Hello and welcome to Podiatry practice Mastery.
My name is, Don felt. Oh, and I have dr.
Ben Pearl here. Welcome Ben.
Hey, thanks, Don and to be best nice to have you back.
And today we're going to focus all about Orthotics and and also
biomechanics. I think that's a passion of
yours. So, you know, let's kind of Dive
Right In what I'm really excited about is you're going to talk
today about kind of these little things that we can modify in our
practice implementing, these little things of biomechanics
and kind of make big changes. With our patients.
So, tell me a little bit about this upcoming conference, and
your shoe tips. And where do you want to start?
Yeah, let's start with just biomechanics in general.
I think that Podiatry is losing a little bit of ground to the
sports industry Health gurus. So what I mean by that is that
there are a lot of podiatrists like you and I that are curious
and they're in there are Also, a lot of podiatrists that are in
the algorithm of what they learned from Merton, root and
weed. And there's nothing wrong with
some of those precepts as a starting point, but we've
evolved so much into the marriage of shoe Foot orthotic
sock. All those things come together
in a seven-layer cake to make the the result in terms of
friction fit bail instability. And I think that that's where
Podiatry needs to hone back in, start reading more articles.
Start attending more things like the Seminary you're putting here
on today. No, listen to those Snippets.
Don't listen, just to Podiatry. Listen to some of the
biomechanics information that is out there in biomechanics land
via an onp person, be it biomechanics PhD, like been
oneg. Be it a podiatrist from another
country. That may have a different band,
like Simon Barr told, or Simon Spooner or you know, many others
that are that are out there. So, I think that If we look at
doing things in a stepwise fashion, and this is, this is
like a precept, right out of Richard Blake's Playbook, you
know, he just wrote a very lucid book.
Practical biomechanics for the podiatrist.
You couldn't get any more elegantly simple than that.
And if we take the variables that we have and add 1, small
variable at a time. We will then know, right?
Right, what biomechanically we did to make the change?
Yeah, it's so I think these are great and I think a lot of us
are probably like me your little bit more advanced and
biomechanics. How does someone I'm thinking
like, we're all I think that one of the biggest changes we've
gone so surgical right? We don't we do mostly surgery.
A lot of we're trained, surgical right?
We're not training biomechanics and our residencies.
So if someone wants to kind of shift things back and you
mentioned a lot of great names, but I'm a busy podiatrist, you
know, seeing my 30 patients a day.
Is there a resource? I know there's this conference
coming up. Like, what do you do, or what?
Should a podiatrist do? Because we don't have all this
time. We're like maybe reading this
between patients. So, what are some good tips?
Yeah, I think like you say, identifying.
Professionals that are interested in disseminating
information. That is available on stoop
roach. So look at the look at the
agenda. Look at the faculty, make sure
that it is not just to promote an afo.
For instance. There's nothing wrong with a
good based lecture that talks about afos.
I applaud that it's just that we want to make sure that we're
approaching. Both the pros and cons of the
various Orthopedic appliances, that were that were using.
For instance. Let's say an afo, we all know
we've had our Medicare age population.
Come in with an afo that they got from let's say another
podiatrist or hanger Labs or some other prosthetic source
that has been sitting in the closet.
So what? We have to determine is number
one. We're looking at the patient
right in front of us. Do they have the skill set to
apply the brace properly. Are they going to use it more
than just, you know, for the time frame that you teach them
to how to apply it in your office.
And is this going to be a six-month measure or a long-term
measure? And then, of course, it gets
down. Also to making sure when we
dispense them. From a practical standpoint that
we take into mind the same and similar.
If they've had a cam boat. For instance.
We then have to enter the discussion of even though this
may be better for you. Mrs. Jones.
We see that you've had a can both.
This may be a problem and then it's up to you to determine you
want to just give them an avian, or you going through the
Appellate levels and and documentation that will be
required to get that device that you want covered be an ankle
brace. Or Some type of a fo one of the
things that I just picked up from a colleague of mine just
recently. I like this idea of not just
referring to a cam boot for offloading, the ankle or a
fracture. So let's say we have a stable
fracture. We know that when we put the cam
Bhutan we're going to have an inequity there with with the leg
lengths. So and I have no affiliation
with these folks whatsoever. But I really like the idea of
this take. Oh, brace, that is external to
the shoe. So instead of having a
differential of, let's say half an inch three quarters of an
inch, whatever. The cam boot, differential is an
inch. Now you have minimal because
it's a, it's an external skeleton.
