Ep. 41 Talysha Reeve: P3 the Progressive Podiatry Project

Transcript

Why P3 Exists And Collaboration

SPEAKER_00 0:14

Hi there and welcome back to Simply the Best Podiatry, where we want to pass on simple tips to enhance your best podiatry practice. I'm Jason Agosta, and in this episode, I'm speaking with Talisha Reeve from P3, the Progressive Podiatry Project. The Progressive Podiatry Project provides educational content that will keep you up to date with your current literature but aims to link current evidence into your clinical practice. You can check ProgressivePodiatryproject.com online. So joining me now is Talisha Reeve from P3Podiatry. Talisha, thanks a million for coming on our show. And I'm so stoked because I think what you're doing with P3 is giving another resource to podiatrists and broadening what they can learn. I love it.

SPEAKER_01 1:11

Well, thanks, Jace. I'm stoked to we finally caught up in the chaos of scheduling. But no, I'm yeah, big fan of the potty that you guys have got up and running as well. I think the more voices we have that like a bit progressively minded and sharing insights, I think it's something that the profession as a whole can definitely lean on. So yeah, very happy to be here.

SPEAKER_00 1:38

Well, the reason why I started this show was to just try and get more info out there. Um, try and give simple tips, which is what it was all about. And it's funny how that title came up simply the best. But it was basically simply give simple um tips that hopefully can help people in their practice. But is that why you've set up P3? Because there's you've seen that there are so many gaps in what people do in their practice or they learn at university. Is that how all this originated?

Building Referral Networks That Work

SPEAKER_01 2:13

Yeah. So, like if we go to way, way, way back when, where I first realized that I because we all have something to offer, right? Um, so there's so many clinicians that know infinitely more about info, infinitely more things than I do. But way back when, when I had my podiatry clinic on the New South Wales Mid-North Coast, I had a couple of really good relationships with some of the clinicians and clinics that were in the surrounding area, or even just up the road, really. And it was actually really nice. So there are a couple a couple of people in town that were quite territorial and like that's fine. We all have them. But then there were a few others that there was no issue with this sort of inter-referral. And there were a few instances where I had a couple of colleagues that they'd call me up and they were like, hey T, I've got this patient, I've they've got this presentation, I've done XYZ. Can you have a look at it? And they were happy to refer over to me. But then I actually didn't want to sort of take over because they'd done the legwork, they'd build the build the rapport with the patient. So what I did in a number of instances. So, and sometimes that clinicians will come in as well. But basically, I'd see the patient review the patient and then I'd defer them back to their or refer them back to their original clinician with a bit of a plan, and then I'd have a chat to the clinician, like, okay, I've assessed XYZ, and it looks like that this might be a direction or a missing link. And it that's kind of where it started, and then it just sort of built and built, and then there were sort of a few more people that would come and ask bits and pieces, and I was I was personally finding I was really enjoying it. But you were becoming a resource for them, yeah, and like and vice versa, because I'd refer patients to them. So if a patient had call up the clinic uh looking to book in, and I had amazing reception staff, they were just brilliant front of house, they were invaluable. And I'd sort of um had them kind of trained up to okay, if a patient sort of asks for XYZ, that's not in my wheelhouse. So they'd be best suited to go to this clinic or that clinic. And there was no issue with um yeah, me giving out those clinic numbers and sending them elsewhere because I thought that they would be better served in that clinic versus seeing me. Um, but yeah, so that's kind of where it started.

SPEAKER_00 4:48

And then that's a very important part of practice, though, isn't it? I mean, like, you know, I I'm I just don't see any high risk, you know, patients at all because I've got no idea. And I always refer them off, but it's such an important thing to do if there's gaps in, I suppose, what we've focused on.

SPEAKER_01 5:06

Yeah, 100%. And like we all have our own, like it's guided by our interests, our skill set, the demographics that we see. And I it's actually quite funny that we're talking about this because I literally just finished writing an article this morning that I'll throw up on LinkedIn later about how a good referral is equally, if not better, than a treatment that you can provide if you're not the best person suited to them. So it's that's what makes us good clinicians is one, having our skill set, but two, knowing our limits within our skill set and then knowing who else we can lean on.

SPEAKER_00 5:42

Well, that person you refer off is your w walking advert. Oh, 100%. That's the way I say it.

Knowing Limits And Patient First Decisions

SPEAKER_01 5:50

And I agree, yeah, 100%, because it's like you could do a half-assed treatment if you're not 100% sure on what you're doing, or you can better serve the patient, and then like it looks good on you. So the it's as good as a treatment. Like this clinician, they didn't milk me for 10 visits and 600 bucks or however much it would cost. They sent me to this person who was able to provide the service for what I needed. So it looks good for you, it builds a referral network. So there's no negative that I see from yeah, deferring to other people. And part of that comes from, I think there's financial drivers and ego drivers and a few things that feed into why clinicians hold on to patients. Um, yeah, not all negative, some of it's coming potentially from a well-intentioned place, so that need or feeling that they want to help the person in front of them. But yeah, sometimes the best help that you can provide them is sending them to someone else for help.

