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A new report launched by the UK’s leading experts in foot health and the medical research charity, Arthritis Research UK, has criticised the health service for its longstanding failure to provide arthritis patients with appropriate footwear. Without good quality therapeutic footwear people with rheumatoid arthritis are often left unable to walk, and the condition of their feet degenerates.
The new research showed widespread dissatisfaction with all types of therapeutic footwear. Patients raised concerns around poor fit, appearance, weight of shoe and comfort.
Rheumatoid arthritis affects nearly half a million people in the UK. It is a chronic, disabling condition in which the body’s immune system attacks the joints. As the disease progresses, feet become more damaged and deformed. Nine out of ten rheumatoid arthritis patients complain of foot pain, with seven out of ten having difficulty walking and a further 80 per cent reporting problems with their footwear.
Arthritis Research UK medical director, Professor Alan Silman said: “The right therapeutic footwear can make the difference between someone being able to walk or not. For a relatively low cost, we can give people their independence and mobility. If we do not improve the current system, we will collectively fail people with rheumatoid arthritis, causing them greater long-term problems, as well as increasing the cost to the NHS.”
The report made a series of observations and recommendations for the current service:
• Patients reported limited access to orthotist or podiatry services; referral pathways were unclear and subject to frequent delays. Where referrals were made to external agencies, there was insufficient communication between teams.
• Sixty-two per cent of people with rheumatoid arthritis felt they had received an inadequate assessment of their needs.
• Eighty nine per cent of service users had problems with the choice and style of footwear.
• Ninety per cent were embarrassed about their appearance and felt that they had to hide their shoes from other people.
The report showed that health care professionals routinely failed to understand the needs of patients, resulting in shoes being made that people would not wear which could lead to further deterioration and greater health problems. Additionally high street and therapeutic footwear designers and manufacturers do not fully embrace the therapeutic needs of the patient. These factors have an impact on patient quality of life and well-being.
In order to stop this wastage, the charity is calling for system overhaul and improved training of podiatrists, orthotists and primary care specialists to ensure the effective provision of appropriately designed footwear to meet the needs of people with rheumatoid arthritis.
Arthritis Research UK senior lecturer in rheumatological podiatry at the University of Leeds Dr Tony Redmond, also one of the report’s authors said: “It wasn’t until we started compiling the report that I realised just what a terrible state orthotic and footwear services are in.
“The real scandal is that despite repeated reports going back some 20 years, the system has changed precious little. The need for better services is well recognised and the models to actually provide these services better are well established.
“What we need is better patient choice and patient buy-in. Patients need to be able to be involved in the choices about the trade-offs between therapeutic effect and aesthetics. I wear glasses but I wouldn’t let the optician choose my frames, so why would I let a podiatrist or orthotist dictate what I wear on my feet? Embracing this would solve many of the ills currently blighting the system.”
Two recent studies provided the information in the report. EFFORT 1, a qualitative study, involved 20 semi-structured interviews including 11 with groups of service users and nine with groups of service providers, over a period of two years. EFFORT 2 involved questionnaires posted on the websites of Arthritis Research UK and the National Rheumatoid Arthritis Society, with contributions from 113 service users and 186 health professionals.
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
"...The new research showed widespread dissatisfaction with all types of therapeutic footwear. Patients raised concerns around poor fit, appearance, weight of shoe and comfort."
Must be just an issue in the UK, if done right weight, fit and comfort can all be taken care of however with these clients appearance is always an issue when they have a foot like this to go into a shoe.
Narrow heel, broad forefoot, a late heel lift, ABducted gait and poor dexterity to do up fastenings, it is a battle but once the shoe is on the foot and they have walk its a winner.
Actual clients foot, not modified, one of three sisters all the same
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by Boots n all
"...The new research showed widespread dissatisfaction with all types of therapeutic footwear. Patients raised concerns around poor fit, appearance, weight of shoe and comfort."
Must be just an issue in the UK, if done right weight, fit and comfort can all be taken care of however with these clients appearance is always an issue when they have a foot like this to go into a shoe.
