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Patient self casting poll

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Phil Morris, Jun 15, 2011.


Should patient be allowed to self cast

  1. No! totally obsurd

  2. not really.....

  3. does it make a difference

  4. yes it saves time and is accurate enough

  5. best idea since sliced bread!

    0 vote(s)
  1. Phil Morris

    Phil Morris Member

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    Just after a few opinions here, i am experiencing more and more practitioners sending foam boxes out to patients requesting them to cast them selves. Is this just me or is this extremely obsurd?
  2. Is it any more absurd than a person buying some prefabricated devices from a chemist shop or e-bay? Is it any more absurd than a practitioner with poor reliability in their casting methods taking the cast? Is it any more absurd than a practitioner with limited skills and knowledge base taking the cast? etc etc. What if the patient in question was me?

    The cast is only one element in the puzzle, you need a diagnosis and be able to prescribe the device too, or do you?

    Some very preliminary data I'll be presenting next week in Manchester seems to indicate why "meat-pies" might be efficacious in a proportion of the population.
  3. Phil Morris

    Phil Morris Member

    isn't the aim to get the best you can all the time or as close to perfect as possible as basically isnt the general rule garbage in = garbage out?
  4. If there was a perfect position to capture an individuals foot in, there would still be reliability issues in capturing this. Trouble is we don't know what position the foot needs to be captured in.

    To reiterate the cast is only one link in the chain. As you know, regardless of the scanned data you receive, you can make the finished orthosis look anyway you want it to. This being the case, do you need a foot model at all? In certain circumstance you probably do, but not in all. Hence prefabricated and library systems are efficacious in some individuals. In others, you are going to need a cast.

    If the patient can reproduce the same position I would aim to produce, what's the issue? Lets say I wanted a cast of the foot in relaxed weightbearing. I reckon the patient could achieve that with fairly basic instruction. Lets say I wanted a cast in MASS position, I doubt the patient could achieve that.
  5. RobinP

    RobinP Well-Known Member

    One mans perfect is another mans bin job

    The destination is important, the journey to get there, less so.
  6. David Wedemeyer

    David Wedemeyer Well-Known Member


    I was thinking the same thing just the other day with regard to 'customized' devices Simon. Are others of the opinion that there is a subset of say "heel pain" patients who would benefit from a step up from prefabs but not a fully custom device initially, a mid-range device from a library that is more cost effective and could be casted semi weight-bearing in foam?

    Many of the prefabs that I have encountered seem no better suited to this purpose than the insoles that come stock in shoes.
  7. There are some excellent prefabs available here in the UK, it's just a case of picking the horses for the courses. One of the best library systems here in the UK (in my opinion) is that offered by Salts, which is basically a custom device without the casting/ scanning; you can specify any variables you wish. So, if you want a 15 degree medial heel skive with a medial longitudinal arch height of 15mm with heel cup height of 15mm, shell thickness of 3.5mm et etc you can have it. Specify heel width, forefoot width, whatever. As they say, "have it your way". You can even design your own range of prefabs and call them the "Wedemeyer no.1, 2, 3" etc. I'm thinking of setting some up and calling them the Wanklesplank range, just because I can. Phil Wells- what say you?

    Let's imagine for a moment though that if rather than describing the neutral suspension cast, Root, Weed and Orion had described weightbearing casting standing in a foam box 30 or 40 years ago. We wouldn't even be having this discussion. Patients would be casting themselves left, right and centre. So why were Root and colleagues
    right and why is standing in a foam box wrong? Riddle me that and stay fashionable y'all.
  8. I think (hope), we may have a model before too long which will help us spot the ones that will need custom devices. But I'll save that idea for next Saturday.
  9. David Wedemeyer

    David Wedemeyer Well-Known Member

    Hopefully there will be a similar product here in the U.S. soon, although it will be from a cast, scan or foam and matched to a very large library Simon. It will also be more cost effective short-term ;)

    Weightbearing will capture the deformity for myriad conditions, not to mention the effect on the MLA. I don't think anyone would argue that but here goes...:boxing:
  10. David Wedemeyer

    David Wedemeyer Well-Known Member

    Simon I would be very interested in your thoughts on this subject!
  11. Got a question then to those that have voted does it make a difference.

