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By Larry Huppin, DPM on 4/28/2011 2:08 PM
We have a question from a ProLab client today:

Hi Larry,

I saw one of my partner's pts on Fri. who has had lateral column foot pain for several mos. She was treated in a CAM boot for 4 mos for a presumed stress fx, however, she has no callus formation on XR and has pain diffusely along the 4th and 5th met shafts as well as base (no cuboid pain and no pain localized to the styloid process). She has minimal STJ eversion and upon standing has ~4 degrees of calc varus b/l. When she walk
By Larry Huppin, DPM on 4/25/2011 9:00 AM
 Podiatry ArenaPodiatry Arena is a forum in which some of the best foot biomechanists in the world participate in online discussions, debates, arguments and occasional virtual wrestling matches on matters pertaining to foot biomechanics and orthotic therapy.   

Over the past few years there have been several threads on Podiatry Arena regarding rearfoot posts.  If you want to learn some of the thoughts behind posts
By Larry Huppin, DPM on 4/21/2011 8:55 AM
 I have had a couple of client calls recently regarding the use of rigid Morton’s extensions. A rigid Morton’s is essentially a continuation of the polypropylene or graphite shell of the orthosis beyond the first metatarsophalangeal joint, extending to the tip of the toe. In cases of hallux rigidus, this rigid Morton’s can act to limit any remaining first metatarsophalangeal joint motion that may be leading to pain.

By Larry Huppin, DPM on 4/18/2011 10:50 AM
  I had a client call today with a question regarding orthoses for a patient with pain under the styloid process and the proximal portion of the fifth metatarsal shaft. This is on one foot only. On examination, there is distinct enlargement of the proximal portion of the fifth metatarsal shaft relative to the contralateral foot. There is also callus formation on the involved foot only.

The goal for treatment of this problem is fairly straightforward. We want the orthosis to act to transfer force off of the 5th metatarsal shaft and onto other portions of the foot, primarily the medial arch.
By Larry Huppin, DPM on 4/14/2011 8:41 AM
 In a recent blog at PodiatryToday.com, Dr. Kevin Kirby reviewed the biomechanics of subtalar arthroresis. He did a thorough review of the literature, and in the blog discusses kinematic and kinetic functions of the subtalar joint, and the biomechanical effects of the subtalar arthroereisis procedure.

We recommend this article to anyone who performs stj arthroresis or deals with patients who have undergone the procedure.
By Larry Huppin, DPM on 4/11/2011 6:59 AM
I had a ProLab client call me today stating that he had made a pair of orthotics for a patient and she was now complaining they were too soft. Ironically, he had made her a softer pair of orthotics of medium density Plastazote because she complained that her previous pair of orthotic devices felt too hard for her. This brings up the question of how to approach a patient who is requesting an orthosis that is softer than you might think is best for her treatment.

Most of the conditions that are commonly treated with orthotic devices respond more effectively to more rigid orthosis. For example, a patient with plantar fasciitis requires some rigidity in the orthosis to prevent collapse of the orthosis, which would allow collapse of the arch and increase tension on the plantar fascia.
By Larry Huppin, DPM on 4/7/2011 6:49 AM
 I have written about this before but it is an important aspect of orthotic therapy, so I wanted to mention it again. I just got off the phone with a ProLab client who called requesting help on writing a prescription for a patient with plantar fasciitis and hallux limitus. We have studies available showing that for both of these pathologies an orthosis that conforms very closely to the arch of the foot is more effective at
  • Decreasing tension on the plantar fascia
  • Decreasing compression in the first metatarsophalangeal joint to help decrease functional hallux limitus symptoms.
To conform close to the arch requires a foot orthosis with a minimum cast fill and also a couple degrees of inversion. You can read more about minimum fill orthotics for plantar fasciitis here and for hallux limitus here.


By Larry Huppin, DPM on 4/6/2011 3:11 PM
Podiatry ArenaPodiatry Arena is a forum in which some of the best foot biomechanists in the world participate in online discussions, debates, arguments and occasional virtual wrestling matches on matters pertaining to foot biomechanics and orthotic therapy.   A new  feature of our blog will be a monthly "best of Podiatry Arena" list of those discussions that we think ProLab clients would find educational, interesting or entertaining.  Sign up for the RSS feed to this blog to ensure you get your updates every month.  Here is what you should be reading from March:   
By Larry Huppin, DPM on 4/4/2011 9:31 AM
I had a ProLab client call me this morning stating that an orthopedist had referred to him an 11 year old girl diagnosed with a talocalcaneal coalition. The request was for a pair of UCBL orthotic devices. Our client had never written a prescription for UCBL and was curious as to the best prescription for such a device and whether that was the best choice for a patient with a tarsal coalition.

Our goal when treating this patient is fairly straightforward. We want to limit subtalar joint motion in order to reduce or eliminate pain. In order to best reduce subtalar joint motion we want to, not only reduce motion directly at the subtalar joint, but eliminate or reduce mid-tarsal joint motion.

A UCBL would be an effective way to control the foot but the disadvantage of UCBL is it does not provide forefoot to rearfoot balancing. By using an orthosis that does balance the forefoot to rearfoot we can more effectively limit midtarsal joint motion
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