That goes around the shoe. And we've also taken out some of
the Compliance issues with having something internal in the
shoe where now you have something you're jamming into
the shoe creating more volume and now it becomes a shoe fit
issue. Yeah, in some cases.
It's a it's a it's a great. It's a great tip.
You had some other kind of real practical biomechanical tips.
You're going to like what you use every day in the office.
What are some of those other other tips?
You talked about a ball or something like that?
What are those? Those things.
Yeah. Yeah.
I'm going to review those. I just wanted to finish with one
little caveat that that I think people should understand when we
wear a cam boot or one of these take over racist when we're
talking about offloading. Offloading vertically.
We're really as measurements go with those devices offloading.
Approximately 30% that's supported in the literature.
So just bear in mind that although you're It's not like
100% offload with those devices. So even though people think in
their mind. Oh Cambodia is the gold
standard. We're really only offloading 30%
on the you know, the vertical forces going through the the
Foot and Ankle as far as some of the things that I'm not always
going to be. We're going to go down these.
Now, we're going to go down as we're gonna go even more.
So do you have any good options? So I've been struggling with
this like a lot of my patients. I see, let's say posterior
tibial. Tendonitis, peroneal, tendon,
itís, even plantar, fasciitis. I don't want to put them into a
can boot. I'm going to do Shockwave on
them. Okay, but then I want to offload
it. So, I've tried like a velocity
brace to offload a little bit, which is like, kind of a
non-custom a fo. But I would love to have an
offloading brace. That worked really well, that
would put the pressure into the lower leg and offload the fash
or these tendons during the course of the Shockwave.
You have anything that works great as a non customer
customer. You is frequently.
I would say that I'm very eager to see what the compliance rate
will be with the take old brace, because I think it's lighter.
And from a standpoint of compliance.
They've actually worked with some of the workman's comp folks
that don't have, for instance. Osha Osha will restrict them
with a cam boot to return to the workplace, but they've actually
now been able to get these take o braces and it's an example of
one brace. There's other braces out there
that aren't exactly the same. In terms of the offload, is it?
There's an awful more than 30% or is it only 30% in offload?
So it's a 30. It's the 30% brace.
Yeah. I was talking to this gentleman.
I interviewed him a while ago. I forgot which one it was.
He's in Colorado, but it's a Race that almost offloads,
eighty to ninety percent to the lower leg.
And I don't, I haven't found anyone locally.
Like hanger doesn't do it for me.
They were a local lab that did it for them.
I just thought that was an Eda. There are, there are other races
that offload more. Those are going to be a
compliance issue because they're more restrictive.
Okay. So we've heard of things like
Crow braces and other things that are very, you know, they
encumber the limb. So sometimes it's, it's so I
guess none. A friendly for patients to wear
that they defer out of that. Yeah, there are little things
though that we can do within the shoe to use.
For instance. Let's just say a shoe that has a
nice roller. This is a Zeller.
Oh, shoo. So this I, this is like a tank.
I mean, so we used to be thinking about shoes, like the
Brooks Beast or the New Balance 1980 as, you know, our best
support shoes, but The fact of the matter is that, and I'll see
if we can grab the Cutaway on that Zorro shoe.
The nice thing about that. It's got a carbon Morton's
extension built into the actual sole of the shoe.
So not only does it have the roller.
Okay, but it's got an inner carbon layer that helps
propulsion as and built as a Morton's extension and this is a
cutaway of the shoe. It's a brilliant.
Zayn. And I actually borrowed this
idea because not everybody has that for what hallux limit is
for. Yes.
Recovering some pre dislocation
syndrome submit to recovering stress fracture recovering,
hallux fractures, you know, so these things that don't require
a fixation or if they do require fixation, you're now in week 2,
and let me tell you something, I think.
As long as there's not swelling, once the stitches are out.
I would bet you that this is going to be a lot more
supportive than a surgical shoe. Hmm.
Good idea. That's good.
Now, as far as price point, we're now approaching, you know,
with gasping what we're getting up into what 575 a gallon.
So now we've got economic pressures on patients.
That's why I came up with a concept that I call small ball.
So let's just get a base hit or a double.
