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

By Dianne Mitchell on 3/28/2012 4:10 PM
A young patient presented with: 
severely pronated feet, 12+ degrees calcaneal eversion with further collapse through the midtarsal and the tarsometatarsal joints, and a pretty rigidly abducted forefoot on the rearfoot. The patient has a history of a tarsal coalition that was resected bilaterally which took this otherwise rigid hindfoot, and loosened it up which allowed the patient to pronate even more. This resulted in calcaneal fibular impingement and pretty severe pain. Another doctor had constructed a custom orthotic for her and, unfortunately, the patient was pronating so aggressively that she tipped her very wide poly shell orthotics (with a small 1st ray cut out) right off of the ground when viewing from behind and watching the rearfoot post. The entire orthotic was valgus!

I decided to make the patient a new pair of orthotics with the following
By Dianne Mitchell on 2/2/2012 1:29 PM
I found an interesting article in JAPMA this month.
Effect of a Metatarsal Pad on the Forefoot During Gait
KLM Koenraadt et al. JAPMA. Vol 102. No 1, Jan/Feb 2012. Pg 18-24.

By Dianne Mitchell on 1/4/2012 5:20 PM
As I reviewed prescriptions sent into the lab, I came across one issue several times - doctors asking for accommodations on their orthotics, but no marks on the casts indicating the specific locations. It is very important that the casts are marked for accurate accommodation location.

A simple technique is to mark the area with something that will transfer to the plaster. Use lipstick or betadine solution applied to the specific region of the foot with a Q-tip. This will then transfer to your mold. Improve the accuracy of placement for your accommodations with this simple technique - your patients will appreciate it!
By Dianne Mitchell on 12/30/2011 9:15 PM
A patient was placed in graphite functional orthotics for foot and knee pain. The foot pain quickly diminished but the knee pain persisted. What modification can be done to the orthotic to potentially help this issue?
These were low profile dress-type orthotics without a post designed to fit in as many pairs of shoes as possible. Without a post, these devices may rock into varus/valgus and could result in continued knee pain.
Recommendation: post the devices with EVA 0/0.

This will stabilize the orthotic and add some shock absorption.
By Dianne Mitchell on 12/16/2011 9:45 PM
I saw a new patient in the office today with foot pain. He brought in his orthotics from another provider and wanted to know why they weren't helping him. On orthotic evaluation, these are rigid poly shell devices with cork postings 0/0, and no topcovers. They contour the patient's arch wonderfully and control his hindfoot position well. The patient has a pretty neutral resting calcaneal stance position with mild pronation through the midtarsal joint. His main pain is to the ball of the foot. He has full ankle joint range of motion with no equinus, no skin lesions/calluses. On palpation of the forefoot the 3rd metatarsal head is sitting below the plane of the neighboring metatarsals, which was where the pain/soreness was. This was a b/l finding with no h/o injury.

By Dianne Mitchell on 12/1/2011 9:21 PM
Last month was the first (of hopefully many to come) Learning in the Vineyards seminar, co-sponsored by Prolab orthotics and Western University College of Podiatric Medicine. It featured numerous well-known podiatrists including Paul Scherer, Douglas Richie and Thomas Chang. The keynote speaker Peter Cavanagh, a PhD biomechanist.
The three day seminar started with a pair of interactive workshops including 3D digital scanners for custom orthotics and how custom orthotics are made, including a tour of the Prolab facility where attendees got to see where and how custom orthotics are fabricated from the molds podiatrists send in!
The next two days were full of lectures geared at both non surgical and surgical treatment of patients, and the biomechanical effects of that treatment. Also, additional workshops concerning shoes and orthotic modifications were given.
With the seminar located in Napa,
By Dianne Mitchell on 12/1/2011 7:44 PM
I saw a patient in the office today for an orthotic consult. He has pes plano valgus feet and callusing to the plantar medial midfoot where the navicular bone is touching the ground. He brought in a pair of orthotics stating he hates them and they aren't helping. These are very flat, poly shell devices, without posting and no padding or accommodations built in. In stance he pronates over the medial sides of the devices, and without any posting the device tips over to the side with him.

While he clearly needs a new orthotic fabricated, what can you do in the office to this device for pain management?

You can mark the calluses with lipstick or a dab of iodine solution and have the patient stand on the device to mark the callus location on the plastic. Next, outline that area with a sharpie marker so you don't lose it. I glue poron 1/4" to the orthotic shell (and out to the toes) and cut out the area of the sharpie outline.
By Dianne Mitchell on 11/7/2011 9:16 PM
I saw a number of cases of sub-2nd metatarsalgia pain today in the office. This varied from mild pain (bruise sensation) to swelling and more severe pain with activity limitations. The quickest modification to add to these patients' orthotics is an 1/8" thick forefoot extension beneath the top cover with a cut out beneath the 2nd met head. Another modification could be a metatarsal bar. These can both be added to a forefoot rocker shoe, surgical shoe, or walking boot for higher levels of pain in order to decrease pressure through the forefoot.
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
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