SPEAKER_00 6:52

Yeah. So the one thing that caught my eye with P3 was you've done a fair bit with the strengthening side of things, and you put up a graph or you were talking about calf strengthening, and it really caught my eye. I mean, yeah, I know you've done you put up a lot about strengthening, but the calf strengthening um section really caught my eye because we've been talking about how the loads that you produce during calf strengthening are nowhere near that of running. And I think I read also, or you maybe you had another um video put up about running training. You're talking about progressive loading of running training, and that caught my eye as well, because that's my big thing. Um, but that has seems to be like a fair focus of what you've done, is focus on the strengthening side of things.

Achilles Loading And The Baxter Framework

SPEAKER_01 7:47

It's I'd say not so much like so. Strengthening, I guess maybe in a global sense, but outside of strengthening, I'd say probably capacity building and load management would probably, if we're sort of getting into the nuance of it, because like if we like strength, if we're looking at it from a purely strength perspective, that's one element of performance and of sort of physical output of what our body can do. But then we have endurance, we've got sort of speed work and um yeah, all of that. So capacity building. So but a lot of it where it sort of delves into is yeah, a lot of the people that we see are runners, and strength comes into that, and strength to actually perform the running. So I know what you're talking about. It's the um oh Baxter paper, I'm pretty sure. It's yes, the Baxter paper. So that's what um one of the talk, I know what you're talking about with that graph. So in 20, it was either 21 or 22, I think 2021, um, there was a paper that came out. Um, and Josh Baxter was the lead author, but then a few more pay um people were in the mix with that. But put out a paper, exercise progression, to incrementally load the Achilles tendon. And what I loved about it was basically they had a look at the internal loads that were applied to the Achilles with uh it was about 20 odd exercises. So we had our lunges, our bilateral calf raises, unilateral calf raises, progressing up to walking, running, jumping, hopping, and forward hopping. And it was really interesting. And where I found it actually reflected quite well what we see in clinical practice. So in clinical practice, and this is what happens for a lot of people, is because calf strengthening and the eccentric calf strength is kind of the gold standard for Achilles rehab. And so you'd have a patient and clinicians would see them, they'd do their bilateral eccentrics and they'd progress to unilateral eccentrics. And often there wasn't a much paid or much attention paid, sorry, to um all the other variables that come with an exercise dosage. So we've got our sex and reps, which is what they tend to gravitate towards, but then we have uh the tempo, the range of movement, the frequency, and even just to angles, so where our center of mass is over the joint that we're leveraged off. Um with the Baxter paper, they had uh so walking sits way down the lower end of the scale. And then with running, it's not actually up the top end of the scale. And with that, so even our unilateral calf raises, they don't load the Achilles as much as what running does. And that's where you'd see clinically these problems eventuate, where you'd have a patient, they'd come in and they go, Oh, I was seeing a physio, I was seeing a podiatrist, and I did the rehab. And then basically for symptoms, like for walking and everyday activities, well, the symptoms were fine. I could do 25 repetitions, so I'll return to running, and then bang, six weeks later, we're back. So it was often uh an issue of underdosing, so we're not taking into account the actual physical capacity that the person needs. And that paper was just really good at sort of giving an answer as to why.

unknown 11:29

Yeah.

SPEAKER_00 11:29

If that makes sense, yeah, absolutely. But the other thing I that you've you've um spoken of also is running training, and we don't often and the progressive loading that is so important with that to create adaption in in whatever facet you want to look at it. But um you seem to be like quite sort of focused on that uh progressive loading aspect of training, and I think I read on one of your posts or maybe on your website about um how to do it, and it was one of the first times I thought, oh, here we go. There's podiatrists or talking about how to do the running training as best as possible. And uh I just it was so interesting. So anyone listening needs to look up P3 because you um it is so good in um in just clarifying what we need to do and what we need to know about uh increasing our running training and the rates.

unknown 12:29

Yeah.

