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Blog

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 1/14/2013 3:10 PM
QUESTION

Dave is a 73 year old male. His primary complaint is mild pain in his left foot over the 2nd-4th metatarsal heads. He has bilateral heel spurs (about 6mm each) that are currently asymptomatic after corticosteroid injections and custom orthotics about a year ago. He also has a bilateral very prominent base of the 5th metatarsal with significant callus formation bilaterally, greater on the right, that seem to be getting larger with time, but are asymptomatic; the prominence is quite visible laterally but also INFERIORLY in a plantar direction (to a lesser extent than laterally).

By Larry Huppin, DPM on 1/13/2013 9:18 AM
  In November, I gave a webinar on using orthotic devices to treat plantar fasciitis. ProLab clients can watch that webinar here. After the webinar there were a number of questions. One of those was from a podiatrist who stated that he prescribed prefabricated orthotics for feedback on whether orthotic therapy was likely to function for a particular patient. He wants to know how long a period of time that I would let my patients use prefabs to find out if custom devices will likely work.
By Larry Huppin, DPM on 1/7/2013 9:26 AM
 I had a patient come in today for dispensing of new orthotic devices. He had worn orthoses for years and was starting to get a return of his plantar fasciitis symptoms and so a new pair was made. I did not made the previous pair for him.

The older orthoses were gapping quite significantly from his arch and were also about a centimeter narrower than his foot. The new devices were the full width of his foot and were made with a minimum fill with 2 degrees of inversion. This resulted in orthoses that conformed very closely to the arch of the foot. In addition, when I took the cast of the foot the first ray was plantarflexed to the end of its range of motion which enhances arch height. 
By Larry Huppin, DPM on 1/6/2013 9:11 AM
  I use a lot of prefabricated orthosis in my practice. They are usually my first line treatment for a majority of the mechanical conditions I treat including plantar fasciitis, hallux limitus, and metatarsalgia. My go-to device is the ProLab P3 prefabricated orthosis. It is only prefab in the market that incorporates valgus forefoot correction and a medial heel skive along with a rearfoot post and deep heel cup. These are the same modifications I would prescribe when treating these most common problems that are treated with orthotic devices. For more detail and references on why these features are important, you can go to the following pages for information on these specific pathologies: 
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
 
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