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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 7/28/2010 1:32 PM
When you prescribe a custom foot orthosis, do you always know what you are getting from your lab?

Not long ago it was clear that if you ordered a custom orthosis you were getting a truly custom orthosis. You sent in a plaster cast and the lab made a plaster positive cast, modified it as prescribed and then heat molded a material to create an orthosis on top of that cast. The resulting orthosis was clearly custom made for a specific patient.

Orthotic fabrication has changed dramatically over the past two decades. More likely than not, a plaster positive will no longer be produced when you send a negative cast to your orthotic lab. Instead, the corrections that were previously performed to create a plaster positive are now done on a CAD / CAM computer system. The same corrections can be performed on the computer as were done in plaster and then a positive cast can be milled on which the orthosis is produced; or the orthosis can be milled directly. This tec ...
By Larry Huppin, DPM on 7/22/2010 1:49 PM
Aetrex has a new line of sandals called "Sandalistas". These are attractive and stable sandals with a removable insole. This insole is the perfect size to allow the shoe to accept a custom orthosis. I usually use the following prescription for an orthosis to fit in the Sandalistas.
  • Direct milled poly semi rigid
  • Standard heel cup
  • Standard width
  • Soft EVA black cover to toes
  • Firm EVA forefoot extension to toes
This Rx works well with most of the Sandalistas. If you send the sandal along with the prescription form, we can e ...
By Larry Huppin, DPM on 7/12/2010 4:49 PM
I had a patient last week who was looking for a stable slip-resistant shoe to wear at his restaurant job. That got me doing a little research on stable slip-resistant shoes so I thought I would share the info here.

Many people have jobs where slip-resistant shoes are required and/or beneficial. These include nurse shoes, hospital shoes, chef shoes, and restaurant shoes. I looked for slip resistant shoes with orthopedic superior support, a removable insole, and durable leather uppers. I also found some slip resistant extra depth shoes.

What to tell your patients about slip resistant work shoes:
  • ANSI Standards: For many work situations, shoes must be ANSI certified as slip-resistant. The shoes below fit those standards. In most cases, the words “Slip Resistant” will be foun ...
By Larry Huppin, DPM on 7/1/2010 7:04 AM
A couple weeks ago I wrote on Realistic Expectations for Dress Shoes – talking about what are realistic expactations regarding orthoses for women’s dress shoes. I received some questions regarding specific shoe brands that I recommend. Some are listed below. Keep in mind, that, for the most part, there are several models from each brand that work well with orthoses. The key is that your patient take their orthoses with them when they are trying on shoes.

For “business dress” shoes for women I often recommend:
Aravon, Ariat, Theresia, Munro, Stonefly, Sofft, Softspots, Aetrex, Cole-Haan, Softwalk, Indigo by Clarks, and Trotters. Look for any closed heel shoe that will accept the orthosis.

For these shoes with a heel less than 3” I usually use a graphite or ...
By Larry Huppin, DPM on 6/21/2010 12:36 PM
Orthoses for dress shoes can be great. Personally, I prescribe many graphite orthoses with a shallow heel cup, normal width, and vinyl cover to the sulcus for these shoes. This device works wonderfully in many women’s and men’s dress shoes.

I tell every patient, however, that I make NO guarantee that the orthoses will fit in ANY shoe that they currently own. In fact, I tell them that they probably will NOT fit in any of their current shoes but that I will give them a list of fashionable shoes that often work well with orthoses.

Even if you send the shoe to the lab, we can only guarantee you that the orthosis will fit the shoe. We cannot guarantee that the foot will then fit into the shoe with the orthosis. It may make the shoe too tight or the patient’s heel may slip ...
By Larry Huppin, DPM on 6/17/2010 10:43 AM
 
By Larry Huppin, DPM on 6/10/2010 2:08 PM

Have you ever had a patient complain that their orthoses cause pain under the anterior distal arch or feel they are "too far forward”? More often than not, what the patient is actually experiencing is excessive pressure from the orthoses under the anterior metatarsal shafts. You can quickly and easily troubleshoot this problem by increasing the flex of the orthosis under the distal metatarsal shafts.

By Larry Huppin, DPM on 6/3/2010 1:57 PM
Providing Realistic Expectations about Orthotic Therapy

We spend a lot of time educating our patients about the benefits of orthotic therapy. We spend just as much time ensuring that our patients understand the limitations of their new orthoses.

We try to provide our patients with very realistic expectations about some of the limitations of orthotic therapy. By making sure that they understand these limitations before making the decision to proceed with casting for the orthoses, we eliminate most disappointment and misunderstanding. Just a few of the issues we raise with patients are:
  • New shoes will likely be necessary as we cannot guarantee that the orthoses will fit in any shoes they currently own.
  • Women need to choose whether their first pair of orthoses will be used in dress or athletic shoes. They will not work for both
  • Orthoses are not a cure, just a tool to r ...
By Larry Huppin, DPM on 5/24/2010 5:16 PM
I had a client call with the following question today: 

QUESTION:
Do you have any idea of how to successfully treat a sheer varus friction type of callus at the plantar tip of the 4th toe? In theory, a good pair of functional orthoses with a Spenco extension should work. But I have never had good success with this. Any suggestions?

ANSWER
This is a tough keratosis to treat with orthoses, but here are a couple ideas. The following information assumes you already have an orthosis that is providing adequate control of the foot.

The most important thing is to use a topcover on your orthosis that will show an impression of areas of increased pressure. For example, Diabetic Topcover works well. This is a tri-layer material with a Poron bottom layer, soft Plastizote middle layer, and a leather topcover. EVA is another material that will show an impression.

After the patie ...
By Larry Huppin, DPM on 5/20/2010 9:05 AM
Prescribing rearfoot post motion is one of the more confusing issues on orthotic prescriptions.

Traditionally, the post motion is prescribed as 4/4, 0/0, or some other similar combination. It is important to understand what each of these numbers mean.

The first number is the amount of lateral grind on the post that holds the front edge inverted before forefoot loading. This is most often 4 degrees to accommodate the inverted position of the heel at heel contact.

The second number is the amount of motion the orthotic has during forefoot loading when the front edge comes down to the ground.

A 0/0 post is ground parallel to the front edge of the orthotic and is intended to keep the front edge flat in the shoe regardless of foot movement.

A 4/4 post is one in which the lateral aspect of the post is inverted 4 degrees to the front edge of the orthosis and there is 4 degrees of mot ...
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