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Podiatry seems to be getting a bit of a bad rep

Discussion in 'General Issues and Discussion Forum' started by flipper, Sep 13, 2010.

  1. flipper

    flipper Member

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    Hey people

    Have been looking through the runners world web site and watching the discussions on barefoot running etc (very amusing). I have noticed a fair amount of people are quite annoyed at the insoles their podiatrists have given them and now they start thinking that barefoot running will fix them.

    My concern is not with the barefoot debate (can go on about that for days)but, how we are being perceived by the general public. Seems we may start to get a name as being another profession that just dispenses insoles! And in some cases i can agree with how these people feel. Some are not even aware of how the orthotic works IE they think its giving them an arch. Surely we have an obligation to tell these patients what they are using and how it will work, and if it doesn't work we can adjust it... and if you cant help them give them to some one that can. I get the feeling that they are being given orthotics and told to go on their way.

    I have only been doing this for 2 years so I'm far from an authority on where podiatry should be going ETC, but this isn't about being a podiatrist. Its about being a decent human and not selling these patients short.

    Any way thats just a little concern I have.

    Nick M
  2. Craig Payne

    Craig Payne Moderator

    Yawn ... been there done that before. A few people whinging about their foot orthotics not fixing them ....

    The simple facts are that every single study that has looked at outcomes with the use of foot orthotics (rigid and other wise) whether that is a patient satisfaction study, outcomes or the orthotic arm of an RCT has shown foot orthotics work. NOT ONE study has been able to show they don't. When you look at the success rates or patient satisfaction rates or etc ... they all come out at around 80% or so ..... THEY WORK

    The interesting thing is that figure of around 80% is pretty common... I have seen those figures for antibiotics for throat infections; for knee replacement surgery; etc etc. Foot orthotics are no different to most other interventions in their successful outcomes.

    Of course people are going to whinge if their orthotics don't work; or their throat is still sore; or their knee replacement failed.

    There is a difference between incompetent practice and adverse outcomes; incompetence should have an outcome in the courts. All interventions have adverse outcomes .... foot orthotics are no different.

    BTW ... on your rounds did you notice how many barefoot runners were asking advice for their injury? Kind of paradoxical when you look at all the advice on how you get less injuries running barefoot !

    A podiatrist can be sued if the foot orthotics (or surgery) were used inappropriately or incompetently and caused injury. They cannot be sued if there was just an adverse outcome, which is a side effect of any intervention.

    Can those who advise people to run barefoot inappropriately or incompetently be sued for the bad advice that barefoot running causes less injuries? (when it’s clear that it does not)
  3. flipper

    flipper Member

    Cheers Craig.
    Completely see what your saying. Suppose my concern Is more to do with the Patient education side of things - what we want to achive and other options/ orthotics/Modifications we can try.
    If some one says that we will "fix" your arch then I suppose they will assume that an arch will be created.
    And I still wonder if some are just being told to take the orthotic and go. (hope not but might be happening)

    Its not that hard to spend time with the patient and explain a few basics around what the orthotic is trying to achieve. Once the public understands the concept of what an insole is trying to achieve, we might not have so many stupid comments from barefoot running forums etc (if that is even possible).

    Yeah I have seen Barefooters asking for injury advice. But apparently the answer is they are doing too much too soon :dizzy: . I'm pretty sure thats the only answer I have ever seen given (or re-worded to say the same thing) :rolleyes:

    Nick M
  4. Craig Payne

    Craig Payne Moderator

    Thats the other paradox you see from the Church of Barefoot Running ... when you get an injury running barefoot, its always a training error. Whenever you get an injury using running shoes, then the shoe is to blame and it can't be a training error ... I don't get it :confused::confused:
  5. TedJed

    TedJed Active Member

    Probably a little idealistic Nick to assume patients want to know how orthoses work. They are usually just seeking a solution to their problem.

    I'm not interested in the mechanisms of refractions of the angle of parellax of light waves influencing my retina, I just want to be able to see clearly with my glasses.

    I suspect that this is the conclusion 27 years of practice has brought me to...

  6. Alex Adam

    Alex Adam Active Member

    I have found that if the patient is aware of what you, he profesional, is trying to achieve thwn compliance is higher. Also a discussion on patient expectations is important.
  7. Sally Smillie

    Sally Smillie Active Member

    I work in exclusively in PodoPaeds and yet when I dispense any form of treatment I explain (simply) what and how it works.

    In response to Ted's comment, I find the opposite, in that runners (more than any other athletes) are most obsessed with how things work and I usually have to expand the detail of my simple biomechanical explanation.

    I strongly agree with Adam's post in that it improves compliance. It also reinforces your professionalism - that you know what you are talking about and you have carefully thought through the rationale to prescribe what you have. This increases their confidence in you and your prescription.

    It doesn't necessarily mean that you explain the minutiae of foot mechanics. I particularly emaphasize that it will NOT create an arch (especially relevant to paeds practice) any more than normal development will, but also that arch shape is not the goal of treatment, but rather improved function. I also back this up in writing in their fact sheet / wear-in instructions I issue with all orthoses.

    Feet and arches are like noses, how they look is irrelevant, what matters is if it works. If it doesn't, then you have a problem

    How many of you are prescribing exercises to correct the gross mechanics of the limb in conjuction with the orthoses? I see this as essential, and in-fact correct that before addressing the foot mechanics. Food for thought.

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