1 00:00:08,400 --> 00:00:10,300 Hey everyone. Matt here at welcome one. 2 00:00:10,300 --> 00:00:12,400 Welcome to the doctors are running podcast. 3 00:00:12,400 --> 00:00:15,600 Were we a group of doctor of physical therapy, talk about the 4 00:00:15,600 --> 00:00:19,100 art and the science of the things we put on our feet today? 5 00:00:19,100 --> 00:00:22,100 We have a very special guest who we haven't got to see for a 6 00:00:22,100 --> 00:00:23,600 little bit. So it's really nice to hear an 7 00:00:23,600 --> 00:00:26,200 update. This is vessel who I had. 8 00:00:26,200 --> 00:00:29,700 The honor of sitting on tis. It been two years already. 9 00:00:30,200 --> 00:00:33,800 That two years ago, got ya, I got to sit in on your, on your 10 00:00:33,800 --> 00:00:37,500 Masters defense, which was phenomenal, by the way, and he 11 00:00:37,500 --> 00:00:41,800 has now pivoted into another area of Footwear, but wanted to 12 00:00:41,808 --> 00:00:44,400 come back and share with us some of the stuff that he's been 13 00:00:44,400 --> 00:00:45,500 going through. So vessel. 14 00:00:45,500 --> 00:00:48,500 Why don't you give us a little more of an introduction and 15 00:00:48,500 --> 00:00:50,800 we'll jump right into this. All right? 16 00:00:50,800 --> 00:00:52,800 Yeah, the honor is all mine Matt's. 17 00:00:52,800 --> 00:00:56,400 I've been a longtime listener of the show, so it's nice to well, 18 00:00:56,400 --> 00:00:58,700 use this platform to have this conversation. 19 00:00:59,400 --> 00:01:01,100 It's a gift. Bit of an introduction. 20 00:01:01,100 --> 00:01:04,500 I'm vessel Vincennes. I'm 27 years old. 21 00:01:04,500 --> 00:01:09,200 So, a little bit of New Kids on the Block before this. 22 00:01:09,200 --> 00:01:13,500 I did an education at the University of Groningen and yet 23 00:01:13,500 --> 00:01:17,300 biomedical engineering. And for my master thesis, I did 24 00:01:17,300 --> 00:01:22,500 a research project together with vow to hold camera and puma in 25 00:01:22,500 --> 00:01:26,600 which I did some testing on an earlier prototype of the fast 26 00:01:26,600 --> 00:01:31,500 are, which is now on the market. So it's nice to see That I maybe 27 00:01:31,600 --> 00:01:36,900 put a little bit of a part in that and right now it's 28 00:01:37,500 --> 00:01:41,500 mathematicians, I'm working at an advisor for an orthopedic 29 00:01:41,500 --> 00:01:46,000 shoe company which mainly focuses on the clinical side. 30 00:01:46,200 --> 00:01:50,700 So people with walking problems or pain in joints and we try to 31 00:01:50,700 --> 00:01:54,800 help them with what's Matt calls, we use shoes as tools. 32 00:01:55,400 --> 00:01:59,500 So for example, people with diabetes or osteoarthritis in 33 00:01:59,500 --> 00:02:02,600 their food, We try to make sure that we have the best possible 34 00:02:02,600 --> 00:02:06,600 tool for them to alleviate pain or make them able to walk 35 00:02:06,600 --> 00:02:09,199 further. So that's what I do on a daily 36 00:02:09,199 --> 00:02:12,500 basis. So I would like, to well, talk 37 00:02:12,500 --> 00:02:14,700 more about my profession here today because I think it's a 38 00:02:14,708 --> 00:02:17,400 nice conversation to have. Yeah, and this is very important 39 00:02:17,400 --> 00:02:20,900 because, you know, many of our listeners readers are often 40 00:02:20,900 --> 00:02:23,500 coming looking either. The website of the stuff that we 41 00:02:23,500 --> 00:02:26,200 do talk going. Hey, I'm looking for running 42 00:02:26,200 --> 00:02:28,600 shoes, but to be honest with you, the majority of emails that 43 00:02:28,600 --> 00:02:30,400 we got. And as we've discovered We 44 00:02:30,400 --> 00:02:33,200 released a walking shoe guide because there was so many 45 00:02:33,200 --> 00:02:34,400 questions that we're getting from going. 46 00:02:34,400 --> 00:02:36,800 Hey, that's great that you guys talked about running shoes. 47 00:02:36,800 --> 00:02:40,400 But I, I don't run. I'm looking for a walking shoe 48 00:02:40,400 --> 00:02:44,000 in the mechanics and the biomechanics and some components 49 00:02:44,000 --> 00:02:47,900 of the shoes, you know, you need to be able to a lot of them to 50 00:02:47,900 --> 00:02:49,300 you to figure out. Hey, how's this working for 51 00:02:49,300 --> 00:02:52,000 walking housework and running at the end of the day as medical 52 00:02:52,000 --> 00:02:55,000 professionals or biomechanism word or Orthopedics? 53 00:02:55,000 --> 00:02:57,900 We're trying to figure out, how can we help people move better, 54 00:02:57,900 --> 00:03:01,900 regardless of the mecca of the Type of locomotion or gate that 55 00:03:01,900 --> 00:03:03,800 they're using and so that's where this comes in. 56 00:03:03,800 --> 00:03:06,500 So many people got really excited with the carbon fiber. 57 00:03:06,500 --> 00:03:09,200 Plated shoes. I remember two years ago, watch 58 00:03:09,300 --> 00:03:11,900 watching your Master's thesis and there's our defense and 59 00:03:11,900 --> 00:03:14,500 going that's an interesting looking shoe. 60 00:03:14,800 --> 00:03:17,600 And then who to thought, you know, years later that this the 61 00:03:17,600 --> 00:03:20,000 faster which has been a phenomenal and very interesting 62 00:03:20,000 --> 00:03:22,200 shoe and I'm finally glad that it's actually available in the 63 00:03:22,200 --> 00:03:25,000 market I know, Puba really struggled with some of like the 64 00:03:26,200 --> 00:03:28,600 kind of availability and Mark but it's now coming out and 65 00:03:28,700 --> 00:03:32,300 people are really pushing some And things, but I hope that what 66 00:03:32,300 --> 00:03:35,600 our listeners and viewers get from this is that these shoes 67 00:03:35,600 --> 00:03:39,600 don't just come out of like thin air there's years and years in 68 00:03:39,600 --> 00:03:41,000 development. So I was you know, vessel you 69 00:03:41,000 --> 00:03:45,200 are working on this a year, two years, three years plus before 70 00:03:45,200 --> 00:03:47,100 the shoot. We even saw photos of this. 71 00:03:47,100 --> 00:03:49,200 So I'm sitting there going wow this is really cool. 72 00:03:49,400 --> 00:03:53,100 It was a very I was so honored to get to to watch that you did 73 00:03:53,100 --> 00:03:57,000 a phenomenal job by the way. But again, going back that yes, 74 00:03:57,000 --> 00:03:58,200 running and walking or different. 75 00:03:58,200 --> 00:04:00,600 I just want to start with a couple things that You know, 76 00:04:00,600 --> 00:04:03,800 yes, the majority of who we treat are usually going to be 77 00:04:03,800 --> 00:04:07,300 Walker's, even as a physical therapist, you know, it's 78 00:04:07,300 --> 00:04:10,500 exciting when I get some Runners but clinically the Footwear 79 00:04:10,500 --> 00:04:13,400 stuff that I usually talk about is for walking and just going in 80 00:04:13,408 --> 00:04:15,900 to educate people, little bit on differences between running and 81 00:04:15,900 --> 00:04:19,399 walking mechanics walking. It's a little bit more 82 00:04:19,399 --> 00:04:22,600 inherently stable you running. There's it's just basically a 83 00:04:22,600 --> 00:04:24,900 series of single leg hops walking. 84 00:04:24,900 --> 00:04:28,200 You generally have one limb on the ground at all times. 85 00:04:28,400 --> 00:04:31,500 There's less forces associated. With it whereas running I think 86 00:04:31,500 --> 00:04:34,200 is like three to four times your body weight with every single 87 00:04:34,200 --> 00:04:38,300 step so it's very impactful but it doesn't make walking any less 88 00:04:38,300 --> 00:04:42,000 complex even though there are sometimes lower forces with the 89 00:04:42,000 --> 00:04:45,300 patients that you'll see if you have arthritic joints or 90 00:04:45,300 --> 00:04:49,400 diabetes, you have a diabetic foot or a neuropathies, some of 91 00:04:49,408 --> 00:04:52,700 the same principles that you hear us talk about on the 92 00:04:52,700 --> 00:04:57,800 website, apply into walking. So can you give us a little bit 93 00:04:57,800 --> 00:05:02,500 more detail about your masters? Says clay, I loved geeking out 94 00:05:02,500 --> 00:05:04,700 about that and it's been exciting to go. 95 00:05:04,700 --> 00:05:07,700 Oh my gosh, I can't believe that he put so much work into this 96 00:05:07,700 --> 00:05:10,100 and it's done so many cool things, but a little bit little 97 00:05:10,100 --> 00:05:12,400 bit more on that. Yeah, sure. 98 00:05:12,600 --> 00:05:17,600 Yeah, it was probably around the end of 2020 that I was. 99 00:05:18,200 --> 00:05:20,600 Well, looking forward. What am I going to do for my 100 00:05:20,600 --> 00:05:24,000 master thesis? So I reached out to about the 101 00:05:24,000 --> 00:05:28,000 hook armor who is also from the Netherlands and we have some 102 00:05:28,300 --> 00:05:31,500 well, Connection through my University. 103 00:05:31,500 --> 00:05:35,400 I was able to send him an email and my plan was actually two to 104 00:05:35,400 --> 00:05:39,200 go to the United States to work there together with his lab. 105 00:05:39,700 --> 00:05:41,900 But unfortunately, it was Kofi time. 106 00:05:41,900 --> 00:05:46,700 So I was not able to go to his university, which was the 107 00:05:46,700 --> 00:05:50,000 University of Amherst. Massachusetts, but I was still 108 00:05:50,000 --> 00:05:53,600 able to keep in touch with him and he was able to be my 109 00:05:53,600 --> 00:05:57,100 supervisor from a distance. And at that time, about you 110 00:05:57,100 --> 00:06:00,700 started working together with the Innovation team at Puma and 111 00:06:00,700 --> 00:06:06,200 Germany, so that were working on some prototypes of the fast are. 112 00:06:06,500 --> 00:06:10,800 And also a shoe for well, maybe the 5K 10K, which is called the 113 00:06:10,800 --> 00:06:15,300 fast forward, which is still not on the market, but I also have 114 00:06:15,300 --> 00:06:19,500 prototype of that too. So I would say a little bit, the 115 00:06:19,500 --> 00:06:22,000 front of the, the general public. 116 00:06:22,400 --> 00:06:26,600 But for my thesis because it was Kofi time, I did some testing on 117 00:06:26,600 --> 00:06:30,300 myself. I was running on a with 118 00:06:30,300 --> 00:06:34,200 instrumented treadmill together with 3D motion capture system. 119 00:06:34,700 --> 00:06:37,700 And my research question was, basically, are there any 120 00:06:37,700 --> 00:06:42,200 differences between the original paper fly 4% and the fast our 121 00:06:42,200 --> 00:06:45,900 prototype, which I had. And I also did some metabolic 122 00:06:45,900 --> 00:06:48,800 testing to see if there was a differences in running economy, 123 00:06:48,800 --> 00:06:51,600 between shoes. And what I found at that time 124 00:06:51,600 --> 00:06:54,700 was that there weren't any large differences between issues, 125 00:06:55,100 --> 00:06:58,100 which was at that time, actually a good results for Puma to see 126 00:06:58,100 --> 00:07:00,000 that there were going in the right direction. 