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Post by robertisaacs on Feb 15, 2008 15:33:01 GMT
The Debate about how "complex" Biomechanics is has been running forever. David had been heard to say "its not rocket science". However it is possible to get it very badly wrong and sometimes i wonder if people should be allowed to even have a go. The following was found in the shoe of a patient with a significant PVD, high BMI, and who walked at best very slowly with a zimmer... Critique if you will... (ps sorry bout the size)   |
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Post by dtt on Feb 15, 2008 16:09:50 GMT
Hi Robert Is this some sort of joke or perhaps an attempt to recycle bits from the bin ??  You may want to cry mate but I bet the patient did more than you !! Bloody disgrace Cheers D  |
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Post by blinda on Feb 15, 2008 16:24:28 GMT
i don`t claim to be a biomech whiz....but even I can`t begin to see what, whoever created this masterpiece was trying to do! So they have cut out the 1st MPJ, but then placed what looks like fleecy web? under the 1st MPJ? Most disturbing is the forefoot posting....and this is a pt with PVD and limited mobility??
As Del says, you sure they weren`t using up their left over bits of felt and wedges?
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Post by Admin on Feb 15, 2008 18:00:31 GMT
It isn't rocket science ;D Pt's leg just dropped off - Don't start treating their functional hallux limitus! BTW I have a similar "device" in my Black Museum prescribed by a pod working for the Leicester NHS. I wrote to the Pod Dept to "point out their error", and had an a*s*y phone-call from their Head of Service who was very unpleasant - evidently the "poor girl" in question " was most upset"! |
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Post by robertisaacs on Feb 15, 2008 18:39:47 GMT
Its worse than it looks.
The Forefoot post you refer to is, if you look carefully, under the midfoot.
The Cavity in the SCF and the cavity in the freelan do not, in fact, line up!
(i think the scf must have shifted.)
The pink stuff under (alledgedly) the 1st met head is that really soft
foam which they use in tubefoam and tubepad, name escapes me.
The one which reaches max compression under about 30 grams.
The 5 degree wedging is not beveled. Thats Unacceptable in a
patient with PVD but perhaps understandable for a chairside made with no
access to a grinder (although you can do it with a 10 blade if you are careful / good
/ not attached to your fingers). The SCF is also not beveled! Thats just bloody lazy!
I think what the person must have been trying to acheive with the
midfoot posting was some kind of planterflexion on the 1st met.
Why they thought that this would work when they have not put any
kind of valgus filler in and have bunged a bloody great lump of SCF
on the top of the freelan i have no clue. I suspect they did not think
that far ahead! What this pad amounts to is a medial heel wedge /
raise and a lateral forefoot wedge.
Black museum. Love it.
Most upset? Diddums! If somebody on my team produced
something like this i'd have them flogged! (sotto voice conversation
with manager off to stage left.) Or give them training. LOTS of
training.
I got in a bunch of trouble for refusing to make a chairside
prescription for something equally horrific when a fresh, wet behind
the ears podiatrist. The prescriber, a Pod of some 30 years
experiance was most upset.
It Ain't rocet science... But some pods Ain't rocket scientists!
Can you imagine the damage this person could do with access to
a full orthotics lab? It frightens me. And more so when one
considers that it is not such an isolated incident...
Depressed of Maidstone
Robert
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Post by RobinCrawley on Feb 15, 2008 20:04:33 GMT
On my browser I'm not getting a picture of the orthoses...
Is it just me or is something wrong?
Wonderingly,
Robin.
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Post by twirly on Feb 15, 2008 20:19:05 GMT
Dearest Robin, On my browser I'm not getting a picture of the orthoses... Is it just me or is something wrong? Wonderingly, Robin. Please blame Robert. It's all his fault. He even admitted it. ;D Regards, that twirly 1 |
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Post by robertisaacs on Feb 15, 2008 20:27:18 GMT
The wife used to say "its all your fault". She has discarded this in favor of "i blame you" Same outcome, but more technically accurate!  Robert He who is that gets blamed. Although in the words of the great poet shaggy, "it wasn't me!" |
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Post by blinda on Feb 15, 2008 20:27:43 GMT
The lack of beveling (sp?) is an understatement. I looked again, and yes it is indeed the mid foot, not the forefoot (not too easy to see from here - see Twirls post).
From your description i can see, albeit at a skew angle, that plantarflexion of the 1st ray was what the creator was trying to acheive, but I too would have added a valgus pad.
Despite my lack of confidence in producing custom orthoses, this confirms that i actually can`t be too bad!!
Cheers,
Bel
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Post by dtt on Feb 15, 2008 20:48:54 GMT
Hi Bel As I told you and Twirls!! why does no one believe me D |
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Post by Admin on Feb 15, 2008 21:08:49 GMT
He who is that gets blamed. Although in the words of the great poet shaggy, "it wasn't me!" Or, in the words of Bart but, I'll admit, praphrasing Shaggy - "I didn't do it!" ;D |
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Post by blinda on Feb 15, 2008 22:07:03 GMT
cheers Del, nice to know someone does!
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ronm
Full Member
but a simple man working against insurmountable odds
Posts: 141
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Post by ronm on Feb 18, 2008 20:13:20 GMT
robert,
out of curiosity, what did you do for this patient?
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Post by robertisaacs on Feb 18, 2008 21:02:57 GMT
Attaboy. Back to the podiatry.
Actually all i did was whack a 6mm poron lining in the shoe which was a cosyfeet elastine special. Virtually unlimited depth, its like a pristine canvas! I love em.
I'll do something clever when the ulcer has healed up. For now he's in Semi compressed felt and allyvn. 10mm valgus pad, and 7mm from midfoot to base of digits with a cavity under the ulcer 1st met. and a deep bevel posterior.
Orthotics are great and i can do some pretty nifty stuff with them. But Semi compressed felt is king for an active ulcer.
I Did'nt really get time to do a full assessment but i suspect the insole when he is healed will be a shank dependant Lunarsoft 2/3rds length with soft tissue deviation compensations as needed and a Poron 94 5mm over poron 5mm laminate forefoot extention with elevations for any mobile planterflexed metatarsals as needed.
Regards
Robert
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ronm
Full Member
but a simple man working against insurmountable odds
Posts: 141
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Post by ronm on Feb 18, 2008 23:24:04 GMT
didn't realize the patient had active ulceration be interested to see what you come up with when you really put a bit of thought into it ;D ;D |
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Beautiful people are inside out.
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