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Post by robertisaacs on Nov 2, 2007 19:26:38 GMT
I strongly doubt the latter! My technique is as follows. I make no claim to this being the only way, or indeed the right way, but it works for me. Seat the patient on the edge of a chair / platform with their knee bent at 90 degrees and the foot flat on the ground. Explain to the patient that you need to position their foot correctly. Ask them to relax their foot and not to push down, wriggle their toes etc. Position the STJ wherever you want it, (neutral or otherwise) place the foot lightly on the foam. Holding the ankle apply three point pressure to the foot in order to keep the position you have decided on. If the prescription indicates, dorsiflex the hallux to engage the windlass Place your left hand on the patients knee and your left shoulder on your left hand to apply steady pressure. Check that your right hand is still holding the foot in the position you want it. . Using the heel of your right hand to keep the pressure even on the forefoot apply steady downward pressure through the knee. Aim for 25% of patients body mass for most patients. If the foot has a correctable ff supinatus, and you wish to intrinsically post use the left hand to push the FF plantergrade. If you want a planterflexed 1st ray, plnaterflex the ist ray. Remove the foot and examine the imprint. If the foot had a non correctable FF supinatus and you want an intrinsic ff post press the ff plantergrade. Examine your patient standing in the desired ST position. Check the height of their lateral arch. If they don;t have one (most don't) and the box does (most do) press out the lat arch in the foam (unless you specifically want a lat arch. Thats another thread too). Make any other mods (ie ffo, neuro, pf groove etc etc) Or, For young or non compliant children Position them as above. Wish you'd taken a neurofen for the screaming Position the stj as above Lean back to stop them braining you with the wooden train Engage the windlass with the left hand and hold the 1st ray dorsiflexed and use the right hand to dab the foot into the foam, be quick, it literally is an in-out movement. The trick is to apply even pressure across the whole foot at the same time. Check imprint Swear under breath  Repeat. Apply sticking plaster to head where the train was longer than you realised. Regards Robert |
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Post by Martin Harvey on Nov 2, 2007 21:13:02 GMT
Hi all, I came across a gadget around a year ago that was a box the Pt stood on that had multiple (blunt) metal pins that were driven up (?by compressed air?/ ?magnetism?) into contact with the plantar surface while the weight - bearing foot was positioned according to the intent of the Pod'. I think it interfaced with a computer and prepared a Rx that a lab could work from. Is this a new/ old / effective / ineffective system? It reminded me of these things you can get in gadget shops that can take a 'cast' of your face etc, it seemed an interesting idea, and, if it worked, very simple.
Cheers,
Martin
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paulm
Junior Member
Posts: 61
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Post by paulm on Nov 3, 2007 7:41:34 GMT
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Post by robertisaacs on Nov 3, 2007 17:11:14 GMT
Sounds like Amfit
I've had a certain amount of experiance with this system. It has its points.
Impression wise i would say it is similar to foam apart from the amount of time it takes for the pins to raise. (which makes it unsuitable for paeds. Its VERY easy to modify the shape of the insole, you just use to software to manipulate the shape on the screen before you e mail the data to the lab. If you know what you are doing it is far quicker and cleaner than cast modding. It's weakness (for me) is that it can ONLY produce shank dependant EVA FFOs or HFOs. If thats what you are after, super. If you want something different, tough.
Like all systems it has pro's and cons. Like many systems it does what it does well... but that is ALL it does. Personally i would find it too limiting in terms of what it can produce but i know people who do good things with it.
Regards
Robert
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Post by dtt on Nov 3, 2007 17:59:34 GMT
Hi Robert Now I'm laughing tea down my nose ;D ;D ;D Nice one Cheers Derek  |
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Post by twirly on Nov 18, 2007 14:31:37 GMT
Afternoon boys & girls, (who seem to be in the minority methinks)  Tis just a thought, but the cogs have been grinding. (Ouch) Craig & Co. in far far away I'm a celeb get me outa here land, seem to be presenting the boot camp as a regular feature for Pods with either loadsa money for flights or in Oz to start with. I for one would be very interested if us Brits could come up with a boot camp of our own (slingback camp). I for 1 would be happy to travel to UK destinations to learn from others with far greater knowledge than my own). DTT & Robert just to mention 2. By the way: casting Vs crush boxes. flowers don't sit as nicely in POP. ;D |
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Post by dtt on Nov 18, 2007 18:43:47 GMT
Hi Twirly Remember what I told you " Be the best" which excludes me sorry There are far better "trainers" with far better minds and facilities than I Twirly ( mines mainly "dirty" these days but, just reminiscing in truth)  ( bloody old age ARGHH ) Robert & others, Davidh , Dave Smith ( if it is the Dave Smith I "know"  ) may be able to help ?? Anyway be lucky Cheers Derek |
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Post by ianl on Nov 19, 2007 9:06:00 GMT
Hi
Hi Twirly
I guess it will depend a little on what you are trying to get out of it. A boot camp that presents latest research outcomes (a paper course if you wish) or a camp that presents opportunity for people to iron out:
1. How to practically apply latest research outcomes (if at all possible)
2. How to apply specific techniques for assessment and treatment.
I quite enjoyed hearing Craig at the conference but the actual practical applications of what was said was missing (obviously that was not his remit). There again I tend to think that in many cases that present to us in PP the actual orthotic intervention can be simpler than we realise.
