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The Athlete's Foot....

Discussion in 'Australia' started by surfboy, Mar 2, 2014.

  1. surfboy

    surfboy Active Member


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    Hi everyone,

    The other week I had a patient come in with an Achilles tendinopathy. So after assessment including ultrasound imaging I advised the patient to acquire a pair of suitable, supportive footwear from Athlete's Foot.

    At this point, I advised the patient to try wearing the footwear for a month or two and if no improvement, to come back and see me for orthotic therapy. Main reason I did this was to take a stepped approach, so that the guy wasn't spending unnecessary money.

    The patient rang me up, and advised that he went to the Athlete's Foot and that the storeman had diagnosed him as needing "Orthotics" after walking over the pressure plates, which he then proceeded to sell the patient in store. This was additional to the $260 shoes which the storeman had just fitted. These turned out to be Orthoheel supports which cost some $80.

    It is not the job of these storemen to diagnose and treat medical conditions. Very irritating when I refer the patient for footwear, and the store man looking for another sale decides to dispense Orthoheel supports at the same time.

    Anyone else having these problems ?
     
  2. BEN-HUR

    BEN-HUR Well-Known Member

    Hi Surfboy.

    Yes, I have had a similar problem, hence why I don't refer patients to the Athlete's Foot unless I advise they purchase from the Ascent footwear range (i.e. school shoes for children). I too would be very annoyed under the circumstances & would phone (Athlete's Foot store) & express my views. Then again, why did the patient fall for the sales pitch when you seemed to have articulated to him/her your reasoning of putting off orthotic therapy awaiting for their body's response? [which is admirable professional judgement/conduct - of which the patient should have been respectful/grateful of] You may find part of the issue here lays with the patient.

    We Podiatrists are often given a bad rap in relation to an erroneous generalisation that we dispense (over prescribe) orthotics to every Tom, Dick & Harry that hobbles into our clinics (believe me, the viewpoint is out there - in the public & amongst health professionals :mad:). Yes, the viewpoint is out there for a reason - unscrupulous Podiatrist in the past/present pushing devices onto patients :mad: (I have heard such from new patients). I am quite mindful of this & if I feel an issue i.e. a niggle (acute minor injury) was not the direct result of adverse biomechanical traits i.e. training error, trauma from a lone incident (fall, compromised running terrain etc...), compromised muscle/tendon integrity (i.e. tight muscles, muscle imbalance, scar tissue) then I too would like to see how the niggle/injury will respond via my professional judgement (treatment regime i.e. exercises, massage, strapping, more appropriate footwear etc..) aside from orthotic therapy. Just recently I had a patient with your stated case of Achilles Tendinopathy - advised massage (frequent & somewhat aggressive) of Achilles & Triceps Surae, eccentric loading exercises (i.e. lowering heel off step, walking backwards, running backwards) & added temporary heel lifts to footwear - these were the areas/factors which were more symptom (causation) focussed than the minor potential foot issues I was picking up via running on & off the treadmill... which may warrant orthotics in future (depending on subsequent circumstances i.e. compliance to treatment, training load).

    The other thing we need to consider is that many patients want a quick fix (whilst at the same time seemingly not wanting to put much effort themselves to help themselves get fixed :craig:) - basically they want to be treated with some kind of magic healing wand (which I don't have) or a quick fix pill (which orthotics can be seen as)... & for the injury/pain to just disappear to thus continue running/playing sport as if nothing had happened. Whilst that would be nice (I am a keen runner [& surfer]) it just is not practical/reasonable - tissues/bone pretty much will heal in their own sweet time (once trauma has occurred)... our job is to find the cause, remove or reduce its affect on the offending area, re-strengthen/condition & help the healing process - maybe speed it up a bit. In fact it has been this aspect (speeding up the healing process i.e. ridding of scar tissue etc.) which has been on my mind quite a bit of late (hopefully will post a thread here in the near future... when I get some time). Anyway, this post is longer than intended (got carried away) - needed to get similar/associated related issues off my chest as well :rolleyes:.
     
  3. Paul Bowles

    Paul Bowles Well-Known Member

    The more interesting questions is: Did the patient get better though? And if they did was the salesperson still wrong?
     
  4. podcare

    podcare Active Member

    Interesting question. I can understand your frustration Surfboy.

    I remember seeing a patient for routine foot care many years ago and tried to use the "stepped approach" when I found out she was suffering with plantar heel pain, once again trying to save the patient money. Anyway, to cut a long story short... on a visit to her GP, he suggested she try another podiatrist who prescribed orthotics without hesitation and eventually her pain settled down.

