'Chiropractic like' Podiatry

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I have recently seen numerous patients who have been consulting a podiatrist who sounds very similar to a chiropractor in practice.

They come to me because general treatment is not offered at this other clinic.
The reports have been mixed, with more complaints than positive outcomes.

The patients have shared their experiences with me, and although some have been quite happy with treatment, most have felt they spent up to "thousands" of dollars with no change to symptoms or structure (even with x-rays).

The headline for the treatment is "Relieve foot pain naturally WITHOUT orthotics".
Advertised, are conditions I would've thought, reserved for surgery such as:

"bunions, hammertoes, rolled and weak ankles, etc."

1 - Apart from compliance and fitting issues, I did not think orthotics are a poor form of treatment. It is a medically (that is evidence based) proven method to treat a vast array of problems that we use EXTENSIVELY - therefore should it be widely promoted in such a negative light?

2 - Has anyone heard of these radical treatment methods, do they work, and how does one learn the techniques?

PLEASE voice your knowledge and opinions! I'm not sure whether I am deeply intrigued or CONCERNED.

Cheers

 

Re: CHIRO-PODIATRY ?!?!?!?!?!?!?!

There are a number of Podiatrists around Australia who base there practice on a particular philiosophy where manipualtion underpins what they do:

See this thread: Manipulation

 

Hi Tin,

I'm a podiatrist who has specialised who has specialised in Foot Mobilisation Techniques (FMT) and manual therapies since 1994. I'm not sure where you are based Tin, but we are a specialist practice that doesn't provide general treatment so, you may be seeing our clients.

My interest grew from patients asking me 'isn't there something else?' for their biomechanical complaints. While the majority of cases we accept (women aged 40-60 wanting to wear 'normal' shoes) are seeking alternative treatments from orthotic therapy (due to the fitting and compliance issues you identified) FMT is not a 'cure-all' treatment.

I think there's a danger in categorising a mode of practice as 'chiropractic'. Hylton Menz articulates well the philosophical differences between 'straight' and 'mixer' chiropractors in his article Foot Manipulation, Science or Mesmerism?'

We utilise orthotic therapy and refer to surgeons when we cannot provide the outcome being sought through FMT. We will apply to FMT to improve the ROM which has been limited by connective tissue adaptation due to joint dysfunction. This may include any joints distal to the hip.

I'm often asked by manual therapists (physios and chiros) why podiatrists rarely use manual therapies. It seems like a logical service to them. As podiatrists are not trained in FMT at an undergraduate level, their exposure and understanding of the application of FMT in practice is severely limited.

IMHO, I don't think FMT is 'radical'. After all, its rationale and techniques have been the basis of chiropractic and manipulative physiotherapy for decades. Its application is not well understood by podiatrists in general and therefore, FMT seems to be at the mercy of ignorant opinions. I'm looking forward to the day when undergraduates have the opportunity to learn 'spin-less' FMT.

As a business dependent on providing the public a professional service for a fair fee, we have consistently met the market's needs. A shonky or ineffective service would have a very difficult time surviving, let alone prospering.

The punters will always vote with their feet (pun intended) and if patients are given a choice of orthotic therapy, FMT or a combination, I think you'll find that they will be happy to make their decision. This has been my experience.

Kind Regards,
Ted.

 

Here in the United States there are some podiatrists who had training indirectly from Dr. John Hiss. He was a D.O. with orthopedic surgery training practicing in the 1920's and 1930's in Hollywood. His book Functional Foot Disorders describes many osteopathic manipulation techniques along with state of the art surgery techniques for 1920 (interesting read). Dr. Hiss believed orthotics were unnecessary and actually weakened muscles in the feet. Manipulative therapy has been revived a little bit recently by sagittal plane guru Dr. Dananberg. He describes some simple techniques on his the Vasyli website.

Manipulative therapy was never taught to me or my friends at school. I doubt there are any schools in the U.S. teaching these techniques, but they are out there in the literature if you look hard enough. Some recent reviews are coming out that substantiate manipulative therapy for the feet. Personally, I perform osteopathic manipulation in my practice on perhaps 30-40% of the patients. I do not find manipulation hepful for warts, ingrown toenails, ulcer care etc. I also do forefoot surgery, gait analysis, and custom foot orthotics. I am a fan of whatever work and no single therapy works all the time.

I think it is possible to specialize or limit your podiatry practice to only manipulation therapy. However, this will not work for all patients and appropriate referrals should be considered for patients who fail to improve.

Dr. Mike DeBrule
Marshall, MN

 

I am not going to weigh into the manipulation/mobilization debate - those of you who know me understand my thoughts on it - however I would like to make a comment on Tin's statement above....

Do you not think the next Podiatrist down the road/next suburb also would see some of your patients who have had mixed or poor results?

 

I"m intersested to know if there are Podiatrics who are specialized on the manipulation / mobilazation of the foot?
I self have a long experience as a manual therapist (P.T) and I wonder if Podiatrics do have their own gurus in the field of mobilazation/manipulation of the foot?

