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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. Email them and ask. They welcome enquiries from podiatrists ;)

    I wonder too. If you're going to pluck a figure out of your **** why stop at 15%.
     
  2. BEN-HUR

    BEN-HUR Well-Known Member


    Good points 'BAMBLE1976' & Robert.
    You just may have better luck than what I did with my enquiries.

    Here's my modified version of that infamous "Snake Oil" picture...

    [​IMG]
     
  3. phil

    phil Active Member

    who cares if people sell insoles at the show? and who cares if they're literature is BS. they're hardly a threat to your practice (unless your practice is a glorified version of what they are doing?).

    if people are dumb enough to get health advice from a random bloke at the show, then let them! and remember, some people will probably get improvement of symptoms. and those who dont will come and see you anyway eventually.

    hey, maybe I should be at the show flogging prefabs! i'd probably get better outcomes. (probably).

    something that makes me mad (while we're on the topic) is when I get a patient with onycocryptosis who has been tortured by the GP half a dozen times with the ancient art of ripping toenails off. now, thats not some random man at the show, its their GP! grrrrrrr. get angry at that!

    Phil
     
  4. BEN-HUR

    BEN-HUR Well-Known Member

    Have you thought about the bad experiences that people may have with these show people/devices?... which could later affect their perception of you & orthotic therapy in general? I've come across it... "Oh no, I don't want those things... they made me feel worse". Yes but... :wacko:


    Yes, well some people are known to do "dumb" things when they are in pain - pain is a very strong emotion... & then there are some who are intent &/or know how to exploit this vulnerability.

    You reckon?... that's not saying much for your clinic.

    Yes, me to. Also the G.P informing the patient that we (Podiatrists) can't do what we do i.e. PNA procedures.
     
  5. Paul Bowles

    Paul Bowles Well-Known Member

    My wife recently had this experience at the Royal Easter show in Sydney (where there are two companies which do this - in my personal opinion one is quite reputable the other is not as nice me thinks).

    My wife was approached by a sales person who asked her if she had sore feet - after 8 hours pushing three kids around the show who wouldn't. I went along with the ride to see where it would take us.

    The salesperson sat my wife down took her shoes off, lifted her custom made orthotics out of the shoe and said "Hmm hard plastic, a Podiatrist must have prescribed these, these will never work and only cause you problems".

    My wife, calmly and genuinely inquisitive asked why:

    "Podiatrists don't understand what they are doing, they simply charge you lots of money and give you a piece of hard plastic which causes pain"

    The salesperson then pulled out one of their "orthotics" and proceeded to talk techno babble for a few minutes. My wife asked how much they were:

    "$350 dollars and they are guaranteed to work," Smuggly the salesperson said "what would your Podiatrist say if they were here and could see that their expensive orthotics were causing you foot pain and our orthotics were about to solve it!!!"

    My wife with a smug look on her face pointing to me and said:

    "I don't know, but you should ask him because he is standing right there!"

    Needless to say the off the shelf orthotics went straight back into the box, grumpiness ensued and without me even saying a word the 4-5 people in the stand watching the "show" suddenly left.

    That is the power of being a Podiatrist. Funny thing is I don't think can't recall disliking the devices they were dispensing......
     
  6. phil

    phil Active Member

    Matthew,

    Well maybe these guys are scoundrels. But they're doing less harm to the general public than KFC. Selling something that costs $20 for $350 and probably getting a reasonable outcome isn't a bad business model. And there's nothing stoping you from doing it. Just leave out the bagging podiatrists bit and just dont tell any lies. You could even give out literature supporting the use of OTC devices for plantar fasciitis.

    To quote you- "Have you thought about the bad experiences that people may have with these show people/devices?... which could later affect their perception of you & orthotic therapy in general? I've come across it... "Oh no, I don't want those things... they made me feel worse". Yes but... "

    I've also had people coming in with simmilar objections, e.g. "oh, i've tried something like that before and it didn't work". Somes times it's even after seeing other podiatrists. That's when your skill as a professional comes in. If you can't convince your patients that what you have to offer is better, then you're in trouble. There's sales skills in what we do too.

    And by the way, if you close your eyes and gave over the counter orthoses to your patients who complain of heel or arch pain, you might do just as good as making them custom orthoses. So the guy at the show might be saving people money. Although at $350 a pair, maybe not? What's it cost someone to see you a few times and get some OTC orthoses?

    (Effectiveness of Foot Orthoses to Treat Plantar Fasciitis
    A Randomized Trial Karl B. Landorf, PhD; Anne-Maree Keenan, MAppSc; Robert D. Herbert, PhD Arch Intern Med. 2006;166:1305-1310.

