Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
How many people out there (in the UK) have heard of the field of Pedorthics, there are only six of us in the uk and i am interested in finding out who knows about us and what we do.... I will leave this one open to comments before i explain any more to those who do not know :) :)
I am at present involved in writing the introduction to a textbook, and in the introduction I touch upon the historical development of pedorthics in the U.S.A.
I would be very interested to learn how long the pedorthic profession has existed in the U.K. and what its history is here.
well then Pedorthics, not wanting to bore the world with a dictionary definition but a certified Pedorthist (C.Ped) is trained to use footwear footwear modifications and orthotics as a conservative method of treatment for foot problems caused by injury , overuse, disease, truama, etc. etc. originally started in the US to help people with diabetic foot problems by dispensing shoes and inserts under the theraputic shoe bill
training invoves a course in the US and a cerification exam (requirements have just changed to a longer period of training and more exams and hands on training)
for more information see www.cpeds.org this is the Board for certification in Pedorthics (accrediting body) or www.pedorthics.org membership body.
pedorthics in the Uk is new there are 6 C.Peds at present in the UK I was the first certifying in 2002, two others passed in 2003 and one in 2004 all 3are podiatrists and two more just passed in 2005 both work in the outdoor and ski industry
basically what we do is biomechanical assessment, orthotics and footwear modifications working with either retail style clients or with a prescription form a doctor. the main reason for the post is that most podiatrists do not do footwear modifications or sell shoes, there is a school of thought that says that we are out to rob business from the podiatrists, this is not the case a pedorthist does not diagnose or perscribe, we work as part of the team approach to foot care
How many people out there (in the UK) have heard of the field of Pedorthics, there are only six of us in the uk and i am interested in finding out who knows about us and what we do.... I will leave this one open to comments before i explain any more to those who do not know :) :)
Hi CEM,
I've heard of Pedorthics. IMO an interesting and useful concept, and a great adjunct to podiatry.
Cheers,
davidh
Hopefully not sounding too disparaging here, but many clinicians have made good use of their local cobbler and/or orthopaedic shoe manufacturer over the years for a range of footwear modifications such as balloon stretches, balloon patches, buttress heels, medial flanges, to name but a few.
Obviously footwear is central to many case managements and a competent clinician will certainly avail themselves to local suppliers and manufacturers. Soft-walker in Cumbria is one of the latest smaller shoe manufacturers who are developing a niche market, but it could be argued that Hotter and Ecco – with their removable insoles and variable uppers – incorporated shoe modifications into the volume market some years ago. Custom footwear like Simple Way Shoes have adopted a component build system for years since Dave Price first bought the lasts from Clarks in the late 1970s.
Interesting that pedorthists are moving into prescriptive biomechanics – perhaps seeking to develop their own niche market a little further. Of course the orthopedic shoe manufacturer has done similar for many years with both external modifications and casted insoles, and this has never troubled corn-cutters greatly in the past. I note that there has been some hostility to this ‘new’ emerging profession and I can’t help wonder if it is the re-branding that causes so much hostility and suspicion of territorial encroachment.
Podiatrists (or chiropodists) have short memories it seems.
Hopefully not sounding too disparaging here, but many clinicians have made good use of their local cobbler and/or orthopaedic shoe manufacturer over the years for a range of footwear modifications such as balloon stretches, balloon patches, buttress heels, medial flanges, to name but a few.
certainly is not a cobbler by another name!!!! how many cobblers do you know that are trained in biomechanics, pathology of disease and orthotic manufacture. seems to me that you need to come into the 21st century
certainly is not a cobbler by another name!!!! how many cobblers do you know that are trained in biomechanics, pathology of disease and orthotic manufacture. seems to me that you need to come into the 21st century
Quite a few. I am not referring to the High Street repairers like Timpsons et al. but specialist shoe manufacturers who are very well acquainted with gait, biomechanics and the pathology of certain conditions such as polio, rheumatoid arthritis, TEV, and many more besides.
