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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 10/25/2012 2:46 PM
 I had a patient come in today who was having metatarsal pain while doing yoga. The only time it really hurt him was during yoga. Only the right foot was painful.

My examination showed that he had a mild bunion deformity. He had contracted third digit and retrograde force on the third metatarsal. He had pain to palpation at the third metatarsal head consistent with capsulitis. A goal for treatment was to decrease pressure under the third metatarsal head during the day while he was wearing shoes and then also trying to decrease pressure by cushion under the metatarsal head during yoga.

By Larry Huppin, DPM on 10/22/2012 4:54 PM
We have a new webinar available on the website.  This one covers the use of custom and prefabricated orthoses for pediatric flat foot.   ProLab clients can watch the webinar here.

Other webinars available online include:
By Larry Huppin, DPM on 10/15/2012 12:37 PM
Dr Jenny Sanders has a practice in San Francisco and is one of the top orthotic and shoe therapy specialists in the country.  Jenny also writes a column at the Podiatry Today blog.  I just read her latest entry today and it is an excellent suggestion on how to prescribe an orthosis can provides maximum support using minimum bulk.   You can read Dr. Sander's suggestion for a low bulk-high support orthosis here.   
By Larry Huppin, DPM on 10/11/2012 5:25 AM
  I had a ProLab client call me today regarding a patient who is having plantar heel pain following a lengthening procedure of the Achilles tendon. She apparently had excessive lengthening. Along with other problems, she is now having a feeling under her heel of extreme pressure directly plantar. On evaluation, the pain is more central under the calcaneus rather than on the medial tubercle, as would be likely with plantar fasciitis.

This seems to be an issue of excessive pressure on the plantar heel. Our client wanted to find now what would be the best orthotic prescription to transfer pressure off of this particular area.

Our goal is this situation is to

Our goal in this situation
By Larry Huppin, DPM on 10/8/2012 9:06 AM
  ProLab is known throughout the podiatric profession as the orthotic lab that focuses on evidence based orthotic therapy. But did you know that we are the pediatric biomechanics specialists in the orthotic industry?

Our medical consultants and orthotic technicians have a special interest in orthotic therapy for children. And we can help you with even the most complicated orthotic solution for your pediatric patients. Particularly for pediatric patients
By Larry Huppin, DPM on 10/4/2012 6:17 AM
 I had a ProLab client call this morning regarding a patient of hers who happened to be one of her referring physicians and who is a runner. The patient has developed bilateral sesamoiditis. She was looking at using our standard pathology specific orthosis for sesamoiditis but wanted to know if there is any modification she should make. I thought there were some changes that she should do to this device.

There is some fairly good evidence that extra cushioning on the orthoses will decrease lower extremity shock absorption in runners. Because of this, I like to add little extra cushion to my runners orthoses regardless of what pathology we are treating. Our standard pathology specific device for sesamoiditis is a polypropylene orthoses with a polypropylene post and an EVA cover. 
By Larry Huppin, DPM on 10/1/2012 7:57 AM
 I had a consult call from a ProLab client this morning. He has a patient who is a chef. The gentleman weighs about 220 pounds. He is on his feet all day in a hot environment and his feet have a tendency to sweat. He just returned to see our client because he picked up a pair of orthotics about four months ago and the cover seems to have worn through very quickly. He had a leather cover with Poron glued to the bottom and is noticing that the Poron seemed to be cracking along the edge of the orthotic. Also, the leather was starting to look stained. Our client wanted to know if there might be a better choice for a top cover.

It is always difficult to predict how long any top cover might last. It is very dependent on how much force is on the cover, the amount of foot motion and resultant friction, and also how much the foot sweats. Increased moisture and friction will cause top covers to wear very quickly.

I do not think there is one perfect top cove
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.  
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