Insights On The Evolving Nature Of Orthotic Education And Casting

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Author(s): 
Guest Clinical Editor: Doug Richie Jr., DPM, FACFAS

   As for the ability of a pedobarograph to dictate what the shape of the orthotic should be, Dr. Phillips says there is absolutely no literature to support the possibility. Most systems that claim that they can do this are “black box” proprietary systems, he notes. For the most part, Dr. Phillips says such pedobarographs provide nice pictures that impress the viewers but the users rarely ask the question as to how the actual transformation from pressure data to shape data occurs. If practitioners do ask, he says they learn that it is proprietary information. Saying he believes in prescription orthotics, Dr. Phillips says he will not turn over the responsibility of the prescription to a black box system that he does not know everything about.

   Dr. Phillips is affiliated with the Orlando Veterans Affairs Medical Center in Orlando, Fla., and is a Professor of Podiatric Medicine at the College of Medicine at the University of Central Florida. All opinions he expresses are his own and in no way should be construed as representing the opinion of the U.S. government or any of its agencies.

   Dr. Scherer is a Clinical Professor at the College of Podiatric Medicine at the Western University School of Podiatric Medicine. He is also the CEO of ProLab Orthotics/USA.

   Dr. Smith is the Vice President of Northwest Podiatric Laboratory and is a Professor Emeritus at the California College of Podiatric Medicine at Samuel Merritt University.

   Dr. Richie is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is a Fellow of the American College of Foot and Ankle Surgeons. He is in private practice in Seal Beach, Calif. Dr. Richie writes a monthly blog for Podiatry Today. One can access his blog at www.podiatrytoday.com/blogs/301 .

   For related articles, see the November 2011 DPM Blog, “What Happened To Continuing Education For Podiatric Biomechanics?,” by Doug Richie, Jr., DPM, FACFAS at http://tinyurl.com/phfawo7 and the article “Orthotics Are Not Biomechanics” in the December 2012 issue of Podiatry Today. For other articles, visit the archives at www.podiatrytoday.com .

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MBsays: June 2, 2014 at 10:35 am

The reason so many orthotics do not reduce symptoms is that those feet are attached to a body and a pelvis that may not tolerate what the orthotics try and make the feet do. Podiatrists should work with skilled orthopedic physical therapists to determine and work with patients who have restrictions and imbalances elsewhere in their body.

There are numerous pedorthic programs across the country. I took one at Temple that was only 2 weeks. Great class. Young podiatrists should seek out those programs to learn how to cast and how orthotics are made instead of relying on a lab that will never see your patient's foot nor do they want to.

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Robert D. Phillipssays: June 25, 2014 at 10:22 am

In response to MB's comment:

Pedorthotic programs are good and I do avise you learn as much as you can from them. However, they will not be able to teach you how to cast for a "Root functional orthotic" nor teach you the theory that they are built on. You should use such programs to add to your knowledge base, not to replace it.

As to the need to work with physical therapists, again that is important, however the podiatrist should be trained to also fully examine the patient for restrictions in movement. We expect the podiatrist to learn to do a complete H&P because we want podiatrists to do their own admissions to hospitals. Why shouldn't a podiatrist know how to fully examine a patient for abnormalities that create gait limitations? Are we not the "gait experts?"

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