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A female elite marathon runner that I've been successfully treating with custom FFO's came into clinic today. She had been to a local county show and been told that the custom ffo's that I had made for her which had totally relieved her symptoms were rubbish because they "didn't alter her muscle function and change her foot to normal".

Just viewed their site, seems they support the hard flat surface theory- nice

http://www.stepforwardfootcorrectors.ca/

I want to be corrected.

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Jamie posted this in another thread: Sound familiar

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Sure does. As an experienced trade supplier (as well as being a partner to a podiatrist) I have a great deal of respect to what Jamie writes. My impression is that lower limb biomechanics and orthotic therapy is a great deal more complex than we currently comprehend. Often problem foot disorders in some patients respond well to simple insole Rx; sometimes the same conditions respond better with FFOs. Sometimes FFOs relieve the foot symptoms but aggravate (or even create) debilitating symptoms elsewhere - in the knee or hip joints for example.

What is particularly frustrating is the variances in prescription from the orthotic laboratories. Take one patient with well defined symptoms; do your measurements and take several casts and send them off to a number of labs and tick "Prescription at Laboratory Discretion" and you get back several differing devices! Sometimes you get lucky I guess, but I started off 25 years ago very much on a trial and error basis with orthotics, and I still find myself doing so today. One observation I do have of late is the importance of ensuring the patient has as much knee, ankle & mid-tarsal ROM function as possible and in that respect we underestimate the value that mobilisation techniques have as an adjunct to biomechanic and orthotic therapy. Paul Conneely provided a link for his Jones Counterstrain Technique for sesamoiditis and we applied this to a patient recently who has been suffering from severe chronic pain for over 18 months. The improvement after just one treatment has been nothing less than miraculous!

I guess we still have a long way to go on the journey of discovery on locomotor biomechanics but I'm sure we're heading collectively in the right direction.

Mark Russell

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Where do i hand over my $500............Only need to sell two a day with that mark up and make a killing!

Mark
I just want to take issue with this concept of getting different orthoses from different orthotic labs when 'Prescription at lab discretion' is requested.
Firstly, how do you know that the when 2 pairs of casts are taken that they are indeeed the same?
Secondly, lab defualts for the treatment of the casts are very different from lab to lab.
I believe that every practitioner should take resposibilty for their orthoses rather than handing over the 'prescription' to a third party with limited info - they havn't seen the patient after all.
Once a cast is produced, the emphasis should be on the practitioner to assess it, decide how they want it treated (ballanced to heel vertical, inverted, everted, intrinsically, extrinsically etc etc etc)
In my opinion the lab should be a facilitator not a decsion maker.
Sorry but as I work for a lab this is a very emotive subject for me.

Phil

Simon,

There is a trail of upset Podiatrists all over the UK and Ireland who have seen the same as you. 2 weekends ago they were in the Midlands of Ireland. I did hear Trading Standards have been alerted but where do they go to investigate further.

Mark and Phil - This has nothing to do with the Science of Biomechanics and differences in Custom Labs. This is about Public Perception and knowledge of what a Podiatrist does and what the Public expects

I actually had a discussion with the/a guy from Step Forward Orthotics in an Indian Restaurant in Earls Court last year. He was wearing a foot logo on his shirt and was exhibiting at the Ideal Home Show as I was at a Diabetic Foot Conference and having dinner with a group of Podiatrists I thought it would be friendly to say hello and said I sold insoles too. Big mistake, he was immediately on the attack - They are not insoles they are Orthotics - My reply was actually Orthotic is the Adjective and they are actually Orthotic Insoles - Lets just say it went down hill from there. His "Orthotics" were the only insoles IN THE WORLD that helped Heel Pain - I replied what about Interpod, Vasyli, Formthotices, Vectorthotics etc etc etc....... It wasn't worth continuing the discussion.

Lets just say I was gobsmacked as were 2 other Pods who had joined the conversation.

BUT THIS RAISES A VERY IMPORTANT POINT. This guy and others I have met like him are not Grandparented, HPC, FHPs or whatever....they do not even claim to have a qualification. They tell the public they are right and they sell £5 insoles for £280 as advertised on their website. If they speak to enough members of the public they will sell insoles - it is a numbers game. Does this include the "Biomechanics Consultant" advertising in the Daily Mail. THAT IS WHY PODIATRY NEEDS TO MARKET ITSELF TO THE PUBLIC. THE PUBLIC NEEDS TO BE EDUCATED TO WHAT A PODIATRIST DOES. THERE WILL ALWAYS BE THIS QUACKERY BUT THE PROFESSION NEEDS TO LIMIT THEIR EFFECT.

