Ep.38 Orthoses Reviews: A Component of Effective Podiatric Management

Have you ever wondered why some podiatrists insist on regular orthoses reviews while others believe "no news is good news"? In episode 38 of Simply the Best Podiatry, I'm back after a hiatus to tackle this question head-on. Join me, Jason Agosta, as I uncover the crucial role of orthoses reviews in podiatry. You'll learn why assessing the impact on the patient's initial pain and overall treatment plan effectiveness is indispensable. 

We also explore the importance of monitoring pressure points, ensuring comfort, and preventing secondary issues caused by orthoses. From my criteria for patient comfort to managing running-related problems, this episode offers valuable insights into maintaining activity levels while addressing foot issues. Tune in to understand how these essential aspects contribute to optimal patient care, and why regular orthoses reviews are more than just a follow-up—they're a cornerstone of successful podiatric treatment.

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Transcript

Speaker 1: 0:10

Hi there and thanks for tuning in to Simply the Best Podiatry passing on tips for your best podiatry practice. I'm Jason Agosta and thanks for joining me and in this episode we are talking orthoses reviews. Well, it's been a huge break and apologies for the delay in getting back. I've been a bit snowed under and just haven't been able to fit everything in and also, unfortunately, been super ill, which has been a bit of a shocker. So the weeks just passed me by this episode has been a bit of a shocker. So the week's just passed me by. This episode has been a long time coming. So thanks for hanging in there, folks, and once again, apologies for being off the radar. As I've mentioned previously, if there is anyone who wants to join in, co-host or host a show or even just come on intermittently, that would be of huge assistance. It's nice to know that, while we have not recorded for many weeks, it's given people a chance to catch up on episodes and the downloads have been amazing. So thanks to everyone for listening and a very big thanks to all those who have contributed to the show in the past as well. Okay, but we're back on with episode 38 and this episode finishes off the series on orthoses and we're talking about orthoses reviews. This is reviewing patients after dealing with injuries and problems that have presented, and orthoses have been one part of a treatment plan. This episode, as the other orthoses episodes, is supported by Genie Orthoses and more details are on the webpage thegenieau. That's thegenieau Now speaking with others.

Speaker 1: 2:03

It's interesting that some practitioners have orthoses reviews and others don't. Some want to have reviews following the issue of orthoses, to follow any progress, and others are in the space of no news. Is good news approach and let me know how you go and if there are any problems and we're talking any type or style of orthoses. Well, I'm one for orthoses reviews and there are several reasons why. So this is the first point of this discussion as to why I and others have orthoses review appointments.

Speaker 1: 2:39

Firstly, pain and the presenting problem. I want to know if there has been a change in the initial presenting problem and have I been able to assist with orthosis and my treatment plan and therefore, do I need to change the approach in managing the patient? Now, obviously, it's not just a review of orthosis effectiveness, but a review of the overall clinical approach to managing a problem. I should say that in managing many running issues and many of the problems we see in running. They do not resolve quickly because nearly always we are still training, but usually at a lower level. This will be another episode in itself maintaining activity or running while having a problem and why it's important to keep moving and how to return to activity from injury. We'll discuss this later in a forthcoming episode. But getting back to the first point in having orthosis reviews is to also review the pain or the presenting problem, seeing if you have had an impact and whether or not your treatment plan is effective or not and whether changes need to be made. So that's the first point as to why I would have a review.

Speaker 1: 3:59

Secondly, pressure I want to know if there are any problems with pressure from the orthoses Now, after wearing in. Your patient should be completely comfortable for daily activities within a short five to seven day period, and I should say that these are my opinions and what I want to see in my rooms. So my feeling is that people should be quite comfortable and have a short few days maybe five to seven days of getting used to their devices, but they should be really comfortable in their daily activities. We don't want pressure to be offensive, which obviously can be uncomfortable, but we don't want any secondary problems due to pressure. We don't want any pressure from orthoses that can contribute to maintaining or accentuating a problem, particularly to the plantar foot, and this often happens where the orthoses can apply pressure and it just maintains the problem, such as heel pain or some sort of arch pain.

Speaker 1: 5:07

In my rooms I mainly use my preformed orthoses, the the genie, that are smooth and have an elongated curve. The idea was to have something that has a minimal amount of pressure but can be supportive. This is difficult to get a good balance with, but it is achievable. But getting back to the pressure, it's crucial there is comfort and no offensive pressure from your orthoses. If I'm using orthoses, I want them to be super comfortable and they're usually quite conservative in support and almost always using conjunction with an extensive strengthening regime, I should add.

Speaker 1: 5:50

Thirdly, we don't want any secondary issues from orthoses. We don't want to change a patient's natural pathway of movement too much, as this will create other issues. This is why we have a very conservative approach to using orthoses in my rooms. If you're getting secondary responses such as lateral tightness, which is really common, and discomfort or other issues, it's probably due to too much change and support and too much shift in position. This is for the patient and not what you can see in alignment and or position of the foot. It's all about the patient and how they feel, not regarding alignment and the position of the foot. It is no use sorting a problem or having an ideal position that you may see, only to have a secondary issue arise. So the most common problems are usually pressure to the foot and then lateral tightness, some medial knee joint pain and there'll be other issues like lateral foot pain as well if there's too much support and secondary issues have arisen. So it's important to keep tabs on that and to know how your patient is progressing, making sure that they're not just comfortable but they've had no problems arise with your intervention.

