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Providing better footwear and foot orthoses for people with rheumatoid arthritis

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Jun 14, 2012.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Report from Arthritis UK:
    Providing better footwear and foot orthoses for people with rheumatoid arthritis (pdf file)

    Press Release:
    NHS footwear services failing arthritis patients
  2. Admin2

    Admin2 Administrator Staff Member

  3. Boots n all

    Boots n all Well-Known Member

    "...The new research showed widespread dissatisfaction with all types of therapeutic footwear. Patients raised concerns around poor fit, appearance, weight of shoe and comfort."

    Must be just an issue in the UK, if done right weight, fit and comfort can all be taken care of however with these clients appearance is always an issue when they have a foot like this to go into a shoe.

    Narrow heel, broad forefoot, a late heel lift, ABducted gait and poor dexterity to do up fastenings, it is a battle but once the shoe is on the foot and they have walk its a winner.

    Actual clients foot, not modified, one of three sisters all the same

    Attached Files:

  4. I think one of the issues here is that both made to measure and stock footwear is being combined here. In my experience, made to measure footwear, rarely does; cosmetically it doesn't hit the patients expectation; it costs a ridiculous amount to the NHS and frequently ends up in the bottom of the patients wardrobe unworn.

    Cosmetically, stock shoes are usually better. But again a lot of it comes down to the gender and age of the patient and their perception of what a "good lucking" shoe is.
  5. Boots n all

    Boots n all Well-Known Member

    "...cosmetically it doesn't hit the patients expectation;"
    It will if they take a moment and look down at their foot shape to start with

    "....it costs a ridiculous amount .."

    In perspective the cost is nothing if it gives them back their mobility.

    But lets chat about costs, what do you earn an hour, not you personally but the average UK pod?

    Then workout the cost of an orthosis materials and the number of hours to produce an orthosis and the charge out for it?

    Then we can chat about costs once we know that and we some perspective to work from.

    Do you know how long it takes to produce a pair of custom made shoes?

    Simon what are the costs of custom made in the UK?
  6. Phil Wells

    Phil Wells Active Member

    Hi David

    Custom footwear ranges from £250 - £800 per pair - dependent on both supplier and modification/RX requested.

    I am a fan of modifying patients own footwear as compliance is improved significantly. There is usually a compromise re outcome medically but patients seem happy to accept this or have a 'ugly' pair when things are bad or fashion allows it.
    I think the biggest problem we have in the Uk is not communicating enough with the patient/customer!
    The primary source for footwear in the NHS (UK) is the Orthotist and due to commercial pressures, they do not have any where near enough time to have meaningful conversations with the patient.
    Couple this with a separation from the manufacture of the shoes and the patient can easily get lost in the process resulting in poor compliance.
    People will often then label the Orthotist as a poor practitioner but this could not be further from the truth.
    I think think we could learn alot from the Pedorthic model - maybe its time to have a footwear discussion forum as I am sure us Pods could learn alot.


  7. Phil Rees

    Phil Rees Active Member

    I couldn't agree more with your comments. Both you and I work for companies with a strong history of footwear manufacture and I'm sure you're as acutely aware as I am of the balancing act we perform to provide footwear that satisfies the needs of function, comfort and cosmesis. I strongly believe it's time we considered adopting the Pedorthic model for therapeutic footwear provision in the UK, It works in the USA, Canada, Australia and mainland Europe so why not here?
  8. Joe Bean

    Joe Bean Active Member

    I do not claim to be an expert on the history of ‘orthopaedic footwear’ I watched Forest Gump, I grew up with an aunty with a polio short leg, I listened to the owner of Cosyfeet a fully trained cordwainer explain the categories used in the footwear industry to describe shoes, fashion, comfort and roomy.

    Guessing these categories cover say 99% of the population then Pods and orthotist are dealing with a tiny sector? ½ million Rh sufferers, 9/10 of which have foot problems, perhaps not so small?

    As far as I understand it the major cost of custom footwear is in producing the last, after that it is down to the skill of the cordwainer to fashion the shoe.

    Podiatry is full of challenges, perhaps this one should be added to the list? Possibly one of the problems is it could be categorised as ‘palliative’?