127 00:07:00,200 --> 00:07:04,200 Then let's for me, it was a very fun project because I've been a 128 00:07:04,208 --> 00:07:07,900 longtime Runner and I've always had a passion for running shoes. 129 00:07:08,300 --> 00:07:13,500 So to combine my education, as a biomedical engineer together 130 00:07:13,500 --> 00:07:16,800 with my passion for running and also really great great project 131 00:07:16,800 --> 00:07:21,200 for me. So yeah, it was my master thesis 132 00:07:21,200 --> 00:07:24,800 was probably the most fun time I had during my master's as a 133 00:07:24,800 --> 00:07:28,000 biomedical engineer. That's also the so it was very 134 00:07:28,000 --> 00:07:30,000 cool at that, point to go oh you know too. 135 00:07:30,100 --> 00:07:34,400 Two years ago, 2022 is most companies really had even come 136 00:07:34,400 --> 00:07:37,100 close to touching wear. Nike was with the vapor fly and 137 00:07:37,100 --> 00:07:39,300 stuff like that. So, to see that two years ago 138 00:07:39,300 --> 00:07:42,000 and going, oh my gosh, Pumas, got something. 139 00:07:42,000 --> 00:07:44,300 And then a lot of other companies have obviously caught 140 00:07:44,300 --> 00:07:47,000 up now, but again, I'm going to emphasize to our listeners. 141 00:07:47,000 --> 00:07:51,000 That people have this stuff in the works for years. 142 00:07:51,000 --> 00:07:53,300 So Puma had that other companies were working on that. 143 00:07:53,300 --> 00:07:55,700 And we're just now seeing this, you can imagine what's going to 144 00:07:55,700 --> 00:07:59,000 show up to plus years from now. So it's a very exciting thing to 145 00:07:59,000 --> 00:08:01,600 happen is very cool to see The research that goes through this 146 00:08:02,100 --> 00:08:05,200 and Puma was very lucky to have you because a lot of times, you 147 00:08:05,200 --> 00:08:08,700 know, there is research done but it never gets shared with the 148 00:08:08,700 --> 00:08:10,700 public. So to see that and see published 149 00:08:10,700 --> 00:08:13,600 research is phenomenal, because it gives us some idea of so 150 00:08:13,600 --> 00:08:17,700 people like myself who aren't doing as much in the actual lab 151 00:08:17,700 --> 00:08:19,500 testing because I'm not there yet. 152 00:08:19,500 --> 00:08:22,200 I've got to finish my dissertation on different topic 153 00:08:23,100 --> 00:08:25,300 but to actually see some of the data come out and go. 154 00:08:25,300 --> 00:08:26,500 Okay? Now we have some more 155 00:08:26,500 --> 00:08:28,300 information is really, really helpful. 156 00:08:28,300 --> 00:08:34,400 I hope in the future. Companies probably won't share 157 00:08:34,400 --> 00:08:36,600 as much as we might Hope just because a lot of its proprietary 158 00:08:36,600 --> 00:08:39,500 but to have even the little we can get is helpful because it 159 00:08:39,600 --> 00:08:41,500 for the rest of us can help us figure out going. 160 00:08:41,500 --> 00:08:44,500 All right, so I know a lot of this is being used for running 161 00:08:44,500 --> 00:08:46,800 performance but how can we use this from an orthopedic 162 00:08:46,800 --> 00:08:49,300 standpoint or support which goes into the next topic? 163 00:08:49,400 --> 00:08:52,000 Can you tell us a little bit more about what it means to be 164 00:08:52,000 --> 00:08:56,500 an orthopedic advisor? Yeah. 165 00:08:56,500 --> 00:09:00,900 So I finished my Master's Degree at the end of 21. 166 00:09:01,800 --> 00:09:07,300 And I started as Orthopedic advisor at the end of 20 21. 167 00:09:08,100 --> 00:09:12,400 So part of my job is mainly helping patients, who have 168 00:09:12,600 --> 00:09:16,700 walking problems, which can be either that they have, for 169 00:09:16,700 --> 00:09:20,500 example, muscle weakness. Or when someone has a diabetic 170 00:09:20,500 --> 00:09:24,500 food that they get and diabetic foot ulcers, which is something 171 00:09:24,500 --> 00:09:27,200 that you don't want because that costs a lot of money and to the 172 00:09:27,200 --> 00:09:31,500 health care. So my job is basically to find 173 00:09:31,500 --> 00:09:33,300 out. Well, what are the main 174 00:09:33,300 --> 00:09:37,700 limitations in someone's life, is it walking distance? 175 00:09:37,700 --> 00:09:41,500 So is it a energetic perspective? 176 00:09:41,500 --> 00:09:44,900 Is it that they have a pain, which can be a foot pain, or 177 00:09:44,900 --> 00:09:48,500 knee pain, or hip pain, depending on what the problem 178 00:09:48,500 --> 00:09:52,300 is. And then we can have or together 179 00:09:52,300 --> 00:09:55,200 we can find the best solution for them, which can be, for 180 00:09:55,200 --> 00:09:59,700 example, as simple as an insole or it Can be a fully made 181 00:09:59,800 --> 00:10:04,300 orthopedic shoe. Well, it depends on what the 182 00:10:04,300 --> 00:10:07,600 problems are and also what the goals of the person are because 183 00:10:07,600 --> 00:10:11,200 you can probably prescribe orthopedic shoe to everyone, but 184 00:10:12,000 --> 00:10:14,100 there needs to be a man main reason for it. 185 00:10:14,100 --> 00:10:20,300 And someone also has to be, well, they have to want to use 186 00:10:20,300 --> 00:10:23,300 your product, so you can make a shoe for someone, but if he 187 00:10:23,300 --> 00:10:25,700 doesn't want to use it, then we'll just end up in the 188 00:10:25,700 --> 00:10:29,700 shelves, which is something that you Have to carefully walk 189 00:10:29,700 --> 00:10:31,700 through at the start of the process. 190 00:10:31,900 --> 00:10:32,600 It's something. Yeah. 191 00:10:32,600 --> 00:10:36,000 That's the reminder to people that comfort really is key. 192 00:10:36,000 --> 00:10:38,500 And we talked about been own eggs, like Comfort filter, and 193 00:10:38,500 --> 00:10:40,800 one of the reasons is if shoes, not comfortable, people are 194 00:10:40,800 --> 00:10:43,300 probably not going to use it. Like you said, it's going to end 195 00:10:43,300 --> 00:10:46,100 up, you know, on the shelves or somewhere else. 196 00:10:46,100 --> 00:10:48,800 So that's, it's not as simple as. 197 00:10:48,800 --> 00:10:51,800 Oh, here's the pathology, here's the shoe. 198 00:10:51,800 --> 00:10:53,500 It's we got to figure out, is it comfortable? 199 00:10:53,500 --> 00:10:55,800 Does it match the mechanics? So you mentioned a couple 200 00:10:55,800 --> 00:11:00,000 pathologies that you treat. So, Edik like pain, so are 201 00:11:00,000 --> 00:11:03,700 probably arthritic pain. Diabetic ulcers are really, 202 00:11:03,700 --> 00:11:05,800 really, really big thing. And it's interesting that you 203 00:11:05,800 --> 00:11:09,000 brought that up because I still remember to this day, one of the 204 00:11:09,000 --> 00:11:12,700 other I can reverse one of your advisors, brought up a comment 205 00:11:12,700 --> 00:11:15,100 on some of the Rockers and the designs going. 206 00:11:15,100 --> 00:11:20,700 Hey, this has been used in unloading for people with 207 00:11:20,700 --> 00:11:22,100 diabetic ulcers and stuff like that. 208 00:11:22,100 --> 00:11:24,000 And I hope a lot of people realize, a lot saw, a lot of 209 00:11:24,000 --> 00:11:25,600 This research is going back and forth. 210 00:11:25,600 --> 00:11:28,100 So a lot of the stuff that you see with rockers the evidence 211 00:11:28,100 --> 00:11:32,100 that Suppose pores, actually usually done in those with 212 00:11:32,500 --> 00:11:35,700 diabetic ulcers which will, we won't dive into that too much. 213 00:11:35,700 --> 00:11:38,100 But I just, I want to dive into. So we've talked about the 214 00:11:38,100 --> 00:11:40,400 different pathologies. Can you walk us through a little 215 00:11:40,400 --> 00:11:42,300 bit of the process of how you go? 216 00:11:42,300 --> 00:11:46,900 Okay, here's the pathology, how do we figure out? 217 00:11:47,200 --> 00:11:49,200 And I know this could take forever but just as a kind of in 218 00:11:49,200 --> 00:11:52,900 a short like a short, sweet, how do we figure out do we need an 219 00:11:52,900 --> 00:11:55,300 insole all the way up to a full shoe? 220 00:11:55,300 --> 00:11:59,100 What's that process? Like, well, This process 221 00:11:59,100 --> 00:12:03,600 normally starts together with a doctor, a patient. 222 00:12:03,600 --> 00:12:07,500 Most of the times comes to either a general petition or 223 00:12:07,900 --> 00:12:11,900 which refers them to a hospital and they will try to find the 224 00:12:11,900 --> 00:12:16,100 diagnosis for the problem. So sometimes they just do an 225 00:12:16,100 --> 00:12:20,100 x-ray or an echo or they try to find what's actually happening 226 00:12:20,100 --> 00:12:23,800 inside the body, once that has happened. 227 00:12:23,800 --> 00:12:28,600 Once, there is a diagnosis, we have kind of a consultation And 228 00:12:28,600 --> 00:12:31,900 together with the doctor or the doctor, mainly ask questions, 229 00:12:31,900 --> 00:12:35,200 like when do you have to pay in? How much pain do you have? 230 00:12:36,500 --> 00:12:40,300 What do you do in daily life? And actually, what would you 231 00:12:40,300 --> 00:12:43,900 want to reach West? You are with your shoe or 232 00:12:43,900 --> 00:12:49,200 insult, for example, then they do a little bit of research 233 00:12:49,200 --> 00:12:52,300 where the main limitations are. For example, does someone have a 234 00:12:52,308 --> 00:12:56,000 stiff joints or is it very painful to touch them at certain 235 00:12:56,000 --> 00:13:00,000 points? This is Still most of the part 236 00:13:00,000 --> 00:13:03,900 which doctor does because he has the most medical knowledge. 237 00:13:04,400 --> 00:13:05,900 And this doctor is most of the time. 238 00:13:05,900 --> 00:13:09,800 I really be Rehabilitation doctor orthopedic surgeon 239 00:13:10,000 --> 00:13:12,100 depending on what the problem is. 240 00:13:13,000 --> 00:13:17,500 And one status happens, we go to little bit of a debate, what the 241 00:13:17,500 --> 00:13:21,700 best solution would be for this patient, which can be, as I 242 00:13:21,708 --> 00:13:25,800 mentioned, as simple as just an inlay in issue or fully made 243 00:13:26,000 --> 00:13:30,000 orthopedic shoe but it's yeah. It depends on the severity of 244 00:13:30,000 --> 00:13:33,000 the problems. For example, if someone is able 245 00:13:33,000 --> 00:13:37,000 to buy shoes in the store because some people, for 246 00:13:37,000 --> 00:13:40,700 example, a very wide forefoot. So they have to buy shoes, which 247 00:13:40,700 --> 00:13:44,600 are three or four sizes larger, and then they would actually 248 00:13:44,600 --> 00:13:48,900 have need because they're from the forefoot is so wide. 249 00:13:49,700 --> 00:13:54,300 So there are also options for that with orthopedic shoes, but 250 00:13:55,400 --> 00:13:58,200 that's where we most of the time, start with the process. 