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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 1/20/2011 9:06 AM
I spoke to a client yesterday who was making orthoses for a runner with plantar fasciitis. He wanted to prescribe an orthosis with a maximum arch fill so that he could be sure that the orthosis did not cause any irritation to the arch of the foot.

I think this illustrates a huge problem in podiatry – prescribing orthoses to avoid the need to troubleshoot, rather than prescribing for best clinical outcomes. The best evidence on orthoses for plantar fasciitis indicates that devices that conform closely to the arch (minimum cast fill orthoses) are more effective at reducing tension on the plantar fascia. The downside of these orthoses is that there is certainly more potential that the orthosis could cause some arch irrititation. If this occurs, it is extremely easy to adjust for an arch that feels too high. Simply grind the orthosis thinner in the arch to increase flex in the arch. This is demonstrated in the video below.

Of course, if you ...
By Larry Huppin, DPM on 1/13/2011 8:39 PM
Clinical Goal for Orthoses Following Bunion Surgery:
Following a bunion procedure, our primary goal with orthotic therapy is to encourage full range-of-motion in the first metarsophalangeal joint .

Biomechanical Goal:
To encourage first MPJ full range of motion, we wish to decrease excessive ground reactive force under the first ray and to allow the first ray to plantarflex. The orthosis should be designed to decrease the everted position of the calcaneus when an everted rearfoot is present. In the case of an everted forefoot, the orthosis should support the lateral forefoot (forefoot valgus).

Prescription:
The ProLab Hallux Limitus Pathology Specific Orthosis
By Larry Huppin, DPM on 1/10/2011 3:05 PM
Do you recommend specific socks to your patients? The proper socks can make a tremendous difference in foot comfort and your patient’s perception of orthotic function.

For example, if you are using orthoses for treatment of metatarsalgia, the proper socks can decrease force under the ball of the foot by providing greater cushion. Studies are clear that acrylic socks provide greater protection against shock and shear than do cotton socks (1-7). So, anytime you are prescribing orthoses for metatarsalgia, you should also be telling your patient to switch to acrylic socks. Because these socks are often thicker than the cotton socks your patient is currently wearing, it is critical to have them try on any new shoes with both the orthoses AND with the thickest socks they will be wearing.

By wearing the proper socks, your patient will see improvement in symptoms and find more satisfaction with their orthoses and thei ...
By Larry Huppin, DPM on 1/3/2011 2:55 PM
Our new shoe list for 2011 will be available soon. In this new version we have separate sections for women’s and men’s dress shoes.  The shoe list is available in the client section of the website.  Contact us if you have lost your log-in information 
 
In a previous post I discussed my favorite site for finding fashionable but healthy women’s shoes. Today, we will focus on men’s dress shoes. The shoes I recommend will be stable and have a removable insole so that there will be room for an orthosis. Most of these shoes will accept a fairly full sized orthosis, although for dress shoes I tend to go without topcovers or a thin cover such as vinyl. I’ll ...
By Larry Huppin, DPM on 1/3/2011 10:52 AM
We can make orthoses to fit sandals as long as the sandal has a removable insole.  Have your patient first purchase the sandal and then send the sandal to the lab along with the cast and prescription. 

I've been working with a patient the last few days to help him find a sandal that would work.  He found he likes Mehphisto and Naot sandals. Both have some models that have removable insoles.  

Anyway, I did a bit of research to discover which sandals in these brands have removable insoles.   Here is what I found:

Mephsito sandals with removable footbed

By Larry Huppin, DPM on 12/27/2010 7:14 PM
I figure no one is working this week , so just watch this and enjoy. The politics are Canadian (by the way...there is evidence), but the performance is priceless.
By Larry Huppin, DPM on 12/27/2010 2:30 PM
I have included a couple of shoe lacing videos in this blog over the past several weeks.  You can use the search feature on the right to find those - just search for "lacing".  

Familiarity with different lacing techniques is helpful in troubleshooting orthotic problems.  For example, patients with high insteps who receive orthoses will benefit from a looser dorsal lacing technique.   There are dozens of lacing techniques that can help your patients.  It pays to be familiar with a variety of techniques.  

One of my favorite lacing guides is a website called Ian's Shoelace Site. Ian has a list of 33 lacing ...
By Larry Huppin, DPM on 12/25/2010 1:12 AM
By Larry Huppin, DPM on 12/23/2010 4:52 PM
Is your patient's running shoe just a little tight now that they have received their new orthoses?  If so, this video demonstrates lacing technqiues designed to loosen the shoe. This technique is particullary good for patients with high insteps and wide feet.
By Larry Huppin, DPM on 12/20/2010 2:56 PM
By altering foot function, we all know that custom orthotics also have an effect on other areas of the body. In most cases this is a positive effect. For example, there is good evidence that foot orthoses can have a positive effect on patello-femoral dysfunction. Patients with a history of these problems, however, can also find that the use of new orthotics can increase pain during the break-in period. To avoid these problems, we instruct those patients who have a history of knee, hip or back problems to break-in their orthotics on a slower schedule.

Those people who should have a slower break-in include patients with the following conditions:
  • Significant back pain, hip pain or knee pain
  • Artificial knees or hips
  • Patients who previously have had trouble getting used to orthotic devices

If a patient is in one of these groups, we suggest the following break-in ...
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