Here are some of the highlighted topics that generated the most discussion:

1. Use of a functional brace in a prophylactic/preventative mannor:

• Many Athletic Departments have been engaging in this practice and are measuring the results. (Examples: Use of Ligament Knee braces for all linemen in NCAA Football, Volleyball teams/clubs encouraging use of ankle braces to prevent or limit ankle sprains).
• Some studies have been publish that indicate the use of an ankle brace or knee brace will increase flexion of the knee. That increase in flexion could be preventing or limiting injury by placing the body in a safer posture.
• Point #3

2. Non-standard use of OA unloading braces:

• Can be used to offload the meniscus of a particular knee compartment after injury or full/partial surgical removal. Meniscal damage is known to increase the likelihood of early onset Osteo-Arthritis, so offloading can be used to delay the onset of OA.
• Can be used to offload in the event of a fracture of the tibial plateau.

4. The Value Of Trial Programs:

• Unlike most other kinds, OA braces usually have the option to go through a trial program prior to purchase. This is an excellent resource to determine if your knee can tolerate the application of a brace, and the unloading effect.

3. Patient Results Vary:

• Finding the right brace fit has as much to do with the function of the brace as it does with the comfort. A brace that fits well and feels comfortable will be worn more often, which will yield better results over the long term.
• Proper follow is the other key to getting a good fitting and functioning brace. Most comfort and function issues with braces come from the brace not being adjusted proper or being applied properly. Finding knowledgable and proficient brace fitters that provide adequate follow up is key to making sure that you have the best fit.

One of the core values we have here at White Rock Footcare is Collaboration. Working with other professionals will collectively elevate our level of service, which results in a better experience for our patients. We will continue to facilitate these events and post the results as we feel that not just those in attendance will be able to learn.

So in what will be an increasing amount of educational, collaborative events, we are hosting an event tomorrow. We are bringing in a representative from the bracing comany, Ossur, and will be reviewing a number of case studies with the group of Physiotherapists that will be in attendance.

When the event is complete, we will be posting a summary of the discussion and some video clips of the highlights. Tomorrow’s topic is “Bracing Options for Osteo-Arthritis & Meniscal Injuries”. If you have an interest in this subject be sure to check back here in a few days, or subscribe to have our blog posts sent to you by email.7

Return Policy for Custom Orthotics: The First of its Kind

This “Return Policy”, for lack of a better way to describe it is the result of the evolution of our treatment process. Seeing patients reporting Improvement in Comfort at the Six Week Follow-up appointment in the mid 90% range gave us the confidence to explore this kind of promise a little further.

From there we consulted our local Doctors and Physiotherapists to find out what they thought the challenges were to patient success when referring for orthotics. Overwhelmingly they responded by saying that they believed their patients weren’t sure if orthotics will work, as there is no guarantee for the price paid. They also believed that patients saw more success when they went through more thorough assessments and follow-up.

With that information in hand the solution we came up with was the improved comfort promise, as described above. Previous to that we added an in-clinic follow-up appointment after the first six weeks wearing a pair of new orthotics. We are confident that our unique approach will give more people the confidence to try orthotic therapy (if it relevant to their condition) and receive the benefit of an increased amount of one-on-one time with our Pedorthists. There is also the added benefit knowing that we are only going to be promoting the use of custom orthotics when we believe they will work for any given situation.

This is something that we are very excited about. We hope that this will help us see a whole new group of people who may otherwise not have tried orthotics. Seeing patients have success and positive change is one of the most rewarding aspects of this kind of work. We will keep you updated as to how people in our area react to this change.

1. The Generalist. This Referring professional manages their patients concerns and works with a stable of known and trusted specialists and secondary referral sources. Once diagnosing your issue you are sent off the the specialist for that area. They trust that the specialist they are sending to will take things from there. A family doctor is a good example of a generalist.
2. Allied Health Care. A professional in the Allied Health Care field works directly with the patient on a closer basis and refers out to a trusted network if they feel you can benefit from a different form of treatment. Again they trust in the specialist they are sending you to will do a good job. A Physiotherapist (or Physical Therapist depending on where you are from) or Chiropractor(one branch of them at least) are a good example.
3. Professional Health Care. I made up this term to define someone in an Allied Health Care role that has modified their clinic to provide more end treatment types for their patients. This more of a one-stop-shop type approach. Since the solution is in house you may want to exercise some caution or ensure you have some kind of second opinion or way to balance their advance.
4. The Specialist. The specialist knows their stuff. They tend to write much more specific referrals and know the treatments at a deeper level than most. Their referrals are typically to specific clinics that they trust will deliver top notch service. An Orthopaedic Surgeon is a good example of a specialist, although they can be found in General Physicians, Physiotherapists, etc who have an active personal interest or experience.

Prior to their launch, there were very few options in the supportive flip-flop category. They were able to take the success of their arch support insole business and translate the fit into a sport sandal. Better yet they were able to make the whole package attractive enough to bridge the gap between fashion and function, without compromising much in the way of support.

Now a few seasons in, they are finding new ways to expand their product offering, the addition of the cork based line and the all leather sandals are the best example. With each new kind of sandal, the support story remains quite consistent, while the styling and colour choices improve each season. Needless to say, we are big fans of this brand in our clinic.

