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Dr. Davis and Cpeds orthotic issues

Posted by Donna SL on 9/06/01 at 13:28 (059236)

Dr. Davis, Cpeds,

I have two seperate issues that I am hoping you could give me an opinion on.

I asked your opinion a little while ago about using semi wt bearing casting instead of a non wt bearing for orthotics when dealing with high arched feet, because my pod was out of town on vacation. I think Dr. Davis prefered a non wt bearing casting method. I just asked my pod why he also preferred this method, and in his opinion he felt that's the best way to get a true representation of the foot. He felt in a semi-wt bearing, or wt bearing position that the true bone structure of the foot becomes distorted, and it is much more difficult to get an accurate picture of the foot, and therefore an accurate correction. Do you agree with this reasoning even for high arches? I don't think he has actually ever used semi wt bearing cast for functional orthotics. I was curious if you have.

I had mentioned in a previous post that I had seen an orthotist several weeks ago. He said all my problems with the orthotics stemmed from not having my foot in a semi wt bearing position, and my pod disagrees with this. He was familiar with the three point system method that the orthotist spoke of, and said that is old fashioned way to correct orthoses, and that they don't really understand the proper way to correct a positive cast. He said with that method you end up with all these phlanges, and stuff to hold the foot instead of having the correction into the shell of the orthoses.

The orthotist didn't ask me to walk on the first meeting. All he kept talking about was the casting method, and didn't seem concerned about my biomechanics. My pod had encouraged a second opinion with this orthotist, because he thought he was more familiar with working with softer materials than he was. My pod said that the most important thing though is someone watching me walk, undertanding my biomechanics, and what needs to be corrected. After hearing that the orthotist thought the casting method would solve all my problems, he didn't think it was worth pursuing anything further with someone who's main concern was the casting method.

I did meet with a Cped last winter that only used a non wt bearing plaster casting method, and was very experienced using softer materials. His lab is right on the premises. He had done a gait analysis, and correctly picked up on all my biomechancial problems as quickly as my podiatirst, and explained an orthosis solution using softer materials for me. I paid him a fee for the consultation. I never returned, because I called him, and had a couple of additional questions before I made my decision, and he couldn't be bothered returning my call which I though was not very nice. Also, he was expensive, charged for all adjusments after the first two, and was far from where I lived. He's really the only the other choice though.

I like my pod very much, but most of his experience with orthotics is in plastic. He has no problems with me having someone who is more experienced with softer materials producing an orthotic. He would also over see the results. My pod produces his own orthotics using plastic, and seems to be struggling with these softer materials due to lack of experience in handling them. Also different lab equipment like finer grinders, etc., are needed to really do a nice job which he doesn't have. He could always send my cast off to one of the big labs, but most of them have a limited amount of soft materials, and it's not the same as someone who is experienced first hand with these.

I do know one other very nice orthotist technician who just recently received a Cped certificate. He has his own lab, and does beautiful work in the actual production of soft orthotics, and is very reasonble. I can't really deal with him for the entire orthoses process, because he has very limited biomechanical knowledge. Also his lab and office isn't in the city any more, so my pod would have to do all the adjustments without the greatest equipment, but hopefully they would be minor. Do you think it would just be easier to go back to the Cped I mentioned above even though he never returned my call, or just have my pod try to attempt to work with the orthotist technician I mentioned above first.

I deeply appreciate any input you could give.

Donna

Re: Dr. Davis and Cpeds orthotic issues

BG CPed on 9/06/01 at 21:53 (059322)

Not to ad confusion but there a re a few things that I dont get. This 3 point thing is over stated. All feet that have a heel and 5 met heads will have 3 points. The alignment of the 3 points 1st, 5th met head and center of heel are a part of the picture but not all of it. How the foot functions while standing and walking is the important part. Feet can be not 'perfect' as far as alignment and be non symptomatic.

