The Footprint Hub: Recent Episodes

Footprint Hub

Regular discussions with industry experts in the prescription, design, production and clinical use of medical foot orthoses.

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  • Plantar fasciitis commonly over diagnosed…

thorough assessment before diagnosing. * Possible differential diagnosis & red flags * Knowledge and Identification of specific anatomical structures essential. * Plantar heel pain is more aptly named...... ? * Importance of ascertaining biological forces, stresses and strains behind diagnosis * Maybe 10 patients with Pl. F but 10 different aetiologies and 10 different treatment programmes! * External factors…age, activity levels, job, lifestyle, footwear…etc…. * Ask patient lots of questions

Orthotic considerations (HM & SR):

  • Don't rule out other treatments

Discussion Focuses on Mechanisms of Injury (MOI) into orthoses prescription * Our thoughts on condition specific orthoses... not mentioned... not appropiate professionally. * In no particular order, Thoughts and experiences on the following:

  1. Plantar fascial grove
  2. Heel cushion
  3. High heel cups
  4. Medial wedging
  5. Choice of material for whole device
  6. Soft button under Pl. F insertion
  7. Kirby skive
  8. Medical flange
  9. Heel raise
  10. Met pads / met dome to drop 1st and engage windlass

Conclusion

  • Importance of using anatomical knowledge, good assessment to determine acute and ongoing mechanisms of injury (causes) and go into planning therapy approaches from there....

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At a Footprint Hub not so far away…

...clinical guru Heidi Meckler and design podiatrist Stuart Roeszler regularly get together and discuss all things orthoses and their relevance to modern clinical practice.

This week, the conversation between Heidi and Stuart flows to the selection and consumption selection of popular orthotic materials.

Feel free to join our semi-regular Wednesday Web Feat sessions, lunchtime Wednesdays, to discuss all things prescription, design, and manufacture of medically manufactured foot orthoses.

Find out more at facebook.com/footprinthub/events.

Now put your feet up and enjoy this week's episode...

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Unfortunately bulkiness of devices is an all to common occurrence in orthosis manufacture. So why does it keep occurring?

Heidi and Stuart recorded their weekly web feats session for you to consider at time with your feet up. Feel free to join us each Wednesday for a rundown of all things orthosis manufacture in the modern world - facebook.com/footprinthub/events/

Key Notes for this Week

The seemingly elusive hunt to avoid bulkiness is key area where we are seeing a “dumbing down” of the profession and orthotic manufacturing techniques. Manufacturing labs are targeted for an issue that, unfortunately, is most often a prescribing practitioner based...

On an internal review of privately held business data (not available to the public), of those errors recorded, for bulkiness seems to be:

  • more than 85% were represented by either 1. the direct position of a scan or 2. absence or non-referenced position of a prescription variable.

Needless to say, it is very costly to re-manufacture and re-deliver a device and is not something a manufacturer sets out to do… or even legally required to do!?

Large motivations to attend to it… but not upset the customer…. leads to homogenisation of products through software smoothing algorithms or templated shapes.

The inconvenient truth is, the error of bulk more often lies with the practitioner. To control this, manufacturing has steadily veered toward a fool proof system of “semi-custom” production, where shapes are homogenous and independent of supplied foot data. Its cheaper and quicker and customers (us) always seem much happier….

FPH approach is vastly different - Sign off of a custom product. All that would be left is a simple to minimise any remaining process error.

Factors affecting device thickness// bulk:

  1. Scan position

Relative to…?

Plantigrade forefoot

Heel displacement loading

Parallax errors 2. Relationship of scan to prescription variables / No-correlation between Foot to shoe to prescription

Selection of shoes, materials & device types to suit each other 3. Foot shape / morphology

Sulcus position

Metatarsal lengths - parabolas - head thicknesses 4. Soft tissue displacement & joint movement 5. Thinking errors

Forefoot to rearfoot relationships

Transverse plane destabilisations 6. Interpretation errors

heel width

Heel height

Bulk - Shank dependant (vs Shank Interdependent) devices 7. Unit of reference

% vs mm

Size conversion 8. Responsibility of checking devices fit for purpose?

Fit to shoe - What shoe?

Fit to foot?

Fit to prescription?

Fit of foot to shoe = how much space to play with in the shoe will affect the orthosis... foot in the shoe is typically never seen by the technician. 9. Shank Dependant use Bulk to provide support. Devices too bulky? Try a 3D printed shank independent devices…. 10. Production Pathway

POSSIBLE SOLUTION:

  • PRESCRIPTIVE COMMUNICATION
  • AUTHORISATION PRIOR TO MANUFACTURE
  • MAINTAIN DISCIPLINE
  • RECORD ERRORS FOR TREND ANALYSIS

PAYOFFS

  • Reduced costs
  • Reduced waste
  • Happy Clients

See you Next Time!