By Larry Huppin, DPM on
6/28/2012 6:53 AM
We are recommending that all ProLab clients read a recent article in Lower Extremity Review: Role of foot orthoses for patellofemoral pain
This article discusses level 1 evidence for the use of foot orthoses in treating PFPS. From the article:
“Specifically, there were significantly more self-reported improvers at six weeks in a group receiving prefabricated foot orthoses compared to a group receiving a control intervention (flat inserts). The number needed to treat for one additional improver in th
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By Larry Huppin, DPM on
6/25/2012 6:00 AM
ProLab provides webinars on a specific topics in orthotic therapy on the second Thursday of every month at 12:30 PST. These webinars are available to ProLab clients, podiatric students, and podiatric residents. They are focused on Evidence-Based Orthotic Therapy and about 20 minutes in length.
All of the webinars are recorded and available for viewing at anytime, day or night. We currently have the following webinars available and we'll be adding more every month:
- Evidence-Based Orthotic Therapy For Plantar Fasciitis
- Evidence-Based Orthotic Therapy For Metatarsalgia
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By Larry Huppin, DPM on
6/21/2012 5:54 AM
Prescribing orthoses for patients with plantar fibromas can be challenging. In general, our treatment goal is to reduce tension on the plantar fascia and then reduce pressure on the plantar fibromas. This can lead to a Catch-22 situation; orthoses that conform closely to the arch of the foot can help reduce tension on the plantar fascia, but they may also increase pressure on the fibroma. Luckily, there are some fairly straightforward orthotic modifications that can lead to an excellent clinical outcome for these patients.
To decrease plantar fascial tension, you will want to prescribe the initial orthosis
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By Larry Huppin, DPM on
5/17/2012 5:48 AM
I had a ProLab client call me today regarding a patient with an ulcer under the hallux. The patient is active. He works in an OR and spends most of the day on his feet. The client is looking for a way to use orthotic therapy to decrease force under the hallux.
There are a number of studies showing the most effective methods to decrease force under the hallux. Our primary goals are to decrease any functional hallux limitus that is occurring in order to decrease pressure under the hallux, and then transfer pressure directly off the ulcerated area.
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By Larry Huppin, DPM on
5/11/2012 6:56 AM
I just finished a consult with a ProLab client who had a patient with severe cavus foot and an inverted heel causing him to have severe lateral instability. The patient has had many pairs of orthotics over the years and none of them have been effective. I had previously done a consult in helping the doctor to write an appropriate prescription to try to apply force laterally to decrease this lateral instability.
He called me back today to say that the patient was extremely happy. By using this orthotic, he felt the most stable that he had in his entire adult life. He actually wanted to see if there was any way to try to improve upon the function of this orthotic.
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By Larry Huppin, DPM on
3/15/2012 1:42 PM
 In ProLab’s home of Napa, many workers in the wine industry require orthotics that can regularly get wet. If you also have patients who require waterproof orthoses, here are our suggestions.
The most waterproof orthotic by far is a direct milled polypropylene (CD) orthosis with no cover. This all plastic device is completely waterproof and dries off in seconds.
If you require a cover and some cushion, I think the best choice is
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By Larry Huppin, DPM on
3/12/2012 11:22 AM
I received a question from a client today on the consultation page here on our website. This allows ProLab clients to send in questions and include pictures, MRI reports, etc.
QUESTION:
Hi Larry, I wanted your opinion on this orthotic. As you can see from the MRI he has a plantar plate rupture sub 3rd on left foot and possible neuroma in 2nd interspace. I also included the pic of the orthotic he has now which does have a small met pad, and his shoe type. Would you agree he needs to have a met pad that is bigger, say 1/2", proximal to 2nd and 3rd met heads?
ANSWER:
The goal of the orthosis in the presence of a plantar plate tear is to transfer as much pressure off of the 3rd met head (MPJ) as possible. You do this by prescribing
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By Larry Huppin, DPM on
3/9/2012 8:19 AM
I received an emailed question from a client this morning:
QUESTION
 I would like to send you some pics. Interesting case of Cavus foot type with severe painful IPK sub 3rd bilateral. Wanted your opinion whether you see some calcaneal varus? and do you recommend a metatarsal pad behind the 3rd metatarsal. He also has IPK sub 1st but asymptomatic. Will send you castings shortly.
ANSWER
I don't think you need to worry about the rearfoot, it looks pretty stable and rectus.
This is really just an issue of getting the pressure off of the 3rd met, and to a lesser extent, the 1st.
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By Larry Huppin, DPM on
3/5/2012 11:09 AM
 I did a consult with a ProLab client yesterday regarding a patient who was laterally unstable and how best to write the orthotic prescription. He stated that in the biomechanical exam he measured the resting calcaneal stance position as nearly 10 degrees inverted. I then asked if he had performed the Coleman block test to determine whether it was the forefoot that was holding the foot inverted, or if this patient had a rigid inverted rearfoot. He had not checked that and did not know the answer. This is a critical question when looking at a patient who has an inverted heel, so he decided to have the patient return to clinic so that he could perform the Coleman block test.
The Coleman block test consists of supporting the lateral forefoot in order to determine if
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By Larry Huppin, DPM on
3/1/2012 1:20 PM
I had a ProLab client call me this morning with questions regarding a patient of his who keeps wearing through his orthotic cover. He is wearing through just under the second toe. No other area is showing excessive wear. This current pair of orthotics is about 18 months old. He has a vinyl cover with Poron glued to the bottom of the cover and then a vinyl bottom cover.
Actually this is a very strong cover. The vinyl and Poron combination is probably the best wearing topcover.
It is important to realize that there are some patients who simply do wear through topcovers much faster than others. They either have more motion leading to friction or they possibly have hyperhidrosis. Both of these things can lead to faster wear of the covers. These patients should be told that the orthotic cover may need to be replaced every year. Some patients may have to have the cover replaced every six months. Those patients that do wear through
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