WEBVTT
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Welcome to Sole Science, the official podcast
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of Sports and Exercise Podiatry Australasia.
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Each episode, we sit down with leading clinicians,
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researchers and innovators from across sports
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medicine, biomechanics and podiatry to unpack
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the ideas shaping our profession. From cutting
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edge research and clinical pearls to career journeys,
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controversial topics and lessons learned along
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the way, we're here to bridge the gap between
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science and practice. Whether you're a student,
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clinician, researcher or simply passionate about
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human movement. Join us as we explore the evidence,
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challenge assumptions, and discover what it takes
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to keep people performing at their best. This
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is Sole Science. John Charles. Evening. I'm quite
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excited about tonight because we have, I guess,
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a very special episode for our listeners. This
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is the first time we're running a panel. Let's
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step right into it. Today's episode is a special
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panel of Sole Science, bringing together some
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of the leading voices shaping the future of custom
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foot orthoses. across clinical practice, manufacturing
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and digital innovation in Australia. This is
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not a single perspective. That is the ecosystem.
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Tonight, we're joined by a panel that represents
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the full spectrum of orthotic development from
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clinician to lab, from traditional craftsmanship
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to advanced digital workflows. First up, we have
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Kent Sweeting. He is the owner of Queensland
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Orthotic Lab and a clinician researcher with
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over two decades of experience across private
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practice, academia and manufacturing. A first
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class honours graduate from QUT, Kent's work is
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in Achilles tendinopathy and has been recognised
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nationally and is a contributing author to Bracken
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& Kahn's Clinical Sports Medicine. He has served
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as the president of formerly APSIM, now SEPA,
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worked within the 2018 Commonwealth Games Polyclinic
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and continues to contribute to high performance
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environments including Queensland Ballet. We
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also have up next Rhys Pierce. He's the General
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Manager of Footwork, bringing a unique perspective
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as both a clinician and a senior leader in orthotic
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manufacturing. After establishing and growing
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a multidisciplinary podiatry clinic, Rhys transitioned
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into a lab environment where he oversees the
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broader Footwork operation. His experience across
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both sides of the profession provides a rare
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insight into how orthotics are prescribed, produced
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and scaled in modern practice. Thirdly, we have
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Konrad Job. He's a podiatrist specialising in
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orthotic technology and digital manufacturing
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systems. He's closely involved in the development
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of LaserChem orthotics platform, and works across
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clinics, laboratories and universities to advance
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how orthoses are designed and produced. Konrad
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also plays a key role in educating clinicians
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on 3D scanning, digital workflows, while contributing
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to ongoing research exploring differences in
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foot capture techniques. And lastly, we have
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Darcy Dore. He's a sports podiatrist at the Run
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Clinic in Brisbane with a clinical focus on running
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-related injuries and performance. Alongside
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his clinical work, Darcy is involved in research
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with QUT exploring advanced footwear and material
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science. Through his work with Propel 3D, Darcy
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is helping bringing in -house orthotic manufacturing
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into clinics, utilizing 3D printing, TPU materials
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to reshape turnaround times, customization, and
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clinician control. Gentlemen, thanks for coming
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on tonight. Welcome. Good to be with you guys.
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Thanks for having us. Thanks, Pat. Thanks, JC.
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I guess in a rare opportunity, we have a panel
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tonight rather than individual guests. We're
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going to throw this to the floor and I'll probably
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start with you first, Kent. How do you define
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success when you're looking at orthosis in clinical
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practice and what are your markers for success?
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Yeah, I think for me success is when the orthotic
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changes the load in the way that the clinician
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intended and the patient can comfortably tolerate
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that change. So, you know, we need the orthotic
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to be comfortable. But, you know, we need to
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get to a certain end point. So sometimes that
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might be symptom resolution, but other times
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it's, you know, producing tissue stress to enable
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a loading progression. So, yeah, I guess that's
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how I would define it. Darcy? I would definitely
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second Kent's version there. I think that an
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orthotic that is... modifying the load that needs
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to be modified in order for the person to do
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what they need to do and obviously sometimes
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that's temporary a lot of the times it's not
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and looks very different for different people
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but um yeah sometimes we're thinking more about
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kinematic changes sometimes more about kinetic
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if we can measure them but yeah i'd second second
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Kent's points Rhys i'll probably direct you
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next um but just to add on to that question i
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guess you've lived through a career where you've
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transitioned from traditional orthotic manufacturing
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to now more 3d printing how do you define success
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and has that changed since you've adopted new
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technologies yeah so it's it's a good question
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pat because i'd say probably halfway through
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my now career is when we did see that change
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uh around 2019 into 3d printing and i don't necessarily
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think the change in material or manufacturing
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technique has changed my perspective on clinical
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outcomes. For me, it's about the patient journey
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and the patient outcomes. When someone presents
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to the clinic, are they presenting because of
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their pain or are they presenting because their
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lack of ability to... you know, runner or compete
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in a sub five hour half iron like JC on the weekend.
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So is it about the pain that they're presenting
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or is it the lack of, or the ability or inability
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to actually compete or do what they want to do?
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It may just be as simple as keeping up with their
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kids. So for me, it's about defining what that
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outcome is. And if we can achieve that outcome
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through the use of orthoses or combining that
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with other treatment options, that helps to define
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success for me. cool and as um obviously you
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guys all work in a laboratory environment and
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um i guess i'm interested to know like where
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from a lab end where do you feel like your measure
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of success comes from the orthotic like is it
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is it people reordering orthotics is it kind
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of you know happy is it the relationship you
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build up with a podiatrist or are you really
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interested in the end result when it comes to
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patients i think personally jc if that was um
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directed it at me uh i really get satisfaction
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around podiatrists when they not just have their
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patients successful outcomes the orthotic is
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matching their expectation as well and i think
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we see that when podiatrists really invest in
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understanding terminology and also understand
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you know, processes of orthotic manufacturer
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as well. So, you know, when people come back
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and say, look, the orthotic achieved exactly
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what I wanted to achieve on the fitting and consultation,
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and then follow up down the track and say, look,
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my patient's now pain -free or they're able to
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compete in a certain event or play football on
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the weekend, et cetera. You know, that's success
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in my perspective. Konrad, can you tell us your
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perspective on success and how your orthotic
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laboratory, I guess, develops over the years?
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A big question. I'd have to sort of reiterate
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a lot of what the other panellists said and,
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you know, on Rhys' comment about, you know, markers
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in their quality of life, like stripping it back
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to the important things for the individual patient.
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Like I think Rhys said walking with their kids,
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you know, having a grandpa be able to go to the
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park and, you know, enjoy spending time with
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their family to a greater extent. If you strip
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it back to the orthotic, itself you know we you
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might be looking at initially whether it simply
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matches the prescription in the clinic you know
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having a certain series of checks to make sure
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you know are all the features that i requested
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in the correct locations does it properly fit
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the footwear Does it fit the foot in a weight
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-bearing position out of shoes and within shoes?
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And then, you know, making sure that the patient
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understands the purpose of the devices and, you
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know, engaging with the treatment. And, of course,
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comfort, as the other panellists said as well.
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You know, I don't think many podiatrists would
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be doing, you know, 100mm visual analogue scales
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of, like, comfort and pain, but, of course, some
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would. Usually it's just sort of a conversation.
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I think more interestingly, we see measures of
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success, like for me, working with maybe hospitals
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where they have Intu PDAR systems and things
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like that, where you can get more objective data
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on reductions in pressure to see more visible
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change in healing of ulcers and things like that.
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And what was the second part to your question
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there, Pat? Tell us about the history of laser
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cam. short and sweet and tell us um how your
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products have been developed yeah well it actually
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started in 1997 there was actually four podiatrists
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that started the lab um it was called adelaide
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podiatry group it's before my time i think it
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was about eight years old and at the time we
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were using a system called amfit which i'm sure
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everyone knows and the old owner at the time
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who was a great boss, but a very polarizing figure
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in the profession as well. He started developing
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his own software because he wanted more control
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over the entire CAD process. So since then, it's
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been purchased by three new owners. We're under
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a different umbrella now called GMZ Medical,
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but we're basically just continuing to write
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software and try and improve our CAD. That's
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our focus. Awesome. I guess we'll move on to
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a slightly more controversial topic so um i guess
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we're quite interested to know you know what
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your guys views are on i guess you could call
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it the over prescription of orthotics or maybe
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prescribing orthotics in cases where they're
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they're not required or patients are asymptomatic
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um where where do you guys stand on it and i
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guess it's for anyone to kind of chip in initially
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uh do you feel like the orthotics are often over
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prescribed when when other approaches could be
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taken first i think we're currently in a landscape
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where uh footwear can make a really big difference
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to pressure and loads on the bottom of the feet
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so orthotics are obviously you know can be over
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prescribed by podiatrists where you know having
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the shoes be able to do so much of that work
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it's just making our job i think a lot easier
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and probably a little bit less likely to over
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prescribe considering the shoe can do quite a
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bit what do you guys think Yeah, I think it's
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a very difficult question to answer from a lab
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perspective, because, you know, from a lab perspective,
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we're just trying to manufacture the best possible
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product based on our prescription. So our role
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isn't really to determine someone's justification,
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essentially, for the orthotics. But, you know,
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I guess for me, I don't really see orthotics
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as much of a performance device, more of it as
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like a treatment modality. So, you know, I think.
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prevention in asymptomatic patients gets a little
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bit gray especially for you know pediatric populations
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where it probably it's it's not justified a custom
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orthotic compared to something like a prefab
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um and i think our focus should probably be more
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on conditions um you know that are symptomatic
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or clearly limiting function and quality of life
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i just say that maybe a caveat is like you know
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it might not be this way forever we can see that
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modern footwear as you brought it up you know
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it definitely influences performance significantly
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you know what is it like uh every world record
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from 5k to marathon or something has been broken
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in the last how how many years five years or
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something like that 2017 i think yeah so um i
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don't think it's unreasonable to you know have
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clinicians that have very specific sports focused
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you know experience the prescribing for performance
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reasons but that's just not me because i don't
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i'm not in that role yeah i think uh as a profession
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um being podiatry it's really important to not
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necessarily contribute to the hysteria of over
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prescribing i think one of sort of certainly
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my clinical ethos is pathomechanical prescribing.
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Are we prescribing based on a pathological presentation
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in combination with a mechanical assessment as
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well? So if you can then sort of measure that
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pathomechanical finding and... as part of your
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patient's treatment journey, contribute to that
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with an orthomechanical device. It's justified.
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But as Darcy said, the use of a holistic treatment
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approach with footwear, load -based exercise
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treatments, I think is really important as well.
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And like we mentioned before with... Footwear,
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you know, obviously footwear has contributed
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significantly to performance, but has it also
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contributed to, you know, injury as well? I certainly
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see a lot more patients present laterally loading
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through the use of low density, you know, midsole
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shoes when, you know, that's not necessarily
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the most appropriate treatment option for them,
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albeit, you know, that shoe may be over prescribed.
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uh so i think definitely podiatry needs to retain
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uh i guess a high level of education around orthotics
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and these sorts of sessions will contribute to
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that but also at the university level the educational
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level as well kent do you want to weigh in yeah
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look don't disagree with anything that's been
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said by the other panelists there i guess my
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only point to add um to that is from a purely
00:14:48.490 --> 00:14:50.830
athletic performance or high performance you
00:14:50.830 --> 00:14:55.509
know lens um and and really you know in that
00:14:55.509 --> 00:15:00.230
sort of uh population i guess we need to ask
00:15:00.230 --> 00:15:04.570
ourselves you know is their morphology interacting
00:15:04.570 --> 00:15:06.909
with their training load in a way that deserves
00:15:06.909 --> 00:15:12.230
intervention um so um you know that group of
00:15:12.230 --> 00:15:15.399
individuals you know, we might use that lens
00:15:15.399 --> 00:15:20.379
a little more so than, say, an asymptomatic paediatric
00:15:20.379 --> 00:15:24.419
patient. Good one. All right. Next question off
00:15:24.419 --> 00:15:28.039
the panel, and I'll probably start with Rhys
00:15:28.039 --> 00:15:31.620
with this one. Who owns orthotics as a profession?
00:15:31.860 --> 00:15:36.240
Should podiatrists remain the people who prescribe
00:15:36.240 --> 00:15:38.899
orthoses? Because we know chiropractors, physiotherapists,
00:15:39.019 --> 00:15:42.100
even some sports doctors to a degree. We've got
00:15:42.100 --> 00:15:46.539
one. around the corner who prints his own. Who
00:15:46.539 --> 00:15:49.139
should own this? Because I get we get the private
00:15:49.139 --> 00:15:51.580
health insurance codes, but is it something that's
00:15:51.580 --> 00:15:55.080
within our scope to keep? Yeah, Pat, I'll throw
00:15:55.080 --> 00:15:57.259
it back to you. What is an orthotic? That's a
00:15:57.259 --> 00:16:01.179
very good question. Because if we're talking
00:16:01.179 --> 00:16:05.879
about custom foot orthoses based on a 3D scan
00:16:05.879 --> 00:16:08.500
or a plaster cast or a physical impression, I
00:16:08.500 --> 00:16:11.440
think podiatrists need to own that as a profession.
00:16:12.619 --> 00:16:17.279
We're all aware of other professions, you know,
00:16:17.279 --> 00:16:21.220
prescribing certain types of in -shoe devices.
00:16:21.700 --> 00:16:25.679
But I think custom prosthesis, you know, manufactured
00:16:25.679 --> 00:16:28.759
from a scan or a physical impression, it needs
00:16:28.759 --> 00:16:30.399
to be something that the podiatry profession
00:16:30.399 --> 00:16:36.440
continues to own and educate and grow because
00:16:36.440 --> 00:16:40.580
it is, at the end of the day, as you said, a
00:16:40.580 --> 00:16:46.500
private health podiatry -specific intervention,
00:16:46.759 --> 00:16:49.840
which would, I guess, suggest that it is something
00:16:49.840 --> 00:16:52.320
that podiatrists should continue to excel in
00:16:52.320 --> 00:16:55.419
over other professions. Tasi? Yeah, I think that's
00:16:55.419 --> 00:16:58.100
a really good point Rhys made, that it is important
00:16:58.100 --> 00:17:00.299
for the podiatrist to be the most proficient
00:17:00.299 --> 00:17:04.700
at prescribing for orthotics, and also that if
00:17:04.700 --> 00:17:08.359
another profession is prescribing, that they
00:17:08.359 --> 00:17:11.069
may not be using an actual scan and impression
00:17:11.069 --> 00:17:17.109
of the foot. So yeah I also do think that some
00:17:17.109 --> 00:17:20.769
simple prescriptions could be done by a non -podiatrist
00:17:20.769 --> 00:17:24.170
where there's a clear evidence base for say if
00:17:24.170 --> 00:17:27.569
it was you know patellofemoral pain for a simple
00:17:27.569 --> 00:17:32.390
foot orthotic or you know a plantar foot problem
00:17:32.390 --> 00:17:35.730
that can be you know usually improved by some.
00:17:36.170 --> 00:17:38.849
medial support. Obviously, there's a bit of space
00:17:38.849 --> 00:17:43.430
for that to go wrong, but I think that it could
00:17:43.430 --> 00:17:45.529
be helpful. I think podiatrist books are generally
00:17:45.529 --> 00:17:49.190
pretty full for the most part, and people can
00:17:49.190 --> 00:17:52.730
buy all sorts of things on the internet. So having
00:17:52.730 --> 00:17:58.529
a competent physiotherapist prescribe a basic
00:17:58.529 --> 00:18:02.490
off -the -shelf medial supporting device is not...
00:18:02.670 --> 00:18:04.950
the biggest problem that I see. But I do think
00:18:04.950 --> 00:18:07.730
that, as Ray said, podiatrists should be able
00:18:07.730 --> 00:18:09.529
to have the ownership over things that are more
00:18:09.529 --> 00:18:14.150
specialised and provide, you know, the most quality
00:18:14.150 --> 00:18:16.630
foot orthotics for whatever outcome we're trying
00:18:16.630 --> 00:18:19.109
to achieve. Can I interject here? And I'll probably
00:18:19.109 --> 00:18:21.069
direct this at Kent because I'm building on that
00:18:21.069 --> 00:18:23.549
original question. If we're talking about foot
00:18:23.549 --> 00:18:25.970
capture foundations, right, whether that be plaster
00:18:25.970 --> 00:18:30.759
casts, slipper sock. phone boxing or scanning
00:18:30.759 --> 00:18:34.420
with various technology we have now, if there's
00:18:34.420 --> 00:18:37.019
no solid sort of evidence to say is one better
00:18:37.019 --> 00:18:41.240
than the other, right? And it sounds like anyone
00:18:41.240 --> 00:18:44.440
can really capture a foot apart from, you know,
00:18:44.460 --> 00:18:46.960
people who go to uni to do plaster casting, because
00:18:46.960 --> 00:18:49.019
that's, I guess, probably the only refined technique
00:18:49.019 --> 00:18:53.660
that requires a high repeatability. Kent, what
00:18:53.660 --> 00:18:57.859
are your thoughts on foot capture methods, right?
00:18:58.640 --> 00:19:01.079
Does the perfect position matter? Absolutely,
00:19:01.279 --> 00:19:04.480
yeah. I think, you know, to your first point
00:19:04.480 --> 00:19:10.420
around, you know, this who owns orthotics or
00:19:10.420 --> 00:19:13.400
custom orthotics, so to speak, I think it comes
00:19:13.400 --> 00:19:17.599
down to clinical reasoning and orthotic therapy
00:19:17.599 --> 00:19:22.759
really belongs with the profession that has the
00:19:22.759 --> 00:19:25.380
deepest understanding of foot structure, you
00:19:25.380 --> 00:19:28.250
know, lower limb function. tissue stress, et
00:19:28.250 --> 00:19:32.150
cetera. And that's podiatry. That's, you know,
00:19:32.150 --> 00:19:37.430
we should absolutely be proud of that. You know,
00:19:37.450 --> 00:19:41.730
so I think if another profession can perform
00:19:41.730 --> 00:19:45.789
a thorough assessment, you know, understand forefoot
00:19:45.789 --> 00:19:48.150
to rearfoot relationship, you know, to your point,
00:19:48.349 --> 00:19:51.769
you know, prescribe from a defined reference
00:19:51.769 --> 00:19:55.049
position, all of those sorts of things, then.
00:19:55.720 --> 00:19:58.880
then maybe there's some scope there. But I think
00:19:58.880 --> 00:20:05.619
to the second part of your question, a high -quality
00:20:05.619 --> 00:20:09.779
capture must represent a clinical meaningful
00:20:09.779 --> 00:20:13.039
position and one that the orthotic can generate
00:20:13.039 --> 00:20:18.119
a desired mechanical effect from. So I think
00:20:18.119 --> 00:20:21.079
having that reference point at the start and
00:20:21.079 --> 00:20:23.660
having that being a consistent, repeatable reference
00:20:23.660 --> 00:20:27.650
point, I think that's critical. I think we all
00:20:27.650 --> 00:20:31.329
understand the variability, you know, in orthotic
00:20:31.329 --> 00:20:33.829
manufacture and orthotic therapy, broadly speaking.
00:20:34.049 --> 00:20:38.509
So, you know, my interpretation is why add another
00:20:38.509 --> 00:20:40.710
variable into it? If we can be pretty consistent
00:20:40.710 --> 00:20:44.369
with our starting point, then surely that's going
00:20:44.369 --> 00:20:48.490
to be more helpful than adding in more inconsistency.
00:20:48.970 --> 00:20:52.789
So just talking about foot captures and maybe
00:20:52.789 --> 00:20:55.250
this one for Comrade. like is there is there
00:20:55.250 --> 00:20:58.470
a perfect position like as a as a lab can you
00:20:58.470 --> 00:21:00.730
can you easily pick up when a capture's been
00:21:00.730 --> 00:21:02.950
done poorly and then are there things that people
00:21:02.950 --> 00:21:05.490
commonly do badly when it comes to foot captures
00:21:05.490 --> 00:21:11.069
yeah so obviously like it's a really hard question
00:21:11.069 --> 00:21:14.369
because on the one hand i want to answer it by
00:21:14.369 --> 00:21:16.630
saying that i want everything to be done in a
00:21:16.630 --> 00:21:19.490
repeatable way um that's very consistent but
00:21:19.490 --> 00:21:24.640
you know i think the intent behind how the foot
00:21:24.640 --> 00:21:27.859
is captured is important as well um you know
00:21:27.859 --> 00:21:31.460
for example like if we look at fully weight bearing
00:21:31.460 --> 00:21:35.380
scanning right it is the most repeatable way
00:21:35.380 --> 00:21:37.900
to capture a foot right it's going to have good
00:21:37.900 --> 00:21:41.740
inter -rater reliability between all of us we
00:21:41.740 --> 00:21:44.660
get someone to stand up and press press go on
00:21:44.660 --> 00:21:47.259
the scanner but i think the the more important
00:21:47.259 --> 00:21:50.150
question with it is it's only repeatable for
00:21:50.150 --> 00:21:52.589
one part of the process and which part of the
00:21:52.589 --> 00:21:57.170
process is repeatability important for so you
00:21:57.170 --> 00:21:59.809
know I just captured you know 20 subjects for
00:21:59.809 --> 00:22:01.869
a scan that we're doing with Flinders Uni in
00:22:01.869 --> 00:22:05.690
seven different positions and I'm fairly confident
00:22:05.690 --> 00:22:10.109
on the reliability intro rater of the scanning
00:22:10.109 --> 00:22:13.710
methods but the repeatability on its own doesn't
00:22:13.710 --> 00:22:16.430
necessarily make it the most appropriate capture
00:22:16.430 --> 00:22:20.950
for the orthotic so we've had situations where
00:22:20.950 --> 00:22:23.750
you know we've had a clinician send us a fully
00:22:23.750 --> 00:22:26.670
weight -bearing scan and although the capture
00:22:26.670 --> 00:22:29.289
method is repeatable the podiatrist being you
00:22:29.289 --> 00:22:31.589
know surprised and disappointed when the orthotic
00:22:31.589 --> 00:22:34.049
comes back flat you know i'm sure that every
00:22:34.049 --> 00:22:37.829
person here like at the lab environment has had
00:22:37.829 --> 00:22:39.750
that situation we get a fully weight -bearing
00:22:39.750 --> 00:22:42.990
scan and the orthotic comes back flat and it's
00:22:42.990 --> 00:22:47.509
a little bit unexpected so um i guess in summary
00:22:47.509 --> 00:22:50.359
like with foot capture what we try and educate
00:22:50.359 --> 00:22:55.000
is to have like an intention behind the shape
00:22:55.000 --> 00:22:57.079
that you're capturing because the purpose is
00:22:57.079 --> 00:23:00.559
to match the shape of the scan to the final product
00:23:00.559 --> 00:23:03.299
as closely as possible so you can better understand
00:23:03.299 --> 00:23:07.920
you know how you're applying prescription variables
00:23:07.920 --> 00:23:10.380
to the surface of the orthotic so it's not necessarily
00:23:10.380 --> 00:23:14.279
one way at all times it could change and it might
00:23:14.279 --> 00:23:16.539
even be pathology driven in the end i'm not really
00:23:16.539 --> 00:23:19.180
sure so I don't think anyone knows the perfect
00:23:19.180 --> 00:23:23.299
answer yet. Rhys, I guess your laboratory accepts
00:23:23.299 --> 00:23:28.660
all sorts of products from plaster casting to
00:23:28.660 --> 00:23:33.000
3D scanning. Do you have a preference or what's
00:23:33.000 --> 00:23:35.779
your sort of take on how the foundations of foot
00:23:35.779 --> 00:23:39.900
capture should be processed? Yeah, lots of good
00:23:39.900 --> 00:23:42.579
points raised so far. I think combining this
00:23:42.579 --> 00:23:45.019
with the previous question of what should podiatrists
00:23:45.019 --> 00:23:48.559
be? Or how should podiatry sit in the scheme
00:23:48.559 --> 00:23:50.700
of orthotics? I think podiatrists should choose
00:23:50.700 --> 00:23:54.539
the highest quality of capture. You know, we've
00:23:54.539 --> 00:23:57.960
got research now around higher quality versus
00:23:57.960 --> 00:24:01.880
lower quality, accuracy and reliability, reproducibility
00:24:01.880 --> 00:24:04.460
of certain scanning modalities. And I think if
00:24:04.460 --> 00:24:07.039
podiatry wants to own that product, being orthotics
00:24:07.039 --> 00:24:10.759
or 3D custom put orthotics, it should continue
00:24:10.759 --> 00:24:15.140
to. you know, except the highest level. So we
00:24:15.140 --> 00:24:17.319
know nowadays things like LiDAR and TrueDepth
00:24:17.319 --> 00:24:20.059
are widely available for everyone who has an
00:24:20.059 --> 00:24:22.779
iPhone or everyone who has an iPad Pro, but we
00:24:22.779 --> 00:24:27.900
know they have a higher variability rate compared
00:24:27.900 --> 00:24:31.859
to iCubes, E500s, you know, iCube Mini, Structure
00:24:31.859 --> 00:24:34.759
Sensor Scanners, which provide consistency across
00:24:34.759 --> 00:24:39.759
a range of devices. So, look. I think like Konrad
00:24:39.759 --> 00:24:42.700
said, we'd all like the perfect world where every
00:24:42.700 --> 00:24:45.059
scan is high quality and produced in the same
00:24:45.059 --> 00:24:47.559
system. But I think as long as we know that there
00:24:47.559 --> 00:24:50.789
is... confidence in accuracy and reliability
00:24:50.789 --> 00:24:53.109
of the scanning modality it should be accepted
00:24:53.109 --> 00:24:57.890
position is important agree and we do see some
00:24:57.890 --> 00:25:01.829
obscure positions but i think one of the most
00:25:01.829 --> 00:25:04.009
important things there is contact your lab and
00:25:04.009 --> 00:25:06.049
speak to your lab and ask them about their processes
00:25:06.049 --> 00:25:08.670
and how they prefer you know scanning and how
00:25:08.670 --> 00:25:10.750
that influences the orthotic design and manufacture
00:25:10.750 --> 00:25:13.509
and collectively you'll get the outcome that
00:25:13.509 --> 00:25:17.210
you're looking for awesome um this question our
00:25:17.210 --> 00:25:20.269
initially directed to Darcy given that he works
00:25:20.269 --> 00:25:22.289
in an environment where you're you're uh producing
00:25:22.289 --> 00:25:25.910
orthotics at the chair side um or very quickly
00:25:25.910 --> 00:25:29.029
have you found with 3d printed orthotics like
00:25:29.029 --> 00:25:31.049
there is you lose something in terms of your
00:25:31.049 --> 00:25:34.529
capacity to to modify or adjust orthotics i mean
00:25:34.529 --> 00:25:36.950
is the future just reprinting another set of
00:25:36.950 --> 00:25:39.509
orthotics when the first when the circumstances
00:25:39.509 --> 00:25:44.220
change yeah i guess by um uh Further eliminating
00:25:44.220 --> 00:25:47.019
the question, obviously, we've had SLS 3D printed
00:25:47.019 --> 00:25:49.779
for a while, you know, through the major labs.
