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By Cherri Choate, DPM on 5/26/2010
Efforts to standardize issues in research always intrigue me. Since there is such a chasm between a great idea, and a practical and validated process, I always have respect for those who not only propose, but develop their idea into a working measure. Such a measure is the Foot Posture Index 6 (FPI-6). In the early 21st century a group from the Univeristy of Leeds developed this stardardized method to determine foot posture. 

So, why do you, as a practice based physician, need to know about the Foot Posture Index? Well, it really has to do with the value of valid clinical research.  As practitioners we would like studies to be reliable and quantifiable. We would like the methods section of a research paper to be written in common language so that we can compare results and conclusions with ease.  Returning to the original  FPI article, their motivating issue ...
By Larry Huppin, DPM on 5/24/2010 5:16 PM
I had a client call with the following question today: 

Do you have any idea of how to successfully treat a sheer varus friction type of callus at the plantar tip of the 4th toe? In theory, a good pair of functional orthoses with a Spenco extension should work. But I have never had good success with this. Any suggestions?

This is a tough keratosis to treat with orthoses, but here are a couple ideas. The following information assumes you already have an orthosis that is providing adequate control of the foot.

The most important thing is to use a topcover on your orthosis that will show an impression of areas of increased pressure. For example, Diabetic Topcover works well. This is a tri-layer material with a Poron bottom layer, soft Plastizote middle layer, and a leather topcover. EVA is another material that will show an impression.

After the patie ...
By Larry Huppin, DPM on 5/20/2010 9:05 AM
Prescribing rearfoot post motion is one of the more confusing issues on orthotic prescriptions.

Traditionally, the post motion is prescribed as 4/4, 0/0, or some other similar combination. It is important to understand what each of these numbers mean.

The first number is the amount of lateral grind on the post that holds the front edge inverted before forefoot loading. This is most often 4 degrees to accommodate the inverted position of the heel at heel contact.

The second number is the amount of motion the orthotic has during forefoot loading when the front edge comes down to the ground.

A 0/0 post is ground parallel to the front edge of the orthotic and is intended to keep the front edge flat in the shoe regardless of foot movement.

A 4/4 post is one in which the lateral aspect of the post is inverted 4 degrees to the front edge of the orthosis and there is 4 degrees of mot ...
By Cherri Choate, DPM on 5/19/2010

Prolab offers three different types of accommodative orthotics devices.  Al the devices should be fabricated from a semi-weightbearing casts, due to the production process of not adding soft tissue expansion (no fill). All three options have some similarities:  14 mm heel cup, standard width and no cast fill.  The differences are listed below:

   Custom Diabetic- Firm Plastazote shell, diabetic cover to toes
   Custom Insole- Full length medium Plastazote shell, P-cell cover to toes
   EVA Accommodative- 3 mm VF shell, extended EVA arch fill, 3 mm nylene to toes

All three devices are a good option for pathology such as severe Charcot deformity, late stage RA and severe fat pad atro ...
By Larry Huppin, DPM on 5/13/2010 9:31 AM
Some of the studies we discuss in our eJournal Club refer to the Foot Posture Index(1, 2). The Foot Posture Index consists of six specific criteria:
  • Palpation of the talar head
  • Supralateral and infralateral malleolar curvature
  • Calcaneal frontal plane position
  • TN joint prominence
  • Abduction and adduction of the forefoot on the rearfoot.
  • Congruence of the longitudinal medial arch
Each Foot Posture Index criterion is scored by an examiner on a 5-point scale ranging from -2 (very supinated) to +2 (very pronated)

Scores are then summed to give an overall foot posture score. The summed score has the potential to range from –12 (highly supinated) to +12 (highly pronated).(1, 2)

To increase accuracy multiple examiners can be used and the totals averaged.

St ...
By Cherri Choate, DPM on 5/12/2010

Heel cup irritation with orthotic use is not uncommon.  If this is happening on a regular basis in your practice, then perhaps a few changes in habit will help.  Unlike many other aspects of troubleshooting with orthotics, a narrow heel cup is difficult to adjust in your office.  If you do a large volume of orthotics, you probably have already invested in calipers.  If you are newer in practice, these may seem unnecessary, until you face a series of patients with poor heel cup fit. 

When do you need to provide the lab with heel width measurements?  Can you tell by the patient weight, shoe ...

By Larry Huppin, DPM on 5/10/2010 12:15 PM
The ProLab Medical Consultants can provide consultation for even the most challenging biomechanical cases when we can see your patient.  Today's technology makes that easy.  If you have a particularly difficult case, take pictures and / or video of the patient and email them to us. &# ...
By Larry Huppin, DPM on 5/6/2010 6:39 AM
In the year we have been using diagnostic ultrasound (US)in our office, I’ve made changes in some orthotic prescriptions based on US findings. In particular, US has affected my orthotic prescription in those cases where there is thickening of the plantar fascia directly plantar to the calcaneus.

When US indicates that there is excessive inflammation / thickening of the plantar fascia directly plantar to the calcaneus (rather than at the medial tubercle where we primarily see thickening of the fascia) I’ve started adding extra cushion to my orthotic devices. I’ll usually prescribe one of our Pathology Specific plantar fasciitis orthoses, but add a
By Cherri Choate, DPM on 5/5/2010
FAQ Series:  Does Prolab recycle any of their materials?
Since we have entered the 21st century, the importance of being environmentally responsible, is vital for any company.  Prolab has developed a set of programs which are aimed at lowering the environmental impact of the production process:

     1)  Polypropylene shavings are recycled into other types of plastic products.
     2)  Wood shavings and scraps are recycled locally into mulch.
     3)  Prescription forms are printed on recycled paper.
By Larry Huppin, DPM on 5/3/2010 3:40 PM

I was in Canada this weekend.  I learned that they play a strange game up there that has to do with ice and sticks and pucks.   Apparently, the stick is used to hit the puck which moves at great speed across the ice.   Occasionally, a foot or ankle gets in the way of the puck resulting in a fairly high incidence of foot fractures and contusions.  

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