Prescribing 'orthotics' without a podiatric degree

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I was recently flipping through the sunday paper when i discovered an advertisment for "THE ROBERT CHARLES CLINIC" which claimed to realign patients legs and treat the cause of their problems.
I thought that it was an advertisment for a Podiatry Clinic, but i scanned the page and realised that the practitioner had an exercise science degree. I thought that seemed a bit strange so i went to the web page www.trcc.com.au and found that the guy makes orthotics for people, and basically slams the podiatric proffession for prescribing 'plastic orthotics'.
If this guy claims to be a clinical biomechanist, shouldnt he have a masters in his degree as well?

It doesnt seem to add up to me.

 

So he is expanding to Brisbane. RC is based in SA and has been active in Vic for a number of years and is just another competitor for podiatrists. If he is having to go as far afield as Qld for business that might say something

 

Since when did you need a podiatric degree to dispense orthotics?

 

you don't. Im simply saying that i think you need a little more than a 3 year exercise sports science degree before you start bagging the podiatric proffession. You also need a masters degree in biomechanics before you can call yourself a biomechanist.

 

I always find it laughable when anyone chooses to "bag" orthotics made by another group, when its obvious they are totally unfamiliar those types of orthotics. A superficial read of the website above shows the person in question has no idea what "podiatric orthoses" are (whatever they are!) ... funny how he chooses to "bag" something he knows so little about. How many times have we seen this before? I ask, where is his evidence? We can certainly roll out numerous RCT's, outcome studies, and patient satisfaction studies on "podiatric orthoses" that show they work, so I guess he is spreading BS on his site.

 

Netizens

Foot paraphalia is classed as a commody and there is no restriction on who can sell them to the general public. Money back guarentees if not completely satisfied will meet most fair trade regulations.

Bagging other groups is also a common convention in modern advertising, seen too with politicians unwilling to make comment on a concrete matter will take a swipe at the opposition to detract the public's attention. Most discerning consumers take this type of advertising with a pinch of salt.

Expanding sales to other areas may have no significance other than the operation is expanding its market because it can now deal with greater demand.

Something which may come as a surprise (nothing to do with the topic per se)is many podiatrists will use regularly shore orthotic services because they are cheaper and considered better quality than local manufacturers. That is the way of the world.

Cameron

 

We don't need to consult an exercise physiologist to undertake a exercise program & we don't need to consult a GP to self-prescribe a whole host of drugs... but are these professionals unworthy - of course not. Those who 'bag' another, harbour doubts about their own worth.

Lots of practitioners of many modalities prescribe foot orthotics as a clinical tool, however always remember the tools of the trade are not the trade itself.

 

The difference with RC is that i think he has a provider number, hence pt's are able to claim from their health benefits. I know this was the case in SA a few years ago. Whether it still is, I'm not sure.

 

I was prescribed orthotics by a specialist in another field from podiatrists. Scans were taken of my feet using a computer sensing device which printed a diagram on paper which was sent to a lab overseas and the orthotics made up and posted back. Costs were over $400 and despite the orthotics feeling comfortable to wear over a period of time I began to experience pain in my legs from knees down, the longer one more so. Unfortunately for me the orthotics were not diagnosed as being the cause of the pain. After a year or so and visits to doctors no results until I was recommended to a long standing podiatrist who diagnosed that the orthotics were the cause of the problem as they were not providing the proper support for my feet, were mass produced and in fact due to their softness were flattening out when pressure was applied. New conventional orthotics fixed the problem fairly quickly. Various claims had been made about how good the original orthotics were.I think orthotics should only be prescribed by podiatrists who specialise in that field rather than allowing any 5 minute expert to prescribe them and then not have the experience or skills to support the patient.

 

Hi John,

It's the educated design application of an orthotic with an educated diagnosis and review program that assists with positive outcomes...

it's not the orthotic.......

Your case is so common - you have experienced what many patients I consult have in the past.

 

interesting remarks...
A certain sports footwear and clothing company in australia is currnetly releasing into its stores a computer system whereby shoe salesman can scan feet and prescribe CUSTM insoles to customers. They are charging $240.00 I believe. This is very concerning to me. How can a shoe salesman have the knowledge to do this? What happens when things go horribly wrong? These devices should be regarded as medical appliances.... not footwear!

 

Have you seen them? Plastic template shells - must be able $5 to produce. Therefore the other $235 is for the 'technology' - pressure mapping at it's most basic, and the expertise of the prescibing practitioner (oopps, sorry - the teenager working retail part-time).

Where does that leave the patient??

