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Things that annoy me, part 1.

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Jan 28, 2015.


  1. Members do not see these Ads. Sign Up.
    Not going to be here for ever, so I wanted to start listing these:

    Tick boxes on the "prescription forms" that labs provide which state something along the lines of: shell material- flexible; semi-flexible; rigid.

    Cobblers, trouser-taters and a bit more bollox. Meaningless none-sense. Unfortunately, the tail has been allowed to wag the dog for too long here.

    "arch fill"? Minimal; Moderate; Maximal? - you got to be kidding me.

    And obviously: "Lab's discretion".
     
  2. Lab Guy

    Lab Guy Well-Known Member

    Simon, what should the ideal lab form include?

    Many of my customers fill nothing out and simply write "Steven, call me".

    Steven
     
  3. Your phone number, so that they call you; that way they pay for the call.;)
     
  4. Lab Guy

    Lab Guy Well-Known Member

    On top of my list are people that have closed and locked their small minds with their rigid beliefs whether it be biomechanics or any other subject.

    Building a belief system is akin to building a sand castle on the beach. Sand can be added or removed just as knowledge to a particular belief can be added or discarded.
    The sand castle is open to change; change for the better, change based on the evidence of the current time.

    It is when the sand castle is built not with sand but with bricks and mortar does it stay resistant to change. Its fortified walls prevent new ideas from coming within so the old ideas within the castle can be safe and protected.

    I like what Craig Payne writes frequently, "I go where the evidence takes me". It is that kind of thinking that allows us to always continue to build and reshape our sand castles.

    Steven
     
  5. Tkemp

    Tkemp Active Member

    When a client asks for an identical pair of orthotics to their 10yr old ones that have worn down and no longer represent any known device. hahahaha.
    God love the Lab that dealt with the returns and adaptations! They were so patient.
     
  6. rdp1210

    rdp1210 Active Member


    Steven,

    Isn't there something between these two dichotomies. The important thing is to be flexible, but not easily blown over with the latest "evidence." Evidence is cumulative, and of course it is important that one consider whether the new evidence really negates the old evidence. That is why the most important part of any article is the methodology section. And of course it is important that the reader not accept the conclusions that the author has made, but instead really analyze the data presented to see if they come up with the same conclusion.

    An important example is all the discussion about the movement of the MTJ, and how many axes there are. Much of the discussion on this forum has been more like the seven blind men discovering what the elephant is and making their models. Yes the elephant can be modeled as a spear, but it can also be modeled as a snake, a tree-trunk, etc. Everyone takes their favorite researcher or author and then builds their little castle around that author and protects it from attack, instead of trying to see if the two castles can be merged into a larger castle that can hold all the evidence, and with the realization that there is more evidence to come.

    While Simon may be correct in his lamentation about the quality scale of arch fill tick boxes, as well as other tick boxes, he himself also creates a gap in that he rarely tries to make quantitative clinical measurements. So without quantitative clinical measurements, how does he expect to fill in a quantitative lab order form. He's got to start becoming part of the quanitative clinical and laboratory solution, not just keep throwing rocks at the old guard.

    As you remember from the 'old' days at CCPM, all students were taught to make their own orthotics. Such is a rare bird today, to find a clinician who makes his/her patient's orthotics themselves. However, if you really want to learn orthotic prescription techniques (note I did not say learn biomechanics because biomechanics is a lot more than just make inserts for shoes), then make the orthotics yourselves, and welcome every opportunity you get to fix a pair of orthotics as another learning experience.

    Best wishes,
    Daryl
     
  7. Daryl, for someone so concerned with the accuracy of evidence, I find it strange that you are happy to misquote and misinterpret what I said with regard to quantification. What I actually said is that I rarely quantify range of motion. You have taken this to mean that I don't quantify anything clinically- this isn't true. Jeff took it to mean that I do not assess range of motion, nor examine joints- this isn't true either. For the record I quantify various things during my clinical work up, I also manufacture all of my own devices, for research purposes I've quantified how the design characteristics of foot orthoses impact upon the stress and strains developed in the orthoses and developed a number of measurement jigs to better able quantify foot function. Please don't try to paint me as someone who doesn't quantify anything, Daryl.
     
  8. rdp1210

    rdp1210 Active Member

    Thanks for your clarifications. I'm really glad to hear you're making your own devices. I do respect your intelligence and some of the ways you've tried to show stress and strain on orthotics. It would be nice to see such practices universally.

