By Dianne Mitchell on
5/23/2013 7:22 AM
Patient came in today with 5th toe pain. This is a patient who has a functional hallux limitus with transfer metatarsalgia and associated pains. She presented with a pair of great custom molded functional foot orthotics which we placed a top cover on and added a 3mm cork reverse morton extension. While this fit fine in the athletic shoes we saw in the office, she headed out for a hike the following weekend and reported back to the office the following week with new onset 5th toe pain.
Clearly the top cover with added cork was too thick.
So, a simple, quick fix for this is to leave the accommodation in place and simply mark were the 5th toe sits on the device in weight bearing. Next, file that portion of the cork thin with the grinding wheel. The patient loved it.
Before removing any modification you add to an orthotic, stop and ask why it didn't work. I troubleshoot orthotics frequently and many times a tiny adjustment to stop irritation ...
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By Dianne Mitchell on
5/20/2013 7:06 AM
I see a bunch of kids in the office for orthotics and many of them see me frequently for new top covers. The most frequent reason, is: the orthotics got wet and the cover either came off or smells or looks poor. I was also getting similar complaints with the rearfoot post becoming saturated. Typically this involves a puddle at recess that got played in and the shoes are soaking along with the socks and the orthotic device. As everything dried out that evening, parent and child observed damage.
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By Dianne Mitchell on
5/16/2013 7:54 AM
A woman came into the office today for custom orthotics and wants them to fit in as many shoes as possible. She understands the types of flats she should be in and really didn't want to have to buy a bunch more shoes to accommodate the orthotic.
Some thoughts ...
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By Dianne Mitchell on
5/13/2013 9:44 AM
A patient presented to the office today with a severely planus foot and associated arch pain/strain, posterior tibial tendon dysfunction, sinus tarsi and calcaneofibular impingement. He was miserable and was seeing me for custom orthotics in hopes of the pain being reduced. In stance there was a large degree of bow-legged deformity also in addition to the feet being completely flat to the floor. What to do ...
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By Dianne Mitchell on
5/9/2013 7:34 AM
We all see patients in the office who have sustained an inversion ankle sprain. We also see patients who continue to sprain their ankle multiple times later. What can we do to an orthotic prescription to decrease the inversion forces?? How do you create a pronatory torque?
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By Dianne Mitchell on
5/6/2013 7:19 AM
We frequently see painful inner-metatarsal space neuromas in the office. Once you confirmed this is indeed a neuroma and not metatarsalgia, capsulitis, stress fracture, etc ...
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By Larry Huppin, DPM on
4/15/2013 6:23 AM
A fairly common complaint that I hear in my office is that of patients saying that their heel is slipping up inside one or more shoes when they wear their orthotic devices. This is usually a very easy problem to address and one that every orthotic practitioner should be aware of.
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By Larry Huppin, DPM on
4/8/2013 1:44 PM
I saw a patient a few weeks ago who had come back in for followup after getting her orthotics. She was comfortable in the orthotics for the most part and they have worked very well in relieving her symptoms. However, there was one area that was bothering her and that was the lateral heel cup on one orthosis. When I had her stand on the devices, I noted that she had a quite a bit of fat pad expansion and that the fat pad of the heel was overriding the lateral edge of the heel cup.
I always try to avoid this problem by measuring the fat pad of the heel when I order orthoses. I checked the copy of her prescription form and I found that in this situation I had forgotten to take the measurement and send it to the lab. By measuring it, I almost always avoid this problem.
It has to be kept in mind that
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By Larry Huppin, DPM on
4/4/2013 8:43 AM
I saw a patient this morning who suffered a crush trauma to his mid and rearfoot a number of years ago and now has both midfoot and rearfoot osteoarthritis. He has done fairly well using a gauntlet AFO to limit motion. The last time I saw him, I also recommended that he get a rocker-soled shoe. A rocker sole will further act to decrease mid and rearfoot motion, particularly if the rocker is placed near the midfoot.
Since the last visit, he purchased a pair of PW Minor shoes, which had a built in rocker. They fit the gauntlet AFO extremely well and he has found that the rocker has substantially further decreased his symptoms.
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By Larry Huppin, DPM on
4/1/2013 8:41 AM
I recently saw a patient for whom I dispensed a new pair of orthotic devices. This patient had prominent styloid process.
If you ever are prescribing an orthosis for a patient with a prominent styloid process, you have to determine if the styloid needs accommodation. When making this determination, you must first determine whether the styloid is prominent laterally, plantarly, or both. Lateral and plantar styloid prominences required different accommodation.
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