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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 8/24/2009 1:26 PM
A client called today with a question about a patient with OA of the left ankle joint. His biomechanical examination was significant for a 10 degree everted RCSP. Xrays show a valgus angulation of the ankle joint with increased moment through the lateral ankle and decreased moment medially.

Our goal with the orthosis to reduce the RCSP and bring the heel as close as possible to perpendicular in order to equalize force across the ankle joint. Thus, this will be an aggressive orthotic prescription. In fact, I would recommend warning the patient that the orthosis may have to be adjusted if the patient experiences uncomfortable pressure on the foot. The patient would not likely tolerate an orthosis that applied enough force to bring the heel all the way to perpendicular, but our prescription will act to bring it as close as possible to perpendicular.

Here is what we recommended:
By Larry Huppin, DPM on 8/20/2009 1:37 PM
I spoke to a client today who had dispensed a pair of our Featherweight orthoses to a patient. The patient was complaining that the devices were difficult to move from shoe to shoe as the Nylene (Spenco-type) topcover would curl up. A simple solution to this problem is to add a Poron or EVA extension from the distal end of the orthosis to the end of the topcover.

Then glue a piece of vinyl on the bottom of the orthosis extending from about an inch proximal to distal edge of the orthosis to the end of the topcover.

This combo will result in a cover that is stiffer distally and slides easily in and out of shoes.

The ProLab medical consultants
By Larry Huppin, DPM on 8/17/2009 11:40 AM
July 1st is the beginning and end of the residency year and many podiatrists fresh out of residency are now just starting their practices. Every year about this time we start getting calls from newly practicing podiatrists who have not thought about orthotic therapy in 3 years or more and are now realizing that their training has been lacking in the area of orthotic therapy. We can help.

ProLab has a 20 year committment to educating podiatrists in state of the art orthotic therapy with a focus on evidence based medicine. This website is the internet's largest resource on clinical orthotic therapy. We have the nation's top podiatric orthotic experts as consultants - ready to help ProLab clients with any patient.

Over the next several months we will be developing material on this website devoted to helping the new practitioner develop...
By Larry Huppin, DPM on 8/13/2009 10:01 AM
A relatively common orthotic complaint is a patient who feels the arch of the orthosis too far proximal.  Essentially they feel excessively pressure under the distal aspect of the first metatarsal shaft. 

To fix this problem, first ensure that the orthosis is sliding all the way back into the shoe.  If it is not, the device will be sitting farther distal than it should leading to the complaint.   If the orthotic does not sit all the way back in the shoe, consider lowering the heel cup a few millimeters or having the patient get a wider shoe.

If the orthosis does sit properly in the shoe, you can eliminate the feeling of excessvie pressure distally by thinning the orthotic shell in the area where they feel excessive pressure.   Gently grind it thinner until the flex increases slightly.  Then have the patient try the orthosis.   Take a little bit at a time until it fee ...
By Larry Huppin, DPM on 8/10/2009 9:25 AM
If you have a patient with a severe flatfoot, a PTTD for example, who continues to pronate excessively even when wearing a foot orthosis or Ankle-Foot orthosis, consider prescribing shoe modifications.

Two modifications can help these patients significantly:
1. Medial Flare (medial expansion of midsole and outersole)
2. Medial Buttress  (strengthening the medial wall of shoe)

A good pedorthist or shoe repair center can help you. If you don’t have someone in your community, mail-in shoe modification facilities are available. 

ProLab medical consultants are experts at prescribing shoe modications and can help you determine the best modifications for your patients. ProLab clients can consult with a medical consultant any weekday a ...
By Larry Huppin, DPM on 8/6/2009 1:49 PM

A loose definition of a flexible orthosis is one where the arch collapses about halfway to the ground under the weight of a particular patient.   A semi-rigid orthosis is one that shows a minimal amount of deformation under a patient's weight and a rigid device is one that does not deform at all.   

The flexibility of an orthosis is dependent on a number of factors, including:   

By Larry Huppin, DPM on 8/3/2009 12:33 PM

One of the most common orthotic adjustments is the addition of covers and extensions.  To do this, you must use glues.  But if you are going to use glues in your office, ventilation is a must.  One method to achieve ventilation is to build a hood that vents to the outside.  If that isn’t feasible you can purchase a Fume Buster - a free standing filter for glue fumes.  The video below shows the function of Fume Busters.  We have used the "

By Larry Huppin, DPM on 7/30/2009 4:27 PM

now is the time for all good men to come to the aid of their party
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.

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