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By Cherri Choate, DPM on 1/28/2011
Are there times when patient's feet just don't tolerate the typical orthotic?  I recently evaluated a friend's feet who has not been able to tolerate even well made devices. 
By Larry Huppin, DPM on 1/20/2011 9:06 AM
I spoke to a client yesterday who was making orthoses for a runner with plantar fasciitis. He wanted to prescribe an orthosis with a maximum arch fill so that he could be sure that the orthosis did not cause any irritation to the arch of the foot.

I think this illustrates a huge problem in podiatry – prescribing orthoses to avoid the need to troubleshoot, rather than prescribing for best clinical outcomes. The best evidence on orthoses for plantar fasciitis indicates that devices that conform closely to the arch (minimum cast fill orthoses) are more effective at reducing tension on the plantar fascia. The downside of these orthoses is that there is certainly more potential that the orthosis could cause some arch irrititation. If this occurs, it is extremely easy to adjust for an arch that feels too high. Simply grind the orthosis thinner in the arch to increase flex in the arch. This is demonstrated in the video below.

Of course, if you ...
By Cherri Choate, DPM on 1/19/2011
Sweet spots are a commonly ordered modification in orthotic fabrication.  They are often included in prescriptions for pathology such as plantar fibromatosis and posterior tibial tendon dysfunction (adult acquired flatfoot). 
By Larry Huppin, DPM on 1/13/2011 8:39 PM
Clinical Goal for Orthoses Following Bunion Surgery:
Following a bunion procedure, our primary goal with orthotic therapy is to encourage full range-of-motion in the first metarsophalangeal joint .

Biomechanical Goal:
To encourage first MPJ full range of motion, we wish to decrease excessive ground reactive force under the first ray and to allow the first ray to plantarflex. The orthosis should be designed to decrease the everted position of the calcaneus when an everted rearfoot is present. In the case of an everted forefoot, the orthosis should support the lateral forefoot (forefoot valgus).

The ProLab Hallux Limitus Pathology Specific Orthosis
By Cherri Choate, DPM on 1/12/2011
The first ray, and specifically related deformities, seem to garner a great deal of attention in the podiatric medicine/surgery field.  Most laypersons assume that if you have a "bunion" then the only appropriate treatment is surgery.  In some cases surgery is the answer, but pathology of the first ray is progressive, and mechanically based, so it would be logical to think that early intervention to adjust the poor mechanics, may help slow down this progressive problem. 
By Larry Huppin, DPM on 1/10/2011 3:05 PM
Do you recommend specific socks to your patients? The proper socks can make a tremendous difference in foot comfort and your patient’s perception of orthotic function.

For example, if you are using orthoses for treatment of metatarsalgia, the proper socks can decrease force under the ball of the foot by providing greater cushion. Studies are clear that acrylic socks provide greater protection against shock and shear than do cotton socks (1-7). So, anytime you are prescribing orthoses for metatarsalgia, you should also be telling your patient to switch to acrylic socks. Because these socks are often thicker than the cotton socks your patient is currently wearing, it is critical to have them try on any new shoes with both the orthoses AND with the thickest socks they will be wearing.

By wearing the proper socks, your patient will see improvement in symptoms and find more satisfaction with their orthoses and thei ...
By Cherri Choate, DPM on 1/5/2011
The New Year is the trigger for many of us to make resolutions for life style modifications.  Perhaps it can also be a time for orthotic changes and modifications.
By Larry Huppin, DPM on 1/3/2011 2:55 PM
Our new shoe list for 2011 will be available soon. In this new version we have separate sections for women’s and men’s dress shoes.  The shoe list is available in the client section of the website.  Contact us if you have lost your log-in information 
In a previous post I discussed my favorite site for finding fashionable but healthy women’s shoes. Today, we will focus on men’s dress shoes. The shoes I recommend will be stable and have a removable insole so that there will be room for an orthosis. Most of these shoes will accept a fairly full sized orthosis, although for dress shoes I tend to go without topcovers or a thin cover such as vinyl. I’ll ...
By Larry Huppin, DPM on 1/3/2011 10:52 AM
We can make orthoses to fit sandals as long as the sandal has a removable insole.  Have your patient first purchase the sandal and then send the sandal to the lab along with the cast and prescription. 

I've been working with a patient the last few days to help him find a sandal that would work.  He found he likes Mehphisto and Naot sandals. Both have some models that have removable insoles.  

Anyway, I did a bit of research to discover which sandals in these brands have removable insoles.   Here is what I found:

Mephsito sandals with removable footbed

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