00:25:50.200 --> 00:25:52.700
In terms of what we've been doing with Propel
00:25:52.700 --> 00:25:56.339
3D, being more the FDM printing where, you know,
00:25:56.339 --> 00:25:59.180
you have the small 3D printer that is able to
00:25:59.180 --> 00:26:02.259
be put in the clinic's laboratory and then have
00:26:02.259 --> 00:26:07.460
the orthotic printed out there. So, yeah, we'll
00:26:07.460 --> 00:26:12.880
call it the FDM printed devices. ability to modify
00:26:12.880 --> 00:26:16.000
through the bottom you know compared to you know
00:26:16.000 --> 00:26:19.000
an eva for example where it's a continuous material
00:26:19.000 --> 00:26:21.220
the whole way through it's not quite as good
00:26:21.220 --> 00:26:24.059
where you know you can start to go through the
00:26:24.059 --> 00:26:27.319
uh the top shells essentially or the bottom shells
00:26:27.319 --> 00:26:32.019
and uh you know it's it's not as a continuous
00:26:32.019 --> 00:26:35.940
material like like eva is so maybe a little bit
00:26:35.940 --> 00:26:38.059
but it's not it's not really rocket science in
00:26:38.059 --> 00:26:39.779
terms of being able to modify how you'd like
00:26:39.779 --> 00:26:43.680
it um and then have the device still maintain
00:26:43.680 --> 00:26:47.000
a high quality and structural integrity. The
00:26:47.000 --> 00:26:50.579
other thing with the FDM printed orthotics is
00:26:50.579 --> 00:26:52.380
that there's actually dramatically less need
00:26:52.380 --> 00:26:54.960
to modify them in the first place, oftentimes,
00:26:55.359 --> 00:26:58.859
particularly with the ability just to create
00:26:58.859 --> 00:27:04.059
the actual solid device in terms of the dimensions
00:27:04.059 --> 00:27:08.480
and the shape to just drop straight into the
00:27:08.480 --> 00:27:13.339
shoe. the you know one of the key advantages
00:27:13.339 --> 00:27:15.740
other you know key advantages just being the
00:27:15.740 --> 00:27:19.539
the turnaround times you can get the modifications
00:27:19.539 --> 00:27:22.559
to be very specific can obviously tune the densities
00:27:22.559 --> 00:27:25.339
use different materials you know have your uh
00:27:25.339 --> 00:27:28.819
you know person with a high pressure lesion come
00:27:28.819 --> 00:27:32.000
in you know in the morning and then dispense
00:27:32.000 --> 00:27:34.539
the foot of like in the afternoon in the the
00:27:34.539 --> 00:27:38.420
same clinic but um you haven't really found many
00:27:38.420 --> 00:27:43.420
downsides that don't compete with downsides of
00:27:43.420 --> 00:27:45.859
other types of devices in terms of the grass
00:27:45.859 --> 00:27:48.420
being greener on the other side and just having
00:27:48.420 --> 00:27:53.099
different problems. Can I just follow on with
00:27:53.099 --> 00:27:56.859
what John was asking? And let's talk about 3D
00:27:56.859 --> 00:27:59.319
printing orthotics in the aspect where you can
00:27:59.319 --> 00:28:02.180
print the post, right? And obviously you can
00:28:02.180 --> 00:28:04.680
also print the heel raise on there. What about
00:28:04.680 --> 00:28:07.700
in cases where you really need to be able to
00:28:07.700 --> 00:28:10.980
adjust? either the post or the raise right and
00:28:10.980 --> 00:28:14.440
when you grind 3d like pa nylon for for example
00:28:14.440 --> 00:28:17.059
it goes into this like pasties like substance
00:28:17.059 --> 00:28:20.000
and it becomes extremely difficult to grind like
00:28:20.000 --> 00:28:23.180
is are we in an environment where 3d printing
00:28:23.180 --> 00:28:25.140
is really great it's scalable should we just
00:28:25.140 --> 00:28:32.619
be printing the shells um look i guess to start
00:28:32.619 --> 00:28:39.039
with um i would i'd love to get the input of
00:28:39.039 --> 00:28:43.720
the other labs who are 3D printing. But my experience
00:28:43.720 --> 00:28:46.519
with 3D printing, both in a lab environment and
00:28:46.519 --> 00:28:49.859
in a clinical environment, and I appreciate that
00:28:49.859 --> 00:28:52.500
there's some difference in machinery between
00:28:52.500 --> 00:28:54.539
what you've got available in a clinic versus
00:28:54.539 --> 00:28:58.740
a lab, but there is a bit of a myth that you
00:28:58.740 --> 00:29:02.619
can't adjust 3D printed devices. I do hear it
00:29:02.619 --> 00:29:06.140
from time to time, and it's not something...
00:29:06.359 --> 00:29:10.359
that I find to be true. So I guess first and
00:29:10.359 --> 00:29:14.160
foremost, you know, I probably want to just clarify
00:29:14.160 --> 00:29:18.200
that I don't have problems modifying, you know,
00:29:18.200 --> 00:29:22.640
a PA11 or we're doing a lot more polyprope 3D
00:29:22.640 --> 00:29:27.000
printer devices that do grind and work much better
00:29:27.000 --> 00:29:31.329
than the nylon material. um yes they work differently
00:29:31.329 --> 00:29:34.569
to eva yes they work differently to your traditional
00:29:34.569 --> 00:29:39.910
handcrafted stuff but you can absolutely grind
00:29:39.910 --> 00:29:44.230
and adjust both of those types of devices is
00:29:44.230 --> 00:29:46.230
that something that you guys come across much
00:29:46.230 --> 00:29:51.869
Rhys yeah i think where the misconception may
00:29:51.869 --> 00:29:56.700
be is when people try and recreate the device
00:29:56.700 --> 00:30:02.460
is is the device fundamentally wrong uh and do
00:30:02.460 --> 00:30:05.119
you need to fundamentally change the orthotic
00:30:05.119 --> 00:30:06.980
because you're not going to be able to achieve
00:30:06.980 --> 00:30:12.079
that uh in a 3d printed like pa11 device whereas
00:30:12.079 --> 00:30:17.279
you know if i've got um you know a a eva device
00:30:17.279 --> 00:30:22.109
like in my hand uh and i have a high point of
00:30:22.109 --> 00:30:26.190
um you know uh mutual can i form base of first
00:30:26.190 --> 00:30:28.950
and it's 30 mil higher i can i can make that
00:30:28.950 --> 00:30:32.170
more proximal by grinding distally and reduce
00:30:32.170 --> 00:30:34.009
the archite so if the athletic is fundamentally
00:30:34.009 --> 00:30:36.930
wrong uh you're not going to be able to achieve
00:30:36.930 --> 00:30:40.049
that but um you know basic modifications within
00:30:40.049 --> 00:30:43.509
pa11 and other 3d printed i think is very easily
00:30:43.509 --> 00:30:47.369
achieved i agree with that and Kent's for sure
00:30:50.259 --> 00:30:53.799
I'd just add that, you know, the main area that
00:30:53.799 --> 00:30:56.859
we've had fitting issues with 3D printed devices
00:30:56.859 --> 00:31:00.200
was just mainly at the heel post. And, you know,
00:31:00.200 --> 00:31:02.299
you can do really simple things in clinic, like
00:31:02.299 --> 00:31:05.339
get a pair of calipers or a fabric tape measure
00:31:05.339 --> 00:31:08.099
and just measure the internal width of the shoe
00:31:08.099 --> 00:31:10.400
to the stitching. And then the lab can design
00:31:10.400 --> 00:31:13.160
the 3D printed post so it doesn't need to be
00:31:13.160 --> 00:31:15.799
tapered in in the clinic. Like, it's very simple.
00:31:16.380 --> 00:31:21.119
The angle on the heel post, if it was extrinsically
00:31:21.119 --> 00:31:23.480
posted for some of the 3D prints, definitely
00:31:23.480 --> 00:31:27.839
is more aggressive than the 400 density EVA just
00:31:27.839 --> 00:31:31.680
because it's a higher density material. So just
00:31:31.680 --> 00:31:36.400
making clinicians aware of that change or modifying
00:31:36.400 --> 00:31:40.140
prescriptions to potentially use heel scarves
00:31:40.140 --> 00:31:43.000
or... intrinsic rear foot posting on the top
00:31:43.000 --> 00:31:45.319
surface of the shell instead of extrinsically
00:31:45.319 --> 00:31:51.359
angulating the post so um yeah and and same as
00:31:51.359 --> 00:31:55.019
what uh Kent said as well we've gravitated more
00:31:55.019 --> 00:31:57.779
towards polypropylene for those clinicians that
00:31:57.779 --> 00:32:00.299
preferred a little bit more adjustability because
00:32:00.299 --> 00:32:02.940
it's I think the density difference is about
00:32:02.940 --> 00:32:08.900
1100 the PLF PA 11 to 800 poly powder so it translates
00:32:08.900 --> 00:32:11.640
to being you know a little bit lighter a little
00:32:11.640 --> 00:32:13.660
bit easier to grind and you a little bit easier
00:32:13.660 --> 00:32:16.900
to heat but PA 11 is certainly not impossible
00:32:16.900 --> 00:32:21.759
to adjust either so yeah I think really what
00:32:21.759 --> 00:32:26.339
you know we need to get our head around is the
00:32:26.339 --> 00:32:30.400
a 3D printed device might look a little bit different
00:32:31.079 --> 00:32:33.660
in some of the design features, you know, specifically
00:32:33.660 --> 00:32:38.799
things like extrinsic posting. But I can get
00:32:38.799 --> 00:32:42.259
a device that functions the same as a handcrafted
00:32:42.259 --> 00:32:45.420
device with an EVA post, but it just looks a
00:32:45.420 --> 00:32:48.740
little bit different. So it's just about understanding
00:32:48.740 --> 00:32:50.599
the material properties, knowing how to work
00:32:50.599 --> 00:32:55.119
with them and adjusting scripts accordingly if
00:32:55.119 --> 00:32:57.740
you are making the change from handcrafted to
00:32:57.740 --> 00:33:03.349
3D printed. All right. Moving on. Darcy and Rhys,
00:33:03.470 --> 00:33:04.970
I think I'll probably hit you guys with this
00:33:04.970 --> 00:33:09.710
question. Lab clinician relationships. I know
00:33:09.710 --> 00:33:11.750
we've gone through, I've gone through multiple
00:33:11.750 --> 00:33:14.049
labs since, you know, starting as a new graduate.
00:33:15.549 --> 00:33:17.789
Where do you think the biggest disconnect exists
00:33:17.789 --> 00:33:20.349
between a clinician and a lab? And how important
00:33:20.349 --> 00:33:24.829
is it for a fully functional, customised orthotic
00:33:24.829 --> 00:33:28.710
laboratory to have podiatrists on staff to be
00:33:28.710 --> 00:33:31.980
able to interpret? those questions and those
00:33:31.980 --> 00:33:34.420
relationships. Rhys, I can let you go first for
00:33:34.420 --> 00:33:38.400
this one. Yeah, sure. So I think it's important
00:33:38.400 --> 00:33:42.980
for podiatrists or labs to have podiatrists on
00:33:42.980 --> 00:33:47.539
staff to have those conversations, you know,
00:33:47.539 --> 00:33:50.839
with customers. It's really important that you
00:33:50.839 --> 00:33:54.259
build relationships with the podiatrists at the
00:33:54.259 --> 00:34:00.380
lab so you understand the terminology. I guess,
00:34:00.400 --> 00:34:04.400
changing products or changing anything really
00:34:04.400 --> 00:34:08.260
because what you may have been used to at...
00:34:08.489 --> 00:34:10.909
Haymart is called something different at Big
00:34:10.909 --> 00:34:16.010
W, no different to orthotic products. So building
00:34:16.010 --> 00:34:17.610
that relationship is really important, investing
00:34:17.610 --> 00:34:20.750
the time in the educational platforms, workshops.
00:34:21.670 --> 00:34:24.730
And as a lab, I think you need to be highly accessible
00:34:24.730 --> 00:34:27.369
to your customers as well so that you can provide
00:34:27.369 --> 00:34:29.170
a high quality product and high quality service
00:34:29.170 --> 00:34:32.489
as well. In terms of that process, where do you
00:34:32.489 --> 00:34:35.329
feel like the biggest challenges are there in
00:34:35.329 --> 00:34:39.630
terms of that? Do you find that there are cases
00:34:39.630 --> 00:34:42.230
where there are disconnects between the clinician
00:34:42.230 --> 00:34:45.489
and the lab? Yeah, I think so. And I think there
00:34:45.489 --> 00:34:49.010
can be. Everyone at certain times can be time
00:34:49.010 --> 00:34:54.130
poor. And if you're a sole business owner or
00:34:54.130 --> 00:34:58.489
even if you run a business with half a dozen
00:34:58.489 --> 00:35:01.750
or more employees, your time is really important.
00:35:01.929 --> 00:35:05.110
So you need to prioritise where you put that
00:35:05.110 --> 00:35:07.760
time and investing in. building a relationship
00:35:07.760 --> 00:35:10.199
with your lab i think is a high priority if you
00:35:10.199 --> 00:35:13.559
consider orthotic therapy to be important to
00:35:13.559 --> 00:35:15.940
your clinic into your business as well so making
00:35:15.940 --> 00:35:18.079
sure that you make the time and and the lab should
00:35:18.079 --> 00:35:20.460
you know return equally by making that time available
00:35:20.460 --> 00:35:22.719
to you as well whether it's emails phone calls
00:35:22.719 --> 00:35:25.599
online workshops in -person workshops i think
00:35:25.599 --> 00:35:27.460
all those need to be accessible to the consumer
00:35:27.460 --> 00:35:30.380
yeah i've had the experience of being you know
00:35:30.380 --> 00:35:33.679
obviously the podiatrist that ordering orthotics
00:35:33.679 --> 00:35:35.940
and the podiatrist that is sort of designing
00:35:35.940 --> 00:35:38.800
and producing the orthotics. So I do think that
00:35:38.800 --> 00:35:41.719
close relationship is really important and developing
00:35:41.719 --> 00:35:45.960
a shared language to be quite critical. I think
00:35:45.960 --> 00:35:49.199
that the prescription form is actually quietly
00:35:49.199 --> 00:35:53.039
really critical and having the education platform,
00:35:53.179 --> 00:35:56.039
as Rhi said, just to be really important. I've
00:35:56.039 --> 00:36:00.750
made the habit just of reaching out to Younger
00:36:00.750 --> 00:36:03.250
practitioners where if I'm trying to interpret
00:36:03.250 --> 00:36:07.269
a script and then potentially the quality of
00:36:07.269 --> 00:36:09.369
the scan is not very good, between those two
00:36:09.369 --> 00:36:11.409
things, using that as an indicator to try and
00:36:11.409 --> 00:36:14.530
reach out, have a chat and just try and educate
00:36:14.530 --> 00:36:19.050
where I can and clarify and maybe help the practitioner.
00:36:19.130 --> 00:36:21.809
Because let's face it, you know, orthotics in
00:36:21.809 --> 00:36:25.670
terms of prescribing and fitting and managing
00:36:25.670 --> 00:36:29.389
expectations. orthotics is not a simple thing
00:36:29.389 --> 00:36:34.269
to do and I think that you know I'll just say
00:36:34.269 --> 00:36:37.650
that generally speaking I don't think podiatrists
00:36:37.650 --> 00:36:40.110
on the whole are that amazing at it there certainly
00:36:40.110 --> 00:36:43.550
are some very good podiatrists and there are
00:36:43.550 --> 00:36:45.409
definitely some podiatrists who through no fault
00:36:45.409 --> 00:36:47.670
of their own find it quite challenging and don't
00:36:47.670 --> 00:36:49.889
get very good outcomes so I do think that there
00:36:49.889 --> 00:36:55.380
is an onus on the lab representatives to try
00:36:55.380 --> 00:36:59.880
our best to close that gap guys i think um i
00:36:59.880 --> 00:37:02.300
also want to bring in like a broader uh economic
00:37:02.300 --> 00:37:06.179
question in terms of relationships um think back
00:37:06.179 --> 00:37:08.139
to when you were a new grad probably life was
00:37:08.139 --> 00:37:09.960
potentially a simpler time to where it is today
00:37:09.960 --> 00:37:12.880
you know there's less wars less fuel costs and
00:37:12.880 --> 00:37:16.179
less um orthotic lab costs inflation all that
00:37:16.179 --> 00:37:18.599
sort of stuff so as a young new graduate coming
00:37:18.599 --> 00:37:22.440
out into the profession right um if they send
00:37:23.079 --> 00:37:25.599
a cast to multiple labs in Australia, will they
00:37:25.599 --> 00:37:28.920
get the exact same orthotic coming back in terms
00:37:28.920 --> 00:37:30.679
of from their prescription and from the design?
00:37:31.139 --> 00:37:34.559
Probably not. So what's your sort of advice to
00:37:34.559 --> 00:37:37.280
younger practitioners on how to better understand
00:37:37.280 --> 00:37:41.320
what laboratories you use and how to refine their
00:37:41.320 --> 00:37:43.039
prescription? Kent, I'll probably start with you,
00:37:43.059 --> 00:37:45.840
given you had a tremendous career in both podiatry
00:37:45.840 --> 00:37:48.940
and orthotic making. Oh, look, I think. comes
00:37:48.940 --> 00:37:51.800
down to making sure that your relationship with
00:37:51.800 --> 00:37:54.920
your lab, as the other guys have already sort
00:37:54.920 --> 00:37:56.739
of talked about, making sure that relationship
00:37:56.739 --> 00:38:01.619
is collaborative and not transactional. So the
00:38:01.619 --> 00:38:05.760
lab isn't like your electricity provider. That's
00:38:05.760 --> 00:38:09.300
a more transactional relationship in your business.
00:38:09.980 --> 00:38:15.119
I think it's critical that you develop that relationship
00:38:15.119 --> 00:38:19.920
with your lab, understand what they want from
00:38:19.920 --> 00:38:23.699
you in terms of input and then and then as the
00:38:23.699 --> 00:38:27.119
guys said you know having a podiatrist at the
00:38:27.119 --> 00:38:30.679
lab to understand what the intent is from the
00:38:30.679 --> 00:38:36.619
clinician is critical as well so you know we
00:38:36.619 --> 00:38:39.400
like at the lab if we were to see a script come
00:38:39.400 --> 00:38:44.420
through for a 95 year old lady and it was a you
00:38:44.420 --> 00:38:48.539
know, a rigid carbon fibre or a six mil polyprope
00:38:48.539 --> 00:38:52.619
shell, a transactional relationship would just
00:38:52.619 --> 00:38:55.559
make that and send it back. Whereas a collaborative
00:38:55.559 --> 00:38:58.360
one will actually get on the front foot and ring
00:38:58.360 --> 00:39:01.929
that new clinician and say, hey, look. you know,
00:39:01.969 --> 00:39:06.349
we see Mrs. Jones here is 95 and she's got a
00:39:06.349 --> 00:39:08.530
tiny little foot. Is this what you're actually
00:39:08.530 --> 00:39:10.429
after? Or did you actually just make a mistake
00:39:10.429 --> 00:39:12.750
because you're in a hurry or, you know, you weren't
00:39:12.750 --> 00:39:15.809
entirely sure what you were selecting there?
00:39:15.969 --> 00:39:19.329
So that's what I mean about building that really
00:39:19.329 --> 00:39:23.730
collaborative relationship. Awesome. I think
00:39:23.730 --> 00:39:24.909
there's some really good points there, Kent,
00:39:24.929 --> 00:39:27.130
in terms of building those relationships for
00:39:27.130 --> 00:39:32.210
new clinicians. I guess moving on forward now
00:39:32.210 --> 00:39:35.389
future future directions and you don't have to
00:39:35.389 --> 00:39:38.989
reveal any trade secrets here but uh but where
00:39:38.989 --> 00:39:41.369
is orthotic therapy going in the next five to
00:39:41.369 --> 00:39:44.769
ten years yeah look i think probably the most
00:39:44.769 --> 00:39:48.230
obvious shift would be a continued move away
00:39:48.230 --> 00:39:52.309
from subtractive you know we've all sort of slowly
00:39:52.309 --> 00:39:55.449
been phasing out of vacuum forming um it's very
00:39:55.449 --> 00:39:57.769
limited now the availability of vacuum forming
00:39:57.769 --> 00:40:00.110
in australia and i think you know likely that
00:40:00.900 --> 00:40:04.219
subtractive and CNC will be next. We're not yet
00:40:04.219 --> 00:40:08.960
there. Personally, doing TPU devices, we're not
00:40:08.960 --> 00:40:12.059
quite happy with what we're prototyping, but
00:40:12.059 --> 00:40:15.820
certainly that is the direction. And I think
00:40:15.820 --> 00:40:22.159
all the labs are aware of that. And maybe I think
00:40:22.159 --> 00:40:24.420
what is less clear about the direction is the
00:40:24.420 --> 00:40:27.079
type of delivery model, which we sort of talked
00:40:27.079 --> 00:40:29.570
about a little bit, which is are we going to
00:40:29.570 --> 00:40:32.369
see more in -clinic manufacturing are we going
00:40:32.369 --> 00:40:36.409
to see more in -clinic design with external manufacturing
00:40:36.409 --> 00:40:40.269
or are we going to see you know as some have
00:40:40.269 --> 00:40:43.150
pushed for like lab design and in -clinic printing
00:40:43.150 --> 00:40:45.869
so there's there might actually be multiple models
00:40:45.869 --> 00:40:49.030
operating at once in the profession at a which
00:40:49.030 --> 00:40:50.489
is going to be a little bit different and they
00:40:50.489 --> 00:40:54.360
can probably all coexist but what i do see there
00:40:54.360 --> 00:40:57.440
is like an amazing opportunity for podiatry and
00:40:57.440 --> 00:41:00.320
it sort of goes back to like who owns orthotics
00:41:00.320 --> 00:41:03.239
you know and we certainly don't really own it
00:41:03.239 --> 00:41:05.159
at the moment because it's they're dispensed
00:41:05.159 --> 00:41:08.219
by you know orthotists prosthetists pedorthists
00:41:08.219 --> 00:41:11.800
you know all sorts of professionals but um really
00:41:11.800 --> 00:41:16.130
embedding ourselves in you know, the computer
00:41:16.130 --> 00:41:18.250
-aided design and having a much better understanding
00:41:18.250 --> 00:41:21.090
of that will be a big shift in the industry and
00:41:21.090 --> 00:41:24.389
really make sure podiatry really excels, I think.
00:41:25.190 --> 00:41:28.489
And maybe one more thing, a little bit more out
00:41:28.489 --> 00:41:31.590
of left field, will be probably more active orthotic
00:41:31.590 --> 00:41:34.869
devices popping up into the market, things that
00:41:34.869 --> 00:41:39.329
are able to, you know, basically have sensors
00:41:39.329 --> 00:41:41.809
embedded in wearable technologies and things
00:41:41.809 --> 00:41:45.269
like that, where, like... sensor technology uh
00:41:45.269 --> 00:41:47.869
continues to get cheaper and cheaper so i think
00:41:47.869 --> 00:41:50.469
that'll be a really interesting push but i i
00:41:50.469 --> 00:41:53.349
foresee that being in probably over 10 years
00:41:53.349 --> 00:41:56.070
more widespread not within the next 10 years
00:41:56.070 --> 00:41:58.650
and Rhys where are things going at Footwork
00:41:58.650 --> 00:42:03.750
yeah i think uh broadly speaking not necessarily
00:42:03.750 --> 00:42:07.989
at Footwork um solely but i think like authority
00:42:07.989 --> 00:42:10.449
therapy is going to become more accessible to
00:42:10.449 --> 00:42:12.750
the to the consumer or to the customer whether
00:42:12.750 --> 00:42:16.590
that's online platforms like e -commerce platforms
00:42:16.590 --> 00:42:22.510
uh i i think it's harder or becoming harder to
00:42:22.510 --> 00:42:26.550
see a podiatrist uh i think i think it's really
00:42:26.550 --> 00:42:28.829
important as a profession that we continue to
00:42:28.829 --> 00:42:32.590
invest in podiatry and invest in in custom put
00:42:32.590 --> 00:42:36.150
off those ease um because at the same time it's
00:42:36.150 --> 00:42:38.150
also going to be become easier for the consumer
00:42:38.150 --> 00:42:44.110
to access or access the the the product um So,
00:42:45.230 --> 00:42:47.690
yeah, certainly Footwork is all about empowering
00:42:47.690 --> 00:42:49.929
the podiatrist, empowering the individual. So
00:42:49.929 --> 00:42:52.110
giving them the ability to be involved in the
00:42:52.110 --> 00:42:55.090
process of that orthotic manufacture and orthotic
00:42:55.090 --> 00:42:58.809
design. So education providing different platforms
00:42:58.809 --> 00:43:02.710
for, you know, designing in -house, you know,
00:43:02.710 --> 00:43:05.090
printing or manufacturing in -house as well.
00:43:05.570 --> 00:43:09.210
But all about empowering the podiatrist to achieve
00:43:09.210 --> 00:43:12.010
what they want to achieve. I think I'll echo
00:43:12.010 --> 00:43:15.030
Konrad's sentiment about the evolving business
00:43:15.030 --> 00:43:20.050
models where I guess we've got a good sort of
00:43:20.050 --> 00:43:23.070
sample of that today with the major labs, bigger
00:43:23.070 --> 00:43:26.329
labs, smaller labs, and then Propel 3D just,
00:43:26.429 --> 00:43:29.329
I guess, having that more innovative print -in
00:43:29.329 --> 00:43:33.070
clinic business model. So I have found just as
00:43:33.070 --> 00:43:35.710
a podiatrist who's both, you know, working on
00:43:35.710 --> 00:43:39.579
both sides, just... the few advantages of being
00:43:39.579 --> 00:43:42.860
able to turn things around really quickly have
00:43:42.860 --> 00:43:45.440
the materials be different in different ways
00:43:45.440 --> 00:43:47.840
has been really helpful but at the end of the
00:43:47.840 --> 00:43:52.500
day i am the biggest fan of a nylon sls printed
00:43:52.500 --> 00:43:55.380
device and nothing i don't think fdm printed
00:43:55.380 --> 00:43:58.320
is going to change that so those machines are
00:43:58.320 --> 00:44:03.079
obviously you know very expensive and very sophisticated
00:44:03.079 --> 00:44:06.739
compared to an FDM printer. So I do think there's
00:44:06.739 --> 00:44:11.139
plenty of space for that. In saying that, we
00:44:11.139 --> 00:44:14.019
have been able to sort of reduce the cost per
00:44:14.019 --> 00:44:17.840
orthotic quite significantly with this business
00:44:17.840 --> 00:44:21.139
model. So it will be quite an interesting time
00:44:21.139 --> 00:44:27.219
to see what happens and where, I guess, the podiatrist's
00:44:27.219 --> 00:44:31.130
feet move. Given there's so much variability
00:44:31.130 --> 00:44:34.150
in manufacturing, I'll just throw it to the floor.
