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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 5/24/2010 5:16 PM
I had a client call with the following question today: 

QUESTION:
Do you have any idea of how to successfully treat a sheer varus friction type of callus at the plantar tip of the 4th toe? In theory, a good pair of functional orthoses with a Spenco extension should work. But I have never had good success with this. Any suggestions?

ANSWER
This is a tough keratosis to treat with orthoses, but here are a couple ideas. The following information assumes you already have an orthosis that is providing adequate control of the foot.

The most important thing is to use a topcover on your orthosis that will show an impression of areas of increased pressure. For example, Diabetic Topcover works well. This is a tri-layer material with a Poron bottom layer, soft Plastizote middle layer, and a leather topcover. EVA is another material that will show an impression.

After the patie ...
By Larry Huppin, DPM on 5/20/2010 9:05 AM
Prescribing rearfoot post motion is one of the more confusing issues on orthotic prescriptions.

Traditionally, the post motion is prescribed as 4/4, 0/0, or some other similar combination. It is important to understand what each of these numbers mean.

The first number is the amount of lateral grind on the post that holds the front edge inverted before forefoot loading. This is most often 4 degrees to accommodate the inverted position of the heel at heel contact.

The second number is the amount of motion the orthotic has during forefoot loading when the front edge comes down to the ground.

A 0/0 post is ground parallel to the front edge of the orthotic and is intended to keep the front edge flat in the shoe regardless of foot movement.

A 4/4 post is one in which the lateral aspect of the post is inverted 4 degrees to the front edge of the orthosis and there is 4 degrees of mot ...
By Larry Huppin, DPM on 5/13/2010 9:31 AM
Some of the studies we discuss in our eJournal Club refer to the Foot Posture Index(1, 2). The Foot Posture Index consists of six specific criteria:
  • Palpation of the talar head
  • Supralateral and infralateral malleolar curvature
  • Calcaneal frontal plane position
  • TN joint prominence
  • Abduction and adduction of the forefoot on the rearfoot.
  • Congruence of the longitudinal medial arch
Each Foot Posture Index criterion is scored by an examiner on a 5-point scale ranging from -2 (very supinated) to +2 (very pronated)

Scores are then summed to give an overall foot posture score. The summed score has the potential to range from –12 (highly supinated) to +12 (highly pronated).(1, 2)

To increase accuracy multiple examiners can be used and the totals averaged.

St ...
By Larry Huppin, DPM on 5/10/2010 12:15 PM
The ProLab Medical Consultants can provide consultation for even the most challenging biomechanical cases when we can see your patient.  Today's technology makes that easy.  If you have a particularly difficult case, take pictures and / or video of the patient and email them to us. &# ...
By Larry Huppin, DPM on 5/6/2010 6:39 AM
In the year we have been using diagnostic ultrasound (US)in our office, I’ve made changes in some orthotic prescriptions based on US findings. In particular, US has affected my orthotic prescription in those cases where there is thickening of the plantar fascia directly plantar to the calcaneus.

When US indicates that there is excessive inflammation / thickening of the plantar fascia directly plantar to the calcaneus (rather than at the medial tubercle where we primarily see thickening of the fascia) I’ve started adding extra cushion to my orthotic devices. I’ll usually prescribe one of our Pathology Specific plantar fasciitis orthoses, but add a
By Larry Huppin, DPM on 5/3/2010 3:40 PM
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I was in Canada this weekend.  I learned that they play a strange game up there that has to do with ice and sticks and pucks.   Apparently, the stick is used to hit the puck which moves at great speed across the ice.   Occasionally, a foot or ankle gets in the way of the puck resulting in a fairly high incidence of foot fractures and contusions.  

By Larry Huppin, DPM on 4/12/2010 3:28 PM
Twice in the last week I have had a question about the best orthotics for ballet flats.  These are a currently popular style of womens dress shoe based on ballet shoes.  They are very flexible and have little or no heel height.   They tend to be very shallow.  

The short answer is that it is nearly impossible to fit an orthosis of any kind into a ballet flat and you are setting yourself, and your patient, up for failure if you give them the impression that any orthosis will fit in their ballet flats.  

We can make orthoses to fit many, maybe most, women's dress shoes.   But ballet flats are simply too shallow to accept an orthosis.  ...
By Larry Huppin, DPM on 4/8/2010 8:00 AM
A client emailed some pictures today of a patient who was having heel cup irritation from his orthoses. You can see the pictures below. He wanted to know what we could do to fix the problem.

Unfortunately, there is no way to effectively adjust this orthosis to reduce heel irritation. The device will need to be redone with a more heel expansion on the positive to create a wider heel cup.

This problem occurs because the non-weightbearing cast ...
By Larry Huppin, DPM on 4/1/2010 1:33 PM
We had a patient present earlier this week who had a prominent plantar fascia that was being irritated by her new orthoses. Below is detailed our standard troubleshooting plan for creating a plantar fascial groove in an orthosis that was made without one:
  1. If you have an EVA cover on the orthosis, leave it on. If the cover is anything other than EVA, remove it.
  2. If there is on cover, glue 3mm EVA or Poron to the dorsum of the orthosis
  3. Mark the plantar fascia with lipstick
  4. Line the orthosis up with the foot and press it into the foot in order to transfer the lipstick mark to the orthosis
  5. Use a Ticro Cone to grind a groove into the orthosis
  6. Put a thin cover on top of the device.
By Larry Huppin, DPM on 3/29/2010 1:57 PM
If you ever grind polypropylene, you know it can look a bit rough after grinding. If you are going to be grinding poly in your office, you should have the ability to polish it also.  Read here why you should have a grinder in your office.

To polish polypropylene, we recommend the use of a Ticro Cone. This is a Hot Dog shaped f ...
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