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By Larry Huppin, DPM on 12/27/2010 7:14 PM
I figure no one is working this week , so just watch this and enjoy. The politics are Canadian (by the way...there is evidence), but the performance is priceless.
By Larry Huppin, DPM on 12/27/2010 2:30 PM
I have included a couple of shoe lacing videos in this blog over the past several weeks.  You can use the search feature on the right to find those - just search for "lacing".  

Familiarity with different lacing techniques is helpful in troubleshooting orthotic problems.  For example, patients with high insteps who receive orthoses will benefit from a looser dorsal lacing technique.   There are dozens of lacing techniques that can help your patients.  It pays to be familiar with a variety of techniques.  

One of my favorite lacing guides is a website called Ian's Shoelace Site. Ian has a list of 33 lacing ...
By Larry Huppin, DPM on 12/25/2010 1:12 AM
By Larry Huppin, DPM on 12/23/2010 4:52 PM
Is your patient's running shoe just a little tight now that they have received their new orthoses?  If so, this video demonstrates lacing technqiues designed to loosen the shoe. This technique is particullary good for patients with high insteps and wide feet.
By Cherri Choate, DPM on 12/22/2010
After practicing for a number of years, I noticed a trend specifically related to women of menopausal age.  As a whole, they seemed to present with the most recalcitrant cases of plantar fasciitis/heel pain.
By Larry Huppin, DPM on 12/20/2010 2:56 PM
By altering foot function, we all know that custom orthotics also have an effect on other areas of the body. In most cases this is a positive effect. For example, there is good evidence that foot orthoses can have a positive effect on patello-femoral dysfunction. Patients with a history of these problems, however, can also find that the use of new orthotics can increase pain during the break-in period. To avoid these problems, we instruct those patients who have a history of knee, hip or back problems to break-in their orthotics on a slower schedule.

Those people who should have a slower break-in include patients with the following conditions:
  • Significant back pain, hip pain or knee pain
  • Artificial knees or hips
  • Patients who previously have had trouble getting used to orthotic devices

If a patient is in one of these groups, we suggest the following break-in ...
By Larry Huppin, DPM on 12/16/2010 1:40 PM
A patient complaining of their heel slipping out of their shoe while wearing orthotics is a common but easily corrected problem.

Often, simply thinning the heel contact point of the orthosis takes care of the problem. With polypropylene orthoses you can girnd the heel of the orthosis thin using a grinder. Grind it until it is just slightly flexible. This leaves you with an orthosis that is nearly paper thin at the heel contact point.

In running and walking shoes a simple change in lacing technique can also help prevent heel slippage. Take a look at this video from Zappos for instructions on this technique.
By Cherri Choate, DPM on 12/15/2010
Although the practice of medicine has existed for centuries, the term "evidence-based" is relatively new.  Many who have been in practice in recent years have witnessed this term being used by insurance companies to demand justification for treatment.  As I was researching the history of this most recent trend, I came across some articles that I found both fascinating and a little disturbing.
By Larry Huppin, DPM on 12/13/2010 4:52 PM
One of the primary problems when fitting an orthoses for a patient with a metatarsus adductus foot type is irritation from the lateral edge of the orthoses because the lateral fat pad expands over the lateral edge of the orthoses.

The basic rule here is this:
If the foot is “C-shaped” the orthosis should also be “C-shaped.”

You can eliminate this problem by asking for “extra lateral expansion"; we will then increase the expansion by a few mm in order to accommodate the lateral foot and fat pad. It really helps if you send a weight-bearing tracing of the foot to us along with your negative casts.

This can also be a helpful for patients who simply have extra soft tissue spread along the 5th metatarsal shaft during weightbearing.  In this case, just ask for "extra expansion along 5th metatatarsal shaft" in the special instructions section of the Rx form. 
By Larry Huppin, DPM on 12/9/2010 8:00 AM
Do you use orthotics to prevent blisters? Blisters are not a pathology that are usually treated with foot orthoses, but orthoses can play a large role in preventing blisters of the feet.

Since a primary cause of blisters is friction, and friction is due to motion, if orthoses can decrease motion, then they should decrease blister formation.

In general the following is a good orthotic prescription for preventing blisters:
  • Semi-rigid polypropylene.  A more rigid device is better as an excessively flexible orthosis leads to foot motion and friction
  • Wide width. By spreading force over a larger surface area, wider devices are more effective at reducing motion, friction and blisters
  • Minimum cast fill: A minimum fill orthosis conforms tightly to the arch of the foot. This “total contact orthosis” further limits motion of the foot.
  • Rearfoot post: A r ...
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