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

By Dianne Mitchell on 7/16/2013 9:12 AM
Patient presented for second opinion of her 1st MTPJ pain. This is an athlete with functional foot orthotics. The main question of the patient was whether or not she was "due for a new pair" ... as the pain in the big toe wasn't going away despite efforts to "pad" the pain area.

On evaluation of the patient: minimal hindfoot pronation with a functional hallux limitus and associated medial hallux and 1st MTPJ callusing.

Prior to pulling the orthotic devices out of the shoe, what do we expect to see on the orthotic? This could be a simple orthotic shell with great hindfoot control and a simple top cover and could potentially include a reverse morton extension, as this modification allows plantarflexion of the 1st metatarsal and therefore increased ROM thru the 1st MTPJ during the gait cycle.

Periodically I see addition of padding beneath the 1st MTPJ in an effort to literally pad the painful region. In this particular in ...
By Dianne Mitchell on 7/11/2013 9:22 AM
Patient presented today with complaint of callusing on her orthotics.
By Dianne Mitchell on 5/23/2013 7:22 AM
A patient came in today with 5th toe pain. This is a patient who has functional hallux limitus with transfer metatarsalgia and associated pains. She presented with a pair of great custom molded functional foot orthotics, with a shell that supported and corrected her foot appropriately. A minor modification to the soft materials could make this orthotic more effective. I added a top cover and a 3mm cork reverse Morton's extension. While this fit fine in the athletic shoes she had in the office, she headed out for a hike the following weekend in different footwear and reported back to the office the following week with new symptom of 5th toe pain.

Clearly the top cover with the added cork extension was too thick. A simple, quick fix for this is to leave the accommodation in place and simply mark the location of the 5th toe in weight bearing on the device. Next, thin the portion of cork below the marking with the grinding wheel. The patient loved it!

Before removi ...
By Dianne Mitchell on 5/20/2013 7:06 AM
I see a bunch of kids in the office for orthotics and many of them see me frequently for new top covers. The most frequent reason, is: the orthotics got wet and the cover either came off or smells or looks poor. I was also getting similar complaints with the rearfoot post becoming saturated. Typically this involves a puddle at recess that got played in and the shoes are soaking along with the socks and the orthotic device. As everything dried out that evening, parent and child observed damage.
By Dianne Mitchell on 5/16/2013 7:54 AM
A woman came into the office today for custom orthotics and wants them to fit in as many shoes as possible. She understands the types of flats she should be in and really didn't want to have to buy a bunch more shoes to accommodate the orthotic.
Some thoughts ...
By Dianne Mitchell on 5/13/2013 9:44 AM
A patient presented to the office today with a severely planus foot and associated arch pain/strain, posterior tibial tendon dysfunction, sinus tarsi and calcaneofibular impingement. He was miserable and was seeing me for custom orthotics in hopes of the pain being reduced. In stance there was a large degree of bow-legged deformity also in addition to the feet being completely flat to the floor. What to do ...
By Dianne Mitchell on 5/9/2013 7:34 AM
We all see patients in the office who have sustained an inversion ankle sprain. We also see patients who continue to sprain their ankle multiple times later. What can we do to an orthotic prescription to decrease the inversion forces?? How do you create a pronatory torque?
By Dianne Mitchell on 5/6/2013 7:19 AM
We frequently see painful inner-metatarsal space neuromas in the office. Once you confirmed this is indeed a neuroma and not metatarsalgia, capsulitis, stress fracture, etc ...
By Dianne Mitchell on 3/25/2013 6:43 AM
Saw a child in the office today who simply doesn't want to play sports because of foot pain. He pointed to the arch/heel/and posterior tibial tendon distribution as pain locations despite a history of custom molded orthotic intervention. On exam, there is really only tenderness on palpation at the navicular tuberosity. All other pain spots happen with activity. This is a flexible flat foot on exam with equinus.
The currrent orthotics are
By Dianne Mitchell on 3/20/2013 6:29 AM
A cyclist came to the office today for orthotic molding. He has been in orthotics in the past in running shoes and felt like he would benefit from the additional support in the cycling shoes. This is a flat footed patient with h/o plantar fasciitis and is a distance cyclist, spending many hours on the bike. He reported arch pains at 50+ miles.
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