 

But what are we as a profession doing to support our well founded belief that what we have to offer is superior? Having worked in the footwear industry (in footwear fitting training and other sundry exercises), I met an awful lot of shoe retailers who really did not know what podiatrists were up to. The typical questions they asked me were:

Why are your orthotics so very much more expensive than others - they essentially look the same?
(Well, if you don't have explained to you what goes into the prescriptions and manufacture and dispensing of orthotics, how can they know by just gazing upon the end product?)

Why do you tell patients to come and buy shoes which do not actually exist? Why do you not warn patients that their orthotics will only fit into butt-ugly shoes?
(Hey, you might have warned them, but the frustrated patient who can't find shoes they like will take it out on the retailer. And let's face it, the 'ideal' shoe for women still doesn't exist in a consumer friendly form).

And so on and so forth. When I took the time to explain to them what we are trying to do (and these people were very open and willing to understand as much biomechanics as I could feed them), they were very grateful.

Now, extrapolate this to the whole population. We spend a great deal of time in our own milieu trying to explain and justify what we do. But if you are a punter who doesn't know any better - time and convenience and cost will be powerful factors influencing your choice as to who gives you orthotics! Add to that the fact that our 'competition' is willing to make claims of certainty that we as professionals refuse to, and you can see what is happening.

What we need is a couple of significant figures (Prime Ministers, Presidents, Royalty, Paris Hilton...) to be saved by our fair hands, and we will have our advertising and endorsement problems solved!

 

Hi

An earlier poster made this comment:

What happens when things go horribly wrong?

It would be interesting to to see if we could define:

a. what we mean by "horribly wrong"
b. any examples of such cases, albeit anecdotal - indeed if any at all (thinking here of FFO for feet as opposed to AFO issues)

We often use the idea of horrily wrong in defence of our role but what proportion of devices issued by none trained people can we say actually go horribly wrong.

Ian

 

As much as it pains me to say it....if anything I would have to say custom made devices from pods are more likely to go horribly wrong. Sure, your over the counter vasyli might not treat any given condition as well as a custom made device, but i can't recall many that actually caused pain. Where as there are plenty of custom made devices sitting in a cupboard somewhere because they "hurt" to wear. I know which one the client is going to think went horribly wrong.

Not sure if it is the same chain as mentioned above, but i know the store in our area is pushing everyone into a pair of over the counter orthotics to go with the purchase of a pair of shoes. It amazes me how many people go with it too.

Cheers


Tom

 

I was doing exactly this for 15 yrs (before doing the pod degree) in the snow skiing and bushwalking industry. Make and fit "footbeds" NOT orthoses in order to make people more comfortable doing the activities they enjoy. The end user is usually more than capable of deciding if they help or not...it's not rocket science. It's not so wrong a thing to do...and a lot of customers are very happy with the results.
Can some one explain why we seem to want to "medicalize" everything? except that it is in the interests of the proffession to do so....make money with less competition?
Is what we do so different?...other than that we like to tell ourselves that we are better at it?......that's why I did the degree....to be better at it....all these other people in other professions are just raising community awareness about this stuff....they are just warming up "my" future customers.....the ones with real problems will finally discover some who can do the more complicated stuff......and it might be me.....I just want to sell them their last pair of orthoses....not necessarily the first pair....word of mouth will do the rest in the long run.
regards Phill Carter

 

Lets translate this into physio and chiro terms.

I bet that no physical therapist who uses solely electrotherapy (interferential/ultrasound/tens) has ever made a patient worse.

I bet that no chiropractor who has used a 'clicker' has ever made a patient worse.

But how many have they made significantly better?


Ultra conservative therapy won't get horrible results. Bit like staying inside your home to make sure you never get hit by a car.


Mechanical problems have mechanical solutions. Mechanical therapy is mostly about working out which forces are beneficial and which ones are detrimental.

In 2100, despite a century of RCT's and countless books and DVDs and seminars, trial and error will still have a significant role. If you are not prepared to take a 1/4 of a step back on the odd occasion, it will be pretty difficult to take 1 step forward consistently.



Ron

 

Hi all, just thought I'd pass on a bit info about this TRCC guy I've heard down the grapevine:

* He does indeed "bag out" podiatrists to the unwitting public he treats, saying we only know about the flesh and bones of the foot and how to cut nails. This is ok with me, as the only people stupid enough to fall for an insecure man slandering an entire profession are also the same patients likely to wear there orthoses on their heads and complain when they don't work.

* He hasn't technically 'expanded his practice', he works out of a Brisbane workshop, and flies to other cities every now and then to take casts of the feet of those who answer his internet site.

