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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 3/24/2014 3:24 PM
 We have a question from a ProLab client today:   

I have a patient who is 70 yo male with a chronic neuropathic ulcer on the plantar medial 1st MPJ/base of the hallux
Severe HAV/limitus with adult semi-rigid flatfoot

What orthotic would you suggest the adult flat foot with a reverse mortons? I need to get the pressure off the medial MPJ

By Larry Huppin, DPM on 3/17/2014 5:12 PM
I had a ProLab client call today complaining that he had a patient that was feeling that their orthotic device is too hard. He wanted to know if he could possibly make a softer orthotic for this patient. It should be noted that the patient weighs 310 pounds.

Patients who are obese are, of course, putting significant pressure onto their feet and when wearing orthosis there is significant force between the orthosis and the foot. Much more so than on an average weight patient. This means that these patients have more potential to feel the arch of the orthosis as being too high or too hard.
By Larry Huppin, DPM on 3/10/2014 5:08 AM
It is always a challenge to fit orthotic devices in cowboy boots. First of all let me say that since I practice in Seattle, Washington I am not the most experienced practitioner in fitting orthoses into cowboy boots. I am sure my colleagues in Phoenix, Austin, and other parts of the Southwest have much, much more experience using these types of devices. Given that, I have had several patients for whom I have made orthotics for cowboy boots and though I have ended up frustrated several times, I seem to have found a formula that works well.
By Larry Huppin, DPM on 2/24/2014 2:07 PM
  I do a lot of orthotic adjustments in my practice...or I should say that my staff do a lot of adjustments.   Between us, we have some 40 years of orthotic adjustment experience.  Plus, when I'm not in the office, I spend the day talking to ProLab clients about how to adjust orthotics.   

Anyway, I'm fairly proficient in adjusting orthoses and was recently asked by Podiatry Today to write an article on the subject.   

Here is their intro to the article:

Troubleshooting orthoses is a vital skill when a patient returns with a complaint about the prescribed device. This author presents a guide to remediating common problems, including addressing arch irritation, how to add valgus extensions and keys to adjusting orthoses for shoe fit.
By Larry Huppin, DPM on 2/17/2014 2:52 PM
 A ProLab client last week sent in a pair of orthotics for adjustment and included his chart note, which read as:

This 55-year-old female returned several months after being fitted for prescription orthotics. She recently began to wear the orthotics reversed in her sneakers (the left device in the right shoe and vice versa) and peroneal tendonitis quickly resolved. She feels as though the current orthotics when worn in the proper shoe allow her foot to shift laterally. She would like to begin running again and is wondering what her options are. Can the orthotics be adjusted to increase the medial shift or decrease the lateral tilt?
By Larry Huppin, DPM on 2/10/2014 2:36 PM
 A ProLab client called me today with a question regarding a patient who is feeling that his orthoses are very comfortable when he is walking on them but they are feeling hard when he stands in one place on the orthotic devices.

This is an issue I run into a lot. I practice in Seattle and treat a lot of Boeing employees who stand on concrete all day. I have found those people that are standing in one place on hard surfaces do not usually tolerate quite as much arch height as those that spend most of their day walking or sitting.

There are some easy ways to avoid this situation and to correct for it when it does occur. 
By Larry Huppin, DPM on 2/3/2014 3:28 PM
  A fairly common complication for patients with cavus foot type who begin wearing orthosis is to develop pain on the dorsum of the foot secondary to shoe pressure.

Without orthotic devices, the foot is allowed to collapse somewhat which will decrease pressure on the dorsum of the foot. This collapse does, of course, often lead to the symptoms that brought the patient into your practice in the first place. These symptoms are, of course, often treated with foot orthoses. But by placing an orthosis under the arch of the foot, particularly one that conforms well to the arch, it can have the effect of increasing pressure on the dorsum of the foot.

There are several options to address this issue.
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...
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