Adding A Crest Pad To Custom Orthoses

Larry Huppin DPM
6/4/14 | 481 reads | 0 comments
A patient recently came in to pick up her orthotic devices. She has worn orthoses for years for several pathologies. However, what we are addressing now is pain secondary to digital contracture. She is starting to get more pain at the distal aspect of her toes secondary to hammertoes and pressure on the distal aspect of the digits. In the past, she has found that shoes that have a crest in them tend to work well for her. In particular, she has found that the crest in Birkenstock sandals helps keep her toes straight and decreases her symptoms. Read More.

Orthotic Adjustments For A Prominent Fifth Metatarsal Base: Plantar Or Lateral?

Larry Huppin DPM
5/5/14 | 499 reads | 0 comments
It is common to have to make orthotic adjustments for a prominent fifth metatarsal base. However, it is important to note on the prescription form whether the styloid process is prominent laterally or plantarly. There is a distinct difference in accommodating for these two. If the styloid is prominent plantarly, I recommend using a sweet spot. If it is prominent laterally, I would recommend adding extra lateral extension at the base of the fifth metatarsal. If it is prominent both laterally and plantarly, I would recommend both of those accommodations. Read More.

Foot Orthotics For Cowboy Boots

Larry Huppin DPM
4/3/14 | 1072 reads | 0 comments
It is always a challenge to fit orthotic devices in cowboy boots. First of all, let me say that since I practice in Seattle, I am not the most experienced practitioner in fitting orthoses into cowboy boots. I am sure my colleagues in Phoenix, Austin, and other parts of the Southwest have much, much more experience using these types of devices. Given that, I have had several patients for whom I have made orthotics for cowboy boots. While I have ended up frustrated several times, I seem to have found a formula that works well. Read More.

Facilitating Support And Comfort In Orthoses For Obese Patients

Larry Huppin DPM
3/25/14 | 1300 reads | 0 comments
A colleague recently called about a patient who felt his orthotic device was too hard. He wanted to know if he could possibly make a softer orthotic for this patient, who weighs 310 pounds. Or course, obese patients put significant pressure onto their feet. When they wear an orthosis, there is significant force between the orthosis and the foot, much more so than what would occur with a patient of average weight. This means that these patients have more potential to feel the arch of the orthosis as too high or too hard. Read More.

Do Your Patients Have Orthotic Arch Irritation When Standing For Long Periods?

Larry Huppin DPM
2/27/14 | 3573 reads | 1 comments
A colleague called me recently with a question regarding a patient who feels that his orthoses are very comfortable when he is walking on them but they are feeling hard when he stands in one place on the orthotic devices. This is an issue I run into a lot. I practice in Seattle and treat a lot of Boeing employees who stand on concrete all day. I have found those people who are standing in one place on hard surfaces do not usually tolerate quite as much arch height as those that spend most of their day walking or sitting. Read More.

When A High Arched Patient Has Dorsal Foot Pain With Orthoses

Larry Huppin DPM
2/7/14 | 2321 reads | 0 comments
A fairly common complication for patients with cavus foot type who begin wearing orthosis is to develop pain on the dorsum of the foot secondary to shoe pressure. Read More.

Making An Orthotic Accommodation For Plantar Bone Callus

Larry Huppin DPM
1/30/14 | 1629 reads | 0 comments
A colleague recently asked for my opinion on a patient who suffered a midfoot fracture at the base of the fourth and fifth metatarsal shafts. The patient had no treatment at the time of the injury and healed with a large bone callus on the plantar surface of the metatarsals. These bone calluses create a large prominence on the plantar foot. This area is taking excessive pressure, leading to pain, keratoma formation and occasional skin breakdown. My colleague was looking for suggestions on an orthotic prescription for the patient’s foot. Read More.

Should Prefabricated Orthoses For Plantar Fasciitis Have A Plantar Fascia Groove?

Larry Huppin DPM
1/8/14 | 4555 reads | 1 comments
A colleague recently asked whether prefabricated orthoses for plantar fasciitis require a plantar fascia groove. A plantar fascia groove is used to decrease pressure on a very prominent plantar fascia. I find this accommodation is rarely needed, even when making a custom orthosis. In fact, there are some inherent problems with using a plantar fascia groove because it can cause the orthosis to gap excessively from the arch of the foot. My preference is that if a plantar fascia groove is necessary, the clinician should add it after the patient receives the orthosis. Read More.

Should You Use First Ray Cutouts For Pes Cavus Feet?

Larry Huppin DPM
12/10/13 | 1768 reads | 0 comments
A while back, I wrote a blog on why I rarely recommend first ray cutouts (see http://prolaborthotics.com/Blog/tabid/90/EntryID/113/Default.aspx ). More recently, a colleague asked if I would recommend a first ray cutout for a pes cavus foot with plantarflexion of the first ray. Read More.