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By Larry Huppin, DPM on 11/29/2010 1:01 PM
A client today asked for a recommendation for a patient with sub 1 and 5 rheumatoid nodules.

First, all orthotic practitioners should be aware that there are several good studies supporting the use of orthotic therapy in patients with RA. You can find some of rheumatoid arthritis articles listed here

Our goal when treating patients with painful sub-metatarsal nodules is to transfer pressure off of the involved metatarsal heads – in this case met heads one and five.

Here is our recommendation:
  • Material: Semi-rigid polypropylene. Other materials, such as firm Plastizote would also work. The material simply must be rigid enough to resist deformation in order to effectively transfer force
By Larry Huppin, DPM on 11/25/2010 8:18 AM
By Cherri Choate, DPM on 11/24/2010
A common confusion on the ProLab prescription form involves the terminology of arch pad, arch fill and cast fill.  Each of these is distinctly different and should be used for distinct patient symptoms.
By Larry Huppin, DPM on 11/22/2010 1:12 PM
Bike ShoeI have a number of patients who develop numbness, tingling and other neuritic symptoms while bicycling. We have been very successful treating these problems with a combination of foot orthoses and shoe changes.

My assumption is that the neuritic symptoms occur for two reasons:
1. Pressure from the axel of the pedal directly under the metatarsal heads leading to inflammation and compression of digital plantar nerves
2. Shoes that are too narrow due to swelling of the feet during longer rides

Our orthosis treatment is focused on reducing pressure under the metatarsal heads. Bicycle shoes, however, do tend to run small relative to running shoes and some orthotic modifications specific for bike shoes are often necessary. Our recommended bicycle shoe orthosis is ...
By Larry Huppin, DPM on 11/18/2010 6:35 AM
We have spent a lot of time in our lectures, articles and on this website discussing orthoses for hallux limitus, in particular functional hallux limitus (FHL). Our goal with these devices is to decompress the first MPJ and enhance hallux dorsiflexion. Some orthotic prescription items we use for this problem include a minimum cast fill, cast inversion and reverse Morton’s extensions. You can read a number of articles and suggestions on orthotic prescriptions for hallux limitus here. 

We have spent less time, however, addressing hallux rigidus and I think it is worth discussing how your orthotic prescription might change in the presen ...
By Cherri Choate, DPM on 11/17/2010
Symptoms related to the pes cavus type foot are often more complicated than the more typical flat foot.  The majority of orthotic and shoe modifications are targeted at the flat foot but with careful consideration of the patient's activities, shoe type and symptoms, orthotics can be a very successful treatment option for the high-arched foot.
By Larry Huppin, DPM on 11/15/2010 2:03 PM
MatrixLast week we discussed carbon fiber AFOs in the treatment of dropfoot. Some studies indicate that in many situations they may be a better choice than traditional plastic AFOs due to the fact that there is evidence that there is greater function of the posterior muscle group with use of the carbon fiber AFOs.

Most carbon fiber AFOs, such as the ProLab Matrix, are prefabricated. This brings up the question of what kind of customization can be done. Below is information on how to customize the matrix AFO.
  • Add a Foot Orthotic: One of the most important advantages of carbon fiber AFOs is the ability to control different planes of motion independently. Much of this abil ...
By Larry Huppin, DPM on 11/11/2010 5:00 AM
MatrixInteresting article this month in Lower Extremity Review on carbon fiber AFOs such as the ProLab Matrix AFO. More and more data is demonstrating the benefit of these devices to treat drop foot in place of traditional plastic AFOs.

The Benefits of Carbon Fiber AFOs
Not only are these AFOs lighter and often more comfortable than traditional AFOs, but they provide energy return at toe-off to help prop ...
By Cherri Choate, DPM on 11/10/2010

As I watched the last seven months of baseball, I often contemplated the issues with the feet of the Giants.  Just as a psychologist can not help themselves from assessing individuals, I can not help assessing the feet of those I am watching, especially when I care so deeply about their welfare. 

By Larry Huppin, DPM on 11/4/2010 8:56 AM
I have a number of patients who are Seattle firefighters. If you also treat firefighters, it is a great benefit for your patients if you become familiar with the boots that they must wear. 

Firefighters must have two pair of work boots. These are station boots, which they wear in the station; and turnout boots, which they wear on runs.

A number of my firefighter patients have trouble with the turnout boots provided by the Seattle Fire Department (SFD). They are rubber boots which are unstable and large. They tell me it’s like having to wear a pair of waders. Those with foot problems who need orthotic devices particularly have trouble with these boots. A study, which I detail below, has demonstated that the leather boots are likely safer than rubber. 
The SFD only allows a boot substitution with a doctor’ ...
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