    Among other things, I learned many lessons from this experience and remember well what someone else later said to me... "If you don't take care of your patients, someone else will."

    Bottom line is, we are in a business with many competitors including physiotherapists, chiropractors, orthotists, shoe stores, local podiatrists, etc. These days, I offer all the best treatment options with specific patient expectations, regardless of price, and let the patient decide if they want the treatment or not.

    My job is to offer the best advice and treatment. The patient's job is to decide if they want it.
     
  5. Jo BB

    Jo BB Active Member

    "My job is to offer the best advice and treatment. The patient's job is to decide if they want it"
    Thank you Gavin, I think this is a great reminder to us all. Not to assume,not to judge...
    Cheers,
    Jo BB
     
  6. phil

    phil Active Member

    Yes, Paul. That was my first thought! Did it work!

    Truth be told, if you're trying to save the patient money, then they probably did the right thing. How much would your orthotics cost?

    My advice- get to know the owners and staff at your local athletes foot. I have, and I get frequent referrals, and shoes for me at cost price. :)
     
  7. Tin

    Tin Active Member

    I tend to agree with Surfboy but appreciate the consensus of don't judge.

    Have we considered the case of the orthoses NOT working? perhaps they needed specific postings, materials, and degree of correction? Have we also considered the level or knowledge a sales person at AF is equipped with vs podiatrists?

    On a final note - a friend who is heavily supinated and I walked in and we were both diagnosed as being flatfooted after standing on their static weight bearing gimmick. Hmm.

    At the end of the day, we just need to do what we do best, and care about those we do it for.
     
  8. Tan86

    Tan86 Member

    I have had a client come back to me with a metdome on an "orthotic" from the Athletes foot! We used to get regular referrals from the store but not anymore.
    Fitzy(?) dynamic weight bearing gimmick.....people believe it right? Sells shoes right?
     
  9. surfboy

    surfboy Active Member

    Thanks all. - Yes, it is the level of skill or knowledge of the sales staff that concerns me. - They are not medically trained to manage clinical conditions of the feet. Have also had a patient come back in the past with a met dome from the shop!!!

    I notice the NSW Podiatry Association a number of years ago stopped recommending the athete's foot for similar reasons I have raised, and instead recommended Rebel ? Is this right??
     
  10. Paul Bowles

    Paul Bowles Well-Known Member

    I'm sure it was for the reasons you have similarly raised and it had nothing to do with the sponsorship deals which were being done......:rolleyes:
     
  11. Micco

    Micco Member

    We were having similar problems with our local TAF. As per podcare all we can do is provide the best and most ethical advice and it's up to our patients to act on it.
     
  12. Paul Bowles

    Paul Bowles Well-Known Member

    As if its only one shoe store/chain doing this. Come on and be realistic - it happens at all shoe stores, physiotherapists, chiropractors, GPs and god forbid other Podiatrists. Its about relationships and education. We all should know shoes alone don't treat diseases - intervention and education does. So I still wait for the question to be answered - did the patient get better with the sales persons advice? Inquiring minds want to know!
     
  13. BEN-HUR

    BEN-HUR Well-Known Member

    Recently my local Athlete's Foot store invited the local Podiatrists for an information breakfast for their new FITZI system (about 2 - 3 weeks ago). The three staff members stated on numerous occasions that they do not diagnose symptoms or do so via this FITZI system (as if the issue had been raised before). Yet, that morning as I was drifting around the store I was aware of at least two occasions where a diagnosis was implied from the scans of the FITZI system alone (with vague reasoning). I also noted at the rear of the store a variety of off-shelf "orthotic" products (i.e. from Orthaheel; not sure if there were Vasyli orthotic products there also).

    Thus, I'm left somewhat curious as to how a customer can leave an Athlete's Foot store with an off-shelf corrective (i.e. "corrects alignment") insole (advertised "Orthotic")... & particularly with a met. dome attached (as stated in previous posts) when there appears to be a policy of no diagnosis to be made. Albeit, I have no one come to me with a met. dome on top of one of the Athlete's Foot (TAF) store insoles. It is also interesting that I can't find any material relating to their (TAF) insole/"orthotic" range on their website... even when you go to the "Medical" section, there is no mention of them (but they certainly do exist within the store... targeting conditions such as "Plantar Fasciitis", "knee pain" etc...).

