Communicating the Etiology of Diabetic Foot Ulcers to Patients Gustav Jarl, PhD, Jaap J. van Netten, PhD, Peter A. Lazzarini, PhD People at risk for diabetic foot ulcer (DFU) often misunderstand why foot ulcers develop and what self-care strategies may help prevent them. The etiology of DFU is complex and difficult to communicate to patients,… Continue reading Fragile Feet and Trivial Trauma
Hallux Limitus is a condition causing inflammation and soreness of the big toe, accompanied by restriction of movement. If untreated, it can lead to a more severe position of complete rigidity. Fortunately, treatment options are simple and straightforward once we understand the underlying biomechanical processes taking place. Biomechanical Principles In this condition,… Continue reading Hallux Limitus
Patient Female, 62 years old, 165 lbs. Complaints Pain at the 1st metatarsal head bilaterally and pain and numbness in the 3rd interdigital space, right foot. History Four years ago patient was treated with prescription orthotics. They were posted with four degrees rearfoot posts, additions were metatarsal pads and Morton’s extension bilaterally. Examination Findings Bilateral… Continue reading Case of the Season
When considering older patients in any context it’s best to not fall into the trap of chronological age. There are many 70 year old individuals who are in better condition than their 40 year old counterparts. Physiological age should be the prime consideration. This is equally true for the geriatric biomechanical patient as for the… Continue reading Biomechanics and the Geriatric Patient
This concept may sound pretty basic, but there is a lot behind it. With this philosophy, you will generate tons of referrals and patients will walk out of your office feeling that they made the right choice in seeing you. Let’s face it; in any medical school classroom, podiatry or chiropody class, or any academic… Continue reading Being All That You Can Be For Your Patients
Shin splints are a painful injury, common among athletes, soldiers and dancers. They are one of a number of injuries caused by repetitive overuse of leg muscles. Many of those who have sustained injury are unaware of the causes and proper treatment. There are two ways to look at shin splints: clinically and practically.… Continue reading Shin Splints
A Randomized Controlled Trial Patients with a cavus or high-arched foot frequently experience foot pain, which can lead to significant limitation in function. Custom foot or- thoses are widely prescribed to treat cavus foot pain. However, no clear guidelines for their construction exist, and there is limited evidence of their efficacy. In a randomized, single-blind,… Continue reading Effective Orthotic Therapy for Painful Cavus Foot
Hypermobility and Flatfoot- Looking through a connective-tissue lens Steven Gillingham, BSc MSc DPM — The Footnote / Southwest Foot & Ankle Centre (WA, Australia) Article sourced from The Footnote If you treat feet long enough, you meet the patient who makes textbook categories feel flimsy: beautiful arches that collapse after lunch, tendons that protest every… Continue reading Hypermobility & Flatfoot
Patient: Female, 14 years, 105 lbs Complaints Redness, pain and swelling on the back of both heels, several months duration. History Negative- no specific history of injury. Pain is present especially in closed back shoes (slip on and pump styles). Clinical observations Soft tissue swelling and inflammation is apparent. Pain is elicited on palpation of… Continue reading Clinical Case Study
We normally post articles about specific pathologies or cases of biomechanical abnormalities. This time, we wanted to take a step back and remind ourselves, and our readers, of just how amazing and wondrous our feet really are. In our lifetime, our feet cover a distance of roughly four times around the world- that’s about 160,000… Continue reading Feet Appreciation Post
The plantar fascia is a band of connective tissue running from the heel to the ball of the foot. Inflammation of the plantar fascia occurs when this tissue is overstretched. This causes tiny tears to develop, particularly near the insertion site at the heel (at the medial calcaneal tuberosity). When at rest, our body works… Continue reading When Heel Pain is Not Plantar Fasciitis
