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By Cherri Choate, DPM on 3/30/2011
Here are some basic tips on sizing the Prolab Kiddythotics:
  
By Larry Huppin, DPM on 3/28/2011 6:34 AM
I had a client call today with a question regarding an orthotic prescription for a patient with functional hallux limitus affecting one foot and a rather severe hallux rigidus affecting the other. The right foot had less than 5 degrees of dorsiflexion available at the first MPJ, while the left had full range of motion and just a little dorsal exostosis.

The orthotic for the foot with hallux limitus is fairly straightforward. In this situation, we want to design the device to enhance motion in the first MPJ and decrease compression within that joint. You can read more about orthoses for hallux limitus here.

The orthosis for hallux rigidus is a little more complicated. In the presence of hallux rigidus, some patients will feel better if we use the orthosis to dec
By Larry Huppin, DPM on 3/24/2011 1:06 PM
Proper casting position is critical when you are prescribing a Functional AFO (FAFO). Recently we have been seeing a number of FAFO casts coming in with excessive plantarflexion. These casts are unusable and we have to ask the doctor to redo the cast.  This, of course, is inconvenient for you and your patient. 

For best function and comfort, the hinges of a FAFO must be placed so that they are directly over the distal tip of each malleolus. This ensures that the brace moves naturally with the ankle joint and dramatically reduces the possibility that a patient will experience malleolar irritation.

If a cast for a FAFO is taken with the foot plantarflexed to the leg, the hinge ...
By Cherri Choate, DPM on 3/23/2011

It is common for practitioners to make adjustments to insoles or orthotics.  Once these in-office adjustments are made, the ideal would be to convert these to long term modifications on the orthotics themselves.  Translating what was done, to what the lab needs to do, can be challenging, but here are a few suggestions:
 

By Larry Huppin, DPM on 3/21/2011 8:33 AM
A client sent in this question yesterday. My answers are in italics.

I have a patient who is a postal worker and has a chronic sub 4th metatarsal head nucleated callus. He has cavus foot type, fat pad atrophy and supinates when walking. How successful are custom orthotics with a metatarsal bar in treating this condition. Would you recommended any other modifications like a poron pad under the 4th MPJ?

A number of studies have shown that, if prescribed correctly, orthotics are very effective at reducing pressure under the metatarsal heads. Most studies show that orthoses that conform very close to the arch of the foot are most effective at reducing pressure. This would require a minimum cast fill and about 2 degrees of inversion. Metatarsal pads have also been shown to further reduce metatarsal head pressure. A study by Mueller showed that the met pad works best when the thickest portion is about 1 cm proximal to the point of maximum pain. We hav
By Larry Huppin, DPM on 3/17/2011 2:10 PM
 Proper casting position is critical when you are prescribing a gauntlet AFO. Today we want to focus on the error we see most often – that is excessive plantarflexion at the ankle in the negative cast. It’s absolutely critical that the cast be taken with the foot at 90 degrees to the leg. In fact, if the foot is plantarflexed to the leg in the cast, then the cast in unusable.

Having the ankle plantarflexed excessively is the casting error we see most often because it is so easy for it to happen. When taking a cast for a gauntlet AFO your patient will be in a sitting position with the thigh parallel to the floor, the leg at 90 degrees to the thigh and the foot at 90 degrees to the leg. If the foot simply slides forward a few millimeters during casting, then the resultant cast will have the foot plantarflexed to the leg. If we receive this cast at the lab we have no choice but to throw it away and ask you to start over. This is inconvenien
By Cherri Choate, DPM on 3/16/2011

Shin splints is a common injury among atheletes.  More recently, the correct term for this condition is "Medial Tibial Stress Syndrome" and new research has shown important connections to training practices and foot pathology.

By Larry Huppin, DPM on 3/14/2011 12:36 PM
 Medial Tibial Stress Syndrome  (MTSS) is a condition seen in runners and is fairly rare in non-runners. Here is a quick overview of the pathology with some orthotic prescription recommendations for a device to be worn in running shoes.

Known commonly as tibial stress syndrome, tibial fasciitis, shin splints and soleus syndrome, MTSS is characterized by pain / tenderness distal aspect of medial border of the tibia.

Anatomical Etiologies
  • Contrary to common assumptions, posterior tibialis is not likely involved; it has a more lateral tibial origin
  • Likely anatomic etiology is the fascial insertion of the medial soleus
  • Oth ...
By Cherri Choate, DPM on 3/9/2011
The role of physical therapy in the management of musculoskeletal issues can not be over stated.  The best long term patient outcomes, independent of area of interest, are the result of team management.  Physical therapists are an vital part of the team.
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