Jeff, Jeff - there, there, shhh.  It's O.K. Although I wasn't there I don't
think he was attacking you, your lab, biomechanics or orthotics.

Jeff Root wrote:

> Kevin,
>
> I'm glad someone was finally was good enough to explain Morgan's Meat Pie to
> those of us who were not in attendance at BSS 2000.  As the owner of an
> orthotic laboratory, I take great exception to the premises of the Meat Pie
> paradigm.
>
> Speaking on behalf of my laboratory only, I can tell you that filling
> orthotic prescriptions is becoming increasingly difficult and complex
> because the orders we receive are so highly individualized.  Twenty percent
> of the orthoses we manufacture are either poured or balance to a
> non-vertical heel position.  Our prescription form is so detailed that it is
> printed on 8.5 by thirteen inch paper, not conventional 8.5 by 11 inch
> paper.  I am currently attempting to add more options to our Rx form but
> don't know how to fit everything on one page.
>
> Our lab, in an effort to be competitive, has a line of orthoses that are
> called "Basic Orthoses".  The Basic Rx has pre-established Rx defaults that
> are clearly described so as to limited custom options.  Our customers can
> use this simplified Rx form for more routine cases, thereby simplifying our
> production process which allows us to offer the device at a lower cost than
> our regular orthoses.  While the concept is great in theory, guess what?  We
> have found that eighty to ninety percent of our clients want to customize
> there Basic Rx orders!
>
> If the prescription for each patient is the same, who do you blame, the
> practitioner who determines the prescription or the lab who fills it?
> Practitioners need to realize that labs have an incentive to standardize
> their product because it is the most efficient, cost effective, and
> profitable option.  But it is the practitioner who must determine the most
> appropriate prescription for the patent and it is the practitioner who must
> ultimately accept responsibility for their own actions.
>
> In this age of managed healthcare, there is an ever increasing demand by
> practitioners for labs to provide orthoses at lower costs.  Practitioners
> must recognize the fact that true custom, prescription orthoses cost more to
> fabricate and therefore are more expensive to purchase than mass produced,
> cookie cutter, devices.
>
> If a practitioner is eating meat pie it's because that's what they ordered
> or it's because they are only eating what happens to be placed in front of
> them.  Personally, my clients are having prime rib, rack of lamb, salmon, or
> what ever the hell else they order.  And if we don't cook it to their
> satisfaction, I can assure you they will be sending it back to the kitchen!
>
> Respectfully, but pissed off,
> Jeff Root
> meat pie, my ass
>
> ----- Original Message -----
> From: <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, September 09, 2000 8:37 PM
> Subject: Re: Plantar fasciitis/plantar heel pain
>
> > Bart and Colleagues:
> >
> > In a message dated 9/9/00 6:39:02 AM Pacific Daylight Time,
> > [log in to unmask] writes:
> >
> > << I think the podiatry community that was so unfortunate not to be
> present at
> >  the last symposium, is still waiting for some hints to know how this meat
> >  pie tastes.
> >
> >   It is still Q. NOT.E.D.
> >
> >  Is there really nobody who  dears  taking the challenge to explain in
> >  simple terma the mysterie around this pie ? >>
> >
> > Morgan's Meat Pie Paradigm goes something like this (excuse me if I make
> some
> > mistakes since by the time I was told of this new paradigm I had already
> > consumed two glasses of champagne on an empty stomach).
> >
> > While attending lectures from an orthosis lab on the proper prescription
> > methods to use for the various deformities which can be seen by the
> > podiatrist (e.g. rearfoot varus, forefoot varus, forefoot valgus, rearfoot
> > valgus, etc) it was noted that even though there was a wide variation of
> > deformity, the orthosis prescribed was still very much the same orthosis,
> > regardless of the deformity seen.  In other words the patient with a 5
> degree
> > forefoot varus deformity was given the same orthosis prescription as a
> > patient with a 7 degree forefoot valgus deformity, etc.
> >
> > After a while of listening to the authoritative lecture about how orthoses
> > should be properly prescribed using this method, Mr. Gary Morgan, in a
> flash
> > of brilliant light, came up with the idea that ordering foot orthoses for
> > patients can be likened to ordering meat pies.  In other words, no matter
> > what the deformity the patient exhibits, one would still order a meat pie
> for
> > them.  The only difference may be that one meat pie has potatoes, one may
> > have peas or the other meat pie has carrots.  All the patients get meat
> pies,
> > with just subtle differences in the filler.  After he had pondered and
> > refined this new theory of foot orthosis prescription,  Mr. Morgan then
> > announced that a new paradigm of orthosis function had arrived, Morgan's
> Meat
> > Pie Paradigm.
> >
> > I believe that it was Simon Spooner and Tony Achilles who were present
> with
> > me in the lobby at Heythrop Park during BSS 2000 to hear the story of the
> > Meat Pie Paradigm.  I was very impressed with the creativeness of this new
> > paradigm since, like Mr. Morgan, I had also been impressed as a podiatry
> > student how the foot orthosis prescription method taught to me by Dr. John
> > Weed seemed to be always "heel vertical, 4 degree/4 degree rearfoot post"
> in
> > nearly all cases, regardless of what level of deformity of the foot the
> > patient had.
> >
> > Mr. Morgan should be commended for this very unique paradigm which, even
> if
> > it never makes it into a peer-reviewed journal, is still one of the most
> > memorable and enjoyable stories I have ever heard about foot orthosis
> > prescription at a biomechanics seminar.
> >
> > Tony and Simon, will you get Gary Morgan to give the full accounting of
> his
> > new paradigm since, I'm afraid, I may be telling the ethanol tainted
> version
> > of the story.
> >
> > Cheers,
> >
> > Kevin
> >
> > ***************************************************************
> > Kevin A. Kirby, DPM
> > Assistant Professor of Biomechanics
> > California College of Podiatric Medicine
> >
> > Private office:
> > 2626 "N" Street
> > Sacramento, CA  95816   USA
> >
> > Voice:  (916) 456-4768    Fax:  (916) 451-6014
> > ***************************************************************
> >



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