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By Dianne Mitchell on 11/12/2014 9:21 AM
A patient presents to the office with a painful 1st MTPJ. On exam you discover a functional hallux limitus and sub-hallux base callusing. Orthotic considerations:
a. Goal of the orthotic: increase 1st mtpj rom
b. Plantarflexing the 1st metatarsal will raise the 1st MTPJ axis of rotation and therefore decrease or eliminate the functional limitus finding. So, casting this foot in STJ neutral with the 1st metatarsal plantarflexed is essential.
c. Couple this casting technique with a semi-rigid polypropylene shell that is wide with a deep heel cup and flat rearfoot post with minimal arch fill to allow continued 1st metatarsal plantarflexion and stability.
d. Additionally, medial skiving and / or inverting the device will decrease medial column load and further plantarflex the 1st metatarsal to un-jam the 1st MTPJ
e. Finally, if this isn’t enough, or if you are troubleshooting on another providers pair of functional foot orthotics, consider adding a Revers ...
By Dianne Mitchell on 11/5/2014 9:20 AM
Periodically I will see patients in the office who enjoy their orthotics in their higher volume athletic shoes, but report that their heels pop out of the shoes, or they sit too high and their heels rub the “wrong spot” on the heel counter, in lower volume shoes. What can you do to lower the heel position in the shoe? Using your grinding wheel, remove the rearfoot post and proceed to grind the shell of the orthotic as thin as possible without creating a hole. This drops the heel down in the shoe several millimeters to stop the patient from popping out. Note: you must keep the orthotic in a balanced position and not invert or evert the device during this process!
By Dianne Mitchell on 10/31/2014 9:19 AM
Have a Happy and Safe Halloween! From, Your friends at Prolab
By Dianne Mitchell on 10/29/2014 9:17 AM
Patient presents to the office with a painful arch on their orthotics. I troubleshoot orthotics in the office daily and during my exam I notice this patient has a very prominent plantar fascia band and there is remnant blistering in this distribution.
When you re-examine the devices, you notice there is not a plantar fascia groove. Can you add one? Sure! First, apply lipstick to this distribution on the patient’s foot and then press the device onto the patient’s foot to transfer the marking to the device. Next, apply 1/8” thick Korex directly to the orthotic shell dorsal surface to raise the entire orthotic surface higher, minus the region of the prominent fascia that is nicely marked for you. Finally, cover the device with a fresh top cover! When the patient is ready for a new pair of devices you can integrate the groove into the poly shell!
By Larry Huppin, DPM on 10/26/2014 11:35 AM
 A recent study, published in the Journal of American Podiatric Medical Association, evaluated the incidents, location, pain, and risk factors of blisters seen in ultramarathoners.

Research was conducted at a five-day multi-stage trail running competition. At the end of the each day, data was taken on the frequency of blisters, their location, their severity, and what preventative measures were used among 50 ultramarathon runners.

Findings:
By Dianne Mitchell on 10/22/2014 9:16 AM
I had the opportunity to attend and lecture at the Colorado State podiatry meeting a couple weekends ago. It was an excellent assortment of talks with numerous “take home and apply in the office” tools. But my two favorite talks were both presented by Dr Kevin Kirby. The first was “Successful Treatment of Peroneal Muscle / Tendon Disorders and the second a discussion of “Barefoot vs Shod.”
The barefoot talks are always pretty interesting, since we live in an environment where shoes are worn. I have a very small patient population who confess to me that they do any portion of their training barefoot, but many more that are/were part of the “minimalist” shoe fad. Unfortunately many of those patients became patients of mine due to stress fractures or other overtraining types of injuries. More importantly, once these folks were treated and healed, many of these folks had biomechanical findings that are nicely addressed with functional foot orthotics (cavus or planus feet with secondary tendonopathies ...
By Larry Huppin, DPM on 5/19/2014 3:34 PM
  I just spoke to a ProLab client who has a patient with large fibromas and he wants to be able to accommodate for those. We were trying to decide whether he would have us add the accommodation at the lab or whether he would make the accommodation himself. He does have a full lab at his office and it is easy for him to do his own accommodations.
By Larry Huppin, DPM on 5/12/2014 3:32 PM
  I spoke to a ProLab client this morning who is considering getting a ProLab foot scanner in order to replace plaster casting in his office. He was concerned, however, because he sees a lot of diabetic patients and tends to do a lot of accommodative orthoses and he is wondering if the scanner was appropriate for that. Before we answer these questions, I think we have to first define accommodative and functional orthotics.

A functional orthotic is one where the forefoot has been balanced to the rearfoot. This is the most basic of definitions. In general, the cast that is used for this type of foot
By Larry Huppin, DPM on 5/5/2014 4:38 PM
  A patient came in to pick up her orthotic devices this morning. She has worn orthotics for years for several pathologies but what we were addressing primarily today was pain secondary to digital contracture. She is starting to get more pain at the distal aspect of her toes secondary to hammertoes and pressure on the distal aspect of the digits. In the past, she has found that shoes that have a crest in them tend to work well for her. In particular, she has found that the crest in Birkenstock sandals help keep her toes straight and decrease her symptoms. Because that has been effective, we wanted to add a crest pad to her orthotic devices.
By Larry Huppin, DPM on 4/21/2014 9:26 AM
We had this question come in from a ProLab client today: 

QUESTION:
I have a question regarding a prescription for the patient. She has b/l bunions with pain sub second. If she likes these orthotics I will be ordering another pair for her. The first pair she wants to fit into flats for work. Do you have any suggestions for sub second pain that would fit into flats?
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