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By Larry Huppin, DPM on 7/30/2009 1:16 PM
A client called today with a question regarding a patient who is experiencing painful callus on the lateral heel secondary to wearing her orthoses.  The orthoses are otherwise working well.

There are three reasons that patients may develop lateral heel edge callus from orthotics.  To correct this problem you must first diagnose which of these is causing the issue.

Cause #1Orthotic heel cup is simply too narrow for the foot. 
Diagnosis:  Place the pateint on the orthosis. Center the patient's heel in the heel cup.   If the lateral edge of the heel cup is placing excessvie pressure on the heel, then the heel cup is simply too narrow
Correction:  You can try lowering the heel cup, but it is likely that this device will have to be remade ...
By Cherri Choate, DPM on 7/29/2009

This week, I had a discussion with a colleague regarding the question of:   Reverse Morton's Extension vs. a Morton's Extension for Hallux Limitus.  As a rule when someone is having 1st MPJ pain and I observe limited 1st MPJ motion, I always start with an orthotic with a Reverse Morton's Extension.  In addition to this, I recommend a stiff-soled, rocker type shoe.   In my clinical experience at least 29 out of 30 patients do well with this combination.  In my experience, if this combination makes the patient worse, then I need to consider a Morton's Extension.  On the few occasions when I have fabricated an orthotic with a

By Larry Huppin, DPM on 7/27/2009 12:46 PM
If you do any orthotic adjustments in your office you know how difficult it is to remove old topcovers and modifications. More important, if you are using chemicals such as acetone to remove the glues, it can be dangerous.

You should be aware of a product call “De-Solv-It.” De-Solv-It is completely safe solvent that makes it easy to remove glue and glued items from your orthoses. It is a combination of citrus oil, aloe and lanolin and works great. I use it to remove covers that have even been glued with barge. De-Solv-It is available at many hardware stores. I recommend the professional strength, but both types work great. Learn more or order online here.

For ...
By Larry Huppin, DPM on 7/23/2009 1:46 PM
I had a patient present yesterday with complaint of a 10 year history of right-only lateral knee pain when running. Pain would occur on every run after 20 - 30 minutes. He never went more than 30 minutes without pain occurring. Biomechanical exam and knee exam were both normal except for a slightly under-pronated foot (RCSP was slightly inverted) He has had a complete work-up of the knee by an orthopedist and exam was normal.
By Cherri Choate, DPM on 7/22/2009

One of the most important goals at a foot orthotic laboratory is the desire to produce precise modifications to a foot orthotic prescription.  Unfortunately,  as podiatric practitioners we tend to supply the lab qualitative data, instead of precise quantitative data. In the production of custom and pre-fabricated foot orthotics and braces, quantitative values are vital pieces of information. 

For example, when ordering sweet spots for plantar fibromas, it would be beneficial to send accurate measurements of each lesion (mm or in.), as well as drawings of each lesion on the negative cast.  The measurements also provide another 3-D image as they give a visual of the true depth, width and length of the problem lesion on the foot.    Even something as simple as an accurate value for the width of a metatarsal head aperture, would likely result in fewer adjustments.  &# ...

By Larry Huppin, DPM on 7/20/2009 2:15 PM

Several studies advocate the use of laterally wedged foot orthoses for patients with medial knee OA.   The pathomechanics behind the function is to reduce the knee adduction moment and decrease load through the medial compartment. Lateral wedged insoles can reduce this moment.  Foot orthoses with lateral wedges have been shown to be more effective than lateral wedges alone.  This is likely due to the fact that the orthoses reduce STJ pronation and subsequent internal rotation of the tibia.  In addition, the orthoses help prevent collapse of the midtarsal joint that would otherwise likely occur with the use of lateral wedging.  

A pathology specific orthosis prescription for medial knee DJD would be as follows:

By Larry Huppin, DPM on 7/16/2009 11:34 AM
The lateral heel skive is a positive cast modification technique that is very similar to the medial heel skive, first described by Kevin Kirby, DPM in 1991. The lateral heel skive, also introduced to the profession by Dr. Kirby, works on the same principle of shifting the force that the heel cup of the orthosis applies to heel of the foot.

While the medial heel skive creates a varus heel wedge in the heel cup, the lateral heel skive creates a valgus wedge. It is created by shaving plaster from the lateral-plantar aspect of the heel of the positive cast. This valgus wedge creates a pronatory moment around the STJ axis and is used to treat symptoms caused by excessive supination. These may include peroneal tendonitis, lateral ankle instability and medial knee osteoarthritis.
The lateral heel skive is often com ...
By Cherri Choate, DPM on 7/15/2009
How do any of us find time to keep up with reading medical publications?  I have certainly carried around my fair share of guilt everytime I look at the stack of journals on my desk.  Recently, the consultant group here at ProLab has tried to address this situaiton.  Last year, we started a bi-weekly review of recently published biomechanics articles.  This first year has been focused on key articles that define our choices for our Pathology Specific Orthoses.  We all understand how little time is available, so it is hopeful that this new E-Journal presentation will leave you feeling better informed, and hopefully, less guilty. 

The reviews only take a few minutes to read!

Just click on E-Journal Club at the top of the website screen to sign up.& ...
By Paul Scherer, DPM on 7/14/2009 10:20 AM
Last week’s E-Journal Club reviewed a study demonstrating that symptomatic hallux limitus (less than 10° of dorsiflexion but greater than 0°) responds positively to conservative care. In fact, functional orthoses alone successfully treated 47% of all the patients in the study (with minimum one year follow-up). In this era of evidence-based medicine, this study provides direction and documentation for your orthotic therapy treatment before considering surgical care with these patients. Our Pathology Specific Orthoses for hallux limitus incorporate evidence from many studies to provide a simple starting point for your orthotic treatment. ProLab clients can contact one of our Medi ...
By Larry Huppin, DPM on 7/13/2009 5:00 PM
Last week I wrote about the importance of all orthotic practitioners having a grinder in their office in order to adjust orthoses.

I found the post below on a forum about heel pain.  It's a great example of what patients think when you can't adjust orthotics yourself.   Orthotic adjustments will likely be a recurring theme in this blog - if you are not able to adjust your own orthoses, you severely limit your abiliy to have a successful orthotic practice.  

Hello everyone,
I'm checking back in after receiving great advice from you all two weeks ago. Quick update, because my custom orthotics($400 kind) were still extremely uncomfortable after 4 weeks ...... I still feel like I have two golf balls shoved up under my arches. I also made an appointment with the podiatrist who made the mold. Appointment is next Monday. If there are any adjustments that need to be made, the n ...
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