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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 12/27/2012 11:58 AM
 cobra I prescribe a lot of Cobra Dress Orthoses for my patients who wear heels. I think Cobras are by far the best device for anything above a 1- inch heel. One advantage of Cobra’s is that the heel portion is flexible so they adapt very well to different heel height.

The ProLab Cobra orthosis as it is standardly produced works very well in the majority of high heels. If, however, your patient has a small fashionable heel above 3 inches in height, there are some additional adjustments that make it fit easier into the shoe.
By Larry Huppin, DPM on 12/19/2012 8:24 AM
 One of the more common issues that patients might complain of when first wearing a new orthosis is that one or both orthoses may feel like they are “too far forward” in the shoe. The patient may even complain that he or she feels like the orthotic does not match his or her foot well. However, when you compare the orthosis to the foot, you will likely find that, as long as you took a good negative cast, the orthosis matches the foot very well. One of the great benefits of using orthotics from ProLab is that our cast work is extremely accurate compared to that used on most orthoses and so In most cases the orthoses will better match the foot.
By Larry Huppin, DPM on 12/13/2012 7:57 AM
 One of the questions we get a lot is what brands of sandals have removable insoles to allow them to accept custom orthotic devices.

First, if you are wanting to make a pair of custom orthotics for sandals, we do require that the sandals be sent to the lab with a prescription. We cannot make orthotics for sandals without the sandals themselves.

Some of the sandals with that do have removable insoles, and for which we can often make a custom orthoses are as follows:
By Larry Huppin, DPM on 11/29/2012 1:02 PM
I just saw a prescription come into ProLab from a new client. The doctor noted on the prescription form that the patient had plantar fasciitis and weighed 280 pounds. Her prescription was for a Featherweight orthosis (a functional orthosis made from medium density EVA). She also ordered a standard cast fill and a standard width.

This prescription had me concerned for several reasons. First, with the patient weighing 280 pounds, this orthosis was not likely to provide much support. This is a fairly flexible device and it will collapse rather quickly under the weight of this patient. Given that, the device would not last very long.
By Larry Huppin, DPM on 11/28/2012 10:33 AM
Setting realistic patient expectations is a critical aspect of orthotic therapy and is often overlooked. You can improve your orthotic compliance, acceptance, and treatment success by educating your patients as to what they can realistically expect from orthotic therapy. For example, doctors should tell patients that orthoses are not a "cure" for plantar fasciitis; they are designed to reduce the tension on the plantar fascia to facilitate healing and reduce the likelihood of recurrence. In this situation, patients need to understand that orthoses are part of an overall treatment plan. This leads nicely into the necessary discusion of shoes (including shoe types that can irritate the condition, shoe fit with orthotics, etc.).
By Larry Huppin, DPM on 11/22/2012 9:23 PM
By Larry Huppin, DPM on 11/19/2012 9:29 PM
  We have a new webinar available on the website.  This one covers the use of custom and prefabricated orthoses for treatment of calcaneal apophysitis.   ProLab clients can watch the webinar here.

Other webinars available online include:
By Larry Huppin, DPM on 11/15/2012 9:16 AM
Why do you have a 3 degree VALGUS forefoot post when it appears that most people need a 3 to 4 degree varus post? I understand that in open kinetic chain you lock the midtarsal joint by dorsiflexing the 5th ray, but in closed kinetc chain the ray gets dorsiflexed by ground reactive forces, hence it is supposed to lock the midtarsal joint. But when the forefoot is in varus the extra motion to the neutral position causes excess pronation. We learned years ago in school this is stopped by posting the forefoot to its abnormal varus or valgus component. Have I missed a change in biomechanics somewhere along the line? 
By Larry Huppin, DPM on 11/12/2012 9:02 PM
 I recently spoke with a doctor who noted on one of his prescription forms that he wanted an orthosis to "control servere pes planus" and yet prescribed a "narrow" orthosis. By definition, a narrow device is one that is ground lateral to the first met bisection. 

A narrow orthosis has less area against the foot available to apply a supinatory torque medial to the axis of the subtalar joint. Thus, a narrow device is contraindicated in situations where you require control over a very pronated foot (one with a medially deviated subtalar joint axis).
By Larry Huppin, DPM on 11/8/2012 5:03 PM
 This week we had a client send in a pair of old orthotics from another lab along with a pair of casts and ask us to make an orthotic that is “make to match.” This situation always makes us nervous because it is almost always doomed to failure.

It made correctly, functional foot orthoses are designed to decrease stress on tissue that is being overstressed in order to treat pain or other pathologic conditions. In most cases, there is not one exact shape that will do the “best” job at decreasing tension on a particular structure. Your goal when prescribing orthoses should be providing devices that adequately reduce stress on overstressed tissue and are comfortable for the patient. Your goal should not be to match a particular orthotic device.
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