    Also, 100% of clients who came to me with an insole from the Athlete's Foot (TAF) had no resolution from their pain (then again, that's why they were at my clinic). The product these patients had was not suitable at all - hence TAF should not be prescribing such devices for injuries when it would seem they know little about orthotic therapy & the pain they're attempting to address. Now I'm sure there are people out there who have had resolution from an Orthaheel type product... but that's not the main issue behind the start of this thread.

    Also, as far as I know, there are many Athlete's Foot stores which are franchisee operated... hence some stores may have different operating practices than others (i.e. pushing such off-shelf devices to generate a bit more income). I know the local A.F store to me has recently changed hands... & this new person seems quite sincere in aiding the Podiatrist's recommendations/treatment regime with correct fitting footwear... time will tell. In the past I've advised the patient on the characteristics to look for in a shoe, then direct them to Rebel... or preferably to a running shoe store (providing the patient is willing to travel outside the local area).
     
  14. Griff

    Griff Moderator

    Playing devils advocate here... but do people need to be "medically trained" to give out orthoses? We are talking about met domes here, not Temazepam.

    For all of our formal training, certificates in frames in our offices and regular digestion of the published literature on foot orthoses and their mechanical effects... the uncomfortable reality for all of us is that the work experience boy at a running store could pop a prefabricated device in someones shoes and "make them better" simply by having manipulated the kinetics at the foot-orthosis interface. Not saying its right or wrong. But it is what it is.

    The way the patient/runner views this interaction with the store will be very different to the way we as Podiatrists view it.
     
  15. DMax

    DMax Member

    Maybe that salesman is a POD student...LOL :p
     
  16. BEN-HUR

    BEN-HUR Well-Known Member

    Hi Ian - relevant question asked. I feel that people don't need to be "medically trained to give out orthoses"... but it does help (i.e. is more appropriate). After all, it's not rocket science, but some aspects of injury assessment & orthotic therapy are more involved/complicated than others - particularly to the lay public. That being a member of the lay public (with limited understanding) issuing a device to another member of the lay public (with limited understanding) with pain & wanting the pain gone (pain being a strong motivator to quick action) - but neither party realising the potential for complications, miss-treatment & thus money wasted on inappropriate/ineffective actions. It just limits the chance of risk (i.e. health, financial) if appropriate orthotic therapy is carried out by a Podiatrist than an employee in a shoe store. Sure the inserting of an Orthaheel type device could well help resolve someone's Plantar Fasciitis but we both know that such treatment isn't going to be as easy/convenient for the array of other individuals (i.e. some may require a forefoot valgus post to effectively treat their P/fasciitis). The other issue I have picked up on is that an individual's past case of non-resolution with orthotic therapy has subsequently left them disillusioned & thus skeptical of orthotic therapy in general - this has actually been the case with a past Athlete's Foot insole recipient. Besides, the underlying issue here was the intervention of an Athlete's Foot (A.F) staff interfering with the Podiatrist's treatment regime (i.e. holding off from orthotic therapy & seeing how exercises would help). Like I said previously, effective communication (& understanding) between Podiatrist & patient & subsequent A.F staff may have been lacking at some point along the chain for such a result to occur.

    Analogy: I have actually done some minor dental work on my teeth... actually using my clinic nail drill :eek: (I can assure you I cleaned it thoroughly before & afterwards). When I was a young swimmer we use to do lap sprints: swim 50m fast, jump out of pool & run to the other end for the next rep. Towards the end of the workout (with arms naturally getting tired) I slipped whilst pushing myself out of the pool - landed on the edge of the pool on my two front teeth - chipping them :mad:. Years went by, self conscious of my two jaggered front teeth but not having the money to obtain a cosmetically good result (naturally from a Dentist). One day I thought of filing the jaggered edge away - which then lead to the clinic drill (fast oscillating burr - a new small burr) coming to mind :rolleyes:. Carefully I drilled away the jaggered edge & got a nice straight even contour across my two front teeth - it worked perfectly - the result looked great (& still does years later)... yet I was (& still am) oblivious of the potential complications that could have resulted (i.e. nerve damage? enamel damage?) - I'm not a Dentist, haven't been trained in such specifics. I did a similar job on my lower front teeth & all looks & feels good. I have (jokingly) offered my services to friends at far less cost than Dentist treatments... no one has taken me up on my offer (as yet) - despite my great result, my steady hand & (perfectionist) attention to detail... & frankly I don't blame them as there is a higher element of risk with my service than the service of someone trained in the field (a Dentist).

    I can extend my 'Dental' services to P.A members for a limited time... even the ones I have had... hmmm... lively dialogue with over the years ;).
     
  17. podcare

    podcare Active Member

    Far out!

    Thanks, but I'm happy with my dentist!
     
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