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Author: Larry Huppin, DPM Created: 6/20/2009 9:45 AM
This blog is designed to provide foot orthosis and ankle-foot orthosis practitioners and students with unique and practical information on foot orthotic therapy. We will provide insight on what’s new in the literature regarding orthotic therapy, orthotic hints and pearls, practice managment information, our opinions on new technology and even some thoughts on controversial topics in the foot orthotic industry. We welcome input and suggestions from orthotic practitoners and others interested in orthotic therapy. This is, however, a discussion on the practice of orthotic therapy and not designed as site to provide medical information to the public.

By Larry Huppin, DPM on 1/25/2010 12:40 PM
Many of you may have noted that there is a new fad in running circles. Barefoot running (usually in very flexible toe shoes like the ones shown at right) has developed a following - sometimes a very zealous following.  I've been seeing a number of patients lately with foot pain due to barefoot running, so I thought it would be worth discussing here.  

There was recently a discussion on Podiatry Arena on barefoot running and I thought Craig Payne, an Australian podiatrist, provided an excellent summary of the issue and I would have to say I agree with him 1 ...
By Larry Huppin, DPM on 1/20/2010 10:08 PM
Medial hallux pinch callus is a sequellae of functional hallux limitus. When the hallux is unable to dorsiflex during toe-off, abductory twist leads to rolling off of the medial aspect of the hallux and “pinching” the skin – leading to the pinch callus. Thus your goal when prescribing an orthosis to reduce hallux pinch callus is to create an orthosis that treats functional hallux limitus. Our recommendation for an orthotic prescription to best treat hallux limitus can be found here.

ProLab clients are encouraged to ...
By Larry Huppin, DPM on 1/18/2010 3:03 PM
When the rearfoot everts, the medial forefoot is forced into the ground. This results in a dorsiflexion force on the first ray and jamming of the first MPJ as the patients begins to toe-off.

An article published several years ago in the Journal of the American Podiatric Medical Association gives us some good data on this relationship. Paul D. Harradine, MSc, and Lawrence S. Bevan, BSc (Hons), did a preliminary study on "The Effect of Rearfoot Eversion on Maximal Hallux Dorsiflexion." They found that hallux dorsiflexion is decreased with rearfoot eversion*.

This again underscores the importance of prescribing rearfoot control when treating hallux limitus.

To resist rearfoot eversion, your orthotic prescription should contain:
By Larry Huppin, DPM on 1/14/2010 6:34 PM
I had a patient present several months ago with diffuse midfoot osteoarthritis bilateral. Pain was present with most weightbearing activities and increased with exercise. Regardless of the joints involved in the midfoot, our goal with treatment is to limit the motion that causes pain.

Our first line of treatment was a custom foot orthosis with the following prescription:
  • Semi-rigid polypropylene
  • Deep heel cup
  • Wide width
  • Minimum cast fill
  • 0/0 rearfoot post

When trying to limit midfoot motion, be sure that your orthosis conforms very closely to the arch of foot and also acts to limit subtalar joint pronation.

These orthoses provided about 30% improvement of her symptoms, but she was still experiencing significant pain.

Our next line of treatment was the use of r ...
By Larry Huppin, DPM on 1/4/2010 4:14 PM
A patient presented today with bilateral pain on the plantar lateral foot with activity. His exam was significant for:
  • Cavus feet
  • Inverted RCSP with a positive Coleman Block test (by supporting the lateral forefoot the heel came to perpendicular)
  • Humongous styloids – plantar and lateral.
  • Pain to palpation on plantar styloids – no pain lateral.
He had a pair of orthoses that were not helping much. These devices were gapping extensively from his medial arch and although they had some accommodation plantarly for the styloids, it wasn’t nearly enough.

Our treatment goal is to reduce pressure under the styloid processes.

Here is the orthotic I prescribed:
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 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 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 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 ...
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