Narrow heel, broad forefoot, a late heel lift, ABducted gait and poor dexterity to do up fastenings, it is a battle but once the shoe is on the foot and they have walk its a winner.
Actual clients foot, not modified, one of three sisters all the same
I think one of the issues here is that both made to measure and stock footwear is being combined here. In my experience, made to measure footwear, rarely does; cosmetically it doesn't hit the patients expectation; it costs a ridiculous amount to the NHS and frequently ends up in the bottom of the patients wardrobe unworn.
Cosmetically, stock shoes are usually better. But again a lot of it comes down to the gender and age of the patient and their perception of what a "good lucking" shoe is.
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Hi David
Custom footwear ranges from £250 - £800 per pair - dependent on both supplier and modification/RX requested.
I am a fan of modifying patients own footwear as compliance is improved significantly. There is usually a compromise re outcome medically but patients seem happy to accept this or have a 'ugly' pair when things are bad or fashion allows it.
I think the biggest problem we have in the Uk is not communicating enough with the patient/customer!
The primary source for footwear in the NHS (UK) is the Orthotist and due to commercial pressures, they do not have any where near enough time to have meaningful conversations with the patient.
Couple this with a separation from the manufacture of the shoes and the patient can easily get lost in the process resulting in poor compliance.
People will often then label the Orthotist as a poor practitioner but this could not be further from the truth.
I think think we could learn alot from the Pedorthic model - maybe its time to have a footwear discussion forum as I am sure us Pods could learn alot.
Cheers
Phil
The Following 3 Users Say Thank You to Phil Wells For This Useful Post:
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by Phil Wells
I think think we could learn alot from the Pedorthic model - maybe its time to have a footwear discussion forum as I am sure us Pods could learn alot.
Cheers
Phil
Phil,
I couldn't agree more with your comments. Both you and I work for companies with a strong history of footwear manufacture and I'm sure you're as acutely aware as I am of the balancing act we perform to provide footwear that satisfies the needs of function, comfort and cosmesis. I strongly believe it's time we considered adopting the Pedorthic model for therapeutic footwear provision in the UK, It works in the USA, Canada, Australia and mainland Europe so why not here?
__________________
I'm not sure I want popular opinion on my side -- I've noticed those with the most opinions often have the fewest facts.
Bethania McKenstry
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
I do not claim to be an expert on the history of ‘orthopaedic footwear’ I watched Forest Gump, I grew up with an aunty with a polio short leg, I listened to the owner of Cosyfeet a fully trained cordwainer explain the categories used in the footwear industry to describe shoes, fashion, comfort and roomy.
Guessing these categories cover say 99% of the population then Pods and orthotist are dealing with a tiny sector? ½ million Rh sufferers, 9/10 of which have foot problems, perhaps not so small?
As far as I understand it the major cost of custom footwear is in producing the last, after that it is down to the skill of the cordwainer to fashion the shoe.
Podiatry is full of challenges, perhaps this one should be added to the list? Possibly one of the problems is it could be categorised as ‘palliative’?
I can only agree with the report and others that spending more time uniting the user (patient) and provider Pod and orthotist though initially costly may in the long term be cheaper.
This probably applies to all health care disciplines where compliance is important.
The other thing we could consider is surgical intervention. At the moment I have a 60+ female patient considering radical foot surgery both to relieve her pain but primarily to wear ‘normal’ shoes, she has multiple joint deformities but is still lively and attractive!
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by Boots n all
"...cosmetically it doesn't hit the patients expectation;"
It will if they take a moment and look down at their foot shape to start with
"....it costs a ridiculous amount .."
In perspective the cost is nothing if it gives them back their mobility.
But lets chat about costs, what do you earn an hour, not you personally but the average UK pod?
Then workout the cost of an orthosis materials and the number of hours to produce an orthosis and the charge out for it?
Then we can chat about costs once we know that and we some perspective to work from.