251 00:13:58,300 --> 00:14:01,700 So we have this consultation our together with the doctor and the 252 00:14:01,700 --> 00:14:05,000 doctor prescribes to us. Well, this patient patient needs 253 00:14:05,000 --> 00:14:09,000 an insole or it needs a semi orthopedic shoe or a completely 254 00:14:09,000 --> 00:14:12,700 orthopedic shoe and then they come to our company and there we 255 00:14:13,000 --> 00:14:18,800 take measurements of the food we make some audio cards like a 256 00:14:19,200 --> 00:14:21,700 blueprint of the food to see what the pressure under the foot 257 00:14:21,700 --> 00:14:25,400 is, and then we, depending on the patient, we make the 258 00:14:25,400 --> 00:14:28,200 products for them, got it. So one of my big quite this is 259 00:14:28,400 --> 00:14:31,300 Be slightly different but is a common question that we get on? 260 00:14:31,300 --> 00:14:35,800 This thing is a lot of people will ask, should I get an 261 00:14:35,800 --> 00:14:38,200 insult? Just get an insole with my shoe 262 00:14:38,200 --> 00:14:41,700 or should I consider getting an entirely new shoe? 263 00:14:41,700 --> 00:14:44,300 And I understand this is a lot of people asked us from walking, 264 00:14:44,400 --> 00:14:46,800 or from running perspective. But this is also common walking 265 00:14:46,800 --> 00:14:48,200 question because there's a lot of companies. 266 00:14:48,600 --> 00:14:50,500 I don't know how it works. Another lens in the United 267 00:14:50,500 --> 00:14:52,700 States, there's a couple companies that love to sell 268 00:14:52,700 --> 00:14:56,700 people a right shoe and then an orthotic on top of that and one 269 00:14:56,700 --> 00:15:00,000 of our comments has been Why would you need both? 270 00:15:00,100 --> 00:15:03,300 If you can just get a shoe that already has those components? 271 00:15:03,300 --> 00:15:04,900 What do you think about that? And is that something that 272 00:15:04,900 --> 00:15:08,400 factors in? To how your, how your your 273 00:15:08,400 --> 00:15:11,100 patient population is getting these devices? 274 00:15:11,300 --> 00:15:14,200 Yeah, it's really depends on what the problem is. 275 00:15:14,400 --> 00:15:18,500 If someone, for example, has excessive pronation in the foot 276 00:15:18,700 --> 00:15:22,800 and that causes, for example, Achilles problems or plantar 277 00:15:22,800 --> 00:15:27,900 fasciitis, then sometimes, an inlay can already help because 278 00:15:27,900 --> 00:15:30,300 it can Rex the stands of the foot. 279 00:15:30,500 --> 00:15:34,700 So there is a lot less well, pressure on, for example, the 280 00:15:34,700 --> 00:15:41,100 heel or on the Achilles tendon but it really depends on what 281 00:15:41,100 --> 00:15:43,800 the problem is. If someone, for example, has 282 00:15:44,400 --> 00:15:47,800 pain in their forefoot, it can already help to have a shoe with 283 00:15:47,800 --> 00:15:51,600 a nice rocker in the forefoot. As you mentioned before, you can 284 00:15:51,600 --> 00:15:55,000 also use it for diabetic patients, which have a lot of 285 00:15:55,000 --> 00:15:58,300 pressure on the forefoot but if you for example don't have That 286 00:15:58,308 --> 00:16:02,100 much fat pads anymore. Your metatarsals, there are 287 00:16:02,100 --> 00:16:03,800 different ways you can solve the problem. 288 00:16:03,800 --> 00:16:09,400 You can, for example, try to divide the pressure over a 289 00:16:09,400 --> 00:16:13,900 larger area or you can keep the pressure completely away from 290 00:16:13,900 --> 00:16:18,200 that area. So, yeah, it depends on what the 291 00:16:18,200 --> 00:16:21,500 problem is and sometimes there are multiple ways to tackle the 292 00:16:21,500 --> 00:16:23,800 same problem that is exactly what I was thinking. 293 00:16:23,800 --> 00:16:26,900 The answer is going to be, is in this drives, our students crazy 294 00:16:26,900 --> 00:16:30,400 that it's the Usually it depends it'll depend on the pathology. 295 00:16:30,400 --> 00:16:35,900 So what I'm hearing is if you can be the, you know, an insult 296 00:16:35,900 --> 00:16:38,900 is very a great way to be the least invasive, right? 297 00:16:38,900 --> 00:16:42,000 If you're going hey you just got a little extra foot motion. 298 00:16:42,000 --> 00:16:45,100 We can just put this in Seoul in and kind of control that you 299 00:16:45,100 --> 00:16:46,700 don't necessarily need to hold another shoe. 300 00:16:46,700 --> 00:16:50,800 If you're ready for a, if you're ready to buy an entirely new 301 00:16:50,800 --> 00:16:53,400 shoe, then this is something you might want to think about. 302 00:16:53,400 --> 00:16:55,400 We can create this, but we're going to try to be as least 303 00:16:55,400 --> 00:16:59,300 invasive, as possible with this. But if Something more intense, 304 00:16:59,300 --> 00:17:02,100 you might want to start thinking, you might need a shoe, 305 00:17:02,200 --> 00:17:05,599 whether it's partially or fully custom to go, can we shift 306 00:17:05,599 --> 00:17:07,500 forces away? Can we take pressure away from 307 00:17:07,500 --> 00:17:10,700 this area completely am? I understanding that correctly? 308 00:17:11,099 --> 00:17:15,099 Yes, I think that's a nice way to put it because yeah in. 309 00:17:15,099 --> 00:17:19,400 So might be not that big of an investment for someone. 310 00:17:20,200 --> 00:17:23,700 Well, they come to us and we can prescribe an insult. 311 00:17:23,700 --> 00:17:27,900 They can use it on most of the shoes, they already have if you 312 00:17:27,900 --> 00:17:31,900 can Can remove the insole, which is already in the shoe, but for 313 00:17:31,900 --> 00:17:35,600 most people, that's kind of a small step towards to try to 314 00:17:35,600 --> 00:17:40,000 find if that's already enough to to relieve their symptoms. 315 00:17:40,500 --> 00:17:44,200 And people we see with insults or most of the time people with 316 00:17:44,500 --> 00:17:48,700 plantar fasciitis, for example or heel spur or if they have too 317 00:17:48,700 --> 00:17:52,700 much pressure on the forefoot then you can well, add a little 318 00:17:52,700 --> 00:17:56,000 bit of support in the forefoot to to divide the pressure of a 319 00:17:56,000 --> 00:18:00,200 larger contact area. So, I think for most of the 320 00:18:00,200 --> 00:18:04,200 general population and insole can already be a great way to 321 00:18:04,500 --> 00:18:08,400 alleviate some of the problems during walking, and if that's 322 00:18:08,400 --> 00:18:14,300 not enough, then we can go even modify shoe from the store or go 323 00:18:14,300 --> 00:18:18,800 to see my orthopedic shoes or fully orthopedic shoes but for 324 00:18:18,800 --> 00:18:22,200 the general population and in, so most of the time, it's 325 00:18:22,200 --> 00:18:25,500 already enough to alleviate some of these common walking 326 00:18:25,500 --> 00:18:27,700 problems, they don't have to throw all the shoes. 327 00:18:27,800 --> 00:18:30,600 It's out immediately, right? And that's that's kind of the 328 00:18:30,600 --> 00:18:32,800 key. I think I've gotten a bad rap 329 00:18:32,800 --> 00:18:36,300 for being a little harsh on insoles and they work very, very 330 00:18:36,300 --> 00:18:39,200 well, especially short term. So if somebody has it. 331 00:18:39,200 --> 00:18:41,900 Well this is. This pathology does is not 332 00:18:41,900 --> 00:18:44,600 usually short-term actually. But something. 333 00:18:44,600 --> 00:18:48,000 If you have a planet of flare-up of plantar fascial, fasciitis, 334 00:18:48,000 --> 00:18:50,800 or fashio apathy, depending on who you ask, and how the 335 00:18:50,800 --> 00:18:54,500 pathology is actually going and just getting an insert. 336 00:18:54,500 --> 00:18:56,900 Can be helpful going. Hey you just need to temporarily 337 00:18:56,900 --> 00:19:00,000 unload this too. You let the inflammatory process 338 00:19:00,000 --> 00:19:02,000 come down. That's a whole other 339 00:19:02,000 --> 00:19:04,800 conversation whether it is inflammatory, it's not not going 340 00:19:04,800 --> 00:19:07,800 to get into that, but sometimes people just need something 341 00:19:07,800 --> 00:19:10,900 almost like a cast briefly to go, hey, just let this calm 342 00:19:10,900 --> 00:19:13,800 down, let this heal, you'll get back into this stuff. 343 00:19:13,800 --> 00:19:17,100 But if it's a more serious thing going, hey, this is really 344 00:19:17,100 --> 00:19:19,900 something. You need to think about a shoe 345 00:19:19,900 --> 00:19:22,300 modification might be better, especially for walking for 346 00:19:22,300 --> 00:19:23,900 running. It can be more challenging 347 00:19:23,900 --> 00:19:25,500 because people will go through running shoes. 348 00:19:25,500 --> 00:19:28,700 So quickly for walking given that they Tend to last longer 349 00:19:28,700 --> 00:19:31,600 time it might be, sometimes a better investment. 350 00:19:31,600 --> 00:19:32,800 If you've got something serious to go. 351 00:19:32,800 --> 00:19:36,600 Hey, you might need a full shoe modification which goes into the 352 00:19:36,600 --> 00:19:39,300 next part of this. Can you talk it? 353 00:19:39,300 --> 00:19:42,300 So we talked about a lot of these components whether it's 354 00:19:44,100 --> 00:19:49,000 rockers or stiffening agents or bevels are different stuff. 355 00:19:49,000 --> 00:19:52,300 Can you talk about the things that you usually work with in 356 00:19:52,300 --> 00:19:55,600 Footwear and then we'll dive into each some of those? 357 00:19:55,800 --> 00:20:00,400 Yeah yeah just to give a little Bit of context about it, we can 358 00:20:00,400 --> 00:20:02,800 make some modifications to assure. 359 00:20:02,900 --> 00:20:07,900 You can buy in the store but we can also fully made fully make 360 00:20:07,900 --> 00:20:11,900 shoes for patients which are not able to buy shoes in the store 361 00:20:12,200 --> 00:20:14,300 or they need a little bit more extra support. 362 00:20:14,800 --> 00:20:18,500 But when I talk about the shoe modification, we commonly make 363 00:20:18,500 --> 00:20:22,800 is that we add an rocker to a shoe which is already in the 364 00:20:22,808 --> 00:20:28,100 store and most of the time this is used for people who Ooh, have 365 00:20:28,100 --> 00:20:32,000 for example, a big toe joint, which is very limited or people 366 00:20:32,000 --> 00:20:37,400 who have very stiff ankles, they might have had operation in 367 00:20:37,400 --> 00:20:40,400 which their ankle is well fuse together. 