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By Larry Huppin, DPM on 11/14/2013 4:23 PM
We recently had a question asked regarding an older blog entry that I want to address in more detail. In December 2009, I wrote a blog discussing why we rarely recommend first ray cutouts. You can read that blog here.

We had a question from a client this week as to whether we would recommend a first ray cutout for a pes cavus foot with plantarflexion of the first ray.

So first, please go back and read that original blog.

Okay, you are back. Now, here is an extended version of my answer to Julie.
By Dianne Mitchell on 11/6/2013 9:41 AM
A patient presented to the office today with a pair of functional foot orthotics in his hands asking for a second opinion. He reports pain on the rim of the heel to both feet since about a week of wearing them. He stopped wearing them while waiting to see me.
My immediate thought was that the devices were too narrow in the heel cup. He stood on them for me and, yes, they were indeed too narrow. What can you do with this pair of orthotics to adjust them to fit the patient?
Couple options: (Note: These options would certainly depend on whether or not the patient's heel even fits in the heel cup! I make sure the heel fits in the heel cup non-weightbearing first.)
- raise the patient up out of the heel cup with a small heel lift underneath the top cover (Korex or poron works well)
- shallow out the depth of the heel cup (this requires a grinding wheel) this will effectively widen the orthotic

I also educate the patients and make sure they under ...
By Dianne Mitchell on 11/4/2013 9:03 AM
We see many diabetic foot ulcers in the office. My goal is to not only heal the wounds, BUT also prevent recurrent wounds. An example is: A diabetic foot ulcer on the plantar hallux base. On exam of the mechanics of this particular foot there is a functional hallux limitus. Once this ulceration is healed, what can you do to decrease the pressure to this region? AND prevent recurrence?

Couple thoughts on this one:
- functional foot orthotic with a diabetic top cover and addition, or integration, of a reverse Morton extension to allow plantarflexion of the 1st metatarsal. This will offer decreased pressure to the otherwise jammed hallux and the limitus.

- next, you must decrease the recurrent friction. The best way to do this is to add a piece of PTFE (minimal coefficient of friction) to the area that the hallux and first metatarsal head contact.

Together, these modifications will help to decrease the recurrence rate of the ulcerat ...
By Dianne Mitchell on 11/2/2013 9:37 AM
Attending the learning in the vineyard seminar. Day #1proved again very valuable. Three workshops were offered. Dr Hoffman offer a wonderful podiatric vascular workshop, Dr Reeves delivered a shoe update I can immediately apply on Monday in the office and Dr Huppin reviewed pathology specific orthotic prescription writing ... again usable information for the office Monday morning. The afternoon ended with some Napa valley wine tasting!!
If you are missing this conference, you should definitely consider attending next year!
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