    Conclusions Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device. The customized and prefabricated orthoses used in this trial have similar effectiveness in the treatment of plantar fasciitis.)
     
  7. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks for sharing your experience Paul Bowles... however, I think you should have said a few words to the salesperson regarding the views expressed about Podiatry/Orthotic therapy.


    Thanks Phil for your response. Yes, KFC is more harmful in so many ways (coming from a vegetarian). However, I'm not really in the position (i.e. profession) to do much about it... same with smoking & alcohol (yes, even alcohol). I would like to do more about it.


    Yes, this is true as well. In fact I have had a few clients come to me due to the conduct & orthotic practices of a local Podiatrist. In fact, unsavory reports (in general) have come from more than a few people (not just clients). Not sure what to do about this - any ideas... anybody?

    Regarding convincing patients... I do inform them of what I feel was inappropriate & what alternative action can be taken to get a better result, but as the saying goes... once bitten, twice shy... hence it much harder work to get the message across due to their past experience, expense already dished out & subsequent compromised confidence level (even worse when the patch up required is as a result of another Podiatrist).


    My prefab (or OTC if you prefer) treatment package comes to a fair bit less than $350.
     
  8. My first thought, on reading the last few posts, was "Oh hell, not this Sh!t again". But then I mellowed. Those of us who have been arena junkies for a while have indeed seen these debates go around a few times. It is worth remembering though that many people are not so avid and each time they come around they have a new audience. So lets do it. Again.

    You might. But that is not what this study shows. Beware of overextrapolation.

    The study showed that one particular pre fab performed much the same as one particular casting and prescription technique for the treatment of one particular presentation. That is not the same as saying that punting everyone a pre fab works as well as a cast and certainly not the same as someone getting a pre fab mail order is equivalent to someone receiving a package of care from a podiatrist. As Simon says, you can't get there from here.

    1. The pre fab will not be equal to all other pre fabs. As the trotter / pierinowski study showed. So we can't say pre fabs work as well, only that THAT pre fab worked as well

    2. The custom casted used in that study were not the custom casted that most of us use. They were a straight up root protocol FFO. Most of us use other variations like kirby skives, 1st met cutouts, fascial grooves, choice of materials and suchlike. So we can't say that the success rate of customs in the study is predictive of the success rate of customs in vivo.

    3. As someone else has mentioned (can't be bothered to trawl back and find out who), Biomechanics, done well, is not synonymous with othoses. A well trained clinician has a quiverful of other skills and resources he / she may apply. Onward referral, advanced diagnostics, advice, exercises, stretches, lifestyle change, footwear change, home "physiotherapy" etc, etc. I would suggest that the orthotic prescription is one of the least important variables in what we do. Thus, for an example, if we took a child with severs disease, we may indeed use an orthotic, but that is only a small part of what we do. Thus to ONLY supply the orthotic is not comparable to a full treatment program.


    I think that the people at county fairs, and who sell from the back page of the sunday glossy have somewhat missed the point. They have potential to seriously mis-educate the public and to do harm by omission by discouraging people from seeking professional help, either by directly propagating misinformation or by convincing people that a podiatrist is simply an orthoses dispenser in the manner of the chemist.

    The mis-interpretation of the (excellent) Landorf study is a dangerous game as it fishtails with this mis-information. We should be very clear as a profession as to our position on this and here, I think, the debate over "snake oil" has value. There is a saying that a lie can run around the block before the truth has its boots on. The lie here is well funded, well organised and extremely well marketed. The truth, that one device does not "align the skeleton, support the feet in their optimal position and cure X, Y, Z and orthodontic problems", is rather more prosaic, much more complicated, and far less palatable. As such it deserves to be promoted and the lie deserves to be called as such at every opportunity.

    And just for fun, you could always hang around the stand telling people that if they REALLY want to try the $350 insoles that they are available for 99p + P&P from ebayebay. ;) THAT would be hilarious up to the point you got your head kicked in.
     
  9. WILL YOU STOP SAYING BAD THINGS ABOUT MY FAVOURITE THINGS?!!?! IF I WANT TO EAT A KFC WITH A BUD WHILE SMOKING A LARGE CUBAN CIGAR THERE IS NOTHING WRONG WITH THAT!!!!! KFC COVERS MY 5 A DAY FOR 2.4 DAYS IN A SINGLE MEAL, HOW CAN YOU POSSIBLY SAY ITS BAD FOR ME!!!!!?????
     
