Unlock the secrets to effective orthotic therapy for patients at every stage of life as we sit down with podiatrists Matt Mollica and Gus McSweyn. Our experts shed light on the subtleties of custom-fit orthotics for growing children, delve into the complexities of treating mature feet, and reveal why a one-size-fits-all solution is a myth in the world of podiatry. Discover how understanding a patient's unique biomechanics can lead to better outcomes and why the right intervention at the right time is crucial.
Step onto the field with us as we examine the intricate dance between performance footwear and orthotic devices in the competitive arena of sports. Learn how material selection and design considerations can prevent injuries and boost athletic performance. Matt and Gus discuss the nuanced approach needed when treating athletes with degenerative conditions, offering a playbook for balancing correction with comfort. Whether you're a practitioner or a sports enthusiast, this conversation is a game-changer for anyone looking to optimize foot health in high-stress environments.
Finally, we explore the art of communication between Podiatrists and orthotic laboratories, with insights from Matt. They underscore the importance of translating a clinical vision into a tangible product that aligns with patient needs. As we dissect the relationship between practitioners and lab technicians, you'll learn about the pivotal role of understanding lab processes and the continuous loop of feedback necessary for refining orthoses prescriptions. For an eye-opening look into the intersection of craft, care, and technology, tune into this episode and step forward with confidence in your podiatric knowledge.
This podcast is recorded and produced on Naarm and Bunurong the traditional lands of the Kulin Nation. We pay our respects to the elders, past present and emerging and the land, seas and skies for which we all live.
Unlock the secrets to effective orthotic therapy for patients at every stage of life as we sit down with podiatrists Matt Mollica and Gus McSweyn. Our experts shed light on the subtleties of custom-fit orthotics for growing children, delve into the complexities of treating mature feet, and reveal why a one-size-fits-all solution is a myth in the world of podiatry. Discover how understanding a patient's unique biomechanics can lead to better outcomes and why the right intervention at the right time is crucial.
Step onto the field with us as we examine the intricate dance between performance footwear and orthotic devices in the competitive arena of sports. Learn how material selection and design considerations can prevent injuries and boost athletic performance. Matt and Gus discuss the nuanced approach needed when treating athletes with degenerative conditions, offering a playbook for balancing correction with comfort. Whether you're a practitioner or a sports enthusiast, this conversation is a game-changer for anyone looking to optimize foot health in high-stress environments.
Finally, we explore the art of communication between Podiatrists and orthotic laboratories, with insights from Matt. They underscore the importance of translating a clinical vision into a tangible product that aligns with patient needs. As we dissect the relationship between practitioners and lab technicians, you'll learn about the pivotal role of understanding lab processes and the continuous loop of feedback necessary for refining orthoses prescriptions. For an eye-opening look into the intersection of craft, care, and technology, tune into this episode and step forward with confidence in your podiatric knowledge.
This podcast is recorded and produced on Naarm and Bunurong the traditional lands of the Kulin Nation. We pay our respects to the elders, past present and emerging and the land, seas and skies for which we all live.
Hey, welcome back to Simply the Best Podiatry, where we want to pass on simple tips to enhance your podiatry practice. I'm Jason Agosta and I am ably joined with Matt Mollica, podiatrist from Windy Hill Podiatry. Hey, matt, how are you? Hi Jason, well, thanks, good to see you. Thanks for joining me again and I have to say those listening you can go back and listen to Matt's episode on orthoses in clinical practice, which was episode 29 and was an absolute cracker. So thanks again, matt. We have Gus McSwain, who was after you in episode 30 in talking about his approach to orthoses in clinical practice. Gus is a podiatrist in Geelong and Torquay. Hey, gus, thanks again for joining me and, once again, great episodes. And people can also not only listen to episode 30, but go back and I'm looking at it while I'm speaking. Sorry, we spoke regarding running footwear and injuries back in episode 15, which seems like a long time ago now, but thanks for joining us.
Speaker 2:Pleasure. Thanks for having me Looking forward to it.
Speaker 1:So, as I mentioned, this is just a round table general discussion on orthoses and we'll just pick uh like a, a topic or an issue that might present clinically and just give it, give our opinion on it. So, straight into it, and gus, I'll get you to speak first up. Uh, are there differences in your approach to using orthoses when it comes to ages of the presenting patient?
Speaker 2:Yeah, there is. There's different considerations that I'll go with Traditionally, like when you're looking at your pediatric age demographic, I'm usually going with something that's a little less corrective and something that's a little more temporary, particularly during those different stages as you start getting into more your adult populations. That's when we might start looking at a bit more structure in devices and something that's potentially a little bit more semi-permanent. And then, obviously, as you get through some older demographics of individuals that have some of those structural changes or deformities, then you are looking at those more longer-term devices.
