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Salesmen selling orthotics at the show?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Aries4, May 1, 2011.

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  1. Aries4

    Aries4 Member


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    Hi,

    I graduated last year and have LOVED every moment of working. Recently I went to the royal Easter show in Sydney and saw a stand of people selling orthotics. I asked if they were health professionals, but they were just salesmen claiming to fix "plantar fasciitis", "bunion pain" and "flat feet" etc. I also witnessed the man bagging out Podiatrist made orthotics to some customers!! I was really upset and told the man I was a Podiatrist. He was really embarrassed at first but then got really defensive and started arguing why they had the better orthotics. This whole experience has shocked and upset me. I was wondering if anyone else had experienced this and how they have felt? The orthotics were plastic, no top cover, and very flexible. Thanks in advance for your insights :)
     
  2. Yep. Happens all the time. Last county show it was £300 for a really **** pre fab.

    Its always going to be the way. A fool and their money will be parted by anyone with the right sales patter.

    Don't let it upset you. Its life.
     
  3. BEN-HUR

    BEN-HUR Well-Known Member

    Hi Aries4,

    First of all - good for you for questioning these individuals. I'm actually a Sydney sider but didn't attend the show. However, in 2009 I visited friends in Perth & attended their Royal Agricultural show. I came across two groups selling orthotics... or is it insoles?

    First individual was asking people to walk across a GaitScan/Athletes Foot sensor pad type device & suggesting orthotics were needed... hmmm, I thought. I walked away & came back a bit later... & the same result was given for another individual. Walked away & came back, where he was now grinding an 'orthotic' shell... walked to the other side of the bench where I stumbled across about 6 (what looked to be) orthotic shells connected together in a matting format (i.e. off shelf plastic arch supports based on shoe size). Being the curious type, I picked them up & had look. They looked familiar to me (as I have had experience with the TOG GaitScan mob)... looked over to him grinding away... he was looking at me alarmingly. It was about now I remembered I had a camera in my pocket. Being evidence based I was about to take a shot of the insole matting, they were snatched from my hands (rather rude I thought) & was asked who I was. To cut a long story short (which nearly involved a fight amidst the stands) I found out that he was not a health professional & had very little understanding of lower limb biomechanics - based on the fact he didn't even understand the questions I was asking him. I was also informed that the thing I was about to photograph was "confidential" (yet they were sitting on the front bench) & (I quote)... "the technology was copyrighted", thus I couldn't photograph it. "Copyrighted" I said... why would I want to copy that I told him... they are just massed produced generic arch supports. It was about then, much to the relief of my embarrassed/nervous friends, I was told there were wombats further down the hall... they knew I like wombats :D... hence we left.

    Later on the opposite side of the aisle in the same hall I came across a second group selling orthotics. This went a bit more smoothly... I asked a few questions about what these did... also the difference of those pod, pod... what do you call them... ah... pod...iatry orth...otics. I probably got the same spiel as you got. I then asked about their assessment criteria & in what way were they "custom made". He soon realized that my interest was a wee bit more analytical than average... where I stated I am a Podiatrist & didn't agree with his answers/method. His tone quickly changed where he became nearly apologetic & stated the answers given are based on his training... & he understood where I was coming from. We parted company on more friendlier terms.

    I then walked to the other side of the aisle & gave the other guy a wave :D.

    Anyway, I'm guessing that your experience could have been possibly related to the second group I visited i.e... Step Forward Orthotics (front cover of brochure)...

    [​IMG]

    The following is a picture of the 'orthotics' - come as you see them... cost $350 as of 2009...

    [​IMG]

    Was this the group?

    Due to the guy from the second group telling me his answers were based on his training, I got in contact with the company & had an email exchange which wasn't productive (I'll leave at that for now).

    Anyway Aries4, don't be upset by your experience... you did the right thing questioning them. Make sure you have good knowledge behind you & be ready to give an answer backed up by sound reasoning for your next encounter. The thing is, your primary goal (& that of Podiatry) is to help people, whilst their primary goal is to make money (which often attracts other undesirable issues). Unfortunately the field of orthotic therapy is not regulated hence our unsavory experience... which needs to be addressed at some point in time... isn't this what the Podiatry Association should be trying to resolve!!! :mad: :bang:
     
  4. David Wedemeyer

    David Wedemeyer Well-Known Member

    Alzner device Matthew? I looked these over a while back, they appear to invert the medial column mainly and for $30 they're probably fine but chains sell these as an entire program for upwards of $600.00 US. Scandalous for a prefab insole.

    An insole is an insole and a foot orthosis is a foot orthosis. Until we adapt and use terminology to distinguish the two the public will not understand the difference between what the podiatrist prescribes and dispenses (or the orthotist or pedorthist) and what these chains stores are selling.

