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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 1/16/2012 9:44 AM
  Research suggests foot orthoses can affect frontal and transverse plane motion in proximal joints during landing from a jump. This could help decrease the risk of anterior cruciate ligament injury, especially in female athletes.

A recent article in Lower Extremity Review looked at this subject in detail. We are recommending this article to all ProLab clients

Some of the article highlights include: 
In the May issue of the Journal of Applied Biomechanics (JAB), researchers from East Carolina University (ECU) in Greenville, SC, reported that gender and foot orthoses affect frontal plane hip motion during landing from a vertical jump.

“Foot orthotic devices are able to change hip motion in the frontal
By Larry Huppin, DPM on 1/12/2012 9:29 AM
I consulted with a ProLab client today regarding a patient with pain at the calcaneal cuboid joint. He apparently has a fairly stable foot with mild eversion of the heel in stance. Pain is achy with activity and there is a little pain to palpation dorsolaterally. Radiographs were negative.

He does not have an exact diagnosis, but if nothing else, he is certainly having some calcaneal cuboid arthralgia. In a way, it doesn’t really matter what the exact diagnosis is. For patients with chronic pain in the area of the calcaneal cuboid joint we have a fairly straightforward goal of treatment, regardless of the underlying etiology. Our goal is to minimize motion of the calcaneal cuboid joint and to transfer pressure from the lateral column to the medial column. 

The following is the prescription that we recommended for this patient:
By Larry Huppin, DPM on 1/9/2012 7:43 AM
As do most orthotic labs, we offer a number of different choices for dress shoes. Over the years I have tried many different devices including the graphite dress orthotics, the Holethotic and the Cobra orthotic. A few years ago I was most commonly using the graphite dress. I have now, however, migrated to using the Cobra almost exclusively for women’s dress shoes.

The Cobra offers a number of advantages in women’s dress shoes. The first is that it is simply smaller than any of the other devices. In addition, unlike any of the other orthoses, it is flexible in the heel with the ability to bend in the sagittal plane. This allows it to easily adapt to different heel heights. So, not only does it fit into flats, but my patients can wear it in heels. It can even be used fairly easily in four, five, and six-inch heels.
By Larry Huppin, DPM on 12/19/2011 7:22 AM
  These pictures show the feet,shoe and orthoses of a longtime patient of mine. He is 77-year-old who has severe cavus feet bilateral, and on the right suffered a tibia and fibula fracture many years ago which left him with a severely inverted right rearfoot. This led to multiple recurrent sprains of the right ankle.

When I first saw him a couple of years ago, we discussed a number of treatment options including the use of an AFO. He had already tried an AFO and found that they were uncomfortable because of the prominence of his lateral malleolus. It was very difficult to find one that would support him and would not irritate the malleolus.
By Larry Huppin, DPM on 12/15/2011 9:47 AM
The November issue of Lower Extremity Review has an article on Evidence-Based Orthotic Management of PTTD. We are recommending this article to all ProLab clients.

The article states that, in general, studies support the use of orthotic devices for patients with PTTD, especially in the early stages. Orthoses appear to improve foot and ankle alignment, clinical symptoms, and functional outcomes in PTTD patients with success rates up to 90%.
By Larry Huppin, DPM on 12/8/2011 12:56 PM
I had a patient come into our clinic last week who was experiencing plantar fasciitis. Along with that, she has a long history of knee and hip pain. She has had the diagnosis of some mild osteoarthritis affecting the medial knee.

We did discuss the use of custom orthotic devices to treat her problem, but I am always concerned on whether orthoses will be tolerated by those patients with a history of knee, hip, and back pain. Certainly, in many situations, orthotic devices can help these symptoms but they also can make those symptoms worse.

We discussed the options including potential risks and complications and decided that it would be a good idea to try a pair of prefabricated orthosis before proceeding with custom orthotic devices. This would give us a chance to evaluate how her proximal joint pain might be affected by using an orthotic device before investing in custom orthosis.
By Larry Huppin, DPM on 12/5/2011 3:46 PM
There is a direct relationship between prescribing inversion in your orthotics and the width that you should be prescribing.

Inversion of your orthoses is one of the more common, and effective, modifications that you can make for several of the most common pathologies treated with orthotic devices. Inverting an orthosis offers several advantages in treating the following pathologies.

Metatarsalgia: An inverted orthotic has a higher arch. An orthosis with the higher arch is more effective in transferring pressure from the ball of the foot to the medial arch.
By Larry Huppin, DPM on 12/1/2011 8:02 AM
 I saw a patient this morning who presented with significant pain affecting the right foot, particularly in the area of the first metatarsophalangeal joint. Fourteen months ago, she had surgery to correct a bunion. It appears that she likely had a head procedure. She developed a nonunion, and then six months ago had a second procedure; a plate was added. She was nonweightbearing for a number of weeks and used a bone stimulator. The nonunion seems to have healed, but she is still having significant pain. She has been using Rocker soled shoes and she did receive a pair of orthotic devices.

She has continued to have significant pain affecting the right foot particularly in the area in the first MPJ and along the first metatarsal shaft.
By Larry Huppin, DPM on 11/28/2011 2:09 PM
 I spoke to a ProLab client today who had a patient with an osteochondral defect of the ankle. He performed a scope and the patient was doing better, but she was still having what he thought was lateral impingement. She had a calcaneal varus and an ankle valgus. He wanted to know if there was anything we could do with orthotic devices to reduce her symptoms.
By Larry Huppin, DPM on 11/14/2011 2:00 PM
 As we come into our winter sport season, we are seeing more requests for orthotics for ski boots, snowboard boots and ice skates

These are all very tight fitting boots. This tight fit makes fitting an orthosis much more difficult. ProLab has established some requirements for production of these specialty orthoses. 

Ice Skates
We cannot make orthoses for skates unless we have the skates. No exceptions. Note that this will increase both your outbound and inbound shipping costs. We recommend that this cost be passed on to the patient. In my office we charge an extra $25 for shipping of the skates, payable at the time of casting. 
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