Do you know how long it takes to produce a pair of custom made shoes?
Simon what are the costs of custom made in the UK?
Cost to the NHS on provision of footwear is in the region of £20 million per annum. As Phil mentioned cost vary, but it's conservatively estimated at £300 per patient per annum.
For the record, I know exactly how long it takes to make orthopaedic footwear and the processes involved because I used to do it for a living. I am a qualified pattern cutter, but actually worked more on last design and the development of optical scanning and CAD systems. I can hand last uppers and know my way around mechanical manufacture too.
I also know that cost is important if the vast majority of patients don't wear the shoes that are manufactured for them. If say, 50% of a £20 million budget is sitting unworn in patients wardrobes, that's a reasonable amount of money effectively being thrown in the bottom of the wardrobe that could be used elsewhere.
I'm all for pedorthic models providing the training is comprehensive and that regulation by the HPC is compulsory (without any loop-holes, like we have in podiatry).
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by Boots n all
"...cosmetically it doesn't hit the patients expectation;"
It will if they take a moment and look down at their foot shape to start with
I wanted to follow up on this. When we were developing the CAD/CAM protocols at the shoe company I worked for, we were basically pioneering linking 3D scanning with last design, with pattern design. Post-scan, we had a large library of virtual lasts and would pick the closest match, we could then manipulate the last to any shape with the CAD software and the system would automatically link with the upper patterns to fit the original last and make the necessary alteration to enable the upper to be lasted. We worked with a sole maker who could manufacture the soles to fit the last bottom pattern/ feather edge and add any other modifications prescribed. We could make the last the exact same shape as the patients foot if we wanted and have the CAD pull-out the patterns virtually with minimal human intervention since the patterns were linked to the lasts. Patterns were then laser cut and the lasts CNC milled. Yet, what we found was that it was a nightmare to last the upper over the last due to all the lumps and bumps and more importantly, they looked like sh!t and the patients wouldn't wear them.
The moral of this story: you can make shoes to match the patients feet perfectly, but since their feet look like sh!t, the shoes will too. Have a good weekend Y'all.
And yes the company did- Shame, it was ahead of it's time really, I'm talking 20 years ago.
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
A common sense report and not with outrageous suggestions on how to improve the service to its users.
The Daily Mail carried Sally Underwood's interpretation of being a RhA sufferer and her experience of foot pain vs suitable footwear. Sally is also named as a service user in the "credits" of this report. She doesn't deserve criticism from our profession, just admiration for being prepared to speak out for the majority of younger RhA suffers when it comes to the need to feel "normal" in appearance....not fashionable, just normal. She knows her feet, and therefore her shoes, will never look normal. Its a hard place to be in and Sally Underwood, and all like her, deserve our absolute support...not ridicule (as per the other thread on this topic).
I am finding it interesting to read and understand the Orthotists perspective on fitting the Rheumatoid foot and I have always had great empathy with our local Orthotist Dept...huge expectations ( from service providers), minimal time (for service users) and minimal budget (from the commissioners). It must be as disheartening for these guys when the limited resources they are permitted fail to meet a patient's needs and expectations. I wish the Arthritis Research UK all the luck in the world in trying to change the DoH perspective on the need for decent therapeutic footwear.
Quote:
The moral of this story: you can make shoes to match the patients feet perfectly, but since their feet look like sh!t, the shoes will too. Have a good weekend Y'all.
...but we can't tell our patients this...only empathise. Or is there more we can do?
If we were a united profession, we could make great inroads into the palliative management of the RhA foot and footwear expectations. In my opinion it all boils down to making time to communicate, to understand the patient perspective and using our skills to slowly adapt their acceptance to a new situation (shoe appearance) and in the UK to be aware of the care pathways available for patients with foot problems beyond your (my) scope of practice. But in PP I can offer that time to support a patient in coming to terms with foot deformity, expectations and self management. I need to learn more about the psychological approach to health management...CPD 2012/13???