    Caveat emptor.
     
  5. BEN-HUR

    BEN-HUR Well-Known Member

    Not familiar with the "Alzner device" David. Glad you're on the case though in your neck of the woods :boxing:

    We just don't want people getting disillusioned because they were prescribed/soled the wrong device under the guise of orthotics.

    Matt.
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    http://www.alznner.com/

    This is interesting:
    Biomechanical evaluations have shown that arch supports can affect balance, stability, and the distribution of forces on the bottom of the foot in two ways; specifically, they can “…change the motion of the foot, therefore altering ankle, knee and hip joint and upper body movement” and/or “…can change the forces and torques placed on the body by altering their distribution on the plantar (bottom) surface of the foot resulting in a change in the Center of Gravity (CG) of the body. This is referred to as altering the path of the Center of Pressure (COP) on the bottom of the foot."

    Testing of the Alznner® arch support has proven that the material and design do exactly what its inventor wanted it to do. More importantly, it shows that they accomplish both of the desirable actions described above and can have a positive affect on balance, stability, and the distribution of forces on the plantar surface of the foot.
     
  7. Ian Linane

    Ian Linane Well-Known Member

    Looks like Ed's got some serious competition :).
     
  8. Thats the same device people peddle at the UK county shows. They have a table with lots of other supports on it and explain how they are all wrong. They are just "comfort supports" because they don't support all three arches of the foot.

    I listened in wonder, nodded politely and walked away.

    Edit.

    Here we are.
    Thats the shape of an idealised foot apparently.
     
  9. Look at it, say what it is....

    It's a prefabricated foot orthosis which may work for some of the people some of the time. If people are willing to pay the asking price based on the salesman's patter that's up to them, I assume the majority are grown adults. And if it works for them, fair enough; what price is comfort? It won't work for everyone, show me a single orthosis design which will. Tell me why this specific design is inferior to any other specific prefabricated orthosis... Moreover, tell me why the custom devices or prefabricated devices being prescribed and sold by podiatrists around the world are superior? Show me the evidence, p'lease...

    And while you're there... I don't buy the insole versus foot orthosis argument. Define foot orthosis...? "An in-shoe device which is designed to alter the magnitude, distribution and temporal patterns of reaction forces acting on the foot"- right? So, these don't do that because.....? Bet they do.;) "Yeah, but I'm a podiatrist and I know how to control the reaction forces to provide a positive outcome"- do you now? Really? I'm sure you can tell us all the secret then.
     
  10. If its the one I'm thinking about, it becomes shank dependant under about 1 kg and the shape when flattened is nearly, well, flat! I'm sure it works for some people.
     
  11. So? Some device are designed to be "shank dependent" with zero loading? Tell me how foot orthoses alter the magnitude, distribution and timing of reaction forces, Robeer? (I trust you are feeling better?).

    1. Magnitude of reaction forces:..........
    2. Distribution of reaction forces:...........
    3. Timing of reaction forces:.............

    BTW, I could design a foot orthosis which was flat and shank dependent and would still achieve a change in all three of the above, as I'm sure you could too. So............ How do foot orthoses work to alter the above? How do their design characteristics achieve these changes?
     
  12. Robert got me thinking on this. Quick little work out for your heads....

    Lets assume the top picture is part of an orthosis with a reaction force vector acting from the surface at the time of initial contact between the foot and the wedge, and assume the second picture is the wedge at maximum deformation at the point of static equilibrium, how does the deformation of the wedge influence the angulation of the reaction vector? Where should we draw in our vector in the second picture? Will the magnitude of the force have changed?
     

    Attached Files:

  13. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I am sure that they would if they could.
     
  14. efuller

    efuller MVP

    If there's no friction, isn't the force going to be perpendicular to the surface?

    Eric
     
  15. That's my thinking too, Eric. So the degree of deformation will influence the verticality of the net ground reaction force vector. With more deformation leading to a more vertical vector.

    What about in the presence of friction?
     
  16. Better being a highly relative term, yes thankyou. Still chasing the tramadol fairies.

    I would say based on the intellectual nuke you dropped on me in porto that it would have to depend entirely on the amount of friction. If the pressure across the whole surface of the wedge is equal, and the vector with no friction is perpendicular to the surface then might not the vector be anywhere between perpendicular and vertical, increasing with the friction co-efficient?

    But then I'm stoned and malnourished so I probably should not be attempting this.
     