Wt bearing casts are usually done direct mold to plastic for easy fabrication. It is also used in foam box because that is the only way they can be utilized. If you have a cavus foot you will probably have a plantarflexed 1st met. So if you dont balance (correct) the device or the cast you will not make a good device.

Materials are important but it is more important to have the correct cast, modification, objective and shoe to get results. I see junk made from soft material as well as rock hard plastic. This is pilot error not material failure.

One aspect of this profession is that you will almost never hear a practitioner say they dont know how to do it. Maybe it is ego maybe they mean well and just dont have the ability or experience to address it. I dont fix every pt I see. I do have a high success rate. When somebody spends lots of time explaining why their plastic is better or 15 minutes telling how their method of casting is superior. It makes me wonder if they are, as my dear deceased father would say 'trying to put turtle wax on a cow pie' It is ok to answer those questions and it is important to explain the objective to the pt.

I dont know an answer for your orthotic problem. It is very frustrating for sure. I hope you find some better results soon.

Re: Dr. Davis and Cpeds orthotic issues

Richard, C.Ped on 9/07/01 at 08:20 (059350)

I don't understand why if this guy does beautiful work, you don't use him. Is the work just physicially beautuful, or biomechanically beautiful?
When you say he does not know much about biomechanichs, does this mean he is an air head, or is just know good at explaining things? I am only ok at explaining things when I can sit down at this computer and have time to think about the questions posted. I am a layman term C.Ped. I try to make it easy for the patient to understand what is causing their pain. If they want big fancy medical words to impress them, well, that is when I call in Mike. He is the technical guy.

My advice is to try to get references from the new guy. Hear what past paients have thought of his services. Call the Better Business Bureau to check up on his past and present companies.

Check to see what his policies are on adjustments and payment plans.
Richard

Re: Dr. Davis and Cpeds orthotic issues

Donna SL on 9/07/01 at 10:57 (059367)

Hi Richard,

I hate to say it because this orthotist/cped is such a nice guy, but yes he is a an airhead when it comes to biomechanics. Yet, he has vast knowledge of all the new materials on the market, and has a great handle on material synergy.

He never did any type of biomechanical assessment of me, or watch me walk either. I tried to explain what my problems were, and he just couldn't understand what I was talking about, even when explained in basic terms. He took a plaster cast, but I knew he didn't do it right. I requested in the nicest way if he could use my pods cast that I had with me. He offered to make a pair off his cast anyway, and one from my pods, for no additional cost so I could compare. He only charged me his lab cost of $150.00 , so I thought I don't have much to lose.

The one off my pods cast was ok, but the one off the orthotist cast was a total disaster biomechanically. It was so off from the shape of my foot, and the correction was so bad, my pod couldn't even attempt to adjust it. This guy is just bascially a good lab technician. When I told him my pod needs to physically adjust the cast now, he offered to make even another pair at no charge when the cast is finished, which I really appreciate. Also, he doesn't have a place in the city anymore, so he would have no way to service me. He's bascially doing independent contract brace work, and some orthotics for a major hospital here now, and comes into the city frequently because of this.

The other orthotist I talked to that uses the 3 point system who didn't watch me walk either offered no guarantees what so ever. I said what if they didn't come out right for some reason, and they have to be remade, and he said he would have to charge me full price again. Each pair is $350.00. He works out of a major university hospital, and doesn't do the work himself. He uses the orthotist technician I mentioned above to do his orthotics anyway.

I don't know what the other Cped's policy is that I met last winter. He's the one that I thought was very good. I forgot to ask his policy when I met him in person, and that's why I called him back after out meeting, and he never returned my call. The only thing I remember is that he charges $60.00 for each additional adjustment after the first two, on top of a $400.00 initial orthotic charge. As far as other questions I'd have to go up there in person to ask him that. I will be charged $60.00 again for this. I have an appointment in two weeks, but I'm thinking of cancelling. I really don't want to go to someone that treats me like that, but there are not many choices here. He's the owner. The orthotist technician knows him, and said he's a creep. There is one other Cped on staff, but I've never met him.

