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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 11/14/2013 4:23 PM
We recently had a question asked regarding an older blog entry that I want to address in more detail. In December 2009, I wrote a blog discussing why we rarely recommend first ray cutouts. You can read that blog here.

We had a question from a client this week as to whether we would recommend a first ray cutout for a pes cavus foot with plantarflexion of the first ray.

So first, please go back and read that original blog.

Okay, you are back. Now, here is an extended version of my answer to Julie.
By Larry Huppin, DPM on 10/10/2013 6:23 AM
One of our primary missions as a company is to act as a clearing house for our clients in finding the best evidenced based information regarding orthotic therapy for treatment of specific pathologies. That is the primary reason that this website is used so widely as an educational resource for orthotic practitioners.

We have recently completely overhauled and updated the section on this website devoted to evidence-based orthotic therapy for patients with diabetes. This section can be used a guide for any orthotic practitioner to learn the most effective ways to use orthotic therapy to help prevent and treat diabetic-related foot ulcerations.
By Larry Huppin, DPM on 10/3/2013 11:04 AM
  I recently gave a Webinar on the topic of medial pinch callus. In this Webinar, we went into considerable detail on the best orthotic prescription to treat and prevent hallux pinch callus. For complete explanation of how to write the optimum orthotic prescription for this problem, you can watch or listen to the Webinar here. One of the questions that we received after the Webinar was a request to review the most important orthotic additions for treatment of hallux pinch callus. In my opinion, those are the reverse Morton’s extension and the application of a PTFE patch.
By Larry Huppin, DPM on 9/23/2013 8:51 AM
 I spoke with a ProLab client this morning who said he had a patient who presented with plantar fasciitis symptoms for which he made her a pair of posted orthoses with a minimum cast fill. The devices worked extremely well at relieving her symptoms. The only problem is now she is feeling like she is somewhat laterally unstable on the left side only. She states that she “wishes she had something to push her inward a little bit.”

I explained that this is a fairly common problem with patients who receive an orthosis that conforms extremely close to the arch of the foot. This type of orthosis tends to work the best at relieving tension on the plantar fascia and thus relieving plantar fascial symptoms but because it conforms so closely to the arch of the foot, there is a potential that the patient can feel it to be somewhat over aggressive in pushing them laterally.

There are couple easy ways to address this problem.
By Larry Huppin, DPM on 9/12/2013 5:33 PM
  We had a question from a ProLab client today:   

QUESTION:
I would like your opinion on which one of your orthotic types would be best for a runner/cyclist who has chronic sub 2nd MPJ capsulitis, which I feel, is due to a relatively short first ray. I was thinking the ProAerobic with a Mortons extension. Any input would be appreciated.

ANSWER:
By Larry Huppin, DPM on 8/19/2013 6:53 AM
  I had a patient in my office today with complaint of posterior heel pain, right, when wearing several different pairs of his dress shoes. He had a fairly large retrocalcaneal exostosis on the right calcaneus at the proximal aspect of the posterior calcaneus.

There are obviously a number of ways to address the retrocalcaneal exostosis. Our primary goals are to reduce pressure and reduce friction. Reducing pressure in this area is always a little tough without changing shoes. Although you can attempt to stretch shoes in this area, it is usually not particularly effective.

Friction can be controlled in a couple of different ways.
By Larry Huppin, DPM on 8/13/2013 6:59 AM
 Last week, we presented a Webinar on how to use friction management in order to better treat calluses, ulcers, and blisters. Significant research is showing that friction is a strong contributing component to the formation of these problems and that by using a friction reducing material on the orthosis in areas at risk, that both treatment and prevention of calluses and ulcers is improved. We demonstrated how the PTFE Patch can accomplish this. 
By Larry Huppin, DPM on 8/5/2013 2:32 PM
 It is sometimes difficult to fit orthosis for patients who are required to wear steel-toed shoes at work. The reason for this is simply that the number of available steel-toed shoes is somewhat limited and patients simply cannot find a shoe that is comfortable for them and fits well with a foot orthosis.

An option for these patients is to have them
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? 
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