Orthotic Advertising - Are We Harming Ourselves

Q: Orthotic Advertising - Are We Harming Ourselves?

Let's Discuss...

**Trigger Warning**

I published this original opinion-piece a while ago on Linkedin, that was written off the back of some great conversations I'd had with fellow podiatrists regarding how retail outlets are cherry-picking medical terminology and delving into areas of health that are well outside of their lane. I am aware that this opinion is obviously it is going to rub some people up the wrong way. That's fine, let's chat.

I am very passionate about our profession, I think there are so many fantastic podiatrists from around the world. Like all cohorts, there are always going to be outliers to this and I do feel we as a profession need to hold each other to account.

When it comes to podiatrists and other health professionals using certain images to advertise their orthotic devices, I think it is something we should be steering away from for a number of reasons.

One image (and its various iterations) is the one below.

The problem a lot of the podiatry community has with these (and similar) images, is that the more our understanding of how these devices work, how there is not really any ideal posture or position - as it varies significantly from person-to-person and the more our understanding grows that pronation isn't the primary underlying cause of a lot of musculoskeletal pathologies, it just highlights that these images are outdated and don't actually communicate information that is accurate.

Overall I honestly feel that as a profession we seriously need to up our game with advertising, client & public education, treatment approach and in a few cases, ethical practice. Making treatment decisions and recommendations based on your bottom line is not ethical, but that's a rant for another day.

The pronation ‘bad’, neutral ‘good’ education and advertising is

a) incorrect, b) lazy, c) harming us.

First up, we know what foot orthoses are, they're devices prescribed to alter loads that act upon the neuromusculoskeletal system.

They are NOT alignment devices, imbalance and/or postural correctors, braces etc… 
(remember, I am talking about foot orthoses not AFOs).

A great perspective of where we are in regards to orthoses is made by Sports Podiatrist Ian Griffitns on ep177 of The Physical Performance Show.

https://thephysicalperformanceshow.libsyn.com/the-physical-performance-show-117

So how is this image (and similar ones) harming us?

The use of this image (and often the ‘information’ accompanying it) is incorrect and there’s a growing number of retail businesses that are using this (mis)information to advertise to the general public.

So whilst originally the images were likely a tool used to convey what we knew at the time, almost everything we've learnt over the last 10-15+ years has moved well-past this.
BUT pockets of the profession haven't and retailers are able to simply parrot the d-grade information and make a quick buck.

There's a few retail businesses in particular who many Australian podiatrists are fairly regularly up in arms about their practices. Countless podiatrists have seen people who have spent upwards on $1500 for their ‘custom’ devices, achieve poor results at best and then no help being offered by the outlet when things have gone wrong.

Retail outlets should NOT be issuing devices to people in pain and/or with active pathologies present.
But they do...

Yes, orthoses can be an effective treatment tool for a number of pathologies, and not just isolated to the foot & ankle.
However, the information regarding what they are, what they do, how they work etc... really needs an overhaul. Especially when retail outlets are parroting the (mis)information.

How can we differentiate ourselves from retail outlets if health professionals are using the same (mis)information & images?

Of course if health professionals are using information and images that are no different to these retail outlets it’s going to trigger scepticism in the community. 
Why would I go and see a health professional when I can go to a store that's giving me the same information???
(and the sales team are probably more rehearsed and scripted in their sales pitch)

For podiatrists, I believe the origins were well intended, attempting to explain complexities simply. BUT our knowledge and understanding has moved on, so we need to move on too.

However, given that there are a number of groups that are not health professionals out there who lack the knowledge and skill to prescribed devices safely who are building their businesses on these images and misinformation AND our knowledge and understanding of how orthotic devices work has changed dramatically, I believe we should not be using these images at all.

Footwear companies have pivoted and changed tact, why can’t we?

As I mentioned, I feel in healthcare some cases treatment approaches and client education also need an overhaul, as they too are harming the professional as