  17. Aries4

    Aries4 Member

    Hey All,

    Thanks for all your replies and insights. :)

    BEN-HUR: I really enjoyed hearing your stories! The pictures you showed were the people I encountered and I would love to hear more about what they said you, after you emailed them. The Salesman I saw at the show thought he was awesome basically and actually was telling a customer "Podiatrists are yet to catch up with the technology of our devices". :S
     
  18. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks David. I'll agree that these "alznner" insoles look very similar to the "Step Forward" insoles. Maybe there is some relationship there?

    Can I assume you are taking the role of the devil's advocate here to some degree Simon?
    Handing someone a prefab over the counter or via the mail without an adequate assessment of their history, signs/symptoms, alignment, gait etc... is in most (if not ALL) cases... inappropriate, to say the very least. Handing someone a prefab when a thorough assessment has been done would be more satisfactory depending on the circumstances (i.e. would it be suitable & achieve the desired effect) which is also visually assessed. I have no doubt that some people will/do benefit from a prefab... more chance though if they were assessed based on the above... including weight, activity used for, foot shape/structure (i.e. width) etc...

    Would a good analogy be the comparison between the spectacles you buy in a gas station as opposed to those you get prescribed by an Optometrist?

    I would imagine that there are also so many variable issues involved here to gain adequate "evidence" as to which is suitable (prefab or true custom)... which will be enough to satisfy some people. However, I know that I would have far greater success & peace of mind issuing a device which I feel is appropriate for the individual than issuing a generic prefab (based on shoe size) to every client regardless... that required a controlling device of sorts.

    Take a look at you usual prefab (i.e. those pictured in post 3). Do they accommodate the varying weights of individuals i.e. does a small prefab have a different composition/stiffness to a large prefab? Particularly if one wearing the small prefab weighs 45kg & the one wearing the large weighs 100kg... should this not be considered when intending to adequately alter forces?

    On the other hand, the custom orthotics I prescribe have a certain density shell (i.e. 2mm, 3.5mm) as well as coupled with a certain firmness EVA (i.e. 240, 300) underneath (based in the individual's weight & activity) which then gives me control to adjust the orthotic based on my observations (which I won't go into)... as well as what the patient can tolerate.

    Pretty much anything inside the shoe/under the foot will "alter the magnitude, distribution and temporal patterns of reaction forces acting on the foot"... I didn't think anyone here was negating this... but in what manner is conducive or undesirable for the individual? The issue is, is it being done in the appropriate way as determined desirable by one trained to assess these issues (as subjective that may deemed be). A sole arch cookie will do it & a sole rearfoot varus or valgus wedge will do it... heck, even strapping (i.e. Low Dye) will do it... anything that will affect proprioceptive feedback.

    The issue here is not specifically controlling reaction forces to the nth degree due to the various variable factors (i.e. footwear, ground surface etc...) but as stated above... applying educated intentions as to the manner in which the forces contributing to an injury (i.e. Achilles, Tib. Post., knee pain etc...) are offloaded to some degree to the area of concern.


    Really? Which ones are these? Was this the intended purpose... coincidental... or a convenient reasoning tool?

    As stated above, you are not going to specifically control "magnitude", "distribution" & "timing" reaction forces to the nth degree due to the various variable factors (i.e. footwear, ground surface etc...)... neither do you need to... but if one is trained to note what type of variables which alter "magnitude", "distribution" & "timing" reaction forces which are considered to contribute to adverse stress/injury in a particular individual then it is these factors which are acquired during an adequate assessment & then used to fabricate the intended device. It is the manner of conduct along with nature of product which I for one was referring to in post 3 - both of which have very little chance achieving satisfactory reliable/consistent results.

    Then there are the following issues...

    Post 3 had the cover of the "Step Forward" brochure... here's what's inside...

    [​IMG]

    [​IMG]

    Then there is the content on their website... http://www.stepforward.com.au/... which now seems to be going through a "major revamp".

    - It has changed since I last looked at it in 2009... here is some of the content it had of which I saved to use in an email exchange. I focused on the following three Q&A points... of which I got an ignorant reply which also stated that we (i.e. Mxxk) will not enter into further dialogue.


    David... After now looking through the website, these "Foot Forward" insoles are associated to Dr George Alznner.
     
  19. [​IMG]
     
  20. No, think your standard EVA pre fab. Nowt wrong with shank dependant, if they are shaped.
     
  21. BEN-HUR

    BEN-HUR Well-Known Member

    Hi Aries,
    The email exchange was pretty much limited to the tolerance level of the receiver. I sent an email politely asking some very reasonable questions in relation to my conversation with the salesman at the Perth show, as well as content on their website (which is now going through a "major revamp")... as noted material in post 18. I also reasoned through some basic anatomy & biomechanics which probably was as enlightening as their web page on... Anatomy Of The Foot (Basic information about the anatomy of the foot is presented below. The information may have errors and omissions.) Why admit it "may have errors"... after all, it is declared "basic" & I would like to think these people know there "basic" foot anatomy... besides, there's nothing there! (despite being last updated on Friday, 25 February 2011 23:47).