00:44:34.610 --> 00:44:37.949
Where do you guys think standardization under
00:44:37.949 --> 00:44:41.230
things like the Therapeutic Goods Authority,
00:44:41.489 --> 00:44:46.710
TGA, where do we think orthotics are going to
00:44:46.710 --> 00:44:49.090
be moving from a regulatory point of view, given
00:44:49.090 --> 00:44:51.710
that we don't have currently a firm consensus
00:44:51.710 --> 00:44:54.809
across all commercially available laboratories
00:44:54.809 --> 00:44:59.440
what orthotic theories are? I mean, there's patterns
00:44:59.440 --> 00:45:03.340
and similarities, but there's also very big differences
00:45:03.340 --> 00:45:06.659
in interpretation. Where do we see quality control
00:45:06.659 --> 00:45:09.559
coming from standardisation? Kent, I probably
00:45:09.559 --> 00:45:13.960
would start with you with this one. Look, I don't
00:45:13.960 --> 00:45:21.360
think we necessarily need to standardise manufacturing
00:45:21.360 --> 00:45:28.889
processes to the degree of you know, specific
00:45:28.889 --> 00:45:32.030
modelling pathways and things like that. It's
00:45:32.030 --> 00:45:43.050
probably more about standardising outcomes, you
00:45:43.050 --> 00:45:47.010
know, in terms of finished product, trying to
00:45:47.010 --> 00:45:54.789
make sure that, you know, we can track processes,
00:45:55.110 --> 00:45:58.880
you know, we can track devices all the way through
00:45:58.880 --> 00:46:02.860
and also continue to track them, you know, once
00:46:02.860 --> 00:46:07.119
they're fitted to the patient as well. So I don't
00:46:07.119 --> 00:46:10.000
think we necessarily need to, you know, all look
00:46:10.000 --> 00:46:13.579
the same, but I think there are some features
00:46:13.579 --> 00:46:16.980
that we'll all, you know, probably inherently
00:46:16.980 --> 00:46:21.539
do now already, but continue to further develop
00:46:21.539 --> 00:46:26.610
and adopt things like that. Very sweaty, sort
00:46:26.610 --> 00:46:30.389
of see that sort of position. Yeah, I don't see
00:46:30.389 --> 00:46:39.650
it changing rapidly in the short term, albeit
00:46:39.650 --> 00:46:43.989
I think it would be beneficial for some manufacture
00:46:43.989 --> 00:46:48.539
reform. Having worked with Stephen Brown at the
00:46:48.539 --> 00:46:51.559
APOD -A on the TGA Advisory Board for Custom
00:46:51.559 --> 00:46:54.820
Orthotics, we get a bit of an insight as to where
00:46:54.820 --> 00:46:57.480
things are going from a TGA perspective. And
00:46:57.480 --> 00:47:01.820
it's continually being progressed. But, you know,
00:47:01.860 --> 00:47:05.900
like most things, it's not fast. But I think
00:47:05.900 --> 00:47:07.539
it's really important that from a manufacturing
00:47:07.539 --> 00:47:10.000
perspective, we have transparency on how the
00:47:10.000 --> 00:47:12.199
products are made, where they're being made,
00:47:12.300 --> 00:47:14.929
what materials they're being made from. And we
00:47:14.929 --> 00:47:20.010
look at these products, you know, in detail to
00:47:20.010 --> 00:47:26.030
ensure safety, you know, for the consumer. So
00:47:26.030 --> 00:47:28.849
as you would know, I'm a coffee addict. So I
00:47:28.849 --> 00:47:31.090
like to shop at where I know the farmers are
00:47:31.090 --> 00:47:33.389
growing their beans. Is there a possibility that's
00:47:33.389 --> 00:47:35.550
translated into orthotic materials from where
00:47:35.550 --> 00:47:39.110
the manufacturers are overseas? Yeah, I think
00:47:39.110 --> 00:47:41.909
so. I think it's important to understand. safety
00:47:41.909 --> 00:47:45.610
data sheets and what the products actually are,
00:47:45.809 --> 00:47:49.670
which is one of the strengths of the PA11 when
00:47:49.670 --> 00:47:53.409
it was first introduced to the profession. And
00:47:53.409 --> 00:47:58.230
it really took away from, I guess, the less environmentally
00:47:58.230 --> 00:48:02.030
friendly polypropylene at the time. So like on
00:48:02.030 --> 00:48:04.150
Konrad's point before with subtractive manufacture,
00:48:04.449 --> 00:48:06.590
I think it's important that we continually progress.
00:48:07.289 --> 00:48:10.289
And whether that's from a TGA perspective, I
00:48:10.289 --> 00:48:11.699
definitely think. it's something that we should
00:48:11.699 --> 00:48:14.639
as a profession. Konrad was there anything you
00:48:14.639 --> 00:48:17.800
wanted to add on that? Well the TGA where do
00:48:17.800 --> 00:48:19.940
I start you know what I mean I think everyone's
00:48:19.940 --> 00:48:22.719
a little bit exasperated at times with the I
00:48:22.719 --> 00:48:26.320
think maybe the lumping in of orthotic devices
00:48:26.320 --> 00:48:29.139
with other medical devices like I think it's
00:48:29.139 --> 00:48:32.559
become quite clear that the TGA they're probably
00:48:32.559 --> 00:48:36.400
working extremely hard and maybe they don't have
00:48:36.400 --> 00:48:40.099
the bandwidth required to properly regulate and
00:48:40.099 --> 00:48:42.320
make a meaningful change in the way orthotics
00:48:42.320 --> 00:48:45.500
are manufactured in Australia because I think
00:48:45.500 --> 00:48:48.119
it's probably going to come down to our professional
00:48:48.119 --> 00:48:51.719
bodies being advocates for ethical manufacture
00:48:51.719 --> 00:48:54.559
and I could get like a little bit controversial
00:48:54.559 --> 00:48:56.559
but I don't I don't personally think it's that
00:48:56.559 --> 00:49:00.840
controversial I think maybe you know we could
00:49:00.840 --> 00:49:03.699
regulate that orthotics aren't mirrored left
00:49:03.699 --> 00:49:06.239
and right we should make a left and a right orthotic
00:49:06.239 --> 00:49:09.460
from each individual scan like I think everyone
00:49:09.460 --> 00:49:12.300
here, because it's an audio medium, is nodding
00:49:12.300 --> 00:49:16.780
their head in agreement, which is good. But I
00:49:16.780 --> 00:49:20.460
think it would be good to have that regulated.
00:49:20.719 --> 00:49:25.800
I think it would be good to regulate that scanning
00:49:25.800 --> 00:49:29.579
includes color, because from my experience, when
00:49:29.579 --> 00:49:32.940
we have anthropometric landmarks that are marked
00:49:32.940 --> 00:49:35.960
on a scan, we can translate features more objectively.
00:49:37.159 --> 00:49:39.820
you know, if we're looking to do what the TGA
00:49:39.820 --> 00:49:42.480
wants and what we support, which is things like
00:49:42.480 --> 00:49:46.679
making sure we have ISO 13485 for medical devices
00:49:46.679 --> 00:49:50.019
and making sure we have really good QMS, we have
00:49:50.019 --> 00:49:52.320
to make sure that we make things consistently
00:49:52.320 --> 00:49:55.539
and the podiatrists have to help us do that.
00:49:55.619 --> 00:49:59.980
We have to be a team, right? So, yeah, there's
00:49:59.980 --> 00:50:04.159
a few basic things there, but in terms of a...
00:50:04.559 --> 00:50:07.659
you know tga regulatory level it's not really
00:50:07.659 --> 00:50:10.860
their place and i don't think that they're trying
00:50:10.860 --> 00:50:14.599
to standardize how we make orthotics or how software
00:50:14.599 --> 00:50:17.659
is used in the industry more to just make sure
00:50:17.659 --> 00:50:20.440
that you know we have validation verification
00:50:20.440 --> 00:50:23.760
processes in place to make sure that devices
00:50:23.760 --> 00:50:26.960
are safe and perform well and we have material
00:50:26.960 --> 00:50:31.309
safety options so i think It's not too stressful
00:50:31.309 --> 00:50:33.969
when you boil it down, the TGA stuff. It's more
00:50:33.969 --> 00:50:36.929
the labs having to put in place ISO at the end
00:50:36.929 --> 00:50:39.050
of the day, and we'll all get there. It might
00:50:39.050 --> 00:50:41.090
be a little bit harder for the smaller operators.
00:50:41.949 --> 00:50:46.429
I'm not sure how they're going to do it if they're
00:50:46.429 --> 00:50:50.329
not using a software system that may be later
00:50:50.329 --> 00:50:52.650
regulated on the TGA, which would be called a
00:50:52.650 --> 00:50:56.610
medical device production system. If they're
00:50:56.610 --> 00:50:59.349
using one of these regulated systems, they might
00:50:59.349 --> 00:51:03.769
comply inherently, but if they're vacuum forming
00:51:03.769 --> 00:51:06.630
or doing something a little bit different, they
00:51:06.630 --> 00:51:09.730
might have to get their own ISO and it might
00:51:09.730 --> 00:51:12.949
be a big regulatory challenge for small business.
00:51:14.630 --> 00:51:18.469
I think manufacturing seems to be on the ball
00:51:18.469 --> 00:51:22.650
from what all four of you have said, but let's
00:51:22.650 --> 00:51:25.119
bring it back to your first profession, which
00:51:25.119 --> 00:51:30.380
is podiatry. What does neutral mean? And can
00:51:30.380 --> 00:51:35.420
someone explain, is it reproducible? Is it still
00:51:35.420 --> 00:51:38.980
a useful theory to be applying in terms of teaching?
00:51:39.480 --> 00:51:41.880
And how do we accurately measure or sorry, how
00:51:41.880 --> 00:51:45.960
do we actually accurately capture that? Yeah,
00:51:45.980 --> 00:51:49.219
I guess the definition of neutral would be impartial
00:51:49.219 --> 00:51:53.090
or unbiased to a particular. in this case, position.
00:51:53.369 --> 00:51:56.030
So if we're talking about subtalar joint, then
00:51:56.030 --> 00:52:01.369
neutral would be unbiased to a particular position
00:52:01.369 --> 00:52:04.570
in relation to the subtalar joint. So I think
00:52:04.570 --> 00:52:08.289
it is important to try and achieve subtalar joint
00:52:08.289 --> 00:52:13.769
neutral for orthotic reproducibility. But I think
00:52:13.769 --> 00:52:17.010
as well, it comes down to your understanding
00:52:17.010 --> 00:52:20.949
of the application of the prescription to the
00:52:20.949 --> 00:52:25.329
scan. So I'm sure people can achieve, you know,
00:52:25.349 --> 00:52:30.769
the result they're after by scanning in a unneutral,
00:52:30.869 --> 00:52:34.789
you know, position. But certainly, you know,
00:52:34.829 --> 00:52:38.670
I personally and we recommend as a lab trying
00:52:38.670 --> 00:52:40.289
to achieve a subtalar joint neutral position.
00:52:40.989 --> 00:52:44.030
I think in terms of subtalar joint neutral, potentially
00:52:44.030 --> 00:52:47.650
it might even be in the weeds considering what
00:52:47.650 --> 00:52:52.579
we... pragmatically want is a foot that in subductor
00:52:52.579 --> 00:52:55.360
neutral should be idealized where you know obviously
00:52:55.360 --> 00:52:57.159
we can palpate the tail heads that's you know
00:52:57.159 --> 00:52:59.559
week one of year two biomechanics and should
00:52:59.559 --> 00:53:01.219
be able to understand where that is and be able
00:53:01.219 --> 00:53:04.659
to teach that to people but also just really
00:53:04.659 --> 00:53:06.280
simple things with those non -weight bearing
00:53:06.280 --> 00:53:08.059
scans I'm sure everybody's seen you know having
00:53:08.059 --> 00:53:11.380
like a ridiculously plantar flex foot inverted
00:53:11.380 --> 00:53:15.719
foot just in non -weight bearing for the forefoot
00:53:15.719 --> 00:53:18.070
and rear foot to be completely out of whack.
00:53:18.269 --> 00:53:20.389
So, you know, I'm not too concerned with one
00:53:20.389 --> 00:53:22.550
or two degrees of subtalar, eversion, inversion,
00:53:22.789 --> 00:53:25.150
either way. Obviously we can't capture a subtalar
00:53:25.150 --> 00:53:27.650
joint neutral with a foot that has a medially
00:53:27.650 --> 00:53:29.889
deviated subtalar joint axis in a supernatus
00:53:29.889 --> 00:53:31.849
where you can't capture it in neutral because
00:53:31.849 --> 00:53:34.110
the, you know, first and tip J will be off the
00:53:34.110 --> 00:53:36.750
ground. So I think we should probably not sweat
00:53:36.750 --> 00:53:39.150
those things and let's just get some, you know,
00:53:39.170 --> 00:53:45.429
nice, nice square scans that we can create a
00:53:45.429 --> 00:53:49.090
good orthotic out of. Darcy, what about heel
00:53:49.090 --> 00:53:50.969
expansion? Because if you're capturing someone
00:53:50.969 --> 00:53:54.389
non -weight bearing, what about different people
00:53:54.389 --> 00:53:57.230
with different fat pad sizes or pathological
00:53:57.230 --> 00:53:59.909
requirements might have different heel or skin
00:53:59.909 --> 00:54:04.829
fat expansions? Does a neutral cast non -weight
00:54:04.829 --> 00:54:06.829
bearing accurately capture the foot, in your
00:54:06.829 --> 00:54:10.550
opinion? I don't think so. I would always go
00:54:10.550 --> 00:54:13.809
for a semi -weight bearing scan where possible.
00:54:15.110 --> 00:54:18.150
Personally, if I was making my grandmother a
00:54:18.150 --> 00:54:21.550
foot orthotic, I would like her to have a semi
00:54:21.550 --> 00:54:24.389
-weight -bearing scan. Kent, what are your thoughts
00:54:24.389 --> 00:54:28.989
on foot capture? I think you probably know where
00:54:28.989 --> 00:54:37.230
I stand on this, Pat. We absolutely believe that
00:54:37.230 --> 00:54:39.710
subtalar joint neutral is still relevant and
00:54:39.710 --> 00:54:44.800
still should be taught. I think we have to be
00:54:44.800 --> 00:54:51.139
careful that any potential trend away from neutral
00:54:51.139 --> 00:54:54.880
isn't just convenience masquerading as progress.
00:54:56.179 --> 00:55:01.699
I think when we look at, you know, if we sort
00:55:01.699 --> 00:55:04.900
of dig down a level here, when we look at scans
00:55:04.900 --> 00:55:09.880
or casts that come through the lab, I think one
00:55:09.880 --> 00:55:12.940
of the biggest issues that we see probably isn't
00:55:12.940 --> 00:55:15.920
so much around sub -tailored joint neutral. You
00:55:15.920 --> 00:55:19.420
know, I think you can be out by one or two degrees
00:55:19.420 --> 00:55:22.739
either way, and it doesn't affect the plantar
00:55:22.739 --> 00:55:26.639
contours that much. I think where we see a bigger
00:55:26.639 --> 00:55:28.900
difference is when the mid -tarsal joint's not
00:55:28.900 --> 00:55:35.380
loaded. So I can take the same person, and that
00:55:35.380 --> 00:55:38.039
person might have a big forefoot supernatus,
00:55:38.159 --> 00:55:44.280
and if in one capture method... scan, cast. I
00:55:44.280 --> 00:55:49.639
load that mid tarsal joint and eliminate any
00:55:49.639 --> 00:55:51.760
forefoot supinatus and capture a forefoot to
00:55:51.760 --> 00:55:54.179
rear foot, pretty neutral sort of relationship.
00:55:54.519 --> 00:55:57.800
And then on the other foot, I maintain the whopping
00:55:57.800 --> 00:56:02.599
big supinatus. In that one where I've captured
00:56:02.599 --> 00:56:07.239
a big supinatus, every lab can do it. We can
00:56:07.239 --> 00:56:10.380
take that and produce a custom foot orthotic.
00:56:11.019 --> 00:56:14.659
But there's more guesswork involved. There's
00:56:14.659 --> 00:56:17.360
absolutely more guesswork involved. So that's
00:56:17.360 --> 00:56:20.739
where, you know, it comes back to this, you know,
00:56:20.760 --> 00:56:26.340
reduce the variability, you know, start with
00:56:26.340 --> 00:56:30.860
a consistent starting point and you reduce some
00:56:30.860 --> 00:56:34.019
of that guesswork along the way. So in terms
00:56:34.019 --> 00:56:39.239
of your question around heel fat pad, we have...
00:56:39.710 --> 00:56:44.570
data from thousands and thousands of devices
00:56:44.570 --> 00:56:48.070
that have come through the lab around how much
00:56:48.070 --> 00:56:51.789
expansion we should do based purely on the size
00:56:51.789 --> 00:56:55.650
of the foot. Now that can be varied as well.
00:56:55.829 --> 00:57:00.969
So let's say you've got a patient in front of
00:57:00.969 --> 00:57:03.539
you. and you know that they're going to fit into
00:57:03.539 --> 00:57:05.559
a particular dress shoe you might communicate
00:57:05.559 --> 00:57:07.820
to the lab hey i want a minimal lateral plaster
00:57:07.820 --> 00:57:09.699
expansion on this one i just want to bring it
00:57:09.699 --> 00:57:13.500
in a bit tighter and we can do that so that's
00:57:13.500 --> 00:57:18.079
you know that can be varied um accordingly yeah
00:57:18.079 --> 00:57:20.320
i think the point you make about thinking about
00:57:20.320 --> 00:57:22.139
the shoe that you're trying to fill it into is
00:57:22.139 --> 00:57:24.679
a is something that i learned to my cost when
00:57:24.679 --> 00:57:27.199
i was a practitioner it's you can make the perfect
00:57:27.199 --> 00:57:30.059
orthotic but uh it doesn't fit into any shoes
00:57:30.059 --> 00:57:34.420
or then you've got a problem absolutely yeah
00:57:34.420 --> 00:57:38.940
in your opinion gents um let's take the hill
00:57:38.940 --> 00:57:41.360
expansion equation out of the question what's
00:57:41.360 --> 00:57:44.000
wrong with doing a really low if not minimal
00:57:44.000 --> 00:57:46.000
hill cup and getting someone in a shoe with a
00:57:46.000 --> 00:57:47.719
stiff heel counter to kind of counteract that
00:57:47.719 --> 00:57:50.449
maybe i'll direct that one to Rhys Yeah, that's
00:57:50.449 --> 00:57:52.969
a really good point because I think when we try
00:57:52.969 --> 00:57:55.929
and measure like fat pad expansion, we're not
00:57:55.929 --> 00:57:58.489
really factoring in the relationship of the shoe
00:57:58.489 --> 00:58:00.969
to that fat pad expansion. And it's a similar
00:58:00.969 --> 00:58:03.050
principle when we look at modifications like
00:58:03.050 --> 00:58:08.340
medial flares because is the liner of the shoe
00:58:08.340 --> 00:58:13.739
or the outsole of the shoe, sorry, the shoe itself,
00:58:13.820 --> 00:58:16.519
is that capturing and holding in some of that
00:58:16.519 --> 00:58:19.000
splay that you would see when you have that patient
00:58:19.000 --> 00:58:20.980
weight bearer of the orthotic outside of the
00:58:20.980 --> 00:58:24.780
shoe. So yeah, look, we would have a high percentage
00:58:24.780 --> 00:58:27.639
of concave wedge style orthotics that have approximately
00:58:27.639 --> 00:58:32.699
an eight mil lateral height of an orthotic. That
00:58:32.699 --> 00:58:35.860
would be our most commonly. prescribed heel cup
00:58:35.860 --> 00:58:40.039
option. But at the same time, you know, we have
00:58:40.039 --> 00:58:44.340
standard processes for heel pad expansion. So,
00:58:44.440 --> 00:58:46.639
you know, if you use a concave wedge, it's 4mm
00:58:46.639 --> 00:58:51.260
wider than the impression. You know, we have
00:58:51.260 --> 00:58:55.159
the option for courtful heel, which is no expansion.
00:58:55.400 --> 00:58:57.719
You can then go and create, you know, more expansion
00:58:57.719 --> 00:59:00.420
so you choose. So I think it's about empowering
00:59:00.420 --> 00:59:03.659
that individual to understand. what they require
00:59:03.659 --> 00:59:06.380
clinically, how they can achieve that and providing
00:59:06.380 --> 00:59:09.219
the podiatrist with the tools to achieve what
00:59:09.219 --> 00:59:12.320
they want to achieve. All right. This takes us
00:59:12.320 --> 00:59:15.219
to our unpopular opinion segment, overrated and
00:59:15.219 --> 00:59:18.659
underrated. The plan is for a quick fire, but
00:59:18.659 --> 00:59:21.280
I think if you guys are happy to expand, we're
00:59:21.280 --> 00:59:24.719
willing to take on that feedback. And I'm going
00:59:24.719 --> 00:59:27.579
to start with Darcy first, and I'm just going
00:59:27.579 --> 00:59:30.579
to repeat what we said. Sub -tailor neutral casting,
00:59:30.840 --> 00:59:36.559
overrated or underrated? Underrated. Rhys? Sorry,
00:59:36.639 --> 00:59:38.579
quick fire, but I was on mute. Underrated as
00:59:38.579 --> 00:59:45.400
well. Konrad? It's a more nuanced answer. Please
00:59:45.400 --> 00:59:55.699
go, please go. It's both, honestly. It's underrated
00:59:55.699 --> 00:59:59.119
by people. um in my experience that don't pay
00:59:59.119 --> 01:00:01.699
particular attention to how they hold and capture
01:00:01.699 --> 01:00:05.159
the foot right and and it i can't remember exactly
01:00:05.159 --> 01:00:08.980
how Kent put it but it was if we if we basically
01:00:08.980 --> 01:00:13.239
let old habits die out of convenience that's
01:00:13.239 --> 01:00:17.239
when it's um it goes that way right um when we
01:00:17.239 --> 01:00:20.679
see the 42 degree four foot supernatas not holding
01:00:20.679 --> 01:00:22.659
the foot and we're going well you've got to scan
01:00:22.659 --> 01:00:26.679
that again you know that kind of thing um Overrated
01:00:26.679 --> 01:00:29.820
when it's used as a be -all and end -all treatment
01:00:29.820 --> 01:00:32.679
position. It's just a way to consistently capture
01:00:32.679 --> 01:00:35.159
the foot. It's just a shape, right? So you might
01:00:35.159 --> 01:00:38.860
maximally pronate the subtalar joint in a particular
01:00:38.860 --> 01:00:42.400
patient and capture it like that. So what is
01:00:42.400 --> 01:00:48.659
more important is shape, undoubtedly. Okay. Underrated.
01:00:49.260 --> 01:00:54.960
That's why we developed this game, mate. All
01:00:54.960 --> 01:00:59.219
right. Got to get the scan made in. Next one.
01:00:59.800 --> 01:01:01.940
3D printed orthotics. And I'm going to put in
01:01:01.940 --> 01:01:06.699
PA 12 and 11 in the same box here. Darcy, overrated
01:01:06.699 --> 01:01:15.539
or underrated? Underrated. Rhys? 12 overrated,
01:01:15.539 --> 01:01:19.619
11 underrated. Can you expand? It's just a better
01:01:19.619 --> 01:01:22.099
fit for our profession. I think weight -bearing
01:01:22.099 --> 01:01:24.800
orthoses, custom orthoses, 11 is far superior
01:01:24.800 --> 01:01:27.880
breaking strain compared to 12. So other applications,
01:01:27.960 --> 01:01:32.519
it's probably cheaper, more accessible, and therefore
01:01:32.519 --> 01:01:35.760
underrated for other applications and professions,
01:01:35.840 --> 01:01:41.900
but not ours. Quality. Konrad? Definitely underrated.
01:01:41.940 --> 01:01:44.219
We don't even know the possibilities yet. We've
01:01:44.219 --> 01:01:46.739
got so much more to do on them. So we need to
01:01:46.739 --> 01:01:49.519
keep delving into what they're capable of. We
01:01:49.519 --> 01:01:51.360
can print things that we don't even know exist
01:01:51.360 --> 01:01:54.980
yet. So we've just got to keep innovating and
01:01:54.980 --> 01:02:01.239
iterating. Kent? Can we add in 3D printed polyprobe
01:02:01.239 --> 01:02:05.019
into this as well? Sure. We'll say underrated
01:02:05.019 --> 01:02:09.960
then. Awesome. So, guys. highly posted and aggressive
01:02:09.960 --> 01:02:12.900
orthotic designs um is that something that you
01:02:12.900 --> 01:02:15.659
think we're doing going too far in the aggressive
01:02:15.659 --> 01:02:19.519
end or not too much so uh yeah Kent what are
01:02:19.519 --> 01:02:22.619
your thoughts on highly posted orthotics uh i'll
01:02:22.619 --> 01:02:27.239
say overrated uh keep it simple stick with the
01:02:27.239 --> 01:02:32.699
kiss yeah Darcy Yeah, definitely echo Kent, a
01:02:32.699 --> 01:02:34.900
care but simple scientist. But in saying that,
01:02:35.000 --> 01:02:37.059
it's got to still be, the clinical reasoning
01:02:37.059 --> 01:02:39.000
still has to be valid. So we still have to be
01:02:39.000 --> 01:02:44.159
trying to hit the right tissue with the right
01:02:44.159 --> 01:02:47.820
force at the right time or else it doesn't really
01:02:47.820 --> 01:02:53.659
matter how aggressive it is. Rhys? If pathomechanically
01:02:53.659 --> 01:02:57.900
indicated, then underrated. Otherwise, all other
01:02:57.900 --> 01:03:06.530
times overrated. And Konrad? I would say when
01:03:06.530 --> 01:03:09.730
they're really, really aggressive, it's usually
01:03:09.730 --> 01:03:13.110
because it's a bad scan with many overlapping
01:03:13.110 --> 01:03:16.309
prescriptive variables in the same spot. You
01:03:16.309 --> 01:03:19.090
know, your HealSky with a media wedge with an
01:03:19.090 --> 01:03:22.030
inverted scan, and then it's got a huge supernotice.
01:03:22.110 --> 01:03:25.449
So, yeah, it's definitely overrated. But if it's
01:03:25.449 --> 01:03:30.460
needed, then underrated. Same as race. all right
01:03:30.460 --> 01:03:35.000
next one we're gonna go vacuum pressed or vacuum
01:03:35.000 --> 01:03:43.820
formed rear foot eva posts Kent um look i still
01:03:43.820 --> 01:03:51.679
love them um so um i i think neither you know
01:03:51.679 --> 01:03:56.320
i think both have a place um and it's about understanding
01:03:56.320 --> 01:04:01.460
the material properties, the mechanics of the
01:04:01.460 --> 01:04:03.920
materials. So, yeah, it's hard for me to commit
01:04:03.920 --> 01:04:06.400
one way or the other. It's more about the understanding.
01:04:07.440 --> 01:04:13.659
Konrad? Yeah, both. This as well. If you think
01:04:13.659 --> 01:04:16.679
you need to adjust it, then it may be useful.
01:04:17.000 --> 01:04:22.579
But definitely overrated for people that aren't
01:04:22.579 --> 01:04:24.739
measuring the shoes properly because it is easy
01:04:24.739 --> 01:04:26.239
to fit them. You just got to measure the shoes
01:04:26.239 --> 01:04:32.559
and trace a template. Rhys? Overrated. Do tell.
01:04:33.199 --> 01:04:38.219
I thought it was quickfire, Pat. I think it's
01:04:38.219 --> 01:04:44.280
a legacy application from vacuum pressing and
01:04:44.280 --> 01:04:50.159
other forms of manufacture. I think if you're...
01:04:50.460 --> 01:04:52.579
following that tissue stress model, like everyone
01:04:52.579 --> 01:04:55.739
said, and you are applying something to aid or
01:04:55.739 --> 01:04:58.980
an authority to aid in that process, you should
01:04:58.980 --> 01:05:05.059
be comfortable with where that support is. If
01:05:05.059 --> 01:05:07.739
you feel like you might need to adjust that support
01:05:07.739 --> 01:05:10.820
over a period of time or adjust that authority
01:05:10.820 --> 01:05:13.780
over a period of time, it's probably worth considering.
