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Author: Cherri Choate, DPM Created: 6/20/2009
Orthotic therapy blog

By Cherri Choate, DPM on 5/26/2010
Efforts to standardize issues in research always intrigue me. Since there is such a chasm between a great idea, and a practical and validated process, I always have respect for those who not only propose, but develop their idea into a working measure. Such a measure is the Foot Posture Index 6 (FPI-6). In the early 21st century a group from the Univeristy of Leeds developed this stardardized method to determine foot posture. 

So, why do you, as a practice based physician, need to know about the Foot Posture Index? Well, it really has to do with the value of valid clinical research.  As practitioners we would like studies to be reliable and quantifiable. We would like the methods section of a research paper to be written in common language so that we can compare results and conclusions with ease.  Returning to the original  FPI article, their motivating issue ...
By Cherri Choate, DPM on 5/19/2010

Prolab offers three different types of accommodative orthotics devices.  Al the devices should be fabricated from a semi-weightbearing casts, due to the production process of not adding soft tissue expansion (no fill). All three options have some similarities:  14 mm heel cup, standard width and no cast fill.  The differences are listed below:

   Custom Diabetic- Firm Plastazote shell, diabetic cover to toes
   Custom Insole- Full length medium Plastazote shell, P-cell cover to toes
   EVA Accommodative- 3 mm VF shell, extended EVA arch fill, 3 mm nylene to toes

All three devices are a good option for pathology such as severe Charcot deformity, late stage RA and severe fat pad atro ...
By Cherri Choate, DPM on 5/12/2010

Heel cup irritation with orthotic use is not uncommon.  If this is happening on a regular basis in your practice, then perhaps a few changes in habit will help.  Unlike many other aspects of troubleshooting with orthotics, a narrow heel cup is difficult to adjust in your office.  If you do a large volume of orthotics, you probably have already invested in calipers.  If you are newer in practice, these may seem unnecessary, until you face a series of patients with poor heel cup fit. 

When do you need to provide the lab with heel width measurements?  Can you tell by the patient weight, shoe ...

By Cherri Choate, DPM on 5/5/2010
FAQ Series:  Does Prolab recycle any of their materials?
Since we have entered the 21st century, the importance of being environmentally responsible, is vital for any company.  Prolab has developed a set of programs which are aimed at lowering the environmental impact of the production process:

     1)  Polypropylene shavings are recycled into other types of plastic products.
     2)  Wood shavings and scraps are recycled locally into mulch.
     3)  Prescription forms are printed on recycled paper.
  ...
By Cherri Choate, DPM on 4/28/2010

 The lateral (inversion) ankle sprain is the most common sports injury. In fact, the inversion ankle sprain may have actually been the impetus for the development of the "RICE" treatment option. With this being said, once the early phase is over and the patient is "back to normal", treatment often becomes inconsistent and ineffective. What is the most effective means of treating chronic ankle instability due to chronic sprains or poor mechanics?

By Cherri Choate, DPM on 4/21/2010
See full size imageJust like an old pair of shoes, replacing an old pair of orthotics can become a frustrating situation for the physician and the patient.  Many patients have "worn in" their devices to the point of ultimate comfort but limited therapeutic use.  This balance must be recognized and discussed PRIOR to an attempt at making a new pair of devices.  In my experience, usless there are significant symptoms present, it may be more beneficial to create a devices that are as close to p ...
By Cherri Choate, DPM on 4/14/2010

Just yesterday, I was speaking with someone who was having foot pain ...

By Cherri Choate, DPM on 4/7/2010
Since I live in California, I fight the flip flop battle nearly every day of the year.  I discourage the use of flip flops for a variety of reasons, but most importantly because they are unstable and cause numerous foot complaints.  I found some interesting reading on flip flops, inlcuding a letter written in 1967 by a British phsyician regarding some issues with the growing fashion trend of flip flops.   
 The use of flip flops as the sh ...
By Cherri Choate, DPM on 3/31/2010
 I was having a discussion with a group of students this week regarding the effect of equinus on gait. As a group, they quickly determined that the metatarsal area would likely have increased pressure since the foot with equinus exhibits early heel off. This student discussion reminded me how often we forget to take a step back when assessing recalcitrant foot ulcerations in light of biomechanical etiological factors. So often the list of culprits leading to non-healing include osteomyelitis, soft tissue infection, inadequate off-loading, non-compliance, poor glucose control and inappropriate wound environment. These issues are often explored in depth, but the off-loading modification usually is limited to thicker aperture pads, use of a CAM walker or sometime of felt/foam with a surgical shoe. Too often, exploration of the biomechanical cause is forgotten.
By Cherri Choate, DPM on 3/24/2010

See full size imageI had a conversation with a friend and colleague today about my concept of the "hybrid" orthotic. His question was regarding a patient of his that was diabetic, but very active and suffering from symptoms secondary to flexible flat feet. This patient had been casted for custom orthotic in the past, but he continued to have problems secondary to his flat feet.  My friend and I discussed the merits of treating this "diabetic" patient with something other than a ...

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