 

There are several podiatrists who specialise in foot mobilisation/manipulation techniques (FMT) in Australia;
John Sfinas - Melbourne
Claude Tobgui - Melbourne
Michael Talbot - Adelaide
Ted Jedynak - Adelaide

Several dozen podiatrists incorporate FMT into their regular practices.

Regards,
Ted.

 

Hi Guys

I like this debate. I have spent the last five years working on and utilising manipulation and mobilisation into my field of physical therapy provided to patients. However I also specialise in orthotic and biomechanics. I have never ruled on method of treatment better than the other. I work them inconjuction to improve the results for the patient. However I also worked alongside a chiropractor for years and the start of the thread is reminicent of some of their treatment models.

Regards

Dave

 

I just lost an ESSAY that i wrote - darn computer.

I hope my thread did not come across as 'ignorant' to you as I do see the benefits of manual therapy. However, the practices I refer to DO not seem as active in the area of referring for surgery let alone other modalities such as orthoses where I've seen it pitched as less than ideal. If the practice were as you describe yours to be then I don't think there would be an issue to discuss as ALL our skills as podiatrists are still being utilised.

The term I used to describe the therapy, "radical", is better suited to only the podiatrists (or Dr. to some) who I have received numerous accounts of negative feedback.

other common trends such as:

1. HUGE upfront fees and contracts that bind the patient to a treatment that may or may NOT be effective. There is no one treatment that will be effective 100% of the time for every presenting patient, and it seems the aforementioned conditions I have seen it used for are quite frankly ludicrous.

2. X-rays and use of measurements and terminology that seem to leave patients either in fear or confusion. Eg. subluxation

3. You would be amazed the power of the white coat, the public would naturally come to those who are qualified and are in a position of trust. A practice can still be busy with patients attending who have no knowledge whether a service is effective or not. Especially when it is well marketed and this is a strong focus of the business. I have heard of 1 case where one patient had taken the matter further to the courts.

4. There are other factors beyond what this post can cover but I get the impression that certain practices may be pushing boundaries.

These are things I have gathered and I therefore only put this forth as an opinion from my exposure through patients specific to locality and practice.

All that being said, I have researched the techniques further and would like to try using them in future myself. By no means am I discounting the effectiveness of mobilisation and manipulation, on the contrary! I just think it strongly needs more awareness and possibly regulation? As TedJed pointed out, there is a need for more education in the area and I will be one to pursue that personally.

 

Hey Tin,

You've covered 2 key aspects of any recommendation a practitioner may make;
1. The validity of the service proposed
2. The business model the service is delivered through

I reckon that if the service or the business model doesn't deliver on its promises, it's just a matter of time before the paying public 'votes with their feet' and the business will suffer accordingly. (Does One-Tel ring a bell?)

Remember that the unhappy customer will tell 8 people (on average) of their experience while a happy customer may tell 2-3. It's up to the business proprietor to handle the complaints. This is always a useful test of the manner in which a business is conducted.

BTW, have you spoken with the podiatrist(s) to which you refer? I reckon hearing the story from 'the horse's mouth' is a way to develop an informed opinion/view on a controversial matter.

Cheers,
Ted.

 

Podiatrist are missing out badly if they dont introduce foot mobilisation and adjustments. Patients appreciate it greatly. And would travel hours just to have it done. I dont believe foot adjustments can stop you wearing othitics, because of the concrete jungle we walk on , it works great with orthotics to maintain joint congruency and prevents the joint from recurrent subluxation. Im in London at the moment just been doing a lecture circuit all over the UK. From manchester, liverpool, Oxford,down to wales,cardif, brighton, bourmouth, maidstone, now into london.Teaching LOwer limb biomechaics and promoting my book on the" Orthotic Revolution"to Podiatrists and Chiropody group .Also teaching some of the PCT groups of the NHS. These practitioners a hungry to learn about foot manips. NO podiatry Uni is teaching it. WHY ?and Why not? i ask.

When u have people travelling intersate in Australia to have a 10 minute treatment and they thank u from there heart for the foot adjustment. Patient is not having a placeboaffect. THere sweeling and pain goes down instantly.
I think ted can agree on that.

I advise all Podiatrist to learn it and stuffen use it and stop arguing what they think.I have been doing it for 13 years. Also acupunture and Prolotherapy and has thrived my business to the extreme level , i cannot cope with, we need more practitioners to learn this and refer to there area. There is a demand.

I get invited for god sake, by orthopaedic surgeons in Taiwan, Hong Kong and China to teach not only biomechanics of the lower limb, but they love the foot manipulations. They said orthotic therapy and manipulation works hand in hand and for the last 3-4 e been years, I have been going to teach them they have reduced the amount of surgery they do, by treating conservative. There are no Podiatrist there so the surgeon does all. Interesting isnt it, And they dont earn enough on surgery approx $130 US for each operation and they are bombarded with work. So orthotics and manips has helped them treat conservatively.

Anyway, its early in London, and im having a break today might walk around Tower Bridge and knightsbrige. good bye. Ps leave you with some pictures