Comparison of foot orthoses made by podiatrists, pedorthists and orthotists

"Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p< .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and orthotists." More information and comments.

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What defines podiatry as a profession

In this discussion on Who Treats Feet?, I posted this message:

That is an issue - what defines "podiatry" as "podiatry" so that it is different from other professions --- in the USA, podiatry is clearly part of the medical model - in the rest of the world it is not, where it is a discipline similar to physiotherapy etc (that is despite limited numbers with surgical qualifications in places like the UK and Australia).

While it is one thing to aspire to the medical model, but is that feasible outside the USA where historical development and educational models are different? One train of thought I have been considering for a while, is just what is it that underpins the 'podiatric model'?

Take nursing as an eg....they used to be the doctors 'hand maidens' - the textbooks of >20 or so years ago reflected that. BUT, now there is no doubt about the very high levels of independence, professionalism and status of nurses as not being the doctors 'hand maidens'. What changed? What gave them this independence as a profession ..... take a look at the current and recent nursing (up to 10 or so years ago) textbooks - the change is obvious....its the concept of a 'nursing diagnosis' that has got nursing to where it is.

For example - the medical diagnosis might be 'chronic obstructive pulmonary disease'. The nursing diagnosis "is a clinical judgment about an individual, family or community response to actual and potential health problems/life processes" - is it will focus on restrictions in ADL's and how they can be facilitated etc. Look at attempts in the physiotherapy literature to define and develop a theoretical model/framework to define the "physiotherapy model'. Look at the plethora of recent textbooks from occupational therapy defining the occupational therpy model with models and frameworks --- they are very well developed and rapidly catching up to nursing in their ability to define their profession in such a way (no wonder they are no longer perceived as basket makers ).

Maybe its time we need to consider the concept of a 'podiatric diagnosis' that needs to be addressed in each patient to better define podiatry as a profession. Those who want to pursue the medical model will disagree with me here...For eg that corn on the fifth toe has a medical diagnosis of hyperkeratosis due to an adductovarus deformity of the fifth digit.... a podiatric diagnosis could be pain due to a pyschosocial problem that prevents them wearing appropriate footwear .... for which problem did the patient really come to us for? Which definition of this problem should we be directing our treatment at? The concept of a nursing diagnosis has defined 'nursing' and directs nursing interventions --- Do we need something similar?

What say you? Comments

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Plantar fasciitis discussions

Podiatry Arena has had a lot of good topics and discussions on plantar fasciitis:
Orthoses vs plantar fasciitis
Is a calcaneal spur in the plantar fascia?
Extracorporeal Shock Wave Therapy:
Ultrasound therapy for plantar fasciitis
Plantar fasciitis and dorsal pain
Nutrition and plantar fasciitis
Botulinum toxin and plantar fasciitis
First-Step Pain
Plantar fasciitis is associated with functional limitation in older people
Growth Factors For Chronic Plantar Fasciitis?
Wheatgrass cream no more effective than placebo for plantar fasciitis
Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy

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The common cold and cold feet.

The common cold is a viral infection .... being exposed to the cold does not cause a cold.... at least that is what I have always been led to believe - but is it so? This recent study has shown that cold symptoms develope in some when the feet are exposed to the cold:
Acute cooling of the feet and the onset of common cold symptoms.

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Does genu valgum cause the foot to pronate?

This one has troubled me for a while.

When teaching the pediatrics part of the course here, especially the genu varum and genu valgum, it always comes up about the effect they have on foot function. Genu vaurm affects the foot as it has to pronate to get the foot flat on the ground. According to so many podiatric texts, genu valgum also causes the foot to pronate as the center of body weight is medial to the subtalar joint -- this has always troubled me ... how can opposite alignments at the knee cause the same affect on foot function Is this just another one of those podiatric myths

As part of the lecture, I mention this troubling aspect --- sometimes, I get the students to do this exercise:
Stand up with feet wide apart (simulated genu valgum, due to wide base of gait) -what does your subtalar joint feel as though its doing? -- the answer is always "supinating" ---- so how does a genu valgum pronate a foot, like so many podiatric texts claim??

Now thanks to Bart Van Gheluwe we finally got some real data:

Effects of Simulated Genu Valgum and Genu Varum on Ground Reaction Forces and Subtalar Joint Function During GaitBart Van Gheluwe, Kevin A. Kirby and Friso Hagman
Journal of the American Podiatric Medical AssociationVolume 95 Number 6 531-541 2005
"The mechanical effects of genu valgum and varum deformities on the subtalar joint were investigated. First, a theoretical model of the forces within the foot and lower extremity during relaxed bipedal stance was developed predicting the rotational effect on the subtalar joint due to genu valgum and varum deformities. Second, a kinetic gait study was performed involving 15 subjects who walked with simulated genu valgum and genu varum over a force plate and a plantar pressure mat to determine the changes in the ground reaction force vector within the frontal plane and the changes in the center-of-pressure location on the plantar foot. These results predicted that a genu varum deformity would tend to cause a subtalar pronation moment to increase or a supination moment to decrease during the contact and propulsion phases of walking. With genu valgum, it was determined that during the contact phase a subtalar pronation moment would increase, whereas in the early propulsive phase, a subtalar supination moment would increase or a pronation moment would decrease. However, the current inability to track the spatial position of the subtalar joint axis makes it difficult to determine the absolute direction and magnitudes of the subtalar joint moments." (J Am Podiatr Med Assoc 95(6): 531–541, 2005)

What say you?

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Foot Outcomes measures

I let my frustration show a bit here:
Another bl....y outcome measure for the foot
"Does anyone share my frustration at the plethora of outcome tools that have been developed for the foot . When will it stop? When will people actually stop developing them and start doing research that actually uses them."
" It just seems as though people are more keen to develop yet another outcome tool, rather than spend that time using the ones we have. .... why waste resources reinventing the wheel? We should be getting on with doing research on, for eg, differences in outcomes between 2 interventions using outcome tools we now have, rather than develop new tools to measure the outcomes!!"
It followed the publication of yet another tool for measuring outcomes in the foot.

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Good Feet Stores

There has been an exposure on this franchised chain of stores using hidden video camera's:
Good Feet Stores

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