Pedorthic Newswire Issue #470

May 23, 2012, Issue #470

DISCUSSION

Send your comments, questions, responses, articles or case studies to Pedorthic Newswire at editor@pedorthicnewswire.com

Your emails will be reviewed by pedorthists and the editors of Pedorthic Newswire, and selected submissions will be posted in an upcoming issue for feedback from other readers. We reserve the right to edit submissions and responses. Please note:the deadline for all submissions and responses is 12 noon Eastern Standard Time on Tuesday for that week's issue.

NEW QUESTIONS

Question: I saw a patient today, Male in his mid-40s, approx. 220lbs that presented with heavy callusing of both the plantar surface of the foot and the palmar surface of the hand bilaterally. He is struggling with pain which has increased over time and is almost to the point of disrupting work. He has tried various off the shelf orthotics and shoes to no avail. Most orthotics, even firm ones, wear to paper thin quickly. The only portion of the feet which is not callused is the MLA. The thickest portion of the callusing is around the posterior calcaneus and the MPJs as well as the medial hallux edge (pinch callus). The R foot has a hammered 2nd digit which is also callused on the dorsum of the IPJ. I was unable to watch him ambulate barefoot due to pain issues. Static weight-bearing shows slight heel varus and a drop in the 1st ray due to a bunion, also bilateral. There was no overlying syndrome on the Rx, just a classic "evaluate and treat" for orthotics, Dx: metatarsalgia. I am really unsure as to why so many calluses but since they are the same way on his hands as well I am thinking there must be an underlying condition (possibly focal palmoplantar keratosis (PPK) but I'm no Dr.). He warned me that any modality tried typically creates new problems and leaves him unable to ambulate for a while. Any thoughts on orthotic treatment? I was considering a PQ custom FO from Riekens for support, shock absorption and longevity. I figured I would turn this to the community and see what comes around. Thanks for responses in advance.

- Mark C. Scheibelhut, C. Ped., O.S.T.

Question: I posted this question about neutral running shoes months ago. The only response that I got was from Jeff Rich. While he offered excellent advice on sandwiching a firm lateral wedge into the sole of the shoe, I was hoping someone from one of the shoe companies would offer a response. I have been more than perplexed as to why a shoe that is categorized as neutral, would have a thicker and firmer medial outsole and a thinner softer lateral one?

Many of these shoes are basically a medial wedge/pronation control shoe right out of the box. As such, many of the cavus or under-pronators (for which the shoe was designed for) actually have their functional deformity increased with these shoes. The theory may be that making a super soft eva or gel crash pad, it may absorb more shock? It makes no sense to have it collapse like a flat tire. I have seen this in certain shoes from Brooks, Nike, Asics and New Balance, so it isn't an anomaly to be blamed on one design or company.

As Jeff Rich indicated, I have also fixed more than a few of these shoes for desperate patients. I would also like to ad that most of these have been in cavus orthotics with lateral posting, reduced medial arch and a drop for the 1st ray. In spite of that, these shoes were still over-powered due to the lack of firmness and stability of the lateral heel. If you need a simple visual aide, think of this. Let's say you were fitting a CMT patient for an AFO. What would the effect be if you posted it medially with a 6mm thick wedge of 60 durometer eva, then posted it laterally with a piece of cloud crepe or firm Plastazote?

It would tip into varus, which is the exact opposite of what we are trying to control. I hate to sound like a broken record, but I can't possibly be the only one dealing with this. Certain models have progressively gotten worse over the last 2 years. I am getting tired of having to explain to a patient that has a $100 + neutral shoe that causes them to tip into varus and the shoe is less than a month old, sometimes newer. If any designers or product managers are listening, I have a question. Please let me know if there are any plans to go back to basic principles with a neutral shoe. Simply make the medial column almost a mirror image of the lateral column and see how that works. That is the true foundation of a neutral cushion shoe.

That simple design principal isn't sexy and it isn't cool looking.....BUT a large percentage of runners and non runners alike would benefit. I am not big on the minimal shoe craze but when I hear anecdotal stories of people that used to run in heavier structure shoes and their symptoms reduced when switching to a more neutral cushion shoe. I have to wonder, is this due to how great these new-fangled shoes are? Or, is it due to them being previously locked up in a shoe with too much pronation control?

I'm all ears.

