By Dianne Mitchell on
2/2/2012 1:29 PM
found an interesting article in JAPMA this month.
Effect of a Metatarsal Pad on the Forefoot During Gait
KLM Koenraadt et al. JAPMA. Vol 102. No 1, Jan/Feb 2012. Pg 18-24.
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By Larry Huppin, DPM on
2/2/2012 7:00 AM
 I want to talk today about the "Blake inverted Paradox". Blake inversion refers to balancing the positive cast more than 10 degrees inverted. Additional modifications are performed to make the arch height tolerable. This technique is available only in plaster. The paradox is the fact that a 9 degree inverted orthotic has a higher arch than a 10 degree inverted orthotic.
I consulted with a ProLab client yesterday who wanted to order an orthosis with an arch that would conform extremely close to the arch of the foot. He ordered a standard cast fill, but then inverted the device 10 degrees.
He was surprised when he received the orthotic back and found that it did not conform particularly well to the arch of the
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By Larry Huppin, DPM on
1/16/2012 9:44 AM
Research suggests foot orthoses can affect frontal and transverse plane motion in proximal joints during landing from a jump. This could help decrease the risk of anterior cruciate ligament injury, especially in female athletes.
A recent article in Lower Extremity Review looked at this subject in detail. We are recommending this article to all ProLab clients.
Some of the article highlights include:
In the May issue of the Journal of Applied Biomechanics (JAB), researchers from East Carolina University (ECU) in Greenville, SC, reported that gender and foot orthoses affect frontal plane hip motion during landing from a vertical jump.
“Foot orthotic devices are able to change hip motion in the frontal
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By Larry Huppin, DPM on
1/12/2012 9:29 AM
I consulted with a ProLab client today regarding a patient with pain at the calcaneal cuboid joint. He apparently has a fairly stable foot with mild eversion of the heel in stance. Pain is achy with activity and there is a little pain to palpation dorsolaterally. Radiographs were negative.
He does not have an exact diagnosis, but if nothing else, he is certainly having some calcaneal cuboid arthralgia. In a way, it doesn’t really matter what the exact diagnosis is. For patients with chronic pain in the area of the calcaneal cuboid joint we have a fairly straightforward goal of treatment, regardless of the underlying etiology. Our goal is to minimize motion of the calcaneal cuboid joint and to transfer pressure from the lateral column to the medial column.
The following is the prescription that we recommended for this patient:
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By Larry Huppin, DPM on
1/9/2012 7:43 AM
 As do most orthotic labs, we offer a number of different choices for dress shoes. Over the years I have tried many different devices including the graphite dress orthotics, the Holethotic and the Cobra orthotic. A few years ago I was most commonly using the graphite dress. I have now, however, migrated to using the Cobra almost exclusively for women’s dress shoes.
The Cobra offers a number of advantages in women’s dress shoes. The first is that it is simply smaller than any of the other devices. In addition, unlike any of the other orthoses, it is flexible in the heel with the ability to bend in the sagittal plane. This allows it to easily adapt to different heel heights. So, not only does it fit into flats, but my patients can wear it in heels. It can even be used fairly easily in four, five, and six-inch heels.
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By Dianne Mitchell on
1/4/2012 5:20 PM
As I reviewed prescriptions sent into the lab, I came across one issue several times - doctors asking for accommodations on their orthotics, but no marks on the casts indicating the specific locations. It is very important that the casts are marked for accurate accommodation location.
A simple technique is to mark the area with something that will transfer to the plaster. Use lipstick or betadine solution applied to the specific region of the foot with a Q-tip. This will then transfer to your mold. Improve the accuracy of placement for your accommodations with this simple technique - your patients will appreciate it!
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By Dianne Mitchell on
12/30/2011 9:15 PM
A patient was placed in graphite functional orthotics for foot and knee pain. The foot pain quickly diminished but the knee pain persisted. What modification can be done to the orthotic to potentially help this issue?
These were low profile dress-type orthotics without a post designed to fit in as many pairs of shoes as possible. Without a post, these devices may rock into varus/valgus and could result in continued knee pain.
Recommendation: post the devices with EVA 0/0.
This will stabilize the orthotic and add some shock absorption.
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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.
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By Dianne Mitchell on
12/16/2011 9:45 PM
I saw a new patient in the office today with foot pain. He brought in his orthotics from another provider and wanted to know why they weren't helping him. On orthotic evaluation, these are rigid poly shell devices with cork postings 0/0, and no topcovers. They contour the patient's arch wonderfully and control his hindfoot position well. The patient has a pretty neutral resting calcaneal stance position with mild pronation through the midtarsal joint. His main pain is to the ball of the foot. He has full ankle joint range of motion with no equinus, no skin lesions/calluses. On palpation of the forefoot the 3rd metatarsal head is sitting below the plane of the neighboring metatarsals, which was where the pain/soreness was. This was a b/l finding with no h/o injury.
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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%.
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