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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 9/29/2011 9:56 AM
A treatment I use fairly regularly for patients with drop foot is a Dorsiflexion Assist Functional AFO. One problem I sometimes have with this device, however, is that the standard orthotic portion only extends to the metatarsals and that sometimes lets the toes excessively plantarflex.
By Larry Huppin, DPM on 9/26/2011 11:26 AM
Kevin Kirby, DPM gave a lecture at The Western this past June reviewing the current research on minimalist shoes; I thought the lecture was excellent and wanted all ProLab clients to see it so that they could better answer patient questions on barefoot running. 

Kevin recently repeated the lecture at a Fleet Feet store in Sacramento.  That lecture was recorded and we are happy to provide it to you below in four parts. The total length is about 30 minutes.  

By Larry Huppin, DPM on 9/23/2011 7:37 AM
A client called today asking about an orthotic prescription for lateral column overload. He was wondering if we might try a fifth metatarsal or fifth ray cutout. This would be similar to a first ray cutout that we might use for hallux limitus. This is an interesting idea and I actually have not tried it myself.

Our primary goal in this situation is to transfer pressure off of the lateral column and onto the medial column. If we can accomplish that then that should reduce the pain the patient is having from excessive lateral load. Below is the prescription we recommended:

By Larry Huppin, DPM on 9/8/2011 1:26 PM
I just had a client call asking if there was any way to increase arch height on an orthosis. There are a couple of options, but first, let’s discuss arch height for a moment.

There are a number of studies that indicate that orthoses that conform closely to the arch of the foot are likely to be more effective at treating many of the most common complaints that we treat with foot orthoses – including plantar fasciitis, metatarsalgia and hallux limitus.

In order for an orthosis to conform close to the arch of the foot, several things must happen in the casting, prescribing and manufacturing of the orthosis:

By Larry Huppin, DPM on 9/1/2011 10:48 AM
I had an interesting patient today who presented with complaint of pain on the plantar aspect of her foot only when she used the elliptical machine. When asked to point to the most painful area, she pointed under the plantar lateral aspect of the foot, particularly near the styloid process. She had been to two other podiatrists. The first recommended anti-inflammatory measures, and the second made her a pair of orthotics, but they actually made the problem worse.

This seemed to be a fairly straightforward problem in that she had a plantarly prominent styloid process on the right foot, which was the painful foot. This is the area where she was experiencing pain. Obviously, the pain was secondary to pressure on the prominent styloid.

By Larry Huppin, DPM on 8/29/2011 7:41 AM
  I had a consult call this morning from a client whose patient was complaining that his heel was slipping out of his shoe when he wore his orthotics. This was a polypropylene orthosis with an EVA rearfoot post.

This is one of my favorite problems both in the office and when I am consulting with clients because it is such a simple fix. All that needs to be done is
By Larry Huppin, DPM on 8/25/2011 1:04 PM
A recent article in Lower Extremity Review reviewed an abstract presented at the International Society of Biomechanics meeting which took place last month in Brussels. Researchers used a new method to measure dynamic plantar pressure distribution. Results showed that custom orthoses can improve distribution of peak pressure during dynamic foot loading in patients with the painful cavus foot.
By Larry Huppin, DPM on 8/22/2011 1:06 PM
You can help ensure that your patients are comfortable in their AFOs, both the Stabilizer AFO and the Functional AFO, by providing education as to the type of socks that they should use with their AFO. Features to look for on the sock to work well with an AFO include:
By Larry Huppin, DPM on 8/15/2011 1:58 PM
  I had an interesting consult call this morning. A client from the Midwest called in and said that she had a 14-year-old patient who suffered a metatarsal stress fracture while running in minimalist shoes. She convinced him and his mother to go back to a standard Brooks running shoe after the stress fracture occurred and he did fine for about six months. He then decided to try minimalist shoes again, and once again developed the stress fracture. Both the patient and his mother are insistent that he will continue using minimalist shoes. They think this is the best way for him to be a successful collegiate athletic.
By Larry Huppin, DPM on 8/11/2011 9:48 AM
As part of my job with ProLab, I spend a lot of time calling ProLab clients regarding consults for their patients. This means that I spend a lot of time on-hold with podiatrist’s offices around the United States. In the last half-hour I have had three very different on-hold experiences.  Although this blog has more to do with practice management than orthotic therapy, I think it is important to mention.
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