (dx: turf toe) - Reisterstown, MD 2/2/09 (dx:great toe pain) McCook, NE 1/28/09 (High Plains Podiatry - X1 Dealer) - San Diego,CA 1/27/09 (reorder dx:turf toe bilateral) - West Lake Village, CA 1/26/09 (dx: turf toe) - Purdue University Sports Medicine (reorder - multiple sizes various sports dx: turf toe & mid foot sprains) - Buffalo, NY 1/26/09 (dx:turf toe w/djd) - Sarasota, FL 1/24/09 (reorder dx:great toe pain) - Fullerton, CA 1/23/09 (dx:bilateral turf toe) - Gilbert, AZ 1/20/09 (dx:turf toe) - Terre Haute, IN 1/20/09 - Hanger Prosthetics (reorder dx:hallux rigidus) - Indianapolis, IN 1/19/09 (Methodist Sports Medicine - X1 Dealer) (dx:hallux rigidus) - Sioux Falls, SD 1/18/09 (dx: great toe arthritis) - Toronto, Ontario-Canada 1/17/09 (dx: turf toe) - Chalfont, PA 1/16/09 (dx:turf toe) - Durham, NC 1/15/09 Duke University Sports Medicine (turf toe basketball) - Dallas, TX 1/13/09 (dx: hallux rigidus) - Mason, KS 1/12/09 (dx: turf toe) - Bedford, NH 1/11/09 (dx:turf toe) - Suwanee, GA 1/09/09 (reorder for basketball dx: turf toe) - San Diego, CA 1/6/09 (dx:bilateral turf toe) - Pittsburgh, PA 1/5/09 (dx:turf toe) - Watergate Bay, Cornwall UK 1/5/09 (dx:turf toe) - Oxford, MS 1/2/09 (dx:turf toe) - Cordova, TN 1/1/09 (dx: bilateral turf toe) Butler University Basketball 1/1/09 (turf toe)- Huntsville, AL 12/31 (dx: turf toe) - Suwanee, GA 12/30 (dx:turf toe/custom X-1 size 17) - Newport Beach, CA 12/29 ( dx: bilateral turf toe) - Danville, CA 12/27 (dx: hallux rigidus bilateral) - Fordyce, AR 12/27 (dx: great toe pain) - Seguin, TX 12/23 ( dx: hallux rigidus) - Ewa Beach, HI 12/22 (dx:turf toe) - Camarillo, CA 12/22 ( dx: turf toe) - Butler U. Basketball 12/20 (reorder dx: turf toe) - Newnan, GA 12/16 (dx:hallux rigidus) - St. Michaels, MD 12/15 (dx:bunion) - Littleton, CO 12/15 (dx:turf toe) - Chicago, IL 12/15 (dx:turf toe) - Destrehan, LA 12/09 (dx:turf toe) - Lititz, PA 12/06 (turf toe) - Elsmere, KY 12/05 (dx hallux rigidus) - Novato, CA 12/0 4 (dx -hallux rigidus) - Newark DE 12/03 (dx-turf toe) - Indianapolis, IN 12/02 (dx-turf toe) - Shelbyville, IN 12/02(dx-turf toe) - Sarasota, FL 11/30(dx-turf toe) - The Woodlands, TX 11/30(dx-turf toe) - Santa Ana, CA 11/30 (dx-turf toe) - Camarillo, CA 11/30 (dx-turf toe) - Morrill, ME 11/29(dx-hallux rigidus)

Thursday, December 17, 2009

X1 Blade Turf Toe Insert / 2009 Testimonials

X1 Blade for Turf Toe / 2009 Testimonials

I'm a college WR who has been battling with turf toe goin on two years. It started with small pain, now its so bad i cant run on it at all. Ive tried taping, that doesnt work, rest works a lil but works nothing like the X1 Blade turf toe insert! Ive been using it for two weeks now and i love it. It allows me to walk pain free, run, and continue with my football workouts! The X1 Blade turf toe insert is a life saver for any football player battling turf toe! Trust Me! This Damn Thing Works! Thanks Clyde!

My YouTube name says it all - PainsGONE! I bought the X1 Blade turf toe insert in 6/24/2009 and as soon as I started walking with it the pain in my big toe disappeared. I had gone through 2 steroid shots, many different shoe orthotics including custom and even had a rocker sole molded to my shoes and nothing would relieve the pain due to arthritis. I just ordered more for all of my shoes Thank you Mr. Peach. Sincerely, Jay BTW, I just spoke with him - great guy!

Thanks Clyde! I got my X1 Blade turf toe insert a week ago and what a difference! I was worried that i would have to adjust myself to using this insert. Not the case - we went out a few days ago and i can play tennis just like i used to be able to. Also, i can now walk non-stop without having to take long breaks. This device has truly made a big difference in my life. Thanks for your great product.

I am a golfer and I walk and carry my bag. I was recently diagnosed with "turf toe" and had to quit walking entirely. I looked into a number of different inserts and orthotics and finally spoke on the phone with Clyde about the X-1. I ordered one, put it in my golf shoe and was immediately able to walk the course. I've walked almost daily since while my turf toe continues to improve and I have no pain while walking. THANKS to Clyde for the amazing X1 Blade turf toe insert.

"My son developed turf toe over the summer during high school football workouts. He was entering his senior year of football as a receiver. Your X1 Blade turf toe inserts allowed him to continue working out and playing football. He has a second pair he wears in his regular shoes as well. I recommend anyone who has an issue with turf toe to wear them in both feet to help prevent turf toe from occurring or re-occurring. Thank you!"

"My daughter had a broken big toe that truly was hurting her all the time, so much so that she limped whenever she walked. She received one of your X-1 Sweetspot blades and has received immediate relief from her pain and discomfort. It allowed her to return to her normal gait without any pain. It is a real "miracle" for my daughter. She and I thank you and appreciate your X1 blade.
Thank you so much."

"I have hallux rigidis and was given an expensive custom orthotic that did provide some improvement. Once I purchased the X1, it was like my foot never hurt! The X1 is amazing, allowing me to run, and run hard, with virtually no pain. And I can walk around in most any shoe with comfort. thanks!!"

"As a former Ironman finisher, having completed 16 marathons (12 in one year), I was devastated when my orthopedic doctor diagnosed the pain in my toe while running the last two years as "Turf Toe." Nothing seemed to help, including rest; it would re-occur as soon I as ran. I ordered a X1 Blade, and have already logged 55 miles of PAIN-FREE running. Unbelievable... I'll likely order two more, one for my work shoes, and one for my gym shoes."

"My dad is a college football coach in Michigan. One of his wide recievers suffered from turf toe all preseason. After playing the first game he wasn't sure if he was going to be able to play the following week because of the pain. I recommended this turf toe insert for him. He loves it! He has not missed a game and will continue to play with it all season. I highly recommend it for athletes. Any player on this team who suffers from turf toe in the future will definitely be getting one. Thanks!"

"Amazing product. I'm a physician and marathon runner who had surgery for hallux rigidus. My gait had compensated by supinating which led to upstream dysfunctions. After a suggestion by UVA SPEED clinic (highly skilled biomechanists and therapists) I tried the turf toe plate. After first week my feet and form were thankful. I could roll through my large toe without pain and even felt added power as the product seemed to return energy. Hope to keep running for life. Mark in West Virginia"

"A huge step beyond anything that has been offered as a shoe stiffener for hallux rigidus. As a pedorthist who works exclusively with elite athletes I found these to be the best solution for today's athletic footwear."
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awsome video! my names Jessica, kinda feelin bored if any1 wants to join me on cam or wana chat i will be signed on at __ __ my user ID there is Jessica_nseveakb chat soon xx its FR33 to j0in! mwah

"My daughter plays basketball, softball, rodeos, and volleyball. She encountered a severe case of turf toe in November and was put in a walking boot for 8 weeks. We bought the sweetspot orthotic for both feet and she was able to continue training. She says there is a noticable difference when she is not wearing her inserts so we recently purchased a third one for her everyday shoes."

