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By Cherri Choate, DPM on 11/25/2009
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A publication (Kinoshita 2002) referenced in the Journal Club section of our web site a few weeks ago focused on the effect of foot position in tarsal tunnel syndrome. The researchers  presented a quick easy clinical exam where the foot and ankle were held in a dorsiflexed and everted position for a few minutes. When this test was conducted in patients with diagnosed tarsal tunnel syndrome, 84% had an increase in symptoms. 

So how does this translate to orthot ...
By Larry Huppin, DPM on 11/23/2009 5:54 PM
I saw a 120 lb female patient back today who presented last year with medial malleolar pain when hiking. She was an active hiker, so this was significantly hindering her ability to enjoy the outdoors.

She didn’t have a particularly large malleolas, but she was quite pronated. Both heels were everted about 10 degrees in stance. As the feet pronated, the medial ankle rolled medially resulting in increased pressure of the malleolas against the medial wall of the boot.

Our treatment goal was to decrease the pressure between the boot and malleolas by limiting eversion of the heel.

Here is our prescription:
By Larry Huppin, DPM on 11/21/2009 11:51 AM
A patient presented to my office yesterday complaining of lateral foot pain left only. He had a history of clubfoot at birth that was only partially corrected surgically. He now has a left foot that has:
• Inverted heel in stance. Heel sits about 10 degrees inverted. Coleman block test is negative in that I could not reduce the inverted position by supporting the lateral forefoot.
• Equinus. Unless the knee is placed into recurvatum, the heel is about 1 cm off of the ground.
• Extremely high arch and plantarflexed first ray.
• Planatar prominence of the 5th metatarsal base

Overall, pretty classic findings for a clubfoot.

His only complaint is pain under the styloid process. He has never had orthotics, nor have they been recommended.

Our treatment goal is to reduce pressure on the plantar 5th metatarsal base. This is what was prescribed for the left foot:

By Cherri Choate, DPM on 11/18/2009
    Treating the patient with rheumatoid arthritis is a lifelong challenge.  The standard orthotic protocol, which consists of a soft accommodative insole, is no longer the default device for these patient.  This patient group, as well as the population of people with diabetes, are the focus of much of the current podiatric research.  The previous idea of treating chronic disease simply with maintenace is now being questioned.  Researchers and clinicians are creating data that is leading to a paradigm shift.  This "change in the fundamental model of events" is a shift from sof ...
By Cherri Choate, DPM on 11/11/2009

We spend a great deal of time addressing issues to combat the effects of excessive pronation, but there are a large number of patients who have exess supination problems.  When attempting to address the issues associated with excess supination, such as peroneal tendonitis and inversion ankle sprains, a variety of options are available to include within an orthotic prescription.  A few of the most common options are listed below:
                                         & ...

By Larry Huppin, DPM on 11/9/2009 4:08 PM
There was a question on the PM News list serve last week about the use of heel stabilizers for treatment of pediatric flatfoot. While heel stabilizers can act to physically block eversion of the heel, evidence based medicine dictates that more sophisticated and effective devices are preferred for treatment of flat foot in children.

There is a tremendous amount of information on this website devoted to the pediatric flatfoot. Some of the links are below. In particular, we want to make sure you are aware of the P3 Prefabricated Kiddythotic, the first prefabricated children’s orthosis to incorporate features previously found only in custom orthoses. These include a medial flange, medial skive, deep heel cup and a rearfoot post.
By Larry Huppin, DPM on 11/5/2009 4:03 PM
I have a patient with PTTD for whom I made a ProLab PTD Pathology Specific Orthosis. It has worked great and she is pain free when she wears them. As you may know, however, this is a pretty bulky device and fitting it into anything other than a lace-up shoe is difficult. My patient wants to be able to occasionally wear somewhat dressier shoes and was wondering if we could make her a dress orthosis.

Normally, this is not only easy, but expected. About 70% of my female patients will end up with two pair of orthoses. A full sized pair for exercise and a smaller pair for dressier shoes. The PTD foot, however, is so dramatically pronated that a standard dr ...
By Larry Huppin, DPM on 11/2/2009 10:48 AM
If you are casting for a gauntlet type AFO such as the ProLab Stabilizer (these AFOs are often called an Arizona Brace after the company that first popularized this type of AFO), casting position is critical to ensure optimum comfort and function.  In fact, if the cast isn't perfect, we cannot make the AFO.  

We encourage all of our clients to watch this Gauntlet Stabilizer casting video on correct casting technique prior to casting your pati ...
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