Speaker 1: 7:20

Now, fourth on my list as to why I have orthosis reviews is fitting. There must be easy fitting in footwear and there must be suitable fitting that support is maintained. I'm very much of the opinion that, although there may be adequate support, if the bulk of a device is lifting the foot in the shoe too much, it is not maintaining support. The patient will feel a little bit unstable. Being higher, they won't be fitting in their shoes so there'll be a lot of slipping, really want to make sure that the fitting is easy but there is adequate support, not just from your orthotic but from your footwear as well. I'm very strong in my opinion that there should be minimal bulk and there should certainly not be a change in shoe size to accommodate orthosis size. And we see this all the time where orthoses are huge in the thickness and bulk and width and people come in and they've had to increase their shoe size maybe half a size to accommodate the orthoses. And once you go up in shoe size which is bigger than what the person actually needs for their foot size, I think it's very hard to get the whole setup perfect and appropriate and certainly comfortable. The orthosis should fit in the usual sizing of the patient's footwear and not the other way around. This is an important point Make your orthosis fit ideally in footwear.

Speaker 1: 8:55

The fifth point to consider at reviews is alignment. Check the patient's alignment of the lower limb and the position of the foot. It's quick and easy. You just want them to walk up and down and make sure they're well aligned and if you have and can see that there are changes in the foot position, they're a little better than what you first started with. That's great, but remember that it's all about the patient and how they feel and whether you have them in a position that they can tolerate and are most comfortable with. You want to make sure that the patient feels good in the position that they're tolerate and are most comfortable with. You want to make sure that the patient feels good in the position that they're in and that they are super comfortable. It's always worth checking alignment and shoes. Then get the patient to walk barefoot and it's good to observe the differences, but it also gets the patient aware of the change. So I think it's also an interesting thing for the patient to give great feedback on um as and sort of get a positive sort of feedback on what they feel between being unsupported and then with their shoes on and orthosis.

Speaker 1: 10:08

Now my sixth point to make at orthosis Reviews is check the balance of the orthosis. It doesn't matter what style or what device you're using. We don't want to see any twisting or compression. If there is any twisting or compression of your appliance, fix it and maintain the support and the durability. Your orthosis should be easy to modify and easy to fix and you should be able to do this immediately for the patient, within a few weeks of them starting their use of their appliances. Fix the problem and it will add to the durability of their devices. This is really easy and should be done on the spot. Reheating, posting and covering should be able to be done in your rooms. Get hands-on if you're not. This is crucial and provides a far better service. So this is an important point to make. You can focus on the patient, focus on fitting and pressure and alignment, but your devices should sit well and be well and it's up to you to make sure that that is maintained. It doesn't take too long to do and it's really easy to sort out while you're with the patient.

Speaker 1: 11:26

So they are my six points in having orthosis reviews Reviewing the problem. Pressure learning if there is any unwarranted pressure. Making sure there are no secondary issues developed from intervening. Making sure fitting is ideal. Remember the comments about footwear. You should be fitting your orthosis to the shoes and, obviously, the patient, not the other way around. Fitting footwear to accommodate what you've intervened with. As far as your appliances, making sure there's sure fitting and it's ideal. Check alignment and check the devices no matter what they are and make sure they're balanced and well aligned.

Speaker 1: 12:11

I think also there is a responsibility on the patient in having reviews or any reason for review. It gets the patient to consider their issue and the process. Whether you see them in two or three weeks after the initial time, I think you end up with better feedback and it tends to be better for the patient and better for you. It gets them a little bit more engaged and better for you. It gets them a little bit more engaged. So I think there's a sort of spin-off of having reviews there instead of the approach of many, which is just my opinion of yeah, just let me know if there's any issues along the way.

Speaker 1: 12:49

So some people have asked me when do I have my review appointments? I usually have my ethos uh are at three to four weeks, sometimes two to three weeks, but as long as there's a bit of time to allow things to settle, both with the patient and their tolerance and also fitting in shoes and if people are changing footwear, which you've advised, it also gives them a chance to settle into the new footwear if it's a new pair of runners, for instance and making sure their appliances fit appropriately and compress into the shoe, which is a really big deal as well giving time for your plates and devices to sit appropriately. The other question is do I charge for orthoses reviews? It's a common question. Yes, I do if there is work to do and time taken usually a normal standard consultation. But also I do not charge if it tends to be really quick and easy and not much done, minimal time in reviewing the patient. So I sort of make judgment of that as I go along. I'm very aware of the expenses that may be incurred to patients. So I sort of judge that with the time taken and whether there's any work to do at the time or changes in treatment plan. This is very much my opinion, remember, and that my approach and what I see in my rooms may differ from many of you. I hope this helps and many of you may have other points of focus when reviewing patients and orthoses and problems. Please get in touch if you want to add to all this and we'll add some comments on in the coming episodes. Hey, thanks for tuning in. It's been a long time and although I've dropped off the radar, I really thank you for tuning in. Apologies once again for taking so long, but we are back on. And this concludes the series on orthoses.

Speaker 1: 14:51

This series has been supported by Genie Orthoses, as mentioned earlier, which have been developed by me, which is important to declare. I wanted something that was elongated and smooth in the curve, and the aim was to have a preform that was supportive but minimal pressure and lightweight. It's also thin and flexible, which is crucial. As I've mentioned, someone has to pay for the bills of the show and the genie does so. More details are on the webpage thegenieau. Hey. Once again, thanks for joining me and listening in. Make sure you check the show notes and speak to you soon.