TECHNOLOGICAL ADVANCES

Are podiatrists keeping pace with the rate of technological advances in our clinical supply chains for foot orthoses?

When I first qualified back in 1987 my title was ‘Chiropodist’ and I was awarded a Diploma in Chiropody alongside State Registration. The word ‘biomechanics’ had just entered our vocabulary and our lecturers at the Salford School were just embracing these new concepts that had emerged from the then named ‘California College of Podiatric Medicine’.  I was fascinated by anatomy and movement and so readily embraced these new ideas and concepts within my first post of clinical practice. The only downside for me was the amount of time spent in the orthotic laboratory manufacturing all the devices that I had prescribed, often staying much later than my work hours… a victim of my own enthusiasm to do well for my patients.

So fast forward to 2022 and that version of me would not recognise podiatric practice as it is today. A vibrant, progressive profession that has evolved as thinking has changed. The very construct that defines a mature evidence-based profession. We now have a wider range of different materials to select for orthosis manufacture and, with the evolution of technology and advent 3D printing, a process that allows quicker bespoke designs for foot orthoses that can be made in multiple sets. The time saved in this process allows clinicians to focus on the clinical factors as opposed to technical. An unintended consequence of this is that it omits the podiatric clinician from the manufacturing process.

So, what has really changed in clinical practice? Whilst the technological aspects have evolved in leaps and bounds, the assessment and diagnosis that frames the concept of ‘podiatric biomechanics’ has remained fairly static. In working with Paul Harradine over the past six years we have been surprised by our findings in this. To elaborate, Paul’s findings show that the clinical gait assessment, and how this is documented and translated into an orthosis prescription, is no different to what I would have done back in 1987.  Surely our knowledge has changed and the concepts that were new in 1987 would have also evolved with the technology over time, as in many other areas of medicine.  Imaging is a great example where there has been a key shift in assessment and diagnosis of musculoskeletal foot and ankle pathology, especially the use of ultrasound imaging at point of care.

During my sessions at the biomechanics summer school I want us to explore this further by unpacking thoughts as to why the pace of change in the clinical aspects has not kept up with the technical aspects. I also want to challenge biomechanics summer school delegates to find solutions to keeping pace with advances in our clinical supply chain.