In this episode of the Foot and Ankle podcast, host Alex Murray talks with Professor Gabriel Moisan to explore the complexities of custom foot orthotics and the underlying research.

They discuss the mechanisms of how orthotics work, the variability in patient responses, and the importance of individualized treatment plans. Gabriel shares insights from his clinical practice, emphasizing the need for a bottom-up approach in research, figuring out the how and why foot orthoses work, before if they work clinically for specific conditions and patient and the potential for predicting patient responses to orthotics.

They also delve into the complexities of foot orthotic design and management, particularly:

• Individualised orthoses prescription based on the condition, patient population and task to inform the design,
• The importance and impact of casting techniques,
• The balance between prefabricated and custom solutions,
• The evolving role of technology such as 3D printing.
• The lack of research to guide the complete orthotic prescription and therefore
• The need to customise the device after prescription to find the optimum prescription for each patient

You can find Gabriel Moisan and his work here:
https://www.researchgate.net/profile/Gabriel-Moisan
https://www.linkedin.com/in/gabriel-moisan-a382aaa7/

Chapters

00:00 Introduction to the episode

03:14 Gabriel Moisan's Journey in Podiatry

05:15 Understanding the Mechanisms of Foot Orthotics

10:05 Variability in Patient Responses to Orthotics

17:55 The Need for Individualized Orthotic Solutions

23:40 Predicting Patient Responses to Foot Orthotics

29:56 Clinical Approaches to Orthotic Prescription

36:15 Patient-Centered Care in Orthotic Treatment

42:26 Understanding Neurodivergence in Patient Management

46:52 The Importance of Task-Specific Orthotic Design

51:14 Casting Techniques and Their Impact on Orthotic Effectiveness

55:35 The Future of 3D Printing in Orthotic Design

59:32 Navigating Clinical Experimentation and Patient Communication

01:03:16 Ethics in Custom Orthotic Prescriptions

01:07:47 The Role of Prefabricated Orthotics in Treatment

01:13:38 Long-Term Use of Foot Orthotics: When Is It Necessary?

01:18:21 Embracing Uncertainty in Clinical Practice

01:23:04 The Need for Continued Research in Foot Orthotics

Alex is joined by Dr Doug Richie, Podiatrist and Surgeon from Los Angeles and the inventor of the Richie Brace, an ankle foot orthoses.

They talk about everything collapsing flatfoot including:
- The latest clinical name Progressive Collapsing Flatfoot Deformity (replacing adult acquired flatfoot deformity and posterior tibial tendon dysfunction) and what this means for our understanding of the condition.
- The difference between the collapsing flatfoot and posterior tibial tendon pathology
- Diagnosis, clinical tests and communicating the condition to patients
- Treatment, including why we need to aggressively manage people as early as possible
- Discuss Doug's clinical experience as both a physician and surgeon

A perfect accompaniment to our previous episode with Dr Peter Malliaras discussing Posterior Tibial Tendinopathy.

About Douh:
Dr. Richie is a Clinical Associate Professor at the California School of Podiatric Medicine. He has authored many original articles published in peer-reviewed medical journals as well as several chapters in respected textbooks of foot and ankle surgery. Dr. Richie recently published his own textbook titled Pathomechanics of Common Foot Disorders which is available at https://link.springer.com/book/10.1007/978-3-030-54201-6. Dr. Richie is a Fellow and Past President of the American Academy of Podiatric Sports Medicine and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Richie designed and launched the Richie Brace(R) line of custom ankle-foot orthoses in 1996 which are now distributed in seven countries around the world.

You can follow Alex and the podcast on facebook and instagram
@therehabpodiatrist

Alex is joined by Dr Andy Bridgen PhD, Podiatrist and Senior Lecturer at the University of Huddersfield in the UK.

They talk about Andy's PhD thesis, exploring how Podiatrists in the UK utilise evidence in musculoskeletal practice, namely managing people with foot orthoses. The spoiler being, there isn't a consensus on how to use evidence in practice, nor, a significant body of evidence to draw upon.

They discuss the results in detail, what this means for the profession of Podiatry and the future of clinical practice.

About Andy:
Dr Andy Bridgen is a Senior Lecturer in the Division of Podaitry and Clinical Sciences and joined the University of Huddersfield in 2004. After qualiying as a podiatrist in 1995 he worked in the NHS working in MSK podiatry. He completed an MSc in Sports and Exercise Injury Management in 2006. In August 2017 he completed his PhD entitled 'A hermeneutic enquiry into how MSK podiatrists interpret and use evidence in practice'.

You can follow Alex and the podcast on facebook and instagram
@therehabpodiatrist