Under‑Dosing And Return To Running Gaps

SPEAKER_01 12:29

Has that been a background of yours as well, like as far as activities or it has to an extent, but I must um like pay credit where credit's due. So I've been exceptionally lucky to a few years ago, I was working with Michael Nitschke, who is an elite runner, competitive runner, and the amount that he knows about running, running loads, training, footwear is phenomenal. And I'm just a sponge with his brain. He he taught me a lot, and he um so there was a lot that I was aware of with patients that I was seeing over the last 12, hang on, 15 years, time goes fast. 15 years I've been practicing. Yeah um and like I dabble in it, but I didn't know enough about it. And then Michael, because he has that history of elite running, plus he's is an athletics coach and running coach, and he's a sports podiatrist as well. And so me working with him, um basically, yeah, he pointed me in the direction of, well, one his brain, but to a lot of authors and publications and just the evidence that sits probably outside of the podiatry sphere, but is highly relevant, um, to give that structure to it. And this is where it um starts to make sense. So I think when podiatrists we start to enter into the world of rehab, we start with the basic sets and reps, and then after a while, hopefully with P3 and then other resources like you guys are putting out with your podcast, it's okay, there's more to it than sets and reps. There's yeah, other dosage parameters that feed into an exercise dose, right? But then there's not actually a switch where we go from rehab mode to performance mode. It's a bit of a transition. So we can have an injured athlete and we're doing our rehabilitation. Rehabilitation on Tuesday doesn't stop, and then Wednesday they're back into performance training. It's a gradual transition to it. So it's taking a few of the elements from this sort of strength and conditioning and rehabilitation, and then you apply that to running because with running, there are also the dosage parameters that make sense. So it's not just the time or the duration. We have the intensity, we've got the terrain, so and the incline. So there's other intensity metrics that make up a running dose, and they're the things that we need to pay attention to and be able to manipulate and monitor for us to do that progressive loading for reintroduction of running.

SPEAKER_00 15:14

I think you've just explained that perfectly that there is that transition phase, and that's the crucial thing. Otherwise, if people just end up in the revolving door, don't they, of your rooms or elsewhere. Yeah, but that train, I think that's beautifully described what you just said about that transition phase and knowing how to do that is the key of the slow, gradual grind and building up. That's crucial. Yep. It's probably probably it's probably for my rooms, I'm not sure about yours, but for myself, it's probably the most talked about uh issue in my rooms about how to get back into it and how to keep it going. Um because that's the key to obviously preventing the problems, but um, as I said, you know, not having those people come you know in the revolving door, you know, consistently with another problem and another problem and so on. And trying to reach their potential.

SPEAKER_01 16:12

Yeah, that's it, achieving their goal. And if we and this is where clinicians also fall down, and like we've all done it, especially when we're newer to clinical practice, is we will often focus on what we perceive as the goal. So a reduction in pain, that might be what we're concerned about, but a lot of the time people like the human body is amazing, and all of us have been um in this position to some degree, where we might have something that's a bit painful or it's a bit uncomfortable. But if it's not disrupting the activities that we want to do, then it's not a problem. It's when it becomes disruptive and it's removing our desired activities from the equation that it starts to become a problem. So when clinicians focus on pain with our therapeutic modalities or even our sort of clearance to return someone to sport or activities, it just um the focus on pain that can sell a patient short of achieving their goal because symptom-wise, for activities of daily living, they might be okay, but can they actually physically sustain getting back to, or even can they get back to it? So I think that's where we need to be a bit more mindful of focusing on the patient goals and structuring a management plan that will get them there and sort of tying back to the Baxter paper. Like, are we going to be selecting the right exercises and create creating enough progressive overload to the tissue for the tissue to adapt so they can return to that activity in a sustainable manner?

Progressive Loading And Transition Back To Performance

SPEAKER_00 17:56

Yeah, well, that's the key, isn't it? Because we know that we know the rates of adaption of, say, tendon, for instance, are so slow. And when you hear people say, Oh, it doesn't matter. Like I heard this recently, you know, at the conference in Brisbane, you know, there was a presenter who got up and said, it doesn't matter whether you increase 5% or 50%. We don't really know, but we do know how tissue tissue loading progresses. And I was like, hang on, no, when you we do know this, and we should be aligning our training in you know, um aligned with the the changes of tissue loading and and responses. So it's such a crucial point. Can I just move on though? What what are you? I know at the moment P3 has you've got quite a significant program up on footwear, which has just been launched. Yes. So what's the focus of that? Tell me about this, the footwear um program that you have.

