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By Larry Huppin, DPM on 7/28/2010 1:32 PM
When you prescribe a custom foot orthosis, do you always know what you are getting from your lab?

Not long ago it was clear that if you ordered a custom orthosis you were getting a truly custom orthosis. You sent in a plaster cast and the lab made a plaster positive cast, modified it as prescribed and then heat molded a material to create an orthosis on top of that cast. The resulting orthosis was clearly custom made for a specific patient.

Orthotic fabrication has changed dramatically over the past two decades. More likely than not, a plaster positive will no longer be produced when you send a negative cast to your orthotic lab. Instead, the corrections that were previously performed to create a plaster positive are now done on a CAD / CAM computer system. The same corrections can be performed on the computer as were done in plaster and then a positive cast can be milled on which the orthosis is produced; or the orthosis can be milled directly. This tec ...
By Cherri Choate, DPM on 7/28/2010

Many practitioners develop habits of prescription writing for orthotics.  All of us have favorite, and not-so-favorite, additions to our devices.  As we treat more patients, and write more prescriptions, we tend to develop patterns. Although experience is invaluable, one pitfall that can occur is relying on the familiar.  As the process of orthotic and brace fabrication develops, new technologies, materials and device options will become available.  Compared to when I attended podiatry school, the options on any orthotic prescription form have increased by double.  The medial skive, Blake Inversion, Reverse Morton's Extension and no lateral bevel options are fairly recent additions to most prescription forms.  As the world becomes a smaller place, the options for material choice will only expand.  As more research produces evidence, the orthotic/bracing world will continue to grow and improve.

To stay f ...

By Larry Huppin, DPM on 7/22/2010 1:49 PM
Aetrex has a new line of sandals called "Sandalistas". These are attractive and stable sandals with a removable insole. This insole is the perfect size to allow the shoe to accept a custom orthosis. I usually use the following prescription for an orthosis to fit in the Sandalistas.
  • Direct milled poly semi rigid
  • Standard heel cup
  • Standard width
  • Soft EVA black cover to toes
  • Firm EVA forefoot extension to toes
This Rx works well with most of the Sandalistas. If you send the sandal along with the prescription form, we can e ...
By Cherri Choate, DPM on 7/21/2010

Plantar fibromas are common findings in the foot.  Although these benign soft tissue masses are often not overly painful, they are usually sensitive.  What types of accommodations can be done within an orthotic for these small masses?  I would say, there are three different ways to address plantar fibromas:
     1)  Off-load area
              This can be accomplished by either a sweet spot or a modified sweet spot.  A typical sweet spot is an indentation in the plate that is filled with a softer material such as Poron.  A modified sweet spot would be the same indentation, but it would not be filled with Poron.  If a modified sweet spot is ordered, it should be explained to the lab so they make the &q ...

By Cherri Choate, DPM on 7/14/2010

 A 68 year old patient presents with midfoot pain.  He denies any history of trauma and wants to remain active. What is his diagnosis and what type of orthotic device would improve his pain?

By Larry Huppin, DPM on 7/12/2010 4:49 PM
I had a patient last week who was looking for a stable slip-resistant shoe to wear at his restaurant job. That got me doing a little research on stable slip-resistant shoes so I thought I would share the info here.

Many people have jobs where slip-resistant shoes are required and/or beneficial. These include nurse shoes, hospital shoes, chef shoes, and restaurant shoes. I looked for slip resistant shoes with orthopedic superior support, a removable insole, and durable leather uppers. I also found some slip resistant extra depth shoes.

What to tell your patients about slip resistant work shoes:
  • ANSI Standards: For many work situations, shoes must be ANSI certified as slip-resistant. The shoes below fit those standards. In most cases, the words “Slip Resistant” will be foun ...
By Cherri Choate, DPM on 7/7/2010
Gait analysis and evaluation are skills used by both clinicians and researchers alike.  The  response of both the  Center of Mass and the Center of Pressure are important to consider when determining a patients diagosis, as well as when determining the best biomechanical treatment options.
By Larry Huppin, DPM on 7/1/2010 7:04 AM
A couple weeks ago I wrote on Realistic Expectations for Dress Shoes – talking about what are realistic expactations regarding orthoses for women’s dress shoes. I received some questions regarding specific shoe brands that I recommend. Some are listed below. Keep in mind, that, for the most part, there are several models from each brand that work well with orthoses. The key is that your patient take their orthoses with them when they are trying on shoes.

For “business dress” shoes for women I often recommend:
Aravon, Ariat, Theresia, Munro, Stonefly, Sofft, Softspots, Aetrex, Cole-Haan, Softwalk, Indigo by Clarks, and Trotters. Look for any closed heel shoe that will accept the orthosis.

For these shoes with a heel less than 3” I usually use a graphite or ...
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