Some years ago, shortly after I graduated, I was - like most youth - very sceptical of the abilities of others in the field of lower limb abnormalities - especially those who were, in comparison, in their senior years. It is a common mistake that we all usually make - remember the maxim, "the confidence of youth, the confusion of middle age, and the wisdom of the elders"? Our local orthopaedic shoe manufacturer was an Italian who was well respected by the local orthopaedic community, but I couldn't understand how someone with little or no formal training in biomechanics or medicine, could achieve that status - until I sat in with him during an afternoon.
Modern clinical biomechanics, if you haven't realised it already, is pure professional sophistry and has little or no evidence base to it whatsoever. Most of the time it's trial and error and a great deal of luck that gets you to the point where you can relieve symptoms - if you're fortunate enough to stumble upon the correct 'prescription'. Certainly some OSMs will not have much background in medicine or biomech, but they do have experience - which counts for a great deal - as you'll probably find out over time if you're lucky.
I wasn't being insulting by suggesting 'cobblers', merely pointing out that many old professions try and re-brand themselves from time to time and in doing so lose part of their identity they need not feel any shame for, but invariably they do. And usually at great cost.
I wasn't being insulting by suggesting 'cobblers', merely pointing out that many old professions try and re-brand themselves from time to time and in doing so lose part of their identity they need not feel any shame for, but invariably they do. And usually at great cost.
I understand fully that you did not mean high street cobblers and you were refferring to orthopeadic shoe manufacturers and old school cobblers (unfortunately there aren't too many around)
I can assure you that most pedorthists are not cobblers trying to rebrand, infact many DPM's in the US are pedorthists and took the course to round their knowledge. personally i spent some 13 years working with footwear modifications and orthotics before i took the course.
Prehaps if you take a look at the link below you may understand what the training and exam involves instead of making disparaging remarks about myself and my qualification, I am not questioning your training Should I Be!!! : http://www.cpeds.org/associations/25...CPCiriculm.pdf where some of the items are clearly not relevent to practice outwith the USA it is their qualification so it is all part and parcel
I can assure you that most pedorthists are not cobblers trying to rebrand, infact many DPM's in the US are pedorthists and took the course to round their knowledge.
Good to hear that DPMs have finally seen the light. Won't do them any harm.
Quote:
Prehaps if you take a look at the link below you may understand what the training and exam involves instead of making disparaging remarks about myself and my qualification, I am not questioning your training Should I Be!!! : http://www.cpeds.org/associations/25...CPCiriculm.pdf where some of the items are clearly not relevent to practice outwith the USA it is their qualification so it is all part and parcel
No dispararging remarks intended - perhaps I should have said 'orthotists with a special interest in feet' rather than 'cobblers'. Any formailsation of training can only be a good thing after all. Best of luck.
Cardiff School of Podiatry is now offering a Post Grad Certificate in Footwear. I have nothing to do with this except I hope to do it.
It covers measuring and prescribing stock, modular and fully custom made therapeutic footwear.
I think this has evolved partly out of dissatifaction with the current system - reliant on Orthotists. In the NHS orthotists are not employed by the NHS directly but rather they work for the footwear company, unsurprisingly there is little accountability... ( In my area Orthotists have only just recently starting writing patient notes!)
It has also evolved out of the fact that Orthotists have been steadily dwindling in numbers and this will be even more so in the next 10 years (retirement) such their numbers could be half. All this as diabetes doubles.
Clearly in light of this manpower problem people will be looking to fill the gap. Podiatry should definately look to fill it as it would be a skill that will near guarantee our future.
I think this is a potentially good idea, however the finer issues need to be discussed.
Being able to take and prescribe measurements is one thing, troubleshooting problems is another. Most patients needing stock/bespoke footwear have complicated pathologies, hence they don't often get "regular" problems with their shoes.
You might also find that to save money, the PCTs/Hospital Trusts do not purchase insurance/guarantees when allowing non-Orthotists to arrange footwear.
In our Dept, the Orthotists take the measurements, and make the order. Their company pays a premium on top of the purchase cost, that allows them to return the shoes if they are fitting incorrectly, wrong fastening, pt changes their mind etc., without induction of a penalty. In essence, we pay more for the shoes from the company, but if they are wrong, THEY foot the bill for replacement.
