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

By Cherri Choate, DPM on 7/28/2010

Many practitioners develop habits of prescription writing for orthotics.  All of us have favorite, and not-so-favorite, additions to our devices.  As we treat more patients, and write more prescriptions, we tend to develop patterns. Although experience is invaluable, one pitfall that can occur is relying on the familiar.  As the process of orthotic and brace fabrication develops, new technologies, materials and device options will become available.  Compared to when I attended podiatry school, the options on any orthotic prescription form have increased by double.  The medial skive, Blake Inversion, Reverse Morton's Extension and no lateral bevel options are fairly recent additions to most prescription forms.  As the world becomes a smaller place, the options for material choice will only expand.  As more research produces evidence, the orthotic/bracing world will continue to grow and improve.

To stay f ...

By Cherri Choate, DPM on 7/21/2010

Plantar fibromas are common findings in the foot.  Although these benign soft tissue masses are often not overly painful, they are usually sensitive.  What types of accommodations can be done within an orthotic for these small masses?  I would say, there are three different ways to address plantar fibromas:
     1)  Off-load area
              This can be accomplished by either a sweet spot or a modified sweet spot.  A typical sweet spot is an indentation in the plate that is filled with a softer material such as Poron.  A modified sweet spot would be the same indentation, but it would not be filled with Poron.  If a modified sweet spot is ordered, it should be explained to the lab so they make the &q ...

By Cherri Choate, DPM on 7/14/2010

 A 68 year old patient presents with midfoot pain.  He denies any history of trauma and wants to remain active. What is his diagnosis and what type of orthotic device would improve his pain?

By Cherri Choate, DPM on 7/7/2010
Gait analysis and evaluation are skills used by both clinicians and researchers alike.  The  response of both the  Center of Mass and the Center of Pressure are important to consider when determining a patients diagosis, as well as when determining the best biomechanical treatment options.
By Cherri Choate, DPM on 6/30/2010

Bottom covers are an available, but often underutilized component of orthotic fabrication.  A few advantages and disadvantages will be discussed regarding their use.

By Cherri Choate, DPM on 6/23/2010
In today's world stories covering pediatric obesity  are read, nearly on a weekly basis, in both national and local media.  In addition to all the long term health issues related to this epidemic, studies are now being published about the impact on the lower extremity.  But now, we have two intervening issues to make our decisions even more difficult:  Childhood Sports and Obesity
By Cherri Choate, DPM on 6/16/2010
Case Information: 
A 48 year old female presents with pain in the ball of her foot and in her 1st MPJ.  She has attempted to change her shoes and primarily only wears athletic shoes now, and they seem to be the only comfortable shoes.  She walks or rides her bike daily, as she does not drive.  She has always been an active walker, but only walks to get from one place to another now, due to the pain.  She states the pain has gotten increasingly worse over the past 8 months.  She has seen another physician, who gave her an injection and a pad for her shoe, neither of which helped relieve her pain.

Physical Exam:  
    MSK- pain on ROM and palpation 1st MPJ with mild pain on palpation of 2nd MPJ plantarly; mild edema dorsal 1st MPJ; no erythema; no pain on 3-5 MPJs;  hallux dorsiflexion NWB limited but arch raises with hallux dorsiflexion WB< ...
By Cherri Choate, DPM on 6/2/2010

     I was recently on a trip and when I returned home, my husband had left out an article for me to read from the Wall Street Journal.  The article title was:  Why the Hightop Has One Foot in the Grave ( see link below).  I am a former hightop wearer so the article was of interest on a number of levels.  In fact, I had some pink Avia hightops that traveled with me for many years.  Ironically, it was not the information on the demise of the high top athletic shoe that caught my attention.  The second half of the article discussed foot injuries and stated that they are the number one injury in the NBA.  The implication from the article was that players are now being fit with orthotics, to try to protect their feet from injury, instead of solely relying on the shoe.  This is certainly another application of the important orthotic research that is being done throughout the world by many s ...

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 ...
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