New Myth? (computerised measurement)

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In another thread "footfan" asks how we close the gap between research and clinical practice.

In a flyer for an upcoming training weekend (lots of speakers type course) one of the subjects is entitled:

"The need for measurements" linking in with computer equipment etc.

For me one of the reasons for the widening gulf is such bald (and i mean hairless) claims behind the title on the flyer. In all fairness it may be that the speaker has a particular context in mind but often I hear this phrase spoken as though before computerisation came along we were backwoods men.

Certainly speak about the value of computerised measurements of gait or foot pressures (and put that in context) but please can we be careful about developing a new podiatric myth that we need computerised gait scanning measurements in order to do quality biomechanics or produce "an accurate orthosis". There are times when it can be helpful but please do not let it become the generalised "gold standard" I hear it being called.

It is but another tool and has a context but it is not a necessity to effecting good results. Still, saying that it is "needed" could be the equivalent of drug reps selling their wares.

It just makes my blood boil for 3 reasons:

1. That some pods are going away from becoming or doing excellent clinical biomechanics because of a set of voices that suggest that this may be the only way of doing "proper" biomechanics

2. That pods may be conned into buying expensive equipment to do a job when they do not need it in their context

3. It continues to reinforce the idea that clinical biomechanics is a complex thing to do


Certainly a hospital might want to look into pressure analysis systems for "at risk patients" but this narrows the search down quite a bit. For our general population though, who many of us more than adequately treat for biomechical concerns, such things are not needed

Rant over with and I await the mortar shells. Sometimes you just have to say as you see it!

Ian

 

I can not understand why we should use "computerised gait scanning measurements in order to do quality biomechanics or produce an accurate orthosis", since there is no consensus about foot mechanics and pathophysiology

I use a computerised gait scanning myself, but it is only a helpful tool (if you know how to use it)

 

The need for computerised measurement (in-shoe or platform) may or may not be important to do foot orthoses better - we just do not know yet. If you did it, are the outcomes for the patient better - we just do not know yet. If you did it, is your bank balance better? --- probably as the technology impressed the patient enough to open their cheque book

At the end of the day, we do not definitively know which parameters need to be changed with foot orthoses to achieve positive clinical outcomes (...and its NOT the pattern of rearfoot motion), though we are getting closer to a better understanding. It may or may not be the case, that the parameters that need to be changed with the foot orthoses can only be measured with computerised systems - we just do not know yet.

 

A podiatrist does not need computerized gait analysis to be a very effective clinician in the treatment of mechanically-based problems of the foot and lower extremity. As long as the podiatrist has an excellent knowledge of foot and lower extremity anatomy, understands basic mechanics concepts, understands the normal and abnormal mechanical function of the foot and lower extremity, can perform clinical tests effectively, can do a good visual walking and running gait examination, and understands the principles of effective foot orthosis and shoe therapy, computerized gait analysis is unneccesary for at least 95% of the pathology that is treated on a daily basis by the podiatrist specializing in biomechanics. However, for the podiatrist that either wants additional information, needs additional help with diagnosing mechanical pathologies, or wants to appear to the public as if they are technologically advanced, computerized gait anaylsis systems may be very useful in clinical practice.

 

Hi all

Sorry if I ranted a little. I just find that the marketing of such things in the UK seems to be "this is more accurate", this is the equivalent of "having glasses prescribed". Not just by pods marketing their skills but, by implication, hospitals feeling they have to invest in expensive equipment because it seems to be the "gold standard".

Talking with a physio who felt she could not get into podiatric thinking about biomechanics because she felt it was so complicated (???) but she would like to look at the modern computer approaches. Why? It gave the impression of being reliable and accurate.

My concern, I suppose, is that as some of the myths in podiatry are exploded, people are clinging to or creating others.

Ian
because it seems stuffmachieray

 

I am always amazed that "professional" people in a "science" based profession can get blinded by the marketing hype of the use of technology. The way some justify its use amaze me - the "religious" type fervour used by the proponents of systems (not just computerised pressure systems) rather than sound rational arguments based on a rational view of the evidence as opposed to some sort of "blind faith".

