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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 6/23/2011 7:19 AM
 I had a ProLab client call me today as he was having a problem with a 9-year-old patient’s parents. The child presented with calcaneal apophysitis and a rather severe pes planus foot type. Our client prescribed a pediatric flatfoot pathology specific orthosis. It was dispensed and they returned two weeks later stating that all symptoms were resolved and that they wanted a second pair. The second pair was ordered.

Apparently, then the child was seen by an Orthopedic Sports Medicine specialist and the parents were told that these were the “wrong type of orthotics” that the child should be in a more flexible orthosis.
By Larry Huppin, DPM on 6/20/2011 1:44 PM
Jenny Sanders, DPM (a former ProLab Medical Consultant) wrote a great article on high heels published this month in Podiatry Today. The following is the introduction to the article:

While podiatrists strongly advise patients to avoid wearing high heels, the reality is many patients will continue to wear them. With this in mind, this author emphasizes patient education on ensuring optimal fit and support, reviews key features to promote better stability, and discusses helpful shoe modifications.
By Larry Huppin, DPM on 6/16/2011 3:07 PM
 I had a ProLab client call me today with a question regarding a prescription for a patient who had suffered a lawnmower injury, which resulted in the loss of the posterior medial aspect of her calcaneus. After reconstruction she had a fairly normal shaped heel externally, but essentially had a narrow calcaneus which was resulting in plantar pain. The question was how to design an orthosis to help this problem?

Our goal is to transfer pressure off of the heel, and then also to provide some cushion. Cushion slows velocity of the foot and by doing so decreases force. The following is the prescription that we developed:
By Larry Huppin, DPM on 6/13/2011 3:00 PM
 Patients with out-toed gait sometimes have trouble tolerating orthotic devices. This occurs primarily because the out-toed position of their feet forces them to rollover the medial edge of the orthotic device and they develop medial edge irritation.

To prevent this problem, simply make your orthotics wider. By choosing “wide” for the orthotic width, you will extend the medial edge of the orthotic to the medial aspect of the foot. These patients will have the surface area of their orthotic under the entire foot and will not come down on the medial edge of the orthosis.

For orthotic hints every week, subscribe to the RSS feed of this blog.
By Larry Huppin, DPM on 6/6/2011 3:42 PM
Below is an email we received last week from a client with questions on two patients.   If you are a ProLab client please email or call us with any questions you might have regarding the best othotic prescription for your patient:   

Hi, I would like your guidance with two patients.

1. Rigid pes planovalgus from cerebral palsy (CP). She used orthotics when she was 5-10 years old. They caused blisters along the medial arch. Is there something I shoud avoid to prevent this from happening again?  She would really like to
By Larry Huppin, DPM on 5/16/2011 1:23 PM
Podiatry Arena
 Podiatry Arena is a forum in which some of the best foot biomechanists in the world participate in online discussions, debates, arguments and occasional virtual wrestling matches on matters pertaining to foot biomechanics and orthotic therapy.   

Each month we will provide you with links to the threads that would seem to be most interesting for our clients.
By Larry Huppin, DPM on 5/12/2011 9:59 AM
 In the new issue of Lower Extremity Review is an article that reviews theories on how orthotics function.  We are recommending this article to all ProLab clients.   You can read the full article here.  

Here is the introdution to the article:

By Larry Huppin, DPM on 5/9/2011 9:56 AM
 I had a patient present in my office today with a two-year history of fairly classic plantar fasciitis. She had seen a podiatrist during that time and had multiple treatments, which included orthotic devices, physical therapy, multiple injections bilateral, and standard anti inflammatory measures. She sought me out to get a second opinion because she has not seen much improvement. The patient was a pleasant 31-year-old woman who was obese. Pertinent biomechanical findings were a pes planus foot type. She had an everted heel in stance and nearly complete collapse of the medial arch. In gait, she showed fairly rapid midtarsal joint collapse, eversion of the heel,  and stayed maximally pronated throughout gait.

She was wearing her only pair of orthotics today. These were made by the previous podiatrist 9 months ago. They were carbon fiber orthoses. They had no post, a shallow heel cup, a fairly narrow width, and the arch did not conform very closely to the&a
By Larry Huppin, DPM on 5/5/2011 1:45 PM
I had two ProLab clients call me today with a complaint that their patients are sliding laterally off of their orthoses. They are wondering if anything can be added to the orthosis to prevent this problem.

The problem of sliding laterally off of an orthosis usually occur on more aggressive devices. For example, a device with a medial flange, medial skive, and inversion. All of these create a varus force and the medial skive and inversion both create a varus wedge within the heel cup of the orthosis. This can allow the patient to slide laterally.

In trying to address this problem, we can approach it in a couple of different ways. One way is to try and apply something to the 
By Larry Huppin, DPM on 5/2/2011 2:15 PM
I had a client call me today regarding production of a gauntlet AFO for a patient with posterior tibialis dysfunction and adult acquired flatfoot, but complicated by the fact that he has rather severe edema. He wanted to know if I thought this was something that might work for the patient. I had informed him that it is possible it could work well for him, but there are definitely some potential problems, and I certainly would not guarantee the patient a good result.

The gauntlet AFO is an excellent modality for treatment of adult acquired flatfoot. The problem is going to be with the patient’s edema. It is probably best to cast him while the patient is most swollen so that the device would never be too tight on him. The problem is 
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