ORTHOTICS

We use Queensland Orthotic Laboratory which produce the best orthotics in Australia and here's why ...

All of our custom orthotics, including the special ulcer off-loading orthotic APOLLO and the Richie Brace®, are fabricated by Queensland Orthotic Laboratory (QOL). They are without equal when it comes to the quality and specificity of design and fabrication of foot orthotics and special appliances. We have been using the services of QOL since 2007 and continue to be delighted with the level of quality in regards to the service and fabrication of our orthotics. They are the premier laboratory in Australia when it comes to plaster cast fabrication which gives them an extraordinary ability for special individual design and fabrication. 

 

These orthotics were fitted in early 2015 and have been worn constantly since then and finally brought in for refurbishment in July 2020. You can see that the top covers are well worn but still intact. The heel posts and infill are still in perfect condition which is a testament to the quality of QOLs orthotics. The top covers and cushioning layers were replaced and for $150 the refurbished orthotics are ready to go again for at least another five years. Why replace the entire orthotic if they are still working well and just need refurbishing? We have done this repair process many times with great results from either orthitics originally done by QOL or other custom orthotics prescribed by other podiatrists. You can see in the picture below the refurbished orthotics. New covers and cushioning and they are like new.

 

 

 

The patient who has these orthotics wanted another pair so that she did not have to change them from shoe to shoe. We give all our patients the plaster moulds that their orthotics are made from and if they require another pair, we simply send the moulds back to QOL. This saves having another cast done ($105) and is $150 less than a new pair dones from scratch. The only time you would need to redo the casts is if there is significant change to the feet by trauma, surgery or disease. You can see the new orthotics compared to the refurbished pair below. It is hard to spot the difference between the refurbished and the new pair the quality of the work by QOL is so high.

 

 

 

 

 

QOL are the only laboratory in Australia licenced to fabricate the Richie Brace®. The Richie Brace® is a combination of a corrective foot orthotic with ankle braces (AFO). The control over the foot with this special brace is nothing short of extraordinary. The brace is handmade from a plaster cast of the foot and ankle. It requires skill to take the cast and a team of expert technicians to produce the final Richie Brace but they are exceptionally effective, especially for Posterior Tibialis Dysfunction and Acquired Adult Flat Foot.

 

 

In 2018 Allan Donnelly won the Wounds Australia Inaugural Innovation Tank award for a special device for healing wounds under the foot very common in people with diabetes. He had made a prototype device that showed promise and convinced the panel of judges that his entry was worth of he award. Following the award was a small proof of concept study to take the idea further. It was clear from the outset that QOL would be the lab to approach who would have the skill and expertise to develop this device. Kent and Chris were able to take Allan’s idea and develop it into a device that is now available to any wound practitioner worldwide.

 

 

 

 

 

 

 

 

                                                           

                                                              Allan discussing APOLLO with Kent and Chris from QOL

All of the orthotics fabricated by QOL come with a guarantee of workmanship and in all the years we have worked with them we have never had a faulty device sent to us.

PLASTER CASTING OR SCANNING?

Which produces the best orthotics?

The introduction of many aspects of digital technology to podiatry has increased significantly over the years from Shock Wave Therapy for Plantar Fasciitis, Microwave and Laser machines for warts and fungal nails to 3D scanning and printing of orthotics. It would be wrong to think that technology has all the answers or is better than older techniques, or in some cases, does anything of benefit at all. This article explores some of the problems we see with new technology and some of the limitations found in podiatry.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The use of Plaster of Paris bandage (POP) to take an impression of the foot in its neutral position (ie. neither pronated or supinated – the midpoint between both) has been in use for many years. It takes a very accurate impression of the foot but does take time to learn how to do well and is a bit messy. However, once the skill is mastered, POP does capture a very accurate impression of the foot which is critical if you are going to fabricate an effective orthotic. Any orthotic that is fabricated can only be as good as the cast or scan taken. Every fault in a cast or scan will be replicated in the finished orthotic. The aim is to take a perfect cast and then have a perfect orthotic. If the finished orthotic needs constant modification when fitted, then perhaps the original cast or scan was not accurate. If the cast is taken with a foam impression box then you will have a very flat profile of the foot and nothing approximating the neutral position. Foam impression casting has a very limited range of uses. We do not use foam impression at Qcity Podiatry as it does not have the accuracy to meet our standards.

 

An important part of the casting process is to evaluate whether the cast you have taken does indeed capture the neutral position of the foot and the angle of the front part of the foot relative to the rear. You have to use both hands to position the foot whilst the plaster sets and there is a knack to doing this. Once the plaster has set then the cast is removed from the foot and then placed next to the foot so that its accuracy can be evaluated. You can check the profile of the arch and the angle of the front of the foot to the heel as well as several other key features such as the shape of the heel.

 

Scanning has a couple of issues that can limit its accuracy. Firstly, you can’t hold the scan next to the foot. You have to look at the foot then turn away to look at the screen. Some practitioners scan with the foot not held in the neutral position because you need two hands to hold the scanning device. Some scans use a flatbed scanner you stand on which will give you a scan with a flat profile of the foot. Queensland Orthotic Laboratory (QOL) have developed a tool that will hold the foot whilst you scan but any other scan that does not allow the foot to be held in the neutral position is unlikely to produce an effective orthotic.

 

As scanning is cheap, clean and easy to use, it is becoming the tool of choice for many podiatrists, chiropractors and others. However, that does not make it a better process, just a cheaper one. The skill required in taking a cast and knowing how to evaluate its accuracy of the foot enables the practitioner to take a better impression. The effort in learning how to hold the foot in neutral and then checking that the cast is a good one is becoming a lost art and there is no evidence that 3D scanning is a better alternative if you don’t learn the basics of casting first. Belief that technology is always accurate and never makes a mistake is a dangerous assumption, especially if you don’t have the skill to know when it is not correct.

 

                         

                             Holding the foot in the neutral position                                           Checking the cast

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                   A small rack of moulds at QOL

 

Here at Qcity Podiatry we still take plaster casts because we are good at casting and can evaluate the accuracy in situ whilst you are with us. Allan has taken many hundreds of casts over his career and taught this subject when he was the Senior Head Teacher of the Podiatry program at the Sydney Institute of Technology, Sydney. If we are not happy with the cast taken, we can simply take another until we are happy with the outcome. There is no point in sending either a cast or scan to the laboratory unless it is a perfect capture of the foot in neutral. As Kent always says: We are not magicians. We can't turn a poor cast or scan into a perfect orthotic.

QOL will store the moulds for a period of twelve months after which they are then destroyed due to high storage fees and the thousands of moulds they have have kept. We always ask for our moulds to be returned so that we can return them to our patients. If another pair of orthotics is required, our patients have their moulds and the cost of the orthotics is reduced and another plaster cast is not required. We have requested another set of orthotics from moulds that were originally used over six years ago. The orthotics produced by QOL were exactly the same as the original pair and the patient was delighted.

 

QOL are the leading orthotic laboratory in Australia when it comes to fabricating orthotics from plaster casts. The effectiveness that we have had with our casts and their hand made orthotics over the years will ensure that we will continue to use this process for the foreseeable future. It is a bit more time consuming to both cast and have orthotics fabricated by hand, but the results are outstanding and second to none.

Stride for Podiatry - April 2019 email.j

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