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By Larry Huppin, DPM on 5/19/2014 3:34 PM
  I just spoke to a ProLab client who has a patient with large fibromas and he wants to be able to accommodate for those. We were trying to decide whether he would have us add the accommodation at the lab or whether he would make the accommodation himself. He does have a full lab at his office and it is easy for him to do his own accommodations.
By Larry Huppin, DPM on 5/12/2014 3:32 PM
  I spoke to a ProLab client this morning who is considering getting a ProLab foot scanner in order to replace plaster casting in his office. He was concerned, however, because he sees a lot of diabetic patients and tends to do a lot of accommodative orthoses and he is wondering if the scanner was appropriate for that. Before we answer these questions, I think we have to first define accommodative and functional orthotics.

A functional orthotic is one where the forefoot has been balanced to the rearfoot. This is the most basic of definitions. In general, the cast that is used for this type of foot
By Larry Huppin, DPM on 5/5/2014 4:38 PM
  A patient came in to pick up her orthotic devices this morning. She has worn orthotics for years for several pathologies but what we were addressing primarily today was pain secondary to digital contracture. She is starting to get more pain at the distal aspect of her toes secondary to hammertoes and pressure on the distal aspect of the digits. In the past, she has found that shoes that have a crest in them tend to work well for her. In particular, she has found that the crest in Birkenstock sandals help keep her toes straight and decrease her symptoms. Because that has been effective, we wanted to add a crest pad to her orthotic devices.
By Larry Huppin, DPM on 4/21/2014 9:26 AM
We had this question come in from a ProLab client today: 

QUESTION:
I have a question regarding a prescription for the patient. She has b/l bunions with pain sub second. If she likes these orthotics I will be ordering another pair for her. The first pair she wants to fit into flats for work. Do you have any suggestions for sub second pain that would fit into flats?
By Larry Huppin, DPM on 4/14/2014 9:01 AM
We had a question come in today from a ProLab client who recently started using the ProLab 3D Digital Foot Scanner.   Here is his question and my answer:   

QUESTION:
This scanner is fun to use. With regard to the orthotics - any suggestions for him?  I performed a 1st metatarsal phalangeal joint fusion on the right. I was thinking a proaerobic with a mortons extension.

Also I never had such an interest in orthoses as I do now since I have been using the scanner. Just wanted to see if you had any suggestions on good literature on orthoses.

Thanks again for all your help
By Larry Huppin, DPM on 4/7/2014 6:06 AM
We will often have ProLab clients ask us to accommodate for prominent fifth metatarsal base. Rarely, however, do they indicate on the prescription form whether the styloid process is prominent laterally or plantarly. There is a distinct difference in how we would accommodate for these two. If the styloid is prominent plantarly then we would recommend using a sweet spot. If it is prominent laterally then we would recommend adding extra lateral extension at the base of the fifth metatarsal
By Larry Huppin, DPM on 3/31/2014 5:53 AM
A ProLab client contacted us today with a question regarding how to best prescribe an orthosis to treat an 11-year-old child with bilateral apophysitis affecting the base of the fifth metatarsal.

In general, this is fairly straight forward problem in that we have a primary goal of decreasing tension on the peroneal brevis in order to decrease tension on the apophysis at the styloid p
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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