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What do YOU tell the patients when they need Orthotics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by 7Pod7, Sep 13, 2012.

  1. 7Pod7

    7Pod7 Active Member

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    I have been thinking about effective communication with the patient to improve Orthotic wear compliance. Over the years I have met patients when treated with Customised Kinetic Orthotics, vary somewhat with their treatment compliance.

    I always say to them: You need to have another review in 12 months but invariabelly if symptoms cease they think no more foot deterioration, I'm cured I don't need to continue with them.

    What strategies or wise words do you employ to explain 'Orthotics are often a long term treatment modality'.

    (A Quality Improvement in patient education Question)

    Would Appreciate your comments,

  2. phil

    phil Active Member

    Pain is probably the reason they came to see you. If the pain goes away, why bother continuing to wear them? What's wrong with this?

    I generally advise my patients that "the more you wear them, the better your feet will feel", and "you need to wear them at the right times and for the right activities". I've also been known to joke with some of my patients who return complaining that their feet are sore but they haven't been using their orthotics- "they don't work magically from the bottom of the shoe rack!".

    It's really important to work together and clearly define the parts of the week which they will definitely need to wear their orthotics, and to troubleshoot through any objections or concerns, about footwear, fashion, climate, and numerous ridiculous obsessions and habits!

    How to word this question- "Orthotics are often a long term treatment modality"

    How about - "You might need to wear these forever. Or maybe not. It depends if your feet start hurting when you stop wearing them."
  3. I Usually explain that there are 2 types of orthoses.

    Sometimes we use orthoses like a cast on a broken arm, to help the body to fix an anjury, alongside Muscle training, strength and balance work, stretching etc. Then its a short term treatement and when they are symptom free, I take the devices out. If they remain symptom free, I bid them a fond farewell.

    Other times we use Orthoses to compensate for a structural variation very much like one wears eyeglasses. If you get headaches because of a myopia, and wear glasses, the headaches will go away. Stop wearing the glasses, they'll come back.
  4. efuller

    efuller MVP

    I use the eyeglass analogy. You can get around without using your eyeglasses, but you can see a bit better with them. Now that I'm at the age where I actually need them, eyeglasses really reduce the fatigue. I knew, from personal experience, that orthotics have reduced my fatigue for many years. I've used the eyeglass analogy before I actually experienced the truth in it. Some folks can get around better without their eyeglasses/orthotics better than others.

  5. I routinely use the over-the-counter eyeglass vs prescption eyeglass analogy with my patients. This type of analogy seems to make people best understand some of the differences between prefab and custom-molded foot orthoses.
  6. lucycool

    lucycool Active Member

    I also use the glasses theory.. isnt it funny that so many people use the same thing!

  7. 7Pod7

    7Pod7 Active Member

    Thanks for your replies so far. I also was taught the "eye glass" model but opted out for another one I heard at Uni- "Marionette Puppet" I call it:

    I explain to the patient that since all leg bones are connected, when your limb leans one way so do all the joints and they become under strain. I use my leg as a visual to this explanation. That way they receive a message that their entire limb receives the benefit from realighnment of the foot by an Orthotic.
  8. Griff

    Griff Moderator

    Assuming that orthoses will 'realign' that particular individual of course...
  9. drsha

    drsha Banned


    Great clinical question.

    On one side of this debate is Phil who convictedly states, "If the pain goes away, why bother to use them? (there's no evidence to the contrary, eh Phil?)

    I use Wellness Biomechanics, Functional Foot Typing, Compensatory Threshold Training and Foot Centering Props that are at end goal weaned away or removed after the patient corrects.

    I never make the presenting chief complaint the focus of my IOV or my followups or my long term care.

    I say "I'm hoping that you will someday say that the heel pain that brought you to seek my consultation was lucky for you and your family and friends in that it educated you as to what can be done for you, foot type-specific.

    Nothing wrong with the eyeglass analogy but Foot Typers upgraded it years ago when they invented and perfected Lasik.

  10. Interesting analogy. Lasik abrogates the need for eyeglasses. Does foot typing remove the need for orthoses?
  11. 7Pod7

    7Pod7 Active Member

    I realised that when I started this post I was thinking about Orthotics for structural variation hence long term treatment. Where non compliance played a definite role. You have helped me clarify something here. Like Orthotics can be a short term splint and 2 types of Orthotics treatments clearly exist. It seems I has the 2 treatments a little muddled at times.

    Many Thanks,

  12. 7Pod7

    7Pod7 Active Member

    Your post started to make me think. Thanks for your suggestions.

    Many Thanks

  13. drsha

    drsha Banned


    In actuality, Lasik doesn't always work and if it does, the eye can continue to degenerate where glasses may become necessary as one ages.

    So if your question is abrogate, my answer would be no, except in rare youthful and younger patients.

    We are asking if we can get a human foot to defy grf and other forces and "rise above them"?

    My theory is that if we can place the structural foot in closed chain more towards its Optimal Functional Position , determine the primary muscles that are inhibited or exhausted and train them as better leveraged and more trainable.

    Serial orthotics and advanced training may be necessary to do the job as well as the integration of professional therapists and trainers.