    I can only agree with the report and others that spending more time uniting the user (patient) and provider Pod and orthotist though initially costly may in the long term be cheaper.

    This probably applies to all health care disciplines where compliance is important.

    The other thing we could consider is surgical intervention. At the moment I have a 60+ female patient considering radical foot surgery both to relieve her pain but primarily to wear ‘normal’ shoes, she has multiple joint deformities but is still lively and attractive!

  9. Cost to the NHS on provision of footwear is in the region of £20 million per annum. As Phil mentioned cost vary, but it's conservatively estimated at £300 per patient per annum.

    For the record, I know exactly how long it takes to make orthopaedic footwear and the processes involved because I used to do it for a living. I am a qualified pattern cutter, but actually worked more on last design and the development of optical scanning and CAD systems. I can hand last uppers and know my way around mechanical manufacture too.

    I also know that cost is important if the vast majority of patients don't wear the shoes that are manufactured for them. If say, 50% of a £20 million budget is sitting unworn in patients wardrobes, that's a reasonable amount of money effectively being thrown in the bottom of the wardrobe that could be used elsewhere.

    I'm all for pedorthic models providing the training is comprehensive and that regulation by the HPC is compulsory (without any loop-holes, like we have in podiatry).
  10. I wanted to follow up on this. When we were developing the CAD/CAM protocols at the shoe company I worked for, we were basically pioneering linking 3D scanning with last design, with pattern design. Post-scan, we had a large library of virtual lasts and would pick the closest match, we could then manipulate the last to any shape with the CAD software and the system would automatically link with the upper patterns to fit the original last and make the necessary alteration to enable the upper to be lasted. We worked with a sole maker who could manufacture the soles to fit the last bottom pattern/ feather edge and add any other modifications prescribed. We could make the last the exact same shape as the patients foot if we wanted and have the CAD pull-out the patterns virtually with minimal human intervention since the patterns were linked to the lasts. Patterns were then laser cut and the lasts CNC milled. Yet, what we found was that it was a nightmare to last the upper over the last due to all the lumps and bumps and more importantly, they looked like sh!t and the patients wouldn't wear them.:bang:

    The moral of this story: you can make shoes to match the patients feet perfectly, but since their feet look like sh!t, the shoes will too. Have a good weekend Y'all.
    And yes the company did- :sinking: Shame, it was ahead of it's time really, I'm talking 20 years ago.
  11. George Brandy

    George Brandy Active Member

    A common sense report and not with outrageous suggestions on how to improve the service to its users.

    The Daily Mail carried Sally Underwood's interpretation of being a RhA sufferer and her experience of foot pain vs suitable footwear. Sally is also named as a service user in the "credits" of this report. She doesn't deserve criticism from our profession, just admiration for being prepared to speak out for the majority of younger RhA suffers when it comes to the need to feel "normal" in appearance....not fashionable, just normal. She knows her feet, and therefore her shoes, will never look normal. Its a hard place to be in and Sally Underwood, and all like her, deserve our absolute support...not ridicule (as per the other thread on this topic).

    I am finding it interesting to read and understand the Orthotists perspective on fitting the Rheumatoid foot and I have always had great empathy with our local Orthotist Dept...huge expectations ( from service providers), minimal time (for service users) and minimal budget (from the commissioners). It must be as disheartening for these guys when the limited resources they are permitted fail to meet a patient's needs and expectations. I wish the Arthritis Research UK all the luck in the world in trying to change the DoH perspective on the need for decent therapeutic footwear.

    ...but we can't tell our patients this...only empathise. Or is there more we can do?

    If we were a united profession, we could make great inroads into the palliative management of the RhA foot and footwear expectations. In my opinion it all boils down to making time to communicate, to understand the patient perspective and using our skills to slowly adapt their acceptance to a new situation (shoe appearance) and in the UK to be aware of the care pathways available for patients with foot problems beyond your (my) scope of practice. But in PP I can offer that time to support a patient in coming to terms with foot deformity, expectations and self management. I need to learn more about the psychological approach to health management...CPD 2012/13???