So often we are asked to evaluate patients who have failed orthotics from another provider. This article is designed to assist you in evaluating the quality of orthotics and what you can do to facilitate better treatment results. The field can be confusing for the patient, as it is unregulated and anybody can claim… Continue reading Assessing Orthotic Quality
Pediatric Biomechanics Kids are not simply little adults, especially when it comes to their physiology. To understand pediatric biomechanics as it relates to lower limb pain, there are specialized and unique principles at play. In this article we’ll explore a few common pathologies, and get those kids playing pain free! A… Continue reading Pediatric Biomechanics
Patient: Male, 42 years old, 5’9″, 190 lbs History and chief complaint Patient’s feet have always bothered him, and he has “flat feet”. He has been treated by various practitioners and has been prescribed orthotics, but none of them were tolerable. Over the past 10 years he has developed persistent pain behind his… Continue reading Clinical Case of the Season
Doug Richie, DPM, FACFAS, FAAPSM, Bruce Williams, DPM, and James Clough, DPM, FACFAS, Neil Horsley, DPM, FACFAS From Podiatry Today “Treatment of Morton’s neuroma is one of my most successful applications of foot orthotic therapy. Success can be achieved in all forms of footwear if the practitioner is creative in the prescription criteria,” says Dr.… Continue reading Orthotic Treatment for Morton’s Neuroma
Jane Andersen, DPM, Gene Mirkin, DPM, and Bruce Williams, DPM, James Clough, DPM, FACFAS From Podiatry Today Flexible Hammertoes Dr. Mirkin says orthotics can sometimes stabilize flexible hammertoes due to flexor stabilization and prevention of excessive pronation. By preventing the collapse of the medial longitudinal arch and keeping the subtalar joint from pronating beyond… Continue reading Orthotic Treatment for Hammertoes and Achilles Tendonitis
Orthotic Treatment for Bunions Jane Andersen, DPM, Gene Mirkin, DPM, Bruce Williams, DPM, and James Clough, DPM, FACFAS, Neil Horsley, DPM, FACFAS From Podiatry Today Jane Andersen, DPM, tells her patients orthotics will not take away the bunion deformity but they may control the pain and the progression of the deformity. “I have certainly seen… Continue reading Orthotic Treatment for Bunions
Dr. Nick Romansky discusses the concept of load management, and how applying it to orthotic plans can impact outcomes. From Podiatry Today Q: What does load management mean when it comes to orthotics? A: Orthotics play a very big role in load management, where you are trying to load, unload, accommodate, and control to a… Continue reading Load Management and Orthotics
Lawrence Huppin, DPM; Josh White, DPM; Bruce Williams, DPM From Podiatry Today With the warm spring and summer months approaching, more and more patients are moving from the rigidity of dress shoes into the comfort of sandals. Fitting orthotics into both types of footwear has its own unique challenges as the sizes of each vary… Continue reading Prescribing Orthotics for Sandals
Given that limb length differences are a common contributing factor in many conditions, this author offers pertinent insights on proper evaluation, diagnosis and treatment. Limb length difference or discrepancy (LLD), which is also referred to as anisomelia, occurs when one leg is noticeably shorter than the other. Limb length discrepancy is reportedly so common that… Continue reading Keys To Assessing And Managing Limb Length Discrepancy
In light of an increasing body of research on the effect of orthoses on chronic ankle instability and postural sway, this author discusses essential biomechanical considerations and recommends orthotic prescriptions and modifications to treat unstable ankles. Although clinicians use foot orthoses to treat a myriad of clinical conditions, they rarely employ these devices to… Continue reading Foot Orthoses For Chronic Ankle Instability
Dr. Kevin Kirby, DPM Given the common nature of knee osteoarthritis, this author discusses the link with progressive genu varum deformity and shares insights from the literature as well as his clinical experience on the benefits of valgus-wedged insoles and orthoses for this patient population. Over the past three decades, there has been a steady… Continue reading Can Foot Orthoses Have An Impact For Knee Osteoarthritis?
