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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 6/21/2010 12:36 PM
Orthoses for dress shoes can be great. Personally, I prescribe many graphite orthoses with a shallow heel cup, normal width, and vinyl cover to the sulcus for these shoes. This device works wonderfully in many women’s and men’s dress shoes.

I tell every patient, however, that I make NO guarantee that the orthoses will fit in ANY shoe that they currently own. In fact, I tell them that they probably will NOT fit in any of their current shoes but that I will give them a list of fashionable shoes that often work well with orthoses.

Even if you send the shoe to the lab, we can only guarantee you that the orthosis will fit the shoe. We cannot guarantee that the foot will then fit into the shoe with the orthosis. It may make the shoe too tight or the patient’s heel may slip ...
By Larry Huppin, DPM on 6/17/2010 10:43 AM
By Larry Huppin, DPM on 6/10/2010 2:08 PM

Have you ever had a patient complain that their orthoses cause pain under the anterior distal arch or feel they are "too far forward”? More often than not, what the patient is actually experiencing is excessive pressure from the orthoses under the anterior metatarsal shafts. You can quickly and easily troubleshoot this problem by increasing the flex of the orthosis under the distal metatarsal shafts.

By Larry Huppin, DPM on 6/3/2010 1:57 PM
Providing Realistic Expectations about Orthotic Therapy

We spend a lot of time educating our patients about the benefits of orthotic therapy. We spend just as much time ensuring that our patients understand the limitations of their new orthoses.

We try to provide our patients with very realistic expectations about some of the limitations of orthotic therapy. By making sure that they understand these limitations before making the decision to proceed with casting for the orthoses, we eliminate most disappointment and misunderstanding. Just a few of the issues we raise with patients are:
  • New shoes will likely be necessary as we cannot guarantee that the orthoses will fit in any shoes they currently own.
  • Women need to choose whether their first pair of orthoses will be used in dress or athletic shoes. They will not work for both
  • Orthoses are not a cure, just a tool to r ...
By Larry Huppin, DPM on 5/24/2010 5:16 PM
I had a client call with the following question today: 

Do you have any idea of how to successfully treat a sheer varus friction type of callus at the plantar tip of the 4th toe? In theory, a good pair of functional orthoses with a Spenco extension should work. But I have never had good success with this. Any suggestions?

This is a tough keratosis to treat with orthoses, but here are a couple ideas. The following information assumes you already have an orthosis that is providing adequate control of the foot.

The most important thing is to use a topcover on your orthosis that will show an impression of areas of increased pressure. For example, Diabetic Topcover works well. This is a tri-layer material with a Poron bottom layer, soft Plastizote middle layer, and a leather topcover. EVA is another material that will show an impression.

After the patie ...
By Larry Huppin, DPM on 5/20/2010 9:05 AM
Prescribing rearfoot post motion is one of the more confusing issues on orthotic prescriptions.

Traditionally, the post motion is prescribed as 4/4, 0/0, or some other similar combination. It is important to understand what each of these numbers mean.

The first number is the amount of lateral grind on the post that holds the front edge inverted before forefoot loading. This is most often 4 degrees to accommodate the inverted position of the heel at heel contact.

The second number is the amount of motion the orthotic has during forefoot loading when the front edge comes down to the ground.

A 0/0 post is ground parallel to the front edge of the orthotic and is intended to keep the front edge flat in the shoe regardless of foot movement.

A 4/4 post is one in which the lateral aspect of the post is inverted 4 degrees to the front edge of the orthosis and there is 4 degrees of mot ...
By Larry Huppin, DPM on 5/13/2010 9:31 AM
Some of the studies we discuss in our eJournal Club refer to the Foot Posture Index(1, 2). The Foot Posture Index consists of six specific criteria:
  • Palpation of the talar head
  • Supralateral and infralateral malleolar curvature
  • Calcaneal frontal plane position
  • TN joint prominence
  • Abduction and adduction of the forefoot on the rearfoot.
  • Congruence of the longitudinal medial arch
Each Foot Posture Index criterion is scored by an examiner on a 5-point scale ranging from -2 (very supinated) to +2 (very pronated)

Scores are then summed to give an overall foot posture score. The summed score has the potential to range from –12 (highly supinated) to +12 (highly pronated).(1, 2)

To increase accuracy multiple examiners can be used and the totals averaged.

St ...
By Larry Huppin, DPM on 5/10/2010 12:15 PM
The ProLab Medical Consultants can provide consultation for even the most challenging biomechanical cases when we can see your patient.  Today's technology makes that easy.  If you have a particularly difficult case, take pictures and / or video of the patient and email them to us. &# ...
By Larry Huppin, DPM on 5/6/2010 6:39 AM
In the year we have been using diagnostic ultrasound (US)in our office, I’ve made changes in some orthotic prescriptions based on US findings. In particular, US has affected my orthotic prescription in those cases where there is thickening of the plantar fascia directly plantar to the calcaneus.

When US indicates that there is excessive inflammation / thickening of the plantar fascia directly plantar to the calcaneus (rather than at the medial tubercle where we primarily see thickening of the fascia) I’ve started adding extra cushion to my orthotic devices. I’ll usually prescribe one of our Pathology Specific plantar fasciitis orthoses, but add a
By Larry Huppin, DPM on 5/3/2010 3:40 PM

I was in Canada this weekend.  I learned that they play a strange game up there that has to do with ice and sticks and pucks.   Apparently, the stick is used to hit the puck which moves at great speed across the ice.   Occasionally, a foot or ankle gets in the way of the puck resulting in a fairly high incidence of foot fractures and contusions.  

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