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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 3/12/2012 11:22 AM
I received a question from a client today on the consultation page here on our website. This allows ProLab clients to send in questions and include pictures, MRI reports, etc.

Hi Larry, I wanted your opinion on this orthotic. As you can see from the MRI he has a plantar plate rupture sub 3rd on left foot and possible neuroma in 2nd interspace. I also included the pic of the orthotic he has now which does have a small met pad, and his shoe type. Would you agree he needs to have a met pad that is bigger, say 1/2", proximal to 2nd and 3rd met heads? 


The goal of the orthosis in the presence of a plantar plate tear is to transfer as much pressure off of the 3rd met head (MPJ) as possible. You do this by prescribing
By Larry Huppin, DPM on 3/9/2012 8:19 AM
 I received an emailed question from a client this morning:

I would like to send you some pics.  Interesting case of Cavus foot type with severe painful IPK sub 3rd bilateral. Wanted your opinion whether you see some calcaneal varus? and do you recommend a metatarsal pad behind the 3rd metatarsal. He also has IPK sub 1st but asymptomatic. Will send you castings shortly.

I don't think you need to worry about the rearfoot, it looks pretty stable and rectus. 

This is really just an issue of getting the pressure off of the 3rd met, and to a lesser extent, the 1st. 
By Larry Huppin, DPM on 3/5/2012 11:09 AM
   I did a consult with a ProLab client yesterday regarding a patient who was laterally unstable and how best to write the orthotic prescription. He stated that in the biomechanical exam he measured the resting calcaneal stance position as nearly 10 degrees inverted. I then asked if he had performed the Coleman block test to determine whether it was the forefoot that was holding the foot inverted, or if this patient had a rigid inverted rearfoot. He had not checked that and did not know the answer. This is a critical question when looking at a patient who has an inverted heel, so he decided to have the patient return to clinic so that he could perform the Coleman block test.

The Coleman block test consists of supporting the lateral forefoot in order to determine if
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
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