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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 7/18/2011 12:40 PM
I consulted with a ProLab client this morning who has a patient with bilateral midtarsal joint arthritis. He wanted to know if we had a pathology specific orthosis for that problem.

We do not have a pathology specific orthosis on our prescription form for midtarsal joint arthritis, but we certainly do have some ideas on how this should best be treated. Our goal is fairly simple – we want to limit midtarsal joint motion and in doing so reduce the patient’s pain.

Mechanically, this patient has moderate arch collapse. She also has a heel that is everted by about 8 degrees in stance. This means we are going to try and control the arch, and hopefully try to limit some of the rearfoot eversion. The following is what I recommended.

By Larry Huppin, DPM on 7/14/2011 6:19 AM
My business partner was trained at one of the top surgical residency programs in the country and did not have much experience with orthotic therapy during his residency. He is an exceptional surgeon, but feels strongly that if a more conservative option will allow the patient to reach their goals, then surgery should be a last resort. This tendency toward more conservative treatment whenever possible is a trait that tends to be found in the best and most experienced surgeons. Increasing orthotic therapy skills allows these good surgeons to provide their patients with better care. In the last five years, he has taken a much greater interest in orthotic therapy. He now takes a more evidence-based approach to his orthotic therapy and he is finding that he has much better clinical outcomes. He also has become more adept at adjusting orthotic devices.
By Larry Huppin, DPM on 6/30/2011 7:28 AM
I received a call from a ProLab client this morning with questions regarding how to make an AFO for a patient who had a poor outcome following a spinal surgery. She developed a dropfoot on the left side. This is not an unusual complication of such a surgery. What was unusual, however, was that on the right side she had posterior weakness rather than anterior weakness, and developed a calcaneus type of gait. She has a difficult time plantarflexing her right foot and this results in her walking on her heel on the right side, yet having a typical dropfoot on the left side. Our client decided to use a dorsiflexion-assist functional AFO for the left dropfoot (to prevent plantarflexion), but was not sure what to do for the calcaneus type of gait on the right.
By Larry Huppin, DPM on 6/23/2011 7:19 AM
 I had a ProLab client call me today as he was having a problem with a 9-year-old patient’s parents. The child presented with calcaneal apophysitis and a rather severe pes planus foot type. Our client prescribed a pediatric flatfoot pathology specific orthosis. It was dispensed and they returned two weeks later stating that all symptoms were resolved and that they wanted a second pair. The second pair was ordered.

Apparently, then the child was seen by an Orthopedic Sports Medicine specialist and the parents were told that these were the “wrong type of orthotics” that the child should be in a more flexible orthosis.
By Larry Huppin, DPM on 6/20/2011 1:44 PM
Jenny Sanders, DPM (a former ProLab Medical Consultant) wrote a great article on high heels published this month in Podiatry Today. The following is the introduction to the article:

While podiatrists strongly advise patients to avoid wearing high heels, the reality is many patients will continue to wear them. With this in mind, this author emphasizes patient education on ensuring optimal fit and support, reviews key features to promote better stability, and discusses helpful shoe modifications.
By Larry Huppin, DPM on 6/16/2011 3:07 PM
 I had a ProLab client call me today with a question regarding a prescription for a patient who had suffered a lawnmower injury, which resulted in the loss of the posterior medial aspect of her calcaneus. After reconstruction she had a fairly normal shaped heel externally, but essentially had a narrow calcaneus which was resulting in plantar pain. The question was how to design an orthosis to help this problem?

Our goal is to transfer pressure off of the heel, and then also to provide some cushion. Cushion slows velocity of the foot and by doing so decreases force. The following is the prescription that we developed:
By Larry Huppin, DPM on 6/13/2011 3:00 PM
 Patients with out-toed gait sometimes have trouble tolerating orthotic devices. This occurs primarily because the out-toed position of their feet forces them to rollover the medial edge of the orthotic device and they develop medial edge irritation.

To prevent this problem, simply make your orthotics wider. By choosing “wide” for the orthotic width, you will extend the medial edge of the orthotic to the medial aspect of the foot. These patients will have the surface area of their orthotic under the entire foot and will not come down on the medial edge of the orthosis.

For orthotic hints every week, subscribe to the RSS feed of this blog.
By Larry Huppin, DPM on 6/6/2011 3:42 PM
Below is an email we received last week from a client with questions on two patients.   If you are a ProLab client please email or call us with any questions you might have regarding the best othotic prescription for your patient:   

Hi, I would like your guidance with two patients.

1. Rigid pes planovalgus from cerebral palsy (CP). She used orthotics when she was 5-10 years old. They caused blisters along the medial arch. Is there something I shoud avoid to prevent this from happening again?  She would really like to
By Larry Huppin, DPM on 5/16/2011 1:23 PM
 
Podiatry Arena
 Podiatry Arena is a forum in which some of the best foot biomechanists in the world participate in online discussions, debates, arguments and occasional virtual wrestling matches on matters pertaining to foot biomechanics and orthotic therapy.   

Each month we will provide you with links to the threads that would seem to be most interesting for our clients.
By Larry Huppin, DPM on 5/12/2011 9:59 AM
 In the new issue of Lower Extremity Review is an article that reviews theories on how orthotics function.  We are recommending this article to all ProLab clients.   You can read the full article here.  


Here is the introdution to the article:

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