Orthotics Q&A

Robert Bielski, MD, encourages clinicians to narrow down the differential diagnosis of pediatric equinus by asking about the developmental history.
Guest Clinical Editor: Edwin Harris, DPM
21,656 reads | 0 comments | 08/03/2007

Pediatric equinus can be a challenging condition to diagnose and treat. With this in mind, these expert panelists discuss the differential diagnosis, the positioning of orthoses to control the condition, and the benefits that various modalities can have in managing the condition.

Q: How do you narrow down the differential diagnosis of pediatric equinus?
A: Edwin Harris, DPM, cites several possible causes for equinus deformity including: hemiplegic and diplegic cerebral palsy, muscular dystrophies, peripheral neuropathy, spinal cord pathology, acquired contractu

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Guest Clinical Editor: David Levine, DPM, CPed
10,356 reads | 0 comments | 06/03/2007
Guest Clinical Editor: Lawrence Huppin, DPM
16,747 reads | 0 comments | 02/03/2007

      Given the increased emphasis on evidence-based medicine, our expert panelists review the impact of literature findings upon their prescription of custom foot orthoses for different pathologies.       Q: Is there evidence in the literature to support the use of functional orthotic devices?       A: The only supporting evidence relative to orthotic treatment of posterior tibial tendon dysfunction (PTTD) are studies of ankle foot orthoses (AFOs), according to Doug Richie Jr., DPM. Regarding PTTD, he says the evidence is “quite imp

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Guest Clinical Editor: Scott Spencer, DPM
13,499 reads | 0 comments | 10/03/2006

     In this month’s discussion, our expert panelists discuss the importance of an arthrometric exam, whether one should lean more toward accommodation or control with orthotic prescriptions, and share a few key pearls they have learned over the years in optimizing the effectiveness of prescription orthoses.      Q: Do you feel that the arthrometric examination plays a relevant role in your orthosis prescribing?      A: For Kevin Kirby, DPM, the arthrometric examination along with the physical exam and gait exam enable podiatrists to

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Guest Clinical Editor: James Losito, DPM
27,806 reads | 0 comments | 06/03/2006

In this edition of “Orthotics Q&A,” the panelists discuss various issues ranging from indications for the Richie Brace, Arizona AFO and prefabricated orthoses to whether orthotic casting should reduce supinatus. Without further delay, here is what the panelists had to say. Q: What are the indications for using a Richie brace versus using an Arizona brace? A: For Doug Richie Jr., DPM, each custom ankle foot orthotic (AFO) has a different clinical indication and choosing one to treat a pathology is the same as choosing a surgical procedure. He notes the rigid Arizona AFO has a mol

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Guest Clinical Editor: Bruce Williams, DPM
10,766 reads | 0 comments | 04/03/2006

Although what one learned in podiatric medical school is invaluable in a podiatry career, sometimes podiatrists may encounter a different reality in clinical practice. These expert panelists weigh what they learned in school with their experience and the current research. They also detail which directions future orthotic research should take. Q: What is the current research telling us about how the foot really functions as opposed to what many podiatrists were taught in school? A: Much of the current research focuses on the importance of the midtarsal joint(s) and how they have a

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Guest Clinical Editor: Douglas Richie Jr., DPM
14,077 reads | 0 comments | 02/03/2006

   Over the last decade, there have been a variety of changes and trends that have shaped the evolution of orthotic therapy. Accordingly, our expert panelists discuss pertinent orthotic prescription trends. They also examine the importance of having a strong background in biomechanics and whether the podiatric profession is “giving away” its biomechanics expertise to non-podiatric physicians.    Q: What specific changes have you observed in the overall utilization of functional foot orthoses in the typical podiatric practice in the past 10 years? Are or

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18,504 reads | 0 comments | 12/03/2005

   Given the nuances of making adjustments to orthotic prescriptions, our expert panelists discuss their approaches in using adjustments such as first ray cutouts and metatarsal pads, and the tools necessary for making modifications. They also discuss which adjustments they will make themselves and which ones they will send out to an orthotics lab. Without further delay, here is what they had to say.    Q: How do you incorporate footwear when determining appropriate orthotic prescriptions?    A: Ideally, Howard Horowitz, DPM, says one s

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Guest Clinical Editor: Lawrence Huppin, DPM
12,166 reads | 0 comments | 10/03/2005

   The development of new materials and technologies has had an impact on orthotics and biomechanics. These expert panelists discuss the technologies they have found helpful. In particular, they assess the impact of pressure analysis and how it can influence the writing of effective orthotic prescriptions. They also discuss common orthotic modifications and which orthotic materials they use in their practices.    Q: How have new materials and technology changed the state of podiatric biomechanics and orthotic therapy?    A: Russell Vol

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Guest Clinical Editor: Nicholas Sol, DPM, CPed
10,999 reads | 0 comments | 08/03/2005

   Evaluating biomechanics in static stance poses unique challenges because of the differences between static stance and dynamic gait. In addition, one must take the occupation of patients into account when modifying orthotics for patients who spend a significant amount of weightbearing time in static stance. That said, let us take a closer look at what these expert panelists have to say on the subject.    Q: What are the key differences between approaching the biomechanics of static stance and dynamic gait?    A: Podiatry schools and

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