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Podiatric biomechanics in Portugal

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Nov 1, 2010.

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    Robert Isaacs and I had the pleasure of spending last weekend working with a group of students studying for their masters degrees in biomechanics in Portugal.

    I think I can speak for both of us when I say that we were extremely impressed by their enthusiasm for the subject and their willingness to learn.

    One of the most interesting things that struck Robert and I was one of their methods of custom foot orthosis production in which the orthotic shell was formed directly over the outside of the negative cast (making it the positive surface!). Thus by manipulating the foot into the desired position, no additional plaster work is then performed.

    Hopefully we have enthused enough of our colleagues there that they request their own Portuguese forum here soon.

    Here's me and Robert doing our best to look like Sir Digby and Ginger (nice new avatar, Rob).

    Attached Files:

  2. Podiatry in Portugal

    Reflections on a trip to Portugal.

    Simon and I have just returned from a weekends teaching in Portugal. I thought I might share a few thoughts of my time there.

    Podiatry in Portugal is a relatively new profession, only 10 years old. There are around 700 Podiatrists serving a population of about 10 million. A hundred or so of the post graduates (and a smattering of undergraduates) were in the room with us. It was a great privilege to speak to more than 10% of the country’s clinicians!

    Seeing podiatry over there was a little like an ecologist visiting Madagascar. Portuguese podiatry is evolving on much the same lines as English, but with some interesting differences. For example, they encourage the use of clinical setups using dental equipment (chairs, drills, trolleys etc). When I think of some of the rickety and cobbled together systems of bench top drill, sprays and lights I’ve worked with over the years this seems really rather elegant and natty.

    One could not help but be impressed by the level of both skill and enthusiasm for the orthoses they manufacture. As “lab guys” Simon and I were both delighted to find that orthoses manufacture is still a very significant part of the syllabus. Indeed, biomechanics in general appears to receive a good deal of attention. More, perhaps, than in some of the UK schools.

    The nature of the biomechanical knowledge is also very different. The principle of the school, Miguel Olivera is a really solid biomechanist who has made great effort to stay up to date with “modern” biomechanics. This is reflected in his students (viz pretty much everyone) and Simon and I commented on the lack of biomechanical “dogma” we found. A large portion of many of my lectures is “deprogramming”, teaching people that not all they took for granted is true. Delivering these lectures in Portugal left one feeling someone embarrassed as much of this dogma simply does not exist!! “Do people really believe that?!” Was a phrase I heard often. Several of my lectures, especially on insole manufacture, I had to eviscerate because most of them addressed things which are news in England, and accepted fact in Portugal. This man’s contribution to his profession cannot be overstated, and we could learn much from him, his knowledge and his attitude. Hopefully we will. I would love to see him teaching in the UK.

    I was also struck by the commitment of our hosts to EBM. They are aware that they are at the cusp of development and are very keen to develop their profession down Scientific and EBM lines. This may be linked to the lack of dogma I mentioned, they are starting with a clean sheet, free from many of the false assumptions WE have which block the desire to learn. Very soon, we should start to see some interesting academic work come out of there.

    We met several Podiatrists working on their higher degrees and, over some very good wine, we discussed the future of Portuguese Podiatry. Hopefully Craig will soon be receiving a request for a Portuguese section on Podiatry arena and I look forward to seeing some of the names I met there, and on the English speaking boards. I’m sure they will be made welcome

    It was a very enjoyable trip and hopefully the first of many.

  3. Wot no dogma? Brilliant.
  4. Yeah, I made official sidekick status!:drinks
  5. Nice to hear that you had a nice trip - how "red" is the town ?

    ps could you boys expand on the area in bold - how does the lateral heel expansion work with a harder plastic - and probably a few more questions but maybe for a new thread ?
  6. Heel expansion is accounted for by the thickness of the slab of plaster applied to the foot to obtain the negative, they then "press" the plastic over the outside of the negative.
  7. Which is mainly by hand. Vacuum formers are for cissies over there. They really do have mad skills. Not how I'd do it, but they know their methods. One could not but be impressed (no pun intended). That might be one reason they tend to use the thinner materials.

    The town was mainly grey. We had Biblical storms the whole weekend! Invited a few of them back to England to catch some sun. Visibility zero but that didn't matter because they all appeared to drive using the force.
  8. Romeu Araujo

    Romeu Araujo Active Member

    "They all appeared to drive using the force" - lol - unfortunately that's more frequent than desirable.

    I only knew about your lecture a few days before - that made me unable to rearrange my schedule. I felt miserable, but that's life - one other time. I'd really wish I could have meet you both.

    One personal opinion about the necessity of using thinner materials in orthosis manufacturing (hypothetically): I think most of the shoes used by the portuguese population are smaller than they should be (mostly width, but not only). Fashion dictates too much - specially women do have difficulty to find a comfortable shoe.
    I noted a huge difference in the shoes of some american patients I have.

    I laugh out loud with "Vacuum formers are for cissies over there". Has you probably noted, in Portugal doesn't exist an orthotic manufacturing laboratory.
    It consumes a lot of time all the manual work...

    Best regards,
  9. We were very, very impressed with the footwear the female podiatrists were wearing ;)
  10. Romeu Araujo

    Romeu Araujo Active Member

    "Do as I say, but not what I do" ;)
  11. No, when I rule the world all females will wear shoes like those we observed in Portugal. Who wants to see women in comfortable shoes?
  12. David Wedemeyer

    David Wedemeyer Well-Known Member

    I have family in Terceira, Azores. I'm fairly jealous of your trip. It's great to hear that there is interest in the subject in Portugal. I caught what Michael did which was the idea of forming the cast directly from the negative cast. Brilliant!