    Basically I got a cynical & unprofessional response stating generalizing views... i.e. that Podiatry orthotics are "too rigid" & many people have had problems with them (hence all are just no good)... as well as the regurgitated nonsense found on this page... Comparison Of Orthotics . The email closed with the receiver (Mxxk) not wanting to enter into further dialogue... however, I kindly responded anyway under a different email... albeit, got nothing back though :confused:

    However, there web page at the time did state...
    I can only presume that only a certain type of inquiry is welcomed ;).

    I think I get your point... however, your wording isn't that clear.
    Other issues i.e. shank modelled/shaped from what exactly?... shank deformation to varying degrees on varying weights... memory of the material used (particularly high demanding situations)... success rate of these compared to appropriately made (which is another issue in itself) custom devices - comparable???...
     
  22. Aries4

    Aries4 Member

    This company is making me so mad :(

    Can the association do ANYTHING?
     
  23. For the sack of....

    Why ?

    Its just a bent bit of plastic.

    Edit sack should be sake as in for argument´s sake
     
  24. blinda

    blinda MVP

    sack? :confused:

    Oh, d`you mean sake?

    If so, yeah. Agreed. There are more worthwhile problems in life, which is far too short, to concern yourself with.

    Bel
     
    Last edited: May 4, 2011
  25. Yep that would be the one, can´t even claim using my phone and typo on that one - just plain old crap spelling. :drinks
     
  26. [​IMG]

    Sorry. Until my brain starts working again I can only contribute by memes.

    Seriously though, we've all been there. Be it MASS, or FFT, or homeopathy (growl), or whatever. We all hate to, in the words of kipling "See the truth you've spoken, twisted by knaves, to make a trap for fools". Its good that people care, so long as you don't let it hurt you that you care.

    I admire Aries for la passione. Nice to see people out of university caring so much. I think we all did once. Now its more of a cynical groan than an indignant shout for most of us.

    Do not go gentle into that good night,
    Old age should burn and rage at close of day;
    Rage, rage against the dying of the light.

    Though wise men at their end know dark is right,
    Because their words had forked no lightning they
    Do not go gentle into that good night.

    Good men, the last wave by, crying how bright
    Their frail deeds might have danced in a green bay,
    Rage, rage against the dying of the light.

    Wild men who caught and sang the sun in flight,
    And learn, too late, they grieved it on its way,
    Do not go gentle into that good night.

    Grave men, near death, who see with blinding sight
    Blind eyes could blaze like meteors and be gay,
    Rage, rage against the dying of the light.

    And you, my father, there on the sad height,
    Curse, bless me now with your fierce tears, I pray.
    Do not go gentle into that good night.
    Rage, rage against the dying of the light.
     
  27. W J Liggins

    W J Liggins Well-Known Member

    Hi Rob

    Good to hear the guts are working again. Dr Bill prescribes several pints of beer rubbed on internally.

    Good to see the best of Dylan too (as in Thomas, not Bob), but rage though we will, it's an open market. The best that we can do is to so elevate our profession that the media comes to US (emphasis, not shouting) for comment on any matter regarding the foot; then we can rubbish as required.

    All the best

    Bill
     
  28. blinda

    blinda MVP

    We`ll have a drink or two in Roberts` honour next Friday, eh Bill? Sorry Smells, You`ll be missed ;)
     
  29. SarahR

    SarahR Active Member

    We have them here in Canada. Yes they upset me too, however until providing orthotics is a controlled act and we have better control over terminology ie custom orthotic vs custom fitted orthotic vs customized orthotic etc, (I believe orthotic should only apply to custom fabricated prescribed devices), it will remain buyer beware. "you can save a couple hundred dollars" on a certain doctor's custom fitted orthotic centre. Fortunately they no longer say they are designed by podiatrist, but rather foot care scientists in the advertising. This company no longer has podiatric oversight.

    Unfortunately, in part due to our lack of advertising and public educational endeavors (compare to optometrists, dentists etc with associations that have $$ to heavily promote their members as the care provider), our public is woefully naive.

    Some assume because it is an orthotic their insurance will cover it, and are upset twice or three times over when it doesn't get reimbursed AND the device doesn't work, and the provider is no where to be found other than stalking trade shows to get follow-up (which the providers are incapable of providing for the most part).

