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The New York University Lower Limb Orthotics manual will be familiar to many more experienced orthotists who may have used the manual as a foundation text during their training. In the chapter on the “Orthotic Fit and Alignment”, the manual shows very clearly the shear stresses which will result if an orthotic axis is not aligned with the anatomical axis of rotation. In a paper in the October issue of POI, Kobara and colleagues (2015) examine the effect on shear stresses between the buttocks and seat of more closely aligning the chair back axis of a reclining wheelchair with the hip axis. The paper includes a useful review on the genesis of decubitis ulcers and the results have implications for reduction of ulceration in wheelchair users.

We know from considerable experience and supporting research that a longer residual limb improves the chance of a successful prosthetic fitting. A case study by Savage and Munjal, also published in the October issue, describes a patient with a very short tibial remnant as a result of traumatic amputation. The patient rejected his initial prosthesis because of knee and residual limb pain. He subsequently underwent residual limb lengthening using an Ilizarov frame and was eventually fitted successfully. The paper describes the lengthy surgical and rehabilitation process and the important collaboration between members of the rehabilitation team in dealing with this complex procedure.

In elderly women, osteoporosis of the spine can result in severe spinal curvature which, in rare cases, causes painful and debilitating impingement of the lower ribs on the crest of the ilium. A case series reported by Brubaker and Sinaki recently published in OnlineFirst shows that a weighted kypho-orthosis resulted in immediate reduction in pain for all 38 patients treated. In combination with a back extensor strengthening program, all patients who returned for follow-up reported continued improvement. It is interesting that this orthosis provides a corrective moment through application of an eccentric load rather than by applying a more traditional three-point bracing system.

These articles are available for free access on the Prosthetics and Orthotics International website.

Tim Bach