    Best wishes,
    Daryl
     
  9. Lab Guy

    Lab Guy Well-Known Member

    Well said, Daryl, and I agree. I was attempting to convey my annoyance with people that do not even consider the latest evidence; the people that do not seek to educate themselves beyond what they were taught. They become programmed and do not want to explore other software programs for various reasons and then progress becomes stunted.

    My favorite Ad (from Apple):

    “Here's to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can't do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.”

    Steven
     
  10. Ed_Norris

    Ed_Norris Member

    Hi Simon,

    I am at the moment working on designing a prescription form with my partner.

    Would prefer if labs stated the specific material grades that were flexible, semi flexible, or rigid?

    alternatively,

    As I understand many podiatrists prefer to distinguish variously rigid grades of polypropylene and Eva by their colour instead of their specific material number or trade name.

    kind regards,

    Dean
     
  11. Dennis Kiper

    Dennis Kiper Active Member

    orig posted by Simon

    "arch fill"? Minimal; Moderate; Maximal? - you got to be kidding me.

    Simon, you're missing your opportunity to "quantify" your Rx
     
  12. Things that annoy me, part 2: people attempting to flog their dead horses on Podiatry Arena. Stop spamming these pages with your junk Dennis Kiper. https://www.youtube.com/watch?v=anwy2MPT5RE
     
  13. Dean, here's the point: "flexible", "semi flexible" and "rigid" are meaningless terms. If we take the same material and make two different foot orthoses out of it: one high arched, the other low arched, then the deformation that occurs to the two devices will be different with the low arched device deforming more under load than the high arched device under the same load. Viz. The "flexibility" of the material is in part dependent upon the shape it is made into. Moreover, a material which deforms very little under a 4 stone child will deform an awful lot more under a 17 stone rugby player... right? So the material on it's own does not and cannot define the amount of "flexion" nor "flexibiity" that occurs in an orthosis. Probably better to list the durometer and thickness of the un-molded material than claiming it to be "semi-flexible" etc.
     
  14. Dennis Kiper

    Dennis Kiper Active Member

    orig posted by Simon Spooner

    Things that annoy me, part 2: people attempting to flog their dead horses on Podiatry Arena. Stop spamming these pages with your junk Dennis Kiper.

    No dead horses here and certainly not junk. Science based technology predicated on principles of physics. You should take some science classes Simon Spooner or maybe you're trying to come up with a new model for foot orthoses based on more NON-SCIENTIFIC TECHNOLOGY.
     
  15. https://www.youtube.com/watch?v=anwy2MPT5RE
     
  16. Ed_Norris

    Ed_Norris Member

    Thanks Simon,

    I assume you will know this but just for anyone else who does not, the reason the high arches will be more rigid than the low arches is because of the :

    "increased area polar moment of inertia that a high arc has over low arch."

    furthermore it is important to note that as a person chooses a different cross section of a known arch shape to determine rigidity about, they will get a different rigidity due to the different polar moment of inertia of that cross section.

    This effectively makes net rigidity very difficult to calculate unless you use finite element analysis.

    I suspect the overwhelming majority of podiatrists depend on rules of thumb to determine the designs for their patients' orthosis.

    Durometer good idea.

    As for the thickness, many modern orthotic fabrication process allow for varying thicknesses of material throughout the orthotic. The exact material thickness can be specified by the podiatrist or may vary along the cross section.

    Would the best solution be to provide a supplementary datasheet that could be downloaded which quantifies properties of the materials to be selected by the check boxes?

    Best regards,
    Dean
     
  17. Jeff Root

    Jeff Root Well-Known Member

    I think one very important issue missing in this discussion is the practitioner's past experience. Once a clinician has undergone their education and training and has dispensed a number of pairs of orthoses, they get a very good sense of the relative stiffness of orthotic materials. They also should know how foot shape and environmental factors such as extreme heat and cold can influence material stiffness. At Root Lab we indicate the default material thickness for each product on our prescription form and we expect the practitioner to alter it when they want to increase or decrease orthotic stiffness for an individual patient. On the back of our Rx form, we provide a polypropylene stiffness guide that says "This is a general stiffness guide. It does not take into account patient conditions and prescription options that may affect material stiffness characteristics". Based on weight alone, we default to semi-rigid stiffness unless requested otherwise. I don't think that labs should just have a check box for orthotic stiffness based patient weight unless the prescribing practitioner knows what the guideline is so they can vary it accordingly.

    We also have four levels of medial arch fill: minimal, decreased, standard, increased. Customers know from experience how these relative levels of fill will influence the shape of their orthoses. It is important to educate customers and for them to ask for advice if they aren't clear on lab standards and options. It doesn't take too long to gain practical knowledge in orthotic Rx writing.

    Jeff
     
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