James M. Gerrard, Daniel R. Bonanno, Glen A. Whittaker, Karl B. Landorf Introduction Foot orthoses and shock-absorbing insoles are commonly used to treat and prevent many foot and footrelated conditions. Accordingly, it is imperative that clinicians prescribing foot orthoses have robust evidence on the effects of orthotic materials to inform clinical decision-making. This is particularly… Continue reading Effect of Different Orthotic Material on Plantar Pressures
James McGuire, DPM, Milad Manouche, BA We tend to take our feet for granted until we are presented with some sort of foot pathology. Whether its pain, numbness/tingling, sprains/strains, or stress fractures, anything that threatens our mobility, it instantly becomes the single focus of our lives. As our age advances, the body experience many changes.… Continue reading Orthoses and Balance in the Aging Patient
The compensated equinus deformity is caused by either a structural or functional shortage of the gastrocnemius muscle. It creates an inability to achieve a range of 10 degree dorsiflexion of the foot to the leg when the knee is fully extended and the subtalar joint is in neutral position. The reduced range of motion will… Continue reading Compensated Equinus Deformity
Biomechanical and Postural Considerations/ Orthotic Treatment By Joe Coletta, PTA, C.Ped Current Pedorthics Pedorthic Footcare Association http://www.pedorthotics.org Cavus foot deformities are commonly associated with neurological disorders such as Charcot-Marie-Tooth Disease, leg length discrepancy and birth defects such as clubfoot deformity, etc. However, cavus feet actually occur quite naturally as a foot type, perhaps as a… Continue reading The Cavus Foot
Finding shoes that fit the feet properly is incredibly important. If you or your patients require the use of foot orthotics, it is essential to ensure that shoes aid and complement the treatment, not negate it. If you notice your patient is wearing improper footwear, it is important to explain the effects of footwear when… Continue reading Proper Shoe Fit
This article discusses the importance of considering foot flexibility when prescribing orthotics. To ensure maximum therapeutic value from the orthotics, extra care and attention to the degree of compensation of the foot is vital. It is not sufficient to simply measure a subtalar position or a forefoot angle in an attempt to quantify a… Continue reading The Art of Prescribing Foot Orthotics
Are You Over-Prescribing Them? Dr. Lloyd Nesbitt, DPM How are your results going with the orthotics that you prescribe? Do you find that too many patients complain about one thing or another with their orthotics? Or, that you wind up sending them back to the lab for adjustments or remakes? While minor modifications… Continue reading Orthotic Accommodations
Patient Female, 24 years old, 125 lbs. Complaint Dull, throbbing pain on the lateral plantar aspect of the left foot, just proximal to the fifth metatarsal base. History The patient has been a runner for the past five years. She runs 30-40km per week. No previous leg or foot problems. Clinical Observations The patient demonstrates… Continue reading Clinical Case Study
Is a Virtual Cast Equivalent to a Plaster Cast? A lot of practitioners are hesitant to switch from the plaster casting technique to a laser scan. That thinking is perfectly understandable. A plaster cast of a foot in a non-weight bearing neutral subtalar joint position with the midtarsal joint locked, demonstrates a corrected position of… Continue reading Laser Scan or Plaster Cast?
Haglund’s deformity is a commonly seen but not well understood condition also known as retrocalcaneal exostosis. An abnormality of the heel bone and soft tissues cause a fairly prominent bony bump at the back of the heel to appear. Although not medically dangerous, Haglund’s deformity is painful and can lead to other complications, let alone… Continue reading Haglund’s Deformity
Growth plates (apophyses) are areas at the ends of the long bones of children in which new bone growth is occurring. They are made up of cartilage and will determine the future length and shape of the mature bone. Apophyses throughout a growing body tend to fuse near the end of puberty, anywhere from 12-17… Continue reading Sever’s Syndrome
Patient 28 year old female, 121 lbs. Complaint Lateral forefoot pain, left foot only. X-Rays X-rays taken were negative for fractures. On the lateral view- a narrowing of the dorsal portion of the joint space of the calcaneal cuboid joint. On the medial oblique view- the base of the fourth metatarsal is 2mm laterally displaced… Continue reading Clinical Case Study
In a previous blog, we delved into the wondrous and complex structure and function of the foot. The two main functions of the foot are shock absorption and propulsion. In order to accomplish these tasks, our feet are made up of a variety of bones, muscles, and ligaments, all arranged in a specific mechanically efficient… Continue reading Foot Posture Index
