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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 Larry Huppin, DPM on 12/28/2009 9:31 AM
In Orthoses for Soccer Cleats Part 1, we provided a general orthotic prescription for soccer cleats. Using this prescription as a foundation, detailed below are our recommendations for modifying the basic soccer cleat orthotic prescription for specific pathologies. Detailed information on our reasoning for these modifications, including evidence in the literature, can be found by using the links to the Pathology Specific Orthosis for each pathology. Because we are using forefoot extensions,all of the following require a cover.
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.
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By Larry Huppin, DPM on 12/21/2009 9:18 AM
For the most part we recommend prescribing orthoses based on your patient’s pathology rather than for a particular activity. Sometimes, however, your patients’ shoes will play a role in dictating the type of orthosis that can be used. A prime example is the soccer cleat.

Soccer cleats tend to run small. They have a narrow waist, usually a very thin sock liner if they have one at all and on top of this, soccer players often prefer to wear them somewhat tight. This all makes for a challenging task fitting a foot orthotic into a soccer cleat.

It is doable, however, and I prescribe orthoses for soccer cleats almost every week. These are usually an additional pair of orthoses that are used only in the soccer cleats. To ensure proper fit the cleats should be sent with the prescription to the lab.&a ...
By Cherri Choate, DPM on 12/16/2009
    When do we treat chil ...
By Larry Huppin, DPM on 12/10/2009 1:49 PM
  If your patients are complaining about squeaky orthotics, here are a few solutions. 

The first part of finding a solution to the squeaking is to understand what causes it. Rarely does the orthosis itself squeak, rather it is friction between the orthosis and shoe that causes the noise. This is usually the front edge of the orthosis against the bottom of the shoe or the side of the orthosis against the side of the shoe. Here are our recommendations
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 Larry Huppin, DPM on 12/7/2009 12:23 PM
I had a question from a client this morning regarding a patient with hallux limitus. They wanted to know if they should include a first ray or first metatarsal cut-out on the orthosis.  A first ray cut-out is shown below on the left and a first metatarsal cut-out on the right.

The idea behind a first ray/first metatarsal cut-out is to cut away the medial distal portion of the plate of the orthosis in order to let the first ray plantarflex more effectively. When the f ...
By Larry Huppin, DPM on 12/3/2009 3:46 PM
A 23 year old woman who recently took up Salsa dancing presented to my office today complaining of generalized numbness and tingling in the balls of both feet after dancing for an hour.  Pain continued into the morning following dancing. No other foot complaints. Her exam was essentially normal – I couldn’t elicit any pain or symptoms. She is just dancing upwards of 20 hours per week and is overloading her met heads causing inflammation and neuritic symptoms.   She is wearing a shoe like the one on the right.

Our treatment goal is simply to transfer as much force as possible off of the metatars ...
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 ...
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