Speaker 1:Yeah, okay. What about just to go on with that? What about the effects of intervening with orthoses on young children, let's say, under 15 or so? Are there things that we need to be aware of as far as the effects of use of orthoses?
Speaker 2:Yeah Well, my approach to it is pretty similar to how with with adults to a degree where it's around taking load off certain pathological tissue. The way I probably go about it is, if that tissue is really struggling to tolerate the loads going through it or you've got a growth plate pathology going on there, um, obviously getting load off that tissue is really beneficial, but it's probably that education piece with it around. This may be a short-term alternative to help alleviate some of those symptoms while these stages of development are going on, rather than, um, something they'll need forever in a day yeah, yeah, yeah, matt, do you want to add to that at all?
Speaker 3:yeah, I think. I think, just in terms of practicalities with kids and continual foot growth, using something that is, uh, affordable and and not too much of a burden if it's going to be replaced and used for a significant period of time, is something that parents appreciate. Uh, and I'd probably agree with gus in that you're dealing with small feet, smaller forces, lighter bodies, and so the need for really strong materials is not what it is with adult patients.
Speaker 1:Yeah, yeah, okay, all right, perfect. Can I just add to this, while we're talking about the age of a patient, my opinion is with the older patient is that I think we're all a little bit more set in stone. As we get older, a bit stiffer, you know, you get that degenerative stiffness, maybe there's degenerative changes, or 60 onwards or something like that that I reckon you've got to be a little bit conservative with them and sort of learn how you can help instead of rattling them around or changing their position too much. From decades of adaption and I think that's how I explain it to patients is that you know what. We might just go in and use something really simple here, because you've had like decades of you know your own pathway, movement and I want to learn if I can help and you know how that can happen at least.
Speaker 3:Anyway, I reckon that's a great point. People's tolerance to positional change probably diminishes as they age, whether it's the odometer that indicates that they're used to having worked in a particular way for so many miles, or if it is reduced tissue tolerance to adapt to an altered position or an altered pattern of function. Jason.
Speaker 1:I agree, totally Okay. Next one up. We're going to keep this moving quickly, and I also should say, while I'm looking at your face on the golf course, matt, matt Mullica is the host of the Australian Passport podcast, which you need to listen and lend an ear to, because it's a fantastic show, matt it really is.
Speaker 3:Thank you.
Speaker 1:And while you were talking there, I was just thinking about the golf swing. If you try and change someone's golf swing, that's really bloody hard to do, and do well if you've been doing the same thing for decades and decades.
Speaker 3:Yeah, absolutely. Even professionals, like really highly skilled people that practice for a long time and have great positional awareness and they just give themselves so much time to adapt to the tiniest little change. Yeah, and it's an interesting contrast when you think about us in clinic giving someone some sort of support or in-shoe device saying, here you go, adapt to this and it's wholesale change in comparison.
Speaker 1:Yeah, it just takes time, though, doesn't it? Yeah, I think that's the biggest thing we need to, you know, continue with our education of the patient with it is it just takes time. Don't try and be a legend and use your orthoses or change your footwear or whatever it is like, straight up and just think it's all going to be rosy immediately, because it's definitely not. I think one of my biggest points is I always talk about that just takes time. It's okay to get moving and start the changes, but just take your time and be really patient over a couple of weeks at least. Actually, that's a good question. We'll go back to you, matt.
Speaker 1:I'm not sure what your approach is after all these years of talking to patients when you issue an orthotic to someone or a pair of orthoses to someone, but my approach has been you know, you've adapted to yourself, you've got your own pathway movement. We want to learn how well we can help you if we can, but as well as get started with these devices and whatever footwear they might change into, you do have to be patient in getting used to the new positioning and pressures, but I actually don't think it should take too long and in my own opinion, I think if people aren't running in their orthoses within a week or even 10 days, I think that is a red flag and an indicator that you've probably intervened too much, and I'm not sure what either of you feel about that or what your own thoughts are.
Speaker 3:I reckon that's a good rule of thumb. Yeah, I probably err on the cautious side when asking people to adapt. I'll always say that there's no prize for getting used to them quickly. I'd much rather it be a gradual, uneventful process and you can take the time that you need. But if someone's struggling to run in them or at least implement them into part of a training session in the in the first fortnight, yeah I'd think, oh, hang on, maybe this is too big a change.
