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EVA wedging above 5°

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Lisapodgirl, Aug 19, 2009.

  1. Lisapodgirl

    Lisapodgirl Welcome New Poster


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    Hello to all, I'm new to this site, so please excuse me if I'm repeating a previous thread. The question I have is ...does anyone know of any companies that make EVA wedging above 5°?
    I recently attended the Biomechanics Summer School '09 and listened to Paul Harradine’s talk about MOSI skive and the chair side devices he makes within his clinic. Personally I was impressed with the degree of control you can get with such a simple chair side device and have since had a lot of success with this type of posting as have some of my colleagues. The problem however is that this technique does require (in the majority of cases) use of a whole strip of wedging per pair of devises! Which as well as not being particularly cost effective, a lot room required to stock such quantities of wedging within clinic. At present our trust is ordering in 3° & 5° only. Therefore in an attempt to try to keep costs down and to reduce the amount of strips needed I enquired with ‘Algeos’ whether they produce wedging of above 5° and unfortunately they don't. They did however say that if we were ordering in excess of 10,000 strips they could possibly look into it (a big order indeed!).
    So to summarise my question is … does anyone know of any companies that make EVA wedging above 5°? Has anyone experienced the same problems? …and…Are there Podiatrists out there who would want companies like ‘Algeos’ to produce EVA wedging above 5°? Is there a demand??? :wacko::wacko::wacko:
     
  2. Hey Lisa

    Best way to get wedging strip in bigger angles is to make your own. Strip of EVA. Grinding machine. Not too tricky.

    If you really want some done for you I'll do it if you like but strikes me that it would be easier to make your own. If you want some done email me on footprintsorthotics@googlemail.com with your specifications.

    When I'm doing that kind of skive on a flatbed or with a freelan I'd go for a low density EVA rather than High density BTW. Be more forgiving and soft enough to cut chairside.

    Which trust are you with BTW?

    Regards
    Robert Isaacs
     
  3. Lisapodgirl

    Lisapodgirl Welcome New Poster

    Hi Robert, you actually know me young man, we were in the same year at Uni … Jervis is the name ;). Currently I’m working for East Coast Kent. The problem is I don't have a grinding machine within my clinic, and am only at the Lab once a week when I have full clinics, so really not really practical for me to keep doing that. Just a shame these companies don’t offer wedging in higher degrees!?! Hope your keeping well :)
     
  4. David Smith

    David Smith Well-Known Member

    Hello Lisa

    Strips definetely come in 3 4 and 5 dgs as standard. So if you want 7 dgs add 4 and 3 if you want 9 dgs add 5 and 4 and so on, you get the picture. How many strips do you want to store? you can get hundreds in a small draw! And how are they not cost effective when they are only a quid each? Its the whole premise of using temps that is not cost effective.

    Here's my opinion and I realise its probably trust policy to try the cheap option first but I would say stop faffing around with chairside bits of felt and sticky tape and freelens and just make them some proper orthoses. I believe this is the really cost effective way to manage biomechanical problems. Not, make a temp pair see how it works alter it several times until the patient gets fed up and doesn't return or the temp falls apart and needs fixing and eventually you go for a proper bespoke or one of Roberts simples that actually do something and last or at least a good OTC.

    I rarely see the point in making temp orthoses.

    Just my opinion tho

    Regards Dave

    Cheers Dave
     
  5. Pod on sea

    Pod on sea Active Member

    Hi Dave
    If the custom-mades cause problems/aren't tolerated etc and you are in private practice, you could end up with a very hacked off patient who has spent a lot of money.There's no right or wrong way but what does everyone else do? Temporaries or custom-made at first consultation?
     
  6. The assumption that orthoses may be "tested" first by making a temporary chair-side device is somewhat flawed. Since the mechanical characteristics of the temporary device will not be the same as a prefabricated or custom foot orthoses. I'm with Dave, you'd save a lot of time and money (remember time is money) by putting the patient in a decent device in the first place. Similarly, if I want bigger wedges I stick two together. Life is way too short to be trying to grind your own.
     
  7. Ian Drakard

    Ian Drakard Active Member

    That's down to how you manage it. It doesn't mean you have to offer a money back guarantee (we all know about one place that did that ;)) but it might mean you have to apply some more time and effort when you don't get right first time.
     
  8. Pod on sea

    Pod on sea Active Member

    In your experience, does the patient undertaking a program of targeted lower limb stretching and strengthening affect your orthotic prescription, and would that be an arguement for supplying a temporary orthotic initially? Has anyone done any research on this ?
     
  9. jabr

    jabr Active Member

    Agreed wholeheartedly, plus the risk to the image of our profession by handing out these often flimsy ineffective temp devices for every GP and orthopod to scoff at and the impression given to the patient that "oh i've tried orthotics, waste of time", which might stop them ever trying a real pair. It is beyond me why anyone working for the NHS or private would issue a Freelon with a heel wedge and SCF D'filler instead of issuing a £20 pair of Interpods or similar. :bash:
     
  10. The podiatrist that can provide their patients with a nice looking custom foot orthosis that lasts for years, relieves their foot and lower extremity pain, and makes them feel more comfortable during weightbearing activities will, after time, soon be getting referrals of the friends and relatives from these same patients who will also want custom foot orthoses. These pleased patients will proudly show their custom foot orthoses to their friends and relatives and tell them to go see the podiatrist that made the custom orthoses for them.

    On the other hand, podiatrists who prefer to do "piecemeal orthoses", of adding shims and pads to over-the-counter orthoses in never-ending patchwork will likely never get to experience this excellent practice-building good-will from their orthoses because 1) their orthoses look like **** (i.e. like something that an amateur would make) and 2) their orthoses are always changing over time.

    Therefore, how you want to be viewed within the medical community and how busy you want to be with pleased patients may directly influence on which type of foot orthoses you recommend to your patients as a podiatrist. Simon and Dave are right, you are much better doing custom foot orthoses if you want your patients to think more highly of your skills as a foot specialist and you want to have a thriving bioemechanics practice.
     
  11. Sammo

    Sammo Active Member

    Whereas I agree that many temporary orthotics are not neccessarily wonderful, respectfully in my opinion, I don't believe the above is not neccessarily the case.

    I have had successes with a chairside devices and little bits of EVA that have cost the patient $10 after they have failed with a "proper" orthotic costing $400. It all depends on what you are trying to achieve . If it is an acute injury then a temporary device as part of the treatment plan can work well. If it is a really quite unusual foot, again something I can knock up in 20 mins can be really effective.

    I agree with Simon though that using a temporary orthotic to see if the custom made orthotic would work is a waste of time.

    I think it comes down to knowing what the most effective tool is for the job, and sometimes due to financial constraints the "best" is not neccessarily the best.

    As Mr Donald "Duck" Dunn says in the Blues Brothers: "If the sh*t fits, wear it."
     
  12. boredone

    boredone Member

    Hi Lisa,

    If you contact me at Langer / RX / TMC I will arrange some strips to be produced for you in whatever degrees you prefer. Definately won't need to order 10,000 !

    Adrian Bishop
     
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