Not sure how the Profession does that exactly but these quacks are a bigger threat than I think you realise and debating the finer intricacies of Biomechanical function (as pertinent to higher level understanding as they might be) is not going to fight them off.

In Australia where Podiatry has a higher level of respect and recognition is this an issue. Not the low level retail insoles but the high level rip off?

There is food for thought for you all.

Cheers

Jamie

Apologies in advance as I have to be somewhat cryptic as I am not in a position too say too much .... but lets just say that the largest pharmaceutical company in the world will soon be launching a pressure platform attached to a vending machine for foot orthotics ....

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Just back from a two-day Biomech Workshop....

Good thread.
One of the points which our delegates (and this is probably true of many Pods and Pod students too) generally have a big misconception about is Pod Biomech = orthoses.
Wrong.
Pod Biomech may well include orthoses as part of a treatment programme, but doesn't have to. Much can be done, for example, with a couple of bits of cork cut into heel-lifts, provided the clinician understands the basics.

So machines which spit orthoses out the other end, like a certain highly-publicised brand of inexpensive OTC orthoses sold in pretty much every Pharmacy in the UK, and very prominent on the SCP website too BTW (why is that?), are not a huge concern (to me anyway). They might be if I believed these orthoses were the one and only successful treatment-line for lower limb musculoskeletal problems.

The snake-oil salesmen at Exhibitions - what can I say?
Except to question the sanity of anyone daft enough to allow a salesman to flog them very expensive insoles when they know that the Stand will not be there next week.

Phil Wells, I agree completely.

Regards,
davidh

Hi Craig,

I think the idea of a machine that spits out Orthoses is a great idea. It will raise the profile of Foot Healthcare. At least the Vending machine won't be able to "badmouth" Podiatrists.

When they don't work for Joe Public a Podiatrist can step in and say "look at me I am brilliant - Look what I can do with a bit of cork!" - Never mind stretching exercises, padding, decent Preforms and Custom devices too.

I was in the States last year and stood on a pressure mat in a Foot health shop - sorry Retail Store - I stood on twice and was recommended 2 different types of Orthotics, which were hanging off the machine. When I spoke to the Shop manager I asked innocently if I needed Orthotics perhaps I should see a Podiatrist - His reply was that Podiatrists would only supply an expensive arch support anyway......! My wife who is a Podiatrist was very good and smiled sweetly next to me.

I didn't mind the retail guy at all, I knew what I was getting. The so called "consultants" are more damaging. In marketing terms it is all about Positioning yourself in the market. A retail environment is low level, Provincial Private Practices are medium level, Harley Street Clinics are positioned high level and charge accordingly.

The snake oil salesmen are out for their piece of pie and will position themselves wherever they can make money. But that is business so technically I should applaud them for their entrepreneurial skills. Ethically I think they are ripping off the public, which in the medium term will be damaging to the Profession and the Industry.

Rgds

Jamie

Not a "marketeer" in the same sense as Jamie, who said "I think the idea of a machine that spits out Orthoses is a great idea. It will raise the profile of Foot Healthcare".
But yes, I can see this....
Cheers,
davidh

Its not just an idea (I know we have discussed this concept before) .... this time its happening and a biiiiiiigggggg company is backing it with a lot of money. Launching in the USA first.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

We here in Australia "where podiatry is better respected"????? where does that come from?...we are busy handing away our expertise to other professions.....Craig can tell you about the emphasis and importance placed on teaching the finer points of orthoses design,manufacture and prescription in our fine institution....I have a biased opinion and won't talk about it publicly any more, I'd be sure to annoy some one.
regards Phill Carter

Jamie was comparing it to the UK - we much better off than there. I will pass on the second part of your message until we can chat.

CP

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Hi Phil,

With all the success you colonials have in Sports over the Commonwealth mother country. I thought Podiatrists must have something to do with it.

Just went in the "foot correctors" website. I would recommend it to anyone having a bad day who needs a laugh! These insoles cure something called a "Weak Metatarsal" . Increase bone density obviously. Must be why they cost £280 for a Pre fab available on mail order.

Tempted to go to the next county show just to find the stand and Heckle!

I'm slightly confused why they cut short the list of problems cured before Hair loss, piles and personality defects.

Love it.