    Over time, W & D's Laws morph the foot towards a stronger and better structured and functioning Truss-Flexible Tie Beam Architecture.
    For me, the orthotic is a prop that doesn't promise to "fix" anything. It promises to reduce pathological TS and muscle engine compensations and make the foot more trainable so that the flexible tie beam can better support.

    It is a team effort that includes the patient.
    I'd compare it to taking 100 9 year olds and training them for ballet. as most of that is anti-grf moments they are being taught
    Do they all end up en pointe?
    Do you find any logic to that?

    In America, DPM's and others are casting a patients in STJ Neutral position, add a 3 degree varus wedge or medial skive with a promise that once you put that in your shoes, your pains will go away and you will walk and perform better.

    Do you find any logic to that?

  14. efuller

    efuller MVP

    Dennis, are saying that American podiatrists don't use logic? I think they do.

    Anyway, the logic for a medial heel skive: In a foot with a medially deviated STJ axis, ground reaction force is more likley to cause a high pronation moment. Structures that resist might be injured, or might become injured and the treatment/ prevention would be to reduce pronation moment from the ground. A varus heel wedge or an orthotic with a medial heel skive will shift the center of pressure of ground reaction force more medially and this reduces the pronation moment from the ground.

    Podiatrists all over the world use this logic.

  15. drsha

    drsha Banned

    I would state that podiatrists all over the world ( I really only know the American marketplace) use this logic even if they don't have to.

    Eric: you continue to be so mean and then you want answers to questions civilly, how dare you?

    So, out of lets say 100 patients in a row that enter your practice with collapsed feet (eliminate cavus feet) or a navicular sag or a low FPI, approximately how many of them get your medial skive?

    In other words, how many of your patients need you to apply a counter moment to their high pronation moment as treatment?

  16. Eric:

    This is a classic straw man argument made by someone who is becoming ever more desperate to convince others that his patented, trademarked ideas are the way forward for our profession. I find it very telling that when roundtable discussions are held in our magazines (i.e. Podiatry Today, Podiatry Management and Foot and Ankle Specialist) with experts in biomechanics and foot orthoses, that no one ever mentions his patented, trademarked ideas. In fact, the only one that ever mentions it, that I have seen, is the owner of the patent and trademark.

    It will be all downhill from here for his patented, trademarked ideas.........into oblivion.
  17. efuller

    efuller MVP

    Now I understand your In America qualifier.

    Mean, really? From the stuff you have dished out, I was sure you could take it.

    Some feet with high arches have medially positioned STJ axes. So, it wouldn't be fair to exclude them. I haven't kept statistics on how often I use a medial heel skive. My sense is that it's about 50-60% get medial heel skives and 10-15% get lateral heel skives and the rest get a symetrical heel cup.

  18. Here's something which I wrote recently:
    "If new theories have evolved in podiatric biomechanics, it is hopefully because deficiencies in the existing theories have been exposed through scientific study. This is a healthy state for our profession and shows that the scientific method is being applied. However, there also seems to be an element of podiatrists who are attempting to develop their own theories of podiatric biomechanics in order to patent examination techniques, “foot-typing” systems and orthoses designs. Such systems are, in my opinion, often reductionist and retrograde steps within the evolution of podiatric biomechanics and moreover, are frequently driven by motives relating to the financial aspirations of the individuals concerned, rather than the enhancement of podiatric biomechanics."

    This will form part of a published works soon. I trust that I am welcome to my opinion.
  19. David Wedemeyer

    David Wedemeyer Well-Known Member

    This is exactly why foot typing doesn't work, not every high-arched foot supinates excessively at the STJ. Dennis may believe so, his post is an illustration of that.

    The reality is that we see a number of those feet in between. Over the years I've encountered a good number of high arched feet with a medially deviated STJ axis and a good degree of mid and forefoot joint flexibility that pronate in gait. Often these are my problem patients who arrive with a bag full of orthotics in hand accompanied by a script terming their foot 'cavus' and requesting the same flawed devices as the ones in the bag. The same goes for MASS position.

    If your exam procedure consists of a non-weightbearing "typing" of the morphology of their feet it does not translate well to the foot on the ground in weightbearing. Also, the "this is the best position for all feet to function in thus we cast it in this position" is similarly a reductionist philosophy. Foot typing in general does not correlate with the active gait exam and gives physics the day off entirely. Can't be bothered with GRF, if it looks like A it must act like B.

    Prescription orthotics are entirely individual, there is no one best method, material, casting position or even behavior based on shape. FFT is only appropriate for prefabs and even then I have to ask why?
  20. David Wedemeyer

    David Wedemeyer Well-Known Member

    Do you go to the gym just once? How is that one day, low carbohydrate diet working out for you?

    I tell patients that all good habits are reinforced over time and so it is with the body. Meaning that foot orthoses cannot change the structural or biomechanical faults that created your complaints, they can however keep them from causing recurrent issues or alleviate them entirely if worn regularly.

    No analogies necessary.
  21. drsha

    drsha Banned


    I'm sorry that The Arena Bullies have diverted your thread. I no longer respond to Dr Kirby wishing me to oblivion or others comparing me with Hitler. I have better things to do. All I did was answer your query with how I present orthotics.

  22. 7Pod7

    7Pod7 Active Member

    Thanks for your kind words,


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