    Yes there is no proof that mine are better. But you know exactly where to find me, and my office staff will call your house to remind you of your check-ups; my office provides reasonable free adjustments and support. This is in addition to other modalities like strasburg socks, anti-inflammatories, home exercise program, ultrasound, steroid injection, taping, manipulations, etc because I am not a one trick pony but a highly educated regulated health professional.

    Once the anger over their inadequate devices passes, and they have gotten results with us, they will make sure their friends and family members do not waste money on orthotic salesmen.

    Don't sweat these people; I really don't want some of their clients anyways. If cost and cheaper is more important than quality, education/training, follow-up support etc, it makes for tense office visits.

    Sarah
     
    Last edited: May 4, 2011
  30. BEN-HUR

    BEN-HUR Well-Known Member

    Too right - good points there Sarah!
     
  31. "And if you shout, I only hear you". How do you use these to come up with a "prescription"? What difference do they make as to whether you prescribe a 4 degree or 6 degree rearfoot varus post?

    I'm intrigued, you visually assess the effects of the foot orthosis. How?
    How do these variables change the prescription? Let's start with body weight, take a couple of patients with plantar fasciitis- one weighs 60Kg the other 90Kg..... and your prescription is different how?..... Because?

    Maybe, but the spectacles from the garage are efficacious in a proportion of the population, and it saves these people a whole lot of money.
    You "know you would have far greater success issuing a device which you feel is appropriate for the individual than issuing a generic prefab": really? And how do you "know" that?

    I guess when you have treated enough patients, you're confidence level and "peace of mind" will grow and you'll come to the realisation that you can use both custom and prefabricated devices within your practice and still achieve efficacious results with your patients. Horses for courses, the skill is in picking the right horse for the right course.


    Well how scientific of you. How do you calibrate the load/deformation characteristics of the device across the foot-orthosis interface? Or, do you just give the fatty's something harder? By the way, 2mm versus 3.5mm doesn't change the density. And what do those numbers 240, 300 actually mean in real terms? That is, if I make an EVA device out of the 240 eva and another out of the 300 eva how will they differ in terms of their mechanical effects? How much difference in deformation at the medial longitudinal arch per unit load would you expect given identical orthosis geometry using the two different EVA foams? How does the Young's moduli of the materials selected interact with the geometry of the device to determine the overall load-deformation characteristics? Moreover, how does this predict the efficacy of the device? BTW size often does matter in terms of load/deformation characteristics.
    And if you use bold fonts and underline, I'll still only read it. What's you definition of a foot orthosis? I was using a modification of the one Prof. Kirby gave. What's the difference between an insole and a foot orthosis?

    I know many individuals who have been "trained" who get it wrong, myself included. You are obviously trained enough though Matthew, so you know everything you need to know about it and have a 100% hit rate.

    You intimate that proprioceptive feedback is necessary to change the magnitude, distribution and timing of ground reaction forces. Could you define proprioception and tell me why this is so?

    So how do you know the direction of the net ground reaction force vector at any instant in time in relation to the foot's structures? If I add a rearfoot varus post does it increase the supination moment?
    You may want to do some background reading on foot orthoses before you come back to me.

    "like a preacher stealing hearts at a travelling show... for love of...."
     
  32. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks Simon for taking the time to critique my post.

    Simon, you asked some loaded questions in your posts of 9 & 11... mind you, you didn’t provide any answers or insights on your views relating to these questions (which tends to be characteristic of your posts). Frankly, when I ask questions I also like to back them up with my views/perspective on the topic (i.e. attempt to supply answers)... after all this is an academic/education forum where sincere views should be allowed to be expressed... & constructive feedback returned (so we can all gain something from the experience). Hence, I provided an answer (my perspective) to four of your questions... they were not specifically directed back at you (which based on the tone of response you seem to take issue with) but issued to justify my intentions behind orthotic therapy as opposed to that of a salesman issuing a device at a show/fair or via mail/internet order (which is the crux of this thread).

    For the record I do not have anything against the use of prefabricated Orthoses – I use them myself when it is appropriate. This thread was initiated due to the manner of selling prefabricated orthoses.

    Raising straw man arguments in your response to my input is hardly conducive to constructive feedback/input...

    Meaning what exactly? Putting forward the intended views/meanings in a writing format such as this can be perceived as ambiguous at the clearest of times... let alone topics of this nature. Hence explain your reasoning/position more thoroughly.

    What’s your context here – you need to explain yourself clearly so as to reduce the chance of misinterpretation which is easily achieved via a writing format such as this.