    Bet I am not the only PP who has supported a patient with serious foot deformity with their desire to look "normal" for special occasions....padding the mother of the bride's damaged feet so they can wear a pair of Shotter (or similar) sandals for 5 hours to look somewhere near decent for the wedding photos! Is there anything wrong with that?

  12. Phil Rees

    Phil Rees Active Member

    My only criticism of the report is the lack of imput and contribution from footwear manufacturers. I think they could have made a valuable contribution to assist in implementing some of the reports recommendations.
  13. George Brandy

    George Brandy Active Member

    Phil, the sea change has to happen first before it is worth developing a plan for implemtation.

  14. Boots n all

    Boots n all Well-Known Member

    Some good replies.

    Phil Wells at the 200 - 800 cost you are paying your guys peanuts, which may well reflect the amount of footwear sitting in the bottom of cupboards that are not been worn?

    Joe the last is not the most costly part of the task.

    Simon, the footwear company going bust is understandable but a shame, the amortization of that equipment per pair would have been very high.

    Which brings me to the real issue of cost, think what you charge for an orthosis and the small amount of equipment required and the time to produce it and the average number of consults required.

    Then think about the amount of equipment required to produce last and shoes and the time that is required.

    You need patterns, clicking, machining, making and finishing plus the average number of consults, for me thats 5, one for the last, one for the "Glass slipper fit", one for the upper fit and one for final fit and sole adjustment according to Fscan in shoe pressure mapping for high risk clients.

    The Government body in Australia known as Department of Veteran Affairs(returned service men/women) pay $1051.00 per pair and some Pedorthist wont work for them as that is not enough for the task at hand.

    Phil Rees, "My only criticism of the report is the lack of imput and contribution from footwear manufacturers."
    Amen to that! How many studies and reports have l read on footwear and not a shoe maker/Pedorthist listed as consult or writer.

    Just to give others an idea regarding costings, just to sew the shoe upper together you require a Skiver, Plain machine, Zig zag, Beader(optional) and a Single needle post, each of these are from $6000-$9000 each and the footprint of each machine is 1.2 meter by 1.2 meter

    Now compare the charge out for both items, the orthosis and the CM footwear and tell me if you still think those prices for CM footwear are ridiculous? l think CM footwear is ridiculously under priced and under valued
  15. footpower

    footpower Active Member

    According to a company website, custom made leather shoes at a famous shoe maker in London start at 2700 pounds. Given the quality of those shoes, I think it is a fair and very reasonable price. Apparently those shoes are wanted by their clientele for generations.
  16. footpower

    footpower Active Member

    Oh, I forgot “Add VAT (20%) to all prices in the UK to the 2700 pounds” In Australia custom made footwear for a medical reason does not attract GST / VAT.
  17. BrisFoot

    BrisFoot Member

    The major advantage of a pedorthist practitioner model is that the clinician is fully and wholly in charge of the process. H/She interviews the client within the assesment.
    He/She starts understand the personalities, idiosyncrasies, and wants and needs of the client. Gets to explain what is possible and what is not. How it will look. How it wont. He/She has a large range of useful prefabricated footwear to choose from that covers age ranges and style ranges both for aesthetics and function

    Its at this point, up front, where clients are involved from first step where the "shoes in the cupboard" phenomena is halted.

    Therapy that is 60% beneficial and used 60% of the time is better (in my opinion) than 100% beneficial and used 10%.

    The C.Ped also has skilled pedorthists, both design and technical, and technical machinery to provide the modifications to prefabricated and to design and produce custom made footwear.

    Pedorthics is a specialty in itself. If practitioners do orthotic therapy well and "add-on footwear" to their range of tools then this can be to the detriment of their overall practice.
  18. toughspiders

    toughspiders Active Member

    The main gripe i have from female is more the look of the shoe. Lets face it. Most of these patients are
    1. Women
    2. 50's

    They want a shoe to LOOK good and feel good. If it does both i doubt there would really be an issue with cost.