01:05:14.559 --> 01:05:17.179
Is that an overall orthotic application review
01:05:17.179 --> 01:05:20.719
then as opposed to a modification like an EVA
01:05:20.719 --> 01:05:23.380
review or an EVA heel stabilizer review? But
01:05:23.380 --> 01:05:25.199
at the same time, we've also said we can easily
01:05:25.199 --> 01:05:29.880
adjust orthoses. So if you do put a PA11 heel
01:05:29.880 --> 01:05:31.699
stabilizer on there and you want to decrease
01:05:31.699 --> 01:05:35.079
load through the medial tubercle of the calc,
01:05:35.079 --> 01:05:38.039
you can easily put a post -motion grind on your
01:05:38.039 --> 01:05:41.940
heel stabilizer. Do you ever think... vacuum
01:05:41.940 --> 01:05:44.059
press would ever go away given that there will
01:05:44.059 --> 01:05:47.199
be circumstances where patients may need that
01:05:47.199 --> 01:05:50.780
sort of device and obviously 3d printing and
01:05:50.780 --> 01:05:52.699
whatnot is the way of the future do you think
01:05:52.699 --> 01:05:55.039
vacuum presses would actually ever go away or
01:05:55.039 --> 01:05:59.340
just vacuum pressing devices in terms of manufacture
01:05:59.340 --> 01:06:02.300
or more as well as vacuum pressing eva posts
01:06:02.300 --> 01:06:05.769
yeah I think it will eventually be superseded
01:06:05.769 --> 01:06:08.409
by additive manufacturing techniques. And like
01:06:08.409 --> 01:06:10.889
I think what Konrad said around TPU, I just don't
01:06:10.889 --> 01:06:14.010
think we have that same. scope and quality yet
01:06:14.010 --> 01:06:17.110
with some products in comparison to subtractive
01:06:17.110 --> 01:06:20.710
manufacture. I think innately there'll always
01:06:20.710 --> 01:06:22.909
be a place for a lot of things because of what
01:06:22.909 --> 01:06:25.750
people are comfortable using and therefore EVA
01:06:25.750 --> 01:06:28.010
heel stabilizers will probably continue to be
01:06:28.010 --> 01:06:31.570
a thing. But I would see and suggest that we're
01:06:31.570 --> 01:06:35.809
starting to see a decrease in that largely around
01:06:35.809 --> 01:06:40.489
combination of orthotic and footwear as well.
01:06:41.130 --> 01:06:45.960
Das? Yeah, I'd say overrated. Again, just be
01:06:45.960 --> 01:06:50.079
the practitioners and labs that are used to using
01:06:50.079 --> 01:06:52.800
that. Probably be the people that continue to
01:06:52.800 --> 01:06:55.960
use it, not necessarily because that's the most
01:06:55.960 --> 01:06:57.719
superior way. And there's nothing wrong with
01:06:57.719 --> 01:07:03.500
that, but yeah. All right, guys. Prefabs, I guess,
01:07:03.500 --> 01:07:07.699
as a kind of precursor to orthotics, to custom
01:07:07.699 --> 01:07:10.980
orthotics. Overrated or underrated as a treatment
01:07:10.980 --> 01:07:17.460
modality? Darcy? I think underrated as a treatment
01:07:17.460 --> 01:07:21.000
modality, but overrated as a medium to long -term
01:07:21.000 --> 01:07:24.880
modality where outside of the customization of
01:07:24.880 --> 01:07:28.400
getting the tissue stress to change where you
01:07:28.400 --> 01:07:30.099
want it, I think podiatrists don't give enough
01:07:30.099 --> 01:07:33.000
credence to compressive loads versus tensile
01:07:33.000 --> 01:07:37.099
loads. The amount of medial scabs with an aperture
01:07:37.099 --> 01:07:41.550
that I have seen would suggest that. And also
01:07:41.550 --> 01:07:44.070
we just get a better quality of materials under
01:07:44.070 --> 01:07:45.730
the person's foot that's going to do a better
01:07:45.730 --> 01:07:49.469
job for a better amount of time than a prefab.
01:07:49.510 --> 01:07:51.849
So that's the way that I communicate about it.
01:07:53.670 --> 01:07:56.619
Rhys, where do you see a place for prefabs? Yeah,
01:07:56.679 --> 01:07:58.360
there's definitely a place for it. I think as
01:07:58.360 --> 01:08:00.460
a profession being podiatrist, it's probably
01:08:00.460 --> 01:08:03.820
overrated. So I think, you know, as a profession,
01:08:03.920 --> 01:08:05.780
it should be something that we prioritise and
01:08:05.780 --> 01:08:08.780
continue to develop with custom foot orthoses.
01:08:09.559 --> 01:08:12.460
Definitely a place for it as a product within
01:08:12.460 --> 01:08:16.100
the profession. But I'd say on the whole, particularly
01:08:16.100 --> 01:08:19.979
in that early one to four year career, you know,
01:08:19.979 --> 01:08:23.300
podiatrist, they're probably overrated prefabs.
01:08:24.619 --> 01:08:29.760
Konrad? Yeah, I don't think I know any podiatrists
01:08:29.760 --> 01:08:32.520
that don't also do prefabricated orthotics. So
01:08:32.520 --> 01:08:37.420
they're definitely not overrated prefabs. Yeah,
01:08:37.500 --> 01:08:42.779
so definitely can work well and is a good treatment
01:08:42.779 --> 01:08:45.520
modality. So I'm kind of in the middle on this
01:08:45.520 --> 01:08:52.119
one as well. Sorry. And Kent? I'm probably more
01:08:52.119 --> 01:08:57.170
aligned with Rhys' philosophy on this. Yeah,
01:08:57.229 --> 01:09:03.069
I think one of the things that we need to be
01:09:03.069 --> 01:09:07.409
aware of as a profession is what separates us
01:09:07.409 --> 01:09:11.789
from physiotherapy or chiropractic or these kinds
01:09:11.789 --> 01:09:14.430
of things. And I think our deep understanding
01:09:14.430 --> 01:09:18.609
of custom foot orthotics and their place in the
01:09:18.609 --> 01:09:24.199
treatment. is certainly something that separates
01:09:24.199 --> 01:09:29.819
us and shouldn't be underrated. Okay. This one's
01:09:29.819 --> 01:09:36.079
from one of our listeners. 3D printed polypropylene.
01:09:36.619 --> 01:09:41.880
Why can't we just use polypropylene? Overrated
01:09:41.880 --> 01:09:45.060
or underrated? I want to start with you, Konrad.
01:09:47.279 --> 01:09:50.060
Because it's extremely laborious in a manufacturing
01:09:50.060 --> 01:09:53.039
environment to vacuum form when your manufacturing
01:09:53.039 --> 01:09:56.699
has moved towards 3D printing. And also we can
01:09:56.699 --> 01:09:59.539
just do so much more with 3D printed shells and
01:09:59.539 --> 01:10:02.279
the CAD as well. That doesn't allow us to leverage
01:10:02.279 --> 01:10:05.100
CAD as well. When we use vacuum forming techniques,
01:10:05.340 --> 01:10:08.239
we're making foot positive blocks and our staff
01:10:08.239 --> 01:10:12.319
have to put masks on to deal with dust from wood
01:10:12.319 --> 01:10:15.880
or different types of foams. And we would much
01:10:15.880 --> 01:10:18.270
prefer a... a better manufacturing environment
01:10:18.270 --> 01:10:22.130
for our staff than that. So I think due to potential
01:10:22.130 --> 01:10:28.689
and, you know, it would also be fairly bad business
01:10:28.689 --> 01:10:31.770
for a lab to not embrace 3D printing given where
01:10:31.770 --> 01:10:37.029
the industry is at. Rhys? Yeah, probably echo
01:10:37.029 --> 01:10:39.729
the sentiments of Konrad. I think 3D printing
01:10:39.729 --> 01:10:43.390
and progressive or being progressive as an industry
01:10:43.390 --> 01:10:48.460
is really important. you know, how a 3D printed
01:10:48.460 --> 01:10:51.579
poly versus traditional poly, whether that be
01:10:51.579 --> 01:10:56.180
CNC milled or vacuum pressed, how they're derived
01:10:56.180 --> 01:11:00.539
is very different. So, you know, 3D poly, and
01:11:00.539 --> 01:11:02.000
Kent can probably speak to this a little bit
01:11:02.000 --> 01:11:07.159
more, 100 % recyclable. So, you know, there's
01:11:07.159 --> 01:11:11.899
definitely, you know, advantages in 3D printed
01:11:11.899 --> 01:11:16.859
poly compared to typical. uh polypropylene ken
01:11:16.859 --> 01:11:23.039
uh well you can still do vacuum form poly um
01:11:23.039 --> 01:11:27.020
you know we offer both um and to be honest i'm
01:11:27.020 --> 01:11:29.960
proud that we still do that you know we still
01:11:29.960 --> 01:11:34.779
have the ability to do you know um you know plaster
01:11:34.779 --> 01:11:37.079
positives all that kind of stuff all the way
01:11:37.079 --> 01:11:41.899
through and um have managed to embrace, you know,
01:11:41.920 --> 01:11:45.859
3D printing and 3D printing polypro. Again, it
01:11:45.859 --> 01:11:48.460
just comes down to understanding from the clinician's
01:11:48.460 --> 01:11:50.760
perspective what they can and can't do with each
01:11:50.760 --> 01:11:53.920
method. There are some pros and cons of both
01:11:53.920 --> 01:11:59.260
methods. So understanding from the clinician's
01:11:59.260 --> 01:12:05.460
perspective what they are is critical. But yeah,
01:12:05.560 --> 01:12:10.359
I'm really proud that we've retained those. really
01:12:10.359 --> 01:12:14.819
bespoke craftsmanship sort of skills for the
01:12:14.819 --> 01:12:22.180
industry. But yeah, I think it's just understanding
01:12:22.180 --> 01:12:24.140
from the clinician's perspective what they can
01:12:24.140 --> 01:12:29.279
and can't do. Darcy? I'd say I'm impartial. I
01:12:29.279 --> 01:12:32.659
did always really appreciate a CNC polyprobe
01:12:32.659 --> 01:12:37.659
device, but yeah, I'd say I'm impartial. I'd
01:12:37.659 --> 01:12:39.850
say to the... Person who asked the question,
01:12:39.970 --> 01:12:43.430
what's the problem? Oh, well, they're probably
01:12:43.430 --> 01:12:48.050
listening. So they'll probably... All right,
01:12:48.109 --> 01:12:51.250
last one. Probably the biggest one. In -clinic
01:12:51.250 --> 01:12:54.630
manufacturing, overrated or underrated? I'll
01:12:54.630 --> 01:12:58.050
probably start with you, Rhys. I think empowerment
01:12:58.050 --> 01:13:01.050
of the profession is really important. So if
01:13:01.050 --> 01:13:04.390
that's something that the consumer, the podiatrist,
01:13:04.510 --> 01:13:07.210
it's important to them, then I'd probably say
01:13:07.210 --> 01:13:13.439
underrated. Kent? Look, I think it comes back
01:13:13.439 --> 01:13:15.760
to some of the early points we discussed about
01:13:15.760 --> 01:13:20.819
the relationship you have with your lab. I think
01:13:20.819 --> 01:13:25.600
by and large, labs do a really good job of taking
01:13:25.600 --> 01:13:31.119
the intent from the clinician and with the help
01:13:31.119 --> 01:13:35.899
of a prescription form, producing a device that
01:13:35.899 --> 01:13:39.720
has a therapeutic effect. for your patient um
01:13:39.720 --> 01:13:43.020
and and i think that's a relationship to be really
01:13:43.020 --> 01:13:47.619
highly valued so if you if you believe that you
01:13:47.619 --> 01:13:51.239
can achieve the same results by doing it in -house
01:13:51.239 --> 01:13:57.640
absolutely Konrad yeah it's definitely underrated
01:13:57.640 --> 01:14:03.060
um you know we we had like a philosophy 10 years
01:14:03.060 --> 01:14:06.600
ago where you know i'm gonna write software and
01:14:07.159 --> 01:14:09.819
you know try and teach as many podiatrists as
01:14:09.819 --> 01:14:12.399
possible how to use it because we saw the progression
01:14:12.399 --> 01:14:15.699
and the evolution of the industry being with
01:14:15.699 --> 01:14:19.460
podiatrists doing more design and more cad so
01:14:19.460 --> 01:14:24.340
with you know we appreciate a manufacturing landscape
01:14:24.340 --> 01:14:26.659
where labs are you know an open book letting
01:14:26.659 --> 01:14:29.119
people learn their cad processes and we've seen
01:14:29.119 --> 01:14:30.739
that over the last few years which has been a
01:14:30.739 --> 01:14:34.380
bit of a change which has been good and i think
01:14:34.380 --> 01:14:38.159
anything that develops more skills within the
01:14:38.159 --> 01:14:40.520
practitioner that is directly seeing the patient
01:14:40.520 --> 01:14:42.920
is probably going to be good for the patient
01:14:42.920 --> 01:14:48.000
so long as that um you know that sort of takes
01:14:48.000 --> 01:14:49.880
me back to what i mentioned before we don't want
01:14:49.880 --> 01:14:54.180
to see um in clinic 3d printing where clinicians
01:14:54.180 --> 01:14:57.680
are taking much larger shortcuts mirroring devices
01:14:57.680 --> 01:15:00.659
things like that and doing a a disservice to
01:15:00.659 --> 01:15:02.420
the profession as well so we want to make sure
01:15:02.420 --> 01:15:08.460
it's really you know done to an ethical standard,
01:15:08.600 --> 01:15:13.359
basically, in the clinic and in the labs. To
01:15:13.359 --> 01:15:16.840
us. Finish us off. I think if we're playing the
01:15:16.840 --> 01:15:19.260
game to its form, I'd say underrated. But to
01:15:19.260 --> 01:15:22.739
flesh that out, I think that echoing all the
01:15:22.739 --> 01:15:26.100
sentiments, you know, Kent's point around the
01:15:26.100 --> 01:15:29.439
relationship being super critical. That is obviously
01:15:29.439 --> 01:15:32.800
very important. But Konrad did raise a very good
01:15:32.800 --> 01:15:36.800
point regarding the quality and that each individual.
01:15:38.090 --> 01:15:40.909
person who has access to a 3D printer and potentially
01:15:40.909 --> 01:15:42.970
some software are not necessarily going to produce
01:15:42.970 --> 01:15:46.289
good orthotics where there is, you know, in our
01:15:46.289 --> 01:15:50.329
experience as with these guys, you know, a highly
01:15:50.329 --> 01:15:53.270
iterative process is required to produce something
01:15:53.270 --> 01:15:56.470
of quality. I think it is good for the podiatrist
01:15:56.470 --> 01:16:00.430
to be able to see how the, you know, how the
01:16:00.430 --> 01:16:07.470
cake is baked per se, but all... things considered.
01:16:07.609 --> 01:16:10.890
In Australia, we do have some quite good quality
01:16:10.890 --> 01:16:15.250
labs where we're getting quite good quality orthotics.
01:16:15.489 --> 01:16:19.789
So podiatrists are very lucky to have that. But
01:16:19.789 --> 01:16:24.369
yeah, I do think that having access and understanding
01:16:24.369 --> 01:16:29.010
what orthotics will be better for what case is
01:16:29.010 --> 01:16:31.529
something. Also, the podiatrist does have to
01:16:31.529 --> 01:16:34.449
often do some post -processing too, as it depends
01:16:34.449 --> 01:16:37.850
how time poor. They may have to still put a cover
01:16:37.850 --> 01:16:41.770
on that device. They may not have the time. Generally
01:16:41.770 --> 01:16:45.329
underrated. Awesome. All right. Well, moving
01:16:45.329 --> 01:16:50.550
into the close of this fantastic session, for
01:16:50.550 --> 01:16:52.909
the panel, what's one thing you would change
01:16:52.909 --> 01:16:56.090
about how you'd approach orthotic therapy starting
01:16:56.090 --> 01:16:59.449
tomorrow as a clinician? What would you recommend
01:16:59.449 --> 01:17:01.550
them to think about starting tomorrow with their
01:17:01.550 --> 01:17:06.710
practice? Darcy? Keep it simple, understand your
01:17:06.710 --> 01:17:08.930
materials, think a bit harder about the clinical
01:17:08.930 --> 01:17:13.810
reasoning. Konrad? Understand that your prescription
01:17:13.810 --> 01:17:17.590
is basically a set of instructions to interpret
01:17:17.590 --> 01:17:21.289
CAD design. So if you don't know how to design
01:17:21.289 --> 01:17:24.510
orthotics with software, you should speak to
01:17:24.510 --> 01:17:27.270
your lab and go in and sit next to them and watch
01:17:27.270 --> 01:17:29.789
them actually design or learn how to do it yourself.
01:17:30.880 --> 01:17:32.899
It's going to make a profound difference on your
01:17:32.899 --> 01:17:35.899
understanding of prescription. And if I can have
01:17:35.899 --> 01:17:41.039
one more, it would be basically connect foot
01:17:41.039 --> 01:17:45.159
capture very closely and really critically think
01:17:45.159 --> 01:17:47.699
about foot capture in the context of manufacturing,
01:17:47.720 --> 01:17:51.140
how important it is. Because that is the number
01:17:51.140 --> 01:17:54.500
one issue we see in the lab is poor quality foot
01:17:54.500 --> 01:17:58.380
capture and no measurements of scans. Kent, is
01:17:58.380 --> 01:18:02.880
it about subtalar joint neutral? Look, I'd probably
01:18:02.880 --> 01:18:06.039
say go and spend some time in the lab, as Konrad
01:18:06.039 --> 01:18:14.119
said. I think that is such a valuable thing for
01:18:14.119 --> 01:18:16.680
the clinician to do. Make an appointment with
01:18:16.680 --> 01:18:19.199
your lab. Go and have a chat with them. See how
01:18:19.199 --> 01:18:22.479
their devices are modelled, how they're made.
01:18:23.199 --> 01:18:25.539
Understand what the options are, what they mean,
01:18:25.619 --> 01:18:30.899
what they look like. Yeah, it's well worth your
01:18:30.899 --> 01:18:33.060
time and it's well worth the lab's time as well.
01:18:33.260 --> 01:18:37.159
And Rhys? Establish what is the objective of
01:18:37.159 --> 01:18:40.899
your orthotic. Understand the tissue stress model
01:18:40.899 --> 01:18:44.079
and the application of pathomechanical prescribing
01:18:44.079 --> 01:18:48.260
and combine those with rapport and relationship
01:18:48.260 --> 01:18:50.899
with your lab to achieve what you want to achieve
01:18:50.899 --> 01:18:53.899
as podiatrist. i guess for our final strides
01:18:53.899 --> 01:18:55.739
this has probably been one of the most comprehensive
01:18:55.739 --> 01:18:58.859
recorded conversations about orthotics we've
01:18:58.859 --> 01:19:01.720
had in australia so i would like a timeless perspective
01:19:01.720 --> 01:19:03.779
from each and every one of you about something
01:19:03.779 --> 01:19:06.859
that's held true to your beliefs throughout your
01:19:06.859 --> 01:19:09.500
career on orthotics Kent i'll probably start
01:19:09.500 --> 01:19:12.239
with you given you're our commonwealth game slash
01:19:12.239 --> 01:19:16.520
olympic podiatrist what's sort of one principle
01:19:16.520 --> 01:19:18.479
that's helped you throughout your career and
01:19:18.479 --> 01:19:19.779
is that something you're happy to share with
01:19:19.779 --> 01:19:23.920
us In terms of orthotic prescription from a clinical
01:19:23.920 --> 01:19:27.359
standpoint, the world is your oyster, my friend.
01:19:28.479 --> 01:19:33.060
Look, get the patient comfortable. Simple as
01:19:33.060 --> 01:19:36.880
that. You know, we can overcomplicate things,
01:19:37.100 --> 01:19:42.399
but sometimes we just need to strip it back and
01:19:42.399 --> 01:19:47.460
get them comfortable. Rhys? Time. Time is your
01:19:47.460 --> 01:19:54.630
friend. Don't expect. that from the moment you're
01:19:54.630 --> 01:19:56.689
patient or you're standing on the orthotic or
01:19:56.689 --> 01:20:01.350
it's within the shoe, there's no silver bullet.
01:20:01.569 --> 01:20:05.689
Is that what they call it, Pat? You know, time
01:20:05.689 --> 01:20:07.949
is your friend. Trust and back your confidence
01:20:07.949 --> 01:20:16.050
and then allow for time. The best orthotic is
01:20:16.050 --> 01:20:19.390
the one that the person will wear. Great. Konrad.
01:20:20.140 --> 01:20:22.260
Yeah, look, everyone knows that I'm a bit of
01:20:22.260 --> 01:20:24.460
a broken record when they come and do training
01:20:24.460 --> 01:20:27.640
sessions with me, but it's just, you know, that
01:20:27.640 --> 01:20:30.220
the scan is fundamentally the most important
01:20:30.220 --> 01:20:33.500
thing for the lab and that it should be clearly
01:20:33.500 --> 01:20:36.239
measured by the clinician. That's held true.
01:20:38.119 --> 01:20:40.260
Thank you to all our panellists for contributing
01:20:40.260 --> 01:20:42.060
to what's probably one of the most important
01:20:42.060 --> 01:20:44.039
discussions, especially for our younger listeners.
01:20:45.060 --> 01:20:47.619
Hopefully we can get you back on for round two
01:20:47.619 --> 01:20:50.000
or potentially see you at the SEPA conference.
01:20:50.220 --> 01:20:52.100
Thanks, Pat. Thanks very much.
00:00:04.169 --> 00:00:06.530
Welcome to Sole Science, the official podcast
00:00:06.530 --> 00:00:08.509
of Sports and Exercise Podiatry Australasia.
00:00:08.689 --> 00:00:11.250
Each episode, we sit down with leading clinicians,
00:00:11.529 --> 00:00:13.669
researchers and innovators from across sports
00:00:13.669 --> 00:00:16.609
medicine, biomechanics and podiatry to unpack
00:00:16.609 --> 00:00:19.370
the ideas shaping our profession. From cutting
00:00:19.370 --> 00:00:22.170
edge research and clinical pearls to career journeys,
00:00:22.350 --> 00:00:24.769
controversial topics and lessons learned along
00:00:24.769 --> 00:00:27.109
the way, we're here to bridge the gap between
00:00:27.109 --> 00:00:29.609
science and practice. Whether you're a student,
00:00:29.670 --> 00:00:32.570
clinician, researcher or simply passionate about
00:00:32.570 --> 00:00:35.460
human movement. Join us as we explore the evidence,
00:00:35.700 --> 00:00:38.359
challenge assumptions, and discover what it takes
00:00:38.359 --> 00:00:40.939
to keep people performing at their best. This
00:00:40.939 --> 00:00:45.700
is Sole Science. John Charles. Evening. I'm quite
00:00:45.700 --> 00:00:47.820
excited about tonight because we have, I guess,
00:00:47.859 --> 00:00:52.140
a very special episode for our listeners. This
00:00:52.140 --> 00:00:54.219
is the first time we're running a panel. Let's
00:00:54.219 --> 00:00:57.079
step right into it. Today's episode is a special
00:00:57.079 --> 00:00:59.579
panel of Sole Science, bringing together some
00:00:59.579 --> 00:01:01.560
of the leading voices shaping the future of custom
00:01:01.560 --> 00:01:04.469
foot orthoses. across clinical practice, manufacturing
00:01:04.469 --> 00:01:07.430
and digital innovation in Australia. This is
00:01:07.430 --> 00:01:09.989
not a single perspective. That is the ecosystem.
00:01:10.390 --> 00:01:12.310
Tonight, we're joined by a panel that represents
00:01:12.310 --> 00:01:14.530
the full spectrum of orthotic development from
00:01:14.530 --> 00:01:17.010
clinician to lab, from traditional craftsmanship
00:01:17.010 --> 00:01:19.829
to advanced digital workflows. First up, we have
00:01:19.829 --> 00:01:21.870
Kent Sweeting. He is the owner of Queensland
00:01:21.870 --> 00:01:24.450
Orthotic Lab and a clinician researcher with
00:01:24.450 --> 00:01:27.049
over two decades of experience across private
00:01:27.049 --> 00:01:30.290
practice, academia and manufacturing. A first
00:01:30.290 --> 00:01:33.310
class honours graduate from QUT, Kent's work is
00:01:33.310 --> 00:01:35.290
in Achilles tendinopathy and has been recognised
00:01:35.290 --> 00:01:37.969
nationally and is a contributing author to Bracken
00:01:37.969 --> 00:01:40.930
& Kahn's Clinical Sports Medicine. He has served
00:01:40.930 --> 00:01:44.590
as the president of formerly APSIM, now SEPA,
00:01:44.689 --> 00:01:48.290
worked within the 2018 Commonwealth Games Polyclinic
00:01:48.290 --> 00:01:50.430
and continues to contribute to high performance
00:01:50.430 --> 00:01:52.930
environments including Queensland Ballet. We
00:01:52.930 --> 00:01:55.730
also have up next Rhys Pierce. He's the General
00:01:55.730 --> 00:01:58.310
Manager of Footwork, bringing a unique perspective
00:01:58.310 --> 00:02:01.180
as both a clinician and a senior leader in orthotic
00:02:01.180 --> 00:02:04.000
manufacturing. After establishing and growing
00:02:04.000 --> 00:02:06.579
a multidisciplinary podiatry clinic, Rhys transitioned
00:02:06.579 --> 00:02:09.120
into a lab environment where he oversees the
00:02:09.120 --> 00:02:11.400
broader Footwork operation. His experience across
00:02:11.400 --> 00:02:13.240
both sides of the profession provides a rare
00:02:13.240 --> 00:02:15.840
insight into how orthotics are prescribed, produced
00:02:15.840 --> 00:02:18.680
and scaled in modern practice. Thirdly, we have
00:02:18.680 --> 00:02:20.840
Konrad Job. He's a podiatrist specialising in
00:02:20.840 --> 00:02:23.080
orthotic technology and digital manufacturing
00:02:23.080 --> 00:02:25.800
systems. He's closely involved in the development
00:02:25.800 --> 00:02:28.370
of LaserChem orthotics platform, and works across
00:02:28.370 --> 00:02:31.469
clinics, laboratories and universities to advance
00:02:31.469 --> 00:02:34.330
how orthoses are designed and produced. Konrad
00:02:34.330 --> 00:02:36.449
also plays a key role in educating clinicians
00:02:36.449 --> 00:02:40.009
on 3D scanning, digital workflows, while contributing
00:02:40.009 --> 00:02:42.430
to ongoing research exploring differences in
00:02:42.430 --> 00:02:44.389
foot capture techniques. And lastly, we have
00:02:44.389 --> 00:02:46.430
Darcy Dore. He's a sports podiatrist at the Run
00:02:46.430 --> 00:02:48.889
Clinic in Brisbane with a clinical focus on running
00:02:48.889 --> 00:02:51.530
-related injuries and performance. Alongside
00:02:51.530 --> 00:02:53.770
his clinical work, Darcy is involved in research
00:02:53.770 --> 00:02:56.789
with QUT exploring advanced footwear and material
00:02:56.789 --> 00:02:59.270
science. Through his work with Propel 3D, Darcy
00:02:59.270 --> 00:03:02.030
is helping bringing in -house orthotic manufacturing
00:03:02.030 --> 00:03:05.509
into clinics, utilizing 3D printing, TPU materials
00:03:05.509 --> 00:03:08.710
to reshape turnaround times, customization, and
00:03:08.710 --> 00:03:11.530
clinician control. Gentlemen, thanks for coming
00:03:11.530 --> 00:03:13.789
on tonight. Welcome. Good to be with you guys.
