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talk for sports physiotherapists

Discussion in 'Biomechanics, Sports and Foot orthoses' started by wenyanhu, Jul 8, 2009.

  1. wenyanhu

    wenyanhu Welcome New Poster


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    Dear all,

    I will be conducting a talk for sports physiotherapists on podiatry orthotic intervention. I understand these physios know about pronation and they do refer patients to us. They are a big help to us but sometimes unfortunate cases arise when they start modifying the insoles we give to patients without having ample knowledge on modifications.

    I do plan on giving them a general overview of the array of modifications we do for different patients if need arises eg met dome, heel raise, morton's extension, and on what basis we give them such modifications and when such modifications are no-nos

    I would like to seek help in finding out what useful information a podiatrist can provide them with in terms of orthotic intervention, for example, any common mistakes/ or myths physios make/have with managing lower limb musculoskeletal problems? Or what areas are physios most keen on learning from us? Perhaps those who have experience working with physios can help. appreciate any input!

    Thanks!

    Kind Regards,
    yen
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Those who have been to a Boot Camp, know the mental list we build up of things to talk to physiotherapists about:

    1. You can not heat mold shank dependent prefabs (how can anyone keep a straight face when they teach this?)
    2. Do you even check the shank of a shoe before using a shank depedent prefab (guarantee that they don't)
    3. The two most well designed and carried out RCT's that show foot orthotics work in patellofemoral pain were done by physiotherapists
    4. Pronation is not a problem (have you even read the evidence?)
    5. They love the Foot Posture Index (I can't quite work out why?)
    6. Do they check the subtalar joint axis when doing inversion and eversion muscle strength testing? (think about the importance of lever arms)
    7. Do you know when the intrinsic muscles actually fire during gait? How can strengthening them make a difference to foot pronation?
    8. Show them jacks test before and after putting on low dye tape --- that always impresses them!
    9.
     
  3. Griff

    Griff Moderator

    Yen,

    Having been on the boot camp I was thinking about an answer to this question but Craig has been far too thorough and conclusive in his reply for me to be able to really add anything extra of any value to his points.

    Don't make that mistake. I recently gave a talk to a room of Physios and their knowledge began and ended at using a Vasyli to keep the foot in 'neutral'. In the end I spent an hour discussing sub-talar neutral theory, basic intro to sub-talar joint deviation (SALRE) and then orthotic device considerations (i.e. is the prefab they use a rearfoot or midfoot device and when is each appropriate etc).

    I would say 70% of the room didn't get it, and went back to their practices the next day and changed nothing. Maybe 25% seemed to grasp it (given their intelligent questions) and hopefully now realise why some prefabs are blistering the bejesus out of their patients MLA's. 5% were silent so either asleep or indifferent to the whole thing.

    Either way I guess my point is that maybe some time would be better spent ensuring they understand when orthoses are appropriate and how they exert their effect, rather than just talking about orthotic modifications such as met domes and mortons extensions (will this really be of use to a physio?)

    Let us know how it goes

    Ian
     
  4. Foot Lady

    Foot Lady Member

    Yen,

    I worked with a sports physio yesterday and one of the key points he kept asking me to explain were the different compensation mechanisms that lead to pronation eg ankle equinus, tight hamstrings, forefoot equinus, tibial varum and more. Again he was under the impression that every pronated foot needed to be corrected!! Following our discussion i told him that one of the tell tale signs that he has blocked necessary pronation is blistering under the arch, a bit drastic i know but i was trying to shock!

    Now i have written this i am sure this is what Ian was saying above too!! i wrote it so i will post anyway, don't often post a reply, need to get into the habit!!

    I hope the course goes well, is it to UK physios?

    regards Kate
     
  5. Craig:

    I don't think I would make this exact statement since it is potentially misleading. It is more fair to say that the motion of pronation, by itself, may or may not be the problem causing the injury within the foot and lower extremity in a patient. However, as it is excessive pronation moments that are the cause of abnormal pronation motion, then it is abnormal pronation moments acting on or within the foot that are the likely cause of many of the injuries we commonly see within the foot and lower extremities of our patients.
     
  6. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I on the road, so had to keep messages short (its 5.30AM in J'burg) ...what you said is what I meant and thats what I tell them ... they respond well to that.
     
  7. Have a drink with Bart and Simon for me.:drinks
     
  8. Atlas

    Atlas Well-Known Member

    Just prepare some answers for Tracy Grimshaw style investigative probing.

    For example:

    "Instead of orthotics, why not simply retrain the muscles of the arch of the foot. It works on my patients"

    "Peroneal strength, core strength, and proprioception exercises fix most ankle foot conditions....."

    "A hard orthotic made one patint worse once. They dont work. I refer to an orthotist for soft ones...they are much better"

    "Instead of orthotics, give your patient an exercise to strengthen abductor hallucis in combination with transversus abdominus and multifidus".




    Ron
    Physiotherapist (Masters) & Podiatrist
     
  9. moggy

    moggy Active Member

    You could always scare them by going through legal cases where Physios have been sued by top athletes for prescribing the wrong orthtoic!! also you aould be amazed what they don't know! don't be too scared
     
  10. wenyanhu

    wenyanhu Welcome New Poster

    thank you to all for your kind replies!

    To Craig,

    Muscle retraining, interesting. Recently came across a few patients that were given advice relearn their gait eg walk on the lateral column of their feet to prevent pronation. Will definitely touch on that

    To Ian,

    My colleague did a talk on the podiatric assessment of a runner's foot about a month ago to the same audience. So this talk is assuming they have this prior knowledge, prevent major overlapping. Another reason why focus is mainly on orthotic intervention and modification stuff is that we had a few cases of physios doing modifications on our dispensed insoles when patients present in their clinic and causing more pain. However, I do understand where you are coming from, one can't talk about orthotics without discussing the assessment. will look into that.

    to kate,

    not a course, just an hour long lecture to a group of slngaporean physios. will let you know how it turned out to be :)

    to moggy,

    hmm I feel this group of physios still do respect our area of expertise, so i don't think they require the scare tactic as of ye..and sg patients don't really do alot of suing, not in our culture yet.

    kind regards,
    yen
     
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