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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 2/24/2011 2:07 PM
All of us at ProLab are proud to announce that Paul Scherer, DPM is the author of a new textbook on orthotic therapy:
"Recent Advances in Orthotic Therapy: Improving Clinical Outcomes with a Pathology-Specific Approach" by Paul Scherer, DPM. Published by Lower Extremity Review.

The book is focused on evidence based orthotic therapy and organized in a pathology specfic approach. Paul has done an exceptional job of pulling together the available scientific research to support the use of custom foot orthoses for different pathologies. Each chapter includes a guide on recommended orthotic prescription writing for functional orthoses ...
By Larry Huppin, DPM on 2/21/2011 7:04 AM
Dr. Ron Valmassy discusses orthotics for pediatric flatfoot
By Larry Huppin, DPM on 2/17/2011 12:08 PM
In recent blogs I’ve mentioned the importance of orthoses conforming tight to the arch of the foot to achieve better clinical outcomes when treating many of the pathologies most commonly treated with custom orthoses. To confirm that your orthoses are conforming to the arch as they should, it is critical that you evaluate every pair of orthoses when they are dispensed to your patient.

There are several reasons why the arch of the orthosis may not conform adequately to the arch of the foot. These include
  • A negative cast that was taken with the first ray dorsiflexed :
  • A prescription that asks for a standard or maximum cast fill, rather than minimum
  • Overfill of the medial arch by the orthotic lab
The easiest method to evaluate arch height is to place the patient’s foot into casting position with the first ray plantarflexed. Hold the orthosis to the foot. In this pos ...
By Larry Huppin, DPM on 2/11/2011 10:51 PM
A year or two ago I was talking to Kevin Kirby about troubleshooting orthotics and the subject of topcovers came up - proving once again that few people in the world live more glamorous lives than do podiatrists.

We all know how frustrating it can be trying to remove a topcover from an orthosis - specially if it's been glued on for a long time.

Kevin described a simple yet brilliant idea for easily removing topcovers.
By Larry Huppin, DPM on 1/20/2011 9:06 AM
I spoke to a client yesterday who was making orthoses for a runner with plantar fasciitis. He wanted to prescribe an orthosis with a maximum arch fill so that he could be sure that the orthosis did not cause any irritation to the arch of the foot.

I think this illustrates a huge problem in podiatry – prescribing orthoses to avoid the need to troubleshoot, rather than prescribing for best clinical outcomes. The best evidence on orthoses for plantar fasciitis indicates that devices that conform closely to the arch (minimum cast fill orthoses) are more effective at reducing tension on the plantar fascia. The downside of these orthoses is that there is certainly more potential that the orthosis could cause some arch irrititation. If this occurs, it is extremely easy to adjust for an arch that feels too high. Simply grind the orthosis thinner in the arch to increase flex in the arch. This is demonstrated in the video below.

Of course, if you ...
By Larry Huppin, DPM on 1/13/2011 8:39 PM
Clinical Goal for Orthoses Following Bunion Surgery:
Following a bunion procedure, our primary goal with orthotic therapy is to encourage full range-of-motion in the first metarsophalangeal joint .

Biomechanical Goal:
To encourage first MPJ full range of motion, we wish to decrease excessive ground reactive force under the first ray and to allow the first ray to plantarflex. The orthosis should be designed to decrease the everted position of the calcaneus when an everted rearfoot is present. In the case of an everted forefoot, the orthosis should support the lateral forefoot (forefoot valgus).

The ProLab Hallux Limitus Pathology Specific Orthosis
By Larry Huppin, DPM on 1/10/2011 3:05 PM
Do you recommend specific socks to your patients? The proper socks can make a tremendous difference in foot comfort and your patient’s perception of orthotic function.

For example, if you are using orthoses for treatment of metatarsalgia, the proper socks can decrease force under the ball of the foot by providing greater cushion. Studies are clear that acrylic socks provide greater protection against shock and shear than do cotton socks (1-7). So, anytime you are prescribing orthoses for metatarsalgia, you should also be telling your patient to switch to acrylic socks. Because these socks are often thicker than the cotton socks your patient is currently wearing, it is critical to have them try on any new shoes with both the orthoses AND with the thickest socks they will be wearing.

By wearing the proper socks, your patient will see improvement in symptoms and find more satisfaction with their orthoses and thei ...
By Larry Huppin, DPM on 1/3/2011 2:55 PM
Our new shoe list for 2011 will be available soon. In this new version we have separate sections for women’s and men’s dress shoes.  The shoe list is available in the client section of the website.  Contact us if you have lost your log-in information 
In a previous post I discussed my favorite site for finding fashionable but healthy women’s shoes. Today, we will focus on men’s dress shoes. The shoes I recommend will be stable and have a removable insole so that there will be room for an orthosis. Most of these shoes will accept a fairly full sized orthosis, although for dress shoes I tend to go without topcovers or a thin cover such as vinyl. I’ll ...
By Larry Huppin, DPM on 1/3/2011 10:52 AM

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