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

Alex is joined by Prof Peter Malliaras, a Physiotherapist and world renowned tendon researcher from Melbourne to talk about posterior tibial tendinopathy.

A not so often talked about tendon, but a common condition seen in foot and ankle practice, they talk through the specifics of managing difficult cases, considerations for exercise and rehabilitation and managing the person.

About Peter: 
Peter Malliaras is a physiotherapist and researcher from Melbourne, Australia specializing in tendinopathy. In 2006 he completed his PhD in tendinopathy identifying novel risk factors, and since has undertaken post doctoral research in the UK and Australia, and has co-authored over 100 peer review publications.

Currently, he is a Professor at Monash University Physiotherapy Department and involved in multiple funded tendinopathy research projects in Australia and internationally. His research focuses on understanding pain and neuromuscular impairments, and clinical trials testing the efficacy of exercise and other interventions in the management of tendinopathy. Peter maintains a strong clinical focus, specializing in the rehabilitationa and management of difficult tendinopathy cases and regularly consults to elite athletes. He sees about 30-40 tendinopathy patients per week and regularly consults to elite athletes.  

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

Alex is joined by Darcy Dore, a Sports Podiatrist from Queensland to talk about how he utilises technology in clinical practice, specifically Zebris, point of care ultrasound (POCUS), shockwave and Alter-G treadmills.

They talk through the pros and cons of each, how their use has impacted Darcy's clinical practice and who might benefit the most from their use.

About Darcy: 
Darcy is a MSK focused podiatrist that consults out of FootFaults/RunClinic in Brisbane QLD. He has completed a post graduate diploma in Sports Medicine and utilises point of care ultrasound clinically. He is passionate about the benefits of using data to inform clinical reasoning and assist his clients with their goals.

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

Alex is joined by Angelo Vehlo, a Sports and Paediatric Podiatrist from Western Australia to talk about his career, how he developed his career as a sports podiatrist/a niche in managing gymnasts and ballet dancers and what advice he would give to young clinicians with similar goals.

About Angelo: 
Angelo is a Sports and Paediatric Podiatrist whose primary passion involves helping his patients rehabilitate from injuries and return to sport fitter and stronger. 

Throughout his career, Angelo has worked alongside elite gymnasts, ballet dancers, and a range of contact sports to provide treatment for a range of musculoskeletal injuries, joint complaints and post-operative care. He is extremely passionate about keeping athletes active throughout their rehabilitation. He is currently the Consultant Podiatrist for Perth Demons WAFL Club where you’ll often find him on game-day taping the athletes, and works alongside both Rhythmic Gymnastics Academy and WA Youth Ballet

As a born-and-bred Londoner who grew up with a football at his feet (he also passionately supports West Ham United), Angelo has represented and participated in many sporting codes throughout his life including swimming, rugby, and cricket. He loves food and wine and holidaying overseas.

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

Alex is joined by Anja Behling, a Biomechanist and PhD Candidate to discuss her latest paper "Chasing footprints in time - reframing our understanding of human foot function in the context of current evidence and emerging insights". 

Originally designed as a historical review of podiatric biomechanical theories to assist non-Podiatrists attempting to understand how we consider foot function, during the process of writing it developed into a paper highlighting the lack of empirical support for many ways we biomechanically consider the foot and how we treat it. 

In this episode Alex picks Anja's brain on the lack of research for traditional theories, emerging new insights into foot and ankle function and together they work to figure out how we can best understand the foot and ankle with the current research available. 

About Anja: 
Anja is a PhD Candidate in foot and ankle biomechanics working under the supervision of Podiatrist and foot biomechanics researcher Dr Luke Kelly at the University of Queensland and is co-advised by Dr Michael Rainbow at Queen’s University in Kingston, Canada. Originally completing a bachelors degree in biomechanics from Deutsche Sporthochschule Koln in Germany, she went on to complete a Masters of Performance Analysis and work alongside another juggernaut in biomechanics foot(wear) research, Dr Benno Nigg. With 9 current publications, including what I'd consider a seminal paper in foot and ankle podiatric biomechanics, she's someone I feel safe saying is worth watching her work in the future."

Alex is joined by Michael Nitschke, a Sports Podiatrist and Athletics coach to discuss the concept of coaching in clinical practice, for both our athletic and non-athletic population, exercise prescription and how our role moves beyond 'fixing' patients to guiding them back to better health and performance.

About Michael:

Michael graduated with a Bachelor of Podiatry from the University of South Australia (2006) and is a certified Sports Podiatrist (APodA 2017). He has practiced for 15 years in the field of Sports Podiatry with a primary emphasis on reducing running related injury risk via education on training, recovery, strength & conditioning, biomechanics, neuromuscular re-education and footwear selection.

Michael has competed in athletics for over 2 decades, and now continues to work in athletics via coaching middle-long distance runners (Level II advanced MD/LD coach - Athletics Australia) at the Adelaide University Athletics Club and head coach of the Adelaide Milers Crew. He also makes time to train and compete himself both on the track & road running events.

More recently he has begun part-time research where the focus is looking at the training characteristics of elite and recreational runners and the association with performance and sustainability, along with investigating training pace/critical pace and track running performance prediction.

Michael is a co-host of the monthly Shoe Geeks Podcast via the Inside Running Podcast with fellow runners/shoe geeks Julian Spence (The Running Company - Geelong) & Thomas Do Canto (Pinnacle Sports Podiatry).

Alex is joined by Travis to discuss the murky world of injury prevention literature and how we can help our patients avoid future injury.

About Travis:

Dr Travis Pollen, PhD, is a personal trainer, author, and Assistant Professor of Exercise Science. Over his 10-year personal training career, he’s trained professional athletes, senior citizens, and everyone in between. He’s on a mission to bridge the gap between rehabilitation and performance. In addition to his doctorate in Health and Rehabilitation Sciences, Travis has a master’s degree in Biomechanics and Movement Science. He’s previously held two American records in Paralympic swimming. When he’s not engaging in scholarly or athletic pursuits, he can be found listening to indie folk music and eating sushi, preferably at the same time. He currently resides in Philadelphia with his fiancée and their furry friends.

Welcome to my new podcast where I have in-depth conversations with clinicians and academics about all topics relating to the clinical management of pain, injury and rehabilitation of foot, ankle and lower limb conditions.