Orthotics Q&A

Clinical Editor: Nicholas Romansky, DPM
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These expert panelists explore the efficacy of orthoses for hallux limitus, the impact of orthotic devices on the kinetic chain and key considerations with topcovers. Q: How do you use orthotics for hallux limitus? A: David Levine, DPM, CPed, notes hallux limitus can be a challenging problem to treat conservatively and surgically. He says it is helpful to distribute the pressure more evenly... Read More.
Guest Clinical Editor: Nicholas Romansky, DPM
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Are orthotics prescribed too much or are they underutilized when it comes to biomechanical issues in the lower extremity? In addition to emphasizing a tailored treatment approach for each patient, these experts also detail their casting methods and the standards they use to choose orthotic fabrication materials. Q: Do you think every patient can benefit from orthotics? A: None of the panelists... Read More.
Guest Clinical Editor: Joseph D'Amico, DPM
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In addition to sharing their perspectives on rearfoot posting, these expert panelists discuss their approaches to assessing the effectiveness of their orthotic prescriptions and when it is time to replace orthoses. Q: How do you determine the type and amount of rearfoot posting you prescribe? A: Russell Volpe, DPM, prefers extrinsic rearfoot posting. He says it provides stability to the device... Read More.
Guest Clinical Editor: Joseph D'Amico, DPM
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Q: What is your approach and what has been your success with the conservative management of peroneal spastic flatfoot secondary to tarsal coalition? A: Noting that peroneal spastic flatfoot/tarsal coalition can be very difficult to treat with orthoses, Russell Volpe, DPM, may use a peroneal block to break the spasm and then fabricate a neutral cast. After fabricating the orthoses around this... Read More.
Guest Clinical Editor: Paul Scherer, DPM
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Prefabricated orthoses can play a valuable role in the podiatric practice. Accordingly, our expert panelists offer insights on the key characteristics of these devices and how they utilize prefabs in the treatment of patients. The panelists also discuss the use of orthotics to prevent and treat common soccer-related injuries. Q: How valuable are prefabricated orthoses in your clinical practice? A... Read More.
Guest Clinical Editor: Paul Scherer, DPM
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Our expert panelists discuss current approaches to orthotic management of pediatric flatfoot, whether functional orthoses can have an impact for hallux abducto valgus and when to employ orthotic modifications in rigid and semi-rigid devices. Q: Given some of the most recent literature concerning pediatric flatfoot, what is your opinion about using prefabricated or custom orthoses for patients... Read More.
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Prefabricated orthoses can provide improved support and other key benefits for patients with conditions such as plantar fasciitis. In addition to sharing their insights on OTC devices, these expert panelists provide pearls from their experience on common orthotic modifications that can have an impact. Q: Do OTC orthotics play a role in your practice? If so, how much and what do you look for in an... Read More.
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Which paradigms, teachings and studies influence podiatric physicians who prescribe orthotics? These expert panelists enumerate what factors come into play when they dispense orthoses. Q: Which of the more current paradigms for foot function have the most influence in your practice? A: “Time devoted to evaluating a patient in regard to his or her function as well as the biomechanical problem... Read More.
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Our expert panelists discuss whether reducing shear in patients with diabetes is comparable to reducing plantar pressure, when to change insoles and the optimum insole depth, and the future of computer-aided design for orthoses. Q: What is the role of “shear” in orthoses for patients with diabetes? Is “shear reduction” the new plantar pressure reduction? A: As custom orthotics have evolved,... Read More.
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Q: Many studies that investigated the use of therapeutic footwear along with accommodative inserts have reported only moderate rates of efficacy in preventing diabetic ulcer recurrence. Can one attribute this to the oversimplification of the foot ulcer pathology? A: As Metin Yavuz, PhD, notes, well-known scholars such as Cavanagh, Armstrong, Bakker and Bus classified the evidence to support the... Read More.
Ronald Valmassy, DPM
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   When treating patients with orthotic therapy, podiatric physicians may face various dilemmas on when to prescribe devices or how to treat patients who have used over-the-counter devices to no avail. These expert panelists discuss the use of orthoses after bunion surgery, “retail” orthoses and the treatment of pediatric patients among other issues. Q: When would you prescribe... Read More.
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   These expert panelists share their most commonly used orthotic modifications as well as insights on using highly inverted orthoses and the lateral Kirby skive. Q: What are the most common orthotic modifications that you prescribe and why?    A: Joseph D’Amico, DPM, most commonly employs a deepened heel seat at a standard size of between ¾ inches and 1 inch. He... Read More.