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Author: Dianne Mitchell Created: 5/16/2011 9:38 AM
Orthotic Therapy Blog

By Dianne Mitchell on 10/25/2011 7:57 PM
I'd like to direct folks to the October issue of Podiatry Management. Dr. Blake wrote a great article, "A Podiatrist's Guide to Shoe and Shoe Insert Modifications", with 25 modifications you can perform in the office on orthotics or shoes. I preface this blog by stating you should probably practice some of these modifications on old shoes before trying them on your patients!
By Dianne Mitchell on 10/5/2011 7:33 PM
I just received my September issue of Podiatry Management and the cover reads, "Is podiatry turning away from biomechanics?" I found it interesting that this question was being asked.
I have definitely felt this way and asked myself this question ever since interviewing for residency. I went into podiatry for multiple reasons, but one big reason was that I could use my undergrad biomechanics training. When interviewing for residency positions, I was repeatedly asked why I was interviewing for surgical programs if I was "only interested in biomechanics?"
Biomechanics of the foot/ankle should be reviewed in all surgical planning. More importantly, conservative modalities should be exhausted before any elective surgical patients enter the operating room. This article addresses conservative biomechanical options. These modalities tend to be quite successful in my hands, I am able to avoid surgery for patients who initially thought that surgery was the
By Dianne Mitchell on 9/15/2011 8:25 PM
I recently read an article that roughly posed the question: Do you have an orthotic "recipe" that you use for your patients' custom molded orthotics?
By Dianne Mitchell on 8/30/2011 6:28 PM

I see a fair amount of high risk diabetics in the office, as well as partial foot amputation patients. This morning's patient is a partial 5th ray amputee with a Charcot collapse through the midfoot on his contra-lateral foot. His complaint was that he felt as if he was going to roll his ankle (inversion sprain) while wearing his accommodative inserts, but more so when he was without them.

By Dianne Mitchell on 8/23/2011 10:01 PM
I am a paddler, and last Tuesday I was demoing a racing kayak and promptly flipped it upside down. When I reached the shore, I twisted my foot on a rock I didn’t see. This mishap lead to the following discussion of what attributes a canoe shoe and orthotic should have.
By Dianne Mitchell on 8/20/2011 8:31 PM
While I have only been in practice since 2008, patients are already returning for replacement devices. Most of these patients are children and some are adults.

When I dispense orthotics to patients I review things to look, or feel, for as the device ages such as: return of symptoms, callusing, pain, or a cracked device.
By Dianne Mitchell on 8/10/2011 4:17 PM
A patient presented with lateral column pain and the initial evaluation was a cavus foot with rearfoot varus. After utilizing the Coleman Block Test, it revealed that the hindfoot reduced nicely bilaterally to (and slightly beyond) perpendicular. Looking at the forefoot, the 1st metatarsal was rigidly plantarflexed below the transverse plane where the lesser met heads all rested.

The goal in selecting the orthotic prescription was to hold the foot neutral, and then bring the ground up to the lesser met heads. I used a poly shell with an EVA rearfoot post for shock absorption. To accommodate the plantarflexed 1st metatarsal, I added a Korex reverse Morton's extension and a topcover to finish up. Sometimes I back fill the region below the 1st met head with poron for additional padding.
By Dianne Mitchell on 7/2/2011 7:20 AM
I perform quite a few orthotic modifications each day in the office. These are on over-the-counter orthotics, poorly controlling custom devices, and minor adjustments to otherwise good devices. Sometimes the modification will really change how the foot functions on the orthotic. 

Patients often prefer that I don't significantly change their device, so I started using adhesive felt (1/8" and 1/4" thickness) to perform modifications and give patients a taste of what needs to be done. This allows me to modify the orthotic but still give the patient the opportunity to remove it (carefully un-peel it) if they can't tolerate it.
By Dianne Mitchell on 6/15/2011 10:20 PM
A patient with persistent forefoot callusing presented today for debridement.
By Dianne Mitchell on 5/20/2011 6:26 PM

I never thought I would place a full-length valgus wedge on a patient's orthotics.

I see a lot of workers comp cases and presently see a roofer. After about 2-3 hours on the roof he feels pain. In a stance exam of this patient, he is bow legged b/l with pronounced tibial varum and his RCSP is nearly perpendicular to the ground. Initially, he presented with typical plantar fasciitis symptoms and we tried a 0/0 motion rearfoot posted functional foot orthotic, neutral device with no inversion. This seemed to help the arch, but the patient slowly developed peroneal pain. In my initial attempt to relieve this, I added a reverse Morton's extension of cork to the devices that the patient enjoyed; then he increased time on the roof and this was proving to not help. So, I ...

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