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By Dianne Mitchell on 10/28/2013 9:36 AM
I order a fair amount of low profile athletic shoe (cleat/skate) or dress orthotics. A nice shell material option is carboplast. Whereas graphite is stiff and hard, carboplast offers some give, or flexibility, without failing and cracking and is still nice and thin. The lab uses a 2mm (175lbs or less) and 2.6mm (176lbs or more) thick carboplast. My patients are happier with this material and I especially enjoy carboplast more if I need to adjust it in the office. Try it out! The lab is substituting carboplast as the new "graphite" but I write in "carboplast" in the shell material box on the Prolab Prescription form.
By Dianne Mitchell on 10/24/2013 9:28 AM
Patient came in today with a painful metatarsalgia to the central metatarsals 2-3-4. She happened to be wearing her functional foot orthotics which appeared appropriate for her foot shape and type. What can you do in the office to help with pain?

Couple of options:

- add a top cover for padding
- add a forefoot extension of simple poron or soft EVA for paddling beneath the top cover for reinforced padding
- add a metatarsal bar just proximal to the metatarsal heads in order to attempt offloading the painful metatarsal heads

I usually trial these above options in the above order.

I also examine the patient for equinus deformity and start a stretching program.
By Dianne Mitchell on 10/21/2013 9:16 AM
I frequently see patients in the office with under-corrected orthotics. Many of these devices simply do not contour the arch. Instead there is a gap between the arch of the orthotic and the patients arch. One in-office fix is to add arch fill to the device. I use Korex to add height to the top of the orthotic to fill in the gap. Once the gap has been filled in, you can add a fresh top cover.
See the September issue of Podiatry Management for additional in-office tricks!
By Dianne Mitchell on 10/17/2013 9:04 AM
Molded a patient today in the office with two rather different feet. One cavovarus foot with a bunion deformity versus the contra-lateral foot that has a resting calcaneal stance position that is nearly perpendicular (slight eversion) to the ground without a bunion deformity.
When writing the orthotic prescription I like to make sure the lab understands that those two pretty different looking casts are correct and should be different from each other to yield two different orthotic devices. You can let the lab know this information on your prescription form both by writing the diagnoses at the top of the form and also marking the YES box to denote the asymmetry.
By Larry Huppin, DPM on 10/10/2013 6:23 AM
One of our primary missions as a company is to act as a clearing house for our clients in finding the best evidenced based information regarding orthotic therapy for treatment of specific pathologies. That is the primary reason that this website is used so widely as an educational resource for orthotic practitioners.

We have recently completely overhauled and updated the section on this website devoted to evidence-based orthotic therapy for patients with diabetes. This section can be used a guide for any orthotic practitioner to learn the most effective ways to use orthotic therapy to help prevent and treat diabetic-related foot ulcerations.
By Larry Huppin, DPM on 10/3/2013 11:04 AM
  I recently gave a Webinar on the topic of medial pinch callus. In this Webinar, we went into considerable detail on the best orthotic prescription to treat and prevent hallux pinch callus. For complete explanation of how to write the optimum orthotic prescription for this problem, you can watch or listen to the Webinar here. One of the questions that we received after the Webinar was a request to review the most important orthotic additions for treatment of hallux pinch callus. In my opinion, those are the reverse Morton’s extension and the application of a PTFE patch.
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