Speaker 1:Yeah yeah, I think you know this gets back to orthotic reviews, which we'll talk about in another episode. But yeah, I mean, my opinion is, if someone comes in for a review at three or four weeks and they're still struggling to run in their orthoses, that is way, way too long in my opinion. I think there's been way too much change.
Speaker 2:I think you're pretty spot on. I think obviously it depends. If that person hasn't been running, then the expectation around running loads is probably. But yeah, I'm one where in three to five days I like to see them wearing them pretty comfortably and they should be able to adapt into that, into higher loads within seven to ten days is my general guideline.
Speaker 1:Yeah, Okay, well, I've got you on that. Talking about activities and intervening, is your approach to using orthoses quite varied amongst people's activities, whatever they're participating in.
Speaker 2:I sort of agree. I suppose I see quite a lot of running-based athletes and so, from that perspective, you're getting repetitive high loads a lot of the time, and so that conservative aspect in what you do with orthoses is probably the founding position with it. So, yeah, running-based based athletes so footy players, um, recreational runners obviously loads are very high. So the conservative approach to what you do with an athletic, I think is very important in regards to whether you change it depending on the activity. Obviously every person in front of you is a little bit different and their issue is a little bit different. Yeah, so there's going to be considerations with what you're doing with that orthotic because of that. Yeah, so yeah.
Speaker 1:What about with the multi-directional activities? Any particular approach with that?
Speaker 2:Well then that obviously, I think, takes a big part of it as well in combination with that, because obviously, if they're playing a court-based sport and they're in a running-based footwear, you can put the best orthotic in the world in that, but if they're busting out of the shoe, and is there a certain approach to orthoses, like that you would use with the multi-directional activities versus the running activities? Yeah, In regards to the type of orthotic used or the materials, just a general overview or approach.
Speaker 2:Yeah, well, I'm very much a flexible, thin device for pretty much everyone I see in clinic and very much allowing movement rather than trying to resist too much movement or being too bulky. So, as a general consensus for me, that's what I'll look for in an orthotic. Yeah, because, as you know, if everything is too bulky or if it's too much or too aggressive, you just can't wear it.
Speaker 1:Yeah, yeah, yeah, yeah gotcha. Hey, Matt, I know we're having a bit of a joke about the golf scene and how much of a legend you are on the green, but is there an approach to using orthoses with golf that varies from just people's you know, average walking day. You can tell I'm not a golfer, I've got no idea.
Speaker 3:I think the rule of thumb that you probably employ is you probably just adopt a consistent philosophy with what we touched on in the outset of this discussion. You don't want to be overly corrective. Your lead foot really maximally supinates through impact and if anyone has any sort of degree of lateral instability and you're trying to correct their alignment, move them into a more inverted or supinated position and then they're going to supinate further and invert on top of that through impact and the follow-through you're probably going to create more instability than you're trying to resolve.
Speaker 1:Yeah, I'll probably break my ankle. It sounds like yeah.
Speaker 3:Golf shoes are not at the worst end of headaches in terms of footwear that can adapt to housing and orthotic, but they're not the most generous either.
Speaker 1:Why is that? What do you mean?
Speaker 3:Sometimes they have surprisingly narrow heel seats within a lot of foot orthotic within. A lot of golf shoes rather, and so it's difficult to get an orthotic to really recess as it should and sit down in the floor of the shoe.
Speaker 1:So the point to make with that just to go back to what you were saying is that the lead foot supinates like quite extensively, yes, yeah, through your follow through, and if you are correcting someone medially, you just have to be really aware of not going too hard with that for golf.
Speaker 3:Yeah. So if you're in a yes or no or maybe sort of decision regarding the addition of a heel post or a medial scythe or five degrees extra of inversion force on your prescription form, the safer thing is to sometimes err against that.
Speaker 1:Yeah, okay, all righty. And in your approach to using orthoses with a variation of activities.
Speaker 3:I have a tiny bit of hesitancy in using them with tennis players and basketballers. Netball is a tiny bit less so, and I don't know why that is, but I've not found that a lot of my patients have been really, really comfortable playing basketball or tennis in the foot supports that I've prescribed and I've used different materials. I've been really cautious in terms of top surface as well, knowing that they're multidirectional athletes and you've got to use something that can deal with friction and reduced rate of skin blistering.
Speaker 1:It's a tough one. I think tennis and basketball are the two hardest ones because I think you know there's obviously such rapid changes in movement and the amount of force is like double that of running when you brake heavily laterally and change direction. I'm sure it's got to be that impact load, the ground reaction force, that just contributes to that intolerance to using much at all.
Speaker 3:I think so and I think that probably as a group, those athletes are in the same category as soccer players, in that they really value lightness and feel and don't want too much other than a relatively snug fitting shoe between them and the ground.
