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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 4/15/2013 6:23 AM
 A fairly common complaint that I hear in my office is that of patients saying that their heel is slipping up inside one or more shoes when they wear their orthotic devices. This is usually a very easy problem to address and one that every orthotic practitioner should be aware of.
By Larry Huppin, DPM on 4/8/2013 1:44 PM
  I saw a patient a few weeks ago who had come back in for followup after getting her orthotics. She was comfortable in the orthotics for the most part and they have worked very well in relieving her symptoms. However, there was one area that was bothering her and that was the lateral heel cup on one orthosis. When I had her stand on the devices, I noted that she had a quite a bit of fat pad expansion and that the fat pad of the heel was overriding the lateral edge of the heel cup.

I always try to avoid this problem by measuring the fat pad of the heel when I order orthoses. I checked the copy of her prescription form and I found that in this situation I had forgotten to take the measurement and send it to the lab. By measuring it, I almost always avoid this problem.

It has to be kept in mind that
By Larry Huppin, DPM on 4/4/2013 8:43 AM
 I saw a patient this morning who suffered a crush trauma to his mid and rearfoot a number of years ago and now has both midfoot and rearfoot osteoarthritis. He has done fairly well using a gauntlet AFO to limit motion. The last time I saw him, I also recommended that he get a rocker-soled shoe. A rocker sole will further act to decrease mid and rearfoot motion, particularly if the rocker is placed near the midfoot.

Since the last visit, he purchased a pair of PW Minor shoes, which had a built in rocker. They fit the gauntlet AFO extremely well and he has found that the rocker has substantially further decreased his symptoms.
By Larry Huppin, DPM on 4/1/2013 8:41 AM
 I recently saw a patient for whom I dispensed a new pair of orthotic devices. This patient had prominent styloid process. 

If you ever are prescribing an orthosis for a patient with a prominent styloid process, you have to determine if the styloid needs accommodation. When making this determination, you must first determine whether the styloid is prominent laterally, plantarly, or both. Lateral and plantar styloid prominences required different accommodation.
By Larry Huppin, DPM on 3/28/2013 8:35 AM
Achieving optimum outcomes with orthotic therapy is dependent on a number of factors. These include proper prescription writing, correct casting technique, and high quality cast work in production methods by the orthotic lab. If you are ProLab client then you know that our cast work is the best in the industry and that we strive constantly to provide you with the education and information you need to write the best orthotic prescriptions.

Understanding orthotic material differences is often an overlooked but critical part of writing the correct orthotic prescription. This came up in a conversation I had with a ProLab client this morning when doing a consult regarding a patient with a Cavus foot structure.
By Larry Huppin, DPM on 2/28/2013 4:20 PM
There is an article published in the new issue of Lower Extremity Review that we are recommending for all ProLab clients. It is a review of current, past and upcoming materials used in orthotic manufacturing. A quote by Kevin Kirby, DPM in the article helps explain why this is important information for orthotic practitioners.

“It’s critical to understand how these different materials work,” said Kevin Kirby, DPM, an adjunct associate professor at the
By Larry Huppin, DPM on 2/21/2013 9:16 AM
  The first metatarsal cutout or first ray cutout is a common modification used in orthotics to allow the first ray to plantarflex in order to treat functional hallux limitus. I think it should be noted, however, that if a practitioner takes extremely good negative cast and writes an appropriate prescription and uses an orthotic lab and does not overfill the medial arch the first ray cutout should rarely be necessary.
By Larry Huppin, DPM on 2/19/2013 8:12 AM
  It is common to have full length covers on ski orthotics. Traditionally, a fairly rigid cover will cover the orthosis and extend all the way to the toes. When using the cover for ski orthotic it must be rigid in order to allow the device to easily slide into the boot. Soft covers tend to fold up underneath the orthotic as you are putting it into a boot.

This is how I have traditionally made orthosis for skiing. However, over the past couple of seasons, I have started making devices without covers. I find that it is much easier for the patients to put the orthosis into ski boots when there is no cover on the device.
By Larry Huppin, DPM on 1/14/2013 3:10 PM

Dave is a 73 year old male. His primary complaint is mild pain in his left foot over the 2nd-4th metatarsal heads. He has bilateral heel spurs (about 6mm each) that are currently asymptomatic after corticosteroid injections and custom orthotics about a year ago. He also has a bilateral very prominent base of the 5th metatarsal with significant callus formation bilaterally, greater on the right, that seem to be getting larger with time, but are asymptomatic; the prominence is quite visible laterally but also INFERIORLY in a plantar direction (to a lesser extent than laterally).

By Larry Huppin, DPM on 1/13/2013 9:18 AM
  In November, I gave a webinar on using orthotic devices to treat plantar fasciitis. ProLab clients can watch that webinar here. After the webinar there were a number of questions. One of those was from a podiatrist who stated that he prescribed prefabricated orthotics for feedback on whether orthotic therapy was likely to function for a particular patient. He wants to know how long a period of time that I would let my patients use prefabs to find out if custom devices will likely work.
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