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By Larry Huppin, DPM on 12/19/2011 7:22 AM
  These pictures show the feet,shoe and orthoses of a longtime patient of mine. He is 77-year-old who has severe cavus feet bilateral, and on the right suffered a tibia and fibula fracture many years ago which left him with a severely inverted right rearfoot. This led to multiple recurrent sprains of the right ankle.

When I first saw him a couple of years ago, we discussed a number of treatment options including the use of an AFO. He had already tried an AFO and found that they were uncomfortable because of the prominence of his lateral malleolus. It was very difficult to find one that would support him and would not irritate the malleolus.
By Dianne Mitchell on 12/16/2011 9:45 PM
I saw a new patient in the office today with foot pain. He brought in his orthotics from another provider and wanted to know why they weren't helping him. On orthotic evaluation, these are rigid poly shell devices with cork postings 0/0, and no topcovers. They contour the patient's arch wonderfully and control his hindfoot position well. The patient has a pretty neutral resting calcaneal stance position with mild pronation through the midtarsal joint. His main pain is to the ball of the foot. He has full ankle joint range of motion with no equinus, no skin lesions/calluses. On palpation of the forefoot the 3rd metatarsal head is sitting below the plane of the neighboring metatarsals, which was where the pain/soreness was. This was a b/l finding with no h/o injury.

By Larry Huppin, DPM on 12/15/2011 9:47 AM
The November issue of Lower Extremity Review has an article on Evidence-Based Orthotic Management of PTTD. We are recommending this article to all ProLab clients.

The article states that, in general, studies support the use of orthotic devices for patients with PTTD, especially in the early stages. Orthoses appear to improve foot and ankle alignment, clinical symptoms, and functional outcomes in PTTD patients with success rates up to 90%.
By Larry Huppin, DPM on 12/8/2011 12:56 PM
I had a patient come into our clinic last week who was experiencing plantar fasciitis. Along with that, she has a long history of knee and hip pain. She has had the diagnosis of some mild osteoarthritis affecting the medial knee.

We did discuss the use of custom orthotic devices to treat her problem, but I am always concerned on whether orthoses will be tolerated by those patients with a history of knee, hip, and back pain. Certainly, in many situations, orthotic devices can help these symptoms but they also can make those symptoms worse.

We discussed the options including potential risks and complications and decided that it would be a good idea to try a pair of prefabricated orthosis before proceeding with custom orthotic devices. This would give us a chance to evaluate how her proximal joint pain might be affected by using an orthotic device before investing in custom orthosis.
By Larry Huppin, DPM on 12/5/2011 3:46 PM
There is a direct relationship between prescribing inversion in your orthotics and the width that you should be prescribing.

Inversion of your orthoses is one of the more common, and effective, modifications that you can make for several of the most common pathologies treated with orthotic devices. Inverting an orthosis offers several advantages in treating the following pathologies.

Metatarsalgia: An inverted orthotic has a higher arch. An orthosis with the higher arch is more effective in transferring pressure from the ball of the foot to the medial arch.
By Dianne Mitchell on 12/1/2011 9:21 PM
Last month was the first (of hopefully many to come) Learning in the Vineyards seminar, co-sponsored by Prolab orthotics and Western University College of Podiatric Medicine. It featured numerous well-known podiatrists including Paul Scherer, Douglas Richie and Thomas Chang. The keynote speaker Peter Cavanagh, a PhD biomechanist.
The three day seminar started with a pair of interactive workshops including 3D digital scanners for custom orthotics and how custom orthotics are made, including a tour of the Prolab facility where attendees got to see where and how custom orthotics are fabricated from the molds podiatrists send in!
The next two days were full of lectures geared at both non surgical and surgical treatment of patients, and the biomechanical effects of that treatment. Also, additional workshops concerning shoes and orthotic modifications were given.
With the seminar located in Napa,
By Dianne Mitchell on 12/1/2011 7:44 PM
I saw a patient in the office today for an orthotic consult. He has pes plano valgus feet and callusing to the plantar medial midfoot where the navicular bone is touching the ground. He brought in a pair of orthotics stating he hates them and they aren't helping. These are very flat, poly shell devices, without posting and no padding or accommodations built in. In stance he pronates over the medial sides of the devices, and without any posting the device tips over to the side with him.

While he clearly needs a new orthotic fabricated, what can you do in the office to this device for pain management?

You can mark the calluses with lipstick or a dab of iodine solution and have the patient stand on the device to mark the callus location on the plastic. Next, outline that area with a sharpie marker so you don't lose it. I glue poron 1/4" to the orthotic shell (and out to the toes) and cut out the area of the sharpie outline.
By Larry Huppin, DPM on 12/1/2011 8:02 AM
 I saw a patient this morning who presented with significant pain affecting the right foot, particularly in the area of the first metatarsophalangeal joint. Fourteen months ago, she had surgery to correct a bunion. It appears that she likely had a head procedure. She developed a nonunion, and then six months ago had a second procedure; a plate was added. She was nonweightbearing for a number of weeks and used a bone stimulator. The nonunion seems to have healed, but she is still having significant pain. She has been using Rocker soled shoes and she did receive a pair of orthotic devices.

She has continued to have significant pain affecting the right foot particularly in the area in the first MPJ and along the first metatarsal shaft.
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