Key Insights On The Evolution Of Orthoses And Biomechanics

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Guest Clinical Editor: David Levine, DPM, CPed

   A: Dr. Richie says the fact that lectures on biomechanics at podiatry seminars have vanished means current practitioners will lose touch with new advances in foot orthotic therapy. As a result, he fears foot orthotic therapy will become less prevalent as a conservative intervention for many of the pathologies that DPMs treat. Dr. Richie says the lack of awareness of emerging advances in foot orthotic therapy may cause some podiatric physicians to favor less sophisticated orthotics such as prefabs, drugstore arch supports and felt metatarsal pads.

   As Dr. Levine recalls, it was not long ago that orthoses were mainly the domain of DPMs. However, this situation has evolved as other specialties have become prominent. Although other specialists may be attempting to utilize orthotic devices, Dr. Richie says no specialty has the biomechanical knowledge of the podiatry profession.

   While other specialties fabricate orthotic devices, Dr. Richie says they do not do so with the thought process and treatment goals that podiatrists offer. He advocates that the profession continue to emphasize attention to biomechanics, overseeing and delegating exactly what needs to be prescribed when it comes to the use of orthotics.

   With some of the more current ideas on foot function, Dr. Spencer says a lack of awareness of these emerging concepts may have an impact on modifications and additions to the orthotic device. If practitioners are not overly comfortable with biomechanics, Dr. Spencer says some physicians may allow the orthotic lab to make decisions for them. Although this sometimes does not result in a negative orthotic outcome, Dr. Spencer cautions that it could lead to a less than ideal orthotic prescription.

   Dr. Spencer advocates looking into the actual evaluation process of the patient and how DPMs can prescribe a device that will best suit that patient’s pathology. He believes some evidence would be beneficial in convincing practitioners to pay more attention and reinforce their knowledge base in the area of foot mechanics and the foot orthotic prescription.

   Q: Since other specialties, and even specialty stores, are dealing with a variety of shoes and inserts, how will this affect the podiatry profession?

   A: Often, shoes and inserts are all that a patient needs to address a mechanical problem, maintains Dr. Spencer. Although shoes and inserts may not be the best solution, he says one must be sensitive not only to the patient’s best interests but also to the patient’s best financial interests.

   Rather than being wary of shoes and inserts, Dr. Spencer advocates learning as much as one can about them. He feels the profession should start a campaign that podiatrists are the experts on all things related to the foot, including shoes and inserts.

    “It has been my experience that when I can discuss a shoe and or insert with more authority and factual information than the shoe salesman, patients will listen and trust me,” notes Dr. Spencer.

   Dr. Richie says the selling of orthoses in retail stores helps the profession as such stores raise the public’s awareness of how the placement of orthotic devices in shoes can help achieve better foot health. Dr. Richie adds that if a patient finds that a store bought device is insufficient, the next step will be to contact a podiatrist to dispense a custom device.

   However, Dr. Richie notes that the emergence of other specialists in prescribing orthoses may have a negative impact on podiatrist efforts in this arena.

    “The fact that other specialties such as pedorthists and physical therapists are dispensing orthotics is a real threat to the podiatric profession,” argues Dr. Richie. He feels that pedorthists and physical therapists take orthotic therapy more seriously than DPMs, adding that they conduct more research and lecture more on orthoses than do DPMs.

    “It will not be long before they actually do a better job with this treatment modality than we do,” he says.

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