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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 3/29/2010 1:57 PM
If you ever grind polypropylene, you know it can look a bit rough after grinding. If you are going to be grinding poly in your office, you should have the ability to polish it also.  Read here why you should have a grinder in your office.

To polish polypropylene, we recommend the use of a Ticro Cone. This is a Hot Dog shaped f ...
By Larry Huppin, DPM on 3/25/2010 1:19 PM
Over the past several weeks we have discussed five critical rules for casting for functional orthoses.  Following these rules will assist you in providing optimum clinical outcomes to your patients.

All five rules are listed below with links to the blog entries that discuss each rule in detail
By Larry Huppin, DPM on 3/15/2010 1:00 PM
In part 1 of this series, we discussed the first two of our Five Rules of Negative Casting: It turns out that casting with a plantarflexed first ray may have other benefits. A cadaveric study by Kogler in 1999 found t ...
By Larry Huppin, DPM on 3/11/2010 7:51 AM
Casting Criteria for Optimum Clinical Outcomes

When casting for functional foot orthoses, in what position should the foot be held in order to achieve optimum clinical outcomes. McPoil et al looked at this question in 1989 and found that foam box semi-weightbearing casting resulted in a forefoot-to-hindfoot angle that was significantly smaller than the angle measured using either of two nonweightbearing methods.(2) It is suggested by McPoil that the difference is due to the inability of the midtarsal joint to lock using the semi-weightbearing method.

Davis et al did a similar study in 2002 where they compared methods for taking a negative cast of the foot.(3) Non-weightbearing plaster was compared to semi-weightbearing foam. Their conclusions were that NWB casting ...
By Larry Huppin, DPM on 3/1/2010 3:07 PM
I had three new patients today who presented with relatively new foot orthoses received elsewhere. All were continuing to have pain and had questions on whether the orthoses were appropriate for their feet. Two of the patients had plantar fasciitis and the other metatarsalgia.

Each of the three orthoses were gapping significantly from the arch of the feet and one was flexible enough that it collapsed entirely with finger pressure.

Significant literature supports the use of “total contact orthoses” that conform closely to the arch of the foot to both reduce tension on the plantar fasica and to transfer pressure off of the forefoot. None of these orthoses were conforming to the arch of their respective feet.

This is sometimes a difficult situation. The patient has already paid a lot of money for custom orthoses and no ...
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, ...
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