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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 10/28/2010 5:10 PM
One of the questions I get quite frequently from clients is which dress orthosis they should prescribe. We offer three: You can use the links above to learn about each one, but below are ...
By Larry Huppin, DPM on 10/25/2010 2:13 PM

 A question from a client today:

Under what circumstances would you reduce manually a forefoot varus, 1st ray elevatus, or forefoot supinatus while performing a foot casting? 

The short answer to the question is: always. We recommend always applying a plantarflexion force to the first ray when casting. Our reasoning is noted below. Now, in the case of a true forefoot varus, applying this force won’t do anything. Forefoot varus is a rigid (skeletal) deformity.

In a 1986 study, Roukis and Scherer found that prevention of first ray plantarflexion resulted in decreased first MPJ dorsiflexion (hallux limitus). A subsequent study by Scherer, et al. looked at the effect in stance of a polypropylene orthosis made from a nonweightbearing negative cast taken with the first r ...
By Larry Huppin, DPM on 10/14/2010 6:14 AM
A patient presented yesterday with painful 4th and 5th toes on the right foot in the steel toe boots he must wear for work. He had tried a number of brands and always developed rather severe pain by the end of the day. The left foot was fine

He had an interesting foot with considerable splay of the toes. He had a hallux varus right along with adductovarus 4 and 5 with lateral splay of the 5th. The pain was coming from pressure on 4 and 5 both dorsally and laterally.

His boots were a size 14C. We keep a Brannock device in the office and his feet measured as a 14C. If the Brannock could measure width at the toes, however, he probably would be a 14EEE. To relieve his pain he would need more room in the toebox both in depth and width. To get a boot that would not put undue pressure on the toes of his right foot, however, could result in a boot that was too large for the left foot.

By Larry Huppin, DPM on 10/7/2010 12:31 PM
The following is an email we received from a patient who received her orthoses about two years ago and since moved out of state.  It is a good example of how patients need to be educated on the reasonable lifespan of foot orthoses and the importance of occasional refurbishment. You might find this useful in discussing orthotic lifespan with your own patients.  

I've been wearing the orthotics Dr. Huppin prescribed. I like them in many ways and they've definitely relieved bunion pain. I'm disappointed in the durability however. The 3/4 dress pair is coming apart / worn through on the edge of the heel-cup, so is too sharp on my heel now.

Dear _____

Good to hear from you. I hope you are doing well in your new home.

The shell (hard portion) of foot orthotics usually lasts for several years ...
By Larry Huppin, DPM on 10/4/2010 5:04 PM

By Larry Huppin, DPM on 9/27/2010 2:44 PM
I have had a lot of questions lately regarding correct coding for gauntlet type AFOs like the ProLab Stabilizer.  

This is a three-code brace.   Use these three codes to bill for gauntlet AFOs:

L-1940 A semi-rigid, molded, plastic orthosis to hold the foot in neutral position (dorsi -plantar flexion), controls foot position, custom molded from a model of the patient, custom fabricated, includes casting and cast preparation.

L-2330 A leather, or similar material, lacer molded from a model of the patient, that fits around the calf area, includes casting and cast preparation.

L-2820 Addition to lower extremity orthosis, soft Int ...
By Larry Huppin, DPM on 9/13/2010 2:01 PM
I had a patient present several weeks ago with lesser metatarsal pain. This was secondary to an iatrogenic short first.  In fact, the first met head did not touch the ground, leading to rather severe pressure (and pain) under the other metatarsal heads.  

Our treatment goal was to help the first met head bear weight and to transfer pressure off of the lesser met heads.   

You can see on the picture at right how the first ...
By Larry Huppin, DPM on 9/2/2010 1:53 PM

I found a great blog focused on helping women find exceptionally fashionable shoes that are still good for the feet. The blog happens to be written by a friend of mine and a ProLab client.   She is a podiatrist in Portland, Oregon and loves shoes.   Her blog has become my go-to resource when women want to find extremely attractive shoes that still offer some protection for painful feet. 

Here is her introduction to the blog:

This is a place where I can feature shoes that are amazingly adorable, stylish and yet feel quite comfortable. Do all of these shoes work for everyone? No. Can you walk in all of them on vacation without pain? No.  & ...

By Larry Huppin, DPM on 8/30/2010 6:55 AM
I’m sitting on a plane now returning from the ACFAOM meeting in Orlando where Drs. Paul Scherer, Mark Reeves, Doug Richie, Richard Stess, Mr. Jeff Root and myself presented a track on evidence based orthotic therapy. We hear again and again that attending one of these orthotic therapy tracks is a practice changing event for many practitioners who are still practicing orthotic therapy as it was taught to them in school 10, 20 or 30 years ago. Extensive research on the use of foot orthoses has changed dramatically the way orthotic therapy should be practiced and if you haven’t attended an evidence based orthotic therapy seminar in the last few years, make a point to do so. Upcoming seminars can be found here. For those of you in the northeast, nearly two full days of lecture and workshop will be presented at the New York Clinical Confere ...
By Larry Huppin, DPM on 8/26/2010 4:10 PM
Rocker sole shoes have become very popular in the past few years. Often marketed as “toning shoes”, there really is no evidence that they offer any exercise or fitness benefit over regular shoes. Rocker soles, however, have been shown in a number of studies to be an effective  treatment modality for foot conditions including metatarsalgia, forefoot ulcers, midfoot arthritis, ankle arthritis, hallux rigidus and heel pain.

The best known brands of the rocker shoes are MBT and Sketcher Shape-ups. They are not however, in our opinion, the best of the rocker soles. The problem with the MBTs and Sketchers is that they have extremely soft and unstable soles under the heel.  This makes them unstable in the frontal plane.  The manufacturers claim that this lack of stability increases the “toning” function of the shoe, but have no evidence to support this claim.

Instead, if you are going to prescribe rocker shoes for your patients we reco ...
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