Bet I am not the only PP who has supported a patient with serious foot deformity with their desire to look "normal" for special occasions....padding the mother of the bride's damaged feet so they can wear a pair of Shotter (or similar) sandals for 5 hours to look somewhere near decent for the wedding photos! Is there anything wrong with that?
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
My only criticism of the report is the lack of imput and contribution from footwear manufacturers. I think they could have made a valuable contribution to assist in implementing some of the reports recommendations.
__________________
I'm not sure I want popular opinion on my side -- I've noticed those with the most opinions often have the fewest facts.
Bethania McKenstry
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Some good replies.
Phil Wells at the 200 - 800 cost you are paying your guys peanuts, which may well reflect the amount of footwear sitting in the bottom of cupboards that are not been worn?
Joe the last is not the most costly part of the task.
Simon, the footwear company going bust is understandable but a shame, the amortization of that equipment per pair would have been very high.
Which brings me to the real issue of cost, think what you charge for an orthosis and the small amount of equipment required and the time to produce it and the average number of consults required.
Then think about the amount of equipment required to produce last and shoes and the time that is required.
You need patterns, clicking, machining, making and finishing plus the average number of consults, for me thats 5, one for the last, one for the "Glass slipper fit", one for the upper fit and one for final fit and sole adjustment according to Fscan in shoe pressure mapping for high risk clients.
The Government body in Australia known as Department of Veteran Affairs(returned service men/women) pay $1051.00 per pair and some Pedorthist wont work for them as that is not enough for the task at hand.
Phil Rees, "My only criticism of the report is the lack of imput and contribution from footwear manufacturers."
Amen to that! How many studies and reports have l read on footwear and not a shoe maker/Pedorthist listed as consult or writer.
Just to give others an idea regarding costings, just to sew the shoe upper together you require a Skiver, Plain machine, Zig zag, Beader(optional) and a Single needle post, each of these are from $6000-$9000 each and the footprint of each machine is 1.2 meter by 1.2 meter
Now compare the charge out for both items, the orthosis and the CM footwear and tell me if you still think those prices for CM footwear are ridiculous? l think CM footwear is ridiculously under priced and under valued
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
According to a company website, custom made leather shoes at a famous shoe maker in London start at 2700 pounds. Given the quality of those shoes, I think it is a fair and very reasonable price. Apparently those shoes are wanted by their clientele for generations.
__________________
Karl -Heinz Schott
Certified Pedorthist C Ped CM (Australia)
Orthopaedic Shoemaker Meister, Podologe (Germany)
Adjunct Professional Fellow in the School of Health and Human Sciences Southern Cross University
Dee Why NSW 2099
Phone 02 9972 4488
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Oh, I forgot “Add VAT (20%) to all prices in the UK to the 2700 pounds” In Australia custom made footwear for a medical reason does not attract GST / VAT.
__________________
Karl -Heinz Schott
Certified Pedorthist C Ped CM (Australia)
Orthopaedic Shoemaker Meister, Podologe (Germany)
Adjunct Professional Fellow in the School of Health and Human Sciences Southern Cross University
Dee Why NSW 2099
Phone 02 9972 4488
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
The major advantage of a pedorthist practitioner model is that the clinician is fully and wholly in charge of the process. H/She interviews the client within the assesment.
He/She starts understand the personalities, idiosyncrasies, and wants and needs of the client. Gets to explain what is possible and what is not. How it will look. How it wont. He/She has a large range of useful prefabricated footwear to choose from that covers age ranges and style ranges both for aesthetics and function
Its at this point, up front, where clients are involved from first step where the "shoes in the cupboard" phenomena is halted.
Therapy that is 60% beneficial and used 60% of the time is better (in my opinion) than 100% beneficial and used 10%.
The C.Ped also has skilled pedorthists, both design and technical, and technical machinery to provide the modifications to prefabricated and to design and produce custom made footwear.
Pedorthics is a specialty in itself. If practitioners do orthotic therapy well and "add-on footwear" to their range of tools then this can be to the detriment of their overall practice.
