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Blog

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 12/19/2011 7:22 AM
  These pictures show the feet,shoe and orthoses of a longtime patient of mine. He is 77-year-old who has severe cavus feet bilateral, and on the right suffered a tibia and fibula fracture many years ago which left him with a severely inverted right rearfoot. This led to multiple recurrent sprains of the right ankle.

When I first saw him a couple of years ago, we discussed a number of treatment options including the use of an AFO. He had already tried an AFO and found that they were uncomfortable because of the prominence of his lateral malleolus. It was very difficult to find one that would support him and would not irritate the malleolus.
By Larry Huppin, DPM on 12/15/2011 9:47 AM
The November issue of Lower Extremity Review has an article on Evidence-Based Orthotic Management of PTTD. We are recommending this article to all ProLab clients.

The article states that, in general, studies support the use of orthotic devices for patients with PTTD, especially in the early stages. Orthoses appear to improve foot and ankle alignment, clinical symptoms, and functional outcomes in PTTD patients with success rates up to 90%.
By Larry Huppin, DPM on 12/8/2011 12:56 PM
I had a patient come into our clinic last week who was experiencing plantar fasciitis. Along with that, she has a long history of knee and hip pain. She has had the diagnosis of some mild osteoarthritis affecting the medial knee.

We did discuss the use of custom orthotic devices to treat her problem, but I am always concerned on whether orthoses will be tolerated by those patients with a history of knee, hip, and back pain. Certainly, in many situations, orthotic devices can help these symptoms but they also can make those symptoms worse.

We discussed the options including potential risks and complications and decided that it would be a good idea to try a pair of prefabricated orthosis before proceeding with custom orthotic devices. This would give us a chance to evaluate how her proximal joint pain might be affected by using an orthotic device before investing in custom orthosis.
By Larry Huppin, DPM on 12/5/2011 3:46 PM
There is a direct relationship between prescribing inversion in your orthotics and the width that you should be prescribing.

Inversion of your orthoses is one of the more common, and effective, modifications that you can make for several of the most common pathologies treated with orthotic devices. Inverting an orthosis offers several advantages in treating the following pathologies.

Metatarsalgia: An inverted orthotic has a higher arch. An orthosis with the higher arch is more effective in transferring pressure from the ball of the foot to the medial arch.
By Larry Huppin, DPM on 12/1/2011 8:02 AM
 I saw a patient this morning who presented with significant pain affecting the right foot, particularly in the area of the first metatarsophalangeal joint. Fourteen months ago, she had surgery to correct a bunion. It appears that she likely had a head procedure. She developed a nonunion, and then six months ago had a second procedure; a plate was added. She was nonweightbearing for a number of weeks and used a bone stimulator. The nonunion seems to have healed, but she is still having significant pain. She has been using Rocker soled shoes and she did receive a pair of orthotic devices.

She has continued to have significant pain affecting the right foot particularly in the area in the first MPJ and along the first metatarsal shaft.
By Larry Huppin, DPM on 11/28/2011 2:09 PM
 I spoke to a ProLab client today who had a patient with an osteochondral defect of the ankle. He performed a scope and the patient was doing better, but she was still having what he thought was lateral impingement. She had a calcaneal varus and an ankle valgus. He wanted to know if there was anything we could do with orthotic devices to reduce her symptoms.
By Larry Huppin, DPM on 11/14/2011 2:00 PM
 As we come into our winter sport season, we are seeing more requests for orthotics for ski boots, snowboard boots and ice skates

These are all very tight fitting boots. This tight fit makes fitting an orthosis much more difficult. ProLab has established some requirements for production of these specialty orthoses. 

Ice Skates
We cannot make orthoses for skates unless we have the skates. No exceptions. Note that this will increase both your outbound and inbound shipping costs. We recommend that this cost be passed on to the patient. In my office we charge an extra $25 for shipping of the skates, payable at the time of casting. 
By Larry Huppin, DPM on 11/10/2011 6:56 AM
A ProLab client called me today with questions regarding a prescription for a pair of orthoses for a patient who recently had an arthrodesis of the first metatarsophalangeal joint on the right foot, and was experiencing first MPJ pain secondary to hallux limitus on the left foot. On the right foot, the patient was experiencing metatarsalgia pain with pain primarily under the second MPJ.

Our goal of treatment is to decrease pressure on the second metatarsal head on the right foot, and on the left foot to enhance motion in the first metatarsophalangeal joint.

The following was our prescription:
By Larry Huppin, DPM on 11/3/2011 7:14 AM
I had a ProLab client call me this morning regarding how to write a prescription for a patient who is experiencing pain from calcaneal cuboid arthritis. This patient had a subtalar joint fusion 30 years ago. In the past couple of years he started developing lateral column pain that seems to be due to calcaneal cuboid joint OA.


By Larry Huppin, DPM on 10/31/2011 10:18 AM
  If you are having shoe fit problems with your orthoses, make sure you are taking the following into account. 
  • Instruct your staff to tell patients to bring 2-3 pairs of shoes to their initial appointment
  • Evaluate the patient’s shoes before prescribing orthoses
  • Which type of shoe does the patient plan on using for their orthotics? The prescription must be different if the orthotics are for a dress shoe vs. an athletic shoe.
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