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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 2/22/2010 11:02 AM

Sometimes it's important to go back to the basics.  The quality of the negative cast is critical to ensure optimum clinical outcomes from functional foot orthoses.  

For best outcomes, the cast must be taken with
  • The subtalar joint in neutra ...
By Larry Huppin, DPM on 2/18/2010 5:13 PM
I consulted with a client today who had a patient with peroneus brevis enthesiopathy.

The goal with orthotic therapy in these cases is to increase the force that the orthotic is exerting on the foot lateral to the subtalar joint axis. Since the peroneus brevis is acting to evert the foot, our orthoses should assist this action in order to reduce the need to fire this muscle. Not suprisingly, it is often patients who are laterally unstable who experience this problem.

Remove soft tissue varus (supinatus) when taking the negative cast. This is imperative as it results in greater forefoot valgus in the negative cast and ultimately in the orthosis. This results in an orthosis that will better support the lateral forefoot and thus reduce the need for the PB to fire. Watch our casting video

  • Material: A semi-rigid polypropylene. Either direct-milled or vacuum formed.& ...
By Larry Huppin, DPM on 2/11/2010 7:43 AM
A recent paper by Margaret Evans, PhD has been discussed here on this site several times and we summarized it in one of our eJouranl Club Newsletters.  The paper reviews the best studies currently available on treatment of pediatric flatfoot and lays out a clinical pathway with recommendations on treatment. The most controversial portion of her recommendations had to do with those children with asymptomatic flexible flatfoot. Her paper recommended a “monitor” approach to these children. But some practitioners are concerned that these underlying structural abnormalities, ...
By Larry Huppin, DPM on 2/8/2010 4:22 PM
Dr. Choate asked in a recent blog what other practitioners thought about some of the rocker shoes, such as MBT and Sketcher Shape-ups, which are currently available in many shoe stores.

In general I don't recommend these shoes very often. I have a problem with much of their adverting and feel that they make false claims about fitness benefits of their shoes. In addition, they’re ugly.

Given that, however, there are some patients that do relatively well with these shoes.

The first thing to keep in mind is that these are simply shoes with a midfoot rocker sole. For decades, midfoot rocker soles have been effective treatments at reducing motion through the midfoot and reducing ground reactive forces on the heel. < ...
By Larry Huppin, DPM on 1/25/2010 12:40 PM

By Larry Huppin, DPM on 1/20/2010 10:08 PM
Medial hallux pinch callus is a sequellae of functional hallux limitus. When the hallux is unable to dorsiflex during toe-off, abductory twist leads to rolling off of the medial aspect of the hallux and “pinching” the skin – leading to the pinch callus. Thus your goal when prescribing an orthosis to reduce hallux pinch callus is to create an orthosis that treats functional hallux limitus. Our recommendation for an orthotic prescription to best treat hallux limitus can be found here.

ProLab clients are encouraged to ...
By Larry Huppin, DPM on 1/18/2010 3:03 PM
When the rearfoot everts, the medial forefoot is forced into the ground. This results in a dorsiflexion force on the first ray and jamming of the first MPJ as the patients begins to toe-off.

An article published several years ago in the Journal of the American Podiatric Medical Association gives us some good data on this relationship. Paul D. Harradine, MSc, and Lawrence S. Bevan, BSc (Hons), did a preliminary study on "The Effect of Rearfoot Eversion on Maximal Hallux Dorsiflexion." They found that hallux dorsiflexion is decreased with rearfoot eversion*.

This again underscores the importance of prescribing rearfoot control when treating hallux limitus.

To resist rearfoot eversion, your orthotic prescription should contain:
By Larry Huppin, DPM on 1/14/2010 6:34 PM
I had a patient present several months ago with diffuse midfoot osteoarthritis bilateral. Pain was present with most weightbearing activities and increased with exercise. Regardless of the joints involved in the midfoot, our goal with treatment is to limit the motion that causes pain.

Our first line of treatment was a custom foot orthosis with the following prescription:
  • Semi-rigid polypropylene
  • Deep heel cup
  • Wide width
  • Minimum cast fill
  • 0/0 rearfoot post

When trying to limit midfoot motion, be sure that your orthosis conforms very closely to the arch of foot and also acts to limit subtalar joint pronation.

These orthoses provided about 30% improvement of her symptoms, but she was still experiencing significant pain.

Our next line of treatment was the use of r ...
By Larry Huppin, DPM on 1/4/2010 4:14 PM
A patient presented today with bilateral pain on the plantar lateral foot with activity. His exam was significant for:
  • Cavus feet
  • Inverted RCSP with a positive Coleman Block test (by supporting the lateral forefoot the heel came to perpendicular)
  • Humongous styloids – plantar and lateral.
  • Pain to palpation on plantar styloids – no pain lateral.
He had a pair of orthoses that were not helping much. These devices were gapping extensively from his medial arch and although they had some accommodation plantarly for the styloids, it wasn’t nearly enough.

Our treatment goal is to reduce pressure under the styloid processes.

Here is the orthotic I prescribed:
By Larry Huppin, DPM on 12/28/2009 9:31 AM
In Orthoses for Soccer Cleats Part 1, we provided a general orthotic prescription for soccer cleats. Using this prescription as a foundation, detailed below are our recommendations for modifying the basic soccer cleat orthotic prescription for specific pathologies. Detailed information on our reasoning for these modifications, including evidence in the literature, can be found by using the links to the Pathology Specific Orthosis for each pathology. Because we are using forefoot extensions,all of the following require a cover.
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