00:03:13.969 --> 00:03:16.770
Thanks for having us. Thanks, Pat. Thanks, JC.
00:03:17.030 --> 00:03:22.490
I guess in a rare opportunity, we have a panel
00:03:22.490 --> 00:03:25.159
tonight rather than individual guests. We're
00:03:25.159 --> 00:03:27.120
going to throw this to the floor and I'll probably
00:03:27.120 --> 00:03:29.319
start with you first, Kent. How do you define
00:03:29.319 --> 00:03:31.719
success when you're looking at orthosis in clinical
00:03:31.719 --> 00:03:34.219
practice and what are your markers for success?
00:03:35.120 --> 00:03:39.120
Yeah, I think for me success is when the orthotic
00:03:39.120 --> 00:03:42.080
changes the load in the way that the clinician
00:03:42.080 --> 00:03:47.060
intended and the patient can comfortably tolerate
00:03:47.060 --> 00:03:51.400
that change. So, you know, we need the orthotic
00:03:51.400 --> 00:03:56.830
to be comfortable. But, you know, we need to
00:03:56.830 --> 00:04:01.189
get to a certain end point. So sometimes that
00:04:01.189 --> 00:04:04.030
might be symptom resolution, but other times
00:04:04.030 --> 00:04:09.069
it's, you know, producing tissue stress to enable
00:04:09.069 --> 00:04:13.449
a loading progression. So, yeah, I guess that's
00:04:13.449 --> 00:04:17.790
how I would define it. Darcy? I would definitely
00:04:17.790 --> 00:04:22.230
second Kent's version there. I think that an
00:04:22.230 --> 00:04:25.860
orthotic that is... modifying the load that needs
00:04:25.860 --> 00:04:28.279
to be modified in order for the person to do
00:04:28.279 --> 00:04:30.680
what they need to do and obviously sometimes
00:04:30.680 --> 00:04:33.180
that's temporary a lot of the times it's not
00:04:33.180 --> 00:04:35.100
and looks very different for different people
00:04:35.100 --> 00:04:37.779
but um yeah sometimes we're thinking more about
00:04:37.779 --> 00:04:40.360
kinematic changes sometimes more about kinetic
00:04:40.360 --> 00:04:44.279
if we can measure them but yeah i'd second second
00:04:44.279 --> 00:04:47.939
Kent's points Rhys i'll probably direct you
00:04:47.939 --> 00:04:51.220
next um but just to add on to that question i
00:04:51.220 --> 00:04:53.959
guess you've lived through a career where you've
00:04:53.959 --> 00:04:56.360
transitioned from traditional orthotic manufacturing
00:04:56.360 --> 00:05:00.300
to now more 3d printing how do you define success
00:05:00.300 --> 00:05:03.120
and has that changed since you've adopted new
00:05:03.120 --> 00:05:06.120
technologies yeah so it's it's a good question
00:05:06.120 --> 00:05:09.600
pat because i'd say probably halfway through
00:05:09.600 --> 00:05:13.000
my now career is when we did see that change
00:05:13.000 --> 00:05:18.459
uh around 2019 into 3d printing and i don't necessarily
00:05:18.459 --> 00:05:23.170
think the change in material or manufacturing
00:05:23.170 --> 00:05:27.129
technique has changed my perspective on clinical
00:05:27.129 --> 00:05:29.410
outcomes. For me, it's about the patient journey
00:05:29.410 --> 00:05:32.589
and the patient outcomes. When someone presents
00:05:32.589 --> 00:05:36.569
to the clinic, are they presenting because of
00:05:36.569 --> 00:05:39.750
their pain or are they presenting because their
00:05:39.750 --> 00:05:43.519
lack of ability to... you know, runner or compete
00:05:43.519 --> 00:05:46.939
in a sub five hour half iron like JC on the weekend.
00:05:47.160 --> 00:05:49.339
So is it about the pain that they're presenting
00:05:49.339 --> 00:05:52.019
or is it the lack of, or the ability or inability
00:05:52.019 --> 00:05:54.939
to actually compete or do what they want to do?
00:05:54.959 --> 00:05:57.720
It may just be as simple as keeping up with their
00:05:57.720 --> 00:06:00.980
kids. So for me, it's about defining what that
00:06:00.980 --> 00:06:03.379
outcome is. And if we can achieve that outcome
00:06:03.379 --> 00:06:05.899
through the use of orthoses or combining that
00:06:05.899 --> 00:06:09.540
with other treatment options, that helps to define
00:06:09.540 --> 00:06:12.879
success for me. cool and as um obviously you
00:06:12.879 --> 00:06:15.819
guys all work in a laboratory environment and
00:06:15.819 --> 00:06:18.839
um i guess i'm interested to know like where
00:06:18.839 --> 00:06:22.759
from a lab end where do you feel like your measure
00:06:22.759 --> 00:06:25.120
of success comes from the orthotic like is it
00:06:25.120 --> 00:06:28.579
is it people reordering orthotics is it kind
00:06:28.579 --> 00:06:31.199
of you know happy is it the relationship you
00:06:31.199 --> 00:06:33.699
build up with a podiatrist or are you really
00:06:33.699 --> 00:06:36.180
interested in the end result when it comes to
00:06:36.180 --> 00:06:39.740
patients i think personally jc if that was um
00:06:40.139 --> 00:06:43.220
directed it at me uh i really get satisfaction
00:06:43.220 --> 00:06:49.060
around podiatrists when they not just have their
00:06:49.060 --> 00:06:52.839
patients successful outcomes the orthotic is
00:06:52.839 --> 00:06:56.060
matching their expectation as well and i think
00:06:56.060 --> 00:06:58.879
we see that when podiatrists really invest in
00:06:58.879 --> 00:07:02.699
understanding terminology and also understand
00:07:03.580 --> 00:07:05.600
you know, processes of orthotic manufacturer
00:07:05.600 --> 00:07:08.259
as well. So, you know, when people come back
00:07:08.259 --> 00:07:09.899
and say, look, the orthotic achieved exactly
00:07:09.899 --> 00:07:12.079
what I wanted to achieve on the fitting and consultation,
00:07:12.439 --> 00:07:15.399
and then follow up down the track and say, look,
00:07:15.500 --> 00:07:17.740
my patient's now pain -free or they're able to
00:07:17.740 --> 00:07:20.920
compete in a certain event or play football on
00:07:20.920 --> 00:07:23.540
the weekend, et cetera. You know, that's success
00:07:23.540 --> 00:07:27.019
in my perspective. Konrad, can you tell us your
00:07:27.019 --> 00:07:29.720
perspective on success and how your orthotic
00:07:29.720 --> 00:07:31.519
laboratory, I guess, develops over the years?
00:07:31.870 --> 00:07:35.350
A big question. I'd have to sort of reiterate
00:07:35.350 --> 00:07:38.470
a lot of what the other panellists said and,
00:07:38.550 --> 00:07:41.129
you know, on Rhys' comment about, you know, markers
00:07:41.129 --> 00:07:44.470
in their quality of life, like stripping it back
00:07:44.470 --> 00:07:47.029
to the important things for the individual patient.
00:07:47.149 --> 00:07:50.350
Like I think Rhys said walking with their kids,
00:07:50.430 --> 00:07:53.350
you know, having a grandpa be able to go to the
00:07:53.350 --> 00:07:56.230
park and, you know, enjoy spending time with
00:07:56.230 --> 00:07:59.709
their family to a greater extent. If you strip
00:07:59.709 --> 00:08:03.589
it back to the orthotic, itself you know we you
00:08:03.589 --> 00:08:06.670
might be looking at initially whether it simply
00:08:06.670 --> 00:08:09.310
matches the prescription in the clinic you know
00:08:09.310 --> 00:08:12.170
having a certain series of checks to make sure
00:08:12.170 --> 00:08:14.610
you know are all the features that i requested
00:08:14.610 --> 00:08:18.329
in the correct locations does it properly fit
00:08:18.329 --> 00:08:22.110
the footwear Does it fit the foot in a weight
00:08:22.110 --> 00:08:25.009
-bearing position out of shoes and within shoes?
00:08:25.209 --> 00:08:27.850
And then, you know, making sure that the patient
00:08:27.850 --> 00:08:30.829
understands the purpose of the devices and, you
00:08:30.829 --> 00:08:34.370
know, engaging with the treatment. And, of course,
00:08:34.389 --> 00:08:37.190
comfort, as the other panellists said as well.
00:08:37.429 --> 00:08:41.269
You know, I don't think many podiatrists would
00:08:41.269 --> 00:08:44.149
be doing, you know, 100mm visual analogue scales
00:08:44.149 --> 00:08:47.990
of, like, comfort and pain, but, of course, some
00:08:47.990 --> 00:08:51.259
would. Usually it's just sort of a conversation.
00:08:51.480 --> 00:08:55.240
I think more interestingly, we see measures of
00:08:55.240 --> 00:08:58.480
success, like for me, working with maybe hospitals
00:08:58.480 --> 00:09:01.460
where they have Intu PDAR systems and things
00:09:01.460 --> 00:09:04.159
like that, where you can get more objective data
00:09:04.159 --> 00:09:08.440
on reductions in pressure to see more visible
00:09:08.440 --> 00:09:10.600
change in healing of ulcers and things like that.
00:09:11.100 --> 00:09:14.059
And what was the second part to your question
00:09:14.059 --> 00:09:16.379
there, Pat? Tell us about the history of laser
00:09:16.379 --> 00:09:21.480
cam. short and sweet and tell us um how your
00:09:21.480 --> 00:09:24.759
products have been developed yeah well it actually
00:09:24.759 --> 00:09:28.980
started in 1997 there was actually four podiatrists
00:09:28.980 --> 00:09:31.620
that started the lab um it was called adelaide
00:09:31.620 --> 00:09:33.919
podiatry group it's before my time i think it
00:09:33.919 --> 00:09:37.080
was about eight years old and at the time we
00:09:37.080 --> 00:09:40.419
were using a system called amfit which i'm sure
00:09:40.419 --> 00:09:43.779
everyone knows and the old owner at the time
00:09:43.779 --> 00:09:47.929
who was a great boss, but a very polarizing figure
00:09:47.929 --> 00:09:52.070
in the profession as well. He started developing
00:09:52.070 --> 00:09:54.230
his own software because he wanted more control
00:09:54.230 --> 00:09:58.309
over the entire CAD process. So since then, it's
00:09:58.309 --> 00:10:00.850
been purchased by three new owners. We're under
00:10:00.850 --> 00:10:02.990
a different umbrella now called GMZ Medical,
00:10:03.210 --> 00:10:05.730
but we're basically just continuing to write
00:10:05.730 --> 00:10:08.509
software and try and improve our CAD. That's
00:10:08.509 --> 00:10:11.309
our focus. Awesome. I guess we'll move on to
00:10:11.309 --> 00:10:16.090
a slightly more controversial topic so um i guess
00:10:16.090 --> 00:10:18.610
we're quite interested to know you know what
00:10:18.610 --> 00:10:21.009
your guys views are on i guess you could call
00:10:21.009 --> 00:10:22.929
it the over prescription of orthotics or maybe
00:10:22.929 --> 00:10:25.529
prescribing orthotics in cases where they're
00:10:25.529 --> 00:10:28.950
they're not required or patients are asymptomatic
00:10:28.950 --> 00:10:32.490
um where where do you guys stand on it and i
00:10:32.490 --> 00:10:34.710
guess it's for anyone to kind of chip in initially
00:10:34.710 --> 00:10:38.070
uh do you feel like the orthotics are often over
00:10:38.070 --> 00:10:40.590
prescribed when when other approaches could be
00:10:40.590 --> 00:10:43.360
taken first i think we're currently in a landscape
00:10:43.360 --> 00:10:47.220
where uh footwear can make a really big difference
00:10:47.220 --> 00:10:50.580
to pressure and loads on the bottom of the feet
00:10:50.580 --> 00:10:55.960
so orthotics are obviously you know can be over
00:10:55.960 --> 00:11:00.759
prescribed by podiatrists where you know having
00:11:00.759 --> 00:11:02.759
the shoes be able to do so much of that work
00:11:02.759 --> 00:11:05.100
it's just making our job i think a lot easier
00:11:05.100 --> 00:11:07.240
and probably a little bit less likely to over
00:11:07.240 --> 00:11:09.860
prescribe considering the shoe can do quite a
00:11:09.860 --> 00:11:13.429
bit what do you guys think Yeah, I think it's
00:11:13.429 --> 00:11:15.649
a very difficult question to answer from a lab
00:11:15.649 --> 00:11:18.509
perspective, because, you know, from a lab perspective,
00:11:18.610 --> 00:11:21.129
we're just trying to manufacture the best possible
00:11:21.129 --> 00:11:23.490
product based on our prescription. So our role
00:11:23.490 --> 00:11:26.850
isn't really to determine someone's justification,
00:11:27.029 --> 00:11:30.129
essentially, for the orthotics. But, you know,
00:11:30.169 --> 00:11:33.230
I guess for me, I don't really see orthotics
00:11:33.230 --> 00:11:37.269
as much of a performance device, more of it as
00:11:37.269 --> 00:11:40.289
like a treatment modality. So, you know, I think.
00:11:40.639 --> 00:11:44.259
prevention in asymptomatic patients gets a little
00:11:44.259 --> 00:11:47.539
bit gray especially for you know pediatric populations
00:11:47.539 --> 00:11:51.679
where it probably it's it's not justified a custom
00:11:51.679 --> 00:11:53.720
orthotic compared to something like a prefab
00:11:53.720 --> 00:11:57.799
um and i think our focus should probably be more
00:11:57.799 --> 00:12:00.580
on conditions um you know that are symptomatic
00:12:00.580 --> 00:12:03.919
or clearly limiting function and quality of life
00:12:03.919 --> 00:12:07.519
i just say that maybe a caveat is like you know
00:12:07.519 --> 00:12:09.940
it might not be this way forever we can see that
00:12:10.299 --> 00:12:12.740
modern footwear as you brought it up you know
00:12:12.740 --> 00:12:15.759
it definitely influences performance significantly
00:12:15.759 --> 00:12:19.899
you know what is it like uh every world record
00:12:19.899 --> 00:12:23.700
from 5k to marathon or something has been broken
00:12:23.700 --> 00:12:26.480
in the last how how many years five years or
00:12:26.480 --> 00:12:30.940
something like that 2017 i think yeah so um i
00:12:30.940 --> 00:12:34.480
don't think it's unreasonable to you know have
00:12:34.480 --> 00:12:38.080
clinicians that have very specific sports focused
00:12:38.080 --> 00:12:41.639
you know experience the prescribing for performance
00:12:41.639 --> 00:12:44.279
reasons but that's just not me because i don't
00:12:44.279 --> 00:12:49.700
i'm not in that role yeah i think uh as a profession
00:12:49.700 --> 00:12:55.240
um being podiatry it's really important to not
00:12:55.240 --> 00:12:57.340
necessarily contribute to the hysteria of over
00:12:57.340 --> 00:13:01.379
prescribing i think one of sort of certainly
00:13:01.379 --> 00:13:06.950
my clinical ethos is pathomechanical prescribing.
00:13:07.090 --> 00:13:10.789
Are we prescribing based on a pathological presentation
00:13:10.789 --> 00:13:14.909
in combination with a mechanical assessment as
00:13:14.909 --> 00:13:21.450
well? So if you can then sort of measure that
00:13:21.450 --> 00:13:27.389
pathomechanical finding and... as part of your
00:13:27.389 --> 00:13:29.649
patient's treatment journey, contribute to that
00:13:29.649 --> 00:13:34.409
with an orthomechanical device. It's justified.
00:13:35.190 --> 00:13:39.809
But as Darcy said, the use of a holistic treatment
00:13:39.809 --> 00:13:44.230
approach with footwear, load -based exercise
00:13:44.230 --> 00:13:47.830
treatments, I think is really important as well.
00:13:48.230 --> 00:13:52.179
And like we mentioned before with... Footwear,
00:13:52.379 --> 00:13:55.059
you know, obviously footwear has contributed
00:13:55.059 --> 00:13:57.779
significantly to performance, but has it also
00:13:57.779 --> 00:14:00.759
contributed to, you know, injury as well? I certainly
00:14:00.759 --> 00:14:05.440
see a lot more patients present laterally loading
00:14:05.440 --> 00:14:09.620
through the use of low density, you know, midsole
00:14:09.620 --> 00:14:13.120
shoes when, you know, that's not necessarily
00:14:13.120 --> 00:14:15.460
the most appropriate treatment option for them,
00:14:15.519 --> 00:14:19.460
albeit, you know, that shoe may be over prescribed.
00:14:20.440 --> 00:14:23.440
uh so i think definitely podiatry needs to retain
00:14:23.440 --> 00:14:28.179
uh i guess a high level of education around orthotics
00:14:28.179 --> 00:14:30.419
and these sorts of sessions will contribute to
00:14:30.419 --> 00:14:32.440
that but also at the university level the educational
00:14:32.440 --> 00:14:35.679
level as well kent do you want to weigh in yeah
00:14:35.679 --> 00:14:37.759
look don't disagree with anything that's been
00:14:37.759 --> 00:14:41.340
said by the other panelists there i guess my
00:14:41.340 --> 00:14:47.379
only point to add um to that is from a purely
00:14:48.490 --> 00:14:50.830
athletic performance or high performance you
00:14:50.830 --> 00:14:55.509
know lens um and and really you know in that
00:14:55.509 --> 00:15:00.230
sort of uh population i guess we need to ask
00:15:00.230 --> 00:15:04.570
ourselves you know is their morphology interacting
00:15:04.570 --> 00:15:06.909
with their training load in a way that deserves
00:15:06.909 --> 00:15:12.230
intervention um so um you know that group of
00:15:12.230 --> 00:15:15.399
individuals you know, we might use that lens
00:15:15.399 --> 00:15:20.379
a little more so than, say, an asymptomatic paediatric
00:15:20.379 --> 00:15:24.419
patient. Good one. All right. Next question off
00:15:24.419 --> 00:15:28.039
the panel, and I'll probably start with Rhys
00:15:28.039 --> 00:15:31.620
with this one. Who owns orthotics as a profession?
00:15:31.860 --> 00:15:36.240
Should podiatrists remain the people who prescribe
00:15:36.240 --> 00:15:38.899
orthoses? Because we know chiropractors, physiotherapists,
00:15:39.019 --> 00:15:42.100
even some sports doctors to a degree. We've got
00:15:42.100 --> 00:15:46.539
one. around the corner who prints his own. Who
00:15:46.539 --> 00:15:49.139
should own this? Because I get we get the private
00:15:49.139 --> 00:15:51.580
health insurance codes, but is it something that's
00:15:51.580 --> 00:15:55.080
within our scope to keep? Yeah, Pat, I'll throw
00:15:55.080 --> 00:15:57.259
it back to you. What is an orthotic? That's a
00:15:57.259 --> 00:16:01.179
very good question. Because if we're talking
00:16:01.179 --> 00:16:05.879
about custom foot orthoses based on a 3D scan
00:16:05.879 --> 00:16:08.500
or a plaster cast or a physical impression, I
00:16:08.500 --> 00:16:11.440
think podiatrists need to own that as a profession.
00:16:12.619 --> 00:16:17.279
We're all aware of other professions, you know,
00:16:17.279 --> 00:16:21.220
prescribing certain types of in -shoe devices.
00:16:21.700 --> 00:16:25.679
But I think custom prosthesis, you know, manufactured
00:16:25.679 --> 00:16:28.759
from a scan or a physical impression, it needs
00:16:28.759 --> 00:16:30.399
to be something that the podiatry profession
00:16:30.399 --> 00:16:36.440
continues to own and educate and grow because
00:16:36.440 --> 00:16:40.580
it is, at the end of the day, as you said, a
00:16:40.580 --> 00:16:46.500
private health podiatry -specific intervention,
00:16:46.759 --> 00:16:49.840
which would, I guess, suggest that it is something
00:16:49.840 --> 00:16:52.320
that podiatrists should continue to excel in
00:16:52.320 --> 00:16:55.419
over other professions. Tasi? Yeah, I think that's
00:16:55.419 --> 00:16:58.100
a really good point Rhys made, that it is important
00:16:58.100 --> 00:17:00.299
for the podiatrist to be the most proficient
00:17:00.299 --> 00:17:04.700
at prescribing for orthotics, and also that if
00:17:04.700 --> 00:17:08.359
another profession is prescribing, that they
00:17:08.359 --> 00:17:11.069
may not be using an actual scan and impression
00:17:11.069 --> 00:17:17.109
of the foot. So yeah I also do think that some
00:17:17.109 --> 00:17:20.769
simple prescriptions could be done by a non -podiatrist
00:17:20.769 --> 00:17:24.170
where there's a clear evidence base for say if
00:17:24.170 --> 00:17:27.569
it was you know patellofemoral pain for a simple
00:17:27.569 --> 00:17:32.390
foot orthotic or you know a plantar foot problem
00:17:32.390 --> 00:17:35.730
that can be you know usually improved by some.
00:17:36.170 --> 00:17:38.849
medial support. Obviously, there's a bit of space
00:17:38.849 --> 00:17:43.430
for that to go wrong, but I think that it could
00:17:43.430 --> 00:17:45.529
be helpful. I think podiatrist books are generally
00:17:45.529 --> 00:17:49.190
pretty full for the most part, and people can
00:17:49.190 --> 00:17:52.730
buy all sorts of things on the internet. So having
00:17:52.730 --> 00:17:58.529
a competent physiotherapist prescribe a basic
00:17:58.529 --> 00:18:02.490
off -the -shelf medial supporting device is not...
00:18:02.670 --> 00:18:04.950
the biggest problem that I see. But I do think
00:18:04.950 --> 00:18:07.730
that, as Ray said, podiatrists should be able
00:18:07.730 --> 00:18:09.529
to have the ownership over things that are more
00:18:09.529 --> 00:18:14.150
specialised and provide, you know, the most quality
00:18:14.150 --> 00:18:16.630
foot orthotics for whatever outcome we're trying
00:18:16.630 --> 00:18:19.109
to achieve. Can I interject here? And I'll probably
00:18:19.109 --> 00:18:21.069
direct this at Kent because I'm building on that
00:18:21.069 --> 00:18:23.549
original question. If we're talking about foot
00:18:23.549 --> 00:18:25.970
capture foundations, right, whether that be plaster
00:18:25.970 --> 00:18:30.759
casts, slipper sock. phone boxing or scanning
00:18:30.759 --> 00:18:34.420
with various technology we have now, if there's
00:18:34.420 --> 00:18:37.019
no solid sort of evidence to say is one better
00:18:37.019 --> 00:18:41.240
than the other, right? And it sounds like anyone
00:18:41.240 --> 00:18:44.440
can really capture a foot apart from, you know,
00:18:44.460 --> 00:18:46.960
people who go to uni to do plaster casting, because
00:18:46.960 --> 00:18:49.019
that's, I guess, probably the only refined technique
00:18:49.019 --> 00:18:53.660
that requires a high repeatability. Kent, what
00:18:53.660 --> 00:18:57.859
are your thoughts on foot capture methods, right?
00:18:58.640 --> 00:19:01.079
Does the perfect position matter? Absolutely,
00:19:01.279 --> 00:19:04.480
yeah. I think, you know, to your first point
00:19:04.480 --> 00:19:10.420
around, you know, this who owns orthotics or
00:19:10.420 --> 00:19:13.400
custom orthotics, so to speak, I think it comes
00:19:13.400 --> 00:19:17.599
down to clinical reasoning and orthotic therapy
00:19:17.599 --> 00:19:22.759
really belongs with the profession that has the
00:19:22.759 --> 00:19:25.380
deepest understanding of foot structure, you
00:19:25.380 --> 00:19:28.250
know, lower limb function. tissue stress, et
00:19:28.250 --> 00:19:32.150
cetera. And that's podiatry. That's, you know,
00:19:32.150 --> 00:19:37.430
we should absolutely be proud of that. You know,
00:19:37.450 --> 00:19:41.730
so I think if another profession can perform
00:19:41.730 --> 00:19:45.789
a thorough assessment, you know, understand forefoot
00:19:45.789 --> 00:19:48.150
to rearfoot relationship, you know, to your point,
00:19:48.349 --> 00:19:51.769
you know, prescribe from a defined reference
00:19:51.769 --> 00:19:55.049
position, all of those sorts of things, then.
00:19:55.720 --> 00:19:58.880
then maybe there's some scope there. But I think
00:19:58.880 --> 00:20:05.619
to the second part of your question, a high -quality
00:20:05.619 --> 00:20:09.779
capture must represent a clinical meaningful
00:20:09.779 --> 00:20:13.039
position and one that the orthotic can generate
00:20:13.039 --> 00:20:18.119
a desired mechanical effect from. So I think
00:20:18.119 --> 00:20:21.079
having that reference point at the start and
00:20:21.079 --> 00:20:23.660
having that being a consistent, repeatable reference
00:20:23.660 --> 00:20:27.650
point, I think that's critical. I think we all
00:20:27.650 --> 00:20:31.329
understand the variability, you know, in orthotic
00:20:31.329 --> 00:20:33.829
manufacture and orthotic therapy, broadly speaking.
00:20:34.049 --> 00:20:38.509
So, you know, my interpretation is why add another
00:20:38.509 --> 00:20:40.710
variable into it? If we can be pretty consistent
00:20:40.710 --> 00:20:44.369
with our starting point, then surely that's going
00:20:44.369 --> 00:20:48.490
to be more helpful than adding in more inconsistency.