"I bought 2 of these inserts for my turf toe/hallux rigidus on both feet. I use them when I jog/power walk on my treadmill, and they allow me to work out with much less pain and a quicker recovery time. I endorse this product 100% - thanks Clyde."

"Medical advice is that my hallux rigidus is caused by irreversible wear and tear exacerbated by regular tennis. I was told I'd have to get used to the pain in walking, sports etc. Yesterday my X1 insert arrived and I took a brisk walk over a hill with minimal pain - remarkable - I'm very grateful for your ingenuity Clyde!"

We have used the X1 carbon fiber insert on athletes with turf toe at Butler University and have had great results! I would recommend it to any athlete suffering from turf toe!

"I agree with every one here - this insert works great!!! Additionally, the customer service Indiana Brace provided was EXCELLENT!!"

"Clyde- I am a physician runner and your X1 Sweetspot is doing the trick for my hallux rigidus. 2 months of use and the improvement is already 70% to 90% depending on the day and mileage. It only took about two to three runs for the foot to adapt. Please send me another one of those thin inserts (right 27)to wear in my shoes during office. Thanks Clyde."

"I'm 66, and two years ago I injured my right foot playing competitive tennis. Two doctors diagnosed the problem as stress fracture/arthritis of the Lisfranc joint (mid foot). A tennis friend recommended the Indiana Brace sweet spot insert. They provided me with a custom insert that has miraculously eliminated the pain when I play tennis 3-4x/week. Thanks, Clyde, for improving my quality of life."

"I am 54 and had Turf Toe diagnosed by an Orthopedic doc. After I used the Sweet Spot for a few days, all pain was gone, and symptoms soon went away as well.""I have utilized this product on many of my patients here in Indianapolis as well as placed a pair of the Rigid Shoe Stiffeners in my own father's shoes that he wears at work. As of yet I have not had a negative reaction or report from any of my patients. The design of the insert allows for normal walking motion without the flexing of the metatarsal joints and takes all the pressure off of arthritic feet and 1st MP injuries."

"These things really work. My son broke the sesmoid bone at the great toe joint near the end of the football season. By limiting extension at the joint the insert allowed him to finish football and go right into basketball all while the foot was healing. Thank you, Great Product!"

"My type of work requires me to be on my feet and bend down a lot. Throughout the years this has taken its toll and I have hallux valgus and arthritis of the big toe. I use one of Clyde's sweet spot shoe stiffners in my shoe. This has allowed me to function normally and without pain. Thank you"

"This provided the protection my son needed for his turf toe. cleats are made so soft now we need to add orthotics that can protect but allow flexibility for routes and cuts. This is the answer. our trainer said anyone with foot issues needs this. That's why we got one for the foot that wasn't hurt- thanks C lyde."

X1 Blade for Turf Toe Runners World Testimonial


Re: Toe joint pain/Hallux Rigidus relief
posted at 10/29/2009 8:37 AM CDT

Posts: 1
First: 10/29/2009
Last: 10/29/2009
I had surgery in January 2009 to remove a bone spur on my left big toe. The doc said that this type of injury can stem from turf toe. I had turf toe in high school (10 years ago) and never got it treated. I began running longer distances (1 marathon, 2 halfs, 3rd in november) 2.5 years ago and started having issues last year with pain. I have the beginning of arthritis in the big toe joint.

I was contemplating a joint replacement but felt that this was too much too soon and just opted for the bone spur removal. I wasn't convinced that was going to work and felt it might prevent me even more from running. It took a while for me to get back into it as I didn't fully recover from the surgery for at least 3-4 months (doc said 1-2). He gave me a very stiff composite carbon graphite plate to put in my shoe but it definitely was not good for running as it stiffened the entire shoe and made running uncomfortable.

Luckily I found a different insert that is more flexible throughout but still stiff where you need it (beneath the big toe). It is called the X1 Blade turf toe insert made by Indiana Brace ( I found the X1 Blade for turf toe extremely helpful in getting back into running. I read testimonials and talked to Clyde Peach who makes them. I recommend this before any other surgery and wish I knew about the X1 Blade turf toe insole 10 years ago.

Best of luck.

Mike, 28

Wednesday, February 11, 2009

Runners Morphologies

Morphologies and styles of runners

Pronation is natural, and this rolling from the lateral to the medial side of the foot is one of the body's ways of absorbing shock. Overpronation refers to a foot that rolls excessively to the medial side. Footwear makers are keen to provide medial support for their overpronators. Medial posts, described above, are used to increase the firmness and support through the medial area of the shoe. That denser EVA in the medial side of the midsole—as in the dual density EVA in a shoe like the Brooks Adrenaline pictured—is an example of medial posting. There are also unique and proprietary methods used to create medial support, such as Mizuno's Wave, and you'll read about them in our footwear reviews.

This is the opposite of pronation. It's an outward rolling of the forefoot that naturally occurs during the stride cycle at toe-off. Supination—synonymous wtih underpronation—occurs when the foot remains on its outside edge after heel strike. A true supinating foot underpronates or does not pronate at all, so it doesn't absorb shock well. It is a rare condition occurring in a small fraction of the running population.

The shoes of supinators show outsole wear on the lateral side not just at the heel but all the way up to the forefoot (most runners will find their shoes wear on the lateral side at the heel, and the medial side in the forefoot). Typically, underpronators tend to break down the heel counters of their shoes on the lateral side. Supinators should consider running shoes from the "cushioning" and "neutral" categories.
Categories of shoes

With the above as a backdrop, let's use this knowledge to see if we can divine why some shoes are categorized as they are, and what these categories mean.

Motion Control
What do we know of "straight lasted" shoes? They offer support, robustness, durability. What sort of runner might need a shoe like this? Maybe a heavier runner, or an overpronator, or one who is both. A motion control shoe buttresses against overpronation. They are usually the most expensive, heaviest and protective shoes because they employ the most control and stability features. Their downside is weight, and lack of flexibility and suppleness.

Inside of this category are shoes preferred or required by the broadest swathe of runners. Stability shoes usually have a two-density midsole and a stable base of support to reduce overpronation. Inside of this category is the shoe featured in the image, the Brooks Adrenaline, the shoe I've most often worn for training over the past several years. If you marry a "motion control" shoe to a "neutral" shoe, and they mate and have babies, stability shoes are what will pop out.

Cushioned or Neutral or Lightweight Trainer
"Cushioned" is the traditional name for this category, but it is increasingly being replaced by "neutral," because a shoe can wander over into the stability category and still have reasonable cushion. Nevertheless, you're likely to get a softer ride here than in any shoe category, because these shoes are free of the need for any medial or rearfoot stability devices. Cushioned or neutral shoes are preferred by runners who have a good footfall. Here at Slowtwitch, we often refer to them as "lightweight trainers."

Racing flats
These are the lightest, most flexible running shoes. Some racing shoes are half the weight of typical training shoes, but offer much reduced cushioning, protection and durability. Generally, only runners racing at 7-minute pace or faster; who are relatively light; and who have good footfalls (they don't overpronate!) should consider racing flats.

