Blog, Western Weekender
Several years ago A Step Ahead Foot and Ankle care decided that to have more control of our patients outcomes we needed to make our own orthoses in house. Patients and often their referring doctors often don’t realise that many podiatrists in fact do not make their own custom made orthoses. While they can prepare a script they have trouble really making a device that is perfectly matched to the foot.
In our last article we described how orthoses should be prescribed. As you will see the process is fairly complex and requires a number of measurements using some specialised equipment and a great deal of clinical expertise. The junior podiatrists at A Step Ahead Foot and Ankle care who have already completed a university degree and 1000 clinical hours still are observed and work with one of our senior podiatrists for the first two years after graduation to make sure they have a strong knowledge base behind them when designing an orthoses for a patient.
Once a 3 dimensional scan and measurements are taken of both your feet, it’s time for our Podiatrist to design the orthotics. Designing each orthoses is done using Cad-Cam software and specific to each person, each person’s individual design takes approximately 15 minutes ensuring a complete match to your foot.
From here the design is sent to A Step Ahead Foot and Ankle care’s CNC mill for cutting on average this takes about 20minutes for each of the orthoses shell. As mentioned before, each orthotic is individual and subsequently there can be as little as 1 mm differences in measurements in the orthoses so ensuring we get the milling right is very important. 
After the mill has finished its very precise job, the orthoses edges need grinding so they fit comfortably into a shoe. At this time we will add covers to enhance the comfort of the device and small additions which will tweak the way you walk, such as metatarsal domes and rocker bars and possibly even more cushioning! We will also look at any further adjustments needed to change the postural position of your feet and legs. This can all add up and takes about an hour’s worth of time per pair to finish.
As you can see making a custom made orthoses can really take some time they are very complex devices with a real “handmade” component to each of them. Each device is designed to meet each patient’s specific health needs. So when people rightly ask “How come your orthotics cost …….” You can tell them because my orthoses are handmade just for me!
Blog, Western Weekender
So you have been told by your podiatrist that you need custom made orthoses…
Now we would assume these are to be made specifically for you, from a set of measurements taken from your feet and legs. Your Podiatrist will also have taken a video of your walking and or running pattern. They will have watched how you stand walk run and tested muscles and joints. Your Podiatrist will have also taken a cast or better still a 3 dimensional scan of both your feet – to be truly custom made this is essential! If your podiatrist or other practitioner has NOT done these things then frankly I would question if you were truly getting a custom made or true prescription orthotics!
These are all the things we do for our patients at A Step Ahead foot and ankle care. (Note NOT an outline and NOT a 2 dimensional or force plate measurement – you CANNOT make truly custom made orthoses from this)
Orthotics are costly, they are in the same ball park as prescription glasses and at times the same price as some mouth plates Dentists use to correct small alignments for your teeth. Thankfully NOT as expensive as braces though! I would suggest that they are this expensive because, if they are truly prescription custom made orthotics, the time that it takes to make a pair is reasonably extensive. Add to this the cost of your practitioner’s time taking the measurements then preparing the prescription and then finally check-ups fittings and etc and it will quietly add up. We have noted a few podiatrist tell people the cost of the device only. For example “orthotics cost $400” but be warned it is a good idea to ask about associated the cost of appointments.
How about check-ups? You know your feet are ok on the first check, but 4 months later your orthoses don’t feel right. We always give free check-ups for our patients for the life of your device – if its 2 years then so be it! We don’t believe you should have to pay for a check-up of your device if there is a problem. If your friend a relative or any type of patient of ours says they are not comfortable or not happy PLEASE send them back to our clinic – it’s free and we are ALWAYS happy to see them!! It’s included in the cost of the devices and appointments whenever we fit you with orthoses at A Step Ahead Foot and Ankle Care.
We guarantee our devices – if they flatten out, warp, the covers fall off or somehow otherwise your orthoses die an untimely death in the first 12 months we will replace your orthoses! Now you’d think this is common sense BUT if your dog eats them (don’t laugh has happened numerous times) that’s your responsibility, we will always be reasonable and we hope our patients are as well.
So there is much more than just a custom orthoses that’s in your shoe… it’s a long process of getting this very specialised device right. As we have discovered they are very specialised devices made from very specific measurements. What we have not spoken about is the very detailed equipment which makes up the mill that manufactures the devices and how that works. That I thought we would speak about next time.
Blog
A couple of months ago a young 10 year old girl Jessica presented to the clinic as her mother was concerned about her feet. Her mother had told me since the age of 3 Jess had always walked with her feet turning in. She had taken her daughter when she was 3 years old to a GP who then referred her to a paediatrician. The paediatrician told the mother not to worry she will grow out of it and to come back in three years time.
intoeing gait
She returned when Jess turned 6 to the paediatrician, Jess was still walking pigeon toed and often tripping over. The paediatrician once again said not to worry then commenting “but if you are really worried then see a podiatrist”. At the age of 7 she saw a podiatrist who told her “nothing can be done” and “not to worry she will grow out of it” again!
