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

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

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

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

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

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

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

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

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

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

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

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 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

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

  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: 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

  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