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By Larry Huppin, DPM on 10/28/2010 5:10 PM
One of the questions I get quite frequently from clients is which dress orthosis they should prescribe. We offer three: You can use the links above to learn about each one, but below are ...
By Cherri Choate, DPM on 10/27/2010
Off-loading and cushioning various pathologies on the plantar foot can be challenging. A variety of options exist that may give the practitioner a way to mix and match them to best address the individual patient's needs.
By Larry Huppin, DPM on 10/25/2010 2:13 PM

 A question from a client today:

Under what circumstances would you reduce manually a forefoot varus, 1st ray elevatus, or forefoot supinatus while performing a foot casting? 

The short answer to the question is: always. We recommend always applying a plantarflexion force to the first ray when casting. Our reasoning is noted below. Now, in the case of a true forefoot varus, applying this force won’t do anything. Forefoot varus is a rigid (skeletal) deformity.

In a 1986 study, Roukis and Scherer found that prevention of first ray plantarflexion resulted in decreased first MPJ dorsiflexion (hallux limitus). A subsequent study by Scherer, et al. looked at the effect in stance of a polypropylene orthosis made from a nonweightbearing negative cast taken with the first r ...
By Cherri Choate, DPM on 10/20/2010

The development of hallux abducto valgus and hallux rigidus is significantly dependent on the motion and position of the 1st ray.  The abnormal position of the 1st ray impacts the motion of the 1st MPJ. 

By Larry Huppin, DPM on 10/14/2010 6:14 AM
A patient presented yesterday with painful 4th and 5th toes on the right foot in the steel toe boots he must wear for work. He had tried a number of brands and always developed rather severe pain by the end of the day. The left foot was fine

He had an interesting foot with considerable splay of the toes. He had a hallux varus right along with adductovarus 4 and 5 with lateral splay of the 5th. The pain was coming from pressure on 4 and 5 both dorsally and laterally.

His boots were a size 14C. We keep a Brannock device in the office and his feet measured as a 14C. If the Brannock could measure width at the toes, however, he probably would be a 14EEE. To relieve his pain he would need more room in the toebox both in depth and width. To get a boot that would not put undue pressure on the toes of his right foot, however, could result in a boot that was too large for the left foot.

By Cherri Choate, DPM on 10/13/2010

Are straight last shoes still used for mild soft tissue deformities in children?  Are students taught about them during their educational process?

By Larry Huppin, DPM on 10/7/2010 12:31 PM
The following is an email we received from a patient who received her orthoses about two years ago and since moved out of state.  It is a good example of how patients need to be educated on the reasonable lifespan of foot orthoses and the importance of occasional refurbishment. You might find this useful in discussing orthotic lifespan with your own patients.  

I've been wearing the orthotics Dr. Huppin prescribed. I like them in many ways and they've definitely relieved bunion pain. I'm disappointed in the durability however. The 3/4 dress pair is coming apart / worn through on the edge of the heel-cup, so is too sharp on my heel now.

Dear _____

Good to hear from you. I hope you are doing well in your new home.

The shell (hard portion) of foot orthotics usually lasts for several years ...
By Cherri Choate, DPM on 10/6/2010

The incidence of ankle sprains within the general population is alarmingly high.  If you were to  poll a group of people, it is likely that at least 50% have had an ankle sprain sometime during their life.  Even more alarmingly, a larger number have had multiple ankle sprains. For this "recurrent" sprain population, RICE, bracing and orthotics may not be enough.

By Larry Huppin, DPM on 10/4/2010 5:04 PM

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