The Pedorthist: a health care and footwear professional
Custom-made medical grade footwear is a key competency of Pedorthics. Due to its complexity it is often misunderstood and undervalued. It encompasses not only medical requirements but also the appearance and cultural aspect is an important, if not the key issue, for the patient.
By Karl-Heinz Schott, Adam Smith, Adam Jorgensen
Footwear is part of the essentials in life in many cultures. It protects the foot from the environment, is a fashion statement, a status symbol and can be a cultural expression or of religious use. Those factors make footwear at times a very emotional item. Little is understood about the medical application of footwear/pedorthics as an orthotic/therapeutic device and therefore an assistive technology. The best comparison could be made with orthotic devices of the foot but also the foot and ankle.
Foot orthotic-services as well as foot and ankle orthotic-services are offered by a number of health care professionals. It may be argued that the most complex level of non-surgical lower limb health care orthotic services are fully custom-made medical grade footwear (CMGF), also known as custom made orthopaedic or pedorthic footwear with integrated custom orthoses supporting the foot and ankle. Custom made footwear as assistive technology is far more complex in its provisions than generally assumed. An overlooked complexity is that the patient cannot see and comment on the appearance of the footwear prior to it being fitted. Acceptance by the patient may vary as emotions about the footwear can have a strong influence.
The appearance and cultural aspect is an important, if not the key issue, for the patient, while for the health care practitioner there is a range of factors to consider achieving a desired outcome. Typically, CMGF is only provided after the other options have already been explored and therefore is generally for the most challenging foot shapes and medical and biomechanical issues.
Custom-made medical grade footwear: an orthotic in its own right
Yet CMGF may at times be the best or only solution to a foot as well as foot and ankle problem. Modern technologies make it possible to create footwear that is more pleasing and therefore has a higher social acceptance. Scanning technology and the use of a lab service can make the provision of high-quality custom-made footwear services accessible including in areas away from the metropolitan sprawl. However, the practitioner’s clinical involvement is critical and ultimately influences the outcome of the service.
CMGF is an orthosis in its own right. It may have multiple orthotic features built within that are camouflaged for increased acceptance. Those may include the obvious foot orthoses, but also ankle supporting orthotic elements. Those ankle supporting elements maybe of a flexible or rigid nature or have a jointed function depending upon the need of the individual. In pedorthics a heel height is not a random or only cosmetic feature, but a tool to help position the foot and, in particular, the ankle joint. The available ankle joint range of motion influences the heel height posting.
To give the patient, or user of our services, the best outcome the Pedorthist needs a sound understanding of the medical, health, orthotic and footwear issues. Education and research are the keys to developing a secure service provision for those needing the service. A 3D scanner is not a substitute for a good clinically trained Pedorthist but a tool for a better outcome, if used wisely.
Custom footwear is part of the WHO-list
CMGF is the key competency of Pedorthics. Due to its complexity it is often misunderstood and undervalued. Therapeutic diabetic, neuropathic, orthopaedic footwear is part of the recently published WHO list of 50 essential assistive technologies. It features strongly in the Pedorthic Bachelor Program at Southern Cross University (SCU) and research at SCU. Pedorthics is the only health care profession with key competency in footwear, health care and orthoses. The SCU bachelor program prepares students for a challenging career in Pedorthics. It is currently run over 3 years and is also available as a 4-year double degree with Podiatry. There is an option to develop one’s skill and knowledge further, do research and obtain a PhD in Pedorthics.
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