Hi,
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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 :)
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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. -
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)...
The following is a picture of the 'orthotics' - come as you see them... cost $350 as of 2009...
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: -
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. -
We just don't want people getting disillusioned because they were prescribed/soled the wrong device under the guise of orthotics.
Matt. -
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. -
Looks like Ed's got some serious competition :).
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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.
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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. -
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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? -
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:
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Eric -
What about in the presence of friction? -
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. -
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 -
Can I assume you are taking the role of the devil's advocate here to some degree Simon?
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.
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.
Then there are the following issues...
Post 3 had the cover of the "Step Forward" brochure... here's what's inside...
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. -
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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...
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???... -
This company is making me so mad :(
Can the association do ANYTHING? -
Why ?
Its just a bent bit of plastic.
Edit sack should be sake as in for argument´s sake -
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.
BelLast edited: May 4, 2011 -
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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. -
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 -
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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.
SarahLast edited: May 4, 2011 -
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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.
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?
"like a preacher stealing hearts at a travelling show... for love of...." -
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...
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...
Now for your answer to your above question... I too would be intrigued on if & how you assess foot orthoses.
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?
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).
“The issue is, is it being done in the appropriate way as determined desirable by one trained to assess these issues”
How, about your views on this matter?
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.
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Have a nice day (It's just advice) -
Sorry to hear about your mother Simon. Best wishes to you all. Hope she's ok.
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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.
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.
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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 -
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 :) -
Goodluck with it all. -
Si
I hope mum's ok buddy.
If you need and ear gimme a call
Cheers
D;) -
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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