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By Larry Huppin, DPM on 1/14/2013 3:10 PM
QUESTION

Dave is a 73 year old male. His primary complaint is mild pain in his left foot over the 2nd-4th metatarsal heads. He has bilateral heel spurs (about 6mm each) that are currently asymptomatic after corticosteroid injections and custom orthotics about a year ago. He also has a bilateral very prominent base of the 5th metatarsal with significant callus formation bilaterally, greater on the right, that seem to be getting larger with time, but are asymptomatic; the prominence is quite visible laterally but also INFERIORLY in a plantar direction (to a lesser extent than laterally).

By Larry Huppin, DPM on 1/13/2013 9:18 AM
  In November, I gave a webinar on using orthotic devices to treat plantar fasciitis. ProLab clients can watch that webinar here. After the webinar there were a number of questions. One of those was from a podiatrist who stated that he prescribed prefabricated orthotics for feedback on whether orthotic therapy was likely to function for a particular patient. He wants to know how long a period of time that I would let my patients use prefabs to find out if custom devices will likely work.
By Larry Huppin, DPM on 1/7/2013 9:26 AM
 I had a patient come in today for dispensing of new orthotic devices. He had worn orthoses for years and was starting to get a return of his plantar fasciitis symptoms and so a new pair was made. I did not made the previous pair for him.

The older orthoses were gapping quite significantly from his arch and were also about a centimeter narrower than his foot. The new devices were the full width of his foot and were made with a minimum fill with 2 degrees of inversion. This resulted in orthoses that conformed very closely to the arch of the foot. In addition, when I took the cast of the foot the first ray was plantarflexed to the end of its range of motion which enhances arch height. 
By Larry Huppin, DPM on 1/6/2013 9:11 AM
  I use a lot of prefabricated orthosis in my practice. They are usually my first line treatment for a majority of the mechanical conditions I treat including plantar fasciitis, hallux limitus, and metatarsalgia. My go-to device is the ProLab P3 prefabricated orthosis. It is only prefab in the market that incorporates valgus forefoot correction and a medial heel skive along with a rearfoot post and deep heel cup. These are the same modifications I would prescribe when treating these most common problems that are treated with orthotic devices. For more detail and references on why these features are important, you can go to the following pages for information on these specific pathologies: 
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