  10. This is funny - WITH A BUD WHILE SMOKING A LARGE CUBAN CIGAR not many people I know would smoke a bud and Cuban at the same time - you the man. :D


    I digress back to pesty show orthotic saleman
     
  11. blinda

    blinda MVP

    I can confirm this. I was a KFC virgin up until last summer, then Isaacs forced me to pull into a seedy service station on the M3 and coerced me into partaking of the `popcorn` chicken :confused: I drew the line at the cigar, mind.
     
  12. Rob,
    Maybe not, but the interesting result in the mix here is the "sham" device. The sham devices in this study were pretty much the same as those used by Josh Burns in his study- compliant pieces of comparatively low Young's modulus blown foam in the shape of a foot orthosis. What Josh did was to test the effect of the sham devices on interface pressures. If memory serves the sham devices dropped peak pressures by about 9 or 10%, so they are certainly not placebo devices, but if by dropping peak pressure by 10% with a so called "sham" device we can achieve the same long-term benefits as those obtained using a given custom protocol or prefabricated device... The sham devices were not designed to be stiffer for heavier individuals, posted to any specific angles, yet.... food for thought? As I recall, the patients generally still got better, regardless.

    So, if I set up a stand at a travelling show selling sham devices like those used in the study and I specifically target plantar-fasciitis patients, I should do OK in the long-term benefit department. If I advertise this service in National newspapers, offer a money back guarantee, use machines that go ping, charge a grand a pop and recommend that patients buy two pairs, I reckon I could make plenty of cash. Hang on a minute, 30 years of heel pain... gone.
     
  13. DTT

    DTT Well-Known Member


    Now where have I heard that before ...... :D:D

    Nice one Si
    D;)
     
  14. Indeed, it's not a new idea, I'll give you that. And while some of us have had first hand experience of some of Les Bailey's failures, can anyone remind me of his "hit rate"? As I recall in the ads he claimed 98% but wasn't this investigated and found to be.... X%? Again, I'm going on memory but I think it was still pretty high.

    The Les Bailey devices I've seen have all looked very much like Everflex prefab shells. Yet these were the failures. Make of that what you will.
     
  15. It was 98.5% based on the number of patients who successfully got their money back. Which, from what I was told, made blood from a stone look like squeezing an orange by comparison. The ASA made him withdraw the claim as spurious.

    The actual success rate was never, to my knowledge measured, nor would I know the benchmark to compare it to if it was!

    I use a lot of soft devices, I think they have a lot of unfulfilled potential... in some cases. And that's the real rub isn't it, the "in some cases" bit.
     
  16. DTT

    DTT Well-Known Member



    Hmmmmmm yeah cant follow up on this really Si in case I get" the painter" calling and the threatening phone calls starting again:butcher:

    BUT

    I take what you say on board :drinks

    Please dont stop on my account just tell it as you see it.
    Cheers
    D;)
     
    Last edited: May 11, 2011
  17. DTT

    DTT Well-Known Member

    I agree Rob, some soft / semi flexible Orthotics have a real place in orthotic prescription and ( as you know) are used to great effect.

    Its all about fit the patients needs and tollerances not to the orthotics requirements in a text book fashion IMHO.

    Thats my take on it

    Cheers
    D;)
     
    Last edited: May 11, 2011
  18. The point being, some of the people will get better some of the time using "sham devices", some of the people will get better some of the time using prefabricated devices and some of the people will get better some of the time using custom devices. Yet i'm not convinced we can always identify which of the people need which kind of device, all of the time.

    Les Bailey made lots of people better- that's not to be sniffed at. That clinic had it's failures. So do I. And you....?
     
  19. BEN-HUR

    BEN-HUR Well-Known Member

    Sorry Robert... but sometimes... as the song goes... "... you gotta be cruel to be kind"...



    ... now I have this song stuck in my head :eek:
     
    Last edited by a moderator: Sep 22, 2016
  20. Re long term benefit, it's worth remembering that pf is essentially an injury. There is a tendancy for injuries to improve by themselves.

    One could run a study on surgical would dressings and it would find that over a long enough timescale, they heal regardless of dressings. That doesn't mean a bit of folded up loo roll held down with duct tape is as effective as tegaderm, even if the long term outcome is the same.
     
  21. It does if the variable of interest is the long term benefit.
     
  22. Touche. Perhaps I should have said "is as clinically appropriate as tegaderm".
     
  23. Paul Bowles

    Paul Bowles Well-Known Member

    Why? Wasted breath me thinks....plus who am I to criticize their beliefs or opinions......
     
  24. If it gives the same long term benefit..... and long term benefit is what is key, then given your example it would be.

    Just playing Rob. It highlights the need to ask the right research questions.
     
  25. BEN-HUR

    BEN-HUR Well-Known Member

     
    Last edited by a moderator: Sep 22, 2016
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