Speaker 1:Yeah, Okay. So next one is degenerative changes. You've got a patient come in. They've got a degenerative midfoot or ankle, or even a knee. What are we doing as far as and they have quite poor alignment? How are we going to approach that scenario when we have degenerative changes but poor alignment? Gus, do you want to kick this one off?
Speaker 2:I think for me in this consideration is you're never going to get that client back to that zero position, or?
Speaker 2:trying to get them looking perfectly anatomical or anything like that. So for me it's again just bringing it back to those basic principles of the tissue that's affected by it and trying to add a level of correction and offloading that's going to be comfortable for them to wear, still allowing efficient movement and loading of that tissue. But it's probably for me, another education piece around that this is something that that individual may need for the longer term rather than something that might be that shorter term option.
Speaker 1:Yeah, I think in that scenario, and you find the magic, it is going to be long term. You're not changing much at all. Yeah, definitely, and it's really hard though, isn't it? You've got these older patients come through and they've got a few changes, probably even a surgical history. Possibly. It's really hard to find the magic.
Speaker 2:Well, as Matt said, a few cases on the odometer and it doesn't like big. Well, as Matt said, a few Ks on the odometer and it doesn't like big.
Speaker 1:Yeah, tell me about it. Trust me, Matt. What about yourself?
Speaker 3:Getting back to that philosophy of tissue tolerance and ability to withstand positional change. That's something that I'd always consider when I'm faced with a patient who shows some sort of significant joint degeneration, and probably keep it at the front of mind that you're just trying to facilitate improved efficiency of movement.
Speaker 1:Yeah.
Speaker 3:And you're not trying to reinvent the wheel, not going to bullock someone into a distinctly different position.
Speaker 1:I think that's the point to make, isn't it? I mean, we're talking about changes, like we were talking earlier about older patients, how they've adapted to their own pathway and movement. I think it's even more critical with this scenario when there's degenerative joints, isn't it? Yes, yeah, like less tolerance, probably easier to you know, change things, you know, with much less input. Yeah, I find it really hard this one, because it comes in all the time and it's like, okay, let's pull this right back and just start with, you know, base level support if we have to go that pathway, and sometimes that's even just changing shoes. But I think, yeah, I mean, I suppose my message to the patients is hey, I don't know where the magic is and we need to learn, you know, and find the ideal scenario for you, and it will take a little bit of time.
Speaker 3:One of the things that I still wrestle with from time to time is moving distally a degener first mtp joint, yeah, and because I'll take two distinctly different routes in managing it and I'll assess range of motion first, toe strength, single leg, calf raise capacity, the, the status of those immediate three neighboring joints, your, your second mtp ip joint, first, met-medial canary form, and then make a decision of whether or not I think I can work with this joint and ask it to move more and facilitate best possible function at that joint, or if I'm making a clinical determination that I'm essentially going to give up on this joint Because if it's really stiff and think well, I can't put a first-ray cutout into this orthotic prescription and expect this first MTP to move 45 or 50 degrees when I can't elicit 20 degrees of dorsiflexion clinically.
Speaker 3:So I'm really sort of making a decision that I'm going to use a Morton's extension, I'm going to plate this shoe, I'm going to use a relatively firm forefoot extension on this orthotic.
Speaker 1:I'm essentially giving up on it or bracing it I think that's a good point though, because we are going to talk about many forefoot problems in the next few weeks in the episodes coming up, so we are going to focus on forefoot. But that's a great point to make about first, mtp joint impingement or as we know it's called hallux limitus or rigidus that if you host the foot medially and lift that first ray, we are making it more difficult for the hallux to extend over the head of the first metatarsal. From what I understand, yes, and that's a hard one, because sometimes that support does help some patients and other times it just is terrible and even creates more problems.
Speaker 3:I've got a physio who works near me who has from time to time used that approach of providing a significant force inferior to the first met and has attained good symptom response in a range of his patients with forefoot pathologies. And I always wrestle well, I find that I'm struggling a little bit because I know exactly what you've just said. You think, oh you, dorsiflexor, distal aspect of that first met, you're not doing that first MTP, doing any favours long term.
Speaker 1:That's it. Sometimes there is that short-term improvement, though, isn't there.
Speaker 3:Yeah, and you wonder how long do I ride that? Like do I just ride that wave for a little while and then get off when things are more comfortable?
