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Thought everyone would like to know Neil Smith will be presenting his Foot Alignment System (FAS) on The New Inventors on Channel 2 next Wednesday 21st March. For those who haven't heard about it, Neil has developed a system that allows corrected weightbearing casts to be taken.
Quick correction. Its actually on the week after, so the 28th March.
LL, We have been using the system for some time....hence know Neil quite well.
I guess the biggest benefit is that the lab has no additions to make, so the cast that is produced by the podiatrist is what the orthotic is produced from...This gives you a better control on what you get back.
The other major advantage is that it works on force. So by applying a supinatory force to the foot via the machine (as an orthotic does) the foot moves to a similar position to the resulting orthotic shape.
There is also the obvious benefit of better overall orthotic shape, as there is no need for any lateral expansion to be added.
In a way it still relies on NSCP, the idea being to crank the foot up till it gets to neutral, but atleast you know that the resulting orthotic will go close to getting to that postion. (I say close as it still requires some experience to get a feel for the machine....difficult to explain in short here)
Quick correction. Its actually on the week after, so the 28th March.
LL, We have been using the system for some time....hence know Neil quite well.
I guess the biggest benefit is that the lab has no additions to make, so the cast that is produced by the podiatrist is what the orthotic is produced from...This gives you a better control on what you get back.
The other major advantage is that it works on force. So by applying a supinatory force to the foot via the machine (as an orthotic does) the foot moves to a similar position to the resulting orthotic shape.
There is also the obvious benefit of better overall orthotic shape, as there is no need for any lateral expansion to be added.
In a way it still relies on NSCP, the idea being to crank the foot up till it gets to neutral, but atleast you know that the resulting orthotic will go close to getting to that postion. (I say close as it still requires some experience to get a feel for the machine....difficult to explain in short here)
It seems as if the Foot Alignment System (FAS) is a form of weightbearing casting, and, as such, will greatly alter the soft tissue contours of the plantar foot in the cast. This may be good or bad, depending on the patient and what their pathology is. Unless the orthosis lab you use doesn't know how to make specific corrections accurately, then I don't see the point of trying to alter the shape of the soft tissue contours of the negative cast while taking the negative cast when the same process can be done quite well and quite consistently by a good orthosis lab.
Secondly, please explain how the FAS changes the way an orthosis works on the foot...."by force"? Are you saying that the FAS system will allow a foot to get closer to neutral while standing on orthoses made from the FAS system than when I make orthoses from a neutral suspension negative cast? Please explain.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
As far as soft tissue contours go, not having to worry about adding a lateral expansion removes any chance the lateral border of the orthotic won't match the lateral border of the foot. Yes, a good lab should be able to do this, but often i find lateral expansions end up dead straight, rather than contouring with the lateral border of the foot. The other point is it removes that step from the orthotic manufacturing process. If for what ever reason you need something added, then this is still possible, but rarely needed.
The best way i can think to describe it is that the FAS applies a vertical force to the foot in the same way an orthotic does. So by winding up this force on the foot (through the medial heel and sustentaculum tali area for example) the foot behaves as it would in an orthotic that was applying the same force. This means you get all the soft tissue changes captured in the cast. (compression of the medial heel etc) And therefore, a more comfortable device.
I doubt that the machine would be "more" accurate as you would be in conjunction with the Lab you use Kevin, however it would be interesting to compare 10 casts by you sent to 10 different labs. And thats where the FAS has a real advantage, as the cast that you take on the machine could be sent to any lab and the resulting orthotic shape will remain the same as you saw in the cast.
Cheers
Tom
Last edited by PF 3 : 19th March 2007 at 03:53 AM.
The best way i can think to describe it is that the FAS applies a vertical force to the foot in the same way an orthotic does. So by winding up this force on the foot (through the medial heel and sustentaculum tali area for example) the foot behaves as it would in an orthotic that was applying the same force. This means you get all the soft tissue changes captured in the cast. (compression of the medial heel etc) And therefore, a more comfortable device.
Tom:
First of all, I highly doubt that the FAS applies forces through the foot "the same way an orthotic does". Do you have any references that show this, is this something you were told by the manufacturer of the device or is this just something that you measured on your own??
