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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 8/29/2011 7:41 AM
  I had a consult call this morning from a client whose patient was complaining that his heel was slipping out of his shoe when he wore his orthotics. This was a polypropylene orthosis with an EVA rearfoot post.

This is one of my favorite problems both in the office and when I am consulting with clients because it is such a simple fix. All that needs to be done is
By Larry Huppin, DPM on 8/25/2011 1:04 PM
A recent article in Lower Extremity Review reviewed an abstract presented at the International Society of Biomechanics meeting which took place last month in Brussels. Researchers used a new method to measure dynamic plantar pressure distribution. Results showed that custom orthoses can improve distribution of peak pressure during dynamic foot loading in patients with the painful cavus foot.
By Larry Huppin, DPM on 8/22/2011 1:06 PM
You can help ensure that your patients are comfortable in their AFOs, both the Stabilizer AFO and the Functional AFO, by providing education as to the type of socks that they should use with their AFO. Features to look for on the sock to work well with an AFO include:
By Larry Huppin, DPM on 8/15/2011 1:58 PM
  I had an interesting consult call this morning. A client from the Midwest called in and said that she had a 14-year-old patient who suffered a metatarsal stress fracture while running in minimalist shoes. She convinced him and his mother to go back to a standard Brooks running shoe after the stress fracture occurred and he did fine for about six months. He then decided to try minimalist shoes again, and once again developed the stress fracture. Both the patient and his mother are insistent that he will continue using minimalist shoes. They think this is the best way for him to be a successful collegiate athletic.
By Larry Huppin, DPM on 8/11/2011 9:48 AM
As part of my job with ProLab, I spend a lot of time calling ProLab clients regarding consults for their patients. This means that I spend a lot of time on-hold with podiatrist’s offices around the United States. In the last half-hour I have had three very different on-hold experiences.  Although this blog has more to do with practice management than orthotic therapy, I think it is important to mention.
By Larry Huppin, DPM on 8/8/2011 1:47 PM
I spoke with a ProLab client today regarding a patient who is having trouble with her new Cobra orthotics. They had been made to treat pain associated with Morton’s neuroma. Whenever she wore it in her shoe, she felt like her foot was slipping out. When she tried it with a larger shoe, she felt like her foot was slipping excessively in the shoe.

The doctor had sent the shoe to the lab when he had the orthosis made, so the orthosis did fit the shoe very well. The only problem occurred when she put her foot into the shoe.
By Larry Huppin, DPM on 8/4/2011 9:21 AM
There has been an interesting thread lately on Podiatry Arena regarding Carbon Fiber (Graphite) as a material for manufacturing custom foot orthoses.

Personally, I am not a big fan of graphite orthoses, although I use it occasionally for women’s dress flats. Compared to polypropylene, carbon fiber is more prone to fracture and much more difficult to adjust. The material is thinner than poly of the same rigidity, but not all that much thinner.
By Larry Huppin, DPM on 7/18/2011 12:40 PM
I consulted with a ProLab client this morning who has a patient with bilateral midtarsal joint arthritis. He wanted to know if we had a pathology specific orthosis for that problem.

We do not have a pathology specific orthosis on our prescription form for midtarsal joint arthritis, but we certainly do have some ideas on how this should best be treated. Our goal is fairly simple – we want to limit midtarsal joint motion and in doing so reduce the patient’s pain.

Mechanically, this patient has moderate arch collapse. She also has a heel that is everted by about 8 degrees in stance. This means we are going to try and control the arch, and hopefully try to limit some of the rearfoot eversion. The following is what I recommended.

By Larry Huppin, DPM on 7/14/2011 6:19 AM
My business partner was trained at one of the top surgical residency programs in the country and did not have much experience with orthotic therapy during his residency. He is an exceptional surgeon, but feels strongly that if a more conservative option will allow the patient to reach their goals, then surgery should be a last resort. This tendency toward more conservative treatment whenever possible is a trait that tends to be found in the best and most experienced surgeons. Increasing orthotic therapy skills allows these good surgeons to provide their patients with better care. In the last five years, he has taken a much greater interest in orthotic therapy. He now takes a more evidence-based approach to his orthotic therapy and he is finding that he has much better clinical outcomes. He also has become more adept at adjusting orthotic devices.
By Larry Huppin, DPM on 6/30/2011 7:28 AM
I received a call from a ProLab client this morning with questions regarding how to make an AFO for a patient who had a poor outcome following a spinal surgery. She developed a dropfoot on the left side. This is not an unusual complication of such a surgery. What was unusual, however, was that on the right side she had posterior weakness rather than anterior weakness, and developed a calcaneus type of gait. She has a difficult time plantarflexing her right foot and this results in her walking on her heel on the right side, yet having a typical dropfoot on the left side. Our client decided to use a dorsiflexion-assist functional AFO for the left dropfoot (to prevent plantarflexion), but was not sure what to do for the calcaneus type of gait on the right.
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