    Aesthetics is very important in a lady who is not only coming up to that golden era
    menopause, wrinkles, thinning skin, drooping boobs belly and arse, loss of hair etc - combine that with the disfigurement of RHa and it can be pretty damn depressing when someone tells you to wear an ugly pair of shoes!
    Its about time we had a nice pair of shoes that not only look good, fit well and are supportive
  19. footpower

    footpower Active Member

    I believe the message is that Pedorthics is a standalone field; it needs more research and education to improve the current offerings. Pedorthic contributions need to be recognised and valued to attract creative solutions to help those who need Pedorthic solutions. That need for research seems a global need while the delivery and training / educational models are very different from country to county. There may also be a need to improve the education/training and delivery of Pedorthic services globally.
    The price that a public payer will pay will also depend on what you ask your private clientele to pay. A public payer surely does not want to pay more than the private market price. While the private price for custom footwear in the UK seems reasonable, at least for that one over generations’ successful company, are others asking a similar amount from their private clientele? I understand that the NHS is a blanket service for all in the UK. In Australia we have public funding for Pedorthic footwear as well and we have private operators who ask a significantly higher price from the private patient over many years. That has lead to an increase in public funding for such footwear over the years, especially in those states in Australia where the private operators insisted on their price from the private patients and the same price from the public sector. The revenue one realises for ones service influences the availability of such services greatly. To improve the appearance of a pair of custom footwear over the basic functional need requires a lot more time and effort and that needs to be funded. The female patients in their golden years are often the hardest to please and at times it is impossible to match the footwear to the no longer perfect foot and the expectations that is generated by the fashion industry with underage under nourished models.
  20. George Brandy

    George Brandy Active Member

    There has been massive evidence based research into the care and delivery of services to the RhA foot by the NHIR Leeds Musculoskeletal Biomedical Research Unit (LMBRU), The North West Clinical Effectiveness Group (NWCEG) and Arthritis Research UK. I realise similar work has been carried out throughout the UK and the world but I am a humble Private Practitioner based in the NW of England and have found the work of these people massively influential on my practice.

    I was often seeing patients who were at the early stage of RhA and apparently without the need for footwear/orthotic advice. They were deemed "low risk" requiring palliative care which either they or a carer could facilitate. Whilst the evidence to support the paper attached below was being gathered, my patients had direct access to a Podiatrist working alongside the Rheumatology Consultant. This funding has since been withdrawn but for the short term access to support these patient's needs was prompt, appropriate and caring.

    With this evidence, I can now action prompt support for patients with RhA via the NHS - a service which then is of no further cost to the service user. Many with RhA simply cannot afford the work of a private Pedorthotist as they do not have the income, being rendered unable to work to their full potential due to disease process.

    The one part of the service that remains poorly supported and funded by the NHS is the work of the Orthotist and in our dreams, the Pedorthotist.

    This is what the publication from Arthritis Research UK (at the start of this thread) is all about and not a criticism of the costing of bespoke/therapeutic footwear. In its entirety it supports this valuable work of Orthotists/ Pedorthotist and behind the two names from the world of Orthotists listed on the publication will be numerous others who have provided evidence for this research.

    The way I see it the next stage will be the sea change, to convince the Department of Health (our UK Government) that the long term savings will outweigh a short term investment in developing a Pedorthotic system nationally.


  21. Boots n all

    Boots n all Well-Known Member

    LOL, Excuse me but my wife is a touch older than l and looks hot to me in her early 50's...must be the tropiclal heat of QLD causing all that drooping:D its not happening here in Melbourne

    By changing the lines on the upper, making the lines of patterns running heel to toe and mixing light colours to the middle of the shoe and dark to the outer peices, we can give the appearance of a narrower shoe, fitting well and supportive is not the issuie.

    l see Brisfoot here:good: ask him to see your next RA client
  22. halfway

    halfway Member

    "Ugly" is in the eyes of the beholder. or the sufferer, as it is
    So----------- can droopy boobs be corrected with a attractive piece of elastic and can a sinking bum be solved by a sexy piece of lycra .-I think not.
    Unless I am an an idiot ,how can anyone (who is faintly logical, compare these comparisons with footwear.
    I, as a Pedorthist constantly challenge physical improbabilities by trying to manufacture footwear to accommodate unreasonable shapes of orthoses when the foot shape in itself is quite acceptable..

