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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 12/30/2013 9:06 AM
I was recently asked "should prefabricated orthoses have top covers?"

The answer depends on the pathology. Whether you are providing a prefabricated or custom orthosis, your treatment goal should be to reduce stress on tissue that being overstressed. For plantar fasciitis, your goal is to decrease tension on the plantar fascia. If you are treating metatarsalgia, your goal should be to transfer pressure off of the metatarsal heads and provide cushion under the forefoot.
By Larry Huppin, DPM on 12/22/2013 9:02 AM
In last month's webinar on the treatment of plantar fasciitis with prefabricated orthosis, a participant asked how rigid should prefabricated orthosis be.

The answer to this is the same as with custom orthoses: they should be rigid enough to reduce stress on the tissue that is being treated.
By Larry Huppin, DPM on 12/18/2013 6:49 AM
Last month, I gave a Webinar on the use of prefabricated orthotics for treatment of plantar fasciitis. In that Webinar, which is available for ProLab clients to watch online, we reviewed the most effective orthotic modifications for treatment of plantar fasciitis. These include valgus forefoot correction and the use of a medical heel skive. You can read about why those modifications help treat plantar fasciitis here.
By Larry Huppin, DPM on 12/10/2013 12:58 PM
A ProLab client asked what type of orthotic should be used for fifth metatarsal head calluses. There are number of pages on this website that deal with the most effective orthotic prescription for metatarsal head calluses, but today I wanted to deal with what cast fill should be used for a fifth metatarsal head callus.

This is somewhat complicated since you want the orthosis to conform close enough to the arch of the foot that you transfer maximum pressure off of the fifth metatarsal head but not so much that the orthosis supinates the foot and pushes the foot onto the lateral column and fifth metatarsal head.
By Larry Huppin, DPM on 11/14/2013 4:23 PM
We recently had a question asked regarding an older blog entry that I want to address in more detail. In December 2009, I wrote a blog discussing why we rarely recommend first ray cutouts. You can read that blog here.

We had a question from a client this week as to whether we would recommend a first ray cutout for a pes cavus foot with plantarflexion of the first ray.

So first, please go back and read that original blog.

Okay, you are back. Now, here is an extended version of my answer to Julie.
By Larry Huppin, DPM on 10/10/2013 6:23 AM
One of our primary missions as a company is to act as a clearing house for our clients in finding the best evidenced based information regarding orthotic therapy for treatment of specific pathologies. That is the primary reason that this website is used so widely as an educational resource for orthotic practitioners.

We have recently completely overhauled and updated the section on this website devoted to evidence-based orthotic therapy for patients with diabetes. This section can be used a guide for any orthotic practitioner to learn the most effective ways to use orthotic therapy to help prevent and treat diabetic-related foot ulcerations.
By Larry Huppin, DPM on 10/3/2013 11:04 AM
  I recently gave a Webinar on the topic of medial pinch callus. In this Webinar, we went into considerable detail on the best orthotic prescription to treat and prevent hallux pinch callus. For complete explanation of how to write the optimum orthotic prescription for this problem, you can watch or listen to the Webinar here. One of the questions that we received after the Webinar was a request to review the most important orthotic additions for treatment of hallux pinch callus. In my opinion, those are the reverse Morton’s extension and the application of a PTFE patch.
By Larry Huppin, DPM on 9/23/2013 8:51 AM
 I spoke with a ProLab client this morning who said he had a patient who presented with plantar fasciitis symptoms for which he made her a pair of posted orthoses with a minimum cast fill. The devices worked extremely well at relieving her symptoms. The only problem is now she is feeling like she is somewhat laterally unstable on the left side only. She states that she “wishes she had something to push her inward a little bit.”

I explained that this is a fairly common problem with patients who receive an orthosis that conforms extremely close to the arch of the foot. This type of orthosis tends to work the best at relieving tension on the plantar fascia and thus relieving plantar fascial symptoms but because it conforms so closely to the arch of the foot, there is a potential that the patient can feel it to be somewhat over aggressive in pushing them laterally.

There are couple easy ways to address this problem.
By Larry Huppin, DPM on 9/12/2013 5:33 PM
  We had a question from a ProLab client today:   

I would like your opinion on which one of your orthotic types would be best for a runner/cyclist who has chronic sub 2nd MPJ capsulitis, which I feel, is due to a relatively short first ray. I was thinking the ProAerobic with a Mortons extension. Any input would be appreciated.

By Larry Huppin, DPM on 8/19/2013 6:53 AM
  I had a patient in my office today with complaint of posterior heel pain, right, when wearing several different pairs of his dress shoes. He had a fairly large retrocalcaneal exostosis on the right calcaneus at the proximal aspect of the posterior calcaneus.

There are obviously a number of ways to address the retrocalcaneal exostosis. Our primary goals are to reduce pressure and reduce friction. Reducing pressure in this area is always a little tough without changing shoes. Although you can attempt to stretch shoes in this area, it is usually not particularly effective.

Friction can be controlled in a couple of different ways.
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