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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 4/21/2014 9:26 AM
We had this question come in from a ProLab client today: 

I have a question regarding a prescription for the patient. She has b/l bunions with pain sub second. If she likes these orthotics I will be ordering another pair for her. The first pair she wants to fit into flats for work. Do you have any suggestions for sub second pain that would fit into flats?
By Larry Huppin, DPM on 4/14/2014 9:01 AM
We had a question come in today from a ProLab client who recently started using the ProLab 3D Digital Foot Scanner.   Here is his question and my answer:   

This scanner is fun to use. With regard to the orthotics - any suggestions for him?  I performed a 1st metatarsal phalangeal joint fusion on the right. I was thinking a proaerobic with a mortons extension.

Also I never had such an interest in orthoses as I do now since I have been using the scanner. Just wanted to see if you had any suggestions on good literature on orthoses.

Thanks again for all your help
By Larry Huppin, DPM on 4/7/2014 6:06 AM
We will often have ProLab clients ask us to accommodate for prominent fifth metatarsal base. Rarely, however, do they indicate on the prescription form whether the styloid process is prominent laterally or plantarly. There is a distinct difference in how we would accommodate for these two. If the styloid is prominent plantarly then we would recommend using a sweet spot. If it is prominent laterally then we would recommend adding extra lateral extension at the base of the fifth metatarsal
By Larry Huppin, DPM on 3/31/2014 5:53 AM
A ProLab client contacted us today with a question regarding how to best prescribe an orthosis to treat an 11-year-old child with bilateral apophysitis affecting the base of the fifth metatarsal.

In general, this is fairly straight forward problem in that we have a primary goal of decreasing tension on the peroneal brevis in order to decrease tension on the apophysis at the styloid p
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. 
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