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By Dianne Mitchell on 11/27/2014 9:27 AM
Happy Thanksgiving!
By Dianne Mitchell on 11/12/2014 9:21 AM
A patient presents to the office with a painful 1st MTPJ. On exam you discover a functional hallux limitus and sub-hallux base callusing. Orthotic considerations:
a. Goal of the orthotic: increase 1st mtpj rom
b. Plantarflexing the 1st metatarsal will raise the 1st MTPJ axis of rotation and therefore decrease or eliminate the functional limitus finding. So, casting this foot in STJ neutral with the 1st metatarsal plantarflexed is essential.
c. Couple this casting technique with a semi-rigid polypropylene shell that is wide with a deep heel cup and flat rearfoot post with minimal arch fill to allow continued 1st metatarsal plantarflexion and stability.
d. Additionally, medial skiving and / or inverting the device will decrease medial column load and further plantarflex the 1st metatarsal to un-jam the 1st MTPJ
e. Finally, if this isn’t enough, or if you are troubleshooting on another providers pair of functional foot orthotics, consider adding a Revers ...
By Dianne Mitchell on 11/5/2014 9:20 AM
Periodically I will see patients in the office who enjoy their orthotics in their higher volume athletic shoes, but report that their heels pop out of the shoes, or they sit too high and their heels rub the “wrong spot” on the heel counter, in lower volume shoes. What can you do to lower the heel position in the shoe? Using your grinding wheel, remove the rearfoot post and proceed to grind the shell of the orthotic as thin as possible without creating a hole. This drops the heel down in the shoe several millimeters to stop the patient from popping out. Note: you must keep the orthotic in a balanced position and not invert or evert the device during this process!
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