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Hello and welcome to Podiatry 
practice Mastery. 

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My name is, Don felt. 
Oh, and I have dr. 

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Ben Pearl here. 
Welcome Ben. 

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Hey, thanks, Don and to be best 
nice to have you back. 

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And today we're going to focus 
all about Orthotics and and also

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biomechanics. 
I think that's a passion of 

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yours. 
So, you know, let's kind of Dive

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Right In what I'm really excited
about is you're going to talk 

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today about kind of these little
things that we can modify in our

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practice implementing, these 
little things of biomechanics 

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and kind of make big changes. 
With our patients. 

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So, tell me a little bit about 
this upcoming conference, and 

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your shoe tips. 
And where do you want to start? 

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Yeah, let's start with just 
biomechanics in general. 

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I think that Podiatry is losing 
a little bit of ground to the 

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sports industry Health gurus. 
So what I mean by that is that 

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there are a lot of podiatrists 
like you and I that are curious 

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and they're in there are Also, a
lot of podiatrists that are in 

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the algorithm of what they 
learned from Merton, root and 

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weed. 
And there's nothing wrong with 

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some of those precepts as a 
starting point, but we've 

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evolved so much into the 
marriage of shoe Foot orthotic 

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sock. 
All those things come together 

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in a seven-layer cake to make 
the the result in terms of 

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friction fit bail instability. 
And I think that that's where 

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Podiatry needs to hone back in, 
start reading more articles. 

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Start attending more things like
the Seminary you're putting here

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on today. 
No, listen to those Snippets. 

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Don't listen, just to Podiatry. 
Listen to some of the 

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biomechanics information that is
out there in biomechanics land 

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via an onp person, be it 
biomechanics PhD, like been 

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oneg. 
Be it a podiatrist from another 

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country. 
That may have a different band, 

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like Simon Barr told, or Simon 
Spooner or you know, many others

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that are that are out there. 
So, I think that If we look at 

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doing things in a stepwise 
fashion, and this is, this is 

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like a precept, right out of 
Richard Blake's Playbook, you 

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know, he just wrote a very lucid
book. 

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Practical biomechanics for the 
podiatrist. 

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You couldn't get any more 
elegantly simple than that. 

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And if we take the variables 
that we have and add 1, small 

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variable at a time. 
We will then know, right? 

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Right, what biomechanically we 
did to make the change? 

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Yeah, it's so I think these are 
great and I think a lot of us 

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are probably like me your little
bit more advanced and 

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biomechanics. 
How does someone I'm thinking 

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like, we're all I think that one
of the biggest changes we've 

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gone so surgical right? 
We don't we do mostly surgery. 

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A lot of we're trained, surgical
right? 

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We're not training biomechanics 
and our residencies. 

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So if someone wants to kind of 
shift things back and you 

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mentioned a lot of great names, 
but I'm a busy podiatrist, you 

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know, seeing my 30 patients a 
day. 

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Is there a resource? 
I know there's this conference 

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coming up. 
Like, what do you do, or what? 

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Should a podiatrist do? 
Because we don't have all this 

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time. 
We're like maybe reading this 

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between patients. 
So, what are some good tips? 

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Yeah, I think like you say, 
identifying. 

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Professionals that are 
interested in disseminating 

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information. 
That is available on stoop 

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roach. 
So look at the look at the 

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agenda. 
Look at the faculty, make sure 

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that it is not just to promote 
an afo. 

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For instance. 
There's nothing wrong with a 

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good based lecture that talks 
about afos. 

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I applaud that it's just that we
want to make sure that we're 

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approaching. 
Both the pros and cons of the 

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various Orthopedic appliances, 
that were that were using. 

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For instance. 
Let's say an afo, we all know 

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we've had our Medicare age 
population. 

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Come in with an afo that they 
got from let's say another 

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podiatrist or hanger Labs or 
some other prosthetic source 

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that has been sitting in the 
closet. 

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So what? 
We have to determine is number 

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one. 
We're looking at the patient 

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right in front of us. 
Do they have the skill set to 

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apply the brace properly. 
Are they going to use it more 

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than just, you know, for the 
time frame that you teach them 

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to how to apply it in your 
office. 