Speaker 1:Yeah, I think, dealing with that degenerative first MTP, my approach has been yes, have some medial support, because often that's what sets it up anyway is medially loading and then extending off the first MTP, impinging that joint over decades and decades. You're getting all the changes that we see on radiology, but combining some medial support with the lateral forefoot posting, so you're creating that sort of space and that change of distribution of pressure across the forefoot. So yeah, Gus, do you want to add to anything with that one?
Speaker 2:No, it's a good discussion. It's one of those ones where some of the art of what you do as a podiatrist and you guys have obviously spent years and years of it over the journey, but the decisions that we make in clinic around whether you do try and maintain movement through the joint, whether you work with the joint or whether you're actually saying no, this joint is beyond that and we need to lock it up. It's one of the intricacies of the things that we do it is. It's a tough one isn't it so?
Speaker 1:on note, in my rooms I see heat and post-operative care takes up like a large large percentage of my caseload. I'm not sure about you, gus, whether you see many post-op sort of cases from orthopods or not? Yeah, comes for a week. So with the post-op scenario, is there a particular sort of approach to using orthoses that you have to kickstart off? You know, helping someone.
Speaker 2:Again it comes with presentation what's actually happened to the foot, because, as you know, with different surgeries there can be some that are minimally invasive and they're not actually remodeling joint surfaces or changing movement pathways too much, whereas others it's almost a whole reconstruction of that midfoot ankle which is going to have a huge impact on forces through that foot. So again, it's probably that conservative approach to things and ideally if it's able to function fully, efficiently and comfortably without an orthosis in play, the new things like footwear to enable that foot to be able to function efficiently can be a really good option as well.
Speaker 1:Yeah, Matt, post-operative care are you sort of involved in that?
Speaker 3:A little bit. James, my colleague in our clinic, probably sees more of that than I do. He interestingly saw he scrubbed in and watched a calcaneo-navicular coalition surgery on Friday with Brian Lowe and Brian was speaking to him as things were wrapping up surgically and said I want this boy to see you within three weeks because I don't want him to sink back into the position that he was in with this significantly abducted and everted foot. I want him to get used to a new position and he's malleable and young enough to adapt to that quickly. I want to maximize the effects of surgery. So he was probably talking about accelerating things much faster than I thought he might.
Speaker 1:Yeah, okay, I think as long as there's mobility, that's fine. Yeah, and postoperatively, if the sensitivity is not too bad, that's a perfectly fine thing to suggest. I reckon, yeah, some people don't have that, they don't have that mobility, they're still swollen, they're still really like sensitive, and you just can't do too much except, you know, try and get them moving. You know, with the gentle weight-bearing regimes that we pass on, you see, as you said, you see a lot of it.
Speaker 3:Yeah, and all sorts of things in terms of tip post and HIV and lesser toe alignment.
Speaker 1:It is everything and you know what. I might even present a case on this show about an osteochondroma patient I have at the moment. It's going to be a long, long road, but my approach is that basically these people need to regain movement and they need to regain muscular control. There's a group that are swollen and more sensitive than others, for whatever reasons, and you have to be really slow and conservative with them. But initially the focus is the same as far as gaining mobility and turning on muscular control. So that's absolutely crucial.
Speaker 1:For the problems of the midfoot, say first, mtps you mentioned, there's no doubt there's intervention using orthoses, but initially it's usually a very conservative start. And that is getting back to what you just said, matt, as far as trying to get people to adapt or get used to a new position and a sense of having something under their foot where they most probably many times haven't had any support. So a really big deal with it is lots of strengthening in conjunction with mild support and as people get better and better, with less sensitivity and less swelling, you can increase support as necessary. But we want these people to just increase their activities and get stronger and stronger, which is probably the guts of post-op care more than anything else. So it usually is a conservative start and then ramps up to being a lot more supportive, with orthosis if necessary, and that can take.
Speaker 1:You know, the first three months of post-op scenarios usually the red zone where people are really sensitive, so you've got to be. Sometimes that can be tricky within that time. So it does take many months to sort of get things set up appropriately for longer term. So they're not loading up immediately or, you know, still haven't got that lateral instability. It just takes time to get it right and get people used to the you know, change of the pathway of movement really, and hopefully along that way they've just become stronger and stronger.
Speaker 1:Okay, so next one is can I ask you, are there any studies that you guys are aware of of points you want to pass on that relate to orthoses clinically? My one is that it's been very well known for a long, long time that running with rigid, thick materials beneath you has been shown to actually increase the ground reaction forces on a force platform in distance runners, and it's been done many, many times. And if you look in the literature, that one point is just I don't know, it's repeatedly shown and I think it's an interesting one for podiatrists to consider, at least anyway, matt.