All that established, sometimes it's hard to categorize a shoe. Note that our footwear editors-at-large, Jeroen van Geelen and Peter Beauregard, each review the Brooks Racer ST, even though they were reviewing "neutral" and "racing flat" categories, respectively. Mr. Beauregard notes that this is the "heaviest flat" in his review of racing shoes made by three footwear manufacturers, "weighing in at 8.7 ounces." Mr. van Geelen reviews this shoe as well but, while acknowledging that Brooks considers it a racer, "considering the weight (8.7 oz.), I would say this is more a lightweight trainer. This shoe also runs more like a lightweight trainer."

Tuesday, February 10, 2009

Parts of A Shoe

The parts of a shoe

The last

All shoes are built on a last. This is the heart of a shoe. It is a piece of plastic, metal, or wood, and its contour determines the shape and size of the shoe. The etymology of the word is "laest", the Old English word for footprint. There are three basic shapes: straight, semi-curved; and curved; but all three shapes vary from company to company as each company has its own lasts. Semi-curved is by far the most popular and most runners do well in a semi-curve-lasted shoe.

A straight-lasted shoe features a straight-shaped sole with little indentation at the arch. A straight last is appropriate for the overpronator with a flexible, flat arch. It helps to control inward rotation. Shoes with a straight last offer the most medial support, and "motion control" shoes tend to be built with a straighter last than stability shoes. A stability shoe is more likely to have a semi-curved last. Most racing shoes are built on a curved last.

The downsides of straight-lasted shoes is a lack of flexibility; they weight quite a bit; and they're less able to deliver a performance run. This isn't a speedwork shoe, or a tempo run shoe. Curved or semi-curve-lasted shoes are what you want for tempo runs, fartlek, speedwork. But, they break down quicker if you're an overpronator, and your orthotic, if you use one, will "help" break down the medial side of a curve-lasted shoe.

The term "last" can be confusing, because it can also refer to how the upper is attached to the midsole. You'll hear three terms used: slip-lasted; board-lasted; and combination-lasted. A slip-lasted shoe is made by sewing the upper into a shape that resembles a moccasin. This construct is then glued directly to the midsole without any board in between. These are flexible shoes with lots of cushioning and, on balance, little motion control.

Board lasted shoes have a sturdy insole fiberboard running the entire length of the foot bed. This type of construction provides the greatest stability. But shoes of this construction are rare nowadays because of weight, and lack of flexibility.

A combination-lasted shoe is stitched in the forefoot and glued in the rearfoot to that fiberboard. While slip-lasting is the most common construction, Asics is one brand that combination-lasts many of its shoes.

Some runners believe a combination-lasted shoe is the most stable and most supportive for orthotics, because the fiberboard mates nicely with the orthotic's heel. To determine which type of lasting the shoe has, remove the insole (also called the sock liner). If there's stitching in the rearfoot, it's slip-lasted. If you see that fiberboard on top of any of the stitching, it's combination-lasted.
This is the outer sole of a shoe—the bottom of the shoe. It's the layer of the shoe that contacts the ground.

Carbon Rubber, a common outsole material, is rubber with a carbon additive to increase durability. It is denser and heavier than blown rubber, and often used in high impact areas.

Blown rubber, a common outsole material, is rubber mixed in some fashion with air. Blown rubber yields a relatively light, cushier outsole, but suffers in durability compared to carbon rubber. Blown rubber is a process most triathletes rely upon: it's what their wetsuits are made of (though wetsuit rubber is much lighter and softer than what is used in the outsoles of running shoes). It's not inconceivable that your wetsuit, your shoe's midsole and EVA outsole, your swim goggle's liner, and your cycling shoe winter booties, are all made of material from the same factory.

Many outsoles use a combination of blown rubber in the midfoot and forefoot—for a lighter shoe with a cushier ride—with carbon rubber in the rearfoot for added durability.

This is the area of the shoe between the upper and outsole. It's primarily responsible for the shoe's cushioning. Most midsoles are made of foams: either EVA (ethylene vinyl acetate) or polyurethane. EVA is lighter and more flexible than polyurethane, but it also breaks downmore quickly. Many midsoles also have additional cushioning elements such as air and gel.

Just as there are proprietary types of blown rubber used by different triathlon wetsuit manufacturers, there are proprietary types of EVA in the marketplace, such as Nike's Phylon and Brooks' Substance 257. Whether in wetsuits or in running shoes, some proprietary designations are more market- than substance-specific, and some really are substantive and provide specific efficacy. Adidas adiPRENE, Brooks HydroFlow, New Balance AbZORB, are additional examples of proprietary EVA.

Medial posting
"Medial" in this context refers to the inner side (the arch side) of a shoe. Lateral is the corresponding term referring to the outside edge of a shoe. Shoes rarely need much extraordinary support on their lateral sides, because most runners pronate, that is to say, their feet roll to the inside. Arch supports, and orthotics, are examples of products designed to buttress and support the foot on the medial side.

EVA is the most common midsole compound used in running shoes. This shock-absorbing foam is soft, light, and flexible. It can be made in variable densities: the more dense the EVA, the harder the ride, but the more supportive for over-pronators. For this reason, many footwear makers employ two densities of EVA, with the firmer density on the medial side of the midsole. This dual-density EVA combines a smooth, supportive ride with a barrier to compression on the shoe's medial side. This technique is called a medial post.

Other parts of the shoe
The "upper is the leather or mesh material that encloses the foot.

"Flex grooves" are midsole and outsole notches to allow the shoe to bend and flex properly with the natural motion of the foot improving forefoot flexibility at toe-off.

The "heel counter" is a device—often a piece of leather, or a plastic cup—forming the back of a shoe. Its job is to reinforce the heel and prevent excessive heel motion. The heel should fit snugly without being too tight. If it's too wide, the heel will slip in and out of the shoe and cause blisters. Women, in particular, often have narrower heels than men and require a narrow heel counter, common in some brands such as Saucony.

The "sock liner" is the removable insert added to cushion and protect your foot from the shoe's midsole. Orthotics, when used, replace sock liners.

The "toebox" is the area of the shoe that encases your toes.

Monday, February 9, 2009

Pronation (loose)/Supination (rigid) & Gait Timing

January 27, 2009

A journey of 1,000 miles starts with "that first step." So it is with sports.

It starts with the feet -- running, jumping, starting, stopping and balancing. Virtually all movement involves your feet and their ability to do some amazing things. Often taken for granted, the foot is a mechanical marvel designed to perform some specific functions during the so-called gait cycle. The terms pronation and supination describe normal positional changes in the foot and ankle that we'll define as follows: every step you take when walking can generate about half to two-thirds of your weight up the feet and legs. When running or jumping, those forces can be multiplied by three to five times. The ability of the foot to dissipate these forces as the body's first major shock absorber is extremely important.

Pronation is the positional changes that the foot attains to loosen up the joints under the ankle to allow this shock absorption. Pronation also allows the foot to adapt to the ground surface. Once the body passes over the foot this loose bag of bones (pronation) becomes a stable structure as the foot becomes a rigid lever to propel the body forward. This lever position is called supination. Many so-called overuse injuries like plantar fasciitis (arch and heel problems), shin splints, runners or jumpers knee tendonitis are related to abnormal forces associated with foot position changes.

Flat feet, many times associated with too much foot pronation, can cause the expected push off or supinated phase to be either too late or absent totally. Abnormal strain to the structures of the feet and legs can result from this. Since inward rotation of the lower leg accompanies pronation of the foot, problems with shins and knees can result from this increased torque caused by excessive foot pronation.

Examination of the individual standing, walking or running can reveal specifics about these foot positions and mechanics. Identifying weak links in the alignment of the foot, ankle, knee and hip structures can be very valuable in preventing overuse injuries. Stability tests like single leg balance and squat positions can give good information.

