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By Larry Huppin, DPM on 11/28/2011 2:09 PM
 I spoke to a ProLab client today who had a patient with an osteochondral defect of the ankle. He performed a scope and the patient was doing better, but she was still having what he thought was lateral impingement. She had a calcaneal varus and an ankle valgus. He wanted to know if there was anything we could do with orthotic devices to reduce her symptoms.
By Larry Huppin, DPM on 11/14/2011 2:00 PM
 As we come into our winter sport season, we are seeing more requests for orthotics for ski boots, snowboard boots and ice skates

These are all very tight fitting boots. This tight fit makes fitting an orthosis much more difficult. ProLab has established some requirements for production of these specialty orthoses. 

Ice Skates
We cannot make orthoses for skates unless we have the skates. No exceptions. Note that this will increase both your outbound and inbound shipping costs. We recommend that this cost be passed on to the patient. In my office we charge an extra $25 for shipping of the skates, payable at the time of casting. 
By Larry Huppin, DPM on 11/10/2011 6:56 AM
A ProLab client called me today with questions regarding a prescription for a pair of orthoses for a patient who recently had an arthrodesis of the first metatarsophalangeal joint on the right foot, and was experiencing first MPJ pain secondary to hallux limitus on the left foot. On the right foot, the patient was experiencing metatarsalgia pain with pain primarily under the second MPJ.

Our goal of treatment is to decrease pressure on the second metatarsal head on the right foot, and on the left foot to enhance motion in the first metatarsophalangeal joint.

The following was our prescription:
By Dianne Mitchell on 11/7/2011 9:16 PM
I saw a number of cases of sub-2nd metatarsalgia pain today in the office. This varied from mild pain (bruise sensation) to swelling and more severe pain with activity limitations. The quickest modification to add to these patients' orthotics is an 1/8" thick forefoot extension beneath the top cover with a cut out beneath the 2nd met head. Another modification could be a metatarsal bar. These can both be added to a forefoot rocker shoe, surgical shoe, or walking boot for higher levels of pain in order to decrease pressure through the forefoot.
By Larry Huppin, DPM on 11/3/2011 7:14 AM
I had a ProLab client call me this morning regarding how to write a prescription for a patient who is experiencing pain from calcaneal cuboid arthritis. This patient had a subtalar joint fusion 30 years ago. In the past couple of years he started developing lateral column pain that seems to be due to calcaneal cuboid joint OA.

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