Speaker 3:Yeah, it is that is really important in changing people's philosophy and their prescription habits. I'm sure Allows them to think of things that are a little more simplistic in fabrication, softer and lighter and perhaps preformed and not as difficult to implement for a patient.
Speaker 1:Anything stand out for you, as far as you know, points that have come out of studies that you sort of, you know, can reflect on, or pass on, at least.
Speaker 3:Something that perhaps doesn't do the broader profession a great service, but it was definitely a comfort to me. There's a meta-analysis and systematic review on foot orthoses and plantar heel pain that Glenn Whitaker and Shannon Munsonow and Hilton Menz and Jade Tan published with Karl Landorf back in BJSM in 2018. And it seemed like they described variability in terms of short, mid and long-term responses to insole and orthotic implementation upon pain levels.
Speaker 1:And what was the?
Speaker 3:outcome? What did it show? There's moderate quality evidence that foot orthoses were effective at reducing pain in the medium term. Some responded quite quickly. Some of the trials that they included within their analysis indicated a relative absence of short-term response in symptom levels with many patients, but really good long-term response.
Speaker 1:Yeah, yeah, okay, tell me, was that? I think we've mentioned this on the show once before. I think Sophie might have even brought it up. She works with Glenn in that. That was the study. They were using form thotics, the red EVA form thotic devices. Is that the one?
Speaker 3:I think there was one or two studies that they included within their analysis that used form thotics exclusively, and there was also a sham support that was used in one of the studies, okay, and they ended up suggesting in the discussion of that paper that comparison of customised and prefabbed foot orthosis showed no significant difference at any time point with regard to short, medium or long-term pain level responses.
Speaker 1:Yeah, okay, all right, good point to make. All right, good point to make. All righty. Thanks, matt Gus. You got a standout sort of point that comes out of any studies that you're aware of.
Speaker 2:And it's poor by about not knowing the exact study that it is, but I remember when I was going through uni days, one of the beautiful papers that came across was a study around the different colours of orthosis and the interesting aspect of I think it was the colour green that came out of it. That was the most successful orthosis. Even though it was pretty much just all of the machine devices, the green had the most outcome benefits for individuals Placebo effect. Yeah.
Speaker 1:Got the green light.
Speaker 2:I sometimes look at some of that and think we may think everything we do with my foces is amazing and perfect, but when it comes down to it, it might just be the colour that we're using that's making the difference for the client, or the education piece that we're giving with it. So I always like to keep that in the back of my mind to keep things a little bit balanced.
Speaker 1:Yeah Well, the back of my mind to keep things a little bit balanced.
Speaker 3:Yeah, well, I think that paper was presented Ian Griffiths.
Speaker 1:Ian Griffiths presented that in Brisbane last year about the colour of orthoses, and you know it was quite interesting. I'm not sure I really focus on that sort of thing too much at all, but to reiterate what you just said, gus, is that when Matt Appleton came on this show a couple of weeks ago, one point he made is that he mentioned that not only with himself but the people he has had work for him he teaches how to recover and make or rebalance orthoses perfectly at lab quality rebalance orthosis perfectly at lab quality and he said that as a patient, if it was me, I don't want to see something that's all shabby and looks terrible or got a bad color or whatever it is to it. He says I want something that's going to be lab quality and look good. And he said I remember him saying that perhaps there's a positive impact that comes with that as well. I don't know, but I think it was a good point to make. Yeah.
Speaker 3:I like it. I reckon there has to be, because we're all consumers and we unwrap things or we buy things from a shop and we have that. Oh, you're right yeah have that instant attachment to something that is really really neat and really aesthetically pleasing. And yeah, I think Matt raises a really good point there in that we should aspire to have any sort of in-house orthotic modification looking exactly that good.
Speaker 1:If you don't know how to do it, you need to go and learn it. This is the point I was going to make and we've just flowed straight into. This is why you should be hands-on with reposting, rebalancing, recovering, gus.
Speaker 2:Yeah, well, there's aspects of it that if you take pride in what you do and you're good at what you do, then obviously it's something that definitely is worthwhile of your time to facilitate. I think you can definitely get a bit more of a nuanced outcome with it. Sometimes I will send it away to get some form of reposting or recovering on it, but definitely in my shorter to moderate term modifications I'll be there adding a little post and wedging onto it, recovering, hands on.
Speaker 1:Yeah, and, as I said earlier, we're going to talk about this a little bit more in orthotic reviews in a couple of weeks' time. So I think it's like, so important to be able to do that clinically is repost, rebalance, recover. I think to get it right, you need to learn how to do it. I think you need to learn how to do it quickly but at a pro level, because supposedly as practitioners we're pros at it, so we should be able to do it. And I think if you don't know how to do the reposting, rebalancing, recovering, and don't know how to do it really well, you need to get out and learn it. I reckon that's my opinion.