Tissue Adaptation Rates And Training Doses

SPEAKER_01 18:56

Yeah, for sure. It's um it's probably out of all of the P3 stuff that I've launched, this is probably what I'm most excited about because it is such a collaboration. So with the exercise therapies and the plant of fasciopathy course courses, um, that's essentially me just doing my thing. But with athletic footwear for health professionals, it kind of ties back to what we were talking about right at the start, about the deferring to expertise of people that probably know more about this and resources and knowing where to go. So footwear becomes one of the key elements, especially for podiatrists, but for any clinician that is managing lower extremity musculoskeletophologies, right? So footwear is does it cause running related injuries? Read the Cochrane review. Essentially, no, can you use footwear to prevent running related injuries? No. Do they become relevant after the development of symptoms or history of running related injuries? Yes. But it's there's a missing gap. So one, evidence is continually evolving. And then footwear brands, every year you have an update to almost every single model. So trying to keep up with that is incredibly difficult. So a really good example is the New Balance Supercomp trainer. So version one, they've just dropped version two. There's been pretty decent change in the stack height. So they've reduced the stack height, they've reduced the heel pitch two mil. There's been a pretty decent change in the upper. So it's still a mileage trainer, but now the version two is probably a fast-paced mileage trainer. But the feeling underfoot is so completely different between the two. So even though there's been a reduction in stack height, the version two at slower paces actually feels a bit less stable. So that difference between who it may have felt good on for version one versus version two, it can be quite different. And the Keano 29 to 30 is another example of that. But with the big changes, us as clinicians, we might have seen, like, oh, the Keano 20, that was a brilliant shoe for this type of patient. So I'm just going to continue to refer everyone for the Keano with the evolution footwear, it changes. So it may no longer be appropriate for that person. So basically, what I've tried to do with athletic footwear for health professionals is create a kind of consolidation of all the relevant elements. So we've got sort of three pillars that I'm kind of building. So we've got the evidence and literature across footwear, musculoskeletal injuries, and load management. Then we've got the um retail and technical. So what's available on the market at the minute, changes between the models, and then the deferring to the experts. So I am doing some of the presentations, but I've got a whole heap of amazing clinicians on board. So the with the monthly work. Webinars, like it's sort of linking cynical practice with retail with research. So the first webinar kind of just gives a breakdown of the various elements of footwear that we need to be considerate of, which I think when we move away from recommending models of shoes and we move towards recommending footwear characteristics and then deferring to retail experts who are footwear specialty retail. Like in Adelaide, we've got the running company and Sportitude. So deferring to them with this person needs these qualities in a shoe. Yeah. You know the brands better than I do. Find the shoe that meets the brief and feels good for the patient.

SPEAKER_00 22:45

And yeah, well, hopefully they follow suit with that though, too.

SPEAKER_01 22:48

Yeah, well, we're lucky, and that's knowing sort of and getting to know your referrals. So with Sportitude and the running company, like they're all about sports medical. So they're all across it. Um, if you're in a region where, like I know in Sydney they've got a they do have some running company stores, but I know I can't think, I think running science and I can't think of others. So I know in the capital cities there are other specialty retail for footwear, um, but it's just building those relationships. And yeah, so just trying to create a hub. And I finished recording um this month's webinar with Nidder yesterday, and not yesterday, day before the week is a blur. Um, and that was brilliant. So we yeah, Knitter's knowledge on footwear is amazing. So it kind of takes us through the history of footwear, where it kind of sits now, the relevant things that clinicians should be considering when we're making the footwear referral. So it's just trying to create that hub of linking all of the dots, but providing a sort of one-stop shop to get that information instead of wasting 20 hours a month trying to keep up, which is probably what I used to do.

SPEAKER_00 23:58

So this is where I stand with the footwear side of things, and I'm sure I'll speak on behalf of so many people listening, is that it's become so confusing. Um, there's so much out there that has changed, and for me, it's almost like, you know what, the shoes in the middle ground that aren't too thin, that aren't too thick, aren't too soft, or aren't too too hard, which is what we used to have and only used to have, that's where it's at. Is there a place for that thought process, or do you think it's just there's something for every scenario of a uh person that comes in and a problem that comes in? Because I've simplified my outlook on it so much and it has become so confusing. And I'm thinking that surely I'm not the only one out there.

Launching The Footwear Program

SPEAKER_01 24:49

Oh, I think it and I think that was part of the motivation with developing this resource, like seeing how much footwear has changed in the last 10 years, and where I think a lot of it stems from is so historically, like we all know the sort of three foot pictures that we see plastered around the internet. You've got a high arch foot, and there's a red line, and then you've got a neutral foot, green line, and then a pronated foot, big red line. So outside of the neutral is bad, and then surprise, surprise, as a subset or consequence of this, then all of a sudden we had three footwear categories. So we had our cushioned, our neutral, and our support. And then now that evidence has evolved and we go, okay, well, pronation's really not the devil that's creating all of these problems, and you see a lot of shoes are now heading towards more of that sort of stable neutral with nuance. Um, that's probably the best way to describe where it sits now. So do you think it's moving back?

SPEAKER_00 25:51

You in saying that, sorry to cut in, but do you think it's moving back then from what we've seen? That stable, sort of neutral, sort of more simple construction?

