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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 11/29/2010 1:01 PM
A client today asked for a recommendation for a patient with sub 1 and 5 rheumatoid nodules.

First, all orthotic practitioners should be aware that there are several good studies supporting the use of orthotic therapy in patients with RA. You can find some of rheumatoid arthritis articles listed here

Our goal when treating patients with painful sub-metatarsal nodules is to transfer pressure off of the involved metatarsal heads – in this case met heads one and five.

Here is our recommendation:
  • Material: Semi-rigid polypropylene. Other materials, such as firm Plastizote would also work. The material simply must be rigid enough to resist deformation in order to effectively transfer force
By Larry Huppin, DPM on 11/25/2010 8:18 AM
By Larry Huppin, DPM on 11/22/2010 1:12 PM
Bike ShoeI have a number of patients who develop numbness, tingling and other neuritic symptoms while bicycling. We have been very successful treating these problems with a combination of foot orthoses and shoe changes.

My assumption is that the neuritic symptoms occur for two reasons:
1. Pressure from the axel of the pedal directly under the metatarsal heads leading to inflammation and compression of digital plantar nerves
2. Shoes that are too narrow due to swelling of the feet during longer rides

Our orthosis treatment is focused on reducing pressure under the metatarsal heads. Bicycle shoes, however, do tend to run small relative to running shoes and some orthotic modifications specific for bike shoes are often necessary. Our recommended bicycle shoe orthosis is ...
By Larry Huppin, DPM on 11/18/2010 6:35 AM
We have spent a lot of time in our lectures, articles and on this website discussing orthoses for hallux limitus, in particular functional hallux limitus (FHL). Our goal with these devices is to decompress the first MPJ and enhance hallux dorsiflexion. Some orthotic prescription items we use for this problem include a minimum cast fill, cast inversion and reverse Morton’s extensions. You can read a number of articles and suggestions on orthotic prescriptions for hallux limitus here. 

We have spent less time, however, addressing hallux rigidus and I think it is worth discussing how your orthotic prescription might change in the presen ...
By Larry Huppin, DPM on 11/15/2010 2:03 PM
MatrixLast week we discussed carbon fiber AFOs in the treatment of dropfoot. Some studies indicate that in many situations they may be a better choice than traditional plastic AFOs due to the fact that there is evidence that there is greater function of the posterior muscle group with use of the carbon fiber AFOs.

Most carbon fiber AFOs, such as the ProLab Matrix, are prefabricated. This brings up the question of what kind of customization can be done. Below is information on how to customize the matrix AFO.
  • Add a Foot Orthotic: One of the most important advantages of carbon fiber AFOs is the ability to control different planes of motion independently. Much of this abil ...
By Larry Huppin, DPM on 11/11/2010 5:00 AM
MatrixInteresting article this month in Lower Extremity Review on carbon fiber AFOs such as the ProLab Matrix AFO. More and more data is demonstrating the benefit of these devices to treat drop foot in place of traditional plastic AFOs.

The Benefits of Carbon Fiber AFOs
Not only are these AFOs lighter and often more comfortable than traditional AFOs, but they provide energy return at toe-off to help prop ...
By Larry Huppin, DPM on 11/4/2010 8:56 AM
I have a number of patients who are Seattle firefighters. If you also treat firefighters, it is a great benefit for your patients if you become familiar with the boots that they must wear. 

Firefighters must have two pair of work boots. These are station boots, which they wear in the station; and turnout boots, which they wear on runs.

A number of my firefighter patients have trouble with the turnout boots provided by the Seattle Fire Department (SFD). They are rubber boots which are unstable and large. They tell me it’s like having to wear a pair of waders. Those with foot problems who need orthotic devices particularly have trouble with these boots. A study, which I detail below, has demonstated that the leather boots are likely safer than rubber. 
The SFD only allows a boot substitution with a doctor’ ...
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.

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