* The patients who return complaining that their orthoses don't work are given footwear advice, and when they still aren't working, he'll complain that obviously the client hasn't listened to his advice on shoes as his prescriptions are right first off every time so he can't be the one who is wrong.
This is contradicted by the fact that he recasts himself constantly and seems to spend as much time trying to fix his own feet as the clients.

As I said, this is all just what I've heard, as I have never met the man myself, and don't know whether I ever do ( I'm generally quite a placid person, and hate losing my temper..)

The only thing that gets my goat about it all is that:
1. Before the switch into podiatry-I had no idea about what orthoses were/how they function. 2. Since becoming a pod- I've realised that I was not alone in this, and a large proportion of the gen.pop. don't either, and only find out when someone refers them to a podiatrist or to prefab devices.
3. Add to this the presence of 'practitioners' with extreme holes in their knowledge of orthoses spreading their services around through eg the internet, technology in shoe shops. Then add to this a success rate slightly higher than a placebo, and we have the publics definition of 'orthotic' as 'expensive sham device a friend of a friend of a friend got suckered into" and placed into the 'do not touch' file next to scientology and fat-zap.

Well, that's my rant.

xoxo

 

Hey All. I have seen some of this guy's orthotics and they are immediately recognisable. The main problem that I have with them, is that the orthotic is about 2cm thick under the first ray. In this position (as all of us 'fake' biomechanists know) the hallux can't extend and thus creates hallux limitus. This is quite debilitating over time as it will destroy the joint and ultimately incapacitate the wearer. Whenever I see some of these orthotics, I suggest the wearer set fire to them asap. I sometimes supply the matches myself as a community service!

 

I'm STILL not sure I understand how orthotics function .

Mind you, I don't understand how paracetamol functions either, I still know when and how to use it and get good results with it.

LOL. Litigation obviously not so much of a big deal over there! Try that here and the no win no fee brigade would be on you quicker than you can say "small burn on tip of finger".

 

You see, I find it interesting how ideas like this become prevalent within the profession, i.e forefoot varus wedging reduces 1st MTPJ dorsiflexion and "causes" hallux limitus. Really?
http://mortonsfoot.com/articles/halluxlimitus.pdf

 

Hi Simon. I appreciate your comments. I am familiar with this paper, indeed Hallux Limitus is my favourite topic (which always makes me popular at parties). This orthotic of which I speak doesn't have a forefoot post in the podiatric sense of the term. It would be best described as a Morton's extension that creates a metatarsus primus elevatus to the full extent of the range of motion - and actually at 18 mm - probably exceeds most people's ROM. I can't see a benefit in doing this but am interested in your opinion. You can also imagine the fun involved in trying to put these monsters into a shoe.

 

Please, podiatrists do weekend courses in acupuncture and start offering acupuncture to their clients, some offer homeopathy and reflexology and other quakery like Marigold therapy, many do lower limb mobilisations and manipulations, which can be classed as osteopathy or physiotherapy treatment without a physiotherapy or osteopathy degree and the biggest one, surgery, without a medical degree.

I think glass houses and stone throwing comes to mind.


Regards Dave Smith

 

This inconveniant truth was brought to you by Dave Smith, Sh!t stirrer of this parish.

Fair point!

 

Oh well this is one up on The Athletes Foot in Australia.

They do basic Bio mech assessments with their store foot pressure plates.

here in the UK John Lewis Stores, a major high street department store, are now offering a footplate pressure system so as to advise on footwear and also provision of off the shelf orthotics.

So every man and his wife is in the world of the provision of orthoses/insoles.

david

 

"Please, podiatrists do weekend courses in acupuncture and start offering acupuncture to their clients "

Hello fellow pods ! Yes, I too have done a weekend dry needling course BUT I haven't created a website saying that all acupuncturists are dangerously uneducated and create dangerous orthotics with dangerous angles. (Yep, he sure does say dangerous a lot) The part that I most enjoyed was the bit where he points out that no one else understands these issues in the same way as he does. He must be a clever man because this does sound a lot better than 'no one in the rest of the world agrees with me'. I used to see a lot of this guy's orthotics when a pod in Windsor used him to make their orthotics and then I got to remake them a few months later. And for what it is worth, I agree with the above stated concept that the 1st met should not be forced into maximal elevatus just for the heck of it. I vote for Team Moose.

 

It might be worth noting that perhaps the general public are not as stupid as some might like to believe. Since opening on the high street I have had many people who have been for shoe shop gait analysis phone up to book an appointment for a 'proper' gait analysis.

Dave Smith