Evidence, Retail, And Technical Shoe Knowledge

SPEAKER_01 26:02

Well, uh it's in a sense it's simple, but in another sense, maybe not, because it's I think what makes it complex is uh not understanding the footwear elements because like historically for what 20, 30 years when we were going through podiatry training, it like it was quite easy. It's like we need a medially posted shoe, we need a laterally cushioned shoe to meet the brief for the three foot types. But now it's sort of gravitating towards sort of stable neutral, and that's where a lot of shoes sit. It's okay, well, that's kind of the bulk category. So now I've got this patient that they need a sort of footwear recommendation for their pathology. What type of shoe can I recommend? And so this is where I think it's important to because again, the footwear retailers are on top of the changes. Our footwear tech reps, like Maddie Spicer from New Balance, he's probably my favorite. We all know my fanboy Matt. Um, but and there are other tech reps that are amazing, like Lucy from On and or Millie, she's with On now, she was with Mizuna. Anyway, there's lots of tech reps that are amazing. They know their product very well, and they can keep on top of the changes. But I think the best approach, in my opinion, for clinicians is instead of trying to stress about keeping on top of all of the footwear models, is if we just have an understanding of the different elements of a shoe that will like so if we're talking about four-foot rocker, midsole bending stiffness, the responsiveness or the compliance of a foam or the stiffness of a foam, um, yeah, the presence of heel flares, do we need the midsole foam to be more dense medially versus laterally? So having an understanding of those elements as opposed to trying to stress about the specific shoes, if we understand that and we build those good relationships with the footwear retail, that's where we can kind of circumvent a lot of that stress and still get really good footwear referrals. Because if you go, okay, this client has this pathology, they need these footwear elements, send them off, and then the footwear experts actually know what products meet that brief. So that's where I think it's a great way to probably circle back. So we'll probably will see some medially posted shoes creep back into the mix. Um, minimalism might come back. It's hopefully not going to come back with the vengeance that it hit us with.

SPEAKER_00 28:40

It's just amazing to think that that's where we were. I mean, I did a fair bit of work with New Balance during that as well. And we're talking we're talking about the strengthening benefits, that was the big thing. But it took basically the globe by storm, and then 10 years later, everything's gone fatter and softer. And let's just throw everything at this thing. We've gone from one end of the spectrum to the other, but in the middle has sort of been forgotten. And you get the reps, you get the shoe stores, and they're all talking about the latest, greatest flash, but it's not necessarily the best thing, in my view. And I think there's been a forgotten sort of sort of uh category there, as you said, sort of firm neutral, which has just sort of been left behind a little bit.

SPEAKER_01 29:26

It well, I do think it's it's like anything, it's um once there's sort of the new and shiny kid on the block, then everyone rotates towards that. And so we did see a massive influx of the max cushion shoe. But now what we're seeing, like again, sort of swinging back to the um New Balance Supercomp trainer, so massive stack height. Now we've paired that stack down a little bit. So you'll see some of the um previous models of the max cushion shoe. Now they're paring it down a little bit, and then there's other models that they did have maybe not as much foam. So it might have been sort of a 25 mil and a 10, 15 mil, four foot in the stack height. And now the models that may have added sort of three or four mil. So it's a little bit, yeah. I think we'll see sort of some flux coming back to a baseline with it. But I think with that, um, sort of this is just going off topic, but then if we kind of have a look at the history of running, so in like the 1970s, 1980s, like the people that ran were runners. Like, you know, Nick, he um talks about this in one of his papers. It's um like in the yeah, 70s and 80s, like the runners were like the typical runner, like they were mostly male, they were skinny, they ran to run fast, they wanted to win. Now the bulk of runners are like the recreational runners. Like we're not running marathons to not, I can't run a marathon. We're not running our running races, our half marathons, our 10Ks, our park runs. We're not doing it to get the best time. We're doing more recreation out there.

SPEAKER_00 31:10

That's more recreational runners. That's what you're saying.

SPEAKER_01 31:12

Yeah, and so there's um a lot of the recreational runners, they're doing other sporting activities. They're some are overweight, some have metabolic disease. Like it's that's so. I think part of the max cushion shoe is in a sense kind of catering for that, yeah. Like making because the like everyone's running style is a little bit different, and I think a lot of it is catering to the recreational runner for the enjoyment. Because if you're a competitive runner and you know a shoe is going to help you, and like this sort of comes into the comfort filter thing. But if it if you're a runner and you put a shoe on your foot that you know you'll perform better in for your target race, may not be the most comfortable shoe, but if it's going to make you perform better, you'll gravitate towards that. If you're a recreational runner and you put on a shoe and it feels shit, maybe that's not your gateway into running and enjoying running. So I think where a lot of the max cushioning comes into it is to make the rides a lot more comfortable. And that's yeah, because that's sort of the biggest demographic of runners that exist now.

SPEAKER_00 32:25

Well, that's the number one thing, the comfort and fit, isn't it? If you can get that, they're off. That person's gonna be quite happy.

SPEAKER_01 32:31

Yeah.

SPEAKER_00 32:33

Yeah, I see what you mean. Yeah, I never thought of it like that.