Instead of trying to get the home run all the time with, like
we were talking before a colonoscopy out of me, a triple
who has time now to take out of their, you know, their their kid
has just got over covid and you know, the other kids struggling
with IB program or AP program in school.
And so are, you know, we have to be there for our kids and for
our for our extended families, Etc.
So here's for example, something that I designed.
It's Called the turf toe splint, but it's really more about using
it for something like hallux limit.
Its because that's much more common for our practices than
turf toe. So the premise is not to stop
the range of motion, but to slow down that torque, slow down that
moment, and then also to get compression, because this is
like a compressive midlife device and then in doing so,
being adhered to the foot, I've had patients.
Tell me that it feels like their big toe is now like wolverines
toe like that. It's like one long bone.
Instead of a segmented ipj or MTP that it gives them a sense
that they're now getting a full linear axis of strength through
the whole toe joint. So that's that's another example
of something that I use everyday.
I'm going to show another example, and there's great
places to get these. I get mine from juvy.
Jill's, these carbon plates, you know, it's such an easy thing to
use. And yet how many people actually
stop these in their, in their office.
And by the way, I'm all about getting the patient better.
So the patient doesn't have, let's say, 40 bucks or whatever,
whatever you decide to sell these carbon plates for the
pair. If it's just in one foot, why
not? Just sell them one and just keep
that, that other one for the Next, you know, size 10 patient.
So I think if we open up our Paradigm and approach to not be
a one size fits all for our patients.
We can then customize and get more patient compliance, you
know, both from from what it feels like standpoint and also
an economic and realistic standpoint for application.
Yeah, that's great. That's great.
Hey, we're coming towards the a little bit of the end here in
terms of time for us. Tell me a little bit about this
this how you guys put together this kind of biomechanics
Workshop or this, tell me a little bit about this and if
people are considering they want to learn more about
biomechanics. Would this be good for ya?
This is actually good from student resident all the way up
to season practitioner because Don, there's so much new that's
coming out if you look at Magazines, like lower extremity
review, the biomechanics journals, especially things that
are being published in the UK, and Australia.
There's just so much going on and why do they focus on it more
over there? Because they're not, as
surgically focused. Yep.
They don't do as much surgery. I'm sure there's some surgeon is
I'm going to offend somebody. There might be some Australian
surgeons, but it's just not as prevalent as it is here in the
US. So even in so far as things like
the subtalar joint neutral, Bet on it talks about how it's very
difficult to measure this. It's not that we have to throw
that concept out the window, but there are other things.
Let's think about, not just what it looks like.
Kinetics can kinematics. Excuse me, but what the torque
forces are through the joint. Benno has published a study
where he found that you can do various wedges and shoes.
And for some people, those medial and lateral wedges will
influence the knee and to of more of a valgus moment and that
same in another patient. It'll induce a varus moment and
more torque through the outside of the knee.
So because because we're multi segmented, we cannot just have
our eyes on the feet as Richard Blake, dr.
Richard Blake notes, he starts from the head.
He starts looking at head tilt. He looks at shoulder drop.
How does that affect the lumbar? Then?
We've got a referral to our osteopathic Chiropractic
Orthopedic back. Dr. Colleagues, you know
detecting something in the hip, or the back so it's all
connected. And I think that what someone is
going to get out of this seminar is more connectivity, more
assurance and validation. What they're doing is the
correct protocol and it's going to change their mind about a few
things based on the evidence. That's out there.
That's great underneath this. I'm going to be putting just the
information. If you're listening to it's
coming up in June, but then they'll be information about
probably the replay and things like that where they will be at
in the future so good and you can email me directly at
Arlington foot at gmail.com and you can get more information and
make a decision if you want to sit in virtually and we will be
offering a You edited version after the fact that will be a
pay-per-view just because we want to encourage people to
participate live. Cool, cool.
So that's that's that's a benefit than so.
Yeah. I'm going to be sending out this
tweet to the list and see what people say and to see if
anyone's interested and it's great.
You know, I think the trend. Now what I feel is people are
giving stuff for free for people that want to be present in kind
of the early adopters. And then those that maybe are
too busy which is a lot of us than, for a Small fee.
You can watch it afterwards, have access forever.
And I think that's a great way of doing it for people, giving
out that information. So, thanks, but I appreciate
your tips here and I'll put your information underneath this
video and I appreciate your enthusiasm and energizing me for
my lunch hour. Thanks again, Don.
Yep.