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And is this going to be a 
six-month measure or a long-term

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measure? 
And then, of course, it gets 

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down. 
Also to making sure when we 

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dispense them. 
From a practical standpoint that

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we take into mind the same and 
similar. 

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If they've had a cam boat. 
For instance. 

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We then have to enter the 
discussion of even though this 

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may be better for you. 
Mrs. Jones. 

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We see that you've had a can 
both. 

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This may be a problem and then 
it's up to you to determine you 

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want to just give them an avian,
or you going through the 

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Appellate levels and and 
documentation that will be 

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required to get that device that
you want covered be an ankle 

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brace. 
Or Some type of a fo one of the 

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things that I just picked up 
from a colleague of mine just 

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recently. 
I like this idea of not just 

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referring to a cam boot for 
offloading, the ankle or a 

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fracture. 
So let's say we have a stable 

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fracture. 
We know that when we put the cam

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Bhutan we're going to have an 
inequity there with with the leg

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lengths. 
So and I have no affiliation 

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with these folks whatsoever. 
But I really like the idea of 

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this take. 
Oh, brace, that is external to 

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the shoe. 
So instead of having a 

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differential of, let's say half 
an inch three quarters of an 

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inch, whatever. 
The cam boot, differential is an

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inch. 
Now you have minimal because 

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it's a, it's an external 
skeleton. 

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That goes around the shoe. 
And we've also taken out some of

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the Compliance issues with 
having something internal in the

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shoe where now you have 
something you're jamming into 

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the shoe creating more volume 
and now it becomes a shoe fit 

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issue. 
Yeah, in some cases. 

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It's a it's a it's a great. 
It's a great tip. 

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You had some other kind of real 
practical biomechanical tips. 

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You're going to like what you 
use every day in the office. 

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What are some of those other 
other tips? 

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You talked about a ball or 
something like that? 

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What are those? 
Those things. 

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Yeah. 
Yeah. 

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I'm going to review those. 
I just wanted to finish with one

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little caveat that that I think 
people should understand when we

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wear a cam boot or one of these 
take over racist when we're 

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talking about offloading. 
Offloading vertically. 

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We're really as measurements go 
with those devices offloading. 

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Approximately 30% that's 
supported in the literature. 

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So just bear in mind that 
although you're It's not like 

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100% offload with those devices.
So even though people think in 

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their mind. 
Oh Cambodia is the gold 

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standard. 
We're really only offloading 30%

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on the you know, the vertical 
forces going through the the 

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Foot and Ankle as far as some of
the things that I'm not always 

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going to be. 
We're going to go down these. 

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Now, we're going to go down as 
we're gonna go even more. 

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So do you have any good options?
So I've been struggling with 

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this like a lot of my patients. 
I see, let's say posterior 

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tibial. 
Tendonitis, peroneal, tendon, 

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itís, even plantar, fasciitis. 
I don't want to put them into a 

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can boot. 
I'm going to do Shockwave on 

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them. 
Okay, but then I want to offload

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it. 
So, I've tried like a velocity 

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brace to offload a little bit, 
which is like, kind of a 

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non-custom a fo. 
But I would love to have an 

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offloading brace. 
That worked really well, that 

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would put the pressure into the 
lower leg and offload the fash 

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or these tendons during the 
course of the Shockwave. 

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You have anything that works 
great as a non customer 

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customer. 
You is frequently. 

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I would say that I'm very eager 
to see what the compliance rate 

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will be with the take old brace,
because I think it's lighter. 

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And from a standpoint of 
compliance. 

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They've actually worked with 
some of the workman's comp folks

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that don't have, for instance. 
Osha Osha will restrict them 

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with a cam boot to return to the
workplace, but they've actually 

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now been able to get these take 
o braces and it's an example of 

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one brace. 
There's other braces out there 

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that aren't exactly the same. 
In terms of the offload, is it? 

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There's an awful more than 30% 
or is it only 30% in offload? 

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So it's a 30. 
It's the 30% brace. 

