<img style="float: right; margin-left: 3px;" src="https://opedge.com/Content/OldArticles/images/2010-09_12/09-12_01.jpg" alt="" /> Plato said, "Necessity is the mother of invention," and Brent Johnson, CPed, might just agree. Johnson and his wife have a 17-year-old son with cerebral palsy (CP) who has needed bracing and specialized footwear since early childhood. Johnson said that he and his wife felt frustrated and disenchanted with their son's care because his bracing provided rigid support for standing but allowed no other movement, was time-consuming to manufacture, and required frequent visits for fitting. Plus, the braces didn't fit into their son's shoes. Fortunately, the family had spent five years living in Budapest, Hungary, where they experienced a different model. The country's custom-shoe industry usually fit pediatric patients with well-fitting, customized, leather boots that required little breaking in and facilitated independent ambulation. Such specialized care happened fast—in one office visit for measurement plus a second one for fitting. The model inspired Johnson, and armed with several engineering degrees and a master's of business administration, he decided to put his education to work for kids with CP. <h4>1. How did you become interested in O&P?</h4> Having a son with CP was my motivating factor. I started a company that would make customizable boots for kids with CP, and the last step was to create a custom insole modified to support a very deformed foot—that led me to become a CPed. Upon seeing that making foot orthotics was labor intensive and had many sources of variations, the engineer in me couldn't stop thinking, "There must be a better way...." I have come to realize that continuous system improvement can solve almost any problem. <h4>2. Please describe what your company does.</h4> Varifit Orthotics, Payson, Utah, is both an orthotics lab and equipment supplier. We produce all our orthotics based on our direct 3D-forming technology. Our Varifit system is not a traditional milling machine; however, this technology allows for standardization as well as hand manipulations to the positive molds. We sell equipment to clinics that want to make their own orthotics; we sell scanners and finished orthotics to clinics that don't want to make them in-house; and we develop systems for larger clients who want an integrated system between multiple locations and an in-house orthotics lab. <h4>3. What are your top priorities when working with a patient?</h4> To make an effective orthotic, understanding the problem, including the patient's foot geometry and morphology (i.e., the biomechanics) is critical. For many problems, understanding the biomechanics helps get to the root causes of the problem and gives information needed to make the correct orthotic device. Biomechanics knowledge influences the orthotic design, cast manipulations, and materials decisions, and it provides a step change in the care that can be provided. <h4>4. What do you see in the future for the pedorthic profession?</h4> I see the [U.S.] custom-orthosis industry growing dramatically, as it has in both Canada and Europe.... As the healthcare system changes, there will be extreme pressure to replace surgical and other costly treatments with more cost-effective, conservative treatment options. <h4>5. What advice would you give to someone just entering the pedorthic profession or starting his or her own business?</h4> Build your practice to keep costs and labor content to a minimum.