Secondly, does the foot actually behave on the FAS as it would on an orthosis? How about dynamic gait? How does the FAS simulate the dynamics of gait??
Finally, how do you know it is desirable or therapeutic to have "all the soft tissue changes captured in the cast" and how do you know that "a more comfortable device" is achieved? Do you know this from someone else's research, your own research or is this just a guess??
Tom, do you have a financial interest in the Foot Alignment System? Sure sounds like it to me.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
my name is Neil Smith and I'm the inventor of the FAS and all your points are very valid. It's probably more appropriate for me to respond rather than Tom at this point and he definatly doesn't have any financial interest in the machine.
The only way to measure the force of the orthotic is probably with an F-Scan, which has never been done. I would be more than happy to do so. It would be an interesting study to see if it makes any difference with a corrected WB orth. The weight distribution on the orthotic should be more even.
There was a study on control, comfort and fit done by Craig Payne on 23 Podiatry students, compairing orthotics made from non-WB casts and the FAS. It showed that there was little difference in the control (with the amount of control determined by the practitioner using thge FAS) from the non-WB to the FAS orths, with 22 of the 23 students preffering the FAS orths for comfort and 1 having no preference to either.
The other study done by CP again, compaired FAS casts to non-WB casts. It showed the FAS had more repeatability and less variability than the standard non-WB method. Didn't matter if you were a second year student or practising Podiatrist, result was same.
Because the practitioner has total control over how much vertical force is used on the foot when aligning the R/f, MLA and F/F whilst the patient is standing, they will see what the orthotic will do to the foot before it's made.
Again more research needeed to show what the difference is from the casting position to the orthotic position made from thee cast. Did a pilot study years ago with some Pods with great results but nothing further done.
The FAS cannot simulate the dynamics of gait although the patient does step down, and out of the cast to get out of the mould.
I log on to the arena most days to see whats doing in podiatry and without a doubt you are (I believe) the king of this site and would never want to get on your bad side.
The FAS was invented because (as a technician) I could never understand why balance, pour, block and modify a cast to mimic what the foot shape should be, in a corrected WB position.
I would love you to do research on the FAS and I'm sure you'd find it very interesting to work with.
my name is Neil Smith and I'm the inventor of the FAS and all your points are very valid. It's probably more appropriate for me to respond rather than Tom at this point and he definatly doesn't have any financial interest in the machine.
The only way to measure the force of the orthotic is probably with an F-Scan, which has never been done. I would be more than happy to do so. It would be an interesting study to see if it makes any difference with a corrected WB orth. The weight distribution on the orthotic should be more even.
There was a study on control, comfort and fit done by Craig Payne on 23 Podiatry students, compairing orthotics made from non-WB casts and the FAS. It showed that there was little difference in the control (with the amount of control determined by the practitioner using thge FAS) from the non-WB to the FAS orths, with 22 of the 23 students preffering the FAS orths for comfort and 1 having no preference to either.
The other study done by CP again, compaired FAS casts to non-WB casts. It showed the FAS had more repeatability and less variability than the standard non-WB method. Didn't matter if you were a second year student or practising Podiatrist, result was same.
Because the practitioner has total control over how much vertical force is used on the foot when aligning the R/f, MLA and F/F whilst the patient is standing, they will see what the orthotic will do to the foot before it's made.
Again more research needeed to show what the difference is from the casting position to the orthotic position made from thee cast. Did a pilot study years ago with some Pods with great results but nothing further done.
The FAS cannot simulate the dynamics of gait although the patient does step down, and out of the cast to get out of the mould.
I log on to the arena most days to see whats doing in podiatry and without a doubt you are (I believe) the king of this site and would never want to get on your bad side.
The FAS was invented because (as a technician) I could never understand why balance, pour, block and modify a cast to mimic what the foot shape should be, in a corrected WB position.
I would love you to do research on the FAS and I'm sure you'd find it very interesting to work with.
Cheers,
Neil
Neil:
Thanks for responding. I'm here in Belgium now with Craig Payne and I'll ask him about the device. The FAS certainly sounds like an interesting device and I can see it may have some potential for many practitioners. However, I would need to see it at work to better understand its merits and limitations.
