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Author: Larry Huppin, DPM Created: 6/20/2009 9:45 AM
This blog is designed to provide foot orthosis and ankle-foot orthosis practitioners and students with unique and practical information on foot orthotic therapy. We will provide insight on what’s new in the literature regarding orthotic therapy, orthotic hints and pearls, practice managment information, our opinions on new technology and even some thoughts on controversial topics in the foot orthotic industry. We welcome input and suggestions from orthotic practitoners and others interested in orthotic therapy. This is, however, a discussion on the practice of orthotic therapy and not designed as site to provide medical information to the public.

By Larry Huppin, DPM on 9/28/2009 6:31 PM
Occasionally, a patient will develop back pain secondary to wearing new foot orthotics. We have a recommended protocol for dealing with this situation.

First, if back pain is going to occur, it will usually happen during the first couple of weeks the patient is wearing their new orthoses.  When patients complain of back pain during the orthosis break-in, we use the following protocol:  
  • When symptoms first occur we have the patient stop wearing the orthoses until the pain is 100% relieved.
  • Once the pain is gone, we have the patient start wearing the orthoses again, but instead of the standard break-in of one hour on day one and increasing by one hour per day, we start with only 15 minutes on day one and then increase by 15 minutes per day.
  • If pain starts again, the patient is instructed to stop wearing the foot orthoses and call us immediately.
  • < ...
By Larry Huppin, DPM on 9/24/2009 4:00 PM
In the near future, optical foot scanners will replace plaster as the primary method of capturing the foot for production of functional orthoses.  We have spent a tremendous amount of time researching scanners over the past several years and have developed criteria which should be used in evaluating any scanner you are considering.  

I have an article published in the August issue of Lower Extremity Review that is essentially a consumer guide designed to help podiatrists evaluate scanners.  You can read the scanner article here.  

ProLab is the podiatric profession's best source for information on scanners.   We will be providing significant resources here ...
By Larry Huppin, DPM on 9/21/2009 3:15 PM
A ProLab client called me today wanting to know if there was any literature available supporting the use of orthotic therapy in the treatment of patello-femoral pain.  An orthopedist in his area was telling a patient that there was no support for the use of orthotics.  He needed something to send the orthopedist supporting the treatment and, hopefully, helping to develop a referral source.  

In fact, there is a tremendous amount of literature available and we have made it easy for you to find it.  

ProLab has put together the internet's most extensive list of medical literature related to orthotic therapy.  This is available to everyone on our References page.   We have organized ...
By Larry Huppin, DPM on 9/17/2009 2:34 PM
There is still time to register for the International Conference on Foot Biomechanics and Orthotic Therapy.  If you are interested in expaninding your orthotic practice and improving your orthotic therapy efficacy, this is the one seminar you should attend.   There is not likely to be another seminar that will provide as much information that can be immediately applied in your practice.   

The conference will be held in Atlanta October 2nd - 4th, and we have seen some great last minute flight deals in the past few days.  

The seminar is a combination of lecture and workshops.  

Workshops include:
  • Evidence Based Orthotic Prescription Writing
  • Examination of the Hip a ...
By Larry Huppin, DPM on 9/14/2009 2:00 PM
Today we are going to look at a case study from my office – one that I find a bit disturbing in that two podiatrists wanted to perform surgical exploration on a problem that was easily handled with orthotic therapy. The patient is a 49 year old podiatrist (yes, a podiatrist) with a primarily CNC practice.

He has a 7 month history of pain at the plantar base of the 5th metatarsal. He reports a history of stepping on some glass about 8 months ago. A friend who is a physician removed a glass fragment, but since then he has had pain on the plantar foot near the 5th met/cuboid joint. He had both MRI and diagnostic ultrasound – both of which were negative for evidence of foreign body.

He has since seen two local podiatrists. Both of whom advised surgery to explore the area for foreign body.

His exam was significant for a cavus foot structure with a plantarly prominent styloid process right. Pain to palpation was present on the right ...
By Larry Huppin, DPM on 9/10/2009 1:32 PM
A 53 year old woman presented to the office this week with a primary complaint of pain under the first met head right. Her history was significant for an ankle fusion 2 years ago.

Exam was significant for pain on the tibial sesamoid and the fact that she as fused in 5 degrees of plantarflexion. In stance, her heel would not touch the ground unless her knee was in recurvatum. When I placed her knee in a mildly flexed (normal stance) position, I measured the heel off the ground by 9mm.

She wants to be active. She also would like to wear cute shoes occasionally.

Treatment Goal: Reduce pressure on the sesamoids by transferring force to the medial arch and by getting the heel to bear weight

Orthotic prescription:
By Larry Huppin, DPM on 9/7/2009 11:48 AM
Anyone who is interested in improving their orthotic therapy practice should plan to join us in Atlanta October 2 - 4, 2009 for the 12th annual International Conference on Foot Biomechanics and Orthotic Therapy.  

I can't recommend this conference highly enough.  This is the only conference this year focused entirely on biomechanics and foot orthotics and is the "must see" seminar for anyone looking to expand this part of their practice.  

This year's conference is almost entirely clinically oriented.  Seminar tracts include:
  • Orthosis Efficacy
  • Postural Control Interventions
  • Pediatric Flatfoot Strategy
  • Footwear Design and Innovation
  • Mechanisms of Injury
  • Sports Medicine
In addition you will have the opportunity to ...
By Larry Huppin, DPM on 9/3/2009 2:33 PM
I had a 9 yo soccer player in my office today with a complaint of medial ankle pain with activity. She was brought in by her mother who was frustrated with the treatment that had been provided so far. The patient, we’ll call her Cindy Lou, has been active in sports since age 4 and has never been one to complain of pain except for this problem. Now she has been having medial ankle pain for over 4 months. They have seen the pediatrician several times and he has recommended Tylenol and ice. They purchased more stable soccer shoes and some Superfeet arch supports – which helped a little. When they presented again to the pediatrician he told them to it was “growing pains”, don’t worry about it and to stop activity if it continued.

Frustrated, they were referred to us by the mother of one of Cindy Lou’s soccer teammates. Her pain was medial ankle behind the malleolas and posterior-medial leg. There is pain to palpation along the course of the posterior tibial tendon.

By Larry Huppin, DPM on 8/31/2009 2:19 PM
A patient presented to my office today for follow-up on her posterior tibialis tendonitis.  On the last visit we had dispensed a pair of ProLab PTTD orthoses to control her extreme pronation.  She was doing great.  She loves the orthoses and all of her tendon pain has resolved.   The only problem is that she has developed some blisters pn the left foot in the area of the talo-naviuclar joint plantarly. 

The orthoses appear to fit well and they do not appear to be too narrow (which could lead to blistering as the medial foot can ride over the medial edge of the orthosis.

This is a relatively easy problem to troubleshoot.   What we find works well is to simply increase the flex of the orthosis in t ...
By Larry Huppin, DPM on 8/24/2009 1:26 PM
A client called today with a question about a patient with OA of the left ankle joint. His biomechanical examination was significant for a 10 degree everted RCSP. Xrays show a valgus angulation of the ankle joint with increased moment through the lateral ankle and decreased moment medially.

Our goal with the orthosis to reduce the RCSP and bring the heel as close as possible to perpendicular in order to equalize force across the ankle joint. Thus, this will be an aggressive orthotic prescription. In fact, I would recommend warning the patient that the orthosis may have to be adjusted if the patient experiences uncomfortable pressure on the foot. The patient would not likely tolerate an orthosis that applied enough force to bring the heel all the way to perpendicular, but our prescription will act to bring it as close as possible to perpendicular.

Here is what we recommended:
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