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By Cherri Choate, DPM on 1/27/2010

About a month ago, I tried on a popular "rocker soled" shoe for the first time.  Although I did not purchase it, I started wondering about our professional approach to shoe trends.  Since most shoes are not a medical product, there is not a mandate for any supporting medical research.  Yet, we include shoes as part of our treatment regimen for patients on a daily basis.  Many trends come and go quickly, but some get a foothold in the market and become permanent options.
To saitisfy my curiousity, I would like to know what your current opinions are regarding the rocker type of shoes that are now on the market?  A few studies have been completed, but I am interested in personal expeiernce.   If you have a moment to write a quick Blog in ...

By Larry Huppin, DPM on 1/25/2010 12:40 PM

By Larry Huppin, DPM on 1/20/2010 10:08 PM
Medial hallux pinch callus is a sequellae of functional hallux limitus. When the hallux is unable to dorsiflex during toe-off, abductory twist leads to rolling off of the medial aspect of the hallux and “pinching” the skin – leading to the pinch callus. Thus your goal when prescribing an orthosis to reduce hallux pinch callus is to create an orthosis that treats functional hallux limitus. Our recommendation for an orthotic prescription to best treat hallux limitus can be found here.

ProLab clients are encouraged to ...
By Cherri Choate, DPM on 1/20/2010
As our population ages, and remains active, foot health will become more complex.  The term "geriatric" leads one to image an elderly patient who is sitting by the window in their easy chair, but in many cases this image is far from the truth.  Attempts to formulate a "geriatric" orthotic would be challenging due to the variability of this population.  What can be discussed are a few consideration due to the natural process of body aging.  Three common changes with age include poor balance, diminished sensation and decreased fat pad.  Addressing each of these as you consider an orthotic for a patient later in years may include the following considerations:
     1)  Balance-  Decreased ...
By Larry Huppin, DPM on 1/18/2010 3:03 PM
When the rearfoot everts, the medial forefoot is forced into the ground. This results in a dorsiflexion force on the first ray and jamming of the first MPJ as the patients begins to toe-off.

An article published several years ago in the Journal of the American Podiatric Medical Association gives us some good data on this relationship. Paul D. Harradine, MSc, and Lawrence S. Bevan, BSc (Hons), did a preliminary study on "The Effect of Rearfoot Eversion on Maximal Hallux Dorsiflexion." They found that hallux dorsiflexion is decreased with rearfoot eversion*.

This again underscores the importance of prescribing rearfoot control when treating hallux limitus.

To resist rearfoot eversion, your orthotic prescription should contain:
By Larry Huppin, DPM on 1/14/2010 6:34 PM
I had a patient present several months ago with diffuse midfoot osteoarthritis bilateral. Pain was present with most weightbearing activities and increased with exercise. Regardless of the joints involved in the midfoot, our goal with treatment is to limit the motion that causes pain.

Our first line of treatment was a custom foot orthosis with the following prescription:
  • Semi-rigid polypropylene
  • Deep heel cup
  • Wide width
  • Minimum cast fill
  • 0/0 rearfoot post

When trying to limit midfoot motion, be sure that your orthosis conforms very closely to the arch of foot and also acts to limit subtalar joint pronation.

These orthoses provided about 30% improvement of her symptoms, but she was still experiencing significant pain.

Our next line of treatment was the use of r ...
By Cherri Choate, DPM on 1/13/2010

Over the holidays, many people spend a great deal of time standing in their kitchens, usually in socks or slippers.  As a result there are a lot of sore feet, ankles, knees, hips and backs following all the festivities.  This is an opportune time to recommend that patients with patholgy need to invest in a shoe/orthotic combination that is dedicated to the indoor areas of their home.  The best received shoe recommendations are those that are easy to slip on and off, so some type of "clog" like shoes or mule would would great.  My personal recommendation is the Merrell Jungle or Encore line, but many other brands, including Keen, have similar types of shoes.  The important qualities for the shoes include a removable insole, deep toe box, th ...
By Cherri Choate, DPM on 1/6/2010

     As we all know, research topics seem to go through phases.  We are currently in a phase that is well overdue:  Pediatric Biomechanics.  At Prolab, we are certainly focusing more energy on effective, evidence based treatment options for pediatric foot pathology. I have mentioned Peditric Flat Foot in a previous blog and I will likely mention it again in the near future.  As research is published we should begin to build a treatment protocol based on medical evidence.  One such article was published in 2001 in N ...

By Larry Huppin, DPM on 1/4/2010 4:14 PM
A patient presented today with bilateral pain on the plantar lateral foot with activity. His exam was significant for:
  • Cavus feet
  • Inverted RCSP with a positive Coleman Block test (by supporting the lateral forefoot the heel came to perpendicular)
  • Humongous styloids – plantar and lateral.
  • Pain to palpation on plantar styloids – no pain lateral.
He had a pair of orthoses that were not helping much. These devices were gapping extensively from his medial arch and although they had some accommodation plantarly for the styloids, it wasn’t nearly enough.

Our treatment goal is to reduce pressure under the styloid processes.

Here is the orthotic I prescribed:
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