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Yeah. 
I was talking to this gentleman.

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I interviewed him a while ago. 
I forgot which one it was. 

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He's in Colorado, but it's a 
Race that almost offloads, 

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eighty to ninety percent to the 
lower leg. 

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And I don't, I haven't found 
anyone locally. 

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Like hanger doesn't do it for 
me. 

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They were a local lab that did 
it for them. 

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I just thought that was an Eda. 
There are, there are other races

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that offload more. 
Those are going to be a 

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compliance issue because they're
more restrictive. 

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Okay. 
So we've heard of things like 

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Crow braces and other things 
that are very, you know, they 

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encumber the limb. 
So sometimes it's, it's so I 

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guess none. 
A friendly for patients to wear 

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that they defer out of that. 
Yeah, there are little things 

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though that we can do within the
shoe to use. 

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For instance. 
Let's just say a shoe that has a

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nice roller. 
This is a Zeller. 

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Oh, shoo. 
So this I, this is like a tank. 

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I mean, so we used to be 
thinking about shoes, like the 

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Brooks Beast or the New Balance 
1980 as, you know, our best 

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support shoes, but The fact of 
the matter is that, and I'll see

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if we can grab the Cutaway on 
that Zorro shoe. 

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The nice thing about that. 
It's got a carbon Morton's 

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extension built into the actual 
sole of the shoe. 

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So not only does it have the 
roller. 

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Okay, but it's got an inner 
carbon layer that helps 

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propulsion as and built as a 
Morton's extension and this is a

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cutaway of the shoe. 
It's a brilliant. 

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Zayn. 
And I actually borrowed this 

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idea because not everybody has 
that for what hallux limit is 

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for. 
Yes. 

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Yes. 
Recovering some pre dislocation 

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syndrome submit to recovering 
stress fracture recovering, 

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hallux fractures, you know, so 
these things that don't require 

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a fixation or if they do require
fixation, you're now in week 2, 

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and let me tell you something, I
think. 

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As long as there's not swelling,
once the stitches are out. 

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I would bet you that this is 
going to be a lot more 

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supportive than a surgical shoe.
Hmm. 

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Good idea. 
That's good. 

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Now, as far as price point, 
we're now approaching, you know,

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with gasping what we're getting 
up into what 575 a gallon. 

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So now we've got economic 
pressures on patients. 

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That's why I came up with a 
concept that I call small ball. 

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So let's just get a base hit or 
a double. 

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Instead of trying to get the 
home run all the time with, like

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we were talking before a 
colonoscopy out of me, a triple 

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who has time now to take out of 
their, you know, their their kid

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has just got over covid and you 
know, the other kids struggling 

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with IB program or AP program in
school. 

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And so are, you know, we have to
be there for our kids and for 

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our for our extended families, 
Etc. 

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So here's for example, something
that I designed. 

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It's Called the turf toe splint,
but it's really more about using

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it for something like hallux 
limit. 

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Its because that's much more 
common for our practices than 

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turf toe. 
So the premise is not to stop 

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the range of motion, but to slow
down that torque, slow down that

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moment, and then also to get 
compression, because this is 

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like a compressive midlife 
device and then in doing so, 

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being adhered to the foot, I've 
had patients. 

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Tell me that it feels like their
big toe is now like wolverines 

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toe like that. 
It's like one long bone. 

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Instead of a segmented ipj or 
MTP that it gives them a sense 

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that they're now getting a full 
linear axis of strength through 

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the whole toe joint. 
So that's that's another example

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of something that I use 
everyday. 

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I'm going to show another 
example, and there's great 

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places to get these. 
I get mine from juvy. 

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Jill's, these carbon plates, you
know, it's such an easy thing to

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use. 
And yet how many people actually

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stop these in their, in their 
office. 

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And by the way, I'm all about 
getting the patient better. 

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So the patient doesn't have, 
let's say, 40 bucks or whatever,

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whatever you decide to sell 
these carbon plates for the 

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pair. 
If it's just in one foot, why 

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not? 
Just sell them one and just keep

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that, that other one for the 
Next, you know, size 10 patient.

