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By Larry Huppin, DPM on 7/18/2011 12:40 PM
I consulted with a ProLab client this morning who has a patient with bilateral midtarsal joint arthritis. He wanted to know if we had a pathology specific orthosis for that problem.

We do not have a pathology specific orthosis on our prescription form for midtarsal joint arthritis, but we certainly do have some ideas on how this should best be treated. Our goal is fairly simple – we want to limit midtarsal joint motion and in doing so reduce the patient’s pain.

Mechanically, this patient has moderate arch collapse. She also has a heel that is everted by about 8 degrees in stance. This means we are going to try and control the arch, and hopefully try to limit some of the rearfoot eversion. The following is what I recommended.

By Larry Huppin, DPM on 7/14/2011 6:19 AM
My business partner was trained at one of the top surgical residency programs in the country and did not have much experience with orthotic therapy during his residency. He is an exceptional surgeon, but feels strongly that if a more conservative option will allow the patient to reach their goals, then surgery should be a last resort. This tendency toward more conservative treatment whenever possible is a trait that tends to be found in the best and most experienced surgeons. Increasing orthotic therapy skills allows these good surgeons to provide their patients with better care. In the last five years, he has taken a much greater interest in orthotic therapy. He now takes a more evidence-based approach to his orthotic therapy and he is finding that he has much better clinical outcomes. He also has become more adept at adjusting orthotic devices.
By Dianne Mitchell on 7/2/2011 7:20 AM
I perform quite a few orthotic modifications each day in the office. These are on over-the-counter orthotics, poorly controlling custom devices, and minor adjustments to otherwise good devices. Sometimes the modification will really change how the foot functions on the orthotic. 

Patients often prefer that I don't significantly change their device, so I started using adhesive felt (1/8" and 1/4" thickness) to perform modifications and give patients a taste of what needs to be done. This allows me to modify the orthotic but still give the patient the opportunity to remove it (carefully un-peel it) if they can't tolerate it.
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