From Categories To Characteristics

SPEAKER_01 32:36

It's uh yeah, so I think the um and where because the clinicians, we don't dictate, and this is um what I was discussing with Nidda the other day when we were filming. So as clinicians, we don't dictate what's out on the market, the market dictates what the footwear manufacturers are doing. So we need to be responsive to that and sort of learn to adapt with it, if that makes sense, because we don't have control over it. If like we can go to Socony or New Balance and go, we need this type of shoe. And if they're like, well, that's only gonna make up 0.05% of our sales, like good luck. Is the rest of the range? Yeah, um, yeah, so it's being adaptable to the changing demographics of runners and the changing market in the shoe place because there's always gonna be a shoe that will meet the brief. It's just again, we may not know what that is, which is why, yeah, referring to your retail experts is kind of the key.

SPEAKER_00 33:40

Yeah, I think you've got you've still got to have some understanding as to what's out there that I don't you. I mean, you can prescribe the characteristics, but you want a vague idea as to what's out there, which is not too hard to keep up with. I think once you dive in deep, it becomes a little bit more confusing and complex. Yeah, that's where the store has to be on your team.

SPEAKER_01 34:00

I yeah, I very much agree with that. So um Shane looks plug. That's why we've got the footwear um in services with the cloudic footwear for health professionals, but outside of no, but it's good, it's great, that's why we're here.

SPEAKER_00 34:15

Yeah, because having that so important for everyone understanding.

SPEAKER_01 34:18

So getting in touch with the footwear app and getting some samples in the clinic. Like I know a lot of clinicians do that, but yeah, having your finger on the pulse. I was doing a mentorship session this week, no, last week. Um, time is no longer a construct, I've lost grasp on it. Um, and we were talking about footwear in the mentorship session, and that was part of what we were discussing. So having an understanding of some of the ranges, um, because you'll like if you have a conversation with the client, you might be able to talk to, okay, well, having an understanding, okay, that's the shoe that they've got. These are potentially some types of shoe that might be better suited. So we do need to have some level of understanding to even be able to have that conversation with our patient. But then I think the degree of understanding that we need to have varies depending on the demographic. So if you're a um, say, general podiatrist, your client demographic is a certain type. And like they don't come in frothing footwear. Like if you're a clinician that's treating a lot of runners, the runners are going to know a lot about shoes. And if you're treating that type of patient, then you probably should have a good understanding of shoes, like a lot more. You do.

SPEAKER_00 35:35

You have to know the pointy end, don't you? You have to, yeah.

SPEAKER_01 35:39

And because it's one thing, like especially if you're dealing with the elite runners, is they'll come in and they'll probably know as much, if not more, about footwear than you do. Um, so yeah, tailoring your knowledge to who you are treating. So having a base level of understanding for the generalist oftentimes is enough to get you by. But I still think that having an understanding of the footwear structure and elements that affect and function, that's the key. But then, yeah, the more you deal with a client base that has quite an extensive knowledge and understanding and experience in various footwear, that's where you need to have more knowledge in it. Yeah, that goes across any topic that we deal with. Like, I don't deal with wounds, I just defer to people that are infinitely better at that. So, my knowledge about different dressings is non-existent because I refer on for that. But I know enough, like if something came in, I could give the basic advice and basic treatment and then send off. So, yeah, it depends on your nevel level of knowledge will have to reflect the demographic that you're treating. But there always needs to be that base understanding.

Market Shifts: Minimal To Max And Back

SPEAKER_00 36:56

Yeah. I think uh with that, like the you know, people who come in and they've they've you know they've delved deeply into the footwear market and they seem to know so much, they are always so receptive to break it down, in breaking it down to simplify it, because they've gone in so deep and it is so complex out there. And as we said, there's you know, there's shoes at one end of the spectrum to the other. And they're also trying often those people are trying to find a bit of magic. It's gonna prevent an injury or make me run faster. It's like, you know, sorry, champ, but it's not gonna happen. Just stick to the basics and you know, and they actually respond and love that you know simplifying of it, which I think is where I'm at now after all these years, because it it is so confusing, and you can dive deep into it.

SPEAKER_01 37:45

Yeah, it's uh it is a rabbit hole, like any topic, I guess. But yeah, yeah, there is uh, and that's um when you're saying that they want something very, very specific, that's another trap that clinicians can fall into as well. Um, it's sometimes with our footwear prescriptions or recommendations, we can try and make a unicorn. So they need this, this, this, this, this, this, and this. And that shoe may not even exist. Um, so it's kind of, yeah, like you said, simplifying it, picking the key elements. Like if it's someone like a patient that they have a really broad forefoot, narrow rear foot, then okay, and fitting is a massive issue for them and they get corns on the fifth, or they just get nerve compression at the dorsal hallox at the first met joint. It okay, so for them, we need to have a really broad forefoot. So we may need to consider the glass shape and the volume. But then outside of that, just factoring in, okay, what type of run are you going to be doing? Are you after a mileage shoe? Are you after a fast-paced tempo shoe? And then, yeah, okay, so your footwear characteristics that are important are this, this, and this. This is the info that you need on speed, go shopping.