    Are you solely referring to prefabs in this issue? I didn’t state anything about the degree of the varus post at this point (straw man argument?). There are other determining elements to orthotic (even insole) therapy other than the degree of the rearfoot varus post of which I outlined further in my post in question. I was commenting on the general issuing of prefabs in the context of issuing them at shows & via mail/internet. But to specifically answer your perceived question – in most cases a 4 or 6 degree r/foot varus post wouldn’t make much difference – particularly based on the nature of some feet (location of STJ axis i.e. mark medial position) when subjected to devices like the “Step Forward” orthoses which have a smooth plastic texture which will cause some degree of sliding (within some shoes more than others). Also, more importantly, wouldn’t it depend on the nature of the individual’s foot i.e. location of the STJ axis – in other words one with a high pronated foot with mark medially deviated STJ axis may need a greater supinatory moment to achieve adequate correction i.e. greater than 4-6 degree r/foot varus post (or different type of post i.e. long medial post). Hence, prefabs of this nature are likely not as suitable... particularly the “Foot Forward” variety.

    Perhaps feet should be classified in orthotic therapy by the location of the STJ axis. The lack of foot classification by STJ location may be the reason that previous orthotic therapy results have been inconsistent or less effective than ideal. I very much doubt this type of assessment is done by those who are the subject of this thread (show stall salesman) ... or the manufacturers of these prefabs... who even use the footprint methodology.

    Now for your answer to your above question...


    Yes I do... as well as receiving feedback from the patient (i.e. feel & symptoms... as vague/subjective this may seem to you). You are not going to nitpick on this issue & tell me it can’t be done?... & no, I do not have the luxury of owning i.e. a F-Scan in-shoe pressure system (do you really need one?). Anyhow, I put my neck on the line & answer you... as unscientific you no doubt will deem this is, I visually compare the lower limb posture of before & after orthotic application at stance & walking (i.e. Calcaneal eversion, Navicular bulge, forefoot position etc...). If I can achieve what I deem is a more satisfactory foot posture with the orthotics I know there is a chance that the issues possibly related to the non-orthotic foot posture will be resolved... call it a coincidence, but it tends to work out in a high percentage of cases... from my feeble clinician perspective (I don’t have the luxury to research it myself at this stage).

    Now for your answer to your above question... I too would be intrigued on if & how you assess foot orthoses.


    The goal of most clinicians would be to reduce plantar aponeurosis strain & get the quickest recovery from this condition. From memory (on research I read) the quickest recovery out of the various types of orthoses was from a semi-rigid device; hence, support of a semi-rigid type of device is most appropriate. Semi-rigid devices via a well-contoured custom device (minimal arch fill) offer the plantar fascia & the longitudinal arch a foundation that discourages plantar fascia tension. Hence semi-rigid for one individual of a certain weight (i.e. 60kg) may not be so for another (i.e. 90kg) & vice versa. Thus the stiffness of these devices will vary based on the patient’s weight & this is achieved (from me anyway) via selecting the appropriate shell thickness & ILA EVA density/firmness (or is it deemed “hardness” i.e. 190, 240, 300). I then assess the contour & the amount of flex of the device when they stand on it (as well as note patient feedback). If need be grind some of the EVA away to gain more flex (or add some to acquire less flex). They may however both contain a f/foot valgus wedge as this also tends reduce strain to the plantar aponeurosis... something of which the orthoses/company in question (i.e. "Step Forward") would be less likely to accommodate for... once again – hence my point.


    However, not ideal. Someone with visual changes should be assessed by a qualified practitioner as there may be other issues involved. I certainly wouldn’t risk my eyesight on the purchase of generic spectacles that may mask something else, further damage my eyesight, have short term relief etc...


    Do you remember the context of this thread Simon – you know... someone’s prefab. (i.e. “Step Forward”, Alznner device) has this amazing “technology” that is the be all & end all of ‘orthotic’ therapy... oh yes, & that custom devices made by Podiatrists (of which you also are) are just a load of expensive, rigid rubbish (or something to that effect). Well, I for one have issues with these types of views. They are ignorant, narrow minded & disrespectful in the sole quest to earn a buck! The above quote of mine was written in this context... in part based in clinical experience, patient experience (patients coming to me with unresolved prefab. issues) as well as research indicating the effectiveness of an appropriately made custom device (which as already stated, is another issue in itself).

    Research has also outlined the effectiveness of prefabs, hence why I also use them. The thing is, when I issue a prefab, in most cases I need to do things to it so as it is more suitable for the individual patient ... by this I mean i.e. add a shell covering, add a full length covering, add an appropriate wedge - if & when needed (some time down the track), maybe add deflection, grind the shape etc... (do the salesman in the context of this thread do this?). Also, in regard to a custom device I can also incorporate specific intended characteristics such as the contour of the shell as well as the type of correction which is most appropriate to the individual i.e. based on location of STJ axis, degree of medial skive etc...