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
The main gripe i have from female is more the look of the shoe. Lets face it. Most of these patients are
1. Women
2. 50's
They want a shoe to LOOK good and feel good. If it does both i doubt there would really be an issue with cost.
Aesthetics is very important in a lady who is not only coming up to that golden era
menopause, wrinkles, thinning skin, drooping boobs belly and arse, loss of hair etc - combine that with the disfigurement of RHa and it can be pretty damn depressing when someone tells you to wear an ugly pair of shoes!
Its about time we had a nice pair of shoes that not only look good, fit well and are supportive
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
I believe the message is that Pedorthics is a standalone field; it needs more research and education to improve the current offerings. Pedorthic contributions need to be recognised and valued to attract creative solutions to help those who need Pedorthic solutions. That need for research seems a global need while the delivery and training / educational models are very different from country to county. There may also be a need to improve the education/training and delivery of Pedorthic services globally.
The price that a public payer will pay will also depend on what you ask your private clientele to pay. A public payer surely does not want to pay more than the private market price. While the private price for custom footwear in the UK seems reasonable, at least for that one over generations’ successful company, are others asking a similar amount from their private clientele? I understand that the NHS is a blanket service for all in the UK. In Australia we have public funding for Pedorthic footwear as well and we have private operators who ask a significantly higher price from the private patient over many years. That has lead to an increase in public funding for such footwear over the years, especially in those states in Australia where the private operators insisted on their price from the private patients and the same price from the public sector. The revenue one realises for ones service influences the availability of such services greatly. To improve the appearance of a pair of custom footwear over the basic functional need requires a lot more time and effort and that needs to be funded. The female patients in their golden years are often the hardest to please and at times it is impossible to match the footwear to the no longer perfect foot and the expectations that is generated by the fashion industry with underage under nourished models.
__________________
Karl -Heinz Schott
Certified Pedorthist C Ped CM (Australia)
Orthopaedic Shoemaker Meister, Podologe (Germany)
Adjunct Professional Fellow in the School of Health and Human Sciences Southern Cross University
Dee Why NSW 2099
Phone 02 9972 4488
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
There has been massive evidence based research into the care and delivery of services to the RhA foot by the NHIR Leeds Musculoskeletal Biomedical Research Unit (LMBRU), The North West Clinical Effectiveness Group (NWCEG) and Arthritis Research UK. I realise similar work has been carried out throughout the UK and the world but I am a humble Private Practitioner based in the NW of England and have found the work of these people massively influential on my practice.
I was often seeing patients who were at the early stage of RhA and apparently without the need for footwear/orthotic advice. They were deemed "low risk" requiring palliative care which either they or a carer could facilitate. Whilst the evidence to support the paper attached below was being gathered, my patients had direct access to a Podiatrist working alongside the Rheumatology Consultant. This funding has since been withdrawn but for the short term access to support these patient's needs was prompt, appropriate and caring.
With this evidence, I can now action prompt support for patients with RhA via the NHS - a service which then is of no further cost to the service user. Many with RhA simply cannot afford the work of a private Pedorthotist as they do not have the income, being rendered unable to work to their full potential due to disease process.
The one part of the service that remains poorly supported and funded by the NHS is the work of the Orthotist and in our dreams, the Pedorthotist.
This is what the publication from Arthritis Research UK (at the start of this thread) is all about and not a criticism of the costing of bespoke/therapeutic footwear. In its entirety it supports this valuable work of Orthotists/ Pedorthotist and behind the two names from the world of Orthotists listed on the publication will be numerous others who have provided evidence for this research.
The way I see it the next stage will be the sea change, to convince the Department of Health (our UK Government) that the long term savings will outweigh a short term investment in developing a Pedorthotic system nationally.