00:20:48.970 --> 00:20:52.789
So just talking about foot captures and maybe
00:20:52.789 --> 00:20:55.250
this one for Comrade. like is there is there
00:20:55.250 --> 00:20:58.470
a perfect position like as a as a lab can you
00:20:58.470 --> 00:21:00.730
can you easily pick up when a capture's been
00:21:00.730 --> 00:21:02.950
done poorly and then are there things that people
00:21:02.950 --> 00:21:05.490
commonly do badly when it comes to foot captures
00:21:05.490 --> 00:21:11.069
yeah so obviously like it's a really hard question
00:21:11.069 --> 00:21:14.369
because on the one hand i want to answer it by
00:21:14.369 --> 00:21:16.630
saying that i want everything to be done in a
00:21:16.630 --> 00:21:19.490
repeatable way um that's very consistent but
00:21:19.490 --> 00:21:24.640
you know i think the intent behind how the foot
00:21:24.640 --> 00:21:27.859
is captured is important as well um you know
00:21:27.859 --> 00:21:31.460
for example like if we look at fully weight bearing
00:21:31.460 --> 00:21:35.380
scanning right it is the most repeatable way
00:21:35.380 --> 00:21:37.900
to capture a foot right it's going to have good
00:21:37.900 --> 00:21:41.740
inter -rater reliability between all of us we
00:21:41.740 --> 00:21:44.660
get someone to stand up and press press go on
00:21:44.660 --> 00:21:47.259
the scanner but i think the the more important
00:21:47.259 --> 00:21:50.150
question with it is it's only repeatable for
00:21:50.150 --> 00:21:52.589
one part of the process and which part of the
00:21:52.589 --> 00:21:57.170
process is repeatability important for so you
00:21:57.170 --> 00:21:59.809
know I just captured you know 20 subjects for
00:21:59.809 --> 00:22:01.869
a scan that we're doing with Flinders Uni in
00:22:01.869 --> 00:22:05.690
seven different positions and I'm fairly confident
00:22:05.690 --> 00:22:10.109
on the reliability intro rater of the scanning
00:22:10.109 --> 00:22:13.710
methods but the repeatability on its own doesn't
00:22:13.710 --> 00:22:16.430
necessarily make it the most appropriate capture
00:22:16.430 --> 00:22:20.950
for the orthotic so we've had situations where
00:22:20.950 --> 00:22:23.750
you know we've had a clinician send us a fully
00:22:23.750 --> 00:22:26.670
weight -bearing scan and although the capture
00:22:26.670 --> 00:22:29.289
method is repeatable the podiatrist being you
00:22:29.289 --> 00:22:31.589
know surprised and disappointed when the orthotic
00:22:31.589 --> 00:22:34.049
comes back flat you know i'm sure that every
00:22:34.049 --> 00:22:37.829
person here like at the lab environment has had
00:22:37.829 --> 00:22:39.750
that situation we get a fully weight -bearing
00:22:39.750 --> 00:22:42.990
scan and the orthotic comes back flat and it's
00:22:42.990 --> 00:22:47.509
a little bit unexpected so um i guess in summary
00:22:47.509 --> 00:22:50.359
like with foot capture what we try and educate
00:22:50.359 --> 00:22:55.000
is to have like an intention behind the shape
00:22:55.000 --> 00:22:57.079
that you're capturing because the purpose is
00:22:57.079 --> 00:23:00.559
to match the shape of the scan to the final product
00:23:00.559 --> 00:23:03.299
as closely as possible so you can better understand
00:23:03.299 --> 00:23:07.920
you know how you're applying prescription variables
00:23:07.920 --> 00:23:10.380
to the surface of the orthotic so it's not necessarily
00:23:10.380 --> 00:23:14.279
one way at all times it could change and it might
00:23:14.279 --> 00:23:16.539
even be pathology driven in the end i'm not really
00:23:16.539 --> 00:23:19.180
sure so I don't think anyone knows the perfect
00:23:19.180 --> 00:23:23.299
answer yet. Rhys, I guess your laboratory accepts
00:23:23.299 --> 00:23:28.660
all sorts of products from plaster casting to
00:23:28.660 --> 00:23:33.000
3D scanning. Do you have a preference or what's
00:23:33.000 --> 00:23:35.779
your sort of take on how the foundations of foot
00:23:35.779 --> 00:23:39.900
capture should be processed? Yeah, lots of good
00:23:39.900 --> 00:23:42.579
points raised so far. I think combining this
00:23:42.579 --> 00:23:45.019
with the previous question of what should podiatrists
00:23:45.019 --> 00:23:48.559
be? Or how should podiatry sit in the scheme
00:23:48.559 --> 00:23:50.700
of orthotics? I think podiatrists should choose
00:23:50.700 --> 00:23:54.539
the highest quality of capture. You know, we've
00:23:54.539 --> 00:23:57.960
got research now around higher quality versus
00:23:57.960 --> 00:24:01.880
lower quality, accuracy and reliability, reproducibility
00:24:01.880 --> 00:24:04.460
of certain scanning modalities. And I think if
00:24:04.460 --> 00:24:07.039
podiatry wants to own that product, being orthotics
00:24:07.039 --> 00:24:10.759
or 3D custom put orthotics, it should continue
00:24:10.759 --> 00:24:15.140
to. you know, except the highest level. So we
00:24:15.140 --> 00:24:17.319
know nowadays things like LiDAR and TrueDepth
00:24:17.319 --> 00:24:20.059
are widely available for everyone who has an
00:24:20.059 --> 00:24:22.779
iPhone or everyone who has an iPad Pro, but we
00:24:22.779 --> 00:24:27.900
know they have a higher variability rate compared
00:24:27.900 --> 00:24:31.859
to iCubes, E500s, you know, iCube Mini, Structure
00:24:31.859 --> 00:24:34.759
Sensor Scanners, which provide consistency across
00:24:34.759 --> 00:24:39.759
a range of devices. So, look. I think like Konrad
00:24:39.759 --> 00:24:42.700
said, we'd all like the perfect world where every
00:24:42.700 --> 00:24:45.059
scan is high quality and produced in the same
00:24:45.059 --> 00:24:47.559
system. But I think as long as we know that there
00:24:47.559 --> 00:24:50.789
is... confidence in accuracy and reliability
00:24:50.789 --> 00:24:53.109
of the scanning modality it should be accepted
00:24:53.109 --> 00:24:57.890
position is important agree and we do see some
00:24:57.890 --> 00:25:01.829
obscure positions but i think one of the most
00:25:01.829 --> 00:25:04.009
important things there is contact your lab and
00:25:04.009 --> 00:25:06.049
speak to your lab and ask them about their processes
00:25:06.049 --> 00:25:08.670
and how they prefer you know scanning and how
00:25:08.670 --> 00:25:10.750
that influences the orthotic design and manufacture
00:25:10.750 --> 00:25:13.509
and collectively you'll get the outcome that
00:25:13.509 --> 00:25:17.210
you're looking for awesome um this question our
00:25:17.210 --> 00:25:20.269
initially directed to Darcy given that he works
00:25:20.269 --> 00:25:22.289
in an environment where you're you're uh producing
00:25:22.289 --> 00:25:25.910
orthotics at the chair side um or very quickly
00:25:25.910 --> 00:25:29.029
have you found with 3d printed orthotics like
00:25:29.029 --> 00:25:31.049
there is you lose something in terms of your
00:25:31.049 --> 00:25:34.529
capacity to to modify or adjust orthotics i mean
00:25:34.529 --> 00:25:36.950
is the future just reprinting another set of
00:25:36.950 --> 00:25:39.509
orthotics when the first when the circumstances
00:25:39.509 --> 00:25:44.220
change yeah i guess by um uh Further eliminating
00:25:44.220 --> 00:25:47.019
the question, obviously, we've had SLS 3D printed
00:25:47.019 --> 00:25:49.779
for a while, you know, through the major labs.
00:25:50.200 --> 00:25:52.700
In terms of what we've been doing with Propel
00:25:52.700 --> 00:25:56.339
3D, being more the FDM printing where, you know,
00:25:56.339 --> 00:25:59.180
you have the small 3D printer that is able to
00:25:59.180 --> 00:26:02.259
be put in the clinic's laboratory and then have
00:26:02.259 --> 00:26:07.460
the orthotic printed out there. So, yeah, we'll
00:26:07.460 --> 00:26:12.880
call it the FDM printed devices. ability to modify
00:26:12.880 --> 00:26:16.000
through the bottom you know compared to you know
00:26:16.000 --> 00:26:19.000
an eva for example where it's a continuous material
00:26:19.000 --> 00:26:21.220
the whole way through it's not quite as good
00:26:21.220 --> 00:26:24.059
where you know you can start to go through the
00:26:24.059 --> 00:26:27.319
uh the top shells essentially or the bottom shells
00:26:27.319 --> 00:26:32.019
and uh you know it's it's not as a continuous
00:26:32.019 --> 00:26:35.940
material like like eva is so maybe a little bit
00:26:35.940 --> 00:26:38.059
but it's not it's not really rocket science in
00:26:38.059 --> 00:26:39.779
terms of being able to modify how you'd like
00:26:39.779 --> 00:26:43.680
it um and then have the device still maintain
00:26:43.680 --> 00:26:47.000
a high quality and structural integrity. The
00:26:47.000 --> 00:26:50.579
other thing with the FDM printed orthotics is
00:26:50.579 --> 00:26:52.380
that there's actually dramatically less need
00:26:52.380 --> 00:26:54.960
to modify them in the first place, oftentimes,
00:26:55.359 --> 00:26:58.859
particularly with the ability just to create
00:26:58.859 --> 00:27:04.059
the actual solid device in terms of the dimensions
00:27:04.059 --> 00:27:08.480
and the shape to just drop straight into the
00:27:08.480 --> 00:27:13.339
shoe. the you know one of the key advantages
00:27:13.339 --> 00:27:15.740
other you know key advantages just being the
00:27:15.740 --> 00:27:19.539
the turnaround times you can get the modifications
00:27:19.539 --> 00:27:22.559
to be very specific can obviously tune the densities
00:27:22.559 --> 00:27:25.339
use different materials you know have your uh
00:27:25.339 --> 00:27:28.819
you know person with a high pressure lesion come
00:27:28.819 --> 00:27:32.000
in you know in the morning and then dispense
00:27:32.000 --> 00:27:34.539
the foot of like in the afternoon in the the
00:27:34.539 --> 00:27:38.420
same clinic but um you haven't really found many
00:27:38.420 --> 00:27:43.420
downsides that don't compete with downsides of
00:27:43.420 --> 00:27:45.859
other types of devices in terms of the grass
00:27:45.859 --> 00:27:48.420
being greener on the other side and just having
00:27:48.420 --> 00:27:53.099
different problems. Can I just follow on with
00:27:53.099 --> 00:27:56.859
what John was asking? And let's talk about 3D
00:27:56.859 --> 00:27:59.319
printing orthotics in the aspect where you can
00:27:59.319 --> 00:28:02.180
print the post, right? And obviously you can
00:28:02.180 --> 00:28:04.680
also print the heel raise on there. What about
00:28:04.680 --> 00:28:07.700
in cases where you really need to be able to
00:28:07.700 --> 00:28:10.980
adjust? either the post or the raise right and
00:28:10.980 --> 00:28:14.440
when you grind 3d like pa nylon for for example
00:28:14.440 --> 00:28:17.059
it goes into this like pasties like substance
00:28:17.059 --> 00:28:20.000
and it becomes extremely difficult to grind like
00:28:20.000 --> 00:28:23.180
is are we in an environment where 3d printing
00:28:23.180 --> 00:28:25.140
is really great it's scalable should we just
00:28:25.140 --> 00:28:32.619
be printing the shells um look i guess to start
00:28:32.619 --> 00:28:39.039
with um i would i'd love to get the input of
00:28:39.039 --> 00:28:43.720
the other labs who are 3D printing. But my experience
00:28:43.720 --> 00:28:46.519
with 3D printing, both in a lab environment and
00:28:46.519 --> 00:28:49.859
in a clinical environment, and I appreciate that
00:28:49.859 --> 00:28:52.500
there's some difference in machinery between
00:28:52.500 --> 00:28:54.539
what you've got available in a clinic versus
00:28:54.539 --> 00:28:58.740
a lab, but there is a bit of a myth that you
00:28:58.740 --> 00:29:02.619
can't adjust 3D printed devices. I do hear it
00:29:02.619 --> 00:29:06.140
from time to time, and it's not something...
00:29:06.359 --> 00:29:10.359
that I find to be true. So I guess first and
00:29:10.359 --> 00:29:14.160
foremost, you know, I probably want to just clarify
00:29:14.160 --> 00:29:18.200
that I don't have problems modifying, you know,
00:29:18.200 --> 00:29:22.640
a PA11 or we're doing a lot more polyprope 3D
00:29:22.640 --> 00:29:27.000
printer devices that do grind and work much better
00:29:27.000 --> 00:29:31.329
than the nylon material. um yes they work differently
00:29:31.329 --> 00:29:34.569
to eva yes they work differently to your traditional
00:29:34.569 --> 00:29:39.910
handcrafted stuff but you can absolutely grind
00:29:39.910 --> 00:29:44.230
and adjust both of those types of devices is
00:29:44.230 --> 00:29:46.230
that something that you guys come across much
00:29:46.230 --> 00:29:51.869
Rhys yeah i think where the misconception may
00:29:51.869 --> 00:29:56.700
be is when people try and recreate the device
00:29:56.700 --> 00:30:02.460
is is the device fundamentally wrong uh and do
00:30:02.460 --> 00:30:05.119
you need to fundamentally change the orthotic
00:30:05.119 --> 00:30:06.980
because you're not going to be able to achieve
00:30:06.980 --> 00:30:12.079
that uh in a 3d printed like pa11 device whereas
00:30:12.079 --> 00:30:17.279
you know if i've got um you know a a eva device
00:30:17.279 --> 00:30:22.109
like in my hand uh and i have a high point of
00:30:22.109 --> 00:30:26.190
um you know uh mutual can i form base of first
00:30:26.190 --> 00:30:28.950
and it's 30 mil higher i can i can make that
00:30:28.950 --> 00:30:32.170
more proximal by grinding distally and reduce
00:30:32.170 --> 00:30:34.009
the archite so if the athletic is fundamentally
00:30:34.009 --> 00:30:36.930
wrong uh you're not going to be able to achieve
00:30:36.930 --> 00:30:40.049
that but um you know basic modifications within
00:30:40.049 --> 00:30:43.509
pa11 and other 3d printed i think is very easily
00:30:43.509 --> 00:30:47.369
achieved i agree with that and Kent's for sure
00:30:50.259 --> 00:30:53.799
I'd just add that, you know, the main area that
00:30:53.799 --> 00:30:56.859
we've had fitting issues with 3D printed devices
00:30:56.859 --> 00:31:00.200
was just mainly at the heel post. And, you know,
00:31:00.200 --> 00:31:02.299
you can do really simple things in clinic, like
00:31:02.299 --> 00:31:05.339
get a pair of calipers or a fabric tape measure
00:31:05.339 --> 00:31:08.099
and just measure the internal width of the shoe
00:31:08.099 --> 00:31:10.400
to the stitching. And then the lab can design
00:31:10.400 --> 00:31:13.160
the 3D printed post so it doesn't need to be
00:31:13.160 --> 00:31:15.799
tapered in in the clinic. Like, it's very simple.
00:31:16.380 --> 00:31:21.119
The angle on the heel post, if it was extrinsically
00:31:21.119 --> 00:31:23.480
posted for some of the 3D prints, definitely
00:31:23.480 --> 00:31:27.839
is more aggressive than the 400 density EVA just
00:31:27.839 --> 00:31:31.680
because it's a higher density material. So just
00:31:31.680 --> 00:31:36.400
making clinicians aware of that change or modifying
00:31:36.400 --> 00:31:40.140
prescriptions to potentially use heel scarves
00:31:40.140 --> 00:31:43.000
or... intrinsic rear foot posting on the top
00:31:43.000 --> 00:31:45.319
surface of the shell instead of extrinsically
00:31:45.319 --> 00:31:51.359
angulating the post so um yeah and and same as
00:31:51.359 --> 00:31:55.019
what uh Kent said as well we've gravitated more
00:31:55.019 --> 00:31:57.779
towards polypropylene for those clinicians that
00:31:57.779 --> 00:32:00.299
preferred a little bit more adjustability because
00:32:00.299 --> 00:32:02.940
it's I think the density difference is about
00:32:02.940 --> 00:32:08.900
1100 the PLF PA 11 to 800 poly powder so it translates
00:32:08.900 --> 00:32:11.640
to being you know a little bit lighter a little
00:32:11.640 --> 00:32:13.660
bit easier to grind and you a little bit easier
00:32:13.660 --> 00:32:16.900
to heat but PA 11 is certainly not impossible
00:32:16.900 --> 00:32:21.759
to adjust either so yeah I think really what
00:32:21.759 --> 00:32:26.339
you know we need to get our head around is the
00:32:26.339 --> 00:32:30.400
a 3D printed device might look a little bit different
00:32:31.079 --> 00:32:33.660
in some of the design features, you know, specifically
00:32:33.660 --> 00:32:38.799
things like extrinsic posting. But I can get
00:32:38.799 --> 00:32:42.259
a device that functions the same as a handcrafted
00:32:42.259 --> 00:32:45.420
device with an EVA post, but it just looks a
00:32:45.420 --> 00:32:48.740
little bit different. So it's just about understanding
00:32:48.740 --> 00:32:50.599
the material properties, knowing how to work
00:32:50.599 --> 00:32:55.119
with them and adjusting scripts accordingly if
00:32:55.119 --> 00:32:57.740
you are making the change from handcrafted to
00:32:57.740 --> 00:33:03.349
3D printed. All right. Moving on. Darcy and Rhys,
00:33:03.470 --> 00:33:04.970
I think I'll probably hit you guys with this
00:33:04.970 --> 00:33:09.710
question. Lab clinician relationships. I know
00:33:09.710 --> 00:33:11.750
we've gone through, I've gone through multiple
00:33:11.750 --> 00:33:14.049
labs since, you know, starting as a new graduate.
00:33:15.549 --> 00:33:17.789
Where do you think the biggest disconnect exists
00:33:17.789 --> 00:33:20.349
between a clinician and a lab? And how important
00:33:20.349 --> 00:33:24.829
is it for a fully functional, customised orthotic
00:33:24.829 --> 00:33:28.710
laboratory to have podiatrists on staff to be
00:33:28.710 --> 00:33:31.980
able to interpret? those questions and those
00:33:31.980 --> 00:33:34.420
relationships. Rhys, I can let you go first for
00:33:34.420 --> 00:33:38.400
this one. Yeah, sure. So I think it's important
00:33:38.400 --> 00:33:42.980
for podiatrists or labs to have podiatrists on
00:33:42.980 --> 00:33:47.539
staff to have those conversations, you know,
00:33:47.539 --> 00:33:50.839
with customers. It's really important that you
00:33:50.839 --> 00:33:54.259
build relationships with the podiatrists at the
00:33:54.259 --> 00:34:00.380
lab so you understand the terminology. I guess,
00:34:00.400 --> 00:34:04.400
changing products or changing anything really
00:34:04.400 --> 00:34:08.260
because what you may have been used to at...
00:34:08.489 --> 00:34:10.909
Haymart is called something different at Big
00:34:10.909 --> 00:34:16.010
W, no different to orthotic products. So building
00:34:16.010 --> 00:34:17.610
that relationship is really important, investing
00:34:17.610 --> 00:34:20.750
the time in the educational platforms, workshops.
00:34:21.670 --> 00:34:24.730
And as a lab, I think you need to be highly accessible
00:34:24.730 --> 00:34:27.369
to your customers as well so that you can provide
00:34:27.369 --> 00:34:29.170
a high quality product and high quality service
00:34:29.170 --> 00:34:32.489
as well. In terms of that process, where do you
00:34:32.489 --> 00:34:35.329
feel like the biggest challenges are there in
00:34:35.329 --> 00:34:39.630
terms of that? Do you find that there are cases
00:34:39.630 --> 00:34:42.230
where there are disconnects between the clinician
00:34:42.230 --> 00:34:45.489
and the lab? Yeah, I think so. And I think there
00:34:45.489 --> 00:34:49.010
can be. Everyone at certain times can be time
00:34:49.010 --> 00:34:54.130
poor. And if you're a sole business owner or
00:34:54.130 --> 00:34:58.489
even if you run a business with half a dozen
00:34:58.489 --> 00:35:01.750
or more employees, your time is really important.
00:35:01.929 --> 00:35:05.110
So you need to prioritise where you put that
00:35:05.110 --> 00:35:07.760
time and investing in. building a relationship
00:35:07.760 --> 00:35:10.199
with your lab i think is a high priority if you
00:35:10.199 --> 00:35:13.559
consider orthotic therapy to be important to
00:35:13.559 --> 00:35:15.940
your clinic into your business as well so making
00:35:15.940 --> 00:35:18.079
sure that you make the time and and the lab should
00:35:18.079 --> 00:35:20.460
you know return equally by making that time available
00:35:20.460 --> 00:35:22.719
to you as well whether it's emails phone calls
00:35:22.719 --> 00:35:25.599
online workshops in -person workshops i think
00:35:25.599 --> 00:35:27.460
all those need to be accessible to the consumer
00:35:27.460 --> 00:35:30.380
yeah i've had the experience of being you know
00:35:30.380 --> 00:35:33.679
obviously the podiatrist that ordering orthotics
00:35:33.679 --> 00:35:35.940
and the podiatrist that is sort of designing
00:35:35.940 --> 00:35:38.800
and producing the orthotics. So I do think that
00:35:38.800 --> 00:35:41.719
close relationship is really important and developing
00:35:41.719 --> 00:35:45.960
a shared language to be quite critical. I think
00:35:45.960 --> 00:35:49.199
that the prescription form is actually quietly
00:35:49.199 --> 00:35:53.039
really critical and having the education platform,
00:35:53.179 --> 00:35:56.039
as Rhi said, just to be really important. I've
00:35:56.039 --> 00:36:00.750
made the habit just of reaching out to Younger
00:36:00.750 --> 00:36:03.250
practitioners where if I'm trying to interpret
00:36:03.250 --> 00:36:07.269
a script and then potentially the quality of
00:36:07.269 --> 00:36:09.369
the scan is not very good, between those two
00:36:09.369 --> 00:36:11.409
things, using that as an indicator to try and
00:36:11.409 --> 00:36:14.530
reach out, have a chat and just try and educate
00:36:14.530 --> 00:36:19.050
where I can and clarify and maybe help the practitioner.
00:36:19.130 --> 00:36:21.809
Because let's face it, you know, orthotics in
00:36:21.809 --> 00:36:25.670
terms of prescribing and fitting and managing
00:36:25.670 --> 00:36:29.389
expectations. orthotics is not a simple thing
00:36:29.389 --> 00:36:34.269
to do and I think that you know I'll just say
00:36:34.269 --> 00:36:37.650
that generally speaking I don't think podiatrists
00:36:37.650 --> 00:36:40.110
on the whole are that amazing at it there certainly
00:36:40.110 --> 00:36:43.550
are some very good podiatrists and there are
00:36:43.550 --> 00:36:45.409
definitely some podiatrists who through no fault
00:36:45.409 --> 00:36:47.670
of their own find it quite challenging and don't
00:36:47.670 --> 00:36:49.889
get very good outcomes so I do think that there
00:36:49.889 --> 00:36:55.380
is an onus on the lab representatives to try
00:36:55.380 --> 00:36:59.880
our best to close that gap guys i think um i
00:36:59.880 --> 00:37:02.300
also want to bring in like a broader uh economic
00:37:02.300 --> 00:37:06.179
question in terms of relationships um think back
00:37:06.179 --> 00:37:08.139
to when you were a new grad probably life was
00:37:08.139 --> 00:37:09.960
potentially a simpler time to where it is today
00:37:09.960 --> 00:37:12.880
you know there's less wars less fuel costs and
00:37:12.880 --> 00:37:16.179
less um orthotic lab costs inflation all that
00:37:16.179 --> 00:37:18.599
sort of stuff so as a young new graduate coming
00:37:18.599 --> 00:37:22.440
out into the profession right um if they send
00:37:23.079 --> 00:37:25.599
a cast to multiple labs in Australia, will they
00:37:25.599 --> 00:37:28.920
get the exact same orthotic coming back in terms
00:37:28.920 --> 00:37:30.679
of from their prescription and from the design?
00:37:31.139 --> 00:37:34.559
Probably not. So what's your sort of advice to
00:37:34.559 --> 00:37:37.280
younger practitioners on how to better understand
00:37:37.280 --> 00:37:41.320
what laboratories you use and how to refine their
00:37:41.320 --> 00:37:43.039
prescription? Kent, I'll probably start with you,
00:37:43.059 --> 00:37:45.840
given you had a tremendous career in both podiatry
00:37:45.840 --> 00:37:48.940
and orthotic making. Oh, look, I think. comes
00:37:48.940 --> 00:37:51.800
down to making sure that your relationship with
00:37:51.800 --> 00:37:54.920
your lab, as the other guys have already sort
00:37:54.920 --> 00:37:56.739
of talked about, making sure that relationship
00:37:56.739 --> 00:38:01.619
is collaborative and not transactional. So the
00:38:01.619 --> 00:38:05.760
lab isn't like your electricity provider. That's
00:38:05.760 --> 00:38:09.300
a more transactional relationship in your business.
00:38:09.980 --> 00:38:15.119
I think it's critical that you develop that relationship
00:38:15.119 --> 00:38:19.920
with your lab, understand what they want from
00:38:19.920 --> 00:38:23.699
you in terms of input and then and then as the
00:38:23.699 --> 00:38:27.119
guys said you know having a podiatrist at the
00:38:27.119 --> 00:38:30.679
lab to understand what the intent is from the
00:38:30.679 --> 00:38:36.619
clinician is critical as well so you know we
00:38:36.619 --> 00:38:39.400
like at the lab if we were to see a script come
00:38:39.400 --> 00:38:44.420
through for a 95 year old lady and it was a you
00:38:44.420 --> 00:38:48.539
know, a rigid carbon fibre or a six mil polyprope
00:38:48.539 --> 00:38:52.619
shell, a transactional relationship would just
00:38:52.619 --> 00:38:55.559
make that and send it back. Whereas a collaborative
00:38:55.559 --> 00:38:58.360
one will actually get on the front foot and ring
00:38:58.360 --> 00:39:01.929
that new clinician and say, hey, look. you know,
00:39:01.969 --> 00:39:06.349
we see Mrs. Jones here is 95 and she's got a
00:39:06.349 --> 00:39:08.530
tiny little foot. Is this what you're actually
00:39:08.530 --> 00:39:10.429
after? Or did you actually just make a mistake
00:39:10.429 --> 00:39:12.750
because you're in a hurry or, you know, you weren't
00:39:12.750 --> 00:39:15.809
entirely sure what you were selecting there?
00:39:15.969 --> 00:39:19.329
So that's what I mean about building that really
00:39:19.329 --> 00:39:23.730
collaborative relationship. Awesome. I think
00:39:23.730 --> 00:39:24.909
there's some really good points there, Kent,
00:39:24.929 --> 00:39:27.130
in terms of building those relationships for
00:39:27.130 --> 00:39:32.210
new clinicians. I guess moving on forward now
00:39:32.210 --> 00:39:35.389
future future directions and you don't have to
00:39:35.389 --> 00:39:38.989
reveal any trade secrets here but uh but where
00:39:38.989 --> 00:39:41.369
is orthotic therapy going in the next five to
00:39:41.369 --> 00:39:44.769
ten years yeah look i think probably the most
00:39:44.769 --> 00:39:48.230
obvious shift would be a continued move away
00:39:48.230 --> 00:39:52.309
from subtractive you know we've all sort of slowly
00:39:52.309 --> 00:39:55.449
been phasing out of vacuum forming um it's very
00:39:55.449 --> 00:39:57.769
limited now the availability of vacuum forming
00:39:57.769 --> 00:40:00.110
in australia and i think you know likely that
00:40:00.900 --> 00:40:04.219
subtractive and CNC will be next. We're not yet
00:40:04.219 --> 00:40:08.960
there. Personally, doing TPU devices, we're not
00:40:08.960 --> 00:40:12.059
quite happy with what we're prototyping, but
00:40:12.059 --> 00:40:15.820
certainly that is the direction. And I think
00:40:15.820 --> 00:40:22.159
all the labs are aware of that. And maybe I think
00:40:22.159 --> 00:40:24.420
what is less clear about the direction is the
00:40:24.420 --> 00:40:27.079
type of delivery model, which we sort of talked
00:40:27.079 --> 00:40:29.570
about a little bit, which is are we going to
00:40:29.570 --> 00:40:32.369
see more in -clinic manufacturing are we going
00:40:32.369 --> 00:40:36.409
to see more in -clinic design with external manufacturing
00:40:36.409 --> 00:40:40.269
or are we going to see you know as some have
00:40:40.269 --> 00:40:43.150
pushed for like lab design and in -clinic printing
00:40:43.150 --> 00:40:45.869
so there's there might actually be multiple models
00:40:45.869 --> 00:40:49.030
operating at once in the profession at a which
00:40:49.030 --> 00:40:50.489
is going to be a little bit different and they
00:40:50.489 --> 00:40:54.360
can probably all coexist but what i do see there
00:40:54.360 --> 00:40:57.440
is like an amazing opportunity for podiatry and
00:40:57.440 --> 00:41:00.320
it sort of goes back to like who owns orthotics
00:41:00.320 --> 00:41:03.239
you know and we certainly don't really own it
00:41:03.239 --> 00:41:05.159
at the moment because it's they're dispensed
00:41:05.159 --> 00:41:08.219
by you know orthotists prosthetists pedorthists
00:41:08.219 --> 00:41:11.800
you know all sorts of professionals but um really
00:41:11.800 --> 00:41:16.130
embedding ourselves in you know, the computer
00:41:16.130 --> 00:41:18.250
-aided design and having a much better understanding
00:41:18.250 --> 00:41:21.090
of that will be a big shift in the industry and
00:41:21.090 --> 00:41:24.389
really make sure podiatry really excels, I think.