Robert

Here is their International site. I am soooooo tempted to go to their next 'show' near me (in August) and annoy the hell out of them all day with questions.

Just followed DaveK's link thru to the Australian site --- they charging "patients" $350 and the site had a long list of shows that they are exhibiting at --- all home shows and farming exhibitions!!!! They are only prefabs!!!! The really amzing things about them is that

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Dear all,

It is our own fault that this is happening. When many podiatrists make foot orthotics that are no more effective than prefabs (see the article posted on the home page), we deserve this. We need a major shift in paradigm.

ed

Both the Irish and English "Distributors" can only be contacted on mobile phones. - Enough Said!!!!

It is sad but if members of the public are prepared to pay £200 on "smoke and mirrors" then more fool them. Caveat Emptor - Buyer Beware.

Podiatrists can have academic debates and do research studies but while there is so much conflicting theory, companies like this can slip through the gaps. academcally Podiatry is robust but commercially - and Pods do live in a Competitive world - you are vulnerable.

Jamie

Ed,

I'm sure what your are implying here is that if all podiatrists attended your seminar, watched your DVD and used "SoleSupport" insoles and casted in your "MASS" position that plantar fasciitis would be wiped out from the face of the Earth!! Isn't that right??!! I mean, even Gary Dockery, DPM, thinks your orthotics are great...and you use this as "proof" that your orthoses are superior to other orthoses??? What a joke!!

My question to you is this: don't you ever get tired of self-promoting your company's product with no real substantive evidence to back up what you say?? Personally, I am getting very tired of seeing your little comments that self-promote how great your products are without anything more than anecdotal evidence to back up your claims. Do the research, get it published in a peer-reviewed journal and then you will have something to talk about!

Please stop self-promoting your orthoses and your company and start to positively contribute some non-proprietary and useful information to other podiatrists on Podiatry Arena, which is a website dedicated to podiatric education. Please try to contribute positively to Podiatry Arena without always trying to build up your product and company or trying to tear down the methods and types of foot orthoses that most of us use on a regular basis to produce excellent treatment results. Doing so will gain you a lot more respect than what you have achieved by your previous comments to Podiatry Arena.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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I propose the following as a general theory that might explain why almost anything put in the shoe as a corective insole has a positive effect on pain:

It is well understood in neuromusculoskeletal practice that almost any form of newly introduced, high intensity type II afferent stimulus will tend to block pain information from c fibers. So, for the short term at least, pick your favorite bump, put it under the richly innervated plantar foot, and watch the pain decline.

So if success is defined as a patient feeling better, no wonder so many can claim it.

Where a professional source of corrective insole should put themselves above the snake-oilers is the actual change in function that will alter the pathological tissue stresses that ultimately become deformity and pain. Ideally this should be observable as a positive change in gait but this tends to be very subjective. Research that can support these changes concretely is very difficult to do, unfortunately, given the state of our technology to image or measure them in a direct way.

I asked in another thread what the group might propose as the specific goals of biomechanical function, i. e. what are we trying to do with a biomechanical orthosis? I received one response: to reduce pain. Refer to the above to understand why I think this is not a good answer.

So here is my list of goals:
1. Sufficient re-supination of the foot occurs after midstance to stabilize or “lock” the tarsus in the sagittal plane to allow for efficient propulsion.
2. The forefoot contacts the ground without imposed abnormal compensatory motion proximally or in the transverse, sagittal or frontal planes
3. The first metatarsal is stably plantarflexed against the ground during forefoot loading
4. The first metatarsal accepts 60% of forefoot loading force
5. The first metatarsophalangeal (MTP) joint is free to dorsiflex sufficiently to avoid compensations in foot or lower extremity posture that would otherwise be necessary to allow sufficient dorsiflexion or forward gait progression

I would think that achieving these goals as much as possible is the way to insure long-term pain reduction, prevention of deformity and avoidance of surgical corrections.

In order to accomplish these, the foot must actually change in position and function. I have found that using full arch support with a thermoplastic shell that is the right mix of flexibility to allow some pronation but rigid enough to forcibly assist re-supination has been the most effective toward the above goals and for helping improve lower kinetic chain posture as well. I would like to see more research confirming what I see clinically, but this makes the most sense to me bio-mechanically.

I have just tried to follow numerous links on the above site to websites of alleged stockist practitioners. All links I tried were dead - suprise!. By the way, can anyone tell me where the Metatarsalgia heads are? (the ones that cause neuroma's according to stepforwards website) I could do with some to macerate in my Snake Oil.

