Inside Insights On The Evolution Of Orthotic Therapy

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Pushing down on the first metatarsal during the negative casting process optimizes the position of the first ray and enables one to capture a valgus forefoot to rearfoot relationship. Douglas Richie Jr., DPM, notes a deterioration in the quality of impres
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Author(s): 
Guest Clinical Editor: Douglas Richie Jr., DPM

   After five years of visiting or lecturing at all the schools of podiatric medicine, Dr. Richie feels some have neglected the art of casting, noting a deterioration in the quality of impression casts submitted to labs. Dr. Richie says some have also neglected the art of prescription writing and asserts that schools do not teach prescription writing with the detail as they did in the 1980s. Dr. Richie says DPMs are providing less information to the labs regarding specific patients, adding that some podiatrists submit blank prescription forms along with casts.

   Dr. Smith notes that more podiatrists are starting to use accommodations and customization for patients. However, he does acknowledge that some DPMs use uncomplicated rigid devices to control symptoms. He sees a slow but steady improvement in the quality of negative casts. Dr. Smith says that as practitioners learn proper joint positioning, the number of forefoot valgus casts increase while the number of forefoot varus casts decrease. He says DPMs are slowly mastering the ability to evert the forefoot on the rearfoot.

   Q: Since most major podiatric seminars today neglect topics on foot orthoses, how can DPMs continue to learn and improve their skills in podiatric biomechanics?

   A: To improve skills in biomechanics, all three panelists suggest attending the International Conference on Foot Biomechanics and Orthotic Therapy (PFOLA), which balances original research with clinical application.

   While some regional meetings include tracks on biomechanics, Dr. Richie says several national meetings have not focused specifically on biomechanics in several years.

    “This is a disturbing trend since lower extremity biomechanics and foot orthotic therapy was originally the one discipline which set us apart and gave us tremendous advantage over other foot and ankle clinicians,” asserts Dr. Richie. “The vast majority of DPMs in this country still rely on biomechanics and non-operative interventions on a daily basis. A few labs put on local workshops occasionally around the country but there is no single educational institution whom podiatrists can turn to for continuing education in the field of lower extremity biomechanics and foot orthotic therapy.”

   To remedy that, Dr. Smith says podiatrists should demand the inclusion of biomechanics in every seminar.

   Q: Do you perceive that the profession is still interested in learning more about podiatric biomechanics and foot orthotic therapy? What are the solutions to ensure that the profession does not lose its hold on the science of lower extremity biomechanics? Are we giving it away to other specialists like pedorthists and physical therapists?

   A: Dr. Scherer emphasizes the importance of podiatrists taking a leadership role in research in order to apply skills to patient care. Although podiatrists were first to apply the concept of lower extremity biomechanics to patients, he says professionals such as orthotists and physical therapists place more value on orthotic therapy.

    “Podiatrists started this ball rolling and we should be the experts,” says Dr. Scherer. “Being the expert doesn’t just mean telling people we are the experts. It means we must learn more, become the leader in finding new information, share our knowledge, and make sure the podiatrists that follow us are well informed and skilled at orthotic therapy.”

   Dr. Smith believes the profession does want more knowledge about orthotic therapy but says one obstacle is a lack of uniform knowledge. He suggests more scientific research and outcome studies to define the clinical applications of orthotic therapy.

   In addition, Dr. Smith advocates more classroom and clinical exposure for podiatric students, and also suggests the funding of a biomechanics fellowship. “We need talented, dedicated professors who can and will make a career of teaching this material,” says Dr. Smith.

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