Patient Male, 10 years of age, 70 lbs. Complaint Pain in the arches of both feet, sore legs. The parents complain that the child walks funny and he looks like he has flat feet. History The child wore Dennis-Brown bars at 8 months of age for about 6 months in an attempt to correct a… Continue reading Clinical Case Study
There are a wide variety of material options when it comes to creating a foot orthotic. Shell materials range from flexible to rigid, as do top covers and mid-layers. Different pathologies require different material characteristics, patients have various sensitivities and of course, personal preferences. In many cases, a number of different materials can all work… Continue reading Orthotic Materials Guide
Practitioners prescribe foot orthotics to improve foot function and relieve pain. This also produces observable changes in other areas of the lower extremities. The most obvious and well known changes are the reductions in the angle and base of gait. The reduction on the angle of gait with the orthotic plates is generally attributed to… Continue reading How Gait is Affected by Orthotics
Patient Female, 35 years old, 135 lbs Complaint Throbbing pain sub-second and third metatarsal of the right foot. History The patient was treated by another podiatrist and prescription orthotics were made. Although the orthotics were comfortable, the pain is still present and getting worse. Clinical Observations Moderate hallux abducto valgus deformity bilateral, right greater than… Continue reading Clinical Case Study 4
Patient Male, 29 years old, volleyball player, 267 lbs. Complaint Increasing pain and swelling in both knees over a six year period. Pain and stiffness in lower back and morning stiffness in feet and ankles. History He has had multiple and often conflicting diagnoses and treatment, all directed at his knees. Arthtoscopic surgery on the… Continue reading Clinical Case Study
Creating an online presence is now an essential part of any successful business. As a foot specialist, you know you offer products and services that will help your patients with mobility, comfort, and relief. A good website will bring in more customers by: Increase legitimacy and credibility Increasing visibility and name recognition Giving a… Continue reading Creating a Successful Clinic Website
Years ago we redesigned our prescription form to not only include specifications for orthotic fabrication, but also biomechanical examination findings, patient history, and measurements. This information is handy for practitioners to have in one document in the patient’s file, but also for your orthotic manufacturers to have a complete picture of the case. From this… Continue reading Paragon Prescription Form Guide
A Common Error in Negative Casting The neutral position negative casting technique relies on total patient relaxation for optimum results. Any muscular contraction which occurs during the time the plaster is drying on the foot (or the scan is being taken) can change the external morphology of the foot. In some instances, if the patient… Continue reading Anterior Tibial Contraction
Partially due to our work in treating athletes, podiatry has become extremely well respected in North America in recent years. Very often it has been the podiatrists (and other foot specialists) who have been able to get the athletes back into their sports activity quickly, rather than restricting them to “no sports for six months”.… Continue reading Podiatric Sports Medicine
As with anything in life, people don’t always want to take your advice. When it comes to orthotics, there can be all sorts of reasons for patients to say “no”. Even if you did establish excellent rapport with your patient and they like you, even if you were thorough in your history and physical examination.… Continue reading Overcoming a Patient’s Resistance to Orthotics
Foot Type Just like many parts in the rest of their bodies, infants are born without completely ossified bone structures in their feet. It takes times for these structures to become complete, stable, and strong enough to allow for weight bearing and mobility. There is also an additional fat pad that runs along the medial… Continue reading Pediatric Feet
A forefoot valgus deformity is defined as an everted position of the forefoot relative to a perpendicular bisection of the calcaneus when the subtalar joint is in its neutral position and the midtarsal joint is maximally pronated and locked. Although the classic etiology of this deformity involves an increased valgus frontal plane unwinding of the… Continue reading Flexible Forefoot Valgus
When you prescribe custom foot orthotics, do you always know what you are getting from your lab? Not long ago it was clear that if you ordered custom orthotics, you were truly getting custom orthotics. You sent in a plaster cast and the lab made a plaster positive cast, modified it as prescribed, then… Continue reading Your “custom orthotics”… Are they really?