Martin

The stepforward orthotics are essentially the same thing dozens of other websites are selling, a version of the Alznner orthotic. Alznner orthotics have been around for many years. The theory behind the Alznner orthotic is that if you make a cast of a problem foot, you will get an orthosis that matches a lousy foot. Instead you should provide the person with an orthosis that was created from an ideal foot, and the person's feet will adjust to the orthotic and function in a normal and correct way.

I disagree with the theory because poor biomechanics, and other factors, are to blame for the foot problem, not the shape of the foot. And as long as the cast of the foot is not made in a weightbearing position, then the practitioner is not incorporating the faults of the foot into the orthotic.

Some people will benefit from such orthoses, because of the extra support they provide, but to suggest they are a cure-all for foot problems, and is as effective as a well made custom orthosis is untrue.

I am new to the foot care profession, and I really enjoy reading the posts here. Thanks to all who contribute!

Sincerely,

Kevin Jaeger
Certified Pedorthist

Kevin, There are many adherants of numerous types of Orthotics, none of whom agree with each other. As a Podiatrist I seek first of all to arrive at an overall understanding of my Pts general posture, features of their kinetic chains of motion, type of gait (antalgic etc') direct observation, questioning, familiy history, work, sports, unusual pastimes. Take note of footwear wear patterns. Possibly weight bearing analysis (force plates etc) then, and only then, will I try to develop an individual theory of that persons gait pathologies, if any, or if reasonably correctable ( someone born with congenital pes planus who has got on perfectly well for the last forty years with feet as flat as a board - why do they need them anyway??). It is only at this stage, that the type of orthotic, if any, starts to be considered and it is here that the main confusion seems to arise. Does the Pt require an accomodative support or a functional orthotic? If they have discrete pressure points that need support, ie: (but many others): the typical semi rigid cavus foot with its 1stMPJ / 5thMPJ/ med' Calcaneous 'tripod' of pressure points, with little sceptal fibro - fatty tissue 'padding', then any old bit of accomodative support, of any type, is better than nothing. But, obviously, something that can mimic the characteristics of sceptal fibro-fatty padding tissue with its controlled, rheopectic response to shearing forces, would provide the most benefit. Possibly cross-grained silicone polymer 'islands' for the pressure points in a denser supporting structure to accept GRF from surrounding non- weight bearing parts of the foot?. Moving on from 'supports' you then come to the much more complex issue of functional orthoses, and in order to arrive at any meaningful management plan the Clinician needs to have a very clear picture in their mind of EXACTLY what they are trying to accomplish. Am i trying to to increase the windlass effect? am i trying to promote earlier (or later) transition from pronation to supination? etc etc. Also, can I reasonably accomplish this with functional orthotics alone, or do we need to bring a Pod Surg' in to lengthen / shorten medial / lateral columns etc to give me a reasonable chance of influencing function with orthotics? The subject of 'Biomechanics' (I HATE that word - its so overused for just about anything these days, and always offer 'Gait and Posture' analysis to my Pts) is a minefield for the unwary and a source of constant debate. Probably always will be. But the long and short of it is that OTC functional orthotics will always be 'hit and miss' and more about making bucks for the snake oil salesmen who peddle them than about actually helping individuals with specific problems.

Regards,

Martin

http://www.parishandbell.co.uk/

Has anybody had dealings or know about the above?
Obviously doing very well as advertise in National papers??

Tony,

I know ALL about them as I once worked with the "Bell" half, who is no longer with us.

Give me a shout privately if you want the full SP

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My location

I have an innovative design for a preform orthosis. Does anyone know of a manufacturer I could contact who might be willing to develop this?

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Science is the antidote to the poison of enthusiasm and superstition

My location

Dear Kevin

No sane practitioner would ever claim 100% success from any intervention. I am saying that our design is significantly more effective than standard Rootian orthotics because we prevent overstretching the plantarfascia by actually controlling the posture of the foot.


I never said it was proof and certainly do not believe that it is.