Why does one person over pronate and can be prone to overuse injuries while another functions more normally and is less prone? Often it's genetics or inherited foot structure. Blame your parents if you have excessive pronation. Women, because of their hormonal make-up, have a tendency to be loose jointed. Because of this laxity of ligaments, also often inherited, excessive pronation can be a problem even with good foot structure. High arch feet can also cause problems related to over supination. Limited shock absorption can cause strain to ankles, knees, hips and back. This foot type also is often inherited from mom and dad.

By far the best method to properly deal with these timing of foot position abnormalities is with the use of prescription in shoe orthotics. Made from positional molds of the feet, these devices allow the optimum alignment of the foot and lower legs to be obtained. Orthotics can help to get the feet in the proper position at the proper time. If the foot supinates (becomes a rigid lever) at the right time, then speed, stability, balance and function improve. When excessive pronation is controlled, strain to the foot, shins and knees are lessoned.

In the past, orthotics were often confused with arch supports. The thinking was that supports would "hold up" flat feet. If the feet didn't hurt, they weren't considered. Today, we understand that it's not support but alignment and positioning that counts and that's the role of prescription orthotics. Often people, athletes or not will ask, do I need orthotics? It's better to ask would I benefit? Almost all athletes do.

Friday, February 6, 2009

Ankle Sprain Overview

The ankle joint, which connects the foot with the lower leg, is injured often. An unnatural twisting motion can happen when the foot is planted awkwardly, when the ground is uneven, or when an unusual amount of force is applied to the joint. Such injuries happen during athletic events, while running or walking, or even during everyday activities such as getting out of bed.

* The ankle joint is made up of three bones.

o The tibia is the major bone of the lower leg, and it bears most of the body's weight. Its bottom portion forms the medial malleolus, the inside bump of the ankle.

o The fibula is the smaller of the two bones in the lower leg. Its lower end forms the lateral malleolus, the outer bump of the ankle.

o The talus is the top bone of the foot.

* Tendons connect muscles to bones.

o Several muscles control motion at the ankle. Each has a tendon connecting it to one or more of the bones of the foot.

o Tendons can be stretched or torn when the joint is subjected to greater than normal stress.

o Tendons also can be pulled off the bone. An example of an injury of this type would be an Achilles tendon rupture.

* Ligaments provide connection between bones. Sprains are injuries to the ligaments.

o The ankle has many bones that come together to form the joint, so it has many ligaments holding it together. Stress on these ligaments can cause them to stretch or tear.

o The most commonly injured ligament is the anterior talofibular ligament that connects the front part of the fibula to the talus bone on the front-outer part of the ankle joint.

Ankle injuries can be painful and can make it difficult to carry out daily activities.

Thursday, February 5, 2009

Ankle Braces Reduce Risk of Ankle Injuries by 3 Times

The Efficacy of a Semirigid Ankle Stabilizer to Reduce Acute Ankle Injuries in Basketball
Sitler M, Ryan J, Wheeler B, et al: Am J Sports Med 22(4): 454-461, 1994
"This randomized clinical study was designed to prospectively determine the efficacy of a semirigid ankle stabilizer in reducing the frequency and severity of acute ankle injuries in basketball." The results indicate that the "use of ankle stabilizers [Sport-Stirrup] significantly reduced the frequency of ankle injuries… Non-braced players had three times the risk of the control players for sustaining an ankle injury." The data also showed that "wearing the ankle stabilizer did not affect the frequency of knee injuries, [and the] attitude toward ankle stabilizer use improved as use of the stabilizer increased."

Wednesday, February 4, 2009

Aircast Ankle Stirrup

Air-Stirrup® Ankle Brace
Since 1978, the Aircast Air-Stirrup Ankle Brace has been the "standard of care" for the functional management of ankle injuries and has been cited in over 100 medical journals for its superior performance in helping to heal ankle injuries. Each Aircast Ankle Brace features anatomically designed shells lined with the patented Duplex™ aircell system. This exclusive system incorporates two pre-inflated overlapping aircells, distal and proximal, that provide support and produce graduated compression during ambulation. The compression promotes efficient edema reduction in addition to helping accelerate rehabilitation. All Air-Stirrup Ankle Braces (except for the pediatric model) come with a patient guide providing information on brace application and optional rehabilitation exercises. The Standard (Large), Training (Medium), and Small size Ankle Brace is available individually or as part of an Ankle Sprain Care Kit™. The Pediatric Ankle Brace is designed for children 2 to 6 years of age and is ideal for ankle stabilization in hemophilia patients. Extra long straps are available "” contact Customer Service for more information.

Tuesday, February 3, 2009

$990 for Foot Orthotics! Amazing Podiatrists

Woman cries foul over podiatry bill
by Frank Donnelly
Sunday January 25, 2009, 10:26 AM

STATEN ISLAND, N.Y. -- She thought she was getting a free callus clip and a mug.
But an Oakwood woman's visit to a New Dorp podiatry office last summer turned out to be a very expensive pain in the foot.

Ashley Castagna's medical insurance carrier was billed $3,235 for the 20-minute treatment she says she received at A Call Away Foot Care. The office visit, according to an advertisement Ms. Castagna and her mother, Sandra, showed the Advance, was supposed to be gratis.

Yet Ms. Castagna's insurance carrier was charged for it, including $1,550 for five surgical procedures, according to a billing statement that the Castagnas provided. All the doctor did, Ashley Castagna said, was shave part of a callus, take molds of her feet and write a prescription for foot cream.

While their insurer has paid $616, the Castagnas were told they're on the hook for $224.

"When I got the bill I was so livid about it," Sandra Castagna said last week during an interview in her home. "My daughter never had one surgery, let alone $3,200 of surgeries."

Ashley Castagna, 21, is a college student who lives at home.

Doctors at A Call Away Foot Care, a cramped storefront office off Hylan Boulevard, did not return several messages left last week, both in person and on the phone, seeking comment.

Ashley Castagna said she visited the podiatry office on New Dorp Lane on June 28 after her mother saw an advertisement with a coupon for a free office visit in a local weekly shopping tabloid. Valued at $350, the treatment includes "cutting nails, calluses, corns, whirlpool, moisturizing foot massage, routine care" and "a free gift mug," the ad says.

Ashley Castagna said she presented the coupon when she visited the office, but was told she didn't need it. She then filled out a form, which included her medical insurance information. The policy is in her father's name.

"I just assumed it was standard practice," she said.

Nobody said she'd be charged for the visit, and she was not asked for an insurance co-payment, she said.

Ms. Castagna said she was with the doctor about 20 minutes. During that time, he shaved a section of callus, took a mold of her foot for orthotic shoe inserts and wrote a prescription for a moisturizing cream. She said she had not complained of any pain in her feet and was given a mug before she left the office.

Her mother picked up the inserts a few weeks later after the doctor's office called to advise they were ready. In fact, Sandra Castagna also picked up inserts for herself. She said she had visited the office with a coupon about two weeks before her daughter and received similar treatment. Both women believed the orthotics were free.

Sandra Castagna later returned five times to receive cortisone shots in her aching right heel. She said she paid a co-payment for each injection, but not for the initial visit, which was supposed to be free. She has not received a statement from her insurance carrier for any of her visits.

To her surprise, however, Cigna HealthCare recently sent a benefits statement for her daughter's visit. It listed charges from the podiatrist's office of $1,550 for five surgeries, $250 for physician care and $990 for prosthetic devices. Along with other costs, it totaled $3,235.

Cigna agreed to pay $616 and said the Castagnas owed a balance of $224.