- Brian Graham C.Ped. BOC

PREVIOUS QUESTION WITHOUT RESPONSES

QUESTION: We have an 80 yr. old Medicare patient with a LLD of 3 in. and a foot length discrepancy of 1 size. From a clinical standpoint there is going to be an issue with proper foot (specifically ball) alignment if a prefabricated pair of therapeutic shoes will be dispensed with the same size for both feet shoe. The Medicare LCD for therapeutic shoes states the following: A custom molded shoe (A5501) is covered when the patient has a foot deformity that cannot be accommodated by a depth shoe.

Is a foot length discrepancy considered a deformity that warrants a pair of custom shoes for a diabetic patient? Must we supply 2 pairs of prefab shoes instead & who is responsible for the cost of the 2nd pair? Will Medicare pay for 2 prefab shoes in the above situation? Could the LLD be taken in to the equation for custom shoes?

-Judah Rosenberg C.Ped.

ANNOUNCEMENT

In honor and recognition of Heather Moore Bernard's contribution to the pedorthic community, the Pedorthic Foundation is proud to announce the Heather Moore Bernard Scholarship fund.

Heather Moore Bernard unexpectedly passed away on November 17, 2011. The Pedorthic Foundation is honored to celebrate her life as a prominent partner in the family's pedorthic business and a lifelong friend of the profession.

To read the full announcement click here.

SPONSOR NEWS

HEALTH AND INDUSTRY

Wellness Brand MBT Files Bankruptcy in Switzerland

By: Barbara Schneider-Levy

MBT, the Swiss brand that put wellness on the footwear map, is in jeopardy.
Parent company Masai Marketing & Trading AG declared bankruptcy on May 9 in Switzerland, according to a statement on the company's website. Joe Casagrande, president of Portsmouth, N.H.-based MBT USA, declined to comment. Read the full article here.

Source: WWD

Skechers Will Pay $40 Million to Settle FTC Charges That It Deceived Consumers with Ads for "Toning Shoes"

The Federal Trade Commission announced that Skechers USA, Inc. has agreed to pay $40 million to settle charges that the company deceived consumers by making unfounded claims that Shape-ups would help people lose weight, and strengthen and tone their buttocks, legs and abdominal muscles. Read the full article here.

Source: Federal Trade Commission

Rigid Footplate Shows Advantages Over AFO for Idiopathic Toe Walking

Researchers are still unsure what causes idiopathic toe walking in children, although data has shown that 30% of children who are idiopathic toe walkers have a family history. The behavior is usually learned when a child first learns to walk, according to Kinsey Herrin, MSPO, CO, Georgia State University, who presented data from a study comparing rigid footplates with articulated AFOs to control the behavior. Read the full article here.

Source: O&P Business News

AETREX iSTEP WEBINARS

Visit our full May 2012 Schedule

DIABETES

Diabetic foot ulcers can be deadly

Perhaps the most dreaded complication arising out of diabetes is a foot wound that leads to amputation. "Even though many diabetics breathe a sigh of relief, thinking that is the end, that they have handled the problem," said Dr. Steven D. Gross, of Perry Township's Stark County Foot and Ankle clinic, "often it is just the beginning. At first, it may be a toe or toes, but if great care is not taken, further amputations can follow." Read the full article here.

Source: Cantonrep.com

Youth diabetes, pre-diabetes rates soar

By: Nanci Hellmich

Diabetes and pre-diabetes have skyrocketed among the nation's young people, jumping from 9% of the adolescent population in 2000 to 23% in 2008, a study reports today.

The findings, reported in the journal Pediatrics, are "very concerning," says lead author Ashleigh May, an epidemiologist with the Centers for Disease Control and Prevention.

"To get ahead of this problem, we have to be incredibly aggressive and look at children and adolescents and say you have to make time for physical activity," says pediatric endocrinologist Larry Deeb, former president of medicine and science for the American Diabetes Association. Read the full article here.

Source: USA Today

Correct treatment of common diabetic foot infections can reduce amputations

Diabetic foot infections are an increasingly common problem, but proper care can save limbs and, ultimately, lives, suggest new guidelines released by the Infectious Diseases Society of America (IDSA).

Poor treatment of infected foot wounds in people with diabetes can lead to lower extremity amputation, and about 50 percent of patients who have foot amputations die within five years - a worse mortality rate than for most cancers. But about half of lower extremity amputations that aren't caused by trauma can be prevented through proper care of foot infections, note the new IDSA diabetic foot infections guidelines, which are being published today in the journal Clinical Infectious Diseases. Read the full article here.