    Could intrinsic biomechanical factors within the foot & lower extremity of the patient/individual be responsible for the highly variable individual response to foot orthoses? If so, could this influence my position in regard to the above cited quote relating to generic prefabs... as well as my decision in clinical practice?


    Which has been the very crux of my position Simon - I do use both prefab. & custom orthoses – I never stated I didn’t (another straw man?). I determine which device by what I deem appropriate based on what I find in the assessment, the patient’s preference as to a prefab or custom, as well as the patient’s financial status.


    Is your opening sentence sarcasm Simon? Do you think it’s constructive here? Anyhow, I basically give the heavier individuals a shell that is firmer (less flexible i.e. with thicker poly & firmer EVA) than I would to a lighter individual. I confess it isn’t an exact science (which tends to be your basic premise relating to orthotic therapy isn’t it?) but I do the best I can... with elements of which I have control over.

    You are not familiar with the numbering associated with EVA hardness Simon? (I thought you would be). As far as the specific numbering of EVA foam – speak to the manufacturers. I use their allocated numbering system indicating firmness/hardness to help determine the flexibility/deformation of the orthotic shell based on the individual’s weight. I have in the past prescribed a few pairs of orthotics to myself with the same shell thickness but with differing EVA firmness & tested the difference (I’ll leave it at that).


    I think you may have misinterpreted my point/method (or are we misinterpreting each other?). I was not referring to sole “EVA foam” orthotics. I was referring to the use of different polypropylene thickness shells coupled with different hardness of EVA foam adhered underneath the shell (ILA) to gain greater control of the stiffness, flexibility, deformation (whatever you want to call it) once the device is finished & in possession of the patient. As already stated... by control I mean either removing EVA (more flexibility) or adding EVA (less flexibility). The efficacy of the device is subject to the appropriate amount of control I can give to offload adverse forces, coupled with the tolerance of the patient... as well as the ability to control the above factors. Yes, I realize that size does matter (i.e. ILA length) in terms of load/deformation characteristics... I didn’t say it didn’t (another straw man). Has what I stated so far regarding my method of custom orthotic fabrication satisfied your need to incorporate Young’s modulus into this discussion? Tell me – do the prefabs in question utilize these principles (i.e. ratio of the uniaxial stress over the uniaxial strain) & are they intended/designed to be adjusted accordingly?


    Is “bold fonts” & “underline” really an issue here Simon? Yea, sure you read it, but it was used to clarify/highlight a point which should have been obvious in nature. We all express ourselves in different ways & I don’t keep in mind of the possible petty issues that the use of these functions could create in some people – forgive me. If you really have an issue with options of bold fonts & underline then maybe speak to Craig where he may remove the options from the forum. In the mean time I’ll try & refrain from using them... or is it the combination of them? How does using a different colour appeal to you?...

    “The issue is, is it being done in the appropriate way as determined desirable by one trained to assess these issues”


    “100% hit rate” – did I say that Simon... did I even imply it? No. Did I state or imply that I knew “everything” Simon? No, I didn’t (more straw men). I’m not sure what my “hit rate” is Simon... maybe this could be your next thesis? I’m still learning; I just do the best I can with the knowledge I currently have which I would think is a better guarantee of success than some biased & ignorant easy come, easy go cowboy selling a prefab. at a country show.


    Yes, it was only an “intimate”; I didn’t specifically say it is “necessary to change the magnitude, distribution and timing of ground reaction forces”... but an influencing factor. Proprioception was used in the sense that it deals with sensations of body position, posture, balance & motion (i.e. use of Low Dye Strapping as stated)... a subconscious sensation of body & limb movement & position, obtained from non-visual sensory input from muscle spindles & joint capsules in relation to foot position/stimulation... if may influence increased STJ stability, improved sensory feedback &/or increased force distribution. Factors that could influence this could be a Morton’s extension/reverse Morton’s extension, as stated arch support, paddings (i.e. Met. Dome) etc... Such factors may influence CoP & possibly alter leg ‘stiffness’ via neuro feedback. Anyway, these are things I’m pondering on.

    How, about your views on this matter?


    “Net ground reaction force vector at any instant in time”... hmmm... “any instant in time”... @#$%#$!!!! Simon... tell me Simon, what equipment do I need for this (force platform)?... I see what I can do for you. In case you don’t know this yet, I’m a clinician; I don’t have these types of resources at my disposal to validate my reasoning to you to this degree. Is this type of information vital for you to know of me? Several views come to mind but I’ll refrain from expressing them. Putting aside direction which is somewhat easy to assume on... do you know the “net ground reaction force vector at any instant in time in relation to the foot's structures?” yourself?... yes, yes... you’re a researcher/academic... please tell us (me)!