Sandra Castagna couldn't believe it.

"I was irate," she said.

She called the podiatrist's office, but received no satisfaction. All a receptionist told her is that anytime a doctor touches the foot, it's considered a surgery, said Mrs. Castagna.

"She didn't even try to say it was a mistake," Mrs. Castagna said.

Steaming, she told the woman, "You guys are totally screwing people."

Mrs. Castagna said she then called Cigna and was told the company will investigate.

Kathleen Keenan, a Cigna corporate spokeswoman, said the company has "the appropriate people" probing the matter. She declined to elaborate, citing federal and state privacy laws.

Ms. Keenan added that Cigna encourages its members to discuss potential costs with health-care providers and to contact the company to determine what coverage, if any, is in effect, before receiving treatment.

Mrs. Castagna said she has no intention of paying the bill.

"It makes me so angry," she said. "[Ashley] didn't have anything done to her foot."

Monday, February 2, 2009

Nail-Patella Syndrome/Solid Ankle Foot Orthosis

Nail-patella syndrome, skewfoot.
The patient received her previous SAFO on 10/05/2000. Her mother stated that is was leaving marks on her skin; however, she did not bring the brace with her today. It has not been quite 6 months; therefore, we are going to try to adjust the old one when she brings it in later this week. I did cast the patient today for a new brace, which will be made when she is no longer able to wear the old one. She is a 3-year-old female. The patient has no known allergies. She is not taking any medication, and she is active community ambulator. She has not had any surgery.
On weight bearing, the patient pronates at the midfoot and her forefoot is adducted. Her heel is in valgus but correctable. She can get to 90 degrees; however, her forefoot angle has approximately a 15-degree varus, and she then pulls into adduction. She does not have skin breakdown. She is having difficulty with her medial malleolus. There is a callus that has built up. Her mother stated that this is from the brace. The casting procedure went well.
Fabricate left SAFO. Casting and measurement.
We will see the patient at the end of the week for adjustments to her old brace to enable her to wear it for a longer period of time.

Friday, January 30, 2009

Cerebral Palsy/Soft Knee Immobilizer

Left soft knee immobilizer
Cerebral palsy.
This 4-year-old female has no known allergies. She is not taking any medication. She had Botox injections on 03/21/2001 in both of her hamstrings.
The knee immobilizer will be used due to the patient having hamstring spasticity. A 9-inch knee immobilizer fit the patient very well. The parents were concerned because they were under the impression that Dr. ----- was going to order knee immobilizers for both legs. I placed a call to physician's office and left a message asking if physician did indeed wanted the patient to have one for each leg. Doctor wrote specifically just for the left. We will wait to her back. Today I fit and delivered 1 knee orthosis to the left leg.
We will wait for notification from Dr. regarding fit and delivery of a right knee immobilizer.
Evaluation and measurement for right soft knee immobilizer.

Thursday, January 29, 2009

Bilateral Solid AFO's with Anterior Panels

The patient was seen today for fit and delivery of bilateral solid-ankle AFOs with anterior panels. A good fit was achieved. Proper donning and doffing instructions were given. A gradual wearing schedule was discussed and agreed upon. This patient ambulated without discomfort for approximately 10 minutes. I removed the braces, checked his skin, and no redness was noted. He will begin wearing the braces when he gets appropriate shoes. Otherwise, this patient will be seen as needed.

Wednesday, January 28, 2009

PTB Thigh Corset Addition

This patient was in our office today for measurements for a thigh corset and side joints to be added to his existing PTB socket. A standard fiberglass impression was taken over the patient's thigh and including the socket. Patient is fitting in the socket with a five-ply sock. We will contact the patient when the device is ready for fittin

VA Upset

Patient called on the telephone today, requesting to know when his leg is going to be fabricated. Currently on ------, we sent pricing out to VA. In return, we were to wait for a purchase order.Patient has contacted the VA, and they said they were in the process of getting that purchase order, and that they will be in touch with us within the next day or two. I called to confirm this. The secretary's name is -----. She seemed particularly upset that not only our company, but another company, was saying that we were waiting for authorization from the VA. She felt that this terminology only prompted fear and outrage in the veteran because they thought that they were not going to be eligible for,said benefits, and our new terminology is'we are waiting to have the VA process the paperwork for a purchase order which would allow us to go to the next step, and we are not to use "authorization any more" Miss ----- said that, via mail, we will get our purchase order number. I have called back patient and left a message to let him know this to that effect. We will contact him again when it is time to schedule and appointment for him to be seen.

Stabilizing Effect of Aircast Ankle Brace

* CME Programs

Reference Search
A Biomechanical Study of the Stabilization Effect of the Aircast Ankle Brace
Stuessi E, Tiegermann V, Gerber H, et al: Biomechanics X-A International Series 6A: 159-164, 1987
Kinematics and kinetic analyses were used to assess the stabilization effect of the Aircast Ankle Brace on mediolateral movement of the ankle in static and dynamic situations. The authors concluded that "the Aircast Brace has a stabilizing effect on the ankle… the brace reduce[d] the amount of supination in static (isometric) as well as in dynamic (running) situations… The brace had no influence on the EMG activity of the peroneus longus. Therefore, it can be assumed that in the dynamic situation (running), the measured limitation of the range of movement was a result of the Aircast Ankle Brace and not of an increased muscle activity."

Tuesday, January 27, 2009

PTB Height Adjustment/New Shoes

This patient was seen in our office for adjustment to his left PTB endoskeletal below the knee prosthesis. What was done today was to realign and correct the height on his current prosthesis. The patient has switched shoes and has gone to a shoe that does not incorporate an AFO on the right side. This has left him 1/2 inch tall on the prosthetic side and the anterior tilt of the ptton are inappropriate in the new shoes. Both of these items were adjusted on the patient today. He reported after these adjustments that he was comfortable on the limb and was able to ambulate comfortably on the limb. Everything else is appropriate at this time. The patient is currently wearing 4 ply of sock. He will be followed through our office on an as needed basis and through the VA clinic.

Monday, January 26, 2009

UCB Inserts / Down's Syndrome

Prescription: UCB inserts. Diagnosis: Down's Syndrome
History: This is an eight year old white female (patient A) with Down's Syndrome who has a surgical history of having heart surgery in the past. She takes Catapril and Lanoxin. She has no allergies at this time. She has worn UCB-FO's in the past.
Assessment: This is a child who stands with pronated mid-feet, abducted fore-feet, and valgus heels. The feet do correct to a neutral position.
Plan: Fabricate bilateral UCB-FO's.

We attempted to fit patient A today with her bilateral UCB-FO's. These were fabricated out of 3/16" polypropylene and are far too heavy duty for someone of Amy's size. Additionally, the forefoot was wide on these orthoses. We will remanufacture these for her and supply them to her tomorrow.

Patient A returned to our office today for the fitting of her UCB-FO's. These looked much better today. They were fabricated from 1/8" polypropylene and fit quite nicely. These were trimmed and finished and Amy ambulated very comfortably in them. Everything appeares to be satisfactory in these orthoses at the present time. Patient A worn them out of the office.

Obama Puts CMS Competetive Bidding for O&P on Hold

Obama puts ICD-10 regulation on hold for review

By Jennifer Lubell / HITS staff writer
Posted: January 22, 2009 - 5:59 am EDT

HHS’ implementation of ICD-10 and several other rules issued last week could potentially be delayed, as the White House proceeds with a review of any new or pending regulations issued under the Bush administration.

A memorandum released by White House Chief of Staff Rahm Emanuel has “put a hold on all regulations that have either not been published or those that have not yet taken legal effect,” a CMS spokesman said.