My pod fees are extremely high, but at least my insurance covers a large portion of it.

I don't know what it's like in the other cities, but there are not any Cpeds here that operate the way you do. I either stick with my pod, and let the orthotist do the lab work, or go back to the creepy guy that didn't return my call.

BTW thanks for the Better Busines Bureau info.

Donna

Re: don't know why this posted in two areas

Donna SL on 9/07/01 at 11:09 (059371)

This posted in two places. Wonder if I did anything wrong? I did the post to Richard within the reply secion under the thread. Oh well. just ignore the duplicate.

Donna

Re: Dr. Davis and Cpeds orthotic issues

Donna SL on 9/07/01 at 11:36 (059379)

Hi BG,

Thanks for the advice. It seems your thinking is similar to my podiatrist. I have had several orthotics done in the past that were produced with no other biomechanical considerations other then the casting, and they were a disaster. I should know better.

I guess I don't really understand too much about weight bearing casting. He just made it seem like this was the answer to all my problems. I assume direct mold to plastic, or a foam box filled with plaster means there's not much additional correction, if any, and what you see is what you get. I do have a cavus foot with a plantar flexed first ray. The orthotist never looked at my feet, let alone watch me walk, so I guess he would have never taken that into consideration. He was going to use a foam box for the casting. I guess I have to scratch him off my list.

Donna

Re: Dr. Davis and Cpeds orthotic issues

Ed Davis, DPM on 9/09/01 at 23:10 (059682)

You need to be evaluated from a biomechanical standpoint. Perhaps the ideal situation for you may be having a podiatrist and pedorthist work together--your podiatrist doing the biomechanical exam and negative casts and your pedorthist taking it from there.
Ed

Re: Dr. Davis and Cpeds orthotic issues

BG CPed on 9/06/01 at 21:53 (059322)

Not to ad confusion but there a re a few things that I dont get. This 3 point thing is over stated. All feet that have a heel and 5 met heads will have 3 points. The alignment of the 3 points 1st, 5th met head and center of heel are a part of the picture but not all of it. How the foot functions while standing and walking is the important part. Feet can be not 'perfect' as far as alignment and be non symptomatic.

Wt bearing casts are usually done direct mold to plastic for easy fabrication. It is also used in foam box because that is the only way they can be utilized. If you have a cavus foot you will probably have a plantarflexed 1st met. So if you dont balance (correct) the device or the cast you will not make a good device.

Materials are important but it is more important to have the correct cast, modification, objective and shoe to get results. I see junk made from soft material as well as rock hard plastic. This is pilot error not material failure.

One aspect of this profession is that you will almost never hear a practitioner say they dont know how to do it. Maybe it is ego maybe they mean well and just dont have the ability or experience to address it. I dont fix every pt I see. I do have a high success rate. When somebody spends lots of time explaining why their plastic is better or 15 minutes telling how their method of casting is superior. It makes me wonder if they are, as my dear deceased father would say 'trying to put turtle wax on a cow pie' It is ok to answer those questions and it is important to explain the objective to the pt.

I dont know an answer for your orthotic problem. It is very frustrating for sure. I hope you find some better results soon.

Re: Dr. Davis and Cpeds orthotic issues

Richard, C.Ped on 9/07/01 at 08:20 (059350)

I don't understand why if this guy does beautiful work, you don't use him. Is the work just physicially beautuful, or biomechanically beautiful?
When you say he does not know much about biomechanichs, does this mean he is an air head, or is just know good at explaining things? I am only ok at explaining things when I can sit down at this computer and have time to think about the questions posted. I am a layman term C.Ped. I try to make it easy for the patient to understand what is causing their pain. If they want big fancy medical words to impress them, well, that is when I call in Mike. He is the technical guy.

My advice is to try to get references from the new guy. Hear what past paients have thought of his services. Call the Better Business Bureau to check up on his past and present companies.

