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Author: Larry Huppin, DPM Created: 6/20/2009 9:45 AM
This blog is designed to provide foot orthosis and ankle-foot orthosis practitioners and students with unique and practical information on foot orthotic therapy. We will provide insight on what’s new in the literature regarding orthotic therapy, orthotic hints and pearls, practice managment information, our opinions on new technology and even some thoughts on controversial topics in the foot orthotic industry. We welcome input and suggestions from orthotic practitoners and others interested in orthotic therapy. This is, however, a discussion on the practice of orthotic therapy and not designed as site to provide medical information to the public.

By Larry Huppin, DPM on 7/30/2009 1:16 PM
A client called today with a question regarding a patient who is experiencing painful callus on the lateral heel secondary to wearing her orthoses.  The orthoses are otherwise working well.

There are three reasons that patients may develop lateral heel edge callus from orthotics.  To correct this problem you must first diagnose which of these is causing the issue.

Cause #1Orthotic heel cup is simply too narrow for the foot. 
Diagnosis:  Place the pateint on the orthosis. Center the patient's heel in the heel cup.   If the lateral edge of the heel cup is placing excessvie pressure on the heel, then the heel cup is simply too narrow
Correction:  You can try lowering the heel cup, but it is likely that this device will have to be remade ...
By Larry Huppin, DPM on 7/27/2009 12:46 PM
If you do any orthotic adjustments in your office you know how difficult it is to remove old topcovers and modifications. More important, if you are using chemicals such as acetone to remove the glues, it can be dangerous.

You should be aware of a product call “De-Solv-It.” De-Solv-It is completely safe solvent that makes it easy to remove glue and glued items from your orthoses. It is a combination of citrus oil, aloe and lanolin and works great. I use it to remove covers that have even been glued with barge. De-Solv-It is available at many hardware stores. I recommend the professional strength, but both types work great. Learn more or order online here.

For ...
By Larry Huppin, DPM on 7/23/2009 1:46 PM
I had a patient present yesterday with complaint of a 10 year history of right-only lateral knee pain when running. Pain would occur on every run after 20 - 30 minutes. He never went more than 30 minutes without pain occurring. Biomechanical exam and knee exam were both normal except for a slightly under-pronated foot (RCSP was slightly inverted) He has had a complete work-up of the knee by an orthopedist and exam was normal.
By Larry Huppin, DPM on 7/20/2009 2:15 PM

Several studies advocate the use of laterally wedged foot orthoses for patients with medial knee OA.   The pathomechanics behind the function is to reduce the knee adduction moment and decrease load through the medial compartment. Lateral wedged insoles can reduce this moment.  Foot orthoses with lateral wedges have been shown to be more effective than lateral wedges alone.  This is likely due to the fact that the orthoses reduce STJ pronation and subsequent internal rotation of the tibia.  In addition, the orthoses help prevent collapse of the midtarsal joint that would otherwise likely occur with the use of lateral wedging.  

A pathology specific orthosis prescription for medial knee DJD would be as follows:

    ...
By Larry Huppin, DPM on 7/16/2009 11:34 AM
The lateral heel skive is a positive cast modification technique that is very similar to the medial heel skive, first described by Kevin Kirby, DPM in 1991. The lateral heel skive, also introduced to the profession by Dr. Kirby, works on the same principle of shifting the force that the heel cup of the orthosis applies to heel of the foot.

While the medial heel skive creates a varus heel wedge in the heel cup, the lateral heel skive creates a valgus wedge. It is created by shaving plaster from the lateral-plantar aspect of the heel of the positive cast. This valgus wedge creates a pronatory moment around the STJ axis and is used to treat symptoms caused by excessive supination. These may include peroneal tendonitis, lateral ankle instability and medial knee osteoarthritis.
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The lateral heel skive is often com ...
By Larry Huppin, DPM on 7/13/2009 5:00 PM
Last week I wrote about the importance of all orthotic practitioners having a grinder in their office in order to adjust orthoses.

I found the post below on a forum about heel pain.  It's a great example of what patients think when you can't adjust orthotics yourself.   Orthotic adjustments will likely be a recurring theme in this blog - if you are not able to adjust your own orthoses, you severely limit your abiliy to have a successful orthotic practice.  

Hello everyone,
I'm checking back in after receiving great advice from you all two weeks ago. Quick update, because my custom orthotics($400 kind) were still extremely uncomfortable after 4 weeks ...... I still feel like I have two golf balls shoved up under my arches. I also made an appointment with the podiatrist who made the mold. Appointment is next Monday. If there are any adjustments that need to be made, the n ...
By Larry Huppin, DPM on 7/9/2009 8:58 AM
 Reverse Morton's ExtensionI had a ProLab client call yesterday who had a patient developing neuritic pain in her toes.  Several weeks ago he dispensed a hallux limitus pathology specific orthosis to treat pain in the great toe joint.  Six weeks later she has had a complete resolution of her first MPJ pain but now has pain and numbness in digits 2, 3, and 4.   

What likely occured is that the reverse Morton's extension  that is included in this orthosis prescription increased pressure under the metatarsal heads enougth to cause a neuritis.& ...
By Larry Huppin, DPM on 7/6/2009 7:10 AM
A simple, but unique, ProLab innovation is the choice of  having your orthotic topcovers "glued posterior only" and "glued heel only". 

Leaving the anterior half of an orthotic cover unglued allows easy and quick adjustments to the front of the orthosis. This will allow you to easily add a metatarsal pad, bevel the edge or make other modifications to the front half of the orthosis – with no risk of tearing the cover. Many of our clients prescribe "Glue Posterior Only" on all orthoses that they order with a topcover. You can request "glue posterior only" on our Pathology Specific Orthoses
By Larry Huppin, DPM on 7/3/2009 10:12 AM
I had a consult call yesterday from a client who has a diabetic patient with a history of charcot arthopathy and a plantarly prominient 5th met base/cuboid. His question was how to write an orthosis prescription to best accommodate this area. Here is what we came up with:
By Larry Huppin, DPM on 7/1/2009 3:03 PM
The most critical tool for every practitioner of orthotic therapy is a grinder.  Having a grinder in your clinic allows you the ability to make on site modifications anytime an orthosis is somewhat too large or a patient feels arch irritation.   If a grinder is not available practitioners are left with two undesirable options.  The first is to send the orthosis back to the lab every time a minor adjustment is required.   This is obviously inconvenient for the patient and your office st ...
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