Although the CMS has yet to produce a list of the affected regulations, it’s likely that at least four recent rulemakings could be put on hold, including HHS’ final rule for transitioning to the International Classification of Diseases, 10th Revision, the spokesman said.

The final rule for implementing ICD-10 CM (Clinical Modification) and ICD-10 PCS (Procedure Coding System) was issued on Jan. 15. However, the rule itself “doesn’t become effective until March 17, which means the ICD-10 regulation would fall within this additional layer of review” by the White House, said Don May, vice president for policy with the American Hospital Association. ICD-10’s compliance deadline isn’t scheduled to take effect until Oct. 1, 2013.

“We will be working with the new administration in their effort to review actions and regulations subject to the memo,” the CMS spokesman said.

Other recent rules that may be put on hold include an interim final rule to identify protected classes of prescription drugs under Medicare Part D; a proposed rule to make improvements to the cervical cancer proficiency testing program; and another interim final rule that addresses steps to restart the CMS’ competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies.

Sunday, January 25, 2009

An Rx for Ethics - New Rules on Doctors and Medical Firms

By BARRY MEIER - New York Times Business 1/25/09
When the sun goes down in Las Vegas, steer clear of doctors.
Those are the marching orders that Smith & Nephew, a leading maker of artificial hips and knees, has given executives and sales representatives attending a big meeting of orthopedic surgeons next month. The company has told them to limit their interactions with doctors to 9 a.m. to 5 p.m., the "business" hours of the convention of the American Academy of Orthopaedic Surgeons.
It remains to be seen whether such seeming magnets as doctors and sales executives can resist each other. But Smith & Nephew's convention curfew is a sign of an ethical makeover under way within the medical device industry, a field that has been troubled by federal investigations and bad publicity over the volatile issue of frequently undisclosed financial ties between companies and physicians.
On Thursday, two senators increased the pressure further by reintroducing legislation that would require device and drug makers to report all financial links with doctors on a federal Web site. That bill is known as the Physician Payments Sunshine Act, and a parallel effort is in the House.
"The public is clamoring for transparency," one of the Senate sponsors, Herb Kohl, a Wisconsin Democrat, said. The co-sponsor is Charles E. Grassley, Republicanlican of Iowa.

The nation's biggest hip and knee makers, including Smith & Nephew, are operating under Justice Department oversight as part of an agreement to resolve allegations that they gave some doctors illegal inducements to use their products.
Other sectors of the device industry face continuing federal inquiries or are voluntarily taking house-cleaning measures. Much of it involves the public disclosure of information that would be mandated under the Senate proposal — the names of the doctors who work for device manufacturers as consultants, lecturers, researchers or trainers, and how much each one is paid for those services.
Under their Justice Department settlements, the hip and knee makers are already disclosing such payments on their corporate Web sites. And seeing the writing on the wall, several other large device companies, including Boston Scientific and Edwards Lifes Sciences, recently announced they would do so voluntarily.
Meanwhile, the device industry's main trade group, the Advanced Medical Technology Association, said it had supported the Senate measure when it was introduced two years ago.
There is little question that battles over how much companies, doctors and medical institutions disclose about their financial ties will continue. But some experts on medical conflicts of interest, seeing the rapid fall of resistance by most major companies, say that a turning point has arrived.
"We are definitely moving towards more disclosure and disclosure of information that is useful to people," said Lisa Bero, a pharmacy professor at the University of California, San Francisco.
Recently, several big pharmaceutical companies have also said they plan to release the names of doctors they use as consultants. But the ties between medical device makers and physicians are often more entangled and can have a bigger impact on both patient care and product sales.
For one, doctors may be involved in the design of a medical device and can hold a patent on it. Further, device makers also hire surgeons to train other doctors on how to implant their products. And hospitals often give doctors a large say in determining the suppliers of products like artificial hips or heart defibrillators — companies with which those same doctors may have financial relationships. Some hospital systems, including the big Kaiser Permanente network, bar physicians from taking industry money and now require device suppliers to compete on the same basis on which most medical products are purchased — price.
In recent months, the ground has shifted so rapidly under device makers that companies find themselves scrambling to keep -up.
Take Edwards Lifesciences, a producer of heart valves and other devices. Last year, the company's chief executive, Michael A. Mussallem, decided that Edwards would voluntarily disclose all its payments to doctors.
Mr. Mussallem said that the decision came from the push for federal legislation and the passage in Massachusetts last summer of a state law requiring drug and device companies to disclose all payments to doctors in excess of $50.
Edwards, like other device makers, has also been the subject
of media articles raising questions about the motives of physicians with financial ties to the company.
"We make our living on innovation," said Mr. Mussallem, who is also the current president of the Advanced Medical Technology Association. "But every time we turned around there was a story that made this seem negative rather than positive."
But gathering that physician data is proving easier said than done. For instance, Edwards officials soon discovered that each company division had used a different process to account for its doctor payments, and technological havoc resulted when they tried to pull the data together.
The public is clamoring for transparency,' a senator says.
"You couldn't tell if Dr. Jones and Dr. Jones were the same guy," or different ones, said Dirk-sen Lehman, the company's vice president for government affairs.
Edwards hopes to resolve those issues in time to meet its self-imposed deadline of making physician disclosures public by December, he said.
For years, both device makers and their consulting doctors insisted that money did not affect how the physicians treated patients. And device makers rebuffed efforts to disclose such ties.
But the Justice Department changed all that through its investigation of orthopedics companies, which was headed by the United States attorney in Newark. Although federal prosecutors said they found that most financial ties between companies and doctors were legitimate, there was enough evidence of illegal sales inducements • and sham consulting contracts to warrant filing charges.
To avoid prosecution, the companies, without acknowledging wrongdoing, entered settlements in 2007 under which they agreed, among other things, to submit all their doctor ties to an outside monitor for review. They also agreed as a group to limit daily consulting payments to most doctors to $500, and to justify such expenses.
More recently, two companies involved in the Justice Department action, Zimmer Holdings and Biomet, said separately that they would no longer give educational funds directly to medical schools, but instead would give them to professional organizations, which would decide how they should be distributed.
The federal inquiry has also had an impact on surgeons who specialize in hip and knee replacements. Company-sponsored work on new products has largely been at a standstill since 2007, several doctors said. And other types of consulting relationships are just starting to resume under the new disclosure rules.
For instance, Dr. Michael C. Raklewicz, an orthopedic surgeon in Kingston, Pa., said he was notified just a few weeks ago by Zimmer Holdings, the biggest orthopedic implant maker, that it would again retain him to train other surgeons on the use of its products.
"All I knew was that I had a few teaching sessions left and they were canceled" back in late 2007, said Dr. Raklewicz. "Then, it was like, 'Hold on, hold on, we'll get back to you' and finally they did."
The possibility of similar Justice Department action may also be facing other companies that have declared themselves converts to the concept of disclosure.
Since 2005, for example, the Justice Department has been investigating ties between doctors and makers of heart pacemakers and defibrillators. The companies involved deny any wrongdoing. But two of them — Medtronic and St. Jude Medical — have said they support federal disclosure legislation.
A third big producer, Boston Scientific, has gone a step further. The company, which acquired the heart device business of the Guidant Corporation in 2006, recently said that it planned this year to publicly release data about its financial links to doctors among all its business units.

Friday, January 23, 2009

AFO's Improve Mobility After Stroke

Release Date:January 22, 2009

Ankle Splints Improve Mobility After Stroke
By Kurt Ullman, Contributing Writer
Health Behavior News Service

A new review shows that ankle and foot splints can help stroke patients regain the ability to walk and keep their balance, although splints — also called orthotics — offer less improvement for other activities, like climbing stairs.

