Should orthotic manufacture be dropped from Podiatry training?

netizens

Dropping orthotic manufacture would be a considerable saving on most departments' budgets. The skill of orthotic manufacture adds little to the intellectualiation of biomechanics per se and would free up the curriculum.
I would prefer to see the subject as a fourth year elective combined with Lab placements.

toeslayer

 

Hi Guys,
I think the 99% failure rate to make their own is because most of them were never taught enough in the first place in order to have a real chance of being proficient when leaving uni and the overwhelming influence of the faculty in the last 15 years has been to promote the use of labs. And it is certainly in the interests of the labs to promote this. And what a coincidence the lab gets access to all the students.......just one lab for years too????It's very difficult to be the only fish swimming up stream. It is also educationally fashionable to remove things that are expensive to do, and the people who run faculties are under so much financial pressure it is almost irrelevant what they actually think, they just have to keep cutting until the people over them say they can stop.
You'll notice that nobody takes up the other issues I raise about the effects on income when starting a practice or the influence on cost of service to patients in community health centres.....hard to argue with facts.
But yes it is debatable whether pods really need to be very good at this stuff.....it seems being mediocre is OK...and there's little doubt we are heading that way.
regards Phill Carter

 

After having taught an orthotic lab course for several years I can say that many students didn't get 1, 2 or 3 even after having the lab course. You can lead a student to knowledge, but you can't make him or her drink. That said, to facilitate learning there should be some hands on aspect of the student's experience to facilitate learning.

One important sub concept to Craig's list above is that a student should know how prescription variables change the shape of an orthotic. They should also be able to identify those shape changes in an existing orthotic. So, if they need to modify an existing orthotic they can figure out what their patient already has.

I'm not sure that a student has to make an orthotic to learn the above. It perhaps could be taught in a lab setting where there were several orthotics made off of the same cast, but with different modifications so that students could learn both how the modifications change the shape of the orthotic and then would later be able to look at the orthotic and identify the changes.

I feel that a podiatrist who specializes in biomechanics should be able to modify, or have an assistant modify or refurbish an orhtotic. It just seems ridiculous to make a patient wait a couple of weeks for an orthotic to be sent to a lab for a simple modification. If you are going to train an assistant you have to know how to do it yourself. So it might be able to teach these skills without pressing a piece of plastic over a cast. However, there would still have to be some time spent with glue and top cover and posting materials.

If a student wants to make orthotics in their practice they would be receiving an inferior education if they did not have the opportunity to make their own orthotics. I certainly have learned a lot about orthoses by modifying the devices that I wear. When I taught, I encouraged the students to experiment, but so few actually did.

Of course, I'm looking at this education problem through the lens of the tissue stress paradigm. I feel that certain prescription variables should be given in certain situations. A teacher who uses a different paradigm might not even recommend or use some of the design changes that I would use. Another important part of a student's education on orthotics is prescription writing or the choosing which parameters of the orthotic to change.

Well enough musings for now.

Cheers,

Eric

 

I’ve logged in under an anonymous ID as I don’t want this to be about criticism of the university – and they know my thoughts on this already. However, having now just graduated I find this thread very interesting. I was very much looking forward to manufacturing orthotics (thinking through prescriptions, lab work, outcome appraisal etc), but we didn’t ever really get to do anything other than occasional eva posting on slimflex and simple poron with a plantar pad etc.

Having put my bee back in my bonnet, I’m keen to address this lack of knowledge and would appreciate some help and guidance about available courses in the UK. I think I’m starting to get a good(ish) feel for the different biomech theories and which parts to take from Root etc. However I lack the confidence to know whether an advertised ‘orthotics based’ CPD course will be truly up to date or not. Could anyone advise what they feel would be the next step to take? I hope to find NHS work but I will also be working alongside another Pod in a private practice (who is also keen) and therefore hope to have the opportunity to use these skills – maybe not actual manufacture but I would like to be able to cast and prescribe effectively.

I’m pretty peeved to have graduated but not have knowledge of orthotics… at present I don’t just feel like a new pod, I feel like half a new pod struggling to find an identity among other health care professionals!

RobertIsaacs – you mention in post #10 that you train people in chairsides. Is this something you run for pods in general or just local to you?

Thanks in advance for any advice :drinks

 

Just not enough!!

For Theory and "deprogramming" you can't beat Craigs boot camps. Whenever the next one is, go on it.

The biomechanics summer school at heythrop park is sometimes good with a high quality of speakers. It was Simon Spooner at one of these who first really showed me the light many moons ago. However they are pretty heavy and they cram a LOT into 2 days so take red bull and spare biros. First one I understood about one word in 3.

These are the only two courses I can really recommend. I've been on a few but I found the ones run by commercial labs to be very much focused on theory which supports selling their products

Sure, you just have to come work for me (there should be a job coming up). I have been known to run the occasional "biomechanics for the terrified" foundation workshops which are very practical and presume little or no pre knowledge. Its been a while, perhaps I'll do one later this year.

Or if you're in the south east you're welcome to come spend half day in my NHS lab playing with plaster and plastic. Cost you 10 jam doughnuts (tesco's for preference)and 40 teabags (tetley or PG tips).

Regards
Robert

 

Hi all,
I have read some of the opinions for and against orthoses manufacture at university - and I have to agree with those who claim that having a little experience with making a few insoles improves your understanding. Yes our first few insoles may not look fantastic, but i am sure they were comfortable for the patient-if not we modified them. I found it incredibly useful to make 'chair side orthoses' for the patient. We casted, balanced the 'shells', heated the material, and shaped the orthoses with a vac-system (sure you all know what I am talking about). For me this manufacture was one of the 'core' essences of the degree. The only thing I would say would be that I would have liked more guidance with the evidence, as there is a great deal of pseudo science out there. That can put a lot of students off; such as the 'loose weight with orthoses' advert. The point is however that we got a 'feel' for what prescribing an orthoses is like.

I would have wanted more practice, and was lucky enough to get a volunteer position in a hospital out patient clinic for a couple of months. This gave me a bit more insight into the fabrication and prescription of orthoses. I felt that we only touched on the subject of manufacture and prescribing - maybe a good way would be an optional extra module in the third year. Moreover I especially feel that after reading some of the threads here that has shown me how many pathologies orthoses can be used for.

What Craig said about streamlining the teaching seems like a good idea. Breaking down teaching into :

-what are you trying to achieve
-materials
-the evidence especially with RA, seronegative but also sports injuries etc.
-more use of audio visual
-the main orthoses that are used
-and especially; the difference (which has been highlighted in various threads) between running and walking mechanics -

after all that: bless all my tutors at university for managing to cram in everything they did! how can you fit any more into three years; I don't know.

 

From a slightly different perspective, as developer, I learn a lot more from a podiatrist who wants to make their own products than a laboratory that wants to use my system. I think it would degrade the industry if a practitioner wasn't forced at least once in their schooling to not pour plaster and appreciate the work required to make a foot orthotic, and in doing so, earn a few blisters. In fact, the lab referenced most by my new customers has been a lab whose workforce consists mostly of chiropodists. I don't think it's a coincidence.