Speaker 1:It's interesting through these episodes on orthoses in clinical practice, a lot of people have spoken about including myself as well, have spoken about preformed orthoses, a conservative approach, and it's really interesting speaking to people about prescription or whatever you want to call it prescription, molded, custom, scanned orthoses.
Speaker 1:I don't know what the acronym is for that, what I just said, but anyway, let's call it the prescription, custom devices or whatever.
Speaker 1:It seems that I think that people who main I think there's one good point to make is that those devices that we can have customized and sent out to a lab can often be much, much more durable than any of the preforms out there.
Speaker 1:I think that's a really important point to make. If you've learned, you can help someone and maybe you do have a simple approach and it's conservative and you use preforms or whatever, but when you're looking for durability, I'm sure that the devices we can get that are lab made and scanned or whatever are much, much more durable. You just got to get it right and I think that if there's some hesitance out there of prescribing and going down that pathway, I think most often it's probably due to the fact of there's a bit of lack of understanding of how to prescribe, and I think most podiatrists who feel that and sort of really know it and are honest with themselves. They need to follow that up and talk to the labs they're using or talk to the people who do this every day and make it work in the best way possible. Matt, your thoughts.
Speaker 3:I'm probably philosophically on a similar page to you in terms of the percentage of times that I go to a laboratory for a device, as opposed to something that I'll use preformed.
Speaker 1:But what about with? You've got other practitioners in your practice. Is there like some hesitancy, or do you think there's a lack of understanding of using the sort of prescribed devices?
Speaker 3:I think there's still a little bit of difficulty in working their way through the prescription form and a degree of uncertainty in knowing that what's in their mind's eye is what's going to come back. Yes, and it's not on the back of the laboratory. I think it's the communication process Right how they get that idea in their mind down on paper, how they communicate that to a laboratory and make sure that what they're hoping for is what's manufactured.
Speaker 1:Right. Is that a difficulty in prescription? Yes, like an understanding of what to prescribe and to get what I want.
Speaker 3:Yeah, and also maybe the understanding of what the laboratory can actually do is still not where it should be, because if I talk to Arthur from Footwork, I'm confident he can do anything that I ask and I'm I've grown more and more aware of his skills and the the manufacturing repertoires. Time's gone on yeah and I'll have some elaborate little component of a prescription orthotic or some neat little add-on and think, geez, that was cool, I'll use that again in a certain case down the track.
Speaker 3:Yeah, and, and my colleagues might never be aware of that little angle.
Speaker 1:So the point you're making, from what I understand listening to you, is that you need to communicate with the lab. Yeah, you have to learn what their interpretation is going to be of what you send through.
Speaker 3:Yeah, be really clear on what you want and how you want an orthotic to work and what you're trying to achieve with it. Be familiar with the lab's manufacturing abilities and methods and, if in doubt, have great channels of communication to make sure that you can get what you want and clarify any prescription variable.
Speaker 1:Because the lab can actually do whatever you want. Really.
Speaker 3:Yeah, but now more than ever, with scanning and with digital manipulation and 3D printing, their toolbox is as deep as it's ever been.
Speaker 1:Yeah, right, Garth your thoughts.
Speaker 2:Yeah, and on that point I think it's almost the aspect of the label and from Footwork's perspective, everything I've seen come out of Footwork has been really good quality and exactly what I've asked for. I think some of the downfall in that process has been potentially podiatrists getting a device back that has the prescription they've requested but the functional outcomes for the client not being as it should be, because potentially their understanding of what they've requested in orthotic doesn't have the output on the desired tissue or the movement pathways that they think it's going to.
Speaker 1:And I think that Sorry, go on.
Speaker 2:Yeah, I think that fundamentally a lot of the time comes down to it where potentially that education piece of what's actually going to make a certain tissue feel better isn't fully understood in what the orthotic device characteristic required.
Speaker 1:Yeah, okay. So is that again? Does that get back to the communication between the practitioner and the lab and trying to make sure they can do what you want? Is that what I'm hearing here?
Speaker 2:Well, I'm probably more saying I think the lab does a really good job, or the labs that I've used over the journey of giving you what you request. Yeah, I think the breakdown probably comes down more so around clinicians not being as confident as they should be in that request being able to functionally give the client the desired outcomes.
Speaker 1:Okay, so appropriateness, prescribing the appropriate device, that's what you're getting back to. So it's an understanding.
