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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 11/28/2011 2:09 PM
 I spoke to a ProLab client today who had a patient with an osteochondral defect of the ankle. He performed a scope and the patient was doing better, but she was still having what he thought was lateral impingement. She had a calcaneal varus and an ankle valgus. He wanted to know if there was anything we could do with orthotic devices to reduce her symptoms.
By Larry Huppin, DPM on 11/14/2011 2:00 PM
 As we come into our winter sport season, we are seeing more requests for orthotics for ski boots, snowboard boots and ice skates

These are all very tight fitting boots. This tight fit makes fitting an orthosis much more difficult. ProLab has established some requirements for production of these specialty orthoses. 

Ice Skates
We cannot make orthoses for skates unless we have the skates. No exceptions. Note that this will increase both your outbound and inbound shipping costs. We recommend that this cost be passed on to the patient. In my office we charge an extra $25 for shipping of the skates, payable at the time of casting. 
By Larry Huppin, DPM on 11/10/2011 6:56 AM
A ProLab client called me today with questions regarding a prescription for a pair of orthoses for a patient who recently had an arthrodesis of the first metatarsophalangeal joint on the right foot, and was experiencing first MPJ pain secondary to hallux limitus on the left foot. On the right foot, the patient was experiencing metatarsalgia pain with pain primarily under the second MPJ.

Our goal of treatment is to decrease pressure on the second metatarsal head on the right foot, and on the left foot to enhance motion in the first metatarsophalangeal joint.

The following was our prescription:
By Larry Huppin, DPM on 11/3/2011 7:14 AM
I had a ProLab client call me this morning regarding how to write a prescription for a patient who is experiencing pain from calcaneal cuboid arthritis. This patient had a subtalar joint fusion 30 years ago. In the past couple of years he started developing lateral column pain that seems to be due to calcaneal cuboid joint OA.

By Larry Huppin, DPM on 10/31/2011 10:18 AM
  If you are having shoe fit problems with your orthoses, make sure you are taking the following into account. 
  • Instruct your staff to tell patients to bring 2-3 pairs of shoes to their initial appointment
  • Evaluate the patient’s shoes before prescribing orthoses
  • Which type of shoe does the patient plan on using for their orthotics? The prescription must be different if the orthotics are for a dress shoe vs. an athletic shoe.
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
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