Just one final note, I think this idea is great for the Private Practitioner, both from a lucrative and pt satisfaction standpoint.
I would also point out that I know of one PCT, that has a cupboard full of unworn shoes, which do not fit, prescribed and measured by a Pod.
Thats not to say it won't work for the NHS, its just that the finer points need to be addressed, such as who pays the bill for those shoes that don't suit the patient, and haven't we all seen those!
In our area, if the shoes dont fit when prescribed by an Orthotist either the patient doesnt wear them or the NHS pays for a new set. This happens quite often such that if they were kept it would also fill a cupboard pretty quickly.
You said in your posting "their company pays a premium" do you mean the NHS is charged for and pays a premium? Is this not the footwear company saying "we will supply you with shoes and an employee of ours will come along on certain days to collect orders. He will get this wrong and to cover the mistakes of our employee we must charge you more and this charge has been calculated so that it covers cost of replacement and whatever happens we dont lose money". In our area we pay for replacement, in yours the cost of replacement is spread out over the longer run. Great deal. The NHS pays either way do you mean the problem would be deciding whose budget it would come out of?
The only benefit to having a private company employee measuring and fitting footwear would be off-setting the costs of mistakes. It would seem that it does not work that way. The private companies do nicely out of this. The Annual NHS Footwear bill being 20-30 million or more and your average Orthotist paid well over 40K.
I believe the course in Cardiff covers trouble-shooting, in fact it involves a year-long mentorship working in a footwear clinic seeing patients, prescribing shoes and following them up.
Clearly nothing will change overnight. However the reality is that Orthotists are disappearing faster then Podiatrists. I think what you are getting at is that its not an easy skill to aquire but why train people to be a "Pedorthist" when it could be an extension of the Podiatrists role. Somebody will fill the gap.
Hi Lawrence, let me clarify. Our PCT pays a slightly higher fee than directly ordering the shoes from the manufacturer. Thus any alterations to dimensions, fastenings, mismeasurements or change of heart etc are paid for by the Orthotist company. Any mistakes are paid for by themselves. We pay one price for the finished product.
My recommendation would be to work with a very experienced Orthotist. They also bring skills to the field of MSK medicine with their knowledge of splints, braces and other forms of rehabilitation equipment.
Good debate, Merry Christmas.
Hi Peter and Lawrence
not being in the NHS sector i was wondering "is there a common cause of shoe returns, ie miss measurements/dimensions etc or is it simply the fact the patient does not like the look of the finished product ???"
the process of manufacture seems to me to be slightly different here in the UK to the USA
All the Pedorthic facilities I’ve visited in the USA (admittedly not that many when you consider the amount within the USA) when dealing with custom footwear always take a plaster cast of the foot and mark the foot accordingly, this is not like a cast for an orthoses but a complete cast of the foot and up above then ankle, materials such as plaster for a bi-valve cast or casting tape or the casting sock…..
I recently visited an NHS supplier of custom footwear/orthoses etc and asked what their procedure was for custom footwear…more measurements than the cast was the answer, a cast can aid but not essential and then the cast was just the same as one you would do for an orthoses……
I’m not saying this particular company's way is wrong but when dealing with custom footwear in the USA you don't have much financial margin for error
Paul,
Bespoke shoes are plaster casted for, measurements are taken for "stock" footwear.
Some bespoke footwear needs "tweaking" for heel slippage, and fitting around the ankle and forefoot. This is undertaken by the Orthotist, at his/her cost.
Once in a while, the stock footwear measurements vary a little, hence those shoes have to returned to be replaced with others, again at the Orthotists cost.
Paul,
Bespoke shoes are plaster casted for, measurements are taken for "stock" footwear.
Some bespoke footwear needs "tweaking" for heel slippage, and fitting around the ankle and forefoot. This is undertaken by the Orthotist, at his/her cost.
Once in a while, the stock footwear measurements vary a little, hence those shoes have to returned to be replaced with others, again at the Orthotists cost.
