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Blog

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 12/28/2009 9:31 AM
In Orthoses for Soccer Cleats Part 1, we provided a general orthotic prescription for soccer cleats. Using this prescription as a foundation, detailed below are our recommendations for modifying the basic soccer cleat orthotic prescription for specific pathologies. Detailed information on our reasoning for these modifications, including evidence in the literature, can be found by using the links to the Pathology Specific Orthosis for each pathology. Because we are using forefoot extensions,all of the following require a cover.
By Larry Huppin, DPM on 12/21/2009 9:18 AM

By Larry Huppin, DPM on 12/10/2009 1:49 PM
  If your patients are complaining about squeaky orthotics, here are a few solutions. 

The first part of finding a solution to the squeaking is to understand what causes it. Rarely does the orthosis itself squeak, rather it is friction between the orthosis and shoe that causes the noise. This is usually the front edge of the orthosis against the bottom of the shoe or the side of the orthosis against the side of the shoe. Here are our recommendations
By Larry Huppin, DPM on 12/7/2009 12:23 PM
I had a question from a client this morning regarding a patient with hallux limitus. They wanted to know if they should include a first ray or first metatarsal cut-out on the orthosis.  A first ray cut-out is shown below on the left and a first metatarsal cut-out on the right.

The idea behind a first ray/first metatarsal cut-out is to cut away the medial distal portion of the plate of the orthosis in order to let the first ray plantarflex more effectively. When the f ...
By Larry Huppin, DPM on 11/30/2009 4:21 PM
A client question today:  

QUESTION
“I have a pt who is a marathon runner and is having B/L heel pain. He can control it somewhat by taping his foot (he was an athletic trainer) but as long as he keeps running, his heels bother him. He's 40 yrs old and weighs 160 pounds. He doesn't really hyper-pronate when he walks and his STJ is pretty stable. What type of material and top cover should I order with his orthotics? Would you recommend a certain heel cup depth for a runner? How much of a medial heel skive would you recommend? Any other tips for a running orthotic?? “

ANSWER
We recommend basing your orthoses more on the patient’s pathology rather than their activity. The activity comes into play when you are looking at how the device will fit into a shoe, but the pathology should drive your prescription.

The plantar fascia tightens when the first ray dorsiflexes (lengthening the foot a ...
By Larry Huppin, DPM on 11/23/2009 5:54 PM
I saw a 120 lb female patient back today who presented last year with medial malleolar pain when hiking. She was an active hiker, so this was significantly hindering her ability to enjoy the outdoors.

She didn’t have a particularly large malleolas, but she was quite pronated. Both heels were everted about 10 degrees in stance. As the feet pronated, the medial ankle rolled medially resulting in increased pressure of the malleolas against the medial wall of the boot.

Our treatment goal was to decrease the pressure between the boot and malleolas by limiting eversion of the heel.

Here is our prescription:
By Larry Huppin, DPM on 11/21/2009 11:51 AM
A patient presented to my office yesterday complaining of lateral foot pain left only. He had a history of clubfoot at birth that was only partially corrected surgically. He now has a left foot that has:
• Inverted heel in stance. Heel sits about 10 degrees inverted. Coleman block test is negative in that I could not reduce the inverted position by supporting the lateral forefoot.
• Equinus. Unless the knee is placed into recurvatum, the heel is about 1 cm off of the ground.
• Extremely high arch and plantarflexed first ray.
• Planatar prominence of the 5th metatarsal base

Overall, pretty classic findings for a clubfoot.

His only complaint is pain under the styloid process. He has never had orthotics, nor have they been recommended.

Our treatment goal is to reduce pressure on the plantar 5th metatarsal base. This is what was prescribed for the left foot:

By Larry Huppin, DPM on 11/9/2009 4:08 PM
There was a question on the PM News list serve last week about the use of heel stabilizers for treatment of pediatric flatfoot. While heel stabilizers can act to physically block eversion of the heel, evidence based medicine dictates that more sophisticated and effective devices are preferred for treatment of flat foot in children.

There is a tremendous amount of information on this website devoted to the pediatric flatfoot. Some of the links are below. In particular, we want to make sure you are aware of the P3 Prefabricated Kiddythotic, the first prefabricated children’s orthosis to incorporate features previously found only in custom orthoses. These include a medial flange, medial skive, deep heel cup and a rearfoot post.
By Larry Huppin, DPM on 11/5/2009 4:03 PM
I have a patient with PTTD for whom I made a ProLab PTD Pathology Specific Orthosis. It has worked great and she is pain free when she wears them. As you may know, however, this is a pretty bulky device and fitting it into anything other than a lace-up shoe is difficult. My patient wants to be able to occasionally wear somewhat dressier shoes and was wondering if we could make her a dress orthosis.

Normally, this is not only easy, but expected. About 70% of my female patients will end up with two pair of orthoses. A full sized pair for exercise and a smaller pair for dressier shoes. The PTD foot, however, is so dramatically pronated that a standard dr ...
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