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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 9/26/2012 3:37 PM
  The goal of any orthosis used to treat pediatric flatfoot is to limit excessive force that might lead to pain or deformity. The collapse of the medial longitudinal arch seen in children with pes planus can lead to a number of problems, including:
  • Excessive tension on plantar structures resulting in conditions such as calcaneal apophysitis
  • Excessive compression dorsally, leading to dorsal foot pain in the short term and increased likelihood of midfoot arthritis in the long term.
  • Increased forefoot pressure and associated conditions.
  • Functional hallux limitus leading to increased likelihood of bunion formation or hallux rigidus
In order to limit excessive pronation in the pediatric flatfoot a foot orthosis should incorporate the fo
By Larry Huppin, DPM on 9/24/2012 1:18 PM
  We have a new webinar available on the website.  This one reviews literature that demonstrates that foot orthoses may be effective in helping to prevent ACL and knee collateral ligatment injuries.   In the webinar we review the literature and make specific orthotic recommendations.   ProLab clients can watch the webinar here.  
By Larry Huppin, DPM on 9/20/2012 11:03 AM
I recevived this question today from a ProLab client regarding orthotic width in running shoes:  

Hi Larry,

I've been finding that some of the orthotics I prescribe for running shoes are coming back too wide for the patients shoes  Do you have any recommendations on how to prevent this problem?  Should I send a tracing of the shoe insole?   

I find a wide width works fine as long as the patient purchases shoes AFTER getting their orthoses.  The problem you are running into is that the shoe is likely too narrow for the patient.  In this case fitting an orthosis is always going to be difficult.  
By Larry Huppin, DPM on 9/17/2012 1:13 PM
I had a patient come in today who is a runner and for whom we had made orthotic devices to treat hallux limitus pain. Overall, she has done very well. This was a very controlling orthotic which conformed close to the arch of the foot. It is the full width of her foot and it was inverted several degrees to allow first ray plantarflexion.

Since she was still having symptoms, I wanted to accentuate the plantarflexion of the first ray. We accomplished this in two ways. 
By Larry Huppin, DPM on 9/10/2012 8:52 AM
  If you ever have a female patient with a severe pes planus who needs the support of a medial flange but who also wants to wear dress shoes, consider ordering a polypropylene orthosis with a very shallow heel cup and medial flange. It is, in fact, not usually the arch that limits orthotic fit in the shoe but rather heel cup 
By Larry Huppin, DPM on 9/6/2012 8:46 AM
If you ever have a patient who complains that they feel like they are leaning too far forward or feel too much pressure on the ball of the foot when wearing a new pair of foot orthosis, the first thing you should look at is whether or not there might be some excessive heel lift. 

Even in a situation where
By Larry Huppin, DPM on 8/16/2012 12:22 PM
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. Here's a "best of Podiatry Arena" list of those discussions that we think ProLab clients would find educational, interesting or entertaining.  Sign up for the RSS feed to this blog to ensure you get your updates every month.  Here is what you should be reading from July 2012:   
By Larry Huppin, DPM on 8/13/2012 1:12 PM
I have received a number of questions lately on how to bill Medicare for foot orthoses. First, realize that Medicare does not pay for functional foot orthotics under any circumstance. This doesn’t mean that they won’t pay accidently if you bill it. It means that you should not bill it and if you do they will ask for their money back and maybe audit you. So don’t try to get Medicare to pay for FFOs. 

You may have to bill Medicare for FFOs, however, in order to receive a denial so that a secondary insurance can be billed. If you do this you must include a modifier that essentially says “Hey Medicare, I’m billing for these orthotics, but I don’t want you to pay for them, just give me a denial. 

To do this, you must use
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.  
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