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By Dianne Mitchell on 10/25/2011 7:57 PM
I'd like to direct folks to the October issue of Podiatry Management. Dr. Blake wrote a great article, "A Podiatrist's Guide to Shoe and Shoe Insert Modifications", with 25 modifications you can perform in the office on orthotics or shoes. I preface this blog by stating you should probably practice some of these modifications on old shoes before trying them on your patients!
By Larry Huppin, DPM on 10/24/2011 6:21 PM
I did a consult this morning with a ProLab client who has a patient who had a Keller bunionectomy several years ago and now is feeling unstable and developed arch pain on that foot.

The biomechanical examination showed that she had a fairly rectus heel in stance and possibly was even a little bit inverted. She did not have hallux purchase and there was no significant contact of the remaining first metatarsal with the ground.

Our goal with this orthotic is to provide stability, improve hallux purchase, and decrease tension on the plantar fascia. Below is the orthotic prescription we recommended.
By Larry Huppin, DPM on 10/20/2011 7:52 AM
I had a ProLab client call me today with a question regarding orthotics for a patient who has mild to moderate hallux limitus pain while cross-country skiing. In a previous blog, I had written about orthotics for downhill ski boots, and you can read that here. Cross-Country is a significantly different sport, however, primarily because of the need for motion at the metatarsophalangeal joints in some (but not all) boots.

Cross-Country Ski boots can be somewhat narrow in the heel. This means we have to limit the size of the orthotic in the heel. In addition, heel control is not particularly important while cross-country skiing.
By Larry Huppin, DPM on 10/17/2011 1:39 PM
The September 20, 2011 issue of Podiatry Management magazine has an entire section devoted to orthotic therapy. There are several articles I think would be beneficial for ProLab clients to read. One of those is Paul Kesselman’s update to orthotic billing for 2011. He notes that there are four important issues that have occurred in orthotic therapy billing in the last year.
By Larry Huppin, DPM on 10/13/2011 1:32 PM
In my blog on September 29th, I talked about using an extended footplate on a dorsiflexion assist AFO to provide digital support.

This patient returned a couple days after we dispensed this stating that the AFO was working great. It was comfortable except for the fact that she was having too much compression on top of her toes from the shoe. Essentially the footplate was taking up room in the toe box leaving less room for her toes.
By Larry Huppin, DPM on 10/10/2011 1:25 PM
I just spoke to a ProLab client this morning who had a patient return to clinic after wearing her orthoses for a few weeks. She was overall very happy with the function of the devices, but on the right foot she was getting some lateral heel irritation and callus formation. The doctor called asking what he could do to fix this situation.

There are several reasons this can occur. The first is that the heel cup is too simply narrow for the patient’s heel. The only way to determine this is to place the patient on the orthosis in stance and see if the heel cup is too narrow, and the soft tissue of the heel is riding over the edge of the orthosis
By Larry Huppin, DPM on 10/6/2011 10:05 AM
If you have a patient with a prominent plantar fascia, you always have to worry that the orthotic shell may irritate the plantar fascia. This is a fairly common cause of arch pain in a patient wearing orthosis.

II do not generally prescribe plantar fascial grooves within my orthoses since it is very easy to add a PFG to an orthosis that has already been made. The easiest way to do this is to put lipstick on the plantar fascia, hold the orthosis up
By Dianne Mitchell on 10/5/2011 7:33 PM
I just received my September issue of Podiatry Management and the cover reads, "Is podiatry turning away from biomechanics?" I found it interesting that this question was being asked.
I have definitely felt this way and asked myself this question ever since interviewing for residency. I went into podiatry for multiple reasons, but one big reason was that I could use my undergrad biomechanics training. When interviewing for residency positions, I was repeatedly asked why I was interviewing for surgical programs if I was "only interested in biomechanics?"
Biomechanics of the foot/ankle should be reviewed in all surgical planning. More importantly, conservative modalities should be exhausted before any elective surgical patients enter the operating room. This article addresses conservative biomechanical options. These modalities tend to be quite successful in my hands, I am able to avoid surgery for patients who initially thought that surgery was the
By Larry Huppin, DPM on 10/3/2011 10:01 AM
I had a recent question from a client regarding the best orthotic prescription for a patient with a tendency toward hallux ulceration.

Obviously, our primary goal is to reduce pressure on the hallux. We can accomplish that in several ways. The most important aspect of building an orthosis that will act to reduce pressure on the hallux is to ensure that you treat any functional hallux limitus that is occurring. If there is not adequate motion occurring at the first MPJ during gait, pressure increases under the hallux. When writing the orthotic prescription, the first thing you want to check is whether or not there is available first MPJ motion nonweightbearing. If so, you are going to design an orthotic to treat the functional hallux limitus. This would include a device that is taken
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