    Do you charge for a casting consultation ?

    If so do you charge more than the cost of materials ?
    If so what are you charging for ? your time, your expertise ?

    Then you are charging for something that the patient believes make a difference is that ethical ?

    Just asking ?
  12. J.R. Dobbs

    J.R. Dobbs Active Member

    No, I don't.
  13. Nor me neither
  14. RobinP

    RobinP Well-Known Member

    Nope - foam boxes 90% of the time. But I use modified prefabs far more than bespoke these days
  15. Griff

    Griff Moderator

    I charge for casting.
  16. Splitter ;-)
  17. So If I come for an assessment and then need time to think and then decide to come back for a cast it´s a free appointment JR andor Simon - just so Im clear

    How much does a foam box cost Robin and do you not charge for the patient for the foam box - same question to you as Simon andor JR - So If I come for an assessment and then need time to think and then decide to come back for a cast it´s a free appointment

    Why when the patient can do the same job as you - should you not just save time send the equipment home with the patient and move on to the next one ?

    Still just asking lawyer for the Devil and all
  18. Griff

    Griff Moderator

    I charge for my time. So if someone wants to see me for 30 mins they will get billed for it accordingly. Whether that be for a casting, a review or if they want to show me their holiday snaps.
  19. Fair enough so flat rate for 30 min - 30 orthotic review same as 30 min casting appointment ?

    and if you really busy do you ever get a patient to self cast ?
  20. Griff

    Griff Moderator


  21. Yeah (if I like you).
  22. Ok cool.

    Ive make my own as you know and did a review of the process and spend much much more time over the casting and foot position during casting and have noted a great improvement in results. maybe a placebo podiatrist effect - Robert ?

    the argument with standing that the same device can be created from whatever cast or even no cast with CAD I agree with , but personally Ive found spending more time etc during the casting process has worked well for me

    I charge for Casting

    PS has anyone tried the patient casting v´s pod casting trial. I guess foam box would be the only way to achieve this PoP would be a disaster.
  23. RobinP

    RobinP Well-Known Member

    "Are you the Judean People's Front?"

    "F**K OFF - We're the People's Front of Judea"

    Favourite movie ever

    No - see below. If I as the practitioner need to investigate your problem before I decide on an appropriate course of action, I will not charge you when you come in for casting

    £1 approx. Just included in the cost of the consultation

    I do charge for casting if I don't do it within the initial consultation. So for example, I tell someone what is wrong and what they need to solve the problem - ie orthoses. I give them the costs and if they decide that they want to have a think about it and not decide on the day, that is fine. However, if they decide to proceed with treatment and need casting, I will book them a slot and they will pay for that slot

    I work on the same basis as Ian. Pt pays for the slot of time - more or less irrespective of what i do in that time. If I just need a foam box, it will only take me 2 mins and I generally just squeeze them in and don't charge.

  24. I thought we were the popular peoples front.
    peoples front!
    Whatever happened to the popular peoples front?
    He's over there

    Bag of otters noses, make that two.
    Thanks Reg.
  25. What might be interesting is to have a group of patients doing a full weightbearing relaxed standing foam box impression, versus practitioner self-selected method. Make all the devices as "meat-pies" from the casts and look at outcomes for a given pathology.
  26. Phil Morris

    Phil Morris Member

    no quite sure what you mean by this statement simon, sorry for the lack of knowledge regarding terminology
  27. Simons Gary Morgan meat pie story
  28. Phil Morris

    Phil Morris Member

    Thanks for the quick reply Mike :)
  29. Morgan's meat pie paradigm is a central tenet of modern podiatric biomechanics.

    A meat-pie is basically a "neutral" foot orthosis with a 4 degree post.
    You know on prescription forms where there is a tick box which says "labs discretion"? Yeah. You could replace that with a box that says: "meat-pie"

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