368 00:20:40,400 --> 00:20:43,700 So they don't have a lot of movement in the ankle and by 369 00:20:43,700 --> 00:20:48,800 just adding an extra layer of rocker to a shoe, you can buy in 370 00:20:48,800 --> 00:20:52,500 the store, you can already well restrict the motion in these 371 00:20:52,500 --> 00:20:57,600 joints which alleviates some of the problems we have especially 372 00:20:57,800 --> 00:21:04,600 And the take-off face of walking and with the hill bevel, we use 373 00:21:04,600 --> 00:21:07,500 that a lot as well. It's mainly if someone has for 374 00:21:07,500 --> 00:21:11,600 example, muscle weakness in there are tbls anterior, for 375 00:21:11,600 --> 00:21:16,000 example, or drop food. You make the loading response, 376 00:21:16,000 --> 00:21:20,200 last a little bit longer. So people have more time to put 377 00:21:20,200 --> 00:21:25,200 their food on the ground, which well, if you have longer time to 378 00:21:25,600 --> 00:21:29,100 assert this muscle Force, then You muscles have to work a 379 00:21:29,108 --> 00:21:33,800 little bit less hard so if you find that you you clap a lot. 380 00:21:33,800 --> 00:21:36,700 When you put your foot on the ground actually adding a heel 381 00:21:36,700 --> 00:21:39,900 bevel to your shoe already helped with some of these 382 00:21:39,900 --> 00:21:44,700 problems so those are some of the more common things we use. 383 00:21:45,300 --> 00:21:49,100 You also mentioned stiffening shoes which is something we see 384 00:21:49,100 --> 00:21:51,200 a lot in running shoes these days. 385 00:21:51,900 --> 00:21:56,200 Also in our field we use a lot of carbon fiber plates but we 386 00:21:56,200 --> 00:22:00,100 mounted mostly do this. To restrict motion inside the 387 00:22:00,100 --> 00:22:02,100 foot. Mainly, when people have 388 00:22:02,100 --> 00:22:06,700 osteoarthritis either in their MTP joints or the big toe joint 389 00:22:07,100 --> 00:22:10,700 or inside the mid-foot. So it's also a very effective 390 00:22:10,700 --> 00:22:15,500 way to restrict Motion in the foot and with running, they use 391 00:22:15,500 --> 00:22:20,900 it either to, to the same degree to prevent the MTP joint for 392 00:22:20,900 --> 00:22:23,600 bending, but also to stabilize the foam. 393 00:22:24,000 --> 00:22:28,400 But with its use, in our case, not that, not that not necessary 394 00:22:28,400 --> 00:22:30,900 anymore because we mostly use for normal shoes. 395 00:22:30,900 --> 00:22:35,500 We use a rubber outsole, we use a record or midsole, but we use 396 00:22:35,500 --> 00:22:39,100 most of the similar things that you can see in running shoes. 397 00:22:39,100 --> 00:22:42,700 We also use that to alleviate pain during walking so that's 398 00:22:42,700 --> 00:22:45,000 nice to see that. There's a lot of overlap between 399 00:22:45,000 --> 00:22:48,400 the spaces, so a lot of like geometrical changes. 400 00:22:48,400 --> 00:22:51,500 It sounds like whether it's modifying the different parts of 401 00:22:51,500 --> 00:22:53,300 the rocker. Which again, for our audience, 402 00:22:53,900 --> 00:22:56,600 there are some natural rockers in the foot. 403 00:22:56,600 --> 00:23:00,200 So there's three, Major ones, the heel rocker which is the 404 00:23:00,200 --> 00:23:03,300 best is the curve at your heel or calcaneus bone. 405 00:23:03,300 --> 00:23:06,300 When you land there. That curb helps facilitate 406 00:23:06,300 --> 00:23:08,300 forward motion. If it wasn't curbed, you would 407 00:23:08,300 --> 00:23:10,200 just slap down, really, really hard. 408 00:23:10,600 --> 00:23:12,100 Different people have different amounts of Curves. 409 00:23:12,100 --> 00:23:14,200 That's different story. That's the first one. 410 00:23:14,200 --> 00:23:16,900 The middle one is your ankle rocker. 411 00:23:16,900 --> 00:23:20,000 So when your foot is flat on the ground, your ankle joint, or 412 00:23:20,000 --> 00:23:22,700 your tibia translates over that. So your foot doesn't have to 413 00:23:22,700 --> 00:23:24,500 move. Its the tibia translating over. 414 00:23:24,500 --> 00:23:26,700 That's a very efficient forward mechanism. 415 00:23:27,100 --> 00:23:31,000 The One of these rockers is the forefoot rocker, which is the 416 00:23:31,000 --> 00:23:34,900 extension of your toe joints, when your foot heel starts to 417 00:23:34,900 --> 00:23:38,900 rise up or as it does that you extend through those toe joints 418 00:23:38,900 --> 00:23:41,400 and that's a nice efficient mechanism again, lets you just 419 00:23:41,400 --> 00:23:44,000 continue moving forward without using its much energy. 420 00:23:44,600 --> 00:23:48,400 The challenge becomes if you have pain, or if you start 421 00:23:48,400 --> 00:23:50,300 losing Motion in any of those areas. 422 00:23:50,300 --> 00:23:53,700 So, the areas where most people will start losing motion is the 423 00:23:53,700 --> 00:23:55,500 ankle joint. Sometimes people have ankle 424 00:23:55,500 --> 00:23:59,000 fusions or the big toe. Joint is the common one. 425 00:23:59,000 --> 00:24:02,100 Where again, it's stiff. It's painful you're losing 426 00:24:02,100 --> 00:24:04,300 motion and again, people will have surgical interventions 427 00:24:04,300 --> 00:24:06,900 where they will stiffen that up because it's just too painful. 428 00:24:07,200 --> 00:24:09,500 But the problem is, if you stiffen that up, you still 429 00:24:09,500 --> 00:24:13,700 you're taking rocker a way that allows for efficient gate and 430 00:24:13,700 --> 00:24:15,700 you've got to figure out. Okay, how do we replace this? 431 00:24:15,700 --> 00:24:19,400 And that's where some of these rockers come in to place. 432 00:24:19,700 --> 00:24:22,600 The, although you don't lose motion here, the heel rocker the 433 00:24:22,600 --> 00:24:23,900 heel. Beverage is really important 434 00:24:23,900 --> 00:24:29,100 because a lot of people will have Bony, growths their heel, 435 00:24:29,100 --> 00:24:31,800 spurs of like that. And those don't feel is good. 436 00:24:31,900 --> 00:24:34,500 When they're inflamed, you can have people that have them and 437 00:24:34,500 --> 00:24:37,200 they have no symptoms, which is very interesting, but once they 438 00:24:37,200 --> 00:24:40,200 get inflamed, it does not feel good to land on those. 439 00:24:40,200 --> 00:24:43,900 So a heel bevel can help facilitate that forward motion. 440 00:24:43,900 --> 00:24:49,500 It reduces stress or load in that area just by prolonging 441 00:24:49,800 --> 00:24:51,700 that amount. And I also worked very, very 442 00:24:51,700 --> 00:24:54,500 well for weakness. Especially for a lot of poor. 443 00:24:54,500 --> 00:24:58,800 A lot of unfortunate people drop foot is not Not uncommon with 444 00:24:58,800 --> 00:25:02,100 nerve damage or stroke or traumatic brain injuries. 445 00:25:02,400 --> 00:25:04,500 Because you need your brain and your nervous system to control 446 00:25:04,500 --> 00:25:09,300 that stuff and it can be challenging if you don't have a 447 00:25:09,300 --> 00:25:11,500 heel bevel to control that because the foot gets slapped 448 00:25:11,500 --> 00:25:15,400 down so quickly. So the users are very great ways 449 00:25:15,600 --> 00:25:18,500 to help control this motion. Do you do anything with, in 450 00:25:18,500 --> 00:25:21,200 terms of shoe modifications, modifications with like frontal, 451 00:25:21,200 --> 00:25:24,400 plane or like stability stuff? I'll start with that. 452 00:25:24,400 --> 00:25:26,000 I have a billion questions for you. 453 00:25:26,200 --> 00:25:27,500 Oh yes. Yes, we do that. 454 00:25:27,700 --> 00:25:31,700 A lot, most of the time, we do that with the fully made 455 00:25:32,000 --> 00:25:36,900 orthopedic shoes, some of our populations, we use it for our 456 00:25:36,900 --> 00:25:39,400 people who have, for example, had a stroke. 457 00:25:39,700 --> 00:25:44,200 So their foot is placed in like position, which is not 458 00:25:44,500 --> 00:25:50,200 completely correctable by hand. And if the foot is, well, not 459 00:25:50,200 --> 00:25:54,300 able to be corrected, you have to outline your shoe a little 460 00:25:54,300 --> 00:26:00,900 bit wider, otherwise. Well, Go and go through their 461 00:26:00,900 --> 00:26:03,700 ankle, every step. So you have to make the shoe a 462 00:26:03,708 --> 00:26:07,300 lot wider to offer them a stable base of support. 463 00:26:08,500 --> 00:26:11,400 That's what we do. Most of the time we try to find 464 00:26:11,700 --> 00:26:14,400 well what are the movement possibilities Within These 465 00:26:14,400 --> 00:26:17,100 foods? Are we able to correct it from 466 00:26:17,100 --> 00:26:20,500 under the foot? Sometimes if someone has a lot 467 00:26:20,500 --> 00:26:26,900 of excessive pronation you can have medially some some pressure 468 00:26:26,900 --> 00:26:31,900 to Correct. The stands or someone is in 469 00:26:31,900 --> 00:26:34,400 supinating position. You can have some pressure 470 00:26:35,000 --> 00:26:37,500 before. And after the head of the fifth 471 00:26:38,700 --> 00:26:41,400 metatarsal. So there are some ways to do 472 00:26:41,400 --> 00:26:45,000 this under the foot, but if you are not able to fully correct, 473 00:26:46,200 --> 00:26:49,700 the food with with an insult, for example, or putting some 474 00:26:49,700 --> 00:26:52,100 pressure on the foot, you have to go wider. 475 00:26:52,100 --> 00:26:56,600 Otherwise someone will just fall over because there are the 476 00:26:56,600 --> 00:26:59,500 ground reaction force. Outside there, and there stands. 477 00:26:59,500 --> 00:27:02,400 So what I mean, yes. So what I'm hearing is a lot of 478 00:27:02,408 --> 00:27:04,600 times. It can we talk about solar flare 479 00:27:04,900 --> 00:27:09,700 so you can't necessarily post a shoe, right? 480 00:27:09,700 --> 00:27:11,800 That's like, you know, you have a traditional shoe, can't just 481 00:27:11,800 --> 00:27:14,400 you can't just lie. Just put a post into it, but you 482 00:27:14,400 --> 00:27:16,800 correct me if I'm wrong. But you can create solar where 483 00:27:16,800 --> 00:27:20,200 you can extend the soul out in a, in the, in side, to side, to 484 00:27:20,200 --> 00:27:25,100 try to resist motion, Which is exactly where at this all these 485 00:27:25,100 --> 00:27:26,400 Concepts. When I talk about this in 486 00:27:26,400 --> 00:27:29,200 running shoes, this is I learned all of this from orthopedic shoe 487 00:27:29,200 --> 00:27:30,900 stuff and going. Hey, wonder if this works for 488 00:27:30,900 --> 00:27:32,000 running to. Yes. 489 00:27:32,000 --> 00:27:34,100 Exactly. If you have a wider base of 490 00:27:34,100 --> 00:27:39,400 support, it's it's increases the stability of the patients and 491 00:27:39,400 --> 00:27:42,600 especially if the fault is not able to be fully corrected under 492 00:27:42,600 --> 00:27:46,400 the foods, you need some more ground context. 