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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 1/27/2014 3:21 PM
  A ProLab client called today for a consult regarding a patient who is an 11-year-old soccer player and experiencing pain at the styloid process bilateral. The child has a metatarsus adductus foot type and a styloid process that is prominent both plantarly and laterally. Our goal for treatment is to decrease pressure on the styloid process and tension on the peroneus brevis. 

I suggested a vacuum formed polypropylene orthoses with a minimal cast fill. Vacuum formed polypropylene was suggested because we will have the ability to add a sweet spot for the styloid. Minimum fill was selected because it will most effectively transfer pressure from the lateral foot to the medial foot. 
By Larry Huppin, DPM on 1/20/2014 3:16 PM
  I had a consult call from a ProLab client this afternoon. He has a patient who suffered a midfoot fracture at the base of the fourth and fifth metatarsal shafts. He had no treatment at the time of the injury and he has healed with a large bone callus on the plantar surface of the metatarsals. They create a large prominence on the plantar foot. This area is taking excessive pressure leading to pain, keratoma formation, and occasional skin breakdown. Our client was looking for suggestions on an orthotic prescription for this foot.

Our primary orthotic goal is to transfer pressure off of the plantar prominence. We have a second goal of reducing friction in the area, which will help prevent callus formation and skin breakdown.
By Larry Huppin, DPM on 1/13/2014 12:06 PM
Soccer, lacrosse, and ultimate Frisbee are becoming more and more popular throughout the country. What ties these three sports together is the fact that most participants wear soccer shoes when playing them.

Traditionally, these sports have been played by kids whom we often treat for condition such as calcaneal apophysitis. However, more and more adults are playing these three sports, wearing soccer cleats to play them and developing plantar fasciitis. Today, I want to address what to look for in a prefabricated orthosis that will effectively treat plantar fasciitis and yet will also fit inside the often limited confines of a soccer cleat.

First, consider the...
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.
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