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

By Cherri Choate, DPM on 10/28/2009
     When attempting to control the frontal plane motion/position of the foot, forefoot wedges are probably the most common orthotic modification. The forefoot wedges can be ordered two different ways. The wedge can either be placed on the orthotic plate or distal to the orthotic plate. Although the first option allows for more room in the shoe in the metatarsal head area, the application of the principles of physics, favors the second option. The distance from the rearfoot to the FF extension is much longer than the distance from the rearfoot to the distal plate. Therefore, the moment arm is much more effective with the FF extension because the arm is longer and therefore stronger.  < ...
By Cherri Choate, DPM on 10/21/2009

We seldom spend time discussing the trials of certain patient types or how they deal with having foot problems. In my experience, the patient with the pes cavus foot, requires a bit more effort in the area of education. Most of these patients have adjusted to the quirkiness of their feet. They are modified their shoes and activity, without really knowing why.  As practitioners, it is important to explain the chronic nature of this pathology. Most patients have relatives with the same foot type, so sheddng the light on their unexplainable symptoms, will likely benefit an entire group of people. Most of them are relieved knowling that their pain, difficulty with shoe fit, lateral instability and prominent bones, are secondary to a real foot pathology.

By Cherri Choate, DPM on 10/14/2009

A common problem in our baby boomer population is foot arthritis.  For many years, the orthopedists have been primarily treating knee and hip arhritis, but it seems that we are seeing a growing number of cases of foot arthritis.  Whether the joint destruction is due to previous trauma, general osteoarthritis or over use, it can be disabling and difficult to treat conservatively. 

Stability seems to be the key in these patients.  The components of a device that will increase stability include a wide plate, deep heel cup, minimal fill and semi-rigid plate.  For midfoot arthritis in particular, the use of a sweet spot in conjunction with a medial flange, may offer both comfort and stability at the same time.  There is certainly a balance in each of the patients, but by combining the concepts of off-loading and stabilizing, pain can certainly be diminished and quality of life can be improved.

By Cherri Choate, DPM on 10/7/2009
For many years, I have had coversations with my colleagues regarding the value of the topcover on an orthotic.  Many colleagues never apply topcovers, and other always apply them.  So many variables play into this decision, including cost, shoewear and orthotic appearance.  Most of us use "cushion" type of topcovers to add a shock absorption component to the device. 

An article published in 2008 in JAPMA presents evidence that cushioned topcovers alone, in runners,  reduced the mean vertical ground reactive force peak, the loading rate and the peak tibial acceleration.  My cliical application of this information is the use of a topcover.  This study reinforces the premise that topcovers made of shock-absorbing material do indeed decrease vertical forces. It certainly supports using a cushioned topcover in orthotics where the user will be involved in impact type of activities.
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By Cherri Choate, DPM on 9/30/2009

Over time, I have developed a list of questions in my head that I would personally like to ask my fellow practitioners. I am aware of my own practice habits, but I am curious about the practice habits of everyone else.  I would also be very interested in the opinioin of the patient who receives the orthotics. With the addiition of the BLOG to ProLab's website, I figured this is finally the prefect forum to ask some of the questions on my list.  My question of the week is:
                 What type of dress orthotic do you prefer?  Graphite, Cobra, Poly ...

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 ...

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