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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 7/30/2012 3:39 PM
In his blog, Doug Richie recently wrote an excellent article on the use of orthotic devices for the treatment of hallux rigidus. In this article he compares orthotic prescriptions for treatment functional hallux limitus to those for treatment of hallux rigidus. 

From the article:
“… the goal of orthotic therapy for functional hallux limitus is to improve range of motion of the first MPJ. The goal of treatment for hallux rigidus is to restrict range of motion of the first MPJ. Even better, the goal should be offloading of the first MPJ…
By Larry Huppin, DPM on 7/19/2012 7:15 AM
Orthotic Therapy for Tarsal Tunnnel Syndrome is the newest webinar available in our clients only area.   This concise 15 minute lecture reviews the current literature and providies recommendations on how to write the most effective prescription for your patients with tarsal tunnel symptoms.  
By Larry Huppin, DPM on 7/16/2012 7:28 AM
I have received a number of questions lately on how to bill Medicare for foot orthoses. First, realize that Medicare does not pay for foot orthotics. You may have to bill Medicare, however, in order to receive a denial so that a secondary insurance can be billed. 
You would bill Medicare as follows: 


The "GY" modifier is the payment modifier, and indicates
By Larry Huppin, DPM on 6/28/2012 6:53 AM
We are recommending that all ProLab clients read a recent article in Lower Extremity Review: Role of foot orthoses for patellofemoral pain

This article discusses level 1 evidence for the use of foot orthoses in treating PFPS. From the article: 

“Specifically, there were significantly more self-reported improvers at six weeks in a group receiving prefabricated foot orthoses compared to a group receiving a control intervention (flat inserts). The number needed to treat for one additional improver in th
By Larry Huppin, DPM on 6/25/2012 6:00 AM
 ProLab provides webinars on a specific topics in orthotic therapy on the second Thursday of every month at 12:30 PST. These webinars are available to ProLab clients, podiatric students, and podiatric residents. They are focused on Evidence-Based Orthotic Therapy and about 20 minutes in length.

All of the webinars are recorded and available for viewing at anytime, day or night. We currently have the following webinars available and we'll be adding more every month:
  • Evidence-Based Orthotic Therapy For Plantar Fasciitis
  • Evidence-Based Orthotic Therapy For Metatarsalgia
By Larry Huppin, DPM on 6/21/2012 5:54 AM
Prescribing orthoses for patients with plantar fibromas can be challenging. In general, our treatment goal is to reduce tension on the plantar fascia and then reduce pressure on the plantar fibromas. This can lead to a Catch-22 situation; orthoses that conform closely to the arch of the foot can help reduce tension on the plantar fascia, but they may also increase pressure on the fibroma. Luckily, there are some fairly straightforward orthotic modifications that can lead to an excellent clinical outcome for these patients.

To decrease plantar fascial tension, you will want to prescribe the initial orthosis 
By Larry Huppin, DPM on 5/17/2012 5:48 AM
I had a ProLab client call me today regarding a patient with an ulcer under the hallux. The patient is active. He works in an OR and spends most of the day on his feet. The client is looking for a way to use orthotic therapy to decrease force under the hallux.

There are a number of studies showing the most effective methods to decrease force under the hallux. Our primary goals are to decrease any functional hallux limitus that is occurring in order to decrease pressure under the hallux, and then transfer pressure directly off the ulcerated area.
By Larry Huppin, DPM on 5/11/2012 6:56 AM
I just finished a consult with a ProLab client who had a patient with severe cavus foot and an inverted heel causing him to have severe lateral instability. The patient has had many pairs of orthotics over the years and none of them have been effective. I had previously done a consult in helping the doctor to write an appropriate prescription to try to apply force laterally to decrease this lateral instability.

He called me back today to say that the patient was extremely happy. By using this orthotic, he felt the most stable that he had in his entire adult life. He actually wanted to see if there was any way to try to improve upon the function of this orthotic.
By Larry Huppin, DPM on 3/12/2012 11:22 AM
I received a question from a client today on the consultation page here on our website. This allows ProLab clients to send in questions and include pictures, MRI reports, etc.

Hi Larry, I wanted your opinion on this orthotic. As you can see from the MRI he has a plantar plate rupture sub 3rd on left foot and possible neuroma in 2nd interspace. I also included the pic of the orthotic he has now which does have a small met pad, and his shoe type. Would you agree he needs to have a met pad that is bigger, say 1/2", proximal to 2nd and 3rd met heads? 


The goal of the orthosis in the presence of a plantar plate tear is to transfer as much pressure off of the 3rd met head (MPJ) as possible. You do this by prescribing
By Larry Huppin, DPM on 3/9/2012 8:19 AM
 I received an emailed question from a client this morning:

I would like to send you some pics.  Interesting case of Cavus foot type with severe painful IPK sub 3rd bilateral. Wanted your opinion whether you see some calcaneal varus? and do you recommend a metatarsal pad behind the 3rd metatarsal. He also has IPK sub 1st but asymptomatic. Will send you castings shortly.

I don't think you need to worry about the rearfoot, it looks pretty stable and rectus. 

This is really just an issue of getting the pressure off of the 3rd met, and to a lesser extent, the 1st. 
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