Posts for: April, 2021
Over the many years we have been in practice we have largely tried to stay away from selling or recommending one particular brand of footwear over others.
In general most shoe companies make some great shoes and some absolute rubbish, much the same as every other industry.
In the coming weeks we are going to try and acknowledge a few star performers and and what it is about them that makes them standouts and for whom they might be best suited.
As always when discussing footwear with patients, we stress that despite having identified a suitable shoe for your needs, it's imperative that you try the shoe on and judge the fit and feel for your own satisfaction.
If you have any questions or particular needs you’d like us to consider regarding shoe choices please ask away. With some of the more unique specialized sport footwear we might be limited in our depth of knowledge but we have a broad field of experience.
In a recent online forum with our colleagues we were debating the merits of various techniques for capturing foot structures in order to manufacture custom functional orthotic devices.
Most experts in our field will agree that in general the foot should be captured non weight baring with the patient ideally lying face down on a couch. So that rules out foam boxes, pressure mats, weight baring scanners, and little beds of funky nails to contour the weight baring foot (I kid you not!).
If we are making a true functional custom orthotic you can accept that if the shape of the foot is captured weight baring it's kind of like closing the stable door after the horse has already run off and is grazing someone else’s grass.
The goal is to capture the architecture of your foot at its best so we can fabricate an appliance to enable you to function in the most efficient, ,stable orientation.
For most, that leaves us with two real options, the first of which is using plaster of paris.
This was how we functioned for the first 20 or so years of our careers and it works well in skilled hands. It is however messy, time consuming, labour intensive, and not particularly environmentally friendly.
The second method, 3 Dimensional scanners come in various shapes and levels of accuracy. The stand out of the pack for us was the Veriscan system, which we first adopted for use in conjunction with Integrity Orthotics. The system has been revised and improved several times over the years. Essentially it utilized two laser and camera combinations on a carousel to capture a very accurate 3D image. The digital image is transferred to the Integrity laboratory enabling them to mill out an exact replica or custom modified version of the foot using a CAD/CAM system.
In our busy practices we quickly found a significant improvement in clinical fit and accuracy of the orthotic devices and an increased level of patient satisfaction. The environmental impact of reduced cleanup costs, shipping, waste and material, helped hammer the final nail in the plaster coffin. That said there are still occasional cases for very problematic Diabetic foot types (Charcot feet) where we still revert to a semi weight baring plaster cast when making custom orthotics or footwear.
Rest assured we will continue to look at future offerings from the scientific innovators to bring further improvements and refinements to enable you to function better.
A final thought!. One sage contributor to the online debate summarized, without a good diagnosis and appropriately written orthotic prescription, the method of capturing the foot is of no importantance.
If you have any questions regarding this topic please comment below or message us and we'll be quick to reply.
Digital Corns and Callouses
Continuing our recent theme of debunking some long held theories about common foot problems, the subject in question today is digital corns. Again our online sources identify YOU as the source of the problem, or more specifically your inability to choose a shoe that doesn't crush your toes (insert eye roll emoji).
Ok, I think we have all tried on a shoe that was a little tight for a special occasion but for general everyday life, most individuals have sufficient intelligence to know better.
Daily, we encounter patients who are suffering from painful corns on the tips of their toe, in between, or on the top of one of their toe joints. They report gradual formation of the corns over time and often they are wearing good quality correctly fitted shoes, so what happened?
In the vast majority of cases a mechanical functional instability results in overuse of the long digital flexor and extensors muscles.
This influence during the gait cycle causes the toes to contract (curl/claw) so that the tips of the toes are driven in to the ground, or the joints of one toe rub against the bony expansion of the joint on the neighbouring toe. Sometimes the toes contract so much, or the toes are pulled up (retracted) into the top of the shoe causing pressure and the associated callous and corn is born.
Whilst observing out patients standing/weight bearing often there is little or no evidence to support this claim, unless the offending toe is become fused or hammered. However, viewing the individual walking barefoot with our Pedigait system (our digital video gait analysis system) we can see stride after stride in slow motion showing exactly how the lesion was formed and which were the contributing structures. Additionally, If these forces are allowed to persist long enough and in combination with other systemic illnesses like diabetes, they can result in tissue breakdown, ulceration, infection, loss of locomotion and a huge undesirable change in the quality of life.
Treatment must be based on a clear understanding of the underlying cause; otherwise, without addressing this, most interventions will be futile and unsuccessful in the long run.
So I’ve wanted to do a post on this phenomenon for ages!
I am amazed how frequently i find myself especially with new patients feeling like the Inquisitor, dragging out information regarding medical history.
Whether this is fuelled by a distrust in modern medicine or a previous bad
experiences in a doctors office, it greatly reduces the likelihood of success or
satisfaction in the care you receive.
I am not for one second suggesting you walk into every doctors office smiling and
rhyming of your history and symptoms rapid fire. Instead when I refer one of my
patients to another specialty I try to coach them a little regarding getting the best
outcome from the up coming meeting.
First and foremost make it clear you are there because you want to get better and
return to as normal and full a life as possible. You won’t believe how motivating an
effect this will have on the clinician to go above and beyond. Never for get they too
are human, …..well most of them.
Before you go head to your appointment get an idea of the history and symptoms clear
in your mind, better still on paper. General medical history not directly relating to
your condition may be very important that why you’re seeking their help not GOOGLE.
Listen carefully to their questions and reserve your possible frustration and
judgement until later. I had a patient just two days ago who was aggressively
confrontational from the moment I walked in the room demanding to know why I didn’t
have my walls decorated with certificates and diplomas to reassure them of my
professional abilities. After 10 minutes and several deep breaths we finally got
around to discussing her health problem.
By all means question, investigate and become informed about what you believe your
condition to be, YOU are your own best advocate.