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

By Cherri Choate, DPM on 12/30/2009
As we look forward toward a new year, most of us are already placing vacation and CME dates on our calendars.  Although we strive to keep you updated on current research regarding Biomechanics of the lower extremities, CME programs can also be very inspiring and enlightening.  The Prolab site has a complete listing of the progrmas where we are participating, but here are a few to consider:
By Cherri Choate, DPM on 12/23/2009
Due to the manufacturing process of the CAD CAM system vs. the vacuum press, only the vacuum pressed devices can be made with a sweet spot.  All the Pathology Specific Orthotics that need a sweet spot, or other type of intrinsic accommodation, will be made by the vacuum formed method.  The other instrinsic accommodations include: medial/lateral flanges, plantar fascia grooves and EVA arch fill.    If you want to include any of these in the orthotic order, the vacuum formed device is your only choice. 

In addition, only Vacuum Formed devices can be heat adjusted.  The most common adjustment include expansion of sweet spot and raising/lowering of arch height.  CD devices can not be heat adjusted, so they are not as flexible when patient fit is an issue.
&l ...
By Cherri Choate, DPM on 12/16/2009
    When do we treat chil ...
By Cherri Choate, DPM on 12/9/2009

With all the functional prefabs out on the market, here is a quick primer on Prolab's choices.  Firstly, all the devices are made of a semi-rigid polypropylene shell with 2 mm medial skive, 14 mm heel cup and 3 degrees valgus correction
Below are the differences:

  • P3 Low-Impact: Full length 1/8" plastazote and 1/6" poron topcover; 4/4 polypropylene RF post
  • P3 Sport:  Full length synthetic suede 
By Cherri Choate, DPM on 12/2/2009
SandFootprints.jpg image by weirdscience_photos
Although the term center of pressure is used widely in research circles, and infrequently in clinical practice, it is an important concept to consider when fabricating orthoses. The center of pressure is a representative map of where the body weight is focused during each step.  If we are attempting to offer control of medial or lateral instability, then we are trying to modify the patient's natural center of pressure.   An article in our eJournal this week (Paton 2006) is about the impact of different types of rearfoot posts on the ce ...
By Cherri Choate, DPM on 11/25/2009
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A publication (Kinoshita 2002) referenced in the Journal Club section of our web site a few weeks ago focused on the effect of foot position in tarsal tunnel syndrome. The researchers  presented a quick easy clinical exam where the foot and ankle were held in a dorsiflexed and everted position for a few minutes. When this test was conducted in patients with diagnosed tarsal tunnel syndrome, 84% had an increase in symptoms. 

So how does this translate to orthot ...
By Cherri Choate, DPM on 11/18/2009
    Treating the patient with rheumatoid arthritis is a lifelong challenge.  The standard orthotic protocol, which consists of a soft accommodative insole, is no longer the default device for these patient.  This patient group, as well as the population of people with diabetes, are the focus of much of the current podiatric research.  The previous idea of treating chronic disease simply with maintenace is now being questioned.  Researchers and clinicians are creating data that is leading to a paradigm shift.  This "change in the fundamental model of events" is a shift from sof ...
By Cherri Choate, DPM on 11/11/2009

We spend a great deal of time addressing issues to combat the effects of excessive pronation, but there are a large number of patients who have exess supination problems.  When attempting to address the issues associated with excess supination, such as peroneal tendonitis and inversion ankle sprains, a variety of options are available to include within an orthotic prescription.  A few of the most common options are listed below:
                                         & ...

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.

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