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By Larry Huppin, DPM on 4/15/2013 6:23 AM
 A fairly common complaint that I hear in my office is that of patients saying that their heel is slipping up inside one or more shoes when they wear their orthotic devices. This is usually a very easy problem to address and one that every orthotic practitioner should be aware of.
By Larry Huppin, DPM on 4/8/2013 1:44 PM
  I saw a patient a few weeks ago who had come back in for followup after getting her orthotics. She was comfortable in the orthotics for the most part and they have worked very well in relieving her symptoms. However, there was one area that was bothering her and that was the lateral heel cup on one orthosis. When I had her stand on the devices, I noted that she had a quite a bit of fat pad expansion and that the fat pad of the heel was overriding the lateral edge of the heel cup.

I always try to avoid this problem by measuring the fat pad of the heel when I order orthoses. I checked the copy of her prescription form and I found that in this situation I had forgotten to take the measurement and send it to the lab. By measuring it, I almost always avoid this problem.

It has to be kept in mind that
By Larry Huppin, DPM on 4/4/2013 8:43 AM
 I saw a patient this morning who suffered a crush trauma to his mid and rearfoot a number of years ago and now has both midfoot and rearfoot osteoarthritis. He has done fairly well using a gauntlet AFO to limit motion. The last time I saw him, I also recommended that he get a rocker-soled shoe. A rocker sole will further act to decrease mid and rearfoot motion, particularly if the rocker is placed near the midfoot.

Since the last visit, he purchased a pair of PW Minor shoes, which had a built in rocker. They fit the gauntlet AFO extremely well and he has found that the rocker has substantially further decreased his symptoms.
By Larry Huppin, DPM on 4/1/2013 8:41 AM
 I recently saw a patient for whom I dispensed a new pair of orthotic devices. This patient had prominent styloid process. 

If you ever are prescribing an orthosis for a patient with a prominent styloid process, you have to determine if the styloid needs accommodation. When making this determination, you must first determine whether the styloid is prominent laterally, plantarly, or both. Lateral and plantar styloid prominences required different accommodation.
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