    Sure, RA is, in comparison with other disabilities, is difficult, as most are female and usually have aesthetic outcomes which are not possible for the severe sufferer. It also should be noted that a well experienced footwear clinician should guide them through the elimination process and explain to them, why the footwear shape and design needs to be---------------- what it is..
    I would like to have the time to evaluate other health professions, as they do with mine.---------------------------------------- Maybe that says something, as, I quite like being ( last) on a patient's list to solve their prob's.
  23. Joe Bean

    Joe Bean Active Member

    Just to clarify,

    Are the footwear manufacturers or pedorthists suggesting that given enough money they can make an attractive shoe for the foot that looks like sh!t.
  24. Boots n all

    Boots n all Well-Known Member

    Perspective Joe, perspective, we are not trying to make a fashion statement.

    We cant make a 250mm wide forefoot fit into a 150mm wide shoe and if a shoe that is 250mm wide is considered sh*t.....wait, l guess we could jam them into the 150mm wide shoe just for the sake of vanity:dizzy:

    But as l said, with the use of colour and design we can help to make it look a little narrower than it is.

    Mind you, the poor bugger in the UK being paid $300 for a CM footwear cant be blamed if they are sh*t, raw materials cost them $100 before they even started the shoe, lasts, consults, labor and certainly forget money for further CPD and other improvements.

    As l said its all about perspective, we feel there is always room for improvement and will always look for ways to do just that, improve on what we do.

    CM footwear is currently under valued and under priced here in Australia and it would seem in the UK more so.

    But hey Joe give me $10,000 and l will give it a go for you
  25. toughspiders

    toughspiders Active Member

    My post refers to the psychological effects that having these diseases have on people.

    One of my staff has both RHa and Scleroderma. She is constantly battling with disfigurement and severe pain. She see's her feminity drifting away from her. She wants to feel female, she wants to look good. That is not a crime.

    There are ways to improve the look of a shoe that don't cost the earth. Sadly though we don't see them.

    Most of my clients say they want comfort and fit but also want a nice look! It is not an attack on pedothortists and was not meant as such

    PS - you can improve the look of droopy boob and saggy arses with nice supportive bits of clothing
  26. OK, so which service would you take the funding away from within the NHS to provide extra funding for the footwear? Or, would you just provide footwear to fewer people and cover the extra costs per capita that way?
  27. Boots n all

    Boots n all Well-Known Member

    Podiatry of course :rolleyes:( that was humor)

    Simon, they are better off paying more for the right footwear than to pay the cost of the wrong footwear.

    l would think the client should part own the shoe, that way they will put more effort into the whole thing... the client should put up 50% at least, so if NHS is paying $300, then the client should add $300 or even more.

    Here, the state pays $450 towards CM footwear, the client has to pay the rest and very few bat an eyelid, because its standard practice.

    H.A.R.P, the high risk foot group, pay the lot because they are high risk clients

    Some do get other funding from some church and community based groups.

    Toughspider, (humor) Do you have any examples?:cool:
  28. toughspiders

    toughspiders Active Member

    Im very pleased to see you giving thought to the appearance of the shoe. It needn't be costly. Im sure just adding some nice shoe buckles or diamantes etc would be enough to sell the shoe. There's loads of shoe clips also out there on the market that could be added into the leather so not as to rub. There are also some fantastic fashionable leather materials out there too.

    Jeez - i hope im looking hot like your Mrs when im in my 50's!!! I must move to Melbourne ;)
    Sad fact of life though that loss of collagen and muscle tone combined with that huge drop in oestrogen. I guess there's no hope for me!!!
  29. halfway

    halfway Member

    Toughspider (luv the name)

    There are many considerations when providing (Orthopaedic / Pedorthic footwear to patients and as I said earlier , involving the patient with the assessment of the footwear is paramount in their success or failure.
    The best environment to achieve a successful outcome is in a working group from a multi-disciplinary group involving Podiatrists, Pedorthists, Prosthetists, a clinical Specialists and possibly a Rehab team.

