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Author: Cherri Choate, DPM Created: 6/20/2009
Orthotic therapy blog

By Cherri Choate, DPM on 9/23/2009

How and when to treat the child with flat feet has been a question that decades of clinicians have attempted to answer.   This is certainly a question full of many smaller questions:  When do you treat? How do you treat?  Prefabricated vs. custom?  How much correction?  How much  influence does the shoe have? When do you treat to prevent other long term issues?

Over the past few years, researchers have started focusing on the pediatric population.  Included in this research are some studies involving the pediatric flat foot.  It is refreshing to start seeing objective data about an age old question that has been addressed primarily with speculation. (Articles)

My take home messages, to date, include the following:
    * Childhood obesity is on ...

By Cherri Choate, DPM on 9/9/2009

Recognizing and addressing the symptoms of functional hallux limitus (FHL) are a basic part of all podiatric practices. Too often these patients live with the pain for many years, because they subconsciously adjust their shoes and habits.

This week, the ProLab E-Journal discusses an article published by Scherer et al in 2006. One of the important aspects of this study was the role of the casting position in the clinical outcomes. During casting, the 1st ray was plantarflexed in order to encourage maximum plantarflexion of the 1st ray during stance and gait. This position, should ultimately lead to maximum dorsiflexion available at the 1st MPJ.

Although it is unknown which of the study variables was most effective (PF position of 1st ray, custom orthotic or 4 mm medial skive), it is importna ...

By Cherri Choate, DPM on 9/2/2009


One way to help assure that recovering is done on a routine basis is by making your patient's aware of an expected schedule.  On the day the orthotics are dispensed take a few extra minutes to explain the lifespan of the plate, as well as the lifespan of the topcover.  Usually if a patient understands that the cover has it's own role and the material only has a certain wear time, then the patient's will be more likely to return for recovering without issue.  My recommended recovering schedule is once every 12-18 months.  I recommend that patient's write this down in their calendars as a reminder. 

In addition, if a patient experiences significant relief with orthotic use, then getting a second pair will assure that when one pair is out for recovering, they will always have a pair to wear.  Having two pairs, also results in a longer lifetime for both plates and both covers.

By Cherri Choate, DPM on 8/26/2009

Choosing between a metatarsal pad and a metatarsal bar is sometimes difficult.  Most off -loading studies use the metatarsal pad, but seldom provide the specifics regarding the size or material.  A few studies have referenced the metatarsal bar, but historically the metatarsal bar has  been a bar attached to the outsole of the shoe.  At Prolab, we offer two choices of off-loading on the custom orthotic. 

The metatarsal bar is an 1/8" layer of poron at the distal edge of the plate.  It is different than a metatarsal pad because the high point is not as acute.  Because it is present across the entire distal edge, it offers more diffuse off-loading for all the metatarsal heads , and less focus on the 2,3 metatarsa ...

By Cherri Choate, DPM on 8/21/2009

The most recent E-Journal article review about knee pain reminded me of a group of patients that I have seen over the years. These patients often make an appointment specifically to request fabrication of custom orthotics to alleviate their knee pain. They may be anywhere between 20 and 80 with chronic knee pain that is usually activity related. Although the activity of choice may vary, running, hiking and biking are common. They all, without exception, are active individuals who want to stay that way.

As a clinician I am always challenged by these patients. They have usually invested in a variety of orthotics and a bag full of pricey athletic shoes. Despite all their attempted interventions, their pain remains. My prescription would commonly be for a stable orthotic with a small heel lift and some type of wedge, skive or extension. Fortunately, most of the patients did improve, although I was not always clear why.

A few years ago, I started readi ...

By Cherri Choate, DPM on 8/5/2009

At the lab, we often receive requests for soft functional orthoses.  Sometimes this means a soft cover, but often is means a more flexible, but functional device.  The two choices that would fit this category would be the ProAerobic and the Featherweight devices.  Both these orthoses have an 1/8" vacuum molded polypropylene shell, and this is standard thickness independent of patient weight.  They also both have medium density EVA arch fill.  The differences include the topcover and the presence or absence of a bottom cover. 

Although these devices may not offer the ultimate control, patient compliance is high due to an increased sense of comfort. If you have not ever prescribed them, take a l ...

By Cherri Choate, DPM on 7/29/2009

This week, I had a discussion with a colleague regarding the question of:   Reverse Morton's Extension vs. a Morton's Extension for Hallux Limitus.  As a rule when someone is having 1st MPJ pain and I observe limited 1st MPJ motion, I always start with an orthotic with a Reverse Morton's Extension.  In addition to this, I recommend a stiff-soled, rocker type shoe.   In my clinical experience at least 29 out of 30 patients do well with this combination.  In my experience, if this combination makes the patient worse, then I need to consider a Morton's Extension.  On the few occasions when I have fabricated an orthotic with a

By Cherri Choate, DPM on 7/22/2009

One of the most important goals at a foot orthotic laboratory is the desire to produce precise modifications to a foot orthotic prescription.  Unfortunately,  as podiatric practitioners we tend to supply the lab qualitative data, instead of precise quantitative data. In the production of custom and pre-fabricated foot orthotics and braces, quantitative values are vital pieces of information. 

For example, when ordering sweet spots for plantar fibromas, it would be beneficial to send accurate measurements of each lesion (mm or in.), as well as drawings of each lesion on the negative cast.  The measurements also provide another 3-D image as they give a visual of the true depth, width and length of the problem lesion on the foot.    Even something as simple as an accurate value for the width of a metatarsal head aperture, would likely result in fewer adjustments.  &# ...

By Cherri Choate, DPM on 7/15/2009
How do any of us find time to keep up with reading medical publications?  I have certainly carried around my fair share of guilt everytime I look at the stack of journals on my desk.  Recently, the consultant group here at ProLab has tried to address this situaiton.  Last year, we started a bi-weekly review of recently published biomechanics articles.  This first year has been focused on key articles that define our choices for our Pathology Specific Orthoses.  We all understand how little time is available, so it is hopeful that this new E-Journal presentation will leave you feeling better informed, and hopefully, less guilty. 

The reviews only take a few minutes to read!

Just click on E-Journal Club at the top of the website screen to sign up.& ...
By Cherri Choate, DPM on 7/8/2009

It is always difficult to determine if and how much heel lift to add to an orthotic.   Addition of an 1/8" lift is common and this amount usually fits into most shoes without incident.  If you want an intrinsic lift, but you only want a small amount then just add in the Special Instrucitons to "Leave Heel Contact Point Full Thickness."  This will translate to a 1-4 mm "intrinsic" heel lift , depending on the original plate thickness. If the patient seems to need more, it can be added at a later date.  This is a simple way to get a "free" heel lift.

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