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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 10/24/2011 6:21 PM
I did a consult this morning with a ProLab client who has a patient who had a Keller bunionectomy several years ago and now is feeling unstable and developed arch pain on that foot.

The biomechanical examination showed that she had a fairly rectus heel in stance and possibly was even a little bit inverted. She did not have hallux purchase and there was no significant contact of the remaining first metatarsal with the ground.

Our goal with this orthotic is to provide stability, improve hallux purchase, and decrease tension on the plantar fascia. Below is the orthotic prescription we recommended.
By Larry Huppin, DPM on 10/20/2011 7:52 AM
I had a ProLab client call me today with a question regarding orthotics for a patient who has mild to moderate hallux limitus pain while cross-country skiing. In a previous blog, I had written about orthotics for downhill ski boots, and you can read that here. Cross-Country is a significantly different sport, however, primarily because of the need for motion at the metatarsophalangeal joints in some (but not all) boots.

Cross-Country Ski boots can be somewhat narrow in the heel. This means we have to limit the size of the orthotic in the heel. In addition, heel control is not particularly important while cross-country skiing.
By Larry Huppin, DPM on 10/17/2011 1:39 PM
The September 20, 2011 issue of Podiatry Management magazine has an entire section devoted to orthotic therapy. There are several articles I think would be beneficial for ProLab clients to read. One of those is Paul Kesselman’s update to orthotic billing for 2011. He notes that there are four important issues that have occurred in orthotic therapy billing in the last year.
By Larry Huppin, DPM on 10/13/2011 1:32 PM
In my blog on September 29th, I talked about using an extended footplate on a dorsiflexion assist AFO to provide digital support.

This patient returned a couple days after we dispensed this stating that the AFO was working great. It was comfortable except for the fact that she was having too much compression on top of her toes from the shoe. Essentially the footplate was taking up room in the toe box leaving less room for her toes.
By Larry Huppin, DPM on 10/10/2011 1:25 PM
I just spoke to a ProLab client this morning who had a patient return to clinic after wearing her orthoses for a few weeks. She was overall very happy with the function of the devices, but on the right foot she was getting some lateral heel irritation and callus formation. The doctor called asking what he could do to fix this situation.

There are several reasons this can occur. The first is that the heel cup is too simply narrow for the patient’s heel. The only way to determine this is to place the patient on the orthosis in stance and see if the heel cup is too narrow, and the soft tissue of the heel is riding over the edge of the orthosis
By Larry Huppin, DPM on 10/6/2011 10:05 AM
If you have a patient with a prominent plantar fascia, you always have to worry that the orthotic shell may irritate the plantar fascia. This is a fairly common cause of arch pain in a patient wearing orthosis.

II do not generally prescribe plantar fascial grooves within my orthoses since it is very easy to add a PFG to an orthosis that has already been made. The easiest way to do this is to put lipstick on the plantar fascia, hold the orthosis up
By Larry Huppin, DPM on 10/3/2011 10:01 AM
I had a recent question from a client regarding the best orthotic prescription for a patient with a tendency toward hallux ulceration.

Obviously, our primary goal is to reduce pressure on the hallux. We can accomplish that in several ways. The most important aspect of building an orthosis that will act to reduce pressure on the hallux is to ensure that you treat any functional hallux limitus that is occurring. If there is not adequate motion occurring at the first MPJ during gait, pressure increases under the hallux. When writing the orthotic prescription, the first thing you want to check is whether or not there is available first MPJ motion nonweightbearing. If so, you are going to design an orthotic to treat the functional hallux limitus. This would include a device that is taken
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:

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