SPEAKER_00 39:02

Yeah, and it should be fairly um like the yeah, as peditres go, it should be fairly easy to you know, stick with it a little bit. You've got to visit the shoe stores, and as you said, get the shoe reps in. I don't do that anymore at all because I'm sick and tired of them trying to blow me away with the the latest Razamatazz. Very cynical, Talicia. But it's my my time is worth um spending doing it myself and and visiting the shoe stores, creating that relationship, and it's so easy for practitioners to do that, they just need to get out and do it. Yeah, it's and obviously your resources are huge uh assistance as well.

Comfort, Recreational Runners, And Performance

SPEAKER_01 39:40

Like, yeah, I'll actually be keen to see what you think of um because I was at the running company this week, so we were filming the virtual in service, and like virtual is good, but sometimes like you do tangibly need to like hold the product and put it on your foot and have a feeling of it. But yeah, the virtual in service is really good. So basically, I just give the boys like, okay, these are kind of the we have a discussion beforehand, and so we do the new and noteworthy. So new and noteworthy, we just basically I let the guys pick like the most exciting shoe that's come out. I might go, I really want to know about this one. And then we do a category deep dive, sort of exploring a different area. But then we sort of jump into the last section, which is practitioner problem solving. So um, this month's one was actually really good. Um, jumping onto that sort of four foot pathologies I was referring to. Um, so because oftentimes when we're referring people for footwear, it is for a problem, whether or not it's pain, for a niggle, whatever it is. Um, so what we did was okay, so let's say it's first met OA or a four foot pathology. So everyone, as soon as I say that, most people go, hoca, bondye, clifton, home and hosed. But if you're a runner who is wanting to run at a moderately fast pace, you want to do a threshold session tempo run, or you're going to race, try to knock out a PB in a Bondi way. It's not gonna happen. So what we're uh we did in that section, which is really good, is okay, so this is the characteristic. So broad forefoot if that's part of the equation, but yeah, four foot rocker, high degree of midsole bending stiffness. And then outside of that, looking at a couple of different shoes that meet different briefs. So this is a type of shoe that's good for a walker, this is a type of shoe that's good for a heavy person that does like a slower-paced run. This is good for a person who wants to do a 5k race or a 10k race or a half marathon. So it's um yeah, trying to bridge that gap. But like taking that aside, you are 100% correct. Clinicians need to yeah, build those relationships with their footwear retail. And I think one of the best things that you can do is like try on the shoes. And that's how I started my good relationship with a running company, because I just started to deal more with runners when I was working with Knitter. And it was like, well, I want to know more and more. And I'm one of those I was such a shithead teenager, so someone could go, don't do this because uh this consequence would happen. And I'd I'm someone that I'm like, well, I need to actually know what will happen, so for better or worse. So I just kept going down to the running company, and I wanted I basically would go in and try on almost all of the shoes on the wall. So they were very patient with me, but just to get an understanding of like the fit and the feel, and like, okay, on paper it reads like this. Physically, it feels like that with walking and running. Um, and doing that, yeah, it just makes you so much better at huge insight, isn't it?

SPEAKER_00 42:53

You've got to where you've got to put them on. I mean, that that that's the thing about being a runner, is you've worn so many shoes over the years, you do get a feel for what you know what's hot and what's not. There's no doubt.

SPEAKER_01 43:04

Oh, definitely. And sometimes it can be um a bad thing, like especially with a lot of the album-plated max cushion shoes. You go from that back to a shoe that your foot has to work in.

SPEAKER_00 43:18

And you can go, what's this? I know exactly. But likewise, I mean, over here in Melbourne, for me, and I'm not speaking on behalf of everyone else, but for me, running company has been at the forefront of really um assistance in providing the resources for patients we send through. There's absolutely no doubt. And the I think the most important thing for a practitioner to have, no matter what store, what chain it is, is just someone who's going to listen to you and not change the ball game on you. Because that's happened repeatedly to me in the past. And it's like, okay, struck off the list. And we've spoken about this problem, but that store is struck off. So you really just need to have someone who's going to listen to you or any other practitioner. I think that that's a crucial point.