Patient Female, age 34, 126 lbs. History and Chief Complaint For the past seven years, the patient’s feet have become progressively more uncomfortable. At first she developed calluses under her 2nd and 5th metatarsal heads, and she experienced generalized fatigue in her feet and legs after ordinary activity and work. Recently, rather large bumps have… Continue reading Case of the Season
When the rearfoot is neither pronated nor supinated, and the forefoot has been locked against it, this relationship creates a neutrally positioned foot. Ideally in this position, a line bisecting the posterior aspect of the calcaneus will be vertical, and parallel to a line bisecting the lower third of the leg. Neutral position is… Continue reading Subtalar Neutral Position
1. A patient returns two weeks after having orthotics dispensed and complains of orthotics slipping from side to side. Examination reveals orthotic 1/2″ proximal to the metatarsal heads. What adjustment is most likely needed? a. Decrease rearfoot varus post b. Increase rearfoot varus post c. Decrease length of orthotic d. Decrease calcaneal inclination angle e.… Continue reading Clinical Biomechanics Quiz
It is not uncommon for some runners to develop lateral knee pain. This symptom is often associated with a significant reduction in subtalar joint motion, rigid forefoot valgus deformities and other conditions which would tend to make a foot a poor pronator and this a poor shock absorber. Many lateral knee pain complaints are diagnosed… Continue reading Popliteal Tendonitis
The cavus foot has limited motion and absorbs shock poorly. Although it is often only a minor problem in multidirectional sports or sprinting, it can be a severe problem for long distance runners, especially on unyielding surfaces. Treatment Stretching Exercises With all types of cavus feet, stretching exercises are indicated. A good one has the… Continue reading Sports Medicine and the Cavus Foot
Forefoot Valgus- The Plantarflexed First Ray The following chart is designed to clarify the various differences in forefoot valgus and plantarflexed first ray deformities. This illustrates the need for detailed information to properly evaluate and post these deformities. * Note 1: A relationship which is not totally rigid or flexible may be termed semi-rigid or… Continue reading Variations in Forefoot Valgus and Plantarflexed First Ray Deformities
In Brief: About 4% if the athletes with foot problems seen by the authors had cuboid syndrome. The authors say that the syndrome is common but many cases are not recognized or are misdiagnosed. It occurs most often in pronated feet. Pain results from a partial displacement of the cuboid, which prevents its normal range… Continue reading Cuboid Syndrome
The ideal situation is one where a patient is experiencing pain, the practitioner prescribes an orthotic, this orthotic relieves their pain and everyone lives happily ever after. However, tweaks and adjustments need to be made quite often. This is the nature of creating a custom- made, handcrafted device that needs to be comfortable and biomechanically… Continue reading Orthotic Adjustments
What is it? Talipes equinus deformity is a condition in which the foot is held in a plantarflexed position. The patient will lack the ability to dorsiflex their foot up toward the leg. Commonly, this is due to tightness in the Achilles tendon, the soleus muscles, or gastrocnemium muscle. Other causes can be a… Continue reading Equinus Deformity
Patient: Female, 55 years old, 140 lbs Chief complaint In our second case of the season, our patient complains of pain in the third and fourth metatarsal heads. She experiences pain in her right foot only. Examination Findings Moderate hallux abducto valgus deformity Diffuse hyperkeratosis sub second metatarsal B/L Deviated and… Continue reading Case of the Season #2
If you are interested in prescribing more orthotics, this article will help you achieve your goal. The Right Mindset A good mindset to have is the idea of acquired deformity. If it is present, then to stop its progression the patient will need prescription orthotics. In other words, if a biomechanical imbalance… Continue reading Increasing Your Orthotic Productivity
Biomechanical Treatment for Moderate-to-Severe Hallux Abducto Valgus Recently we posted an article about various forefoot deformities. Here we focus on moderate to severe hallux abducto valgus, and look at treatment options. As stated in the previous blog, once the deformity has progressed to the stage where bowstringing of the flexor hallucis longus and extensor… Continue reading Treatment for Hallux Abducto Valgus
Plaster casting vs. 3D non-weight bearing laser scanning For those that have studied lower limb biomechanics, there is agreement of the superiority of a non-weight bearing subtalar neutral plaster cast. In terms of having prescription orthotic devices fabricated, this technique has been the gold standard for many years. Computerized pressure pads capture the… Continue reading Laser Scanners and Insurance Coverage
The purpose of this article is to present a practical, biomechanical approach to managing various common forefoot deformities. Hammertoe Deformities When a patient’s chronic heloma dura becomes markedly symptomatic, periodic palliation may become less appealing to them and another solution may be more appropriate. When the lesion is associated with a contracted… Continue reading Biomechanical Management of Forefoot Deformities
“Experience is the one thing you can’t get for nothing.” Oscar Wilde Paragon has been a leader in orthotic manufacturing for over 45 years. A vital component of our success has been the experience and know-how of our technicians. Without the skill and expertise of our employees, regardless of how superior our materials… Continue reading Experience is the Difference
The concept of patient centered care may sound pretty basic, but there is a lot behind it. With this philosophy, you will generate more referrals and patients will leave the office with confidence in their choice. Let’s face it; in any medical school classroom, podiatry or chiropody class, or any academic venue, some students… Continue reading Patient Centered Care