493 00:27:46,400 --> 00:27:51,200 Otherwise you will just fall over and especially in running 494 00:27:51,200 --> 00:27:53,000 shoes. You see this, you being you Used 495 00:27:53,000 --> 00:27:57,500 as a stability mechanism as well, depending if you can do it 496 00:27:57,500 --> 00:28:02,300 on both sides or immediately most shoe companies try to widen 497 00:28:02,300 --> 00:28:05,600 their base of support, which is a very effective system to 498 00:28:05,600 --> 00:28:07,500 increase stability during The Stance phase. 499 00:28:08,100 --> 00:28:12,000 Yes. So software is one method 500 00:28:12,000 --> 00:28:14,400 mechanism terms of making the soul wider. 501 00:28:15,000 --> 00:28:17,600 Is there any other mechanisms that you can use to increase 502 00:28:17,600 --> 00:28:20,300 stability if that maybe isn't enough? 503 00:28:20,600 --> 00:28:25,000 Mmm. Well, it depends on how you're 504 00:28:25,000 --> 00:28:28,800 able to correct the foot, but another way is to make the shoe 505 00:28:28,800 --> 00:28:34,600 a lot higher and that way you can well almost form like a cost 506 00:28:34,600 --> 00:28:39,400 around the leg. So you restrict a lot of motion 507 00:28:39,400 --> 00:28:44,100 especially in the ankle joints but if someone for example, has 508 00:28:44,100 --> 00:28:48,200 already a problem with with balance because of neuropathy or 509 00:28:48,200 --> 00:28:51,500 a neural disorders, this might not be an effective way. 510 00:28:51,900 --> 00:28:55,500 Because if someone steps puts her foot down, they will also 511 00:28:55,500 --> 00:28:59,300 just followed her because they have no way to able to correct. 512 00:29:00,000 --> 00:29:03,300 So let's promised ability standpoint. 513 00:29:03,300 --> 00:29:05,800 That's the first thing. I think about, we try to correct 514 00:29:05,800 --> 00:29:08,500 the food, so it's in its most natural position. 515 00:29:09,000 --> 00:29:12,600 But if it's not enough, we try to try to use solar flare, for 516 00:29:12,600 --> 00:29:15,900 example, to widen the base. Now, can you add things like 517 00:29:15,900 --> 00:29:18,200 sidewalls? Can you bring the midsole up 518 00:29:18,300 --> 00:29:21,200 around the sewers that not a very common technique? 519 00:29:21,400 --> 00:29:25,800 That's done. No, for rcpd shoes. 520 00:29:25,800 --> 00:29:30,300 We don't use that a lot. I see it a lot in running shoes 521 00:29:30,300 --> 00:29:32,400 as well. That you actually go over the 522 00:29:32,400 --> 00:29:37,800 foods to create the sidewalls. And what we do is sometimes we 523 00:29:37,800 --> 00:29:42,900 try to use harder materials inside the shoe. 524 00:29:43,500 --> 00:29:48,600 So we sometimes use carbon fiber or some other very tough 525 00:29:48,600 --> 00:29:55,000 materials to give some Some support, some stability around 526 00:29:55,000 --> 00:29:59,200 it, so I was thinking that you were looking for that, but it's 527 00:29:59,200 --> 00:30:03,500 not exactly that we have like sidewalls as in running shoes, 528 00:30:03,500 --> 00:30:06,500 but we, we try to play with different materials. 529 00:30:06,700 --> 00:30:10,600 To make the shoe a lot stronger than regular shoe in the store. 530 00:30:10,800 --> 00:30:12,500 Got it. So you're using stiffening 531 00:30:12,500 --> 00:30:14,200 agents. So go at this goes perfectly 532 00:30:14,200 --> 00:30:16,000 into like the carbon fiber stuff. 533 00:30:16,000 --> 00:30:18,700 So you can use Stephanie agents to add more stability. 534 00:30:18,700 --> 00:30:21,800 Can you dive in a little bit more on how you do that? 535 00:30:22,000 --> 00:30:23,000 Because this is really important. 536 00:30:23,000 --> 00:30:26,200 I think this is what people don't realize about the, some of 537 00:30:26,200 --> 00:30:29,400 the carbon fiber plates is that people think that these magic 538 00:30:29,400 --> 00:30:32,400 things that give you energy, which they don't, but they can 539 00:30:32,400 --> 00:30:35,600 add stiffness in areas to potentially facilitate or 540 00:30:35,600 --> 00:30:40,400 restrict motion? Yes, yes, what's running shoes, 541 00:30:40,400 --> 00:30:45,200 do you mainly have carbon fiber and Souls, which are over the 542 00:30:45,200 --> 00:30:49,200 full length of the insole, which we can also use carbon fiber as 543 00:30:49,200 --> 00:30:51,800 a stiffening agent for the shoe itself. 544 00:30:51,900 --> 00:30:57,600 Elf, if you have a very high shoe for example, you can have 545 00:30:57,900 --> 00:31:02,500 the whole shoe strengthens with carbon fiber, so it can resist a 546 00:31:02,500 --> 00:31:06,500 lot more force in the medial lateral Direction. 547 00:31:09,000 --> 00:31:13,400 I'm curious to know how so that traditionally for running shoes. 548 00:31:13,400 --> 00:31:16,100 I think just expanding for audience, on what these 549 00:31:16,100 --> 00:31:18,500 stiffening agents can do. Because a lot of people think 550 00:31:18,800 --> 00:31:23,200 that carbon fiber plates and all the plates is tough, They give 551 00:31:23,200 --> 00:31:26,300 you energy back but they really don't so let instead of me 552 00:31:26,300 --> 00:31:29,100 leading on. Can you say, how what they 553 00:31:29,100 --> 00:31:32,500 really do especially for walking especially from an orthopedic 554 00:31:32,500 --> 00:31:35,600 shoe standpoint. What are they really do for the 555 00:31:35,600 --> 00:31:39,000 carbon fiber place today? Mainly restricted Motion in the 556 00:31:39,000 --> 00:31:42,600 shoes? Yeah, as we mentioned before, 557 00:31:42,600 --> 00:31:46,500 it's mainly for people, when there is motion inside the foot, 558 00:31:47,100 --> 00:31:50,000 if that's can be painful. So people with osteoarthritis, 559 00:31:50,000 --> 00:31:55,500 for example, you want to To reduce motion inside the foot as 560 00:31:55,500 --> 00:31:58,800 much as possible, so you can use a carbon fiber in. 561 00:31:58,800 --> 00:32:03,200 So for example, because then there is no way for the foot to 562 00:32:03,200 --> 00:32:07,700 move around in the shoe. So, that's, that's an effective 563 00:32:07,700 --> 00:32:12,200 way to alleviate pain, which is caused by motion, which is 564 00:32:12,200 --> 00:32:16,600 mainly inside the foot. But as I mentioned, as I 565 00:32:16,608 --> 00:32:20,200 mentioned it as a strengthening material, you can also use it 566 00:32:20,200 --> 00:32:26,200 for people who For example, had a stroke and our food is as we 567 00:32:26,200 --> 00:32:30,700 mentioned before, apparatuses of the the the drop food. 568 00:32:30,700 --> 00:32:34,700 For example, you can use it. If you have a really High Schoo 569 00:32:34,700 --> 00:32:39,600 to hold the food up during the swing phase because and not 570 00:32:39,600 --> 00:32:42,800 always it's during The Stance phase where the problems are 571 00:32:42,800 --> 00:32:45,900 with stability. If someone is not able to fully 572 00:32:46,300 --> 00:32:49,900 raised their foot during the swing phase, it can just get 573 00:32:49,900 --> 00:32:52,400 stuck behind there. And stuff. 574 00:32:53,000 --> 00:32:56,300 And if you have, for example, a very high shoe with a carbon 575 00:32:56,300 --> 00:33:01,400 fiber stiffening material, especially around the dorsal 576 00:33:01,400 --> 00:33:04,900 sides of the cough. It really helps to keep the food 577 00:33:04,900 --> 00:33:09,400 up during the swing phase so it can help with stability 578 00:33:09,400 --> 00:33:12,800 immediately laterally during The Stance phase, but especially 579 00:33:13,100 --> 00:33:16,100 during the swing phase where you want to have enough clearance to 580 00:33:16,400 --> 00:33:18,600 make your next step. This, this is what a lot of 581 00:33:18,600 --> 00:33:21,000 Runners don't realize. Just because they have the 582 00:33:21,000 --> 00:33:24,100 benefit of Flow basically, flying through the air, with 583 00:33:24,100 --> 00:33:27,200 most steps with walking, what we look for, in terms of the 584 00:33:27,200 --> 00:33:30,000 orthopedic, in the neurologic population, especially with the 585 00:33:30,008 --> 00:33:32,900 population, I work with, since I specialize with geriatric in the 586 00:33:32,900 --> 00:33:35,600 older individual worried about Falls, and one of the more 587 00:33:35,600 --> 00:33:37,500 common areas. You'll see this is people 588 00:33:37,500 --> 00:33:39,800 tripping. So just for our listeners 589 00:33:39,800 --> 00:33:42,300 stance, phase is where your foots on the ground when it 590 00:33:42,300 --> 00:33:45,200 comes to forces. That's what we're thinking about 591 00:33:45,200 --> 00:33:48,700 a lot of times with shoes, when your foots off the ground, when 592 00:33:48,700 --> 00:33:51,600 you're bringing back a book over the ground, to take another 593 00:33:51,600 --> 00:33:54,200 step, That's called swing phase. And what's really important to 594 00:33:54,200 --> 00:33:57,200 swing phase is you need to be able to clear the foot, over the 595 00:33:57,200 --> 00:34:01,200 ground, to get it back in front of you, if you don't clear it. 596 00:34:01,300 --> 00:34:03,500 You're going to trip on it. And so that's one of the 597 00:34:03,500 --> 00:34:07,000 challenges with shoes to go. Well, these things generally 598 00:34:07,000 --> 00:34:09,699 when it comes to shock absorption and stiffening tend 599 00:34:09,699 --> 00:34:12,199 to help most with stance. But there are some mechanisms 600 00:34:12,199 --> 00:34:15,300 you can use to actually facilitate What's called the 601 00:34:15,300 --> 00:34:18,000 swing phase, especially, correct me if I'm wrong. 602 00:34:18,300 --> 00:34:20,800 A lot of the stuff in terms of The forefoot Rocker and getting 603 00:34:20,800 --> 00:34:23,400 off that Can be really, really helpful? 604 00:34:24,000 --> 00:34:28,400 Yes, especially if you have, for example, muscle weakness and 605 00:34:28,400 --> 00:34:31,400 your calf muscles. Then you will have a decrease 606 00:34:31,400 --> 00:34:35,000 step length, for example, and already adding a rocker 607 00:34:35,100 --> 00:34:38,300 four-foot rocker, can already help to offload some of those 608 00:34:38,300 --> 00:34:41,500 muscles in the well the back of your cough. 