The mother was getting extremely frustrated with the lack of help she had been receiving, she felt frustrated and let down. Finally after receiving no relief from these other well meaning health professionals she made an appointment for Jess to see us at A step ahead foot and ankle care.
While examining this really happy and bright girls gait, it became apparent to us that something should be done. On discussing this with the mum she replied “you have no idea how many people I have seen before coming to you”! The mother was relieved that after all these years someone had provided her with an answer and the possibility of a proactive treatment plan for Jessica. In this case we recommended orthotic therapy and stretching exercises to help with the in-toed gait and the tripping. It appeared as if this was a form of relief for the Jess’s mum, she had suspected something should have been done, yet all the previous professionals had done nothing!
Its pleasing to report that we have reviewed Jess again recently, she is doing her exercises and her in-toed gait is a lot less dramatic. She is also now doing very well at sports! Jess’s mum reports a happier little girl who is tripping less and smiling more!
For all your Foot and Lower Limb Care needs, come and see us at:
A Step Ahead Foot & Ankle Care
24 Phillip Street, St Marys; or
Suite 4, 36 Woodriff Street, Penrith
www.astepahead.com.au
* All names and identities in our blogs and websites are changed to protect our patients privacy. Not all cases respond the same and this may be taken as an example only of one case. Should you or a relative suffer from this or other conditions it is essential to have a thorough case history and assessment undertaken before a diagnosis and treatment plan can be established for you.
Blog
A couple of weeks ago a lovely lady presented to me with horribly bad heel pain. She has been putting up with it for a few months. She works in a hotel where she is busy attending to other people with little time for her to attend to herself.
She had seen a doctor whom sent her for an x-ray, the x-ray showed a spur and the doctor said there can’t be anything done. This doctor prescribed her pain killers and even though taking these she still felt pain. It wasn’t until she saw another doctor who gave a referral
Heel pain relief for chronic Heel pain patients are available at our heel pain clinic
to our clinic A step ahead foot and ankle care.
When looking at X-rays many times you can see spurs on the heel bone or calcaneus. Most people ,often including family GP’s don’t understand that a spur can exist without pain. It is most often the soft tissue structures that cause pain. When we examined the patient, we noted
her feet were very flat one of a few “biomechanical” issues (problems with her walk and running style and
posture). This often effects the soft tissue structures causing more strain to the structure called the plantar fascia causing a condition called “plantar fasciitis”. In this case after a series of tests and a detailed case history we discovered this to be her correct diagnosis.
We have started treating this patient,after one session of soft tissue therapy and taping she has already reported she’s no longer taking pain killers! We have also scanned her feet up for custom orthotics to correct her foot alignment with the aim of these custom made devices being to correct her poor foot posture.
For all your Foot and Lower Limb Care needs, come and see us at:
A Step Ahead Foot & Ankle Care
24 Phillip Street, St Marys; or
Suite 4, 36 Woodriff Street, Penrith
www.astepahead.com.au
Blog, Ingrown Nails
My patient can’t believe it, well in fact she can’t feel it, which is what she is having trouble adjusting to. You see this lovely lady has had a painful ingrown toenail on her big toe for the last 5 years. Her doctor who thought he was doing the right thing continued to put her on multiple courses of antibiotics but to no relief. Antibiotic whilst obviously successful in treating the infection in the surrounding tissue does not remove the small piece of nail that has protruded sharply into the skin around the nail.
This nail had also been treated by another Podiatrist who recognising that the patient had this nail protruding into the skin removed the nail …….. well the nail that they could see! This is truly what is needed in many cases. A simple quick process of removing the offending piece of nail relatively painless and simple for most people. However in this case, as with others that suffer from this condition over many months or even years a nail surgery was required.
The patient had spoken to their Podiatrist about this a few times and had mentioned it again at their last appointment with the Pod however the Pod was sure that with regular treatment it would be manageable. After many more months this lovely lady justifiably lost patience and faith in her Pod. She was looking for a solution to her ingrown toe nail pain and wanted it NOW !
Nail surgeries are not new for podiatrist and are something we do on a regular basis. It is done in our rooms and is a relatively simple procedure. I often describe this as relatively pain free – it is wrong to say any surgical procedure is “pain free” but as procedures go our patients report very little if any pain. I recommend this procedure for patients with involuted or very curved nails, Nails with areas that seem to catch the skin on the side of the nail. Again nails that have a long history of infection or growing in.
The message – really is a solution and that you don’t need to be in long term pain. 5 years is a long time in pain!
For all your Foot and Lower Limb Care needs, come and see us at:
A Step Ahead Foot & Ankle Care
24 Phillip Street, St Marys; or
Suite 4, 36 Woodriff Street, Penrith
www.astepahead.com.au
Several years ago A Step Ahead Foot and Ankle care decided that to have more control of our patients outcomes we needed to make our own orthoses in house. Patients and often their referring doctors often don’t realise that many podiatrists in fact do not make their own custom made orthoses. While they can prepare a script they have trouble really making a device that is perfectly matched to the foot.
Dr Brenden’s White paper report on the “6 Reasons You Won’t Beat Heal Pain” outlines what’s stopping you from beating this and tips on how to stop it in its tracks!