Out of curiosity, What would you want at a boot camp, who would organise and who would present it?
Cheers
Ian
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Post by twirly on Nov 19, 2007 10:49:30 GMT
Hi Ian, Thank you for your reply. I find I learn & retain information best through active participation. This being the case I personally would value a ''hands on'' approach to updating & improving my skills. I have seen events advertised in the pod mag but most were presented by labs (I always wonder if there will be a sales pitch for their products). The reason I find this forum & the arena so valuable is the fact that Robert, Craig & Co. freely discuss biomx in such a knowledgable way. Any suggestions? Regards, twirly  |
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Post by robertisaacs on Nov 19, 2007 12:04:18 GMT
Thats a damn good idea. I suspect everyone would want somebody else to do the actual course. Don't know where anyone got the idea that i know what i'm doing. Personally i would recommend Dave Smith as an unwholesomely clever bloke.
Having been on quite a few i find the problem with most courses is that they are usually run by either labs (which tend to become biased towards the labs products and form the sylabus with that in mind) or academics, in which case it often goes over clinical peoples heads as they split the atom with graphs, vectors and ideal world conditions where a patient has a single nicely defined set of symptoms and cause.
Perhaps what is needed is a course / seminar / learning event run BY clinicians FOR clinicians. Sometimes it is easier to learn from people closer to you in knowledge and background. Sort of "biomechanics for non biomechanists".
I'm seeing round table discussions. I'm seeing case historys brought by the delagates and discussed openly. I'm seeing a seminar format. I'm seeing practical exercises. I'm seeing 360 degree learning (lots of people doing presentations on stuff they know about rather than 2 or 3 people "teaching" and the rest "learning". I'm seeing debates on fun and contentious issues (flat earth anyone? bio-tensegrity perhaps?). I'm seeing a bunch of pi**ed podiatrists drunkenly trying to analyse the kinematics of one anothers ten pin bowling in the evening.
Sounds good to me.
Regards
Robert
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Post by ianl on Nov 19, 2007 12:49:39 GMT
Hi
OK. When David and I ran the course it was geared at 80% hands on and I got the impression that people gained from that approach, They would have to tell you. Not being academic the brains side of it may have lost out.
I like some of Robeers suggestions although the practicalities of pulling that together could mean possibly two courses with a couple days each, over a twelve month period say, in order to give real ground coverage. (Maybe a couple of days just for the bowling as well!!)
Now, bottom line, what would you be willing to pay for such events, bearing in mind that numbers may be small. Where would you want it - cheapest might be a hospital or would you pay money for somewhere more luxurious where the heat of the day can be chilled out later?
To get bigger numbers may mean getting big names, there again it could start, small run for 3 years getting bigger each time until its season is ended.
I'm not talking of organising it but tossing out questions that would inevitably arise. Whoever organises it may well want to make a profit from it. Certainly marketing it would be a mamoth task if you wanted something bigger than just a handful of people.
Or do people simply want to have a one off go next year over two days and see what happens. Again cost and organisation issues apply.
There are people around who may be willing to give their input for such an event just to be part of it, eg, the SOBSART folks might (who knows)
Ian
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Post by deekay38 on Nov 20, 2007 18:05:17 GMT
Robert Quote "i would recommend Dave Smith as an unwholesomely clever bloke." Unwholesomely clever??  How does that pan out - Good with mechanics but forever scratchin his nuts and has a slight wiff of Camembert. ;D ("Camembert cheese gets its characteristic wiff from many naturally occurring chemical substances betwen the toes, including ammonia, succinic acid and sodium chloride" (ref. - Wikipedia.org/reworked/edit)) Thanks for the compliment. (I think) LoL Dave |
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Post by robertisaacs on Nov 20, 2007 19:11:19 GMT
LOL ;D
It was a complement (albeit backhanded)
See i exalt you with karma as a gesture of my admiration.
Regards
Robert
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Post by dtt on Nov 20, 2007 20:16:35 GMT
Hi All I'll av some ;D Robert, Could I bring that vid as a case history ;D ;D ;D Dave I agree with Robert coz Only you could come out with that !!! ;D ;D Have another Karma on me Cheers Derek |
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Post by Martin Harvey on Nov 20, 2007 20:18:13 GMT
Hi Robert and Colleagues,
just to pick up on a point mentioned earlier in the thread Quote: .... a lot of orthotics prescribed by the NHS sit in the cupboard" end quote.
That is unfortunately true (or has been, at least at times) in my part of the world BUT it needs to be put in the context of the fact that many such orthotics I have seen have been exclusively; green AOL customisable 'footprints' that have simply been taken off a shelf in some stores somewhere and sent via post to patients entirely uncustomised.
I would hazard a guess that the reason for the above is a local lack of resources, either financial or human.
Its obvious that such are entirely different to Robert and Davids definition of an orthotic. Sports people who turn up at chez Dosthill with properly fabricated orthotics that have obviously been worn for years are in direct contrast to the 'throw them in the cupboard' situation.
Cheers,
Martin
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Beautiful people are inside out.
( bloody old age ARGHH 
) may be able to help ??
How does that pan out - Good with mechanics but forever scratchin his nuts and has a slight wiff of Camembert. ;D