    Bom Dia!
  13. Yeah, what they don't seem to have yet is the notion of manipulating the foot position during casting such that the device pressed over said cast will have the desired prescription characteristics within it. The FOS device might be good here? What d'ya think Robeer?
  14. Assuming you mean the FAS system. In which case I'd say that there are other innovations which would suit them better. FAS would do what they do but better, but I'm not sure it would be better enough to justify all the titting about with it.

    I think what we showed them about aiming for the shape of the orthotic you want, not the foot you want, will probably be enough to keep em challenged. Rome was not built in a day.
  15. Did I? I may have been right the first time ;)
  16. I dunno, did you?

    Is this going to turn into one of those threads where we only use questions?
  17. maybe?
  18. Do you feel happier asking questions?
  19. Does it frustrate you when you don't receive a straight answer to yours? Indeed, are you familiar with the Socratic method? Why aren't you in the garage making my iphone mounts?
  20. Doesn't that approach owe more to the sophists than Socrates? Does Alison also want a longbow? (I malfed up the last stave so it's only about 25lbs). Do you want a family set?
  21. CraigT

    CraigT Well-Known Member

    They also have some interesting techniques in Spain- also pressing over the cast as you note, but after taking the cast on a pneumatic bladder and looking at plantar pressure underneath. I have not seen this 'in the flesh'...

    Attached Files:

  22. Paralell evolution. Fascinating. Standard vacuum former in reverse would do it. Weight bearing cast in which you can controll the position. More easily than in foam anyhow. Not for me but one can't help but admire the cleverness!
  23. CraigT

    CraigT Well-Known Member

    Do you have an Amfit system Robert? It is actually similar concept in that there is pressure applied from below via the bladder, different execution as it uses plaster...
  24. N.Smith

    N.Smith Active Member

    Pretty sure Amfit System can't apply forces to the foot to hold in the position you want. Does it?

  25. CraigT

    CraigT Well-Known Member

    Didn't say it did.
    It has a bladder which inflates to push the digitising pins up, and you can adjust the pressure of this. You can manipulate the foot to the shape you want to a degree. Imagine a foam box where the foam rebounds back.
    It is far from perfect, but it is a tool that I can use to achieve my aims.
  26. anDRe

    anDRe Active Member

    Hi Simon and Rob

    I hope you had a good journey home!
    For me it was a pleasure to have attended your workshop on Friday and have had the chance to know you personally! It was better than having known Cristiano Ronado jajajajajaja!

    I loved your lecture topics they were very interesting and educational, I hope to see you around here again soon!

  27. N.Smith

    N.Smith Active Member

    Sorry Craig, didn't think you did. Was more, asking the question.
    Do you think it would be better (Amfit System) if it could manipulate or apply forces to the plantar surface of the foot to put it into "the position" you wanted?


  28. mjccerqueira

    mjccerqueira Member

    Hello Simon Spooner and Robert Isaacs!

    It was an honor for us, Portuguese Podiatrists, attended your workshop and "drink" a little of your experience in biomechanics.
    I liked your words, refer to our method of work, particularly in our clinical equipments and method of manufacture of custom foot orthoses.
    If we are growing well in these recent 10 years is because we have learned from the best examples of Podiatry in the world!! :cool:

    I'll see you soon, certainly.

    Best regards, from Portugal.

    Manuel Cerqueira
  29. efuller

    efuller MVP

    The amfit does have wedges with holes in them that the pins can slide through. For example, you could place a varus heel wedge on the system, take the measurement and the pin would slide more superiorly and would presumably create an orthotic with a varus wedge effect.

    With the AMFit you grab the foot with your hands while it is on the platform, just as in the picture in this thread. So, you can hold the foot in a position when pins about as easily as you could for any other weight bearing casting method.


  30. pod29

    pod29 Active Member

    Attached Files:

  31. javier

    javier Senior Member

    A video from my own Podomodel:

    Last edited by a moderator: Sep 22, 2016
  32. No but I've seen one used in anger several times. Quite impressed with it, especially the software used to manipulate the wireframe.
  33. Do you think she could pull that?
  34. Shall I send it you anyway so she can see? ;)

    No bother. Your's, however, might take a wee while.
  35. N.Smith

    N.Smith Active Member

    I understand how other WB systems work and they all differ in the same way and are not the same. The paient is either asked to move their foot into a position you want, by them firing their muscles in the leg, and guess the angles you need and forces you want to apply (with angulation) Or the practitioner guides their patients foot into a desired postion and this shape captured.

    Both ways don't apply forces to the plantar surface of the foot to manipulate it into the position you want. All other methods obviously work because people (like yourself, with the Amfit System) are getting the results they want, but it's definately not the same because of the above points

    If your keen, I took a bunch of shots of the newest version of the device. I'm going to be able to show how it moves with feet on it and what you can do. The difference with the new one is you can raise the Rearfoot platforms individually (for leg length) and it looks a bit snazzier.
    But only if the punters are keen, I don't want to flaunt the rules of the Forum.:good:


  36. Alternatively you could pay to advertise your product here as others do. No interest from me. I saw something similar about a decade ago in the UK. I was sat next to Bill Orien at the time, he said something about an "abomination". Each to their own.
  37. N.Smith

    N.Smith Active Member

    Anyone who's ever seen it work has never called it an "abomination". Just thought some of you might like to see all the workings and what it does. Not an advertisment, just to show pictures for interest in a new approach like other techniques shown on the forum.

  38. And you're sure of that because........ Like I said: each to their own. I'm sure Bill Orien's opinion was his own, as yours and mine are too. But he wasn't trying to sell such a thing.
  39. N.Smith

    N.Smith Active Member

    No, not sure, but "I've" never heard it. It very well could be, in the eyes of some. Point taken.

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