Happy Christmas!
thanks for the info Peter
Merry Christmas and a happy new year to you
Having worked for an Orthotics company I can state that the cost of the return of the shoes will be included in the cost to the NHS. The company does not 'pay for their mistakes'. If that was so a company would rapidly go out of business.they have to at least cover their costs, although most make some profit!
All of the tweeks are costed into the equation I can assure you. Most footwear even modular (which is what most footwear is nowadays and not bespoke due to cost pressures) is made to order based on standard lasts. and will have fitting appointments as part of the whole. this allows for the tweeks!
Lawrence is correct when he says that orthotics companies do well out of this. There is an Audit Commission report published in 1999 , which looked at costs and spending and the speding on orthotics (provided by orthotists )in the UK at that time was £85mill per year with 40-45mill on footwear and 12-14 on foot orthoses!
As long as the orthotist working in the clinic is employed by the company that makes the orthoses/footwear this situation will continue. In NHS trusts where the orthotist is employed directly by the trust they SAVE money when compared to previous spends through service contracts. The orthotist has responsibility with appliance officer and supplies for the budget and suddenly the amount they spend goes down!
they can purchase orthoses and footwear from any company and can get good deals unlike when the orthotist is employed by the suppling company with all purchasing going through that company with premiums added (to cover paperwork) if the orthotist has the audacity to buy from a differnet manufacturer!
and yes the average salary for an Orthotist is about 40K plus car mobile phone pension and YES a BONUS for using the company products!!!!! (the ave starting salary for graduates is 25+K) and this will increase due to demographics as numbers of orthotists is falling (there are only about 450 in the UK with total orthotist and Prosthetist number about 750) supply and demand will cause this!
But back to the original thread, Pedorths have a great part to play in the treatment of patients, the more the better they are well trained and well skilled, and do an excellent job, in the role that they have.
Basically Orthotist provision of footwear and orthoses is a PRIVATE service paid for by the NHS. It is an illusion to think that mistakes a paid for by the company - they are costed into the product! And generally there is little to nil scrutiny on spending, as I said only recently did the orthotist have to keep any written information at all in our area and even now it is the bare minimum.
My recommendation would be to train Podiatrists to fit all manner of footwear and bid for the contracts! Orthotist numbers are shrinking and we could fill this gap. In my area the Podiatry budget for the county is about £1mil with around 40 full time employees, the Orthotist budget (3 admin employees, orthotists paid for separately by private companies) is £1.5 mil the majority spent on footwear and foot braces, need I say more? Where NHS Trusts directly employ Orthotists the costs go down dramatically which shows the blatant misuse of public money. But most trust can't do this as Orthotists wont work for what the NHS will pay! Have you noticed how the Orthotist in your area changes fairly often? This because their numbers are falling and the system allows them to take advantage of this and keep changing jobs for better pay.
Wigs, wrist braces, neck braces, corsets, cosmetic appliances have all been taken on by others now eg OT, Physio, Oncology etc. I feel that we must wake up to this opportunity and get out acts together. The "Pedorthist" is a new creature adopted for this very reason when we (Podiatry) have virtually all the basic skills requiring only some additional specific training. Moreover footwear provision is central to other departments such as Orthopaedics, Rheumatology and Diabetes and if we are the providers we "plug" ourselves into them. In my area every time they employ a new Orthopod they the Orthopods insist a new Physio is employed, think about it....
I have been following this thread with interest and am interested in the timing of C.E.M's posting. For the Group's information Podiatrists and Orthotists from all over the UK have just formed a Clinical Footwear Group with joint support from BAPO and SCP.
I have been dealing with the UK Orthopaedic footwear industry for 15 years now and know Pedorthics well. I have been to Pedorthics Conferences in the USA and Canada. I also know the German Orthopaedie Schuh market pretty well too. I was in the States before Christmas and hear the "powers that be" in Pedorthics are keen to bring their profession to the UK.
I don't understand why!
The C.Ped qualification is not recognised in the UK by the HPC and the Qualification will not be used for Professional Indemnity insurance so a C.Ped can not take the place of an Orthotist or Podiatrist in the NHS. Does C.E.M. really want to work in the NHS?
