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By Larry Huppin, DPM on 11/29/2012 1:02 PM
I just saw a prescription come into ProLab from a new client. The doctor noted on the prescription form that the patient had plantar fasciitis and weighed 280 pounds. Her prescription was for a Featherweight orthosis (a functional orthosis made from medium density EVA). She also ordered a standard cast fill and a standard width.

This prescription had me concerned for several reasons. First, with the patient weighing 280 pounds, this orthosis was not likely to provide much support. This is a fairly flexible device and it will collapse rather quickly under the weight of this patient. Given that, the device would not last very long.
By Larry Huppin, DPM on 11/28/2012 10:33 AM
Setting realistic patient expectations is a critical aspect of orthotic therapy and is often overlooked. You can improve your orthotic compliance, acceptance, and treatment success by educating your patients as to what they can realistically expect from orthotic therapy. For example, doctors should tell patients that orthoses are not a "cure" for plantar fasciitis; they are designed to reduce the tension on the plantar fascia to facilitate healing and reduce the likelihood of recurrence. In this situation, patients need to understand that orthoses are part of an overall treatment plan. This leads nicely into the necessary discusion of shoes (including shoe types that can irritate the condition, shoe fit with orthotics, etc.).
By Dianne Mitchell on 11/26/2012 6:31 AM
I am frequently asked by parents how often to be ready to have new custom orthotics made for their kids. The simple answer, every approx 2 shoe sizes. Also, many of my kids will actually complain that the orthotic really does fit too short or the arch hurts or is pressing on the wrong spot or is even creating irritation on the skin or allowing for their original pain to return. This could be a year later, or as seen in the office frequently, 6-10 months in a growing kid! If possible, I do attempt fitting my growing kids with the pre-fab kiddythotic but foot shape and mechanical control (and pain control) are not always as good as a custom deivce.
By Larry Huppin, DPM on 11/22/2012 9:23 PM
 
By Larry Huppin, DPM on 11/19/2012 9:29 PM
  We have a new webinar available on the website.  This one covers the use of custom and prefabricated orthoses for treatment of calcaneal apophysitis.   ProLab clients can watch the webinar here.

Other webinars available online include:
By Larry Huppin, DPM on 11/15/2012 9:16 AM
QUESTION
Why do you have a 3 degree VALGUS forefoot post when it appears that most people need a 3 to 4 degree varus post? I understand that in open kinetic chain you lock the midtarsal joint by dorsiflexing the 5th ray, but in closed kinetc chain the ray gets dorsiflexed by ground reactive forces, hence it is supposed to lock the midtarsal joint. But when the forefoot is in varus the extra motion to the neutral position causes excess pronation. We learned years ago in school this is stopped by posting the forefoot to its abnormal varus or valgus component. Have I missed a change in biomechanics somewhere along the line? 
By Larry Huppin, DPM on 11/12/2012 9:02 PM
 I recently spoke with a doctor who noted on one of his prescription forms that he wanted an orthosis to "control servere pes planus" and yet prescribed a "narrow" orthosis. By definition, a narrow device is one that is ground lateral to the first met bisection. 

A narrow orthosis has less area against the foot available to apply a supinatory torque medial to the axis of the subtalar joint. Thus, a narrow device is contraindicated in situations where you require control over a very pronated foot (one with a medially deviated subtalar joint axis).
By Larry Huppin, DPM on 11/8/2012 5:03 PM
 This week we had a client send in a pair of old orthotics from another lab along with a pair of casts and ask us to make an orthotic that is “make to match.” This situation always makes us nervous because it is almost always doomed to failure.

It made correctly, functional foot orthoses are designed to decrease stress on tissue that is being overstressed in order to treat pain or other pathologic conditions. In most cases, there is not one exact shape that will do the “best” job at decreasing tension on a particular structure. Your goal when prescribing orthoses should be providing devices that adequately reduce stress on overstressed tissue and are comfortable for the patient. Your goal should not be to match a particular orthotic device.
By Larry Huppin, DPM on 11/1/2012 9:00 AM
Podiatry 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. Here's a "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 October 2012:   
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