609 00:34:41,500 --> 00:34:46,300 So your plantar flexion muscles. So that's already an effective 610 00:34:46,300 --> 00:34:51,699 way to to at least use less energy during walking, but also, 611 00:34:51,800 --> 00:34:56,100 So to reduce some of the load which is put on these ankle. 612 00:34:56,300 --> 00:35:01,700 Plantar flexion muscles and for the swing phase, you mostly 613 00:35:01,700 --> 00:35:05,000 require issue which is well a lot higher than the shoe you can 614 00:35:05,000 --> 00:35:08,800 normally buy in the store which can sometimes be evenly High 615 00:35:09,200 --> 00:35:14,300 because by mechanically you need it to be that high to be able to 616 00:35:14,500 --> 00:35:17,900 keep the food up during the swing phase and the populations. 617 00:35:17,900 --> 00:35:21,700 We mostly use that for people with well. 618 00:35:21,900 --> 00:35:24,900 Muscle weakness in their legs, which can be either the 619 00:35:24,900 --> 00:35:28,400 plaintiff lectures or the doors of lectures at, this is 620 00:35:28,400 --> 00:35:30,600 interesting concept, because usually, especially for running, 621 00:35:30,600 --> 00:35:32,900 most people are thinking, only about a shoe that really comes 622 00:35:32,900 --> 00:35:36,400 up at the highest to the ankle, but we're talking about starting 623 00:35:36,400 --> 00:35:38,700 to think about bracing going all the way up to the knee, 624 00:35:38,700 --> 00:35:42,600 sometimes up to the hip correct. Now, the shoe is we make are 625 00:35:42,700 --> 00:35:46,200 still under the knee, most of the time, but we work together 626 00:35:46,200 --> 00:35:48,300 with an orthopedic instruments company. 627 00:35:48,500 --> 00:35:51,400 And sometimes if people have muscle weakness, for example, 628 00:35:51,400 --> 00:35:54,500 and Quad muscles or the hamstring muscles, you have 629 00:35:54,500 --> 00:35:57,100 tools which help stabilize that rich. 630 00:35:57,100 --> 00:35:59,300 You're able to go up even higher. 631 00:36:00,000 --> 00:36:04,100 So but that's a nice concept. You brought there because most 632 00:36:04,100 --> 00:36:07,700 of the shoes in the store are mostly under the ankle or 633 00:36:07,700 --> 00:36:10,700 summer, just over the ankle. But some of these are two Pedic 634 00:36:10,700 --> 00:36:15,400 shoes needs to go a lot higher because biomechanically, you 635 00:36:15,400 --> 00:36:19,400 need that to keep the food up during the swing phase and the 636 00:36:19,400 --> 00:36:22,700 higher. You go, the better your Able to 637 00:36:23,600 --> 00:36:26,500 give some stability around the ankle joint, for example. 638 00:36:26,700 --> 00:36:29,400 So we were touching into now how things are different. 639 00:36:29,400 --> 00:36:31,500 Cuz a lot of times before this, we've talked about, hey, there's 640 00:36:31,500 --> 00:36:35,100 a lot of similarities between a running shoe and a lot of the 641 00:36:35,100 --> 00:36:38,600 orthopedic walking shoes, or just use that using, just to 642 00:36:38,600 --> 00:36:41,500 help people facilitate, their gate, not even for dynamic stuff 643 00:36:41,500 --> 00:36:43,800 like running. So we're just starting to touch 644 00:36:43,800 --> 00:36:46,000 on how we there's some different things you can use. 645 00:36:46,000 --> 00:36:47,800 I've got a lot of these, you know, when you start coming 646 00:36:47,800 --> 00:36:50,600 beyond the ankle may not be the best thing for running this to 647 00:36:50,600 --> 00:36:54,000 Sara Lee but what other differences are you seeing in 648 00:36:54,000 --> 00:36:58,400 terms of how an orthopedic shoe is designed or how you approach 649 00:36:58,500 --> 00:37:01,700 a lot of this patient population versus a running shoe? 650 00:37:01,700 --> 00:37:07,300 What differences do you see? Well, most of the time our goal 651 00:37:07,300 --> 00:37:11,400 is to either alleviate pain or to increase the walking 652 00:37:11,400 --> 00:37:13,900 distance. So you really have to make sure 653 00:37:13,900 --> 00:37:18,100 that what you're making is actually what's the person 654 00:37:18,100 --> 00:37:20,600 actually wants from the the tool? 655 00:37:20,600 --> 00:37:25,200 You're designing. It's can also be to decrease 656 00:37:25,200 --> 00:37:28,600 pressure under the foot, which is very important for, 657 00:37:28,600 --> 00:37:31,100 especially the diabetic population, which you touched 658 00:37:31,100 --> 00:37:34,600 on. Most of the people listening 659 00:37:34,600 --> 00:37:36,600 might think, why is this so important? 660 00:37:36,900 --> 00:37:41,000 Because a side effect of diabetes is that you also have 661 00:37:41,700 --> 00:37:43,900 less loss of sensory information. 662 00:37:43,900 --> 00:37:48,400 You have less cardio, vascular flow throughout your system. 663 00:37:48,900 --> 00:37:52,600 So if you have a wound or on for example you're talking So or 664 00:37:52,900 --> 00:37:56,800 under your foot, it takes a very long time to cure that wounds. 665 00:37:57,400 --> 00:38:00,800 So it's actually better to prevent these people getting 666 00:38:00,800 --> 00:38:04,900 wounds then to cure it because in some cases it might lead to 667 00:38:05,200 --> 00:38:09,200 amputation for example. And that's the takes a lot of 668 00:38:09,200 --> 00:38:12,900 time and also very intensive care from different Healthcare 669 00:38:12,900 --> 00:38:16,700 professionals. So diabetic, patients are 670 00:38:16,700 --> 00:38:19,900 actually one of the more common people who use our to Pedic 671 00:38:19,900 --> 00:38:24,500 shoes which is mostly Reduce the pressure under the foot which 672 00:38:24,500 --> 00:38:26,900 can be done with the custom maids in Seoul. 673 00:38:27,200 --> 00:38:31,000 So if someone has a lot of pressure on, for example, their 674 00:38:31,500 --> 00:38:35,300 first metatarsal joint or the mzp-1 you can. 675 00:38:36,200 --> 00:38:39,000 Well, put some cushioning material on the red or you can 676 00:38:39,200 --> 00:38:42,000 have it a little bit deeper in the insole so there's a lot less 677 00:38:42,000 --> 00:38:45,400 pressure on it or as we mentioned before you can use 678 00:38:45,800 --> 00:38:50,000 early stage rocker so you reduce the pressure on the place. 679 00:38:50,200 --> 00:38:54,000 Yeah we talked about we talk about in running modifying 680 00:38:54,000 --> 00:38:57,300 forces but this is for you know a you will usually it's for 681 00:38:57,300 --> 00:39:00,900 recreational activity for this patient population is best. 682 00:39:00,900 --> 00:39:03,500 When you're talking about diabetic ulcers or diabetic 683 00:39:03,500 --> 00:39:07,400 neuropathy, this is can actually be a life-or-death situation. 684 00:39:07,400 --> 00:39:10,900 Just because when you can't a lot of these wonderful people 685 00:39:11,600 --> 00:39:15,000 can't feel what's happening. So, when you have a wound there, 686 00:39:15,400 --> 00:39:17,700 they have no idea. Most of us, you feel a cut or 687 00:39:17,700 --> 00:39:18,500 something like that? Like, okay. 688 00:39:18,500 --> 00:39:21,300 I know this, I'm going to reduce the amount I use this. 689 00:39:21,700 --> 00:39:26,200 But for someone that can't feel that that can progress and get 690 00:39:26,200 --> 00:39:27,900 worse and worse and worse and worse and worse. 691 00:39:27,900 --> 00:39:30,400 And there's a variety of other complications that can happen, 692 00:39:30,400 --> 00:39:34,800 including gangrene and terms of systemic infections so this can 693 00:39:34,800 --> 00:39:37,300 actually like these can progress to the point that people died 694 00:39:37,300 --> 00:39:40,900 not you know and yes losing a limb is terrible because the 695 00:39:40,900 --> 00:39:45,300 mortality rates after amputation or not super great and a lot of 696 00:39:45,300 --> 00:39:48,600 this population just because if you start losing Mobility, it's 697 00:39:48,600 --> 00:39:50,600 kind of a downhill thing. That said there are a many 698 00:39:50,600 --> 00:39:54,300 amazing people who Have had amputations and they're using 699 00:39:54,300 --> 00:39:56,600 some incredible prosthesis and doing some incredible things. 700 00:39:56,600 --> 00:40:00,000 But, you know, the average person, this is not as great. 701 00:40:00,000 --> 00:40:02,900 So it's this is really life or death in terms of hey it's you 702 00:40:02,908 --> 00:40:05,900 know, how can we make shoes that just prevent this. 703 00:40:05,900 --> 00:40:09,300 So, prevention is really key. Sounds like, yes, exactly. 704 00:40:11,500 --> 00:40:14,500 Also some other modifications, which are especially for the 705 00:40:14,500 --> 00:40:18,300 diabetic population is that you have a lining, for example, 706 00:40:18,300 --> 00:40:21,500 inside the shoe, which is a little bit softer or you try to 707 00:40:21,500 --> 00:40:25,200 have Stitches in the shoe on different places that are high 708 00:40:25,200 --> 00:40:28,200 risk for example, to get wounds on top of the shoe. 709 00:40:28,700 --> 00:40:31,900 You try to make sure that there is enough room for the toes. 710 00:40:31,900 --> 00:40:36,300 For example, and that's one of the benefits we can have with a 711 00:40:36,300 --> 00:40:39,200 custom-made shoes, is that during the process, we can 712 00:40:39,200 --> 00:40:43,300 already see how much room there is on specific places inside the 713 00:40:43,300 --> 00:40:46,100 shoe. So, during the process of making 714 00:40:46,100 --> 00:40:49,400 an orthopedic shoe, there are several moments where you can 715 00:40:49,500 --> 00:40:54,100 adjust the last, which is made For the person, which might be a 716 00:40:54,100 --> 00:40:57,500 nice topic to expand a little bit on and how we actually make 717 00:40:57,500 --> 00:41:02,500 these orthopedic shoes. So, we start with the 718 00:41:02,500 --> 00:41:05,800 prescription from the doctor. Then the person comes to us and 719 00:41:05,800 --> 00:41:10,600 we make some measurements of the foot almost like if you're going 720 00:41:10,600 --> 00:41:13,400 to have to make a tailor-made suit for someone, but now for 721 00:41:13,400 --> 00:41:18,000 the feet, we put the cost around the foot and then we immediately 722 00:41:18,000 --> 00:41:20,600 remove it. So we have like a model of how 723 00:41:20,600 --> 00:41:24,300 that person's foot And based on that cost and the measurements 724 00:41:24,300 --> 00:41:27,200 we make, we make custom made lost for someone. 725 00:41:27,600 --> 00:41:31,800 So in our company we have dozens, even thousands of wooden 726 00:41:31,800 --> 00:41:36,000 loss of people especially made for them. 727 00:41:36,600 --> 00:41:40,600 And this last goes through some modifications. 728 00:41:40,800 --> 00:41:46,200 Some fitting. How do you call it appointments? 