Wrist splints, however, do not lead to signs of improvement in the hands or arms, according to the new review.

“A stroke causes weakness of one side of the body, making it difficult to move the affected arm and leg in everyday activities like walking or eating,” said co-author Sarah Tyson, Ph.D. “One common way to manage this problem is using a splint to control movement at weak joints, especially the wrist or the ankle. We undertook a Cochrane Review to clarify whether the splints were effective and to make recommendations about how they should be used in practice.”

The reviewers analyzed 14 clinical studies involving 429 participants. The leg splint studies looked for improvement in walking speed, balance and step/stride length. They also assessed foot drop during the swing phase of walking.

“The results for lower-limb splints show that they can improve walking and balance, at least in the short term,” Tyson said. “This is something of a surprise as, traditionally, physiotherapists have been reluctant to prescribe them, as it was felt orthotics may have a detrimental effect. However, views have been slowly shifting in the last few years as the body of evidence supporting their use has emerged.”

Tyson is a senior research fellow with the Centre for Rehabilitation and Human Performance Research at the University of Salford in Greater Manchester, England.

The new review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The included studies only examined immediate effects of splints, rather than long-term impact.

Both kinds of splints usually are custom made of plastic or metal. Clinicians mold ankle foot splints to the lower leg and then adjust them to help compensate for the patient’s specific deficit. For the most part, the splints start around the ball of the foot and extend upwards to a few inches below the knee.

Arm and hand splints most often include the palm to an inch or so above the wrist. Initially, these braces are used to increase the range of motion in fingers and hands that may have been frozen into a fist or have muscles that are hard to control following a stroke. This is intended to help the patient regain use of their upper extremities to eat, write or pick things up more efficiently.

However, researchers saw no effect from wrist splints on the ability to use the arm; range of movement at the wrist, fingers or thumbs; or pain.

“This result was also surprising as the use of orthotics to prevent contractures (loss of range of movement) is thought to be very important in restoring use of the arm after stroke,” said Tyson. “These results throw that belief into doubt; however, the results are based on a very small number of studies, so we need to do larger trials and look at the use of orthotics combined with other established treatments, such as physiotherapy or botulinum toxin [Botox].”

“This review confirms what most rehabilitation professionals had assumed all along, that the lower extremity splints make an immediate, positive impact on a patient’s balance and walking ability,” said Kyle Covington, P.T, medical instructor and academic coordinator of clinical education at Duke University School of Medicine. “It is nice to have the evidence to back-up what clinical experience was telling us. It also gives more credence to the usefulness of splints, at least in the lower extremities.”

He agreed that the hand and arm results were unexpected.

“That was surprising in that some rehabilitation professionals had assumed that there was a benefit to the patient in splinting the hands and wrists, but as the authors point out, the jury is still out on that question.” Covington said.

Symptoms associated with rotator cuff tears:

Rotator cuff tears are tears of one, or more, of the four tendons of the rotator cuff muscles.

Rotator cuff tears are among the most common conditions affecting the shoulder.[1]

The tendons of the rotator cuff, not the muscles, are most commonly torn. Of the four tendons, the supraspinatus is most frequently torn; the tear usually occurs at its point of insertion onto the humeral head at the greater tuberosity.[2]
The most reliable symptom for determining a rotator cuff tear is probably the least common and is found when there is a complete rupture with detachment of the rotator cuff leading to the complaint of complete loss of function, such as, loss of the ability to actively move the arm away from the side of the body (loss of abduction). Fortunately this finding is rare and when tears are symptomatic, most tears present as pain with limitation of function, a non-specific complaint that cannot distinguish between tendinitis, bursitis or arthritis. The clinical picture of a completely detached tear is more clear-cut, while the more common shoulder problems greatly overlap in their clinical presentation.

Pain in the anterolateral aspect of the shoulder can be due to many causes, [4] symptoms may reflect pathology outside of the shoulder which cause referred pain to the shoulder from sites such as the neck, heart or gut.

Patient history will often include pain or ache over the front and outer aspect of the shoulder, pain aggravated by leaning on the elbow and pushing upwards on the shoulder (such as leaning on the armrest of a reclining chair), intolerance to overhead activity, pain at night when lying directly on the affected shoulder, pain when reaching forward (e.g. unable to lift a gallon of milk from the refrigerator). Weakness may be reported, but is often masked by pain and is usually found only through examination. With longer standing pain, the shoulder is favored and gradually loss of motion and weakness may develop which, due to pain and guarding are often missed by the patient and are only brought out during the examination.

Primary shoulder problems may cause pain over the deltoid muscle that is made worse by abduction against resistance, called the impingement sign. Impingement reflects pain arising from the rotator cuff but cannot distinguish between inflammation, strain, or tear. Patients may report their experience with the impingement sign when they report that they are unable to reach upwards to brush their hair or to reach in front to lift a can of beans up from an overhead shelf.

Thursday, January 22, 2009

Ultra Sling ER Post-Op Care - Massive Rotator Cuff Tear

Surgical Procedure and Rehabilitation

Arthroscopic surgery was performed with the patient in a Beach-chair position (Tenet Tmax Beach Chair, Tenet Medical Engineering, Calgary, CN) following interscalene nerve blockade and administration of parenteral prophylactic antibiotics. An articulated hydraulic arm holder facilitated positioning of the arm for arthroscopy and arthroscopic rotator cuff repair (Spider Arm Holder, Tenet Medical Engineering, Calgary, CN). (Fig. 5).

Routine arthroscopic evaluation was performed in order to rule out comorbid pathology followed by a modified acromioplasty. Care was taken to preserve the coracoacromial ligament so as to prevent the risk of increased superior displacement of the humeral head by removal of this stabilizing barrier.

In all cases, a massive rotator cuff tear with marked medial and inferior retraction of the supraspinatus and infraspinatus respectively was identified (Fig. 6). Arthroscopic repair was performed by placing the arthroscope in a lateral portal so that the entire posterior extent of the tendon tear could be visualized. The tendon was then mobilized using a radiofrequency probe (VaprR, Mitek, Johnson and Johnson, Norwood, MA). The tendon tear was then repaired using a margin-convergence method as described by Burkhart along with direct reinsertion of the tendon in bone, or by partial reinsertion of the posterior component of the tendon tear if the supraspinatus was irreparable (Figs. 7A-C).9,10 After repair an intraarticular pain catheter was placed for postoperative pain control (PainbusterTM, DonJoy Orthopaedics, Carlsbad, CA).

All patients were then placed in a shoulder immobilizer with an external rotation pillow (UltraslingTM, DonJoy Orthopaedics, Carlsbad, CA) in order to protect the posterior component of the tendon repair.

Patients remained in the shoulder immobilizer with an external rotation pillow for six weeks and no therapy was performed during this time period. After six weeks active motion was permitted for daily living activities. Gentle assisted range of motion was performed and strengthening was delayed until four months after the surgical procedure.

Wednesday, January 21, 2009

Ultra-Sling II


Ideal Application

Both versions of the UltraSling II provide immobilization for rotator cuff repairs, capusular shifts, Bankhart repairs, glenohumeral dislocations/subluxation and soft tissue repairs/strains.

Features and Benefits

Breathable extra padded fabric for greater comfort, particularly in longer term use.
Encourages effective healing by allowing the shoulder and arm to remain in a neutral position.
Helps prevent post-operative internal rotation contractures that can occur in a sling.
Promotes axiliary air exchange to reduce risk of secondary infections.
Exercise ball stimulates circulation.
Easy open front panel encourages forearm exercises.
Allows arm to be positioned in a variety of positions dependent on post-operative requirements (either more °°posterior or anterior).

