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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 11/23/2009 5:54 PM
I saw a 120 lb female patient back today who presented last year with medial malleolar pain when hiking. She was an active hiker, so this was significantly hindering her ability to enjoy the outdoors.

She didn’t have a particularly large malleolas, but she was quite pronated. Both heels were everted about 10 degrees in stance. As the feet pronated, the medial ankle rolled medially resulting in increased pressure of the malleolas against the medial wall of the boot.

Our treatment goal was to decrease the pressure between the boot and malleolas by limiting eversion of the heel.

Here is our prescription:
By Larry Huppin, DPM on 11/21/2009 11:51 AM
A patient presented to my office yesterday complaining of lateral foot pain left only. He had a history of clubfoot at birth that was only partially corrected surgically. He now has a left foot that has:
• Inverted heel in stance. Heel sits about 10 degrees inverted. Coleman block test is negative in that I could not reduce the inverted position by supporting the lateral forefoot.
• Equinus. Unless the knee is placed into recurvatum, the heel is about 1 cm off of the ground.
• Extremely high arch and plantarflexed first ray.
• Planatar prominence of the 5th metatarsal base

Overall, pretty classic findings for a clubfoot.

His only complaint is pain under the styloid process. He has never had orthotics, nor have they been recommended.

Our treatment goal is to reduce pressure on the plantar 5th metatarsal base. This is what was prescribed for the left foot:

By Larry Huppin, DPM on 11/9/2009 4:08 PM
There was a question on the PM News list serve last week about the use of heel stabilizers for treatment of pediatric flatfoot. While heel stabilizers can act to physically block eversion of the heel, evidence based medicine dictates that more sophisticated and effective devices are preferred for treatment of flat foot in children.

There is a tremendous amount of information on this website devoted to the pediatric flatfoot. Some of the links are below. In particular, we want to make sure you are aware of the P3 Prefabricated Kiddythotic, the first prefabricated children’s orthosis to incorporate features previously found only in custom orthoses. These include a medial flange, medial skive, deep heel cup and a rearfoot post.
By Larry Huppin, DPM on 11/5/2009 4:03 PM
I have a patient with PTTD for whom I made a ProLab PTD Pathology Specific Orthosis. It has worked great and she is pain free when she wears them. As you may know, however, this is a pretty bulky device and fitting it into anything other than a lace-up shoe is difficult. My patient wants to be able to occasionally wear somewhat dressier shoes and was wondering if we could make her a dress orthosis.

Normally, this is not only easy, but expected. About 70% of my female patients will end up with two pair of orthoses. A full sized pair for exercise and a smaller pair for dressier shoes. The PTD foot, however, is so dramatically pronated that a standard dr ...
By Larry Huppin, DPM on 11/2/2009 10:48 AM
If you are casting for a gauntlet type AFO such as the ProLab Stabilizer (these AFOs are often called an Arizona Brace after the company that first popularized this type of AFO), casting position is critical to ensure optimum comfort and function.  In fact, if the cast isn't perfect, we cannot make the AFO.  

We encourage all of our clients to watch this Gauntlet Stabilizer casting video on correct casting technique prior to casting your pati ...
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 ...
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