729 00:41:46,200 --> 00:41:50,700 They have with us, for example, you can make a plastic shoe and 730 00:41:50,700 --> 00:41:53,500 you can see exactly We threw the shoe, how much space there is in 731 00:41:53,500 --> 00:41:56,800 certain places. And based on that findings, you 732 00:41:56,800 --> 00:42:00,800 can adjust the last to make the shoe especially made for someone 733 00:42:01,600 --> 00:42:04,100 so especially for diabetic population. 734 00:42:04,100 --> 00:42:07,500 But also people who have, for example, a very wide for food, 735 00:42:07,600 --> 00:42:10,500 you can make sure that the shoes have plenty of space in the 736 00:42:10,500 --> 00:42:14,400 forefoot so they don't have any risk of having wounds on their 737 00:42:14,400 --> 00:42:18,000 food. And after that, we make the 738 00:42:18,000 --> 00:42:21,100 shoes, we don't make the whole shoes. 739 00:42:22,500 --> 00:42:25,200 The last part of the process is that the letter is put around 740 00:42:25,200 --> 00:42:28,000 the shoes, but that happens in another country. 741 00:42:29,000 --> 00:42:33,000 And then after yeah, six or seven weeks, we could send the 742 00:42:33,000 --> 00:42:36,400 shoe back and then please the person can use it and have a 743 00:42:36,400 --> 00:42:38,000 shoe made, especially for their food. 744 00:42:38,000 --> 00:42:41,300 So, this this is, wow. This is so, this is not just a 745 00:42:41,308 --> 00:42:43,900 quick, like couple Dave. This is a long, how long of a 746 00:42:43,900 --> 00:42:48,100 process is take in total three months, I would say from the 747 00:42:48,100 --> 00:42:51,500 first time they're being seen by a doctor to the moment that the 748 00:42:51,500 --> 00:42:55,300 person Gets her shoes because we actually, we want to make sure 749 00:42:55,300 --> 00:42:59,100 that the shoe we are, making it actually fits for the person. 750 00:42:59,700 --> 00:43:02,100 And what's nice about these shoes is that the person 751 00:43:02,100 --> 00:43:05,000 themselves can choose what models you they want. 752 00:43:05,400 --> 00:43:08,900 So we have a website with over 1000 models of shoes. 753 00:43:09,400 --> 00:43:13,600 So nowadays people used to think that orthopedic shoes are always 754 00:43:13,600 --> 00:43:18,800 very ugly and black and very heavy but it depends on what's 755 00:43:18,800 --> 00:43:22,300 in the shoe. If you have a very wise for For 756 00:43:22,300 --> 00:43:26,700 example, you're going to have a wide shoe, but regarding the 757 00:43:26,700 --> 00:43:28,800 models, there are a lot of possibilities to make these 758 00:43:28,800 --> 00:43:30,900 shoes. Actually look pretty nice. 759 00:43:30,900 --> 00:43:33,000 That's very, very cool. So it sounds like, people just 760 00:43:33,000 --> 00:43:35,300 don't know the options that are now available. 761 00:43:35,900 --> 00:43:38,300 There's a lot of interest trees are doing this, by the way, 762 00:43:38,900 --> 00:43:41,600 where if you, if you look in the right place, a lot of the 763 00:43:41,600 --> 00:43:45,000 typical Orthopedic stuff or especially the population that 764 00:43:45,000 --> 00:43:47,100 I'll sometimes see is it people didn't fit dealing with 765 00:43:47,100 --> 00:43:50,700 lymphedema, so that's excessive swelling usually because of 766 00:43:50,700 --> 00:43:52,600 lymph node removal. So Those that have had a 767 00:43:52,608 --> 00:43:57,100 mastectomy or breast removals. Very commonly, you'll see this 768 00:43:57,100 --> 00:44:00,100 and people used to hate the coverings that they would wear 769 00:44:00,300 --> 00:44:02,800 because they, oh, it's boring. There are some phenomenal 770 00:44:02,800 --> 00:44:04,700 companies that make some very exciting design. 771 00:44:04,700 --> 00:44:07,300 So it's very excited to hear that the orthopedic shoe world 772 00:44:07,300 --> 00:44:09,400 is also able to go that way because again, if people don't 773 00:44:09,400 --> 00:44:11,100 like it, they're not going to wear it so you got to make it 774 00:44:11,100 --> 00:44:12,800 look, you know, got to make it look good. 775 00:44:12,900 --> 00:44:16,000 So that's good. That you have that but that's 776 00:44:16,000 --> 00:44:19,900 this is is this it's not like this is a little bit newer. 777 00:44:20,300 --> 00:44:21,800 You were going to say something. Oh no. 778 00:44:21,900 --> 00:44:26,000 No you're going to say that's a little bit newer but we work 779 00:44:26,000 --> 00:44:30,300 together with orthopedic shoe company which has a website with 780 00:44:30,300 --> 00:44:34,200 over 1000 models. So for everyone there's probably 781 00:44:34,200 --> 00:44:38,500 orthopedic shoe which which fits their their wishes to Howard 782 00:44:38,500 --> 00:44:42,300 issues to look like and especially if there are not that 783 00:44:42,300 --> 00:44:46,500 many problems, it might just look like a regular shoe, which 784 00:44:46,500 --> 00:44:50,200 you can buy in the store, which is some modifications to it and 785 00:44:50,200 --> 00:44:53,300 most of the time most people. People might not even see that 786 00:44:53,300 --> 00:44:57,500 it's orthopedic shoe. But that's, that's a development 787 00:44:57,500 --> 00:45:00,600 from the last couple of years. We always try to make the shoes, 788 00:45:00,600 --> 00:45:04,800 not as nice as possible, so that people actually want to wear the 789 00:45:04,800 --> 00:45:10,100 shoes because maybe 20 or 30 years ago, it was that they 790 00:45:10,100 --> 00:45:14,100 could only choose black shoes and mainly there were very wise 791 00:45:14,100 --> 00:45:16,700 or not a pretty shoes to walk in. 792 00:45:17,200 --> 00:45:22,500 But now, currently I think a lot of people might even not Might 793 00:45:22,500 --> 00:45:25,100 not even see that some people are wearing orthopedic shoes. 794 00:45:26,200 --> 00:45:29,000 It's just because I work in this business, that I noticed that 795 00:45:29,000 --> 00:45:31,100 some people might be wearing light speed, excuse, but before 796 00:45:31,100 --> 00:45:33,900 that, I had no idea that some people on the street were 797 00:45:33,900 --> 00:45:36,900 actually walking in these custom-made shoes, that's 798 00:45:36,900 --> 00:45:38,100 awesome. It's awesome. 799 00:45:38,100 --> 00:45:40,600 That we have this becoming more widely available, which is 800 00:45:40,600 --> 00:45:42,700 great. But this is still a newer 801 00:45:42,700 --> 00:45:46,200 technology to you mind diving into and you've you alluded to 802 00:45:46,200 --> 00:45:48,500 this earlier that there's some new stuff coming down the 803 00:45:48,500 --> 00:45:51,800 pipeline in terms of the design and development and this can you 804 00:45:51,900 --> 00:45:54,400 To expand on what some of those new developments are. 805 00:45:55,500 --> 00:45:59,800 One of the developments is that we're looking to make well the 806 00:45:59,800 --> 00:46:03,100 the first appointments to have a little bit easier. 807 00:46:03,300 --> 00:46:05,700 Now, we take all the measurements of the foot and we 808 00:46:05,700 --> 00:46:09,000 put the cost around the foot and then we have to remove the cost. 809 00:46:09,200 --> 00:46:11,300 The cost is being scanned into the computer. 810 00:46:11,800 --> 00:46:14,100 So we're trying to make this a little bit more easy. 811 00:46:14,500 --> 00:46:18,400 So we're working towards having, for example, an iPad scanner, 812 00:46:18,600 --> 00:46:22,200 which you can walk around the patient so you can have Already 813 00:46:22,200 --> 00:46:26,500 a digital fell off the foot. There are already some companies 814 00:46:26,500 --> 00:46:31,300 who use this technique and well, it, it makes it easier for us to 815 00:46:31,300 --> 00:46:35,200 work and it's also a lot more reliable to have a good scan of 816 00:46:35,200 --> 00:46:38,100 the leg. Then you can already have the 817 00:46:38,100 --> 00:46:40,900 good measurements of someone's leg in a matter of seconds. 818 00:46:42,200 --> 00:46:46,400 Some other Technologies which might be used in our area are 819 00:46:46,400 --> 00:46:51,500 for example, 3D printing, which is being used a lot in the 820 00:46:51,500 --> 00:46:52,700 ortho. Pedic instruments. 821 00:46:52,700 --> 00:46:56,500 For example, if someone has lost the arm or lost complete the 822 00:46:56,700 --> 00:47:00,300 leg, they're using a lot of 3D printing as well. 823 00:47:01,000 --> 00:47:04,600 So I think in our field it might be possible to have. 824 00:47:04,600 --> 00:47:08,900 For example, a rocker under your shoe, completely customized and 825 00:47:08,900 --> 00:47:13,000 printed by a 3D printer. That would be nice development 826 00:47:13,000 --> 00:47:15,800 to see in the future. So, based on your your 827 00:47:15,800 --> 00:47:20,600 biomechanics, for example, if you do a gait analysis, a 828 00:47:20,600 --> 00:47:24,400 computer program might be Able to predict how you are. 829 00:47:24,400 --> 00:47:27,100 Walking can be improved by the Heel. 830 00:47:27,100 --> 00:47:31,000 Rock are doing the ankle rocker and the fourth was rocker and 831 00:47:31,000 --> 00:47:34,100 maybe that can be 3D printed and put under the shoe. 832 00:47:34,100 --> 00:47:38,200 So you have a shoe which has the best possible Rucker for you, 833 00:47:38,800 --> 00:47:43,700 which might also be a nice way to do with running shoes to make 834 00:47:43,700 --> 00:47:47,500 the running shoe customizable to your gate, to your mechanics. 835 00:47:47,700 --> 00:47:51,200 Yeah, I was gonna say just I people get really excited about 836 00:47:51,200 --> 00:47:53,600 some of these mechanisms. Isms rockers plate, stuff like 837 00:47:53,600 --> 00:47:56,400 that, what they don't realize. Would you get to do on a daily 838 00:47:56,400 --> 00:47:59,000 basis? Is that these rot these 839 00:47:59,000 --> 00:48:04,000 mechanisms, how people respond to them, is very unique, the 840 00:48:04,000 --> 00:48:08,000 angles, the Motions, the line of the line of best movement for 841 00:48:08,000 --> 00:48:10,600 each person is going to be completely different. 842 00:48:10,900 --> 00:48:13,600 So, when you're looking at running shoes or a 843 00:48:13,600 --> 00:48:16,500 over-the-counter the shoe, you're trying to find the one 844 00:48:16,500 --> 00:48:20,500 that best matches you, it's not necessarily made for you, but 845 00:48:20,500 --> 00:48:21,800 trying to go. I'm just trying to get as close. 846 00:48:21,900 --> 00:48:24,500 Close as possible. Something that somewhat works, 847 00:48:24,500 --> 00:48:26,400 that's why certain shoes will work. 848 00:48:26,400 --> 00:48:29,100 Certain shoes won't work for certain people assign the other 849 00:48:29,100 --> 00:48:30,900 way. Is sometimes people are 850 00:48:30,900 --> 00:48:33,300 adaptable now. They'll adapt to mechanics to it 851 00:48:33,700 --> 00:48:35,800 for a lot of patients that you're seeing from the 852 00:48:35,800 --> 00:48:38,100 orthopedic world. That's not always possible. 