GB
Quote:
North West Clinical Effectiveness Group for the foot in rheumatic diseases
The North West Clinical Effectiveness Group (NWCEG) was established in 2003 with the aim of supporting podiatrists in the development of foot care services for people with rheumatic diseases. The group consists of podiatrists from services within the North West of England and academics from the University of Salford. In addition to service development support and providing some of the educational needs of the practitioner, the group has developed guidelines for the management of the foot affected with rheumatoid arthritis (RA).
These guidelines are based on the best available evidence and consensus opinion of the group. Their purpose is to ensure that appropriate foot health management is carried out regardless of the location of that care. Further to this they are considered essential in supporting newly qualified or non-specialist podiatrists who may be managing people with RA as part of their case load. These guidelines have been reviewed by representatives from the medical profession and the Podiatry Rheumatic Care Association.
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by toughspiders
... golden era, menopause, wrinkles, thinning skin, drooping boobs belly and arse, loss of hair etc - combine that with the disfigurement of RHa and it can be pretty damn depressing when someone tells you to wear an ugly pair of shoes!
Its about time we had a nice pair of shoes that not only look good, fit well and are supportive
LOL, Excuse me but my wife is a touch older than l and looks hot to me in her early 50's...must be the tropiclal heat of QLD causing all that drooping its not happening here in Melbourne
By changing the lines on the upper, making the lines of patterns running heel to toe and mixing light colours to the middle of the shoe and dark to the outer peices, we can give the appearance of a narrower shoe, fitting well and supportive is not the issuie.
l see Brisfoot here ask him to see your next RA client
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by toughspiders
The main gripe i have from female is more the look of the shoe. Lets face it. Most of these patients are
1. Women
2. 50's
They want a shoe to LOOK good and feel good. If it does both i doubt there would really be an issue with cost.
Aesthetics is very important in a lady who is not only coming up to that golden era
menopause, wrinkles, thinning skin, drooping boobs belly and arse, loss of hair etc - combine that with the disfigurement of RHa and it can be pretty damn depressing when someone tells you to wear an ugly pair of shoes!
Its about time we had a nice pair of shoes that not only look good, fit well and are supportive
Mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm------
"Ugly" is in the eyes of the beholder. or the sufferer, as it is
So----------- can droopy boobs be corrected with a attractive piece of elastic and can a sinking bum be solved by a sexy piece of lycra .-I think not.
Unless I am an an idiot ,how can anyone (who is faintly logical, compare these comparisons with footwear.
I, as a Pedorthist constantly challenge physical improbabilities by trying to manufacture footwear to accommodate unreasonable shapes of orthoses when the foot shape in itself is quite acceptable..
Sure, RA is, in comparison with other disabilities, is difficult, as most are female and usually have aesthetic outcomes which are not possible for the severe sufferer. It also should be noted that a well experienced footwear clinician should guide them through the elimination process and explain to them, why the footwear shape and design needs to be---------------- what it is..
PS::::::
I would like to have the time to evaluate other health professions, as they do with mine.---------------------------------------- Maybe that says something, as, I quite like being ( last) on a patient's list to solve their prob's.
Cheers
"halfway"
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Perspective Joe, perspective, we are not trying to make a fashion statement.
We cant make a 250mm wide forefoot fit into a 150mm wide shoe and if a shoe that is 250mm wide is considered sh*t.....wait, l guess we could jam them into the 150mm wide shoe just for the sake of vanity
But as l said, with the use of colour and design we can help to make it look a little narrower than it is.
Mind you, the poor bugger in the UK being paid $300 for a CM footwear cant be blamed if they are sh*t, raw materials cost them $100 before they even started the shoe, lasts, consults, labor and certainly forget money for further CPD and other improvements.
As l said its all about perspective, we feel there is always room for improvement and will always look for ways to do just that, improve on what we do.
CM footwear is currently under valued and under priced here in Australia and it would seem in the UK more so.
But hey Joe give me $10,000 and l will give it a go for you
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
My post refers to the psychological effects that having these diseases have on people.
One of my staff has both RHa and Scleroderma. She is constantly battling with disfigurement and severe pain. She see's her feminity drifting away from her. She wants to feel female, she wants to look good. That is not a crime.