Speaker 2:And I think to a degree it's probably something where, when I reflect on and you guys have been out of the education system a little while and both of you have spent time educating but I think there's certain aspects of when I went through the system that there was probably little bridges or deficiencies there that you didn't quite gain the understanding of, and if you never go into a system or if you never seek out opportunities or further learnings with a lab or with an experienced psychiatrist, then you probably don't fully grasp and get on top of those deficiencies.
Speaker 1:Yeah, you're right, I think you stay confused, yeah.
Speaker 2:Yeah.
Speaker 1:That's the big thing, though, isn't it? As I said earlier, we need to stay really honest with ourselves. Do I understand this fully or not? Make contact with people around you, but also make contact with the labs, and really dispel your confusion or lack of understanding, if there is any. I think that's the point you're making.
Speaker 2:Yeah.
Speaker 1:And, as you've said in your last episode when you came to the show, if you don't know something, get some confidence by learning the shit out of it. I think was your comment you made.
Speaker 2:Yeah, well, and also, I don't know everything either. It's a bit of a continual development, no, but you've made a beautiful comment, though, about getting confident by learning something in depth.
Speaker 1:That's the thing, and that is a great message to pass on to anyone listening, I reckon. In regards to this prescribing process, which can be so confusing, I remember coming out in the early years being so confused and I just went and worked in a lab and just learnt so much about what went on and what was going on behind the scenes to see what the outcomes were, and it was the only way, I reckon, I really got it together. So I think your comments, gus, of what you made well, both of you really have just been so brilliant in passing on messages to other people. Just get out there and learn it in depth. I think that's a big problem, isn't? It is people having some confusion on the prescribing or the appropriateness to the presenting. You know, patient problem it's hard it's hard, it's tough.
Speaker 3:And I think it comes with time and probably comes a little bit with, as you both were saying, exposure to different people and different methods and more patients.
Speaker 1:I think discussing things with the people who run the labs is a big winner, though I think most of us have done that over the years. They're so willing to give their time some of these people to helping you out. There's no failure of you making the approach to them. I think that's a really important thing. It's almost like you're trying to make yourself better and better and better. It's not like and you're obviously trying to solve problems all the way, but it doesn't mean there's a failure or a massive deficiency. You're trying to build on what you learn. Just get out there and speak to people yeah, and you're recognizing that.
Speaker 3:Their assets, those there's people in all of those laboratories who are podiatrists and who have worked clinically and now look at things from a different side. So they're a, they're a huge resource that lots of practitioners can benefit from.
Speaker 1:Yes, yeah, I mean, it's interesting just talking about this. I mean even just the differences in materials, of what can be used and the impact of what you can get back from the lab. You need to learn the sort of variation of materials available to you and you know how that's going to perform, but also how that's going to come out, you know, with regards to your prescription. Hey guys, we could go on and on about this, but you've made some really, really important points and, yeah, it's so good to have you both on board for a little bit of discussion about this. Hopefully this is a little provocative and anyone listening don't hesitate to make contact with me and we'll bring things up or go and look things up for you. And again, if you want to come on your show, come on your show, absolutely. Hey Gus, thanks a million for coming on. Again, that's three big ones you've done, I think footwear and orthoses in clinical practice, and then having a chat with Matt, and I Really appreciate your time, mate.
Speaker 2:Oh, it's good. Thanks for having me on.
Speaker 1:And thank you so much for your contribution. It's been so good and absolutely outstanding, mate. Thank you, and Matt, you know, if anyone wants to hear more of that tone of Matt's beautiful voice, just listen to the Australian Golfing Passport. It's a cracker of a show, matt's beautiful voice.
Speaker 3:Just listened to the Australian Golfing Passport. It's a cracker of a show. It's like a how-to or a bucket list golf trip information pod for people travelling to Australia from overseas.
Speaker 1:Thanks again for coming on, matt too.
Speaker 3:My pleasure. Thank you for having me. Always good to speak with you and listen to your little pearls of wisdom too.
Speaker 1:Jase, a wealth of experience, matt. Thank you and hopefully with well to both of you. Hopefully I'll speak to you soon and, who knows, maybe we'll get together soon and do another one of these. Stay in touch. Hey everyone, thanks for listening to Simply the Best Podiatry. That was Matt Mollica, gus McSwain. I'm Jason Agosta. Be sure to check out the show notes on this episode for more details. You can follow and support this show through the show notes. You can also follow on Instagram at simply the best podiatry. This episode is brought to you by Genie Orthoses. More details can be found on the webpage thegenieau. That's the G E N I E dot a? U. Thanks for tuning in and speak to you soon.