My reason for responding to Tom was to ensure that his anecdotal statements regarding the FAS were moderated with some points that would
help keep the discussion more objective.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Hi all,
I have been using the FAS for 2 years now and have no financial interest in the system.
I have really enjoyed using the system and found one of the major advantages is the vertical reference mark you make on the cast before removing it from the person's foot, this way it makes it possible to see any deformations that have occured from the time you have marked the cast, to the time the foot is removed from the cast, also by the time the cast arrives at the lab ( however well it has been packed) if there are deformations in the cast they may be revealed by alteration of the vertical reference point.
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I've just spent all day explaining to patients that watched that show why a non-weight bearing cast is just as good, if not better than the FAS (IMHO).
What a frustrating day...but it just shows the power of the media.
Any publicity is good publicity for podiatry - more people should be out there sticking their heads in the limelight.
Good on you Neil for giving it a go anyway, even if I do disagree on the philosophy of it all.
I sympathise with LL. I spent 15 minutes on the phone with a new patient who'd watched this show, haranguing me about the way I cast my orthoses and whether it was appropriate for her needs. (Most of this time was spent explaining that I couldn't really tell her needs until we'd at least met in person). Guess I'll have to check the link.
I sympathise with LL. I spent 15 minutes on the phone with a new patient who'd watched this show, haranguing me about the way I cast my orthoses and whether it was appropriate for her needs. (Most of this time was spent explaining that I couldn't really tell her needs until we'd at least met in person). Guess I'll have to check the link.
Richard
Remembering an 'old timer' upper limb prosthetist telling me of the hell that was the time just after Luke Skywalker got a 'new' arm in Star Wars
__________________
''The bottom line is too many people prescribe devices who haven't got the faintest idea of what they are doing. There are certain unscrupulous labs supporting this. There are too many people in it for the money.'' paraphrasing Simon Spooner
The FAS was invented because (as a technician) I could never understand why balance, pour, block and modify a cast to mimic what the foot shape should be, in a corrected WB position.
Neil
I can't understand it either. More additions to a plaster mould = more human error. Repeatability must be very average.
I am guesssing that there is little modification to the cast once done in FAS.
Neil, is there anywhere in Melbourne that this gizmo is displayed? Wouldn't mind looking at it close up. Also wouldn't mind looking at the positive moulds produced.
I have been using the FAS device for over 3 years. I thought I would explain how I have used the tool. I have no financial or any gain from the FAS device. The FAS devcie is supported by Neils lab which produces orthosis from casts taken from the FAS. I am not obligied to use the FAS device or Neils lab. If I cast on the FAS device then the casts are sent to Neils lab. The cost of the orthosis are the same as any of the other labs I use.
I found it a very useful device in helping me to understand to static effect an orthotic may have on the clients foot. For example, I can invert the rearfoot, plantarflex the 1st ray, and then see the effect 1st MPJ function, and hence possible windlass effect. Other things I look for include knee position, hip height, and other postural indicators generally, and subjectively the client can provide feedback as regards to general comfort.
I don't cast everybody on this devcie and it does have its limitations. the very elderly or those with hip/knee restriction can not easily stand on the device (although is could be overcome. Another area I have found limition is with the grossly pronated foot. Because many of these clients have large navicular drift, often the orthosis may want to wrap up to the navicular. The cast produced by the FAS device is very shallow, and does not easily accomodate this orthotic style.
The main advantage is I can easily see a force is being applied rearfoot, midfoot, or forefoot and the is relative to the device. This means I can idividualise that force for each client and capture that force as represented in the cast. I get instant feedback, as does the client. More research is required.
This TV coverage has stimulated debate which can only help better our knowlege on how orthosis may apply forces to feet.
The FAS system certainly seems to be a step toward the future of orthotic casting. The next step would be to create an FAS that is more dynamic by incorporating it into an elliptical motion type machine so the person could simulate walking. If the foot bed was adjusted underneath in several strategic spots to create varus/valgus/ first met cutout etc then walking could be simulated during motion on the machine, information can be gathered similar to gait analysis sensors that are currently used to measure force and pressure and that information could be incorporated in the casting. This would help avoid creating orthotics that may beautifully correct people's feet but then cause intolerable back and hip pain.
FAS on The New Inventors 21st March
Linear Mode
