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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 8/30/2010 6:55 AM
I’m sitting on a plane now returning from the ACFAOM meeting in Orlando where Drs. Paul Scherer, Mark Reeves, Doug Richie, Richard Stess, Mr. Jeff Root and myself presented a track on evidence based orthotic therapy. We hear again and again that attending one of these orthotic therapy tracks is a practice changing event for many practitioners who are still practicing orthotic therapy as it was taught to them in school 10, 20 or 30 years ago. Extensive research on the use of foot orthoses has changed dramatically the way orthotic therapy should be practiced and if you haven’t attended an evidence based orthotic therapy seminar in the last few years, make a point to do so. Upcoming seminars can be found here. For those of you in the northeast, nearly two full days of lecture and workshop will be presented at the New York Clinical Confere ...
By Larry Huppin, DPM on 8/26/2010 4:10 PM
Rocker sole shoes have become very popular in the past few years. Often marketed as “toning shoes”, there really is no evidence that they offer any exercise or fitness benefit over regular shoes. Rocker soles, however, have been shown in a number of studies to be an effective  treatment modality for foot conditions including metatarsalgia, forefoot ulcers, midfoot arthritis, ankle arthritis, hallux rigidus and heel pain.

The best known brands of the rocker shoes are MBT and Sketcher Shape-ups. They are not however, in our opinion, the best of the rocker soles. The problem with the MBTs and Sketchers is that they have extremely soft and unstable soles under the heel.  This makes them unstable in the frontal plane.  The manufacturers claim that this lack of stability increases the “toning” function of the shoe, but have no evidence to support this claim.

Instead, if you are going to prescribe rocker shoes for your patients we reco ...
By Larry Huppin, DPM on 8/22/2010 3:00 PM
For the past several weeks I have been testing a new scanner in my office. So far I am impressed with the functionality of the scanner. It’s not perfect, but the manufacturer has been very receptive to our suggestions.

Scanning – also known as digital casting – soon will likely be the most common method of capturing an image of the foot to produce custom foot orthoses.

We have evaluated over a dozen scanners and I have personally tested five of the better ones. Over the next several months we will be providing unbiased reviews of these and other scanners to help you decide whether you wish to use a scanner in your office, and if so, find the best one to serve your needs.

The first thing we did was to come up with the criteria any scanner must fulfill to be considered as a replacement for casting. We came up with the following 9 criteria that the ideal 3D optical scanner should have:

1. < ...
By Larry Huppin, DPM on 7/28/2010 1:32 PM
When you prescribe a custom foot orthosis, do you always know what you are getting from your lab?

Not long ago it was clear that if you ordered a custom orthosis you were getting a truly custom orthosis. You sent in a plaster cast and the lab made a plaster positive cast, modified it as prescribed and then heat molded a material to create an orthosis on top of that cast. The resulting orthosis was clearly custom made for a specific patient.

Orthotic fabrication has changed dramatically over the past two decades. More likely than not, a plaster positive will no longer be produced when you send a negative cast to your orthotic lab. Instead, the corrections that were previously performed to create a plaster positive are now done on a CAD / CAM computer system. The same corrections can be performed on the computer as were done in plaster and then a positive cast can be milled on which the orthosis is produced; or the orthosis can be milled directly. This tec ...
By Larry Huppin, DPM on 7/22/2010 1:49 PM
Aetrex has a new line of sandals called "Sandalistas". These are attractive and stable sandals with a removable insole. This insole is the perfect size to allow the shoe to accept a custom orthosis. I usually use the following prescription for an orthosis to fit in the Sandalistas.
  • Direct milled poly semi rigid
  • Standard heel cup
  • Standard width
  • Soft EVA black cover to toes
  • Firm EVA forefoot extension to toes
This Rx works well with most of the Sandalistas. If you send the sandal along with the prescription form, we can e ...
By Larry Huppin, DPM on 7/12/2010 4:49 PM
I had a patient last week who was looking for a stable slip-resistant shoe to wear at his restaurant job. That got me doing a little research on stable slip-resistant shoes so I thought I would share the info here.

Many people have jobs where slip-resistant shoes are required and/or beneficial. These include nurse shoes, hospital shoes, chef shoes, and restaurant shoes. I looked for slip resistant shoes with orthopedic superior support, a removable insole, and durable leather uppers. I also found some slip resistant extra depth shoes.

What to tell your patients about slip resistant work shoes:
  • ANSI Standards: For many work situations, shoes must be ANSI certified as slip-resistant. The shoes below fit those standards. In most cases, the words “Slip Resistant” will be foun ...
By Larry Huppin, DPM on 7/1/2010 7:04 AM
A couple weeks ago I wrote on Realistic Expectations for Dress Shoes – talking about what are realistic expactations regarding orthoses for women’s dress shoes. I received some questions regarding specific shoe brands that I recommend. Some are listed below. Keep in mind, that, for the most part, there are several models from each brand that work well with orthoses. The key is that your patient take their orthoses with them when they are trying on shoes.

For “business dress” shoes for women I often recommend:
Aravon, Ariat, Theresia, Munro, Stonefly, Sofft, Softspots, Aetrex, Cole-Haan, Softwalk, Indigo by Clarks, and Trotters. Look for any closed heel shoe that will accept the orthosis.

For these shoes with a heel less than 3” I usually use a graphite or ...
By Larry Huppin, DPM on 6/21/2010 12:36 PM
Orthoses for dress shoes can be great. Personally, I prescribe many graphite orthoses with a shallow heel cup, normal width, and vinyl cover to the sulcus for these shoes. This device works wonderfully in many women’s and men’s dress shoes.

I tell every patient, however, that I make NO guarantee that the orthoses will fit in ANY shoe that they currently own. In fact, I tell them that they probably will NOT fit in any of their current shoes but that I will give them a list of fashionable shoes that often work well with orthoses.

Even if you send the shoe to the lab, we can only guarantee you that the orthosis will fit the shoe. We cannot guarantee that the foot will then fit into the shoe with the orthosis. It may make the shoe too tight or the patient’s heel may slip ...
By Larry Huppin, DPM on 6/17/2010 10:43 AM
 
By Larry Huppin, DPM on 6/10/2010 2:08 PM

Have you ever had a patient complain that their orthoses cause pain under the anterior distal arch or feel they are "too far forward”? More often than not, what the patient is actually experiencing is excessive pressure from the orthoses under the anterior metatarsal shafts. You can quickly and easily troubleshoot this problem by increasing the flex of the orthosis under the distal metatarsal shafts.

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