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By Larry Huppin, DPM on 3/24/2014 3:24 PM
 We have a question from a ProLab client today:   

I have a patient who is 70 yo male with a chronic neuropathic ulcer on the plantar medial 1st MPJ/base of the hallux
Severe HAV/limitus with adult semi-rigid flatfoot

What orthotic would you suggest the adult flat foot with a reverse mortons? I need to get the pressure off the medial MPJ

By Larry Huppin, DPM on 3/17/2014 5:12 PM
I had a ProLab client call today complaining that he had a patient that was feeling that their orthotic device is too hard. He wanted to know if he could possibly make a softer orthotic for this patient. It should be noted that the patient weighs 310 pounds.

Patients who are obese are, of course, putting significant pressure onto their feet and when wearing orthosis there is significant force between the orthosis and the foot. Much more so than on an average weight patient. This means that these patients have more potential to feel the arch of the orthosis as being too high or too hard.
By Larry Huppin, DPM on 3/10/2014 5:08 AM
It is always a challenge to fit orthotic devices in cowboy boots. First of all let me say that since I practice in Seattle, Washington I am not the most experienced practitioner in fitting orthoses into cowboy boots. I am sure my colleagues in Phoenix, Austin, and other parts of the Southwest have much, much more experience using these types of devices. Given that, I have had several patients for whom I have made orthotics for cowboy boots and though I have ended up frustrated several times, I seem to have found a formula that works well.
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