Check to see what his policies are on adjustments and payment plans.
Richard

Re: Dr. Davis and Cpeds orthotic issues

Donna SL on 9/07/01 at 10:57 (059367)

Hi Richard,

I hate to say it because this orthotist/cped is such a nice guy, but yes he is a an airhead when it comes to biomechanics. Yet, he has vast knowledge of all the new materials on the market, and has a great handle on material synergy.

He never did any type of biomechanical assessment of me, or watch me walk either. I tried to explain what my problems were, and he just couldn't understand what I was talking about, even when explained in basic terms. He took a plaster cast, but I knew he didn't do it right. I requested in the nicest way if he could use my pods cast that I had with me. He offered to make a pair off his cast anyway, and one from my pods, for no additional cost so I could compare. He only charged me his lab cost of $150.00 , so I thought I don't have much to lose.

The one off my pods cast was ok, but the one off the orthotist cast was a total disaster biomechanically. It was so off from the shape of my foot, and the correction was so bad, my pod couldn't even attempt to adjust it. This guy is just bascially a good lab technician. When I told him my pod needs to physically adjust the cast now, he offered to make even another pair at no charge when the cast is finished, which I really appreciate. Also, he doesn't have a place in the city anymore, so he would have no way to service me. He's bascially doing independent contract brace work, and some orthotics for a major hospital here now, and comes into the city frequently because of this.

The other orthotist I talked to that uses the 3 point system who didn't watch me walk either offered no guarantees what so ever. I said what if they didn't come out right for some reason, and they have to be remade, and he said he would have to charge me full price again. Each pair is $350.00. He works out of a major university hospital, and doesn't do the work himself. He uses the orthotist technician I mentioned above to do his orthotics anyway.

I don't know what the other Cped's policy is that I met last winter. He's the one that I thought was very good. I forgot to ask his policy when I met him in person, and that's why I called him back after out meeting, and he never returned my call. The only thing I remember is that he charges $60.00 for each additional adjustment after the first two, on top of a $400.00 initial orthotic charge. As far as other questions I'd have to go up there in person to ask him that. I will be charged $60.00 again for this. I have an appointment in two weeks, but I'm thinking of cancelling. I really don't want to go to someone that treats me like that, but there are not many choices here. He's the owner. The orthotist technician knows him, and said he's a creep. There is one other Cped on staff, but I've never met him.

My pod fees are extremely high, but at least my insurance covers a large portion of it.

I don't know what it's like in the other cities, but there are not any Cpeds here that operate the way you do. I either stick with my pod, and let the orthotist do the lab work, or go back to the creepy guy that didn't return my call.

BTW thanks for the Better Busines Bureau info.

Donna

Re: don't know why this posted in two areas

Donna SL on 9/07/01 at 11:09 (059371)

This posted in two places. Wonder if I did anything wrong? I did the post to Richard within the reply secion under the thread. Oh well. just ignore the duplicate.

Donna

Re: Dr. Davis and Cpeds orthotic issues

Donna SL on 9/07/01 at 11:36 (059379)

Hi BG,

Thanks for the advice. It seems your thinking is similar to my podiatrist. I have had several orthotics done in the past that were produced with no other biomechanical considerations other then the casting, and they were a disaster. I should know better.

I guess I don't really understand too much about weight bearing casting. He just made it seem like this was the answer to all my problems. I assume direct mold to plastic, or a foam box filled with plaster means there's not much additional correction, if any, and what you see is what you get. I do have a cavus foot with a plantar flexed first ray. The orthotist never looked at my feet, let alone watch me walk, so I guess he would have never taken that into consideration. He was going to use a foam box for the casting. I guess I have to scratch him off my list.

Donna

Re: Dr. Davis and Cpeds orthotic issues

Ed Davis, DPM on 9/09/01 at 23:10 (059682)

You need to be evaluated from a biomechanical standpoint. Perhaps the ideal situation for you may be having a podiatrist and pedorthist work together--your podiatrist doing the biomechanical exam and negative casts and your pedorthist taking it from there.
Ed