Source: Medicalxpress.com

SPORTS AND FITNESS

Americans spend only about two hours each week in sports and fitness activities

Americans spend, on average, only about two hours each week participating in sports and fitness activities, according to researchers at Penn State and the University of Maryland who examined U.S. government data from the American Time Use Study.

The U.S. Centers for Disease Control and Prevention recommends that adults aged 18 to 64 get about four hours of physical activity each week by exercising moderately for 2.5 hours per week and engaging in a vigorous activity, such as running and muscle strengthening, for an hour and fifteen minutes per week. Read the full article here.

Source: News Medical

Born to run barefoot? Some end up getting injured

By: Alicia Chang

Swept by the barefoot running craze, ultramarathoner Ryan Carter ditched his sneakers for footwear that mimics the experience of striding unshod. The first time he tried it two years ago, he ran a third of a mile on grass. Within three weeks of switching over, he was clocking six miles on the road.

During a training run with a friend along a picturesque bike path near downtown Minneapolis, Carter suddenly stopped, unable to take another step. His right foot seared in pain. "It was as though someone had taken a hammer and hit me with it," he recalled.

Carter convinced his friend to run on without him. He hobbled home and rested his foot. When the throbbing became unbearable days later, he went to the doctor. The diagnosis: a stress fracture. Read the full article here.

Source: Associated Press

Fitness in the workplace benefits employers and employees

By: TJ Fjelseth

Helping employees get healthier and helping to curb the rising cost of health care should be priorities for all employers. And May, designated as National Employee Health and Fitness Month, is the perfect time for employers to start taking an active role in their employees' health.

Not only will your employees and their families benefit, but your company's bottom line can get healthier, too. Read the full article here.

Source: Citizen's Voice

BECOMING CERTIFIED IN PEDORTHICS

Pedorthics is a professional field covering the design, manufacture, modification and/or fit of footwear. Pedorthics encompasses shoes, orthoses and foot devices that prevent or alleviate foot problems caused by disease, overuse, injury or congenital defect. Certified Pedorthists work with patients and their footwear to conform to a doctor's footwear prescription as part of the patient's treatment

To earn certification in Pedorthics, you must take a pre-determined number of course hours in pedorthics and pass a certifying examination overseen by either The American Board for Certification in Orthotics, Prosthetics & Pedorthics® or Board for Certification/Accreditation, Int'l. Both the ABC and BOC are independent certification bodies that set standards for the profession and offer certifications that are recognized by the National Commission for Certifying Agencies.

More information, including FAQ's

The American Board for Certification in Orthotics, Prosthetics & Pedorthics information on the step-by-step process of becoming a certified pedorthist

Board of Certification/Accreditation International information on becoming a BOC Pedorthist.

For information on the Canadian certifying organization visit The Pedorthic Association of Canada.

ONGOING COURSES AND EDUCATIONAL OPPORTUNITIES FOR BECOMING CERTIFIED IN PEDORTHICS

The Robert M. Palmer M.D., Institute of Biomechanics "A Not-For-Profit School" has uniquely designed courses to provide pedorthic education for the retail, clinical or biomechanical knowledge seeking pedorthist. Course dates for Levels 1-3 in a variety of locations in the United States, Hong Kong, Mainland China and Korea are available. Click here to view a detailed calendar including dates and locations, information and pricing.

Robert M Palmer 2012 Schedule

June

Brea / El Monte, California TBD - June 23 - July 2

August

Elwood, Indiana - August 18- 27

September

Orlando, Florida - Sept 8 - 17

Elwood, Indiana - Sept 29 - Oct 8

Fall 2012

Malaysia TBD -

November

Elwood, Indiana - Nov 10 - 19

December

Brea / El Monte, California - Dec 8

RMPI Pre Certification Training- PEDORTHIC PRE-CERTIFICATION EDUCATION
PFA Scholarship Value @ 70% Savings
Published Tuition 2010 - $4K, "Powerstep Scholarship" Tuition Total $1500
(does not include travel / books / meals)
Must Enroll Before April 30, 2012
Attendance Date Flexible - CAPE/NCOPE Compliant - Levels 1,2,3
Courses Held In Elwood, Indiana Include Dormitory Housing & Shuttle Service
By prior reservation on a first-come-first-serve basis
To learn more about our courses or how you can share our vision, visit us at:
www.rmpi.org

CFS Allied Health Education: Pedorthic Certification: Exam Review. This review is focused on supplying the student with the skills and knowledge needed to pass the ABC Certified Pedorthic exam by presenting exam-like questions, exploring possible answers, and discussing rationales for correct and incorrect answers. Contact CFS Allied Health Education at (918) 266-3678 or visit http://www.learnpedorthics.com/ for more information.

