Proper Shoe Fit

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

The Art of Prescribing Foot Orthotics

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

Orthotic Accommodations

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

Clinical Case Study

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

Laser Scan or Plaster Cast?

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

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

Sever’s Syndrome

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

Clinical Case Study

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

Foot Posture Index

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

Clinical Case Study

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

Orthotic Materials Guide

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

How Gait is Affected by Orthotics

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

Clinical Case Study 4

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

Clinical Case Study

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

Case of the Season

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

Paragon Prescription Form Guide

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

Feet Appreciation Post

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… Continue reading Feet Appreciation Post

Anterior Tibial Contraction

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

Podiatric Sports Medicine

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

Overcoming a Patient’s Resistance to Orthotics

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

Pediatric Feet

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

Flexible Forefoot Valgus

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

Your “custom orthotics”… Are they really?

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?

Case of the Season

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

Subtalar Neutral Position

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

Popliteal Tendonitis

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

Sports Medicine and the Cavus Foot

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

Being All That You Can Be For Your Patients

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… Continue reading Being All That You Can Be For Your Patients

Variations in Forefoot Valgus and Plantarflexed First Ray Deformities

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

Case of the Season #3

Patient: Female, 14 years, 105 lbs Complaints Redness, pain and swelling on the back of both feels, 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 Case of the Season #3

Cuboid Syndrome

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

When Heel Pain is Not Plantar Fasciitis

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

Orthotic Adjustments

Accuracy and precision are our priority

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

Equinus Deformity

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

Case of the Season #2

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

Increasing Your Orthotic Productivity

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

Treatment for Hallux Abducto Valgus

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

Laser Scanners and Insurance Coverage

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

Hallux Limitus

Help for the Hallux

  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

Case of the Season #1

Patient: Male, 35 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 Case of the Season #1

Patient Centered Care

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

Biomechanics and the Geriatric Patient

Happy feet at any age

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

Assessing Orthotic Quality

Ensure your orthotics are 5 star worthy

  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

Shin Splints

Muscle overuse can cause painful shin splints

  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

Pediatric Biomechanics

Going for gold!

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