I regularly refer students to the thread on Extracorporeal Shock Wave Therapy, and more recently the threads on Rothbarts Insoles and Is there a link between infertility and abnormal foot motion for perfect examples of the "blind faith", "religious type fervour", "the spin" and lack of rational argument about a belief. I suggest they look at the type of arguments used by those supporters ---- they have common themes running through them. Look especially at the lengths they go to to discredit an opposing view or peice of evidence --- yet fail to apply the same stabdard of scrutiny to the evidence that appears to support their view (usually when the same standards are applied the supporting evidence fails miserably)

I feel really proud of students when the "education" rather than "training" (ie brainwashing) we give them, so that when they follow threads here they have the tools and comment to me in a way that shows they have seen through the "religious fervour" etc (though they may or may not agree with what I said).

I am not for one minute suggesting that compuerised technology should not be used, its just the "spin" that goes with it.

 

Craig

To paraphrase

>I feel really proud of my students when the "education" rather than "training" (i.e. brainwashing) they were given allowed them to progress in patient care with the skills to comment in a way that demonstrated they saw through quasi science and sales rhetoric, etc (though they may or may not agree with what I said).

Me thinks this should be tattooed on every educator's chest, and I shall have this (with your permission) as my epitaph.

Use of medical technology is alluring and attractive to podiatry for a myriad of reason. The drive being we are a discipline of independent budget holders in the main and there is an obvious window of opportunity for companies to entice practitioners to incorporate new technologies into modern practice. This is reinforced by clients who are comfortable with the inclusion of feedback which helps them comprehend what may be the problem. Further parity of esteem with peers and competitors drives the need to be competative with the inclusion of medical technology. To that extent inclusion of gait systems may be seen as consumer driven.

Medical technology is expensive and as a profession we are not known to invest in our office furniture and paraphenalia as much as other discilines, so inclusion of new technology often is a considered addition which is unlikely to be replaced in the short term, Quite naturally great confirdence is placed on purchase or rental of equipment and companies targeting the market are well aware of this, and use it to their advantage. After all that is why they are in business.

Unfortunatley technologies are not yet sophisticated enough to provide an all encompacing panacea, albeit taken within their confined parameters medical technologies available to podiatrists can be illuminative and help the clinician and client better understand potenial cause and effect. Clearly conditons apply, however and it is a question of podiatrist beware. A good understanding of mechanics and scientific principles will pay dividents when it comes to choosing equipment.


What say you?

Cameron

 

Beware the person who calls themselves an expert!

A couple of years ago at the Ideal Home Show in Earls Court London (England) a Canadian Orthotics company were using a US$2000 (ie Low level) foot pressure system to explain to consumers why they had back pain, knee pain, etc and why they needed "Orthotics". Look at the Red bits on the computer!!! Their booth was strategicaly placed upstairs so of course visitors had knee pain and back pain - they had been walking on concrete for 3 to 4 hours before they got there. They sold 20 pairs a day for 10 days at £200 a pair. The insoles would have cost them less than £5. Good business and they would have moved on before the complaints came back.

A differently named company was there last year doing the same thing. Podiatrists can debate foot function and science for the next 50 years but the General Public will still buy snake oil products.

Ian's first post to launch the thread is interesting in that he is so agitated that sponsorship of educational courses is happening. In an ideal world all Training would be neutral but the reality is that some courses would not happen without commercial interest. Lets hope that all Educators accept their role of training the un-educated and pass on their knowledge in an unbiased way.

At the moment there are some clinicians being trained up who are vulnerable to the hype and sales pitch. They are making clinical decisions based on limited knowledge and are too easily influenced by their trainers.

Until all Podiatrists can be guaranteed to make informed judgements from the foundation of their background knowledge and Continuous Professional Development the Profession itself is vulnerable to quackery.

Now there is a thought for a Monday Lunchtime.

Kind Rgds

Jamie