Tuesday, January 20, 2009

Rotator Cuff Tear

Rotator Cuff
The rotator cuff is the name for the tendons that surround the shoulder joint. The rotator cuff is important in allowing the shoulder to function through a wide range of motions. In part due to the rotator cuff, the shoulder joint can move and turn through a wider range than any other joint in the body. This motion of the shoulder joint allows us to perform an amazing variety of tasks with our arms.

Unfortunately, a rotator cuff tear is not an uncommon problem, and these injuries make many routine activities difficult and painful. The rotator cuff is part of this mechanism that, when healthy functions very well, but when injured can be a difficult and frustrating problem.

What is the rotator cuff?
The rotator cuff is a group of four muscles and their tendons that wraps around the front, back, and top of the shoulder joint. Together the rotator cuff muscles help guide the shoulder through many motions, and also lend stability to the joint. The ends of the rotator cuff muscles form tendons that attach to the arm bone (humerus). It is the tendinous portion of the rotator cuff that is usually involved in a rotator cuff tear.

What is a rotator cuff tear?
A rotator cuff tear occurs when there is an injury to one of the rotator cuff tendons. Rotator cuff tears occur in many shapes and sizes, but can be thought of as a hole in one of the tendons around the shoulder joint. Like most orthopedic conditions, the most common mechanisms of a rotator cuff tear are separated into 'repetitive use' and 'traumatic injuries.'

* Repetitive Use Injury
In repetitive use injuries to the rotator cuff, repeated activities cause damage to the rotator cuff tendons. Over time, the tendons wear thin and a rotator cuff tear can develop within the tendons. Patients with repetitive use injuries to the rotator cuff often have complaints of shoulder bursitis prior to developing a rotator cuff tear through the tendons.

* Traumatic Injuries
Traumatic injuries to the rotator cuff are seen after events such as falling on to an outstretched hand. The traumatic event can cause a rotator cuff tear by injuring the rotator cuff tendons. This mechanism is much less common than repetitive use injuries, but when a rotator cuff tear occurs in a patient younger than 60 years old it is usually a traumatic injury.

Who is most susceptible to a rotator cuff tear?
A rotator cuff tear is seen both in the young and old, but they are much more common in the older population. Usually in younger patients, there is either a traumatic injury, or the patient is demanding unusual use of their shoulder, as seen in professional athletes.

As people age, the muscle and tendon tissue of the rotator cuff loses some elasticity, becomes more susceptible to injuries, and is often damaged while performing everyday activities. This is the reason that rotator cuff tears are more commonly seen in older patients.

How common are rotator cuff tears?
Not every rotator cuff tear causes significant pain or disability. In fact, autopsy studies have shown rotator cuff tears in up to 70 of people over the age of 80 and 30 of the population under the age of 70. Clearly, all of the people with rotator cuff tears are not complaining of painful symptoms. However, in many individuals, a rotator cuff tear can cause significant disability, and prompt diagnosis and treatment can have a profound improvement in symptoms.
Provides immobilization for rotator cuff repairs, capusular shifts, Bankhart repairs, glenohumeral dislocations / subluxation and soft tissue repairs and strains. For use after initial anterior shoulder dislocation or post operatively when external rotation is desired.
Surgery is also considered in patients who have tried conservative treatment, and still have difficulty with their shoulder.

For more information on what factors are used to decide when rotator cuff surgery is necessary:

o When is rotator cuff surgery needed?

There are several surgical procedures that are possible for rotator cuff treatment. The three most common procedures are:

* Open Repair
Prior to the use of the arthroscope, all rotator cuffs were repaired by looking directly at the torn tendon, through an incision about 6-10 centimeters in length. The advantage is the rotator cuff tendons are easily seen by this method, but the incision is large, and the recovery can be longer and more painful.

* Mini-Open Repair
The mini-open method of repairing a rotator cuff involves both the use of an arthroscope, and a short incision to get access to torn tendon. By using the arthroscope, the surgeon can also look into the shoulder joint to clean out any damaged tissue or bone spurs. The incision is about 3-4 cm, and the recovery is somewhat less involved than the open cuff repair.

* Arthroscopic Repair
An arthroscopic repair is done with small incisions, and the repair is done by the surgeon looking through a small camera to watch his or her repair on a television monitor. This is a more recent development in treatment of rotator cuff tears, and not all types of tears can be treated by this method. Some advantages and disadvantages of this procedure are discussed in the article comparing arthroscopic rotator cuff repairs to open methods.

The surgery to perform the rotator cuff repair generally lasts about two hours.

How long is the recovery from rotator cuff repair surgery?
This will depend on several factors, including your level of strength before the operation and the severity of the rotator cuff tear. Some period of immobilization of the shoulder joint is needed to protect the newly placed sutures from being disrupted. After one to two weeks, physical therapy begins. Initially, the therapy is gentle so as not to affect the rotator cuff repair. After four to six weeks, more active lifting with the arm begins. Several months after the rotator cuff repair, physical therapy will become more intense in an effort to strengthen the rotator cuff muscles. Complete recovery usually requires at least four to six months.

Ultra-Sling for Unstressed Wound Healing

Shoulder Pain, Fever, and Chills in a Fifty-Three-Year-Old Man (continued)

Answer: Abscess between the subscapularis and posterior portion of the chest wall.

Multiplanar magnetic resonance images of the area about the right shoulder girdle, including T1-weighted images, STIR (short-tau-inversion-recovery) images, and T1-weighted images with fat saturation following intravenous injection of gadolinium, demonstrated a multiloculated fluid collection between the subscapularis muscle and the posterior portion of the chest wall (Figs. 1 and 2). The rotator cuff muscles, including the subscapularis muscle, demonstrated no abnormalities. The walls of the lesion were thickened and irregular, with multiple septations that were enhanced with the gadolinium. There was moderate surrounding edema. The abscess extended inferiorly from the area anterior to the scapula, along the midaxillary and posterior axillary lines, to the level of the diaphragm. The pleura, hilum, and mediastinum of the lung appeared to be normal. Aspiration of fluid from the lesion was not performed before the operation.
The patient was taken to the operating room for urgent open drainage of the abscess on the evening of admission. After induction of general anesthesia, the patient was placed in the lateral decubitus position on a beanbag. Routine preparation and draping were performed. A curvilinear incision was made over the medial border of the scapula and was extended inferiorly. The inferior border of the trapezius muscle was retracted superiorly to expose the lower half of the medial scapular border. Electrocautery was used to release the rhomboid musculature from the medial scapular edge and to expose the underlying space. Upon entrance into the scapulothoracic space, a massive amount of purulent fluid was immediately encountered. Approximately 500 mL of purulent material was evacuated. Intraoperative gram-staining of the specimen yielded gram-positive cocci in clusters.

Multiple areas of loculation were released by gently sweeping an index finger through the area. A moderate degree of necrotic tissue was found to be forming the septations and lining the edges of the abscess and was removed with a rongeur. The space was then irrigated with pulsatile lavage with use of 9 L of saline solution with cefazolin antibiotic (2 g of cefazolin per 3-L bag). Two large Hemovac drains were placed to evacuate fluid from the scapulothoracic space. The rhomboid musculature was reapproximated to the medial scapular border with absorbable PDS (polydioxanone) monofilament suture. Prolene monofilament suture (Ethicon, Somerville, New Jersey) was used for skin closure. A shoulder sling (DonJoy UltraSling; dj Orthopedics, Vista, California) was used postoperatively, with the arm positioned at the side to allow unstressed wound-healing.