There is opportunity in the private sector but anybody can sell or fit shoes. The driving force in the States is Insurance reimbursement or Medicare coding, which we do not have in the UK. Canada and Germany are slightly different but no system is has the dominance of Government-funded Healthcare we have in the UK. Without protection of title anybody can call themselves a Pedorthist, is there a danger that the C.Ped certificate becomes a marketing tool?
I hope not. Pedorthics, at its best, has a lot to offer for Clinical Footwear Provision in the UK and can be used as a model for requirements for Multidisciplinary training. 3 UK Universities are now offering CPD and Post Graduate Footwear Training for Orthotists and Podiatrists, plus there are the non-clinical Society of Master Shoe Fitters courses.
Pedorthics could be a good influence but surely it will develop as an add-on to a Podiatrist's daily work or as a specialisation rather than a stand alone Profession. The Orthotist Profession already covers footwear in the NHS although their coverage is limited due to numbers and constraints with the NHS Contracts system.
Where does C.E.M see the profession of Pedorthics fitting in?
I don't think that anyone in their right mind would consider that Pedorthics is a replacement for the orthotist or a podiatrist for that matter. I can assure you i have no desire to work in any area od the NHS the beurocracy quite frankly frightens the hell out of me.
Now in the private sector there is very much a market and i think that the C,Peds in the uk will all agree.
Just look at the number of people walking around in footwear that is not working for them, not fitting them and in many cases causing them harm.
If you recall my thread on the runners world article it would seam that many of the podiatrists that they visited were either unable to diagnose the problem / condition or at very least had no idea how to solve the probblem using a combination of footwear and orthotics..... In a sports setting I see shoe sales people selling shoes that 'cure pronation' in the podiatry setting i see practitioners dispensing orthtoics that require to user to change every shoe in the wardrobes to get the device to fit.
on a ring round (outwith my local area)a couple of years back i called 40 podiatrists/ chiropodists... over 50% did not offer any more technical gait analysis than walk up and down and let me whatch you, (maybe it is just me but i always thought and have seen tht pronation happens so quickly that you cannot possibly see the subtle motions at full speed with someone walking away from you....you may see the gross movements but not much more) about the same number did not offer any orthtoic more than a vasyli product and only one said that they worked with the local shoe shop and could recomend a shoe
Surely there is a desinct gap in the market for something in between, trained to fit and modify footwear, trained to understand biomechanics and trained to produce orthotics. if there was not i guess that i would be out of business by now, we opened our clinic in August 05, by November we are growing month on month slowly but very surely. I am not planning to retire at 45 but prehaps 50!!!
Now with HPC.... for years people have been calling themselves podiatrists some did a 3 year degree course some did 2 years some did a 6 week Dr Scholl corespondance course.
No doubt people if they are so inclined will call themselves pedorthists, as the training requirments increase this number will probably increase...does this sound familiar to anyone!!!!
Ok so lets transport ourselves 20 years into the future... there will be a rveolution of healthcare services and the HPC or whatever they are called at that stage will grandparent everyone who called themselves a pedorthist into the system and they can all be called C.Peds. sound familiar!!!
I am not having a pop at anyone who has gained a qualification through the system and years of practical experience, but i do feel certainly from my experience that there is a massive gap in services, most of my business comes from the local Physios Chiros and wait for it............
PODIATRISTS
As podiatrists how many of you want to carry footwear inventory, have the space for a lab or workshop area or the time to do the modifications to the footwear or the orthotic as and when your patient wants them doing? I would be very interested to know.....
"As podiatrists how many of you want to carry footwear inventory, have the space for a lab or workshop area or the time to do the modifications to the footwear or the orthotic as and when your patient wants them doing? I would be very interested to know....."
I don't, for one. Any Pedorthists in the Birmingham and Leicester areas please?
Cheers,
davidh
none (certified ones) that i am aware of I am a little further south in Bicester Oxfordshire, what area of work are you looking for the pedorthist for.
Pedorthics in the UK
Linear Mode