Top Things We Like Most About SOLE Sandals:

1. Good heel cup and arch support, consistent with their line of insoles.
2. Good flex-point at the forefoot and a modest amount of toe spring (rocker).
3. Durability. They handle the elements well. Backed by great customer service.
4. 90 Day Comfort Guarantee. Try them without risk; enough said.
5. The Premium Leather sandal. Try one on and you will know what I am talking about.

Now, with several years of experience fitting these sandals, there are a few things that we notice could benefit from some incremental improvements. One thing I will say about SOLE is that they take their product development very seriously. Chances are that they are working as we speak to incrementally improve their sandals.

Minor Fit Issues We See (as of June 2011):

1. The strap material on the cork based sandals is a little bit stiffer than that of the sport sandal. About a quarter of the feet we have seen will notice the difference in fit. Only a very small percentage notice enough to not purchase. Our solution so far has been to apply heat to the strap to soften the material, essentially accelerating the break-in process.
2. The instep band on the slide sandal can cause pressure points at the toe or instep of some feet, probably less than 5% of the time. I am honestly not surprised by this simply because not all feet are the same shape. Still worth noting.

There are four key areas to be concerned about with sandals.

1. Support
2. Cushioning
3. Heel to Toe rise
4. Fit, Accommodations

Support

Your typical sandal doesn’t do much more than offer your foot some protection from the ground. And in the case of cheap & flimsy flip-flops, I would argue that they barely accomplish that. The average sandal offers only a fraction of support compared to that of a shoe, which in small doses provides a decent challenge to the body. It can become an issue when that barely supportive sandal is worn day after day for the summer months.

There are some options out there in the market that address this. A brand like Birkenstock is probably the best known for providing strong and stable support. Say what you want about how they look, you can’t knock how they work. I’m not saying your sandal needs to be exactly like that, but it should be more like that than just a slab of foam.

Cushioning

Most sandals do not have that much inherent cushioning. Generally speaking this isn’t a big deal, unless you spend all day walking in them (or days/weeks). This seems to be an increasingly common type of usage for sandals, and therefore is part of the urgency we feel to write this kind of post.

Not all cushioning is created equal. Cheap foam will pack down quickly and the cushioning effect will diminish rapidly. Quality cushioning materials will last much longer and will maintain their resiliency.

Heel to Toe

Almost every shoe out there has a Heel-To-Toe pitch where the heel sits higher than the forefoot. A high-heel shoe is an obvious example of this, but even a running shoe or a dress shoe has at least a half-inch or so of pitch. Your average sandal, however, is much closer to or is perfectly flat. In the short-term this is a good thing. It provides a much-needed stretch to the Achilles/Calf area. In small doses this isnt’ a bad thing. All day, everyday for several months a year can lead to an overuse injury.

Fit

A good fitting sandal should be one with your foot, which means you should have to squeeze your toes or alter your gait to accommodate for your sandal. Any kind of alteration to foot posture or gait over a sustained period can lead to issues. Inexpensive flip-flops are the worst offenders here as the wearer is often forced to scrunch their toes to keep the sandal on their foot or even alter their gait pattern to compensate for a sandal that does not want to stay on their foot. These kinds of alterations to body posture and motion can lead to overuse discomfort or injury.

Brand Reviews

In future posts we will be reviewing our favourite summer sandal brands that pass the tests described above. Stay tuned.

1. An independent referral means that at least two health professionals have agreed that trying orthotic therapy may be a good idea for you (the Doctor and the provider).  This addresses the number one fear that most people have, being sold something they don’t need.
2. The referral allows your orthotic device to be considered “medical” and eligible for zero rated tax (in some jurisdictions), to be claimed as a medical expense (again in some jurisdictions).
3. Any kind of reimbursement through your health insurance plan will require the referral as part of the submission process. Some insurance plans can be particular about who they define as a Referring Professional.
4. Your provider should require the referral to even make the orthotics for you. Be wary of any clinic that will give you “custom” orthotics without requiring a referral.

Sometimes this process works from both ends, and there times where that makes sense. You may be receiving a referral and recommendation to pursue orthotic therapy when it was something that you hadn’t previously considered. Or you may already know about orthotics from a friend or personal experience and you are the one asking your Referring Medical Professional for a referral if they think it is a good idea for you.

Either way you are getting the advice of that Professional on you way to meeting with at least another. The next step will be getting to know a little bit more about your Referring Professional.

This series of posts will be designed as a teaching tool, to help you understand the footwear industry and navigate the store shelves and differentiate the good from the bad. Along the way you will learn about the different kinds of footwear and what they are designed for, the features that pedorthists and foot health professionals are looking for.

What you won’t find are to many rules, simply because there aren’t any that really work for everyone. Instead we will discuss the kinds of questions to ask yourself, and what your answer should look like. Our goal is to help you navigate your way through the shoe store, and how to avoid shoes that may lead to trouble.

Pedorthists Guide To Footwear

1. Summer + Sandals = ?
2. Review: SOLE Sandals

Just a few bits of disclosure before we get started. First, all of the authors of this blog are Canadian Certified Pedorthists. We intend to give the most neutral advice possible, but thought you should all know our point of view. Second, we are based in Canada, so a lot of the advise will be slanted that way, especially as it relates to Referrals and Insurance plans. Whenever possible we will try to include research from other countries.

Everything You Wanted To Know About Orthotics

1. The referral, why you and your orthotic provider should need one.