00:41:25.190 --> 00:41:28.489
And maybe one more thing, a little bit more out
00:41:28.489 --> 00:41:31.590
of left field, will be probably more active orthotic
00:41:31.590 --> 00:41:34.869
devices popping up into the market, things that
00:41:34.869 --> 00:41:39.329
are able to, you know, basically have sensors
00:41:39.329 --> 00:41:41.809
embedded in wearable technologies and things
00:41:41.809 --> 00:41:45.269
like that, where, like... sensor technology uh
00:41:45.269 --> 00:41:47.869
continues to get cheaper and cheaper so i think
00:41:47.869 --> 00:41:50.469
that'll be a really interesting push but i i
00:41:50.469 --> 00:41:53.349
foresee that being in probably over 10 years
00:41:53.349 --> 00:41:56.070
more widespread not within the next 10 years
00:41:56.070 --> 00:41:58.650
and Rhys where are things going at Footwork
00:41:58.650 --> 00:42:03.750
yeah i think uh broadly speaking not necessarily
00:42:03.750 --> 00:42:07.989
at Footwork um solely but i think like authority
00:42:07.989 --> 00:42:10.449
therapy is going to become more accessible to
00:42:10.449 --> 00:42:12.750
the to the consumer or to the customer whether
00:42:12.750 --> 00:42:16.590
that's online platforms like e -commerce platforms
00:42:16.590 --> 00:42:22.510
uh i i think it's harder or becoming harder to
00:42:22.510 --> 00:42:26.550
see a podiatrist uh i think i think it's really
00:42:26.550 --> 00:42:28.829
important as a profession that we continue to
00:42:28.829 --> 00:42:32.590
invest in podiatry and invest in in custom put
00:42:32.590 --> 00:42:36.150
off those ease um because at the same time it's
00:42:36.150 --> 00:42:38.150
also going to be become easier for the consumer
00:42:38.150 --> 00:42:44.110
to access or access the the the product um So,
00:42:45.230 --> 00:42:47.690
yeah, certainly Footwork is all about empowering
00:42:47.690 --> 00:42:49.929
the podiatrist, empowering the individual. So
00:42:49.929 --> 00:42:52.110
giving them the ability to be involved in the
00:42:52.110 --> 00:42:55.090
process of that orthotic manufacture and orthotic
00:42:55.090 --> 00:42:58.809
design. So education providing different platforms
00:42:58.809 --> 00:43:02.710
for, you know, designing in -house, you know,
00:43:02.710 --> 00:43:05.090
printing or manufacturing in -house as well.
00:43:05.570 --> 00:43:09.210
But all about empowering the podiatrist to achieve
00:43:09.210 --> 00:43:12.010
what they want to achieve. I think I'll echo
00:43:12.010 --> 00:43:15.030
Konrad's sentiment about the evolving business
00:43:15.030 --> 00:43:20.050
models where I guess we've got a good sort of
00:43:20.050 --> 00:43:23.070
sample of that today with the major labs, bigger
00:43:23.070 --> 00:43:26.329
labs, smaller labs, and then Propel 3D just,
00:43:26.429 --> 00:43:29.329
I guess, having that more innovative print -in
00:43:29.329 --> 00:43:33.070
clinic business model. So I have found just as
00:43:33.070 --> 00:43:35.710
a podiatrist who's both, you know, working on
00:43:35.710 --> 00:43:39.579
both sides, just... the few advantages of being
00:43:39.579 --> 00:43:42.860
able to turn things around really quickly have
00:43:42.860 --> 00:43:45.440
the materials be different in different ways
00:43:45.440 --> 00:43:47.840
has been really helpful but at the end of the
00:43:47.840 --> 00:43:52.500
day i am the biggest fan of a nylon sls printed
00:43:52.500 --> 00:43:55.380
device and nothing i don't think fdm printed
00:43:55.380 --> 00:43:58.320
is going to change that so those machines are
00:43:58.320 --> 00:44:03.079
obviously you know very expensive and very sophisticated
00:44:03.079 --> 00:44:06.739
compared to an FDM printer. So I do think there's
00:44:06.739 --> 00:44:11.139
plenty of space for that. In saying that, we
00:44:11.139 --> 00:44:14.019
have been able to sort of reduce the cost per
00:44:14.019 --> 00:44:17.840
orthotic quite significantly with this business
00:44:17.840 --> 00:44:21.139
model. So it will be quite an interesting time
00:44:21.139 --> 00:44:27.219
to see what happens and where, I guess, the podiatrist's
00:44:27.219 --> 00:44:31.130
feet move. Given there's so much variability
00:44:31.130 --> 00:44:34.150
in manufacturing, I'll just throw it to the floor.
00:44:34.610 --> 00:44:37.949
Where do you guys think standardization under
00:44:37.949 --> 00:44:41.230
things like the Therapeutic Goods Authority,
00:44:41.489 --> 00:44:46.710
TGA, where do we think orthotics are going to
00:44:46.710 --> 00:44:49.090
be moving from a regulatory point of view, given
00:44:49.090 --> 00:44:51.710
that we don't have currently a firm consensus
00:44:51.710 --> 00:44:54.809
across all commercially available laboratories
00:44:54.809 --> 00:44:59.440
what orthotic theories are? I mean, there's patterns
00:44:59.440 --> 00:45:03.340
and similarities, but there's also very big differences
00:45:03.340 --> 00:45:06.659
in interpretation. Where do we see quality control
00:45:06.659 --> 00:45:09.559
coming from standardisation? Kent, I probably
00:45:09.559 --> 00:45:13.960
would start with you with this one. Look, I don't
00:45:13.960 --> 00:45:21.360
think we necessarily need to standardise manufacturing
00:45:21.360 --> 00:45:28.889
processes to the degree of you know, specific
00:45:28.889 --> 00:45:32.030
modelling pathways and things like that. It's
00:45:32.030 --> 00:45:43.050
probably more about standardising outcomes, you
00:45:43.050 --> 00:45:47.010
know, in terms of finished product, trying to
00:45:47.010 --> 00:45:54.789
make sure that, you know, we can track processes,
00:45:55.110 --> 00:45:58.880
you know, we can track devices all the way through
00:45:58.880 --> 00:46:02.860
and also continue to track them, you know, once
00:46:02.860 --> 00:46:07.119
they're fitted to the patient as well. So I don't
00:46:07.119 --> 00:46:10.000
think we necessarily need to, you know, all look
00:46:10.000 --> 00:46:13.579
the same, but I think there are some features
00:46:13.579 --> 00:46:16.980
that we'll all, you know, probably inherently
00:46:16.980 --> 00:46:21.539
do now already, but continue to further develop
00:46:21.539 --> 00:46:26.610
and adopt things like that. Very sweaty, sort
00:46:26.610 --> 00:46:30.389
of see that sort of position. Yeah, I don't see
00:46:30.389 --> 00:46:39.650
it changing rapidly in the short term, albeit
00:46:39.650 --> 00:46:43.989
I think it would be beneficial for some manufacture
00:46:43.989 --> 00:46:48.539
reform. Having worked with Stephen Brown at the
00:46:48.539 --> 00:46:51.559
APOD -A on the TGA Advisory Board for Custom
00:46:51.559 --> 00:46:54.820
Orthotics, we get a bit of an insight as to where
00:46:54.820 --> 00:46:57.480
things are going from a TGA perspective. And
00:46:57.480 --> 00:47:01.820
it's continually being progressed. But, you know,
00:47:01.860 --> 00:47:05.900
like most things, it's not fast. But I think
00:47:05.900 --> 00:47:07.539
it's really important that from a manufacturing
00:47:07.539 --> 00:47:10.000
perspective, we have transparency on how the
00:47:10.000 --> 00:47:12.199
products are made, where they're being made,
00:47:12.300 --> 00:47:14.929
what materials they're being made from. And we
00:47:14.929 --> 00:47:20.010
look at these products, you know, in detail to
00:47:20.010 --> 00:47:26.030
ensure safety, you know, for the consumer. So
00:47:26.030 --> 00:47:28.849
as you would know, I'm a coffee addict. So I
00:47:28.849 --> 00:47:31.090
like to shop at where I know the farmers are
00:47:31.090 --> 00:47:33.389
growing their beans. Is there a possibility that's
00:47:33.389 --> 00:47:35.550
translated into orthotic materials from where
00:47:35.550 --> 00:47:39.110
the manufacturers are overseas? Yeah, I think
00:47:39.110 --> 00:47:41.909
so. I think it's important to understand. safety
00:47:41.909 --> 00:47:45.610
data sheets and what the products actually are,
00:47:45.809 --> 00:47:49.670
which is one of the strengths of the PA11 when
00:47:49.670 --> 00:47:53.409
it was first introduced to the profession. And
00:47:53.409 --> 00:47:58.230
it really took away from, I guess, the less environmentally
00:47:58.230 --> 00:48:02.030
friendly polypropylene at the time. So like on
00:48:02.030 --> 00:48:04.150
Konrad's point before with subtractive manufacture,
00:48:04.449 --> 00:48:06.590
I think it's important that we continually progress.
00:48:07.289 --> 00:48:10.289
And whether that's from a TGA perspective, I
00:48:10.289 --> 00:48:11.699
definitely think. it's something that we should
00:48:11.699 --> 00:48:14.639
as a profession. Konrad was there anything you
00:48:14.639 --> 00:48:17.800
wanted to add on that? Well the TGA where do
00:48:17.800 --> 00:48:19.940
I start you know what I mean I think everyone's
00:48:19.940 --> 00:48:22.719
a little bit exasperated at times with the I
00:48:22.719 --> 00:48:26.320
think maybe the lumping in of orthotic devices
00:48:26.320 --> 00:48:29.139
with other medical devices like I think it's
00:48:29.139 --> 00:48:32.559
become quite clear that the TGA they're probably
00:48:32.559 --> 00:48:36.400
working extremely hard and maybe they don't have
00:48:36.400 --> 00:48:40.099
the bandwidth required to properly regulate and
00:48:40.099 --> 00:48:42.320
make a meaningful change in the way orthotics
00:48:42.320 --> 00:48:45.500
are manufactured in Australia because I think
00:48:45.500 --> 00:48:48.119
it's probably going to come down to our professional
00:48:48.119 --> 00:48:51.719
bodies being advocates for ethical manufacture
00:48:51.719 --> 00:48:54.559
and I could get like a little bit controversial
00:48:54.559 --> 00:48:56.559
but I don't I don't personally think it's that
00:48:56.559 --> 00:49:00.840
controversial I think maybe you know we could
00:49:00.840 --> 00:49:03.699
regulate that orthotics aren't mirrored left
00:49:03.699 --> 00:49:06.239
and right we should make a left and a right orthotic
00:49:06.239 --> 00:49:09.460
from each individual scan like I think everyone
00:49:09.460 --> 00:49:12.300
here, because it's an audio medium, is nodding
00:49:12.300 --> 00:49:16.780
their head in agreement, which is good. But I
00:49:16.780 --> 00:49:20.460
think it would be good to have that regulated.
00:49:20.719 --> 00:49:25.800
I think it would be good to regulate that scanning
00:49:25.800 --> 00:49:29.579
includes color, because from my experience, when
00:49:29.579 --> 00:49:32.940
we have anthropometric landmarks that are marked
00:49:32.940 --> 00:49:35.960
on a scan, we can translate features more objectively.
00:49:37.159 --> 00:49:39.820
you know, if we're looking to do what the TGA
00:49:39.820 --> 00:49:42.480
wants and what we support, which is things like
00:49:42.480 --> 00:49:46.679
making sure we have ISO 13485 for medical devices
00:49:46.679 --> 00:49:50.019
and making sure we have really good QMS, we have
00:49:50.019 --> 00:49:52.320
to make sure that we make things consistently
00:49:52.320 --> 00:49:55.539
and the podiatrists have to help us do that.
00:49:55.619 --> 00:49:59.980
We have to be a team, right? So, yeah, there's
00:49:59.980 --> 00:50:04.159
a few basic things there, but in terms of a...
00:50:04.559 --> 00:50:07.659
you know tga regulatory level it's not really
00:50:07.659 --> 00:50:10.860
their place and i don't think that they're trying
00:50:10.860 --> 00:50:14.599
to standardize how we make orthotics or how software
00:50:14.599 --> 00:50:17.659
is used in the industry more to just make sure
00:50:17.659 --> 00:50:20.440
that you know we have validation verification
00:50:20.440 --> 00:50:23.760
processes in place to make sure that devices
00:50:23.760 --> 00:50:26.960
are safe and perform well and we have material
00:50:26.960 --> 00:50:31.309
safety options so i think It's not too stressful
00:50:31.309 --> 00:50:33.969
when you boil it down, the TGA stuff. It's more
00:50:33.969 --> 00:50:36.929
the labs having to put in place ISO at the end
00:50:36.929 --> 00:50:39.050
of the day, and we'll all get there. It might
00:50:39.050 --> 00:50:41.090
be a little bit harder for the smaller operators.
00:50:41.949 --> 00:50:46.429
I'm not sure how they're going to do it if they're
00:50:46.429 --> 00:50:50.329
not using a software system that may be later
00:50:50.329 --> 00:50:52.650
regulated on the TGA, which would be called a
00:50:52.650 --> 00:50:56.610
medical device production system. If they're
00:50:56.610 --> 00:50:59.349
using one of these regulated systems, they might
00:50:59.349 --> 00:51:03.769
comply inherently, but if they're vacuum forming
00:51:03.769 --> 00:51:06.630
or doing something a little bit different, they
00:51:06.630 --> 00:51:09.730
might have to get their own ISO and it might
00:51:09.730 --> 00:51:12.949
be a big regulatory challenge for small business.
00:51:14.630 --> 00:51:18.469
I think manufacturing seems to be on the ball
00:51:18.469 --> 00:51:22.650
from what all four of you have said, but let's
00:51:22.650 --> 00:51:25.119
bring it back to your first profession, which
00:51:25.119 --> 00:51:30.380
is podiatry. What does neutral mean? And can
00:51:30.380 --> 00:51:35.420
someone explain, is it reproducible? Is it still
00:51:35.420 --> 00:51:38.980
a useful theory to be applying in terms of teaching?
00:51:39.480 --> 00:51:41.880
And how do we accurately measure or sorry, how
00:51:41.880 --> 00:51:45.960
do we actually accurately capture that? Yeah,
00:51:45.980 --> 00:51:49.219
I guess the definition of neutral would be impartial
00:51:49.219 --> 00:51:53.090
or unbiased to a particular. in this case, position.
00:51:53.369 --> 00:51:56.030
So if we're talking about subtalar joint, then
00:51:56.030 --> 00:52:01.369
neutral would be unbiased to a particular position
00:52:01.369 --> 00:52:04.570
in relation to the subtalar joint. So I think
00:52:04.570 --> 00:52:08.289
it is important to try and achieve subtalar joint
00:52:08.289 --> 00:52:13.769
neutral for orthotic reproducibility. But I think
00:52:13.769 --> 00:52:17.010
as well, it comes down to your understanding
00:52:17.010 --> 00:52:20.949
of the application of the prescription to the
00:52:20.949 --> 00:52:25.329
scan. So I'm sure people can achieve, you know,
00:52:25.349 --> 00:52:30.769
the result they're after by scanning in a unneutral,
00:52:30.869 --> 00:52:34.789
you know, position. But certainly, you know,
00:52:34.829 --> 00:52:38.670
I personally and we recommend as a lab trying
00:52:38.670 --> 00:52:40.289
to achieve a subtalar joint neutral position.
00:52:40.989 --> 00:52:44.030
I think in terms of subtalar joint neutral, potentially
00:52:44.030 --> 00:52:47.650
it might even be in the weeds considering what
00:52:47.650 --> 00:52:52.579
we... pragmatically want is a foot that in subductor
00:52:52.579 --> 00:52:55.360
neutral should be idealized where you know obviously
00:52:55.360 --> 00:52:57.159
we can palpate the tail heads that's you know
00:52:57.159 --> 00:52:59.559
week one of year two biomechanics and should
00:52:59.559 --> 00:53:01.219
be able to understand where that is and be able
00:53:01.219 --> 00:53:04.659
to teach that to people but also just really
00:53:04.659 --> 00:53:06.280
simple things with those non -weight bearing
00:53:06.280 --> 00:53:08.059
scans I'm sure everybody's seen you know having
00:53:08.059 --> 00:53:11.380
like a ridiculously plantar flex foot inverted
00:53:11.380 --> 00:53:15.719
foot just in non -weight bearing for the forefoot
00:53:15.719 --> 00:53:18.070
and rear foot to be completely out of whack.
00:53:18.269 --> 00:53:20.389
So, you know, I'm not too concerned with one
00:53:20.389 --> 00:53:22.550
or two degrees of subtalar, eversion, inversion,
00:53:22.789 --> 00:53:25.150
either way. Obviously we can't capture a subtalar
00:53:25.150 --> 00:53:27.650
joint neutral with a foot that has a medially
00:53:27.650 --> 00:53:29.889
deviated subtalar joint axis in a supernatus
00:53:29.889 --> 00:53:31.849
where you can't capture it in neutral because
00:53:31.849 --> 00:53:34.110
the, you know, first and tip J will be off the
00:53:34.110 --> 00:53:36.750
ground. So I think we should probably not sweat
00:53:36.750 --> 00:53:39.150
those things and let's just get some, you know,
00:53:39.170 --> 00:53:45.429
nice, nice square scans that we can create a
00:53:45.429 --> 00:53:49.090
good orthotic out of. Darcy, what about heel
00:53:49.090 --> 00:53:50.969
expansion? Because if you're capturing someone
00:53:50.969 --> 00:53:54.389
non -weight bearing, what about different people
00:53:54.389 --> 00:53:57.230
with different fat pad sizes or pathological
00:53:57.230 --> 00:53:59.909
requirements might have different heel or skin
00:53:59.909 --> 00:54:04.829
fat expansions? Does a neutral cast non -weight
00:54:04.829 --> 00:54:06.829
bearing accurately capture the foot, in your
00:54:06.829 --> 00:54:10.550
opinion? I don't think so. I would always go
00:54:10.550 --> 00:54:13.809
for a semi -weight bearing scan where possible.
00:54:15.110 --> 00:54:18.150
Personally, if I was making my grandmother a
00:54:18.150 --> 00:54:21.550
foot orthotic, I would like her to have a semi
00:54:21.550 --> 00:54:24.389
-weight -bearing scan. Kent, what are your thoughts
00:54:24.389 --> 00:54:28.989
on foot capture? I think you probably know where
00:54:28.989 --> 00:54:37.230
I stand on this, Pat. We absolutely believe that
00:54:37.230 --> 00:54:39.710
subtalar joint neutral is still relevant and
00:54:39.710 --> 00:54:44.800
still should be taught. I think we have to be
00:54:44.800 --> 00:54:51.139
careful that any potential trend away from neutral
00:54:51.139 --> 00:54:54.880
isn't just convenience masquerading as progress.
00:54:56.179 --> 00:55:01.699
I think when we look at, you know, if we sort
00:55:01.699 --> 00:55:04.900
of dig down a level here, when we look at scans
00:55:04.900 --> 00:55:09.880
or casts that come through the lab, I think one
00:55:09.880 --> 00:55:12.940
of the biggest issues that we see probably isn't
00:55:12.940 --> 00:55:15.920
so much around sub -tailored joint neutral. You
00:55:15.920 --> 00:55:19.420
know, I think you can be out by one or two degrees
00:55:19.420 --> 00:55:22.739
either way, and it doesn't affect the plantar
00:55:22.739 --> 00:55:26.639
contours that much. I think where we see a bigger
00:55:26.639 --> 00:55:28.900
difference is when the mid -tarsal joint's not
00:55:28.900 --> 00:55:35.380
loaded. So I can take the same person, and that
00:55:35.380 --> 00:55:38.039
person might have a big forefoot supernatus,
00:55:38.159 --> 00:55:44.280
and if in one capture method... scan, cast. I
00:55:44.280 --> 00:55:49.639
load that mid tarsal joint and eliminate any
00:55:49.639 --> 00:55:51.760
forefoot supinatus and capture a forefoot to
00:55:51.760 --> 00:55:54.179
rear foot, pretty neutral sort of relationship.
00:55:54.519 --> 00:55:57.800
And then on the other foot, I maintain the whopping
00:55:57.800 --> 00:56:02.599
big supinatus. In that one where I've captured
00:56:02.599 --> 00:56:07.239
a big supinatus, every lab can do it. We can
00:56:07.239 --> 00:56:10.380
take that and produce a custom foot orthotic.
00:56:11.019 --> 00:56:14.659
But there's more guesswork involved. There's
00:56:14.659 --> 00:56:17.360
absolutely more guesswork involved. So that's
00:56:17.360 --> 00:56:20.739
where, you know, it comes back to this, you know,
00:56:20.760 --> 00:56:26.340
reduce the variability, you know, start with
00:56:26.340 --> 00:56:30.860
a consistent starting point and you reduce some
00:56:30.860 --> 00:56:34.019
of that guesswork along the way. So in terms
00:56:34.019 --> 00:56:39.239
of your question around heel fat pad, we have...
00:56:39.710 --> 00:56:44.570
data from thousands and thousands of devices
00:56:44.570 --> 00:56:48.070
that have come through the lab around how much
00:56:48.070 --> 00:56:51.789
expansion we should do based purely on the size
00:56:51.789 --> 00:56:55.650
of the foot. Now that can be varied as well.
00:56:55.829 --> 00:57:00.969
So let's say you've got a patient in front of
00:57:00.969 --> 00:57:03.539
you. and you know that they're going to fit into
00:57:03.539 --> 00:57:05.559
a particular dress shoe you might communicate
00:57:05.559 --> 00:57:07.820
to the lab hey i want a minimal lateral plaster
00:57:07.820 --> 00:57:09.699
expansion on this one i just want to bring it
00:57:09.699 --> 00:57:13.500
in a bit tighter and we can do that so that's
00:57:13.500 --> 00:57:18.079
you know that can be varied um accordingly yeah
00:57:18.079 --> 00:57:20.320
i think the point you make about thinking about
00:57:20.320 --> 00:57:22.139
the shoe that you're trying to fill it into is
00:57:22.139 --> 00:57:24.679
a is something that i learned to my cost when
00:57:24.679 --> 00:57:27.199
i was a practitioner it's you can make the perfect
00:57:27.199 --> 00:57:30.059
orthotic but uh it doesn't fit into any shoes
00:57:30.059 --> 00:57:34.420
or then you've got a problem absolutely yeah
00:57:34.420 --> 00:57:38.940
in your opinion gents um let's take the hill
00:57:38.940 --> 00:57:41.360
expansion equation out of the question what's
00:57:41.360 --> 00:57:44.000
wrong with doing a really low if not minimal
00:57:44.000 --> 00:57:46.000
hill cup and getting someone in a shoe with a
00:57:46.000 --> 00:57:47.719
stiff heel counter to kind of counteract that
00:57:47.719 --> 00:57:50.449
maybe i'll direct that one to Rhys Yeah, that's
00:57:50.449 --> 00:57:52.969
a really good point because I think when we try
00:57:52.969 --> 00:57:55.929
and measure like fat pad expansion, we're not
00:57:55.929 --> 00:57:58.489
really factoring in the relationship of the shoe
00:57:58.489 --> 00:58:00.969
to that fat pad expansion. And it's a similar
00:58:00.969 --> 00:58:03.050
principle when we look at modifications like
00:58:03.050 --> 00:58:08.340
medial flares because is the liner of the shoe
00:58:08.340 --> 00:58:13.739
or the outsole of the shoe, sorry, the shoe itself,
00:58:13.820 --> 00:58:16.519
is that capturing and holding in some of that
00:58:16.519 --> 00:58:19.000
splay that you would see when you have that patient
00:58:19.000 --> 00:58:20.980
weight bearer of the orthotic outside of the
00:58:20.980 --> 00:58:24.780
shoe. So yeah, look, we would have a high percentage
00:58:24.780 --> 00:58:27.639
of concave wedge style orthotics that have approximately
00:58:27.639 --> 00:58:32.699
an eight mil lateral height of an orthotic. That
00:58:32.699 --> 00:58:35.860
would be our most commonly. prescribed heel cup
00:58:35.860 --> 00:58:40.039
option. But at the same time, you know, we have
00:58:40.039 --> 00:58:44.340
standard processes for heel pad expansion. So,
00:58:44.440 --> 00:58:46.639
you know, if you use a concave wedge, it's 4mm
00:58:46.639 --> 00:58:51.260
wider than the impression. You know, we have
00:58:51.260 --> 00:58:55.159
the option for courtful heel, which is no expansion.
00:58:55.400 --> 00:58:57.719
You can then go and create, you know, more expansion
00:58:57.719 --> 00:59:00.420
so you choose. So I think it's about empowering
00:59:00.420 --> 00:59:03.659
that individual to understand. what they require
00:59:03.659 --> 00:59:06.380
clinically, how they can achieve that and providing
00:59:06.380 --> 00:59:09.219
the podiatrist with the tools to achieve what
00:59:09.219 --> 00:59:12.320
they want to achieve. All right. This takes us
00:59:12.320 --> 00:59:15.219
to our unpopular opinion segment, overrated and
00:59:15.219 --> 00:59:18.659
underrated. The plan is for a quick fire, but
00:59:18.659 --> 00:59:21.280
I think if you guys are happy to expand, we're
00:59:21.280 --> 00:59:24.719
willing to take on that feedback. And I'm going
00:59:24.719 --> 00:59:27.579
to start with Darcy first, and I'm just going
00:59:27.579 --> 00:59:30.579
to repeat what we said. Sub -tailor neutral casting,
00:59:30.840 --> 00:59:36.559
overrated or underrated? Underrated. Rhys? Sorry,
00:59:36.639 --> 00:59:38.579
quick fire, but I was on mute. Underrated as
00:59:38.579 --> 00:59:45.400
well. Konrad? It's a more nuanced answer. Please
00:59:45.400 --> 00:59:55.699
go, please go. It's both, honestly. It's underrated
00:59:55.699 --> 00:59:59.119
by people. um in my experience that don't pay
00:59:59.119 --> 01:00:01.699
particular attention to how they hold and capture
01:00:01.699 --> 01:00:05.159
the foot right and and it i can't remember exactly
01:00:05.159 --> 01:00:08.980
how Kent put it but it was if we if we basically
01:00:08.980 --> 01:00:13.239
let old habits die out of convenience that's
01:00:13.239 --> 01:00:17.239
when it's um it goes that way right um when we
01:00:17.239 --> 01:00:20.679
see the 42 degree four foot supernatas not holding
01:00:20.679 --> 01:00:22.659
the foot and we're going well you've got to scan
01:00:22.659 --> 01:00:26.679
that again you know that kind of thing um Overrated
01:00:26.679 --> 01:00:29.820
when it's used as a be -all and end -all treatment
01:00:29.820 --> 01:00:32.679
position. It's just a way to consistently capture
01:00:32.679 --> 01:00:35.159
the foot. It's just a shape, right? So you might
01:00:35.159 --> 01:00:38.860
maximally pronate the subtalar joint in a particular
01:00:38.860 --> 01:00:42.400
patient and capture it like that. So what is
01:00:42.400 --> 01:00:48.659
more important is shape, undoubtedly. Okay. Underrated.
