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By Dianne Mitchell on 5/20/2011 6:26 PM

I never thought I would place a full-length valgus wedge on a patient's orthotics.

I see a lot of workers comp cases and presently see a roofer. After about 2-3 hours on the roof he feels pain. In a stance exam of this patient, he is bow legged b/l with pronounced tibial varum and his RCSP is nearly perpendicular to the ground. Initially, he presented with typical plantar fasciitis symptoms and we tried a 0/0 motion rearfoot posted functional foot orthotic, neutral device with no inversion. This seemed to help the arch, but the patient slowly developed peroneal pain. In my initial attempt to relieve this, I added a reverse Morton's extension of cork to the devices that the patient enjoyed; then he increased time on the roof and this was proving to not help. So, I ...

By Paul Scherer, DPM on 5/20/2011 8:37 AM
We are very pleased to introduce a great addition to our online blogging community. Dianne Mitchell, DPM, is a 2004 graduate of the California College of Podiatric Medicine. She completed her PM+S 36 residency training at Encino-Tarzana Regional Medical Center in California, followed by a Sports Medicine Fellowship at Virginia Mason Medical Center in Seattle, WA.

Dr. Mitchell is currently working in the Podiatry Department at Mercy Medical Group in Sacramento, CA and has offered to share her expertise in sports medicine and orthotic therapy through our blog. Watch for fresh insights from Dr. Mitchell online.
By Larry Huppin, DPM on 5/16/2011 1:23 PM
Podiatry Arena
 Podiatry Arena is a forum in which some of the best foot biomechanists in the world participate in online discussions, debates, arguments and occasional virtual wrestling matches on matters pertaining to foot biomechanics and orthotic therapy.   

Each month we will provide you with links to the threads that would seem to be most interesting for our clients.
By Larry Huppin, DPM on 5/12/2011 9:59 AM
 In the new issue of Lower Extremity Review is an article that reviews theories on how orthotics function.  We are recommending this article to all ProLab clients.   You can read the full article here.  

Here is the introdution to the article:

By Larry Huppin, DPM on 5/9/2011 9:56 AM
 I had a patient present in my office today with a two-year history of fairly classic plantar fasciitis. She had seen a podiatrist during that time and had multiple treatments, which included orthotic devices, physical therapy, multiple injections bilateral, and standard anti inflammatory measures. She sought me out to get a second opinion because she has not seen much improvement. The patient was a pleasant 31-year-old woman who was obese. Pertinent biomechanical findings were a pes planus foot type. She had an everted heel in stance and nearly complete collapse of the medial arch. In gait, she showed fairly rapid midtarsal joint collapse, eversion of the heel,  and stayed maximally pronated throughout gait.

She was wearing her only pair of orthotics today. These were made by the previous podiatrist 9 months ago. They were carbon fiber orthoses. They had no post, a shallow heel cup, a fairly narrow width, and the arch did not conform very closely to the&a
By Larry Huppin, DPM on 5/5/2011 1:45 PM
I had two ProLab clients call me today with a complaint that their patients are sliding laterally off of their orthoses. They are wondering if anything can be added to the orthosis to prevent this problem.

The problem of sliding laterally off of an orthosis usually occur on more aggressive devices. For example, a device with a medial flange, medial skive, and inversion. All of these create a varus force and the medial skive and inversion both create a varus wedge within the heel cup of the orthosis. This can allow the patient to slide laterally.

In trying to address this problem, we can approach it in a couple of different ways. One way is to try and apply something to the 
By Larry Huppin, DPM on 5/2/2011 2:15 PM
I had a client call me today regarding production of a gauntlet AFO for a patient with posterior tibialis dysfunction and adult acquired flatfoot, but complicated by the fact that he has rather severe edema. He wanted to know if I thought this was something that might work for the patient. I had informed him that it is possible it could work well for him, but there are definitely some potential problems, and I certainly would not guarantee the patient a good result.

The gauntlet AFO is an excellent modality for treatment of adult acquired flatfoot. The problem is going to be with the patient’s edema. It is probably best to cast him while the patient is most swollen so that the device would never be too tight on him. The problem is 
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