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So I think if we open up our 
Paradigm and approach to not be 

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a one size fits all for our 
patients. 

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We can then customize and get 
more patient compliance, you 

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know, both from from what it 
feels like standpoint and also 

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an economic and realistic 
standpoint for application. 

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Yeah, that's great. 
That's great. 

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Hey, we're coming towards the a 
little bit of the end here in 

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terms of time for us. 
Tell me a little bit about this 

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this how you guys put together 
this kind of biomechanics 

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Workshop or this, tell me a 
little bit about this and if 

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people are considering they want
to learn more about 

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biomechanics. 
Would this be good for ya? 

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This is actually good from 
student resident all the way up 

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to season practitioner because 
Don, there's so much new that's 

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coming out if you look at 
Magazines, like lower extremity 

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review, the biomechanics 
journals, especially things that

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are being published in the UK, 
and Australia. 

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There's just so much going on 
and why do they focus on it more

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over there? 
Because they're not, as 

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surgically focused. 
Yep. 

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They don't do as much surgery. 
I'm sure there's some surgeon is

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I'm going to offend somebody. 
There might be some Australian 

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surgeons, but it's just not as 
prevalent as it is here in the 

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US. 
So even in so far as things like

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the subtalar joint neutral, Bet 
on it talks about how it's very 

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difficult to measure this. 
It's not that we have to throw 

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that concept out the window, but
there are other things. 

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Let's think about, not just what
it looks like. 

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Kinetics can kinematics. 
Excuse me, but what the torque 

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forces are through the joint. 
Benno has published a study 

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where he found that you can do 
various wedges and shoes. 

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And for some people, those 
medial and lateral wedges will 

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influence the knee and to of 
more of a valgus moment and that

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same in another patient. 
It'll induce a varus moment and 

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more torque through the outside 
of the knee. 

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So because because we're multi 
segmented, we cannot just have 

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our eyes on the feet as Richard 
Blake, dr. 

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Richard Blake notes, he starts 
from the head. 

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He starts looking at head tilt. 
He looks at shoulder drop. 

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How does that affect the lumbar?
Then? 

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We've got a referral to our 
osteopathic Chiropractic 

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Orthopedic back. 
Dr. Colleagues, you know 

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detecting something in the hip, 
or the back so it's all 

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connected. 
And I think that what someone is

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going to get out of this seminar
is more connectivity, more 

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assurance and validation. 
What they're doing is the 

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correct protocol and it's going 
to change their mind about a few

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things based on the evidence. 
That's out there. 

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That's great underneath this. 
I'm going to be putting just the

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information. 
If you're listening to it's 

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coming up in June, but then 
they'll be information about 

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probably the replay and things 
like that where they will be at 

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in the future so good and you 
can email me directly at 

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Arlington foot at gmail.com and 
you can get more information and

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make a decision if you want to 
sit in virtually and we will be 

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offering a You edited version 
after the fact that will be a 

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pay-per-view just because we 
want to encourage people to 

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participate live. 
Cool, cool. 

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So that's that's that's a 
benefit than so. 

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Yeah. 
I'm going to be sending out this

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00:17:37,200 --> 00:17:39,700
tweet to the list and see what 
people say and to see if 

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anyone's interested and it's 
great. 

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00:17:42,000 --> 00:17:45,400
You know, I think the trend. 
Now what I feel is people are 

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giving stuff for free for people
that want to be present in kind 

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of the early adopters. 
And then those that maybe are 

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00:17:52,600 --> 00:17:55,100
too busy which is a lot of us 
than, for a Small fee. 

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00:17:55,100 --> 00:17:57,500
You can watch it afterwards, 
have access forever. 

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And I think that's a great way 
of doing it for people, giving 

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out that information. 
So, thanks, but I appreciate 

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00:18:02,800 --> 00:18:05,400
your tips here and I'll put your
information underneath this 

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00:18:05,400 --> 00:18:10,400
video and I appreciate your 
enthusiasm and energizing me for

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00:18:10,400 --> 00:18:13,900
my lunch hour. 
Thanks again, Don. 

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Yep.