    In relation to the supination moments of r/foot varus posts : for the sake of the reader of this already very long post, I have answered this question to some degree in to the second quote response i.e. determined by location of STJ axis.



    I responded to Robert on my unclear interpretation of the point in question. However, You may want to clarify your position clearer in future, submit some answers for a change, loose the straw man arguments & sarcasm... as well as the inflated ego which is highlighted by your academia rhetoric.
     
  33. Thanks for the advice, Matthew. Let me return the advice: you'd do well to wind your neck in, learn that using bold fonts is often considered the equivalent of shouting on internet chat rooms; don't make sweeping statements which you cannot substantiate and stop attempting to attack the person that points this out to you. Learn about Socratic teaching. Realise that questions are often asked to help your learning, not necessarily the questioners and not as an opportunity for the questioner to give their opinion (no-one learns by being told the answer, nor having the questioners opinions forced down their throats). Read Carl Rogers. Learn about how foot orthoses work (and don't work). Understand that you may not know everything you need to know just because you've been trained. Do some background reading in materials science. Audit your outcomes. Learn from your mistakes. Recognise that some people may actually be more experienced and more knowledgeable on a subject than you. Realise that submitting erroneous answers on an internet forum may be harmful. Recognise that there is a time to be vocal, and a time to shut your mouth. Understand that learning is a life-long process. That not everyone likes you, nor ever will. Recognise your weaknesses, work hard to overcome them and be honest to yourself and those around you. Read Kipling: "if..." and live it. And lighten up, since life is too short. I could spend some time answering your questions, but with your attitude, why would I want to give my free-time, knowledge and experience to you? Moreover, I've just been informed by my sister that my mother has been taken into hospital with a cardiac arrest. Frankly, she is way more important to me than podiatry arena or especially you can ever be.

    Have a nice day (It's just advice)
     
  34. Sorry to hear about your mother Simon. Best wishes to you all. Hope she's ok.
     
  35. BEN-HUR

    BEN-HUR Well-Known Member

    Let me say from the start Simon... I'm real sorry to hear about your mother - I really do hope that all turns out well.

    Thanks Simon for your advice... I found it ironic that most of your points are referring to issues that you yourself can take note of. The difference being that I want use straw man arguments & red herrings to put the message across.


    Is this really the case - I thought the use of caps was. However, if this really is the case I'll stop using it - fair? I should state that I used bold fonts & colour in my opening sentence to highlight & emphasize an important point - these were my sincere intentions.

    As far as "attack the person"... coming from you of all people Simon. I put forward an opinion which you chose to take issue with... & as for "sweeping statements"... subjective & probably another straw man.


    Convenient position for you to take; but... answering questions also stimulates critical thinking & illuminates ideas. Crikey, how far would we get on this forum if we just asked questions without the accompaniment of answers... which do not need to be "forced down their throats".


    Likewise to you... oh, & which of my apparent "erroneous answers" has been "harmful"?


    Oh... strange... well I know it true for some people to take this position... but can't really see much logic & relevance on a forum such as this.... particularly in this context. Anyway, I don't particularly care who chooses to dislike me (particularly for forwarding an opinion on a forum of this nature)... that's their issue.

    Yep, do this every day... subjected physically (athletic training) & psychologically (spiritual connection). Good point Simon.


    "lighten up"... "with your attitude"... like I said - the irony. All for having the balls to express an opinion/justification on Podiatry based orthotic therapy as opposed to a salesman selling an expensive generic prefab/arch support to unsuspecting people at a country show :wacko:.
     
  36. markleigh

    markleigh Active Member

    Wow all this angst between Podiatrist's. Very sorry Simon's mum is seriously sick but that does put life into perspective - arguing over orthotic theories versus family & health issues - I know which is the more important.

    I hope at the end we can all :drinks
     
  37. Aries4

    Aries4 Member

    Thanks again everyone (this was the first time I've ever started a thread!).

    Sarah--> I love your insights! You're right.

    In conclusion, my initial anger has ceased and after everyone's input I've realised the best thing I can do is concentrate my energies on being the best biomechanist I can be, trying really hard and making sure patients I see are happy :)
     
  38. Exactly Well said.

    Goodluck with it all.
     
  39. DTT

    DTT Well-Known Member

    Si

    I hope mum's ok buddy.

    If you need and ear gimme a call

    Cheers
    D;)
     
  40. BAMBLE1976

    BAMBLE1976 Active Member

    Hi

    I notice that they claim the insoles improve circulation by 15%. WTF???? I would like to see the evidence base for that!

    Barry
     
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