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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 10/29/2009 10:39 AM
In the coming months and years, we predict that 3-D optical foot scanning will replace plaster casting as the method of choice for capturing foot shape for production of functional foot orthoses. We also predict that there is great potential for laser scanning of the feet to result in better casts and, subsequently, better orthoses.

Digital imaging of the feet will result in better orthoses primarily because plaster is a difficult material to work with. Plaster is slippery, wet, soft, slimy and takes a long time to dry. If not dry, it bends out of shape easily when being removed from the feet. In addition, because it takes a long time to dry, some practitioners have staff take the casts. This usually results in a less than optimal cast. Others resort to using foam boxes, which have been shown in several studies to cause excessive varus to be captured in the cast and, ultimately, the orthoses. In fact, foam box casts tend to produce such poor functional orthoses that
By Larry Huppin, DPM on 10/26/2009 7:25 AM
Villager™Winter is coming and with it wet, cold and slippery weather.   Do you have patients who require supportive shoes or need to wear prefabricated or custom orthoses, but must wear waterproof boots for work, play or chores? If so, we have a solution for you.

Our solution is to have your patient wear stable shoes and have them purchase a NEOS overshoe. NEOS (New England Overshoe Company) is a line of high-tech overshoes. Essentially, they are high-tech galoshes. They are completely waterproof, go on easily, are lightweight, have great traction and come in many styles for various activities and climates. They fit over almost all shoes and boots. Some patients use a pair of NEO ...
By Larry Huppin, DPM on 10/22/2009 7:07 AM
I have a patient who, by history, seems to have had a triple done years ago by an orthopedist ...
By Larry Huppin, DPM on 10/15/2009 12:07 AM
Dr Cherri Choate wrote in her blog entry last week about research demonstrating that a cushioned topcover can act to reduce shock.  You can read her entry here and you can read our eJournal Club article on the subject here.   

Based on this article, my standard cover for runners is now a 3mm soft EVA cover to the toes with 1.5mm Poron gluded to the bottom of the cover.   This combination not only provided excellent cushion but has been shown to hold up well.& ...
By Larry Huppin, DPM on 10/8/2009 1:20 PM
There are few pathologies that have more literature supporting the use of custom foot orthotic therapy than lateral ankle instability. Unfortunately, orthoses are rarely a first line treatment for this problem.

We recommend every orthotic practitioner read /Dr. Doug Richie's excellent literature review of the subject:
Richie, DH: Effects of foot orthoses on patients with chronic ankle instability. J Am Podiatric Med Assoc 97:19-30, 2007.

The orthotic prescription for this condition is fairly complicated, in that the prescription will vary depending on the foot type. The literature indicates that the lateral ankle instability patient with an overly pronated foot should have an orthosis that resists pronation. We refer you to Dr. Richie's article for an explanation of why this is necessary. For the patient with an excessively supinated foot, however, the literature indicates that the patient sho ...
By Larry Huppin, DPM on 10/1/2009 6:56 PM
We just arrived in Atlanta for the annual International Conference on Foot Biomechanics and Orthotic Therapy.  This should be an excellent program focusing on practical applications of orthotic therapy.   In the coming weeks I'll use this space to provide you with pearls we learn this weekend.   Start thinking now about attending the conference next year - as soon as I learn the dates and location it will be posted here.  

In the meantime, I highly recommend that every podiatrist with an interest in orthotic therapy read the September 2009 issue of Podiatry Management.   This issue is devoted to orthotic therapy.   I haven't seen the articles up on the Podiatry Management website yet, but as soon as they are up we'll lin ...
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 ...
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