Caring for Feet and Ankles
November 2018 Issue
Many of you may, like me,assume that an item or category of items would be readily available at a local brick and mortar store, particularly if you live in a metropolitan area—that is until it becomes something you need to purchase and find your options are scarce, if not nonexistent. While I've had this experience with a variety of specialty kitchen gadgets or household items, it's generally posed only a minor inconvenience for me to seek them out online. But, when a friend of mine found that she needed comfort shoes that met specific criteria to accommodate a recently diagnosed foot condition and foot orthotics, the lack of retail options posed a serious challenge. In her situation, being unable to buy the footwear she needed came with significant daily foot pain as a consequence. Even her pedorthist was unable to provide her with a recommendation for a local source, though he was able to suggest some manufacturers that might meet her needs for casual footwear. With this scenario in mind, "Pedorthics and Online Sales, Are They Compatible?" tackles the issue of how to balance the need for in-person evaluation and service and the customer's desire for online purchasing. Perhaps, as in the case of my friend, both are necessary and can work in concert.
Another important aspect of treating the foot and ankle is the appropriate use of lower-limb orthoses. Because there are fewer political and legal motivators related to reimbursement for new orthotic technology than for prosthetic developments, orthotics has historically seen fewer new advancements. One relatively recent development is the use of an adjustable ankle joint AFO system. Santiago Muñoz, CPO, FAAOP, reviews literature related to the efficacy of an example of this type of system, as well as benefits and contraindications, in "The New Generation of AFOs."
Determining the right type of orthotic intervention is often decided on the basis of an individual clinician's experience. However, clinicians must also look to research to justify reimbursement and to provide additional guidance. So, when the two seem in contradiction, it can be difficult to navigate the divide. In "When Clinical Experience and Research Collide: A Recent Controversy in Lower-limb Orthotics," John Brinkmann, MA, CPO/L, FAAOP(D), explores this tension in context of a recent study comparing off-the-shelf and custom-fabricated AFOs.
I hope you enjoy this issue focusing on care of the foot and ankle.