01:00:49.260 --> 01:00:54.960
That's why we developed this game, mate. All
01:00:54.960 --> 01:00:59.219
right. Got to get the scan made in. Next one.
01:00:59.800 --> 01:01:01.940
3D printed orthotics. And I'm going to put in
01:01:01.940 --> 01:01:06.699
PA 12 and 11 in the same box here. Darcy, overrated
01:01:06.699 --> 01:01:15.539
or underrated? Underrated. Rhys? 12 overrated,
01:01:15.539 --> 01:01:19.619
11 underrated. Can you expand? It's just a better
01:01:19.619 --> 01:01:22.099
fit for our profession. I think weight -bearing
01:01:22.099 --> 01:01:24.800
orthoses, custom orthoses, 11 is far superior
01:01:24.800 --> 01:01:27.880
breaking strain compared to 12. So other applications,
01:01:27.960 --> 01:01:32.519
it's probably cheaper, more accessible, and therefore
01:01:32.519 --> 01:01:35.760
underrated for other applications and professions,
01:01:35.840 --> 01:01:41.900
but not ours. Quality. Konrad? Definitely underrated.
01:01:41.940 --> 01:01:44.219
We don't even know the possibilities yet. We've
01:01:44.219 --> 01:01:46.739
got so much more to do on them. So we need to
01:01:46.739 --> 01:01:49.519
keep delving into what they're capable of. We
01:01:49.519 --> 01:01:51.360
can print things that we don't even know exist
01:01:51.360 --> 01:01:54.980
yet. So we've just got to keep innovating and
01:01:54.980 --> 01:02:01.239
iterating. Kent? Can we add in 3D printed polyprobe
01:02:01.239 --> 01:02:05.019
into this as well? Sure. We'll say underrated
01:02:05.019 --> 01:02:09.960
then. Awesome. So, guys. highly posted and aggressive
01:02:09.960 --> 01:02:12.900
orthotic designs um is that something that you
01:02:12.900 --> 01:02:15.659
think we're doing going too far in the aggressive
01:02:15.659 --> 01:02:19.519
end or not too much so uh yeah Kent what are
01:02:19.519 --> 01:02:22.619
your thoughts on highly posted orthotics uh i'll
01:02:22.619 --> 01:02:27.239
say overrated uh keep it simple stick with the
01:02:27.239 --> 01:02:32.699
kiss yeah Darcy Yeah, definitely echo Kent, a
01:02:32.699 --> 01:02:34.900
care but simple scientist. But in saying that,
01:02:35.000 --> 01:02:37.059
it's got to still be, the clinical reasoning
01:02:37.059 --> 01:02:39.000
still has to be valid. So we still have to be
01:02:39.000 --> 01:02:44.159
trying to hit the right tissue with the right
01:02:44.159 --> 01:02:47.820
force at the right time or else it doesn't really
01:02:47.820 --> 01:02:53.659
matter how aggressive it is. Rhys? If pathomechanically
01:02:53.659 --> 01:02:57.900
indicated, then underrated. Otherwise, all other
01:02:57.900 --> 01:03:06.530
times overrated. And Konrad? I would say when
01:03:06.530 --> 01:03:09.730
they're really, really aggressive, it's usually
01:03:09.730 --> 01:03:13.110
because it's a bad scan with many overlapping
01:03:13.110 --> 01:03:16.309
prescriptive variables in the same spot. You
01:03:16.309 --> 01:03:19.090
know, your HealSky with a media wedge with an
01:03:19.090 --> 01:03:22.030
inverted scan, and then it's got a huge supernotice.
01:03:22.110 --> 01:03:25.449
So, yeah, it's definitely overrated. But if it's
01:03:25.449 --> 01:03:30.460
needed, then underrated. Same as race. all right
01:03:30.460 --> 01:03:35.000
next one we're gonna go vacuum pressed or vacuum
01:03:35.000 --> 01:03:43.820
formed rear foot eva posts Kent um look i still
01:03:43.820 --> 01:03:51.679
love them um so um i i think neither you know
01:03:51.679 --> 01:03:56.320
i think both have a place um and it's about understanding
01:03:56.320 --> 01:04:01.460
the material properties, the mechanics of the
01:04:01.460 --> 01:04:03.920
materials. So, yeah, it's hard for me to commit
01:04:03.920 --> 01:04:06.400
one way or the other. It's more about the understanding.
01:04:07.440 --> 01:04:13.659
Konrad? Yeah, both. This as well. If you think
01:04:13.659 --> 01:04:16.679
you need to adjust it, then it may be useful.
01:04:17.000 --> 01:04:22.579
But definitely overrated for people that aren't
01:04:22.579 --> 01:04:24.739
measuring the shoes properly because it is easy
01:04:24.739 --> 01:04:26.239
to fit them. You just got to measure the shoes
01:04:26.239 --> 01:04:32.559
and trace a template. Rhys? Overrated. Do tell.
01:04:33.199 --> 01:04:38.219
I thought it was quickfire, Pat. I think it's
01:04:38.219 --> 01:04:44.280
a legacy application from vacuum pressing and
01:04:44.280 --> 01:04:50.159
other forms of manufacture. I think if you're...
01:04:50.460 --> 01:04:52.579
following that tissue stress model, like everyone
01:04:52.579 --> 01:04:55.739
said, and you are applying something to aid or
01:04:55.739 --> 01:04:58.980
an authority to aid in that process, you should
01:04:58.980 --> 01:05:05.059
be comfortable with where that support is. If
01:05:05.059 --> 01:05:07.739
you feel like you might need to adjust that support
01:05:07.739 --> 01:05:10.820
over a period of time or adjust that authority
01:05:10.820 --> 01:05:13.780
over a period of time, it's probably worth considering.
01:05:14.559 --> 01:05:17.179
Is that an overall orthotic application review
01:05:17.179 --> 01:05:20.719
then as opposed to a modification like an EVA
01:05:20.719 --> 01:05:23.380
review or an EVA heel stabilizer review? But
01:05:23.380 --> 01:05:25.199
at the same time, we've also said we can easily
01:05:25.199 --> 01:05:29.880
adjust orthoses. So if you do put a PA11 heel
01:05:29.880 --> 01:05:31.699
stabilizer on there and you want to decrease
01:05:31.699 --> 01:05:35.079
load through the medial tubercle of the calc,
01:05:35.079 --> 01:05:38.039
you can easily put a post -motion grind on your
01:05:38.039 --> 01:05:41.940
heel stabilizer. Do you ever think... vacuum
01:05:41.940 --> 01:05:44.059
press would ever go away given that there will
01:05:44.059 --> 01:05:47.199
be circumstances where patients may need that
01:05:47.199 --> 01:05:50.780
sort of device and obviously 3d printing and
01:05:50.780 --> 01:05:52.699
whatnot is the way of the future do you think
01:05:52.699 --> 01:05:55.039
vacuum presses would actually ever go away or
01:05:55.039 --> 01:05:59.340
just vacuum pressing devices in terms of manufacture
01:05:59.340 --> 01:06:02.300
or more as well as vacuum pressing eva posts
01:06:02.300 --> 01:06:05.769
yeah I think it will eventually be superseded
01:06:05.769 --> 01:06:08.409
by additive manufacturing techniques. And like
01:06:08.409 --> 01:06:10.889
I think what Konrad said around TPU, I just don't
01:06:10.889 --> 01:06:14.010
think we have that same. scope and quality yet
01:06:14.010 --> 01:06:17.110
with some products in comparison to subtractive
01:06:17.110 --> 01:06:20.710
manufacture. I think innately there'll always
01:06:20.710 --> 01:06:22.909
be a place for a lot of things because of what
01:06:22.909 --> 01:06:25.750
people are comfortable using and therefore EVA
01:06:25.750 --> 01:06:28.010
heel stabilizers will probably continue to be
01:06:28.010 --> 01:06:31.570
a thing. But I would see and suggest that we're
01:06:31.570 --> 01:06:35.809
starting to see a decrease in that largely around
01:06:35.809 --> 01:06:40.489
combination of orthotic and footwear as well.
01:06:41.130 --> 01:06:45.960
Das? Yeah, I'd say overrated. Again, just be
01:06:45.960 --> 01:06:50.079
the practitioners and labs that are used to using
01:06:50.079 --> 01:06:52.800
that. Probably be the people that continue to
01:06:52.800 --> 01:06:55.960
use it, not necessarily because that's the most
01:06:55.960 --> 01:06:57.719
superior way. And there's nothing wrong with
01:06:57.719 --> 01:07:03.500
that, but yeah. All right, guys. Prefabs, I guess,
01:07:03.500 --> 01:07:07.699
as a kind of precursor to orthotics, to custom
01:07:07.699 --> 01:07:10.980
orthotics. Overrated or underrated as a treatment
01:07:10.980 --> 01:07:17.460
modality? Darcy? I think underrated as a treatment
01:07:17.460 --> 01:07:21.000
modality, but overrated as a medium to long -term
01:07:21.000 --> 01:07:24.880
modality where outside of the customization of
01:07:24.880 --> 01:07:28.400
getting the tissue stress to change where you
01:07:28.400 --> 01:07:30.099
want it, I think podiatrists don't give enough
01:07:30.099 --> 01:07:33.000
credence to compressive loads versus tensile
01:07:33.000 --> 01:07:37.099
loads. The amount of medial scabs with an aperture
01:07:37.099 --> 01:07:41.550
that I have seen would suggest that. And also
01:07:41.550 --> 01:07:44.070
we just get a better quality of materials under
01:07:44.070 --> 01:07:45.730
the person's foot that's going to do a better
01:07:45.730 --> 01:07:49.469
job for a better amount of time than a prefab.
01:07:49.510 --> 01:07:51.849
So that's the way that I communicate about it.
01:07:53.670 --> 01:07:56.619
Rhys, where do you see a place for prefabs? Yeah,
01:07:56.679 --> 01:07:58.360
there's definitely a place for it. I think as
01:07:58.360 --> 01:08:00.460
a profession being podiatrist, it's probably
01:08:00.460 --> 01:08:03.820
overrated. So I think, you know, as a profession,
01:08:03.920 --> 01:08:05.780
it should be something that we prioritise and
01:08:05.780 --> 01:08:08.780
continue to develop with custom foot orthoses.
01:08:09.559 --> 01:08:12.460
Definitely a place for it as a product within
01:08:12.460 --> 01:08:16.100
the profession. But I'd say on the whole, particularly
01:08:16.100 --> 01:08:19.979
in that early one to four year career, you know,
01:08:19.979 --> 01:08:23.300
podiatrist, they're probably overrated prefabs.
01:08:24.619 --> 01:08:29.760
Konrad? Yeah, I don't think I know any podiatrists
01:08:29.760 --> 01:08:32.520
that don't also do prefabricated orthotics. So
01:08:32.520 --> 01:08:37.420
they're definitely not overrated prefabs. Yeah,
01:08:37.500 --> 01:08:42.779
so definitely can work well and is a good treatment
01:08:42.779 --> 01:08:45.520
modality. So I'm kind of in the middle on this
01:08:45.520 --> 01:08:52.119
one as well. Sorry. And Kent? I'm probably more
01:08:52.119 --> 01:08:57.170
aligned with Rhys' philosophy on this. Yeah,
01:08:57.229 --> 01:09:03.069
I think one of the things that we need to be
01:09:03.069 --> 01:09:07.409
aware of as a profession is what separates us
01:09:07.409 --> 01:09:11.789
from physiotherapy or chiropractic or these kinds
01:09:11.789 --> 01:09:14.430
of things. And I think our deep understanding
01:09:14.430 --> 01:09:18.609
of custom foot orthotics and their place in the
01:09:18.609 --> 01:09:24.199
treatment. is certainly something that separates
01:09:24.199 --> 01:09:29.819
us and shouldn't be underrated. Okay. This one's
01:09:29.819 --> 01:09:36.079
from one of our listeners. 3D printed polypropylene.
01:09:36.619 --> 01:09:41.880
Why can't we just use polypropylene? Overrated
01:09:41.880 --> 01:09:45.060
or underrated? I want to start with you, Konrad.
01:09:47.279 --> 01:09:50.060
Because it's extremely laborious in a manufacturing
01:09:50.060 --> 01:09:53.039
environment to vacuum form when your manufacturing
01:09:53.039 --> 01:09:56.699
has moved towards 3D printing. And also we can
01:09:56.699 --> 01:09:59.539
just do so much more with 3D printed shells and
01:09:59.539 --> 01:10:02.279
the CAD as well. That doesn't allow us to leverage
01:10:02.279 --> 01:10:05.100
CAD as well. When we use vacuum forming techniques,
01:10:05.340 --> 01:10:08.239
we're making foot positive blocks and our staff
01:10:08.239 --> 01:10:12.319
have to put masks on to deal with dust from wood
01:10:12.319 --> 01:10:15.880
or different types of foams. And we would much
01:10:15.880 --> 01:10:18.270
prefer a... a better manufacturing environment
01:10:18.270 --> 01:10:22.130
for our staff than that. So I think due to potential
01:10:22.130 --> 01:10:28.689
and, you know, it would also be fairly bad business
01:10:28.689 --> 01:10:31.770
for a lab to not embrace 3D printing given where
01:10:31.770 --> 01:10:37.029
the industry is at. Rhys? Yeah, probably echo
01:10:37.029 --> 01:10:39.729
the sentiments of Konrad. I think 3D printing
01:10:39.729 --> 01:10:43.390
and progressive or being progressive as an industry
01:10:43.390 --> 01:10:48.460
is really important. you know, how a 3D printed
01:10:48.460 --> 01:10:51.579
poly versus traditional poly, whether that be
01:10:51.579 --> 01:10:56.180
CNC milled or vacuum pressed, how they're derived
01:10:56.180 --> 01:11:00.539
is very different. So, you know, 3D poly, and
01:11:00.539 --> 01:11:02.000
Kent can probably speak to this a little bit
01:11:02.000 --> 01:11:07.159
more, 100 % recyclable. So, you know, there's
01:11:07.159 --> 01:11:11.899
definitely, you know, advantages in 3D printed
01:11:11.899 --> 01:11:16.859
poly compared to typical. uh polypropylene ken
01:11:16.859 --> 01:11:23.039
uh well you can still do vacuum form poly um
01:11:23.039 --> 01:11:27.020
you know we offer both um and to be honest i'm
01:11:27.020 --> 01:11:29.960
proud that we still do that you know we still
01:11:29.960 --> 01:11:34.779
have the ability to do you know um you know plaster
01:11:34.779 --> 01:11:37.079
positives all that kind of stuff all the way
01:11:37.079 --> 01:11:41.899
through and um have managed to embrace, you know,
01:11:41.920 --> 01:11:45.859
3D printing and 3D printing polypro. Again, it
01:11:45.859 --> 01:11:48.460
just comes down to understanding from the clinician's
01:11:48.460 --> 01:11:50.760
perspective what they can and can't do with each
01:11:50.760 --> 01:11:53.920
method. There are some pros and cons of both
01:11:53.920 --> 01:11:59.260
methods. So understanding from the clinician's
01:11:59.260 --> 01:12:05.460
perspective what they are is critical. But yeah,
01:12:05.560 --> 01:12:10.359
I'm really proud that we've retained those. really
01:12:10.359 --> 01:12:14.819
bespoke craftsmanship sort of skills for the
01:12:14.819 --> 01:12:22.180
industry. But yeah, I think it's just understanding
01:12:22.180 --> 01:12:24.140
from the clinician's perspective what they can
01:12:24.140 --> 01:12:29.279
and can't do. Darcy? I'd say I'm impartial. I
01:12:29.279 --> 01:12:32.659
did always really appreciate a CNC polyprobe
01:12:32.659 --> 01:12:37.659
device, but yeah, I'd say I'm impartial. I'd
01:12:37.659 --> 01:12:39.850
say to the... Person who asked the question,
01:12:39.970 --> 01:12:43.430
what's the problem? Oh, well, they're probably
01:12:43.430 --> 01:12:48.050
listening. So they'll probably... All right,
01:12:48.109 --> 01:12:51.250
last one. Probably the biggest one. In -clinic
01:12:51.250 --> 01:12:54.630
manufacturing, overrated or underrated? I'll
01:12:54.630 --> 01:12:58.050
probably start with you, Rhys. I think empowerment
01:12:58.050 --> 01:13:01.050
of the profession is really important. So if
01:13:01.050 --> 01:13:04.390
that's something that the consumer, the podiatrist,
01:13:04.510 --> 01:13:07.210
it's important to them, then I'd probably say
01:13:07.210 --> 01:13:13.439
underrated. Kent? Look, I think it comes back
01:13:13.439 --> 01:13:15.760
to some of the early points we discussed about
01:13:15.760 --> 01:13:20.819
the relationship you have with your lab. I think
01:13:20.819 --> 01:13:25.600
by and large, labs do a really good job of taking
01:13:25.600 --> 01:13:31.119
the intent from the clinician and with the help
01:13:31.119 --> 01:13:35.899
of a prescription form, producing a device that
01:13:35.899 --> 01:13:39.720
has a therapeutic effect. for your patient um
01:13:39.720 --> 01:13:43.020
and and i think that's a relationship to be really
01:13:43.020 --> 01:13:47.619
highly valued so if you if you believe that you
01:13:47.619 --> 01:13:51.239
can achieve the same results by doing it in -house
01:13:51.239 --> 01:13:57.640
absolutely Konrad yeah it's definitely underrated
01:13:57.640 --> 01:14:03.060
um you know we we had like a philosophy 10 years
01:14:03.060 --> 01:14:06.600
ago where you know i'm gonna write software and
01:14:07.159 --> 01:14:09.819
you know try and teach as many podiatrists as
01:14:09.819 --> 01:14:12.399
possible how to use it because we saw the progression
01:14:12.399 --> 01:14:15.699
and the evolution of the industry being with
01:14:15.699 --> 01:14:19.460
podiatrists doing more design and more cad so
01:14:19.460 --> 01:14:24.340
with you know we appreciate a manufacturing landscape
01:14:24.340 --> 01:14:26.659
where labs are you know an open book letting
01:14:26.659 --> 01:14:29.119
people learn their cad processes and we've seen
01:14:29.119 --> 01:14:30.739
that over the last few years which has been a
01:14:30.739 --> 01:14:34.380
bit of a change which has been good and i think
01:14:34.380 --> 01:14:38.159
anything that develops more skills within the
01:14:38.159 --> 01:14:40.520
practitioner that is directly seeing the patient
01:14:40.520 --> 01:14:42.920
is probably going to be good for the patient
01:14:42.920 --> 01:14:48.000
so long as that um you know that sort of takes
01:14:48.000 --> 01:14:49.880
me back to what i mentioned before we don't want
01:14:49.880 --> 01:14:54.180
to see um in clinic 3d printing where clinicians
01:14:54.180 --> 01:14:57.680
are taking much larger shortcuts mirroring devices
01:14:57.680 --> 01:15:00.659
things like that and doing a a disservice to
01:15:00.659 --> 01:15:02.420
the profession as well so we want to make sure
01:15:02.420 --> 01:15:08.460
it's really you know done to an ethical standard,
01:15:08.600 --> 01:15:13.359
basically, in the clinic and in the labs. To
01:15:13.359 --> 01:15:16.840
us. Finish us off. I think if we're playing the
01:15:16.840 --> 01:15:19.260
game to its form, I'd say underrated. But to
01:15:19.260 --> 01:15:22.739
flesh that out, I think that echoing all the
01:15:22.739 --> 01:15:26.100
sentiments, you know, Kent's point around the
01:15:26.100 --> 01:15:29.439
relationship being super critical. That is obviously
01:15:29.439 --> 01:15:32.800
very important. But Konrad did raise a very good
01:15:32.800 --> 01:15:36.800
point regarding the quality and that each individual.
01:15:38.090 --> 01:15:40.909
person who has access to a 3D printer and potentially
01:15:40.909 --> 01:15:42.970
some software are not necessarily going to produce
01:15:42.970 --> 01:15:46.289
good orthotics where there is, you know, in our
01:15:46.289 --> 01:15:50.329
experience as with these guys, you know, a highly
01:15:50.329 --> 01:15:53.270
iterative process is required to produce something
01:15:53.270 --> 01:15:56.470
of quality. I think it is good for the podiatrist
01:15:56.470 --> 01:16:00.430
to be able to see how the, you know, how the
01:16:00.430 --> 01:16:07.470
cake is baked per se, but all... things considered.
01:16:07.609 --> 01:16:10.890
In Australia, we do have some quite good quality
01:16:10.890 --> 01:16:15.250
labs where we're getting quite good quality orthotics.
01:16:15.489 --> 01:16:19.789
So podiatrists are very lucky to have that. But
01:16:19.789 --> 01:16:24.369
yeah, I do think that having access and understanding
01:16:24.369 --> 01:16:29.010
what orthotics will be better for what case is
01:16:29.010 --> 01:16:31.529
something. Also, the podiatrist does have to
01:16:31.529 --> 01:16:34.449
often do some post -processing too, as it depends
01:16:34.449 --> 01:16:37.850
how time poor. They may have to still put a cover
01:16:37.850 --> 01:16:41.770
on that device. They may not have the time. Generally
01:16:41.770 --> 01:16:45.329
underrated. Awesome. All right. Well, moving
01:16:45.329 --> 01:16:50.550
into the close of this fantastic session, for
01:16:50.550 --> 01:16:52.909
the panel, what's one thing you would change
01:16:52.909 --> 01:16:56.090
about how you'd approach orthotic therapy starting
01:16:56.090 --> 01:16:59.449
tomorrow as a clinician? What would you recommend
01:16:59.449 --> 01:17:01.550
them to think about starting tomorrow with their
01:17:01.550 --> 01:17:06.710
practice? Darcy? Keep it simple, understand your
01:17:06.710 --> 01:17:08.930
materials, think a bit harder about the clinical
01:17:08.930 --> 01:17:13.810
reasoning. Konrad? Understand that your prescription
01:17:13.810 --> 01:17:17.590
is basically a set of instructions to interpret
01:17:17.590 --> 01:17:21.289
CAD design. So if you don't know how to design
01:17:21.289 --> 01:17:24.510
orthotics with software, you should speak to
01:17:24.510 --> 01:17:27.270
your lab and go in and sit next to them and watch
01:17:27.270 --> 01:17:29.789
them actually design or learn how to do it yourself.
01:17:30.880 --> 01:17:32.899
It's going to make a profound difference on your
01:17:32.899 --> 01:17:35.899
understanding of prescription. And if I can have
01:17:35.899 --> 01:17:41.039
one more, it would be basically connect foot
01:17:41.039 --> 01:17:45.159
capture very closely and really critically think
01:17:45.159 --> 01:17:47.699
about foot capture in the context of manufacturing,
01:17:47.720 --> 01:17:51.140
how important it is. Because that is the number
01:17:51.140 --> 01:17:54.500
one issue we see in the lab is poor quality foot
01:17:54.500 --> 01:17:58.380
capture and no measurements of scans. Kent, is
01:17:58.380 --> 01:18:02.880
it about subtalar joint neutral? Look, I'd probably
01:18:02.880 --> 01:18:06.039
say go and spend some time in the lab, as Konrad
01:18:06.039 --> 01:18:14.119
said. I think that is such a valuable thing for
01:18:14.119 --> 01:18:16.680
the clinician to do. Make an appointment with
01:18:16.680 --> 01:18:19.199
your lab. Go and have a chat with them. See how
01:18:19.199 --> 01:18:22.479
their devices are modelled, how they're made.
01:18:23.199 --> 01:18:25.539
Understand what the options are, what they mean,
01:18:25.619 --> 01:18:30.899
what they look like. Yeah, it's well worth your
01:18:30.899 --> 01:18:33.060
time and it's well worth the lab's time as well.
01:18:33.260 --> 01:18:37.159
And Rhys? Establish what is the objective of
01:18:37.159 --> 01:18:40.899
your orthotic. Understand the tissue stress model
01:18:40.899 --> 01:18:44.079
and the application of pathomechanical prescribing
01:18:44.079 --> 01:18:48.260
and combine those with rapport and relationship
01:18:48.260 --> 01:18:50.899
with your lab to achieve what you want to achieve
01:18:50.899 --> 01:18:53.899
as podiatrist. i guess for our final strides
01:18:53.899 --> 01:18:55.739
this has probably been one of the most comprehensive
01:18:55.739 --> 01:18:58.859
recorded conversations about orthotics we've
01:18:58.859 --> 01:19:01.720
had in australia so i would like a timeless perspective
01:19:01.720 --> 01:19:03.779
from each and every one of you about something
01:19:03.779 --> 01:19:06.859
that's held true to your beliefs throughout your
01:19:06.859 --> 01:19:09.500
career on orthotics Kent i'll probably start
01:19:09.500 --> 01:19:12.239
with you given you're our commonwealth game slash
01:19:12.239 --> 01:19:16.520
olympic podiatrist what's sort of one principle
01:19:16.520 --> 01:19:18.479
that's helped you throughout your career and
01:19:18.479 --> 01:19:19.779
is that something you're happy to share with
01:19:19.779 --> 01:19:23.920
us In terms of orthotic prescription from a clinical
01:19:23.920 --> 01:19:27.359
standpoint, the world is your oyster, my friend.
01:19:28.479 --> 01:19:33.060
Look, get the patient comfortable. Simple as
01:19:33.060 --> 01:19:36.880
that. You know, we can overcomplicate things,
01:19:37.100 --> 01:19:42.399
but sometimes we just need to strip it back and
01:19:42.399 --> 01:19:47.460
get them comfortable. Rhys? Time. Time is your
01:19:47.460 --> 01:19:54.630
friend. Don't expect. that from the moment you're
01:19:54.630 --> 01:19:56.689
patient or you're standing on the orthotic or
01:19:56.689 --> 01:20:01.350
it's within the shoe, there's no silver bullet.
01:20:01.569 --> 01:20:05.689
Is that what they call it, Pat? You know, time
01:20:05.689 --> 01:20:07.949
is your friend. Trust and back your confidence
01:20:07.949 --> 01:20:16.050
and then allow for time. The best orthotic is
01:20:16.050 --> 01:20:19.390
the one that the person will wear. Great. Konrad.
01:20:20.140 --> 01:20:22.260
Yeah, look, everyone knows that I'm a bit of
01:20:22.260 --> 01:20:24.460
a broken record when they come and do training
01:20:24.460 --> 01:20:27.640
sessions with me, but it's just, you know, that
01:20:27.640 --> 01:20:30.220
the scan is fundamentally the most important
01:20:30.220 --> 01:20:33.500
thing for the lab and that it should be clearly
01:20:33.500 --> 01:20:36.239
measured by the clinician. That's held true.
01:20:38.119 --> 01:20:40.260
Thank you to all our panellists for contributing
01:20:40.260 --> 01:20:42.060
to what's probably one of the most important
01:20:42.060 --> 01:20:44.039
discussions, especially for our younger listeners.
01:20:45.060 --> 01:20:47.619
Hopefully we can get you back on for round two
01:20:47.619 --> 01:20:50.000
or potentially see you at the SEPA conference.
01:20:50.220 --> 01:20:52.100
Thanks, Pat. Thanks very much.
