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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 4/12/2010 3:28 PM
Twice in the last week I have had a question about the best orthotics for ballet flats.  These are a currently popular style of womens dress shoe based on ballet shoes.  They are very flexible and have little or no heel height.   They tend to be very shallow.  

The short answer is that it is nearly impossible to fit an orthosis of any kind into a ballet flat and you are setting yourself, and your patient, up for failure if you give them the impression that any orthosis will fit in their ballet flats.  

We can make orthoses to fit many, maybe most, women's dress shoes.   But ballet flats are simply too shallow to accept an orthosis.  ...
By Larry Huppin, DPM on 4/8/2010 8:00 AM
A client emailed some pictures today of a patient who was having heel cup irritation from his orthoses. You can see the pictures below. He wanted to know what we could do to fix the problem.

Unfortunately, there is no way to effectively adjust this orthosis to reduce heel irritation. The device will need to be redone with a more heel expansion on the positive to create a wider heel cup.

This problem occurs because the non-weightbearing cast ...
By Larry Huppin, DPM on 4/1/2010 1:33 PM
We had a patient present earlier this week who had a prominent plantar fascia that was being irritated by her new orthoses. Below is detailed our standard troubleshooting plan for creating a plantar fascial groove in an orthosis that was made without one:
  1. If you have an EVA cover on the orthosis, leave it on. If the cover is anything other than EVA, remove it.
  2. If there is on cover, glue 3mm EVA or Poron to the dorsum of the orthosis
  3. Mark the plantar fascia with lipstick
  4. Line the orthosis up with the foot and press it into the foot in order to transfer the lipstick mark to the orthosis
  5. Use a Ticro Cone to grind a groove into the orthosis
  6. Put a thin cover on top of the device.
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 ...
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