853 00:48:38,100 --> 00:48:40,300 But you can you have the option to go? 854 00:48:40,300 --> 00:48:42,900 Hey, let's customize this exactly as their mechanic. 855 00:48:42,900 --> 00:48:47,500 So how do you foresee customizable, running shoes 856 00:48:47,500 --> 00:48:50,100 coming out in the near future or what are there, some barriers 857 00:48:50,100 --> 00:48:52,500 that are still there. To that. 858 00:48:53,700 --> 00:48:56,800 Unfortunately, I don't know enough about their states if 859 00:48:56,808 --> 00:49:00,300 they running shoe industry right now to make a nice prediction 860 00:49:00,300 --> 00:49:05,400 about it, what I think is maybe at the elite level, they should 861 00:49:05,400 --> 00:49:08,900 be able to do this to have a few Elite athletes. 862 00:49:08,900 --> 00:49:14,000 Do example, 3D gait analysis with different types of shoes, 863 00:49:15,000 --> 00:49:18,700 do some metabolic testing for example, and in that way you can 864 00:49:18,700 --> 00:49:21,500 find out what you is actually the best for you. 865 00:49:22,700 --> 00:49:26,900 Maybe in the future, it should be possible to do it. 866 00:49:26,900 --> 00:49:29,800 For example, quick prototyping of these running shoes to 867 00:49:30,700 --> 00:49:33,800 quickly, try some different rockers, for example, in the 868 00:49:33,800 --> 00:49:37,600 heel or in the forefoot, but I think that's still going to take 869 00:49:37,600 --> 00:49:41,100 a couple of years to have to be available for the general 870 00:49:41,100 --> 00:49:45,200 population and I think for the running shoe companies, it's 871 00:49:45,200 --> 00:49:50,600 very work-intensive to make a shoe especially for someone 872 00:49:51,200 --> 00:49:54,000 that's Probably going to increase the cost of that 873 00:49:54,000 --> 00:49:57,100 running shoe as well. So I'm not sure if people are 874 00:49:58,200 --> 00:50:01,500 actually want to pay. For example, 400 500 euros for 875 00:50:01,500 --> 00:50:04,500 their running shoe, which is, especially made for them. 876 00:50:04,500 --> 00:50:06,800 Yeah, we especially with how long the shoes last me with my 877 00:50:06,800 --> 00:50:08,500 terrible mechanics. That's probably not the most 878 00:50:08,500 --> 00:50:12,400 economical approach, but yes, so from what, I understand some 879 00:50:12,400 --> 00:50:15,200 companies are experimenting with this and they can do this on an 880 00:50:15,200 --> 00:50:17,000 elite level when you're doing one or two shoes, but to 881 00:50:17,000 --> 00:50:20,300 mass-produce them. That's that's the final hurdle 882 00:50:20,300 --> 00:50:21,700 is going. How can we do this? 883 00:50:21,900 --> 00:50:24,300 A larger scale. And I think that costs is going 884 00:50:24,300 --> 00:50:27,000 to be the barrier, because it's going to be so expensive to do 885 00:50:27,008 --> 00:50:29,900 that, so we'll see. But that's that's for running. 886 00:50:29,900 --> 00:50:33,800 When it comes for someone's ability, just to move, I think 887 00:50:33,800 --> 00:50:35,800 that's well worth it. And that's where an orthopedic 888 00:50:35,800 --> 00:50:38,700 shoe of these developments. This is really helpful and it's 889 00:50:38,700 --> 00:50:43,000 very cool to see what you do. I'm the last question. 890 00:50:43,000 --> 00:50:46,600 I wish I'd asked this earlier. Are you doing anything with some 891 00:50:46,600 --> 00:50:48,900 of these newer? The question that comes to mind. 892 00:50:48,900 --> 00:50:51,700 I'm guessing the answer is no. But are you doing anything with 893 00:50:51,800 --> 00:50:55,400 Some of these newer Foams in terms of shock absorption and 894 00:50:55,400 --> 00:50:59,000 serves any of that stuff. Whether it's pebax which I am 895 00:50:59,000 --> 00:51:02,100 curious to hear? No, no not at all. 896 00:51:02,200 --> 00:51:06,000 I think those materials are mainly focused towards running 897 00:51:06,200 --> 00:51:09,400 because they have very good shock absorption and energy 898 00:51:09,400 --> 00:51:11,800 return. But as you mentioned before 899 00:51:11,800 --> 00:51:16,600 during balking, you have a lot longer time on the ground, you 900 00:51:16,600 --> 00:51:20,300 have less energy return, which is needed to, to be able to 901 00:51:20,300 --> 00:51:22,300 facilitate with that motion. Looking. 902 00:51:22,700 --> 00:51:26,300 So now, it's not like we use these next-generation phones 903 00:51:26,300 --> 00:51:28,700 inside regular shoes. It's not because they're not 904 00:51:28,700 --> 00:51:31,800 necessary, right? Just goes walking and yeah, 905 00:51:31,900 --> 00:51:34,800 yeah, probably would add the instability. 906 00:51:35,000 --> 00:51:36,900 Yeah. If it's a really soft foam for 907 00:51:36,900 --> 00:51:41,100 example, like sumacs from Nike. I'm not sure if a lot of people 908 00:51:41,100 --> 00:51:43,300 actually like to walk in the favor fly. 909 00:51:43,300 --> 00:51:49,100 For example, then you need a very wide platform like the Zoom 910 00:51:49,100 --> 00:51:52,800 action finishable which is still very soft Soft foam because it's 911 00:51:53,000 --> 00:51:55,200 such a wide shoe. It's still a little bit stable, 912 00:51:55,600 --> 00:52:00,200 but I wouldn't say it's the most comfortable shoe to, to walk 20 913 00:52:00,200 --> 00:52:02,900 or 25 kilometers, and I would definitely agree. 914 00:52:02,900 --> 00:52:06,800 So, that's so that's what I'm hearing is that, yes, walking 915 00:52:06,800 --> 00:52:08,700 and running is when it comes to Footwear. 916 00:52:08,700 --> 00:52:12,200 In both the mechanics, there are some similarities you can use 917 00:52:12,200 --> 00:52:14,200 some similar concept but they are still. 918 00:52:14,200 --> 00:52:17,500 There are some very large differences in terms of how 919 00:52:17,500 --> 00:52:20,600 you're stabilizing, what you're facilitating and especially the 920 00:52:20,600 --> 00:52:23,600 population. You're working with to and so 921 00:52:23,600 --> 00:52:27,500 there's some very different concepts but no, it's no less. 922 00:52:27,500 --> 00:52:30,300 Important fact, I probably argue it's more important especially 923 00:52:30,300 --> 00:52:32,500 with because again that's what most, you know, we get so 924 00:52:32,508 --> 00:52:35,300 excited about running stuff but there's a lot more people that 925 00:52:35,300 --> 00:52:37,600 have to walk and try to get around then there are Runners 926 00:52:37,800 --> 00:52:40,400 yes. Especially well, I think that's 927 00:52:40,400 --> 00:52:44,300 the nicest part about my job to be able to help people live 928 00:52:44,300 --> 00:52:48,000 their regular lives with little bit less pain, or being able to 929 00:52:48,600 --> 00:52:52,400 walk 10 kilometers instead of 5 km because their food is not 930 00:52:52,400 --> 00:52:55,300 hurting that much. So with what I'm doing, I'm 931 00:52:55,600 --> 00:52:59,700 directly making an impact in someone's quality of life, which 932 00:52:59,700 --> 00:53:04,200 is one of the main reasons I enjoy my job so much because it 933 00:53:04,200 --> 00:53:06,100 does. Sometimes it doesn't take have 934 00:53:06,100 --> 00:53:10,500 to take that much to well to alleviate pain, or to increase 935 00:53:10,500 --> 00:53:13,400 walking distance. And most of the time, A lot of 936 00:53:13,400 --> 00:53:16,500 people are very grateful. If you can help them increase 937 00:53:16,500 --> 00:53:18,900 their quality of life. And the best part is to be 938 00:53:18,900 --> 00:53:20,100 honest. This is. 939 00:53:20,100 --> 00:53:24,600 So, as I mentioned, Forehand a lot of my learning came from, 940 00:53:24,600 --> 00:53:27,400 looking at the research in the orthopedic shoe world, right? 941 00:53:27,400 --> 00:53:29,200 So there's a lot of stuff in running that hasn't been 942 00:53:29,200 --> 00:53:31,300 researched yet, so you are on the Forefront of looking at a 943 00:53:31,308 --> 00:53:32,900 lot of the stuff with in terms of evidence. 944 00:53:32,900 --> 00:53:36,600 So is very appreciated what you do so vessel. 945 00:53:36,600 --> 00:53:39,700 Thank you so much for coming on again, we really appreciate it, 946 00:53:39,700 --> 00:53:42,000 and I'm so excited to watch your progression of these times. 947 00:53:42,400 --> 00:53:45,400 Two years has gone by so quickly, but it's still awesome 948 00:53:45,400 --> 00:53:48,500 to see what you're doing. And now, even though it may not 949 00:53:48,500 --> 00:53:51,600 be exactly in the running world, there's still a lot of the same 950 00:53:51,600 --> 00:53:52,400 out. Application. 951 00:53:52,400 --> 00:53:54,900 And this is again most of the questions that we get on a daily 952 00:53:54,900 --> 00:53:57,800 basis are usually about walking shoes, not running shoes, 953 00:53:57,800 --> 00:53:59,500 they're both great, they're both exciting. 954 00:53:59,500 --> 00:54:02,000 But there's some differences that people need to be aware of. 955 00:54:02,000 --> 00:54:07,100 And both of them are important and interesting and very very 956 00:54:07,100 --> 00:54:09,500 interesting. So we appreciate this. 957 00:54:09,500 --> 00:54:12,500 This is going to be a really interesting topic that we will 958 00:54:12,500 --> 00:54:15,200 continue to expand on the moment. 959 00:54:15,200 --> 00:54:17,900 If you are curious about any more information on the stuff, 960 00:54:17,900 --> 00:54:20,700 we do have a couple pages that have just come up and I have to 961 00:54:20,700 --> 00:54:22,700 thank Bach. Who is Major motivators for 962 00:54:22,700 --> 00:54:25,900 coming up with these. We do have a beginner's guide to 963 00:54:25,900 --> 00:54:28,900 Footwear up on the website, and we also have a walking shoe 964 00:54:28,900 --> 00:54:30,900 guide. So, for questions, non-related 965 00:54:30,900 --> 00:54:34,000 not related to running encourage people to look at those pages. 966 00:54:34,000 --> 00:54:37,200 And they are continually being updated with some of the stuff 967 00:54:37,400 --> 00:54:40,000 as always repatriation, appreciate you listening 968 00:54:40,100 --> 00:54:41,800 viewing. There's several different areas. 969 00:54:41,800 --> 00:54:44,500 You can find, this will be on Spotify YouTube and a couple 970 00:54:44,500 --> 00:54:46,500 other different platforms. But we also have different 971 00:54:46,500 --> 00:54:49,900 socials, including Instagram, Facebook, and other areas that 972 00:54:49,900 --> 00:54:51,300 you can check out all the stuff that's