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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 2/27/2012 4:15 PM
   ProLab provides a Webinar on a specific topic on orthotic therapy on the second Thursday of every month at 12:30 PST. These Webinars are available to ProLab clients, podiatric students, and podiatric residents. They are focused on Evidence-Based Orthotic Therapy and about 20 minutes in length.

All of the Webinars are recorded and available for viewing at anytime, day or night. We currently have the following Webinars available and will be adding more every month:
  • Evidence-Based Orthotic Therapy For Plantar Fasciitis
  • Evidence-Based Orthotic Therapy For Metatarsalgia
  • Could this research change the way that you treat hallux limitus?
  • Integrating scanner technology into your office.<
By Larry Huppin, DPM on 2/20/2012 12:12 PM
In the past 24 hours I have been asked twice about what I think is truly important when doing a biomechanical examination. One was from a resident who is about ready to go into practice and does not feel he has had adequate biomechanical training. The other is from an eight-year practitioner who is still not sure exactly what he should be looking at when doing a biomechanical examination.

I think that the traditional biomechanical examination that many of us, at least those of us over 40, were taught in school is probably not the most effective or efficient type of examination to come up with the best orthotic prescription.

Most evidence in the literature on orthotic therapy points to using a “tissue stress” model of prescribing orthotics. This means looking at
By Larry Huppin, DPM on 2/16/2012 11:21 AM
 I had a patient present today with a complaint of a two-year history of digital numbness and tingling during activity. This was occurring on the right side only. It tended to get worse with increased activity such as hiking and running. He also found that shoes that had a lower heel height differential tended to decrease his symptoms. He had tried a number of over-the-counter arch supports and shoes without any significant improvement of his symptoms.

Read more for orthotic recomendations....
By Larry Huppin, DPM on 2/13/2012 11:55 AM
    Being that I practice in Seattle, I treat a lot of runners who run in the rain. For much of the year, you either run in the rain or you do not run at all. Thus, the ability to recommend water-proof running shoes that work well with orthotics is critical. For those of you who practice in colder climates and have patients that run in the snow, water-proof shoes are just as important.

The best water-proof running shoes have Gore-Tex liners that are both water-proof and breathable. Keeping the feet dry is the best way to keep them warm.

My go to shoes this winter are
By Larry Huppin, DPM on 2/9/2012 9:49 AM
   I spoke with a ProLab client the other day who was having trouble using the STS mid-leg sock to get a good capture of the foot for production of a stabilizer AFO. He was finding that no matter what he did, the sock was too loose around the malleoli and the posterior heel—other than that, it seemed to be working well. Luckily, there is an easy way to adapt for this problem.
By Larry Huppin, DPM on 2/6/2012 2:52 PM
 I had a patient present this morning with complaint of cramping and achiness in her left foot and on the right, she develops numbness when downhill skiing. She complains that “her right foot goes to sleep” whenever she skis. She has tried several pairs of boots and several pairs of OTC arch supports.

Her biomechanical examination was significant for quite severe flexible pes planus bilateral. Both heels were everted in stance; the left was everted about 8 degrees and the right nearly 15 degrees. Both feet show significant collapse of the arch during gait, particularly in late mid stance, the right somewhat more than the left. In summary, she has severe flexible flatfoot with the right worse than the left.

It is common for skiers with pes planus to develop cram
By Larry Huppin, DPM on 2/2/2012 7:00 AM
   I want to talk today about the "Blake inverted Paradox". Blake inversion refers to balancing the positive cast more than 10 degrees inverted. Additional modifications are performed to make the arch height tolerable. This technique is available only in plaster.  The paradox is the fact that a 9 degree inverted orthotic has a higher arch than a 10 degree inverted orthotic.

 
I consulted with a ProLab client yesterday who wanted to order an orthosis with an arch that would conform extremely close to the arch of the foot. He ordered a standard cast fill, but then inverted the device 10 degrees.

He was surprised when he received the orthotic back and found that it did not conform particularly well to the arch of the
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.
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