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By Cherri Choate, DPM on 8/26/2009

Choosing between a metatarsal pad and a metatarsal bar is sometimes difficult.  Most off -loading studies use the metatarsal pad, but seldom provide the specifics regarding the size or material.  A few studies have referenced the metatarsal bar, but historically the metatarsal bar has  been a bar attached to the outsole of the shoe.  At Prolab, we offer two choices of off-loading on the custom orthotic. 

The metatarsal bar is an 1/8" layer of poron at the distal edge of the plate.  It is different than a metatarsal pad because the high point is not as acute.  Because it is present across the entire distal edge, it offers more diffuse off-loading for all the metatarsal heads , and less focus on the 2,3 metatarsa ...

By Larry Huppin, DPM on 8/24/2009 1:26 PM
A client called today with a question about a patient with OA of the left ankle joint. His biomechanical examination was significant for a 10 degree everted RCSP. Xrays show a valgus angulation of the ankle joint with increased moment through the lateral ankle and decreased moment medially.

Our goal with the orthosis to reduce the RCSP and bring the heel as close as possible to perpendicular in order to equalize force across the ankle joint. Thus, this will be an aggressive orthotic prescription. In fact, I would recommend warning the patient that the orthosis may have to be adjusted if the patient experiences uncomfortable pressure on the foot. The patient would not likely tolerate an orthosis that applied enough force to bring the heel all the way to perpendicular, but our prescription will act to bring it as close as possible to perpendicular.

Here is what we recommended:
By Cherri Choate, DPM on 8/21/2009

The most recent E-Journal article review about knee pain reminded me of a group of patients that I have seen over the years. These patients often make an appointment specifically to request fabrication of custom orthotics to alleviate their knee pain. They may be anywhere between 20 and 80 with chronic knee pain that is usually activity related. Although the activity of choice may vary, running, hiking and biking are common. They all, without exception, are active individuals who want to stay that way.

As a clinician I am always challenged by these patients. They have usually invested in a variety of orthotics and a bag full of pricey athletic shoes. Despite all their attempted interventions, their pain remains. My prescription would commonly be for a stable orthotic with a small heel lift and some type of wedge, skive or extension. Fortunately, most of the patients did improve, although I was not always clear why.

A few years ago, I started readi ...

By Larry Huppin, DPM on 8/20/2009 1:37 PM
I spoke to a client today who had dispensed a pair of our Featherweight orthoses to a patient. The patient was complaining that the devices were difficult to move from shoe to shoe as the Nylene (Spenco-type) topcover would curl up. A simple solution to this problem is to add a Poron or EVA extension from the distal end of the orthosis to the end of the topcover.

Then glue a piece of vinyl on the bottom of the orthosis extending from about an inch proximal to distal edge of the orthosis to the end of the topcover.

This combo will result in a cover that is stiffer distally and slides easily in and out of shoes.

The ProLab medical consultants
By Larry Huppin, DPM on 8/17/2009 11:40 AM
July 1st is the beginning and end of the residency year and many podiatrists fresh out of residency are now just starting their practices. Every year about this time we start getting calls from newly practicing podiatrists who have not thought about orthotic therapy in 3 years or more and are now realizing that their training has been lacking in the area of orthotic therapy. We can help.

ProLab has a 20 year committment to educating podiatrists in state of the art orthotic therapy with a focus on evidence based medicine. This website is the internet's largest resource on clinical orthotic therapy. We have the nation's top podiatric orthotic experts as consultants - ready to help ProLab clients with any patient.

Over the next several months we will be developing material on this website devoted to helping the new practitioner develop...
By Larry Huppin, DPM on 8/13/2009 10:01 AM
A relatively common orthotic complaint is a patient who feels the arch of the orthosis too far proximal.  Essentially they feel excessively pressure under the distal aspect of the first metatarsal shaft. 

To fix this problem, first ensure that the orthosis is sliding all the way back into the shoe.  If it is not, the device will be sitting farther distal than it should leading to the complaint.   If the orthotic does not sit all the way back in the shoe, consider lowering the heel cup a few millimeters or having the patient get a wider shoe.

If the orthosis does sit properly in the shoe, you can eliminate the feeling of excessvie pressure distally by thinning the orthotic shell in the area where they feel excessive pressure.   Gently grind it thinner until the flex increases slightly.  Then have the patient try the orthosis.   Take a little bit at a time until it fee ...
By Open Forum on 8/10/2009 1:25 PM
Looking for a place to make a comment or ask a question about a recent E-Journal summary or published article? This is an Open Forum for anything that's on your mind relating to biomechanics, orthotics, or ProLab.  

This area is for questions and comments from medical professionals only.   We are not able to take patient questions on this site. 
By Larry Huppin, DPM on 8/10/2009 9:25 AM
If you have a patient with a severe flatfoot, a PTTD for example, who continues to pronate excessively even when wearing a foot orthosis or Ankle-Foot orthosis, consider prescribing shoe modifications.

Two modifications can help these patients significantly:
1. Medial Flare (medial expansion of midsole and outersole)
2. Medial Buttress  (strengthening the medial wall of shoe)

A good pedorthist or shoe repair center can help you. If you don’t have someone in your community, mail-in shoe modification facilities are available. 

ProLab medical consultants are experts at prescribing shoe modications and can help you determine the best modifications for your patients. ProLab clients can consult with a medical consultant any weekday a ...
By Larry Huppin, DPM on 8/6/2009 1:49 PM

A loose definition of a flexible orthosis is one where the arch collapses about halfway to the ground under the weight of a particular patient.   A semi-rigid orthosis is one that shows a minimal amount of deformation under a patient's weight and a rigid device is one that does not deform at all.   

The flexibility of an orthosis is dependent on a number of factors, including:   

By Cherri Choate, DPM on 8/5/2009

At the lab, we often receive requests for soft functional orthoses.  Sometimes this means a soft cover, but often is means a more flexible, but functional device.  The two choices that would fit this category would be the ProAerobic and the Featherweight devices.  Both these orthoses have an 1/8" vacuum molded polypropylene shell, and this is standard thickness independent of patient weight.  They also both have medium density EVA arch fill.  The differences include the topcover and the presence or absence of a bottom cover. 

Although these devices may not offer the ultimate control, patient compliance is high due to an increased sense of comfort. If you have not ever prescribed them, take a l ...

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