Partnering With Specialty Retailers

SPEAKER_01 44:08

Yeah, 100%. And I know like we're talking, like we're lucky enough that we live in cities where we can refer. Like, but my um experience when I have my clinic, I was, yeah, regional New South Wales. And we didn't have like the closest Athletes' foot, which I'll withhold like the Athletes Foot store, they were actually their own store. Amazing. Built relationships with them, but they were an hour and a half drive away. And we had one local footwear store, and they were brilliant. So they were froth running a little bit. But what um I did, and this is a strategy that I think a lot of regional clinicians can benefit from. And I'm sure many of you are already doing it, but getting on the same page. So I um over the course of a year, I had probably three or four visits initially to this store just to make sure that we're kind of talking or speaking the same language. So one, having an understanding of the shoes that they stock, and then okay, if I'm referring someone in for XYZ, it's typically for a shoe that has these characteristics. And so it's um, so sometimes it's if you have a local footwear retailer, because if you're going to be sending them business, like they're often quite receptive to listening to what you have to say. Um, so sometimes it's a little bit of training them and them training you for them training you like this is what we've got in stock, this is the client experience that happens when someone comes in. But then you communicating to them, like if I'm sending someone in and I have XYZ written as a recommendation, this is kind of the expectation of the type of shoe that they'll get into. So yeah, exactly what you were saying earlier. It's um building those relationships. But for some people or retailers that aren't that sort of medical specialty footwear retail, um then yeah, it can take a little bit more legwork, but that time investment initially is just going to serve you and your patients infinitely. Yeah.

SPEAKER_00 46:20

It's a huge addition to your practice. There's absolutely no doubt. Yeah. Well, it's been fantastic to have you on finally and link up with you. I'd love to talk all day with you, and I'm sure we're gonna uh find something that we can uh speak on again. But you are putting up a program, and I would I have no um shame in doing this for you, but P3 looks amazing. I've had a good flick through it. Um, if people want to, as you've said in your slogan, revolutionize their clinical practice, what you're doing is a huge addition. And uh I would encourage anyone to get on and have a look at it. There's a lot about plant fascia pain, there's a lot about strengthening and your footwear units, you know, it's gonna be so crucial for everyone in their daily practice. I really appreciate it. It's been so good and lovely to meet you too.

SPEAKER_01 47:15

Loved it. Yeah, finally putting a face to the name outside of the phone calls. Yeah, I've enjoyed it and I've yeah, from our chats, I think there's easily probably another day's worth of brain picking that I'd love to do.

SPEAKER_00 47:30

I think our common ground was also, you know, putting something out. Like I just want I just did this show just because I thought, you know what, this is just hopefully I can help people out and fill a gap with um I don't know something that people can refer to and just pick up little tips on. So and likewise, I know that you um, you know, probably a little bit frustrated as well in what you know goes on with uh clinical practice, but the the the gaps that people have week to week or day to day in finding information to enhance their practice.

SPEAKER_01 48:05

Yeah, that's spot on because I think the vast majority of clinicians do good work and they want to do good work, and because they're so busy running their practices, like if you have to, it's yeah, there needs to be more resources out there. So that's part of the motivation, and I think it's fantastic that there's more clinicians, yeah, like getting on podcasts, YouTube videos, creating courses and resources, and um like I know you guys with your sports podiatry course that you've put up, like there's so many good resources that are coming out that yeah, just trying to help the profession, like it's not a um selfish thing because uh I don't think people realise how much time and effort goes into creating content.

SPEAKER_00 48:56

Oh, huge.

SPEAKER_01 48:58

Um so often it's a labor of love. So I yeah, am immensely respectful and appreciative that there's great clinicians in this space that are contributing to it. So it is a huge kudos to you and your team as well.

SPEAKER_00 49:12

So you're also involved with the university over there?

Virtual In‑Service And Practitioner Problem Solving

SPEAKER_01 49:16

Yeah, I've just jumped into um. Yeah, so I'm teaching into uh the third year in um sports and the sports biomechan rehabilitation stream. So um they've just introduced a new subject that I'm working with a few other clinicians that we're teaching into, but it's kind of uh I'm like I'm biased because it's obviously my wheelhouse, but it's sort of the MSK subject that I wish I had when I was at uni. So it's um yeah, teaching the third year's basics of rehab, load management, returning to running, just the bare bones basics that I think will set up a foundation for at least having a little bit more confidence in clinical practice when you've got someone coming.

SPEAKER_00 50:08

Fantastic. Being down that pathway, it's worth it, it's worth every minute. Well done. Yeah, thank you. Appreciate that. Nice talking to you, and I'd love to uh love to chat all day and and also we'll get you back on at some point. But yeah, I will be logging on to P3. So yeah, hopefully everyone else does as well. Talisha, you champion. I love what you're doing, and uh good luck with the whole thing, and thanks for coming on the show.

SPEAKER_01 50:36

No, thanks, Jace. I appreciate it.

SPEAKER_00 50:38

Thanks for listening to Simply the Best Podiatry. That was Talisha Reeve from the Progressive Podiatry Project. And you can check uh Talisha's website, progressivepodiatryproject.com. There's also a podcast related to P3. If you subscribe to P3, you can get your monthly research roundup, which is a fantastic uh email that I receive. And uh there's plenty of information there, including running injury essentials, courses on Ankle practicals, which include taping, rehab framework, case study, or putting evidence into practice. Again, Check Progressive Pediatri Project. Thanks for listening. You can follow this show at SimplyTheBestPodry on Insta. Be sure to check the show notes and any support for this show is much appreciated. And I will be with you.