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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 7/8/2013 8:40 AM
  A ProLab patient called me today stating that she had a patient who is getting blisters when wearing her new orthotics. She stated that she had sent the orthotics back to be lowered once but that they were still causing blisters.

I asked what kind of orthotics they were and it turns out they were a graphite orthosis with a standard width, a standard heel cup, and no rearfoot post. The patient wanted to get one pair of orthotics that would work in both her dress shoes and her athletic shoes.

It turned out that the blistering occurred only when she was running and using the orthotics.

I explained to our client that the problem was
By Larry Huppin, DPM on 6/24/2013 3:54 PM
A question from a client today:

QUESTION:

In patients with a pediatric flat foot or a young adult with flat foot deformity .....with the STJ in neutral upon standing and the first ray doesn't touch the ground, do you add a forefoot extension, first ray cut out or to get the forefoot on the ground? 
By Larry Huppin, DPM on 6/10/2013 2:54 PM
 I had a ProLab client called me today stating that she wanted to make a soft orthotic for a patient who had a significant pes planus foot type and was suffering from plantar fasciitis. She wanted to make a soft device because she said the patient had “hard orthotics” in the past and did not tolerate them.

The first thing that we need to think about when deciding on an orthotic prescription is to determine the goal of therapy. Since this patient’s primary complaint is arch pain due to plantar fasciitis, our goal with the orthotic device should be to reduce tension on the plantar fascia. To accomplish this we need a device that is going to decrease arch collapse in order to decrease lengthening of the arch and increased tension on the plantar fascia. 
By Larry Huppin, DPM on 6/10/2013 2:54 PM
 I had a ProLab client called me today stating that she wanted to make a soft orthotic for a patient who had a significant pes planus foot type and was suffering from plantar fasciitis. She wanted to make a soft device because she said the patient had “hard orthotics” in the past and did not tolerate them.

The first thing that we need to think about when deciding on an orthotic prescription is to determine the goal of therapy. Since this patient’s primary complaint is arch pain due to plantar fasciitis, our goal with the orthotic device should be to reduce tension on the plantar fascia. To accomplish this we need a device that is going to decrease arch collapse in order to decrease lengthening of the arch and increased tension on the plantar fascia. 
By Larry Huppin, DPM on 6/6/2013 2:45 PM
 A common question I get regarding billing for orthotic devices is how to charge for the casting component. This is becoming more complicated lately because many ProLab clients are now using the ProLab foot scanner rather than plaster casting to capture an image of the foot.

In my own clinic, we have never billed separately for casting of orthotic devices. We have always considered casting an integral part of the orthotic have simply billed for the L3000 code for the right and left orthotics and then an EM code for the evaluation and management portion of the orthotic visit, which includes the evaluation of the patient and decision making regarding the orthotic prescription that is best going to treat the problem of each specific patient.
By Larry Huppin, DPM on 4/15/2013 6:23 AM
 A fairly common complaint that I hear in my office is that of patients saying that their heel is slipping up inside one or more shoes when they wear their orthotic devices. This is usually a very easy problem to address and one that every orthotic practitioner should be aware of.
By Larry Huppin, DPM on 4/8/2013 1:44 PM
  I saw a patient a few weeks ago who had come back in for followup after getting her orthotics. She was comfortable in the orthotics for the most part and they have worked very well in relieving her symptoms. However, there was one area that was bothering her and that was the lateral heel cup on one orthosis. When I had her stand on the devices, I noted that she had a quite a bit of fat pad expansion and that the fat pad of the heel was overriding the lateral edge of the heel cup.

I always try to avoid this problem by measuring the fat pad of the heel when I order orthoses. I checked the copy of her prescription form and I found that in this situation I had forgotten to take the measurement and send it to the lab. By measuring it, I almost always avoid this problem.

It has to be kept in mind that
By Larry Huppin, DPM on 4/4/2013 8:43 AM
 I saw a patient this morning who suffered a crush trauma to his mid and rearfoot a number of years ago and now has both midfoot and rearfoot osteoarthritis. He has done fairly well using a gauntlet AFO to limit motion. The last time I saw him, I also recommended that he get a rocker-soled shoe. A rocker sole will further act to decrease mid and rearfoot motion, particularly if the rocker is placed near the midfoot.

Since the last visit, he purchased a pair of PW Minor shoes, which had a built in rocker. They fit the gauntlet AFO extremely well and he has found that the rocker has substantially further decreased his symptoms.
By Larry Huppin, DPM on 4/1/2013 8:41 AM
 I recently saw a patient for whom I dispensed a new pair of orthotic devices. This patient had prominent styloid process. 

If you ever are prescribing an orthosis for a patient with a prominent styloid process, you have to determine if the styloid needs accommodation. When making this determination, you must first determine whether the styloid is prominent laterally, plantarly, or both. Lateral and plantar styloid prominences required different accommodation.
By Larry Huppin, DPM on 3/28/2013 8:35 AM
Achieving optimum outcomes with orthotic therapy is dependent on a number of factors. These include proper prescription writing, correct casting technique, and high quality cast work in production methods by the orthotic lab. If you are ProLab client then you know that our cast work is the best in the industry and that we strive constantly to provide you with the education and information you need to write the best orthotic prescriptions.

Understanding orthotic material differences is often an overlooked but critical part of writing the correct orthotic prescription. This came up in a conversation I had with a ProLab client this morning when doing a consult regarding a patient with a Cavus foot structure.
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