*ABC and The American Board for Certification in Orthotics and Prosthetics are registered trademarks of the The American Board for Certification in Orthotics and Prosthetics, Inc., which is not affiliated with CFS Allied Health Education and does not endorse this review.

Pedorthic Pre-Certification Training Course July 30th - August 12, 2012 In cooperation with ABC requirements, Eneslow Pedorthic Institute (EPI) is offering the three-level competency training course for aspiring CPEDS. To provide maximum benefit in a minimum of time, a portion of the level one curriculum will be administered through a distance learning program that includes required readings, interactive CD's and testing of all mandatory topics.

Upon passing the level one test, students will attend the remainder of the pedorthic pre-certification course at Eneslow Pedorthic Institute for 2 weeks during July 30th, 2012 to August 12th, 2012. This class completes required education prerequisite to sit for national certification exam. It does not satisfy the requirement of 1000 documented hours of field experience.

For more information on ABC Clinical Practice Requirements, please go to www.abcop.org.

Please contact Sarah Goldberg at epi@eneslow.com or 212-477-2300 x211 for more information. Pedorthic Pre-Certification Course - $3,995

BECOME AN ABC THERAPEUTIC SHOE FITTER

For information on Aetrex Worldwide Therapeutic Shoe Fitter Courses, please contact the Aetrex Marketing Department at: marketing@aetrex.com.

Aetrex Worldwide Therapeutic Shoe Fitter Courses

Information on 2012 Aetrex Worldwide Therapeutic Shoe Fitter Courses will be coming soon.

2012 COURSES

2012 FOOT SOLUTIONS PEDORTHIC PRE-CERTIFICATION COURSE SCHEDULE & INFORMATION

Foot Solutions is an accredited facility that holds classes four times per year. The course will offer the certificate needed in all three levels so that you qualify to sit for the C. Ped. Exam. The facility is located at 2359 Windy Hill Road, Suite 400, Marietta, GA 30067

August 3 - 1 Day Cram Session (free with attendance of pre-cert class)

August 6 - August 17

October 8 - October 19

November 9 - 1 Day Cram Session (free with attendance of pre-cert class)

For application and fee information, contact:

Tracy Strickland 1-866-338-2597 EXT: 206 tstrickland@footsolutions.com

Betty Hubauer 1-866-338-2597 EXT: 201 bhubauer@footsolutions.com

Dr. William Faddock 1-866-338-2597 EXT: 209 bfaddock@footsolutions.com

UPCOMING COURSES FOR CERTIFIED PEDORTHISTS & ALLIED PROFESSIONALS

MONTHLY AND ONGOING

Riecken's Orthotic Labs - 800-331-8040; SAFIO Class, Second Friday of every month, at 5115 Oak Grove Rd., Evansville, IN. Four casting stands provided, limited to 8 students. Contact Darlene at the above number for more information.

Traveling Courses To Your Area sponsored by The Robert M. Palmer, M.D., Institute of Biomechanics, Inc. a not-for-profit pedorthic school. Please contact us to discuss your needs at phone: 765-557-7216. Email: pam@pedorthicbiomechanics.org or visit our Web site at: http://www.pedorthicbiomechanics.org/.

The Robert M. Palmer, M.D., Institute Of Biomechanics, Inc. a not-for-profit pedorthic school: Advanced Manufacturing - 50 Hour Course - Approved For 49.5 CME's for Pedorthists by the ABC. This course is designed to teach BAPFOL standards in manufacturing functional feet orthoses and provide an introduction to advanced biomechanical posting. Class size is limited to two students. For more information or to customize a course to meet your manufacturing educational needs, please email pam@rmpi.org or phone 765-557-7216. Tuition cost: $2K - includes housing and transportation to and from the airport and school. Click Here for More Info

May

Elwood, Indiana- Two Courses: May 18 - 22