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By Dianne Mitchell on 5/24/2012 10:35 AM
For patients experiencing pain during cycling, here are some thoughts to consider:
- are the cycling shoes properly fit to the patient's foot?
- what type of socks does the patient wear (thin cycling socks versus thick padded running socks)?
- where is the pain? Many riders complain of forefoot numbness, specific great toe numbness, inner-metatarsal space neuromas.
By Dianne Mitchell on 5/17/2012 9:43 PM
Modifying diabetic accommodative orthotics is similar to modifying a standard functional foot orthotic. I had a patient in the office earlier this week with 5th metatarsal base pain and irritation on his custom molded accomodative inserts. Interestingly, this is a neuropathic patient, so he was really concerned about the fact that he had pain and what looked like a skin lesion. 
By Larry Huppin, DPM on 5/17/2012 5:48 AM
I had a ProLab client call me today regarding a patient with an ulcer under the hallux. The patient is active. He works in an OR and spends most of the day on his feet. The client is looking for a way to use orthotic therapy to decrease force under the hallux.

There are a number of studies showing the most effective methods to decrease force under the hallux. Our primary goals are to decrease any functional hallux limitus that is occurring in order to decrease pressure under the hallux, and then transfer pressure directly off the ulcerated area.
By Dianne Mitchell on 5/15/2012 9:21 PM
When prescribing functional foot orthotics it is important to not only discuss that orthotic devices should be comfortable and address foot mechanics for pain relief, but also explain which shoes the devices fit best in. I frequently see patients who present with orthotics and the complaint that they can't wear them everyday because they don't fit in their shoes.
By Larry Huppin, DPM on 5/11/2012 6:56 AM
I just finished a consult with a ProLab client who had a patient with severe cavus foot and an inverted heel causing him to have severe lateral instability. The patient has had many pairs of orthotics over the years and none of them have been effective. I had previously done a consult in helping the doctor to write an appropriate prescription to try to apply force laterally to decrease this lateral instability.

He called me back today to say that the patient was extremely happy. By using this orthotic, he felt the most stable that he had in his entire adult life. He actually wanted to see if there was any way to try to improve upon the function of this orthotic.
By Dianne Mitchell on 5/8/2012 8:46 PM
Patient came in complaining about arch pain with functional foot orthotics, hates her orthotics. With foot exam, she has a rigid cavus foot with a prominent plantar fascia band with engagement of the windlass mechanism. She had brought in her current devices from another lab and unfortunately they were not accommodating her plantar fascia nor were they padded to decrease pressure to her very prominent metatarsal heads or heel. Also she has an equinus deformity adding to the forefoot pressures/pain she is experiencing. The fix:
By Dianne Mitchell on 5/3/2012 9:25 PM
Frequently patients present to the office for orthotic adjustments with devices they got from other providers and various labs. I get mixed comments from patients as to why they need adjustments, but I see a lot of folks who simply tell me they don't like their orthotics because they cause pain.
Today wasn't any different.
By Dianne Mitchell on 5/2/2012 10:24 PM
Recently, a frequent question in the office has been "what shoes should I wear with my functional foot orthotics?" Specifically, these patients are asking if they can wear a less stable athletic shoe once they have a custom molded orthotic to place in them. A typical patient, approx 180 pounds with knock knees and pronated, flat feet (who now has functional foot orthotic devices, correcting and controlling the foot mechanics) came in with a neutral and flexible athletic shoe. The shoe is already breaking down after only 2-3 weeks of wear.
I place these patients in stability shoes, such as Brooks Adrenaline or Asics 2170 (just to name a couple examples) and add the functional orthotic devices to these. They couple each other well, and offer great support. If the shoe is too soft and flexible, I notice orthotics simply do not sit correctly in the shoes; they seat themselves unevenly in some instances. The orthotics need a stable foundation from which t
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