There are ways to improve the look of a shoe that don't cost the earth. Sadly though we don't see them.
Most of my clients say they want comfort and fit but also want a nice look! It is not an attack on pedothortists and was not meant as such
PS - you can improve the look of droopy boob and saggy arses with nice supportive bits of clothing
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by Boots n all
Mind you, the poor bugger in the UK being paid $300 for a CM footwear cant be blamed if they are sh*t, raw materials cost them $100 before they even started the shoe, lasts, consults, labor and certainly forget money for further CPD and other improvements.
OK, so which service would you take the funding away from within the NHS to provide extra funding for the footwear? Or, would you just provide footwear to fewer people and cover the extra costs per capita that way?
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Podiatry of course ( that was humor)
Simon, they are better off paying more for the right footwear than to pay the cost of the wrong footwear.
l would think the client should part own the shoe, that way they will put more effort into the whole thing... the client should put up 50% at least, so if NHS is paying $300, then the client should add $300 or even more.
Here, the state pays $450 towards CM footwear, the client has to pay the rest and very few bat an eyelid, because its standard practice.
H.A.R.P, the high risk foot group, pay the lot because they are high risk clients
Some do get other funding from some church and community based groups.
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by Boots n all
LOL, Excuse me but my wife is a touch older than l and looks hot to me in her early 50's...must be the tropiclal heat of QLD causing all that drooping its not happening here in Melbourne
By changing the lines on the upper, making the lines of patterns running heel to toe and mixing light colours to the middle of the shoe and dark to the outer peices, we can give the appearance of a narrower shoe, fitting well and supportive is not the issuie.
l see Brisfoot here ask him to see your next RA client
Im very pleased to see you giving thought to the appearance of the shoe. It needn't be costly. Im sure just adding some nice shoe buckles or diamantes etc would be enough to sell the shoe. There's loads of shoe clips also out there on the market that could be added into the leather so not as to rub. There are also some fantastic fashionable leather materials out there too.
Jeez - i hope im looking hot like your Mrs when im in my 50's!!! I must move to Melbourne
Sad fact of life though that loss of collagen and muscle tone combined with that huge drop in oestrogen. I guess there's no hope for me!!!
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Toughspider (luv the name)
There are many considerations when providing (Orthopaedic / Pedorthic footwear to patients and as I said earlier , involving the patient with the assessment of the footwear is paramount in their success or failure.
The best environment to achieve a successful outcome is in a working group from a multi-disciplinary group involving Podiatrists, Pedorthists, Prosthetists, a clinical Specialists and possibly a Rehab team.
I (and many Pedorthists) have several clinics where this happens and the outcome for the patient is generally positive and up-front. They know what is achievable with projected footwear designs and any possible negatives.
An experienced Pedorthist will quickly dissolve a patient's over-expectation of what is achievable (aesthetically) and gain their confidence to achieve a desired outcome..
Please also note---- I often accept a patient's plea to have an attractive footwear design (at my own peril) and most times find myself being paid (nothing) for 12 hours work . Something I am sure other health professionals "don't experience" .
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
Quote:
Originally Posted by Boots n all
LOL, Excuse me but my wife is a touch older than l and looks hot to me in her early 50's...must be the tropiclal heat of QLD causing all that drooping its not happening here in Melbourne
By changing the lines on the upper, making the lines of patterns running heel to toe and mixing light colours to the middle of the shoe and dark to the outer peices, we can give the appearance of a narrower shoe, fitting well and supportive is not the issuie.
l see Brisfoot here ask him to see your next RA client
Yup I agree with Boots. His wife is much "aesthetically pleasing" (is that Ok Boots")
than he is
"halfway"
Providing better footwear and foot orthoses for people with rheumatoid arthritis
Shame, it was ahead of it's time really, I'm talking 20 years ago.
its not happening here in Melbourne
ask him to see your next RA client
Re: Providing better footwear and foot orthoses for people with rheumatoid arthritis
( that was humor)
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