    I (and many Pedorthists) have several clinics where this happens and the outcome for the patient is generally positive and up-front. They know what is achievable with projected footwear designs and any possible negatives.
    An experienced Pedorthist will quickly dissolve a patient's over-expectation of what is achievable (aesthetically) and gain their confidence to achieve a desired outcome..
    Please also note---- I often accept a patient's plea to have an attractive footwear design (at my own peril) and most times find myself being paid (nothing) for 12 hours work . Something I am sure other health professionals "don't experience" .

  30. halfway

    halfway Member

    Yup I agree with Boots. His wife is much "aesthetically pleasing" (is that Ok Boots")
    than he is
  31. toughspiders

    toughspiders Active Member

    Whole heartedly agree! All I'm saying is please add some bling, something to show a little femininity! I've been a Pod now for many many years and to be honest all the ones I have seen do look rather masculine.
    Incidentally do you review your clients after a few months of wearing the shoes?

    Agree about the money! I'm in the wrong job too..... Mr minit charged me 37 dollars for putting in two watch batteries today which took him all of five minutes! :(
  32. footpower

    footpower Active Member

    George Brandy is right there is a need for a short term investment to develop a Pedorthic system in the UK and elsewhere. Part of it will be the investment task to set up appropriate training and education and the required facility.

    There is light at the end of the tunnel. Southern Cross University in Australia will establish a 3 year bachelor program for Pedorthics in a brand new facility with state of the art assessment and manufacturing equipment. The Pedorthic bachelor program will run alongside other allied health professions with many shared subjects. There will also be a Pedorthic student clinic to assure good exposure to a real patient load during the course. The course is in its final stages of academic approval and most of the required equipment has been ordered. To assure the graduates learn to run a Pedorthic practice from a business prospective additionally to the medial Pedorthic aspect, a business unit is part of the course program. The campus is brand new, purpose build, the Pedorthic lab with a fantastic vista of the Australian coastline, right in a publication growth area, next to an airport and only 10 minutes on foot to a beautiful Aussi beach. How good is that!! I am sure SCU will be happy to take enrolments from around the world.
  33. I agree regarding paying for the right footwear. However, it is clear that the right footwear for health professionals is not necessarily the right footwear for patients. Indeed, your idea of "great looking shoes" doesn't even match that of health professionals here. Who should be the judge of the how shoes look, patients or orthopaedic shoe-makers? Surely its a case of meeting somewhere near the middle.

    If only it where so simple as to allow the patient to pay some of the cost toward their shoes. Unfortunately, the NHS doesn't work like that... yet. Moreover, I see that solution actually creating bigger problems for those on the coal-face than it solves. When the shoe they haven't paid for doesn't meet the expectation of the patients, they put 'em in the wardrobe. When the shoe they have paid for doesn't meet their expectations they hassle an already overloaded service and demand their money back. Maybe this is the solution, maybe not. Have you ever worked in the NHS?

    Anyway, here's a finite pot of money, you have to decide who gets which surgery, who gets which pharmacy and who gets which orthopaedic appliances (shoes included). You want to pay more for shoes from a finite pot of money, which means somebody, somewhere doesn't get the drugs they need or the operation they need. How do you decide who gets what?

    Here in the UK, the orthotists (who have undergone a 3 year degree level training and are registered with the HPC) might have something to say about the idea "pedorthists" who undergo what training and are accountable to whom? If I added pedorthist to my CV tomorrow here in the UK, would anyone be able to stop me? No, is the answer. And therein lies a problem.

    Can you tell me how one becomes a C.Ped.CM or an "Orthopaedic Shoemaker Meister, Podologe (Germany)"?
  34. BrisFoot

    BrisFoot Member

    Wish it were so Joe.

    The biggest challenges I face in my practice are not the worst feet but the middle range deformity. These are not the higher cost services.

    Most patients if they have severe RA understand that the device needed to keep them mobile comfortably is not going to be the fashion statement.

    I find the mid range deformity and/or teenagers is where the fashionable and peer acceptable standards cannot be realised.
    The expectations are high of course. And I wish I could do better for some.

    It is discouraging to present to a patient the choice of footwear that is possible to be used and have the treatment rejected outright.

