A Closer Look At Orthotic Technologies And Modifications

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Lawrence Huppin, DPM, says the reverse Morton’s extension (as seen above) is the most common orthotic modification he uses in practice.
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Author(s): 
Guest Clinical Editor: Lawrence Huppin, DPM

   Dr. Volpe concurs. He notes a computerized pressure and gait analysis can provide objective information about pathological structure and function, and also clarify the goal in prescribing a particular patient’s orthosis. Computerized systems offer another advantage since they permit the testing of patients after prescribing therapy to determine if the desired changes or goals are really occurring, notes Dr. Volpe. Otherwise, practitioners tend to depend on the subjective reduction of symptoms to determine the efficacy of therapy.

    “While this is perhaps the first and foremost goal in this era of outcomes medicine, it is valuable to be able to document objectively that desired changes are occurring,” comments Dr. Volpe.

   He adds that objective gait assessment often clearly identifies asymmetries in patients. Objective, pressurized analysis can reveal significant left/right differences in feet, gait and pathologies, and can permit DPMs to tailor therapy to yield a better result, according to Dr. Volpe.

   However, Dr. Huppin does not think analyzing weightbearing via a pressure analysis device can provide enough information to make a functional orthotic. He says using pressure analysis instead of a negative cast for this purpose “compromises the quality of orthoses.” As he argues, one cannot use a two-dimensional shape of a foot produced by a pressure map to determine the three-dimensional shape of the foot.

    “Don’t confuse a colorful 3-D pressure map of the foot with the ability to determine morphology,” cautions Dr. Huppin. “Pressure analysis can tell you nothing of the shape of the foot. It is doubtful that a system that uses that technology can produce anything but a ‘customized’ OTC orthotic.”

   On the other hand, Dr. Huppin does think computerization can allow one to capture the image of the foot. As he notes, technologies such as the Bergman Scanner (Bergman Orthotics) use a laser to scan the foot and produce a “digital negative cast.” Systems such as the Bergman Scanner and newer products that use 3-D digital photography to capture the foot in a neutral position are likely the future of orthotic casting, according to Dr. Huppin.

Dr. Huppin is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College. He is also the Medical Director for ProLab Orthotics/USA.

Dr. Kirby is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College. He is also the Director of Clinical Biomechanics for Precision Intricast Orthosis Laboratory. Dr. Kirby has a private practice in Sacramento, Ca.

Dr. Volpe is a Professor in the Departments of Pediatrics and Orthopedics, and is the Chairman of the Department of Pediatrics at the New York College of Podiatric Medicine. He has a pediatric foot and ankle specialty private practice in Farmingdale and New York, N.Y.

Editor’s Note: For related articles, see “Inside Insights On Orthotic Modifications For Sports” in the Orthotics Q&A column in the October 2004 issue or “Orthotic Modifications And Shoewear For Specific Jobs” in the Orthotics Q&A column in the October 2002 issue of Podiatry Today.

Also check out the archives at www.podiatrytoday.com.




References:

1. Kirby KA. Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002, pp. 161-162.

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