Addressing Retrocalcaneal Exostosis Pain With Friction Management

Larry Huppin DPM
8/29/13 | 2231 reads | 0 comments
I recently had a patient in my office who had a complaint of posterior heel pain when wearing several different pairs of 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. Read More.

Is The Orthotic Really Too Hard Or Was It Just The Wrong Prescription?

Larry Huppin DPM
8/2/13 | 2383 reads | 1 comments
A fellow podiatrist called me recently, stating that she wanted to make a soft orthotic for a patient who had a significant pes planus foot type and was suffering from plantar fasciitis. She wanted to make a soft device because she said the patient had “hard orthotics” in the past and did not tolerate them. Read More.

Should You Use A Morton’s Extension For A Forefoot Varus?

Larry Huppin DPM
7/5/13 | 2575 reads | 0 comments
A colleague recently asked me the following question: In patients with a pediatric flatfoot or a young adult with flatfoot deformity with the subtalar joint in neutral upon standing and the first ray doesn't touch the ground, do you add a forefoot extension, first ray cutout or get the forefoot on the ground? Read More.

Another Tip For Eliminating Orthotic-Induced Heel Slippage

Larry Huppin DPM
6/7/13 | 2763 reads | 0 comments
A fairly common complaint that I hear in my office is that of patients saying that their heel is slipping up inside one or more shoes when they wear their orthotic devices. This is usually a very easy problem to address and one that every orthotic practitioner should be aware of. Jenny Sanders, DPM, recently wrote an excellent DPM Blog ( ) on how to use lacing techniques and tongue pads to decrease heel slippage. Read More.

What To Do If The Orthotic Heel Cup Is Too Narrow

Larry Huppin DPM
5/7/13 | 2636 reads | 0 comments
I recently saw a patient who came back in for followup after getting her orthotics. She was comfortable in the orthotics for the most part and they have worked very well in relieving her symptoms. However, there was one area that was bothering her and that was the lateral heel cup on one orthosis. Read More.

How To Accommodate For Prominent Styloids

Larry Huppin DPM
4/4/13 | 3121 reads | 0 comments
I recently saw a patient for whom I dispensed a new pair of orthotic devices. This patient had a prominent styloid process. When considering an orthosis for a patient with a prominent styloid process, you have to determine where the styloid needs accommodation. To make this decision, you must first determine whether the styloid is prominent laterally, plantarly or both. Lateral and plantar styloid prominences require different accommodation. Read More.

Do Podiatrists Use First Ray Cutouts Too Much?

Larry Huppin DPM
3/6/13 | 3302 reads | 1 comments
The first metatarsal cutout or first ray cutout is a common orthotic modification clinicians use to allow the first ray to plantarflex in order to treat functional hallux limitus. I think it should be noted, however, that if a practitioner takes extremely good negative cast, writes an appropriate prescription, uses an orthotic lab and does not overfill the medial arch, the first ray cutout should rarely be necessary. Read More.

Why Wider Orthotics Tend To Be More Comfortable

Larry Huppin DPM
2/6/13 | 2689 reads | 0 comments
I had a patient come in recently for dispensing of new orthotic devices. He had worn orthoses for years and was starting to get a return of his plantar fasciitis symptoms. Another podiatrist provided the previous orthoses. Read More.

When A Patient Says An Orthotic Feels ‘Too Far Forward’ In The Shoe

Larry Huppin DPM
1/4/13 | 2711 reads | 0 comments
One of the more common issues that patients might complain of when first wearing a new orthosis is that one or both orthoses may feel like they are “too far forward” in the shoe. The patient may even complain that he or she feels like the orthotic does not match his or her foot well. However, when you compare the orthosis to the foot, you will likely find that, as long as you took a good negative cast and use a lab with high standards for castwork, the orthosis matches the foot very well. Read More.