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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 5/16/2011 1:23 PM
Podiatry Arena
 Podiatry Arena is a forum in which some of the best foot biomechanists in the world participate in online discussions, debates, arguments and occasional virtual wrestling matches on matters pertaining to foot biomechanics and orthotic therapy.   

Each month we will provide you with links to the threads that would seem to be most interesting for our clients.
By Larry Huppin, DPM on 5/12/2011 9:59 AM
 In the new issue of Lower Extremity Review is an article that reviews theories on how orthotics function.  We are recommending this article to all ProLab clients.   You can read the full article here.  

Here is the introdution to the article:

By Larry Huppin, DPM on 5/9/2011 9:56 AM
 I had a patient present in my office today with a two-year history of fairly classic plantar fasciitis. She had seen a podiatrist during that time and had multiple treatments, which included orthotic devices, physical therapy, multiple injections bilateral, and standard anti inflammatory measures. She sought me out to get a second opinion because she has not seen much improvement. The patient was a pleasant 31-year-old woman who was obese. Pertinent biomechanical findings were a pes planus foot type. She had an everted heel in stance and nearly complete collapse of the medial arch. In gait, she showed fairly rapid midtarsal joint collapse, eversion of the heel,  and stayed maximally pronated throughout gait.

She was wearing her only pair of orthotics today. These were made by the previous podiatrist 9 months ago. They were carbon fiber orthoses. They had no post, a shallow heel cup, a fairly narrow width, and the arch did not conform very closely to the&a
By Larry Huppin, DPM on 5/5/2011 1:45 PM
I had two ProLab clients call me today with a complaint that their patients are sliding laterally off of their orthoses. They are wondering if anything can be added to the orthosis to prevent this problem.

The problem of sliding laterally off of an orthosis usually occur on more aggressive devices. For example, a device with a medial flange, medial skive, and inversion. All of these create a varus force and the medial skive and inversion both create a varus wedge within the heel cup of the orthosis. This can allow the patient to slide laterally.

In trying to address this problem, we can approach it in a couple of different ways. One way is to try and apply something to the 
By Larry Huppin, DPM on 5/2/2011 2:15 PM
I had a client call me today regarding production of a gauntlet AFO for a patient with posterior tibialis dysfunction and adult acquired flatfoot, but complicated by the fact that he has rather severe edema. He wanted to know if I thought this was something that might work for the patient. I had informed him that it is possible it could work well for him, but there are definitely some potential problems, and I certainly would not guarantee the patient a good result.

The gauntlet AFO is an excellent modality for treatment of adult acquired flatfoot. The problem is going to be with the patient’s edema. It is probably best to cast him while the patient is most swollen so that the device would never be too tight on him. The problem is 
By Larry Huppin, DPM on 4/28/2011 2:08 PM
We have a question from a ProLab client today:

Hi Larry,

I saw one of my partner's pts on Fri. who has had lateral column foot pain for several mos. She was treated in a CAM boot for 4 mos for a presumed stress fx, however, she has no callus formation on XR and has pain diffusely along the 4th and 5th met shafts as well as base (no cuboid pain and no pain localized to the styloid process). She has minimal STJ eversion and upon standing has ~4 degrees of calc varus b/l. When she walk
By Larry Huppin, DPM on 4/25/2011 9:00 AM
 Podiatry ArenaPodiatry Arena is a forum in which some of the best foot biomechanists in the world participate in online discussions, debates, arguments and occasional virtual wrestling matches on matters pertaining to foot biomechanics and orthotic therapy.   

Over the past few years there have been several threads on Podiatry Arena regarding rearfoot posts.  If you want to learn some of the thoughts behind posts
By Larry Huppin, DPM on 4/21/2011 8:55 AM
 I have had a couple of client calls recently regarding the use of rigid Morton’s extensions. A rigid Morton’s is essentially a continuation of the polypropylene or graphite shell of the orthosis beyond the first metatarsophalangeal joint, extending to the tip of the toe. In cases of hallux rigidus, this rigid Morton’s can act to limit any remaining first metatarsophalangeal joint motion that may be leading to pain.

By Larry Huppin, DPM on 4/18/2011 10:50 AM
  I had a client call today with a question regarding orthoses for a patient with pain under the styloid process and the proximal portion of the fifth metatarsal shaft. This is on one foot only. On examination, there is distinct enlargement of the proximal portion of the fifth metatarsal shaft relative to the contralateral foot. There is also callus formation on the involved foot only.

The goal for treatment of this problem is fairly straightforward. We want the orthosis to act to transfer force off of the 5th metatarsal shaft and onto other portions of the foot, primarily the medial arch.
By Larry Huppin, DPM on 4/14/2011 8:41 AM
 In a recent blog at, Dr. Kevin Kirby reviewed the biomechanics of subtalar arthroresis. He did a thorough review of the literature, and in the blog discusses kinematic and kinetic functions of the subtalar joint, and the biomechanical effects of the subtalar arthroereisis procedure.

We recommend this article to anyone who performs stj arthroresis or deals with patients who have undergone the procedure.
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