Phil, Bob, Kevin K. and Xavier;
    First, I need to agree with Kevin K. here ( is it getting cold in here,
or is it just me?  ; - )), and Bob too.  As Xavier pointed out the material
properties can at times make a difference, i.e. geriatric patients, but
overall I agree with Bob that the material is not what truly matters in
orthotic control.
    Kevin is right to push the envelope re: his suggestions for a more
comprehensive study.  I understand what you are attempting to do Phil, and I
commend you for it.  On the other hand, I think that ultimately you will be
disappointed with your outcomes, and possibly confused as well.
    In the U.S. the medicare system provides for 3 pair of diabetic
orthotics for their at risk patients per year.  This is approximately a 4
month period of wear for each pair.  I'd suggest if your evaluation period
is to have a specific length that you shoot for a 4 month interval.
Obviously you may want to take that further, things are probably different
where you practice.
    Finally, I again agree with Kevin and Bob.  The prescription of the
custom, or modified OTC device is what really makes the changes in foot
function.  Strictly attempting to isolate or improve a single area of high
pressure is not effective unless you identify the functional differences in
asymmetry in both feet.  You will find better outcomes, and reduced
pressures, by focusing on bring symmetry to function first, and then chasing
the pressure second, if you even need to.
Sincerely;
Bruce Williams
P.S. Phil, good luck and good for you for even attempting anything of this
nature. It will open your mind to new ideas and give you a greater amount of
information as to what really happens inside your patients shoes!
----- Original Message -----
From: "Philip Wells" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, March 17, 2004 6:04 AM
Subject: Re: F-Scan protocols


> Bob
> I am interested in you saying that material is irrelevant. Have you
> assessed the mechanical properties of soft verse hard materials - both
> short and long term. As I mentioned previously, research backs up the
> point that EVA changes its properties over repeated cycles.
> My point is that if a soft device is prescribed to effect a clinical
> outcome, if the device does not stay 'soft', then how can we make
> assumptions on how the device worked.
> The idea behind this design of orthoses is that the GRF are different
> during the differnt phases of gait, so to make an orthoses that
> mimics/matches these variables seems like common sense.
> I do agree with your comment re. a generic objective measure. This was one
> of the main reasons for this posting.
> One of the key objections I have to a lot of the research done on FFO's is
> that the research will not actually assess whether the device is doing
> what it should be e.g.  if the paper is assessing the occurence of foot
> ulceration in patients treated with TCI's via the ability of orthoses  to
> control peak pressure , it must show that the devices are actually doing
> this before any comments such as ' orthoses do not stop ulceration' can be
> made.
>
> David, the research will be totally indepandant and fully blinded
> Phil
>
> -----------------------------------------------------------------
> This message was distributed by the Podiatry JISCmail list server
>
> All opinions and assertions contained in this message are those of
> the original author. The listowner(s) and the JISCmail service take
> no responsibility for the content.
>
> to leave the Podiatry email list send a message containing the text
> leave podiatry
> to [log in to unmask]
>
> Please visit http://www.jiscmail.ac.uk for any further information
> -----------------------------------------------------------------

-----------------------------------------------------------------
This message was distributed by the Podiatry JISCmail list server

All opinions and assertions contained in this message are those of
the original author. The listowner(s) and the JISCmail service take
no responsibility for the content.

to leave the Podiatry email list send a message containing the text
leave podiatry
to [log in to unmask]

Please visit http://www.jiscmail.ac.uk for any further information
-----------------------------------------------------------------