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By Larry Huppin, DPM on 10/29/2009 10:39 AM
In the coming months and years, we predict that 3-D optical foot scanning will replace plaster casting as the method of choice for capturing foot shape for production of functional foot orthoses. We also predict that there is great potential for laser scanning of the feet to result in better casts and, subsequently, better orthoses.

Digital imaging of the feet will result in better orthoses primarily because plaster is a difficult material to work with. Plaster is slippery, wet, soft, slimy and takes a long time to dry. If not dry, it bends out of shape easily when being removed from the feet. In addition, because it takes a long time to dry, some practitioners have staff take the casts. This usually results in a less than optimal cast. Others resort to using foam boxes, which have been shown in several studies to cause excessive varus to be captured in the cast and, ultimately, the orthoses. In fact, foam box casts tend to produce such poor functional orthoses that
By Cherri Choate, DPM on 10/28/2009
 
     When attempting to control the frontal plane motion/position of the foot, forefoot wedges are probably the most common orthotic modification. The forefoot wedges can be ordered two different ways. The wedge can either be placed on the orthotic plate or distal to the orthotic plate. Although the first option allows for more room in the shoe in the metatarsal head area, the application of the principles of physics, favors the second option. The distance from the rearfoot to the FF extension is much longer than the distance from the rearfoot to the distal plate. Therefore, the moment arm is much more effective with the FF extension because the arm is longer and therefore stronger.  < ...
By Larry Huppin, DPM on 10/26/2009 7:25 AM
Villager™Winter is coming and with it wet, cold and slippery weather.   Do you have patients who require supportive shoes or need to wear prefabricated or custom orthoses, but must wear waterproof boots for work, play or chores? If so, we have a solution for you.

Our solution is to have your patient wear stable shoes and have them purchase a NEOS overshoe. NEOS (New England Overshoe Company) is a line of high-tech overshoes. Essentially, they are high-tech galoshes. They are completely waterproof, go on easily, are lightweight, have great traction and come in many styles for various activities and climates. They fit over almost all shoes and boots. Some patients use a pair of NEO ...
By Larry Huppin, DPM on 10/22/2009 7:07 AM
THIS QUESTION WAS SENT IN BY A PROLAB CLIENT:
I have a patient who, by history, seems to have had a triple done years ago by an orthopedist ...
By Cherri Choate, DPM on 10/21/2009

We seldom spend time discussing the trials of certain patient types or how they deal with having foot problems. In my experience, the patient with the pes cavus foot, requires a bit more effort in the area of education. Most of these patients have adjusted to the quirkiness of their feet. They are modified their shoes and activity, without really knowing why.  As practitioners, it is important to explain the chronic nature of this pathology. Most patients have relatives with the same foot type, so sheddng the light on their unexplainable symptoms, will likely benefit an entire group of people. Most of them are relieved knowling that their pain, difficulty with shoe fit, lateral instability and prominent bones, are secondary to a real foot pathology.

By Larry Huppin, DPM on 10/15/2009 12:07 AM
Dr Cherri Choate wrote in her blog entry last week about research demonstrating that a cushioned topcover can act to reduce shock.  You can read her entry here and you can read our eJournal Club article on the subject here.   

Based on this article, my standard cover for runners is now a 3mm soft EVA cover to the toes with 1.5mm Poron gluded to the bottom of the cover.   This combination not only provided excellent cushion but has been shown to hold up well.& ...
By Cherri Choate, DPM on 10/14/2009

A common problem in our baby boomer population is foot arthritis.  For many years, the orthopedists have been primarily treating knee and hip arhritis, but it seems that we are seeing a growing number of cases of foot arthritis.  Whether the joint destruction is due to previous trauma, general osteoarthritis or over use, it can be disabling and difficult to treat conservatively. 

Stability seems to be the key in these patients.  The components of a device that will increase stability include a wide plate, deep heel cup, minimal fill and semi-rigid plate.  For midfoot arthritis in particular, the use of a sweet spot in conjunction with a medial flange, may offer both comfort and stability at the same time.  There is certainly a balance in each of the patients, but by combining the concepts of off-loading and stabilizing, pain can certainly be diminished and quality of life can be improved.
 

By Larry Huppin, DPM on 10/8/2009 1:20 PM
There are few pathologies that have more literature supporting the use of custom foot orthotic therapy than lateral ankle instability. Unfortunately, orthoses are rarely a first line treatment for this problem.

We recommend every orthotic practitioner read /Dr. Doug Richie's excellent literature review of the subject:
Richie, DH: Effects of foot orthoses on patients with chronic ankle instability. J Am Podiatric Med Assoc 97:19-30, 2007.

The orthotic prescription for this condition is fairly complicated, in that the prescription will vary depending on the foot type. The literature indicates that the lateral ankle instability patient with an overly pronated foot should have an orthosis that resists pronation. We refer you to Dr. Richie's article for an explanation of why this is necessary. For the patient with an excessively supinated foot, however, the literature indicates that the patient sho ...
By Cherri Choate, DPM on 10/7/2009
For many years, I have had coversations with my colleagues regarding the value of the topcover on an orthotic.  Many colleagues never apply topcovers, and other always apply them.  So many variables play into this decision, including cost, shoewear and orthotic appearance.  Most of us use "cushion" type of topcovers to add a shock absorption component to the device. 

An article published in 2008 in JAPMA presents evidence that cushioned topcovers alone, in runners,  reduced the mean vertical ground reactive force peak, the loading rate and the peak tibial acceleration.  My cliical application of this information is the use of a topcover.  This study reinforces the premise that topcovers made of shock-absorbing material do indeed decrease vertical forces. It certainly supports using a cushioned topcover in orthotics where the user will be involved in impact type of activities.
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By Larry Huppin, DPM on 10/1/2009 6:56 PM
We just arrived in Atlanta for the annual International Conference on Foot Biomechanics and Orthotic Therapy.  This should be an excellent program focusing on practical applications of orthotic therapy.   In the coming weeks I'll use this space to provide you with pearls we learn this weekend.   Start thinking now about attending the conference next year - as soon as I learn the dates and location it will be posted here.  

In the meantime, I highly recommend that every podiatrist with an interest in orthotic therapy read the September 2009 issue of Podiatry Management.   This issue is devoted to orthotic therapy.   I haven't seen the articles up on the Podiatry Management website yet, but as soon as they are up we'll lin ...
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