We are now published in a peer reviewed journal.

http://www.humankinetics.com/JSR/vie...X6cv8 wnBX4vx

And NO, I will never tire of promoting our technology because I honestly believe in what I do. This is a question that I wrestle with constantly. We have developed what we feel is a new approach and a major improvement in patient care. We want doctors to know about it. If we were discussing something that is universally available or some minor change in what is already being done it would not seem like self-promotion The claims we have made are the result of my clinical experience and the experience of thousands of practitioners. Only in the last few years has it been financially feasible for us to fund research… which we are doing now.. I find it interesting that the need for research is so heartily invoked as a pre-requisite for enthusiastic sale: I don’t recall there being any research done on Rootian intervention strategies prior to the entire profession adopting it. The fact is, one must start somewhere to develop a new idea and test it empirically prior to having the means or the interest to do the gold-standard research. I believe in research….that is why we are doing it. I believe that it is our research that sets us apart and keeps us ahead of the competition. I know of no other lab that is going in this direction. Unfortunately it takes years to get things published.

I feel it is important that we question the old theories that have brought us to a point where customs=prefabs and reevaluate our goals. What do we mean by “excellent treatment results?” If the patient’s gait looks the same when they walk in without the orthotics as when they walked out, and we have made no visible positive effect on gait, then even if symptoms are masked there will be no long range change in function or form. I call that a treatment failure. Completely new approaches will appear to tear down the old. But the point is to do better, not destroy anything. The only way that custom orthoses will ever clearly be superior to prefabs is if we inform insurance companies and the public that symptom reduction is NOT the only goal, but changes in function, improvement in form and reversal of deformity whenever possible are the goals of a custom orthotic.

Respectfully,
Ed

Dear All,

I live (and teach podiatry) in a smallish (100 000) rural city in Australia.

We have also been visited by the snake oil sellers. Whilst i have a certain respect for their business sense, i was dismayed by the advice they were handing out along with the sales pitch.

From the advice for hammer toes
Use your fingers to actually stretch the toe muscles and tendons that have shortened.
Now squeeze each toe "Pain is GAIN" do this slowly. the muscles and tendons have weakened. (some cut). You may feel improvement and less discomfort in 2-3 weeks. you MUST continue.
{Any typos are mine - however the capitals are from the brochure}

The client who bought this to our attention was neuropathic.

A positive for us is that the brochures make for a very nice tutorial.

regards

Harriet

Tony et al

Had a look at the parish and bell website, sent the following e mail and got the following reply. Watch this space...



-----Original Message-----
From: Issacs Robert (Maidstone Weald PCT) [mailto:rissacs@nhs.net]
Sent: 21 July 2006 08:54
To: info@parishandbell.co.uk
Subject: Interesting website

Dear Sir / Madam

I was reading your rather interesting website when i came
across the following statement:-

"The NHS method of drawing around the foot and cutting an
orthotic out of leather or plastic is at most, making a "pad"
and at worse, a waste of time and risk's making the heel spur
worse."

A few points sprung to mind. Firstly i would suggest that to
make such a statement without researching whether it is true
is at best irresponsibly and at worse actionable. Every
department in the NHS does things differently but i have
never in nine years come across one which does only this. The
department i lead uses a variety of methods for assessing and
prescribing orthotics including Cad Cam (a method you appear
to claim is excluesivly yours!).


Secondly your "unique Co polymer" is a type of plastic and i
am guessing your top covers involve leather. This makes your
rather dismissive statement about leather and plastic
somewhat misleading.

Whilst i am sure your product is wonderful i would suggest
your refrain from trying to improve your image by denigrating
other professionals.

I look forward to seeing if the website changes. If it does
not i shall consider passing the blatant self serving
inaccuracy to Trading standards for their consideration.

Regards

Robert Isaacs
Lead Podiatrist in biomechanical therapies.

THE REPLY

Dear Robert,

Thank you for your email.

Some of the statements you made have been bought to my attention and I agree
that certain statements on the website are probably a little outdated.

Regarding the statement about a method used by the NHS has been explained to
us on many occasions by various practitioners and patients. However, I now
agree that it should be highlighted it is one method used.

With reference to the co-polymer we use, we are assured it is a patented
formula made by our American lab and certainly a particular model we use was
invented by our Senior Biomechanics consultant and a lab technician. This
particular model is not available to any other healthcare organization in
the UK.

I am positive we do not claim the 3D lasers are exclusive to our clinic but
should you have noticed anything I have missed please inform me and I will
look into this immediately.

Please be assured the above change will be made including some others I have
noticed whilst reading through our site. We have never intended to improve
our image by denigrating yourself or other professionals and can only
apologize if it has offended you.

I would appreciate it if you could email me your address and allow me the
privilege of sending you a letter and the newest edition of our information
pack when it is reprinted.

Once again thank you for taking the time to write with your concerns and
allowing me the opportunity to address them.

Kind regards
Samantha Williams