    In my mind I know I can help her battle the full day at work far more comfortably, but in her mind not at the expense of looking different. Yet some people revel in looking different with their footwear (even orthopaedic).

    Wrt the UK study again -
    It's not really the item cost (although like everyone, some can afford a Mercedes some only a Hyundai) it's getting the practitioner with the expertise and an appropriate full tool box of footwear choices.

    God bless orthotists and what they do for the many areas of the body they service but I really think pedorthic footwear service is a speciality that needs to be a single focus for a practitioner. Its complications are many as we can see.
  35. BrisFoot

    BrisFoot Member

  36. BrisFoot

    BrisFoot Member

    Show me the Bling!

    Your right. Our designs are sometimes standard and generic. I agree.

    Re: watch batteries ... hence the name of the business.. Their shoe repairs last about the same time it takes to change a watch battery.
  37. toughspiders

    toughspiders Active Member

    I personally don't discuss the aesthetics of the shoe with my patients. I try to stay away from that and only discuss the fit etc, what i do, do though is listen and i'm afraid, that's is what they are telling me. They don't like them. Whilst i don't agree its not a reason to wear them. i can understand it.

    A question to the Pedorthotists - do you review your clients at a certain time period i.e three or six months?
  38. Boots n all

    Boots n all Well-Known Member

    Simon the best person to answer the Education question, l will leave to
    Certified Pedorthist C Ped CM (Australia),
    Orthopaedic Shoemaker Meister, Podologe (Germany) and
    Adjunct Professional Fellow in the School of Health and Human Sciences Southern Cross University, Mr Karl Schott, thats his area of concern.

    Why is it not simple to tell the client to get involved financially in a product that has the potential to change their mobility so much and hopefully prevent other great issues?

    It would have to be gradual, no one likes change, start this new financial year by asking them, sorry telling them, that due to Euro problems(?) they will have to put $100 towards the new shoes themselves.

    If they dont and they go down to a high street shop they may well spend $100-$200 to get a half decent shoe anyway so what is the difference.

    Why should they get free shoes, you dont and if they are paying they will be back if they are not right which raises the bar on quality.

    For Bilby shoes, our clients sign a "wearing agreement" document, stating they must check their foot after one(then two, then three) hour(s) wearing, show the shoe to their pod or wound care specialist and return to us at the first sign of any rubbing, they get a copy to take home and we keep a copy in their file.

    We have found this the best way to get them back, making appointments is futile as they dont keep them, in their mind, there is no need to all is fine.

    Dont get me wrong, we get returns, with customers needing adjustment but we often see them again for repairs, we repair for these clients in anywhere from 2 hours to 24 hours no more as most only have 1 or 2 pairs of shoes.

    Unlike the battery man, we only charge these clients $25-$45 for most repairs including sole replacement and it takes a little longer than 5 min, but it means we get to see our shoes every 6-12months which the best way to get them back, its an incentive to get them back.

    You would be welcome in Melbourne l am sure
  39. footpower

    footpower Active Member

    How to become a "CPed CM, Orthopaedic Shoemaker Meister, Podologe (Germany) in Germany? The Orthopaedic Shoemaker Meister (OSM) is a qualification that is attained after a training/education program over, currently 4 years. It often takes 5 to 6 years. It is a Pedorthic qualification and the OSM on par with other allied health like an Optometrist or Prosthetist Orthotist in Germany. You are only allowed to us that title if you have that qualification. The use of the title is regulated by law in Germany.
    The qualification of a Podologe is similar to a Podiatrist with currently a 2 year training program. It is a state recognised qualification and the title can only be used if you actually passed the exam. The CPed CM is part of the Australian Pedortic certification system. CM stands for Custom Maker details on http://www.mgfregister.com.au/publications.htm.
    The title certified Pedorthists in a protected title in Australia and you cannot use it unless you are certified in Australia. I believe the same is true for a cPed in the USA and Canada.
    I hope that helps.
  40. Is this four years full-time and validated by a University? Or is it work based learning?

    Again, is this 2 years full-time or part-time learning? Are the courses University validated or run by private companies? Who provides quality assurance and audit of courses?

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