Orthotics Q&A

Guest Clinical Editor: Douglas Richie Jr., DPM
22,611 reads | 0 comments | 04/03/2008


Injuries to the second metatarsophalangeal joint (MPJ) can be challenging to treat. Our expert panelists discuss predisposing factors to injury and review pertinent biomechanical considerations. They also discuss conservative treatment options, including variations of orthotic therapy and modifications that they have employed in clinical practice.

Q: What are the predisposing factors (gender, foot type, activity, etc.) that are associated with injuries to the second MPJ?
A: Second MPJ injuries may have a variety of etiological causes, accordi

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Scott Spencer, DPM, does not believe that he must focus on one specific area to create a foot orthotic that will properly serve the patient. He stresses the importance of getting a clear idea of what all the areas of the foot are doing during function, an
Guest Clinical Editor: Scott Spencer, DPM
8,816 reads | 0 comments | 12/03/2007

Q: How do you evaluate a patient for foot orthotic devices?
A: All three panelists will perform a gait analysis. Russell Volpe, DPM, begins by assessing what he wants the orthosis to accomplish once he decides a CFO is indicated. If control of motion is needed, he will tailor material selection and many of the plaster modifications and prescription items to help accomplish that goal. If Dr. Volpe’s desired goal is accommodation, soft-tissue supplementation or assistance with motion, he will gear material selection and prescription features toward those goals. He also c

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Guest Clinical Editor: Edwin Harris, DPM
16,130 reads | 0 comments | 10/27/2007

Given that toe walking and other gait disturbances are common among children, these expert panelists take a closer look at these conditions, offer keys to the diagnostic assessment and share their insights on appropriate treatment modalities and physical therapy regimens. Q: What is your treatment plan for children with diplegia and hemiplegia?

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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
22,467 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
10,913 reads | 0 comments | 06/03/2007
Guest Clinical Editor: Lawrence Huppin, DPM
17,172 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
13,958 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
29,348 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
11,099 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
14,612 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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