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

By Dianne Mitchell on 5/24/2012 10:35 AM
For patients experiencing pain during cycling, here are some thoughts to consider:
- are the cycling shoes properly fit to the patient's foot?
- what type of socks does the patient wear (thin cycling socks versus thick padded running socks)?
- where is the pain? Many riders complain of forefoot numbness, specific great toe numbness, inner-metatarsal space neuromas.
By Dianne Mitchell on 5/17/2012 9:43 PM
Modifying diabetic accommodative orthotics is similar to modifying a standard functional foot orthotic. I had a patient in the office earlier this week with 5th metatarsal base pain and irritation on his custom molded accomodative inserts. Interestingly, this is a neuropathic patient, so he was really concerned about the fact that he had pain and what looked like a skin lesion. 
By Dianne Mitchell on 5/15/2012 9:21 PM
When prescribing functional foot orthotics it is important to not only discuss that orthotic devices should be comfortable and address foot mechanics for pain relief, but also explain which shoes the devices fit best in. I frequently see patients who present with orthotics and the complaint that they can't wear them everyday because they don't fit in their shoes.
By Dianne Mitchell on 5/8/2012 8:46 PM
Patient came in complaining about arch pain with functional foot orthotics, hates her orthotics. With foot exam, she has a rigid cavus foot with a prominent plantar fascia band with engagement of the windlass mechanism. She had brought in her current devices from another lab and unfortunately they were not accommodating her plantar fascia nor were they padded to decrease pressure to her very prominent metatarsal heads or heel. Also she has an equinus deformity adding to the forefoot pressures/pain she is experiencing. The fix:
By Dianne Mitchell on 5/3/2012 9:25 PM
Frequently patients present to the office for orthotic adjustments with devices they got from other providers and various labs. I get mixed comments from patients as to why they need adjustments, but I see a lot of folks who simply tell me they don't like their orthotics because they cause pain.
Today wasn't any different.
By Dianne Mitchell on 5/2/2012 10:24 PM
Recently, a frequent question in the office has been "what shoes should I wear with my functional foot orthotics?" Specifically, these patients are asking if they can wear a less stable athletic shoe once they have a custom molded orthotic to place in them. A typical patient, approx 180 pounds with knock knees and pronated, flat feet (who now has functional foot orthotic devices, correcting and controlling the foot mechanics) came in with a neutral and flexible athletic shoe. The shoe is already breaking down after only 2-3 weeks of wear.
I place these patients in stability shoes, such as Brooks Adrenaline or Asics 2170 (just to name a couple examples) and add the functional orthotic devices to these. They couple each other well, and offer great support. If the shoe is too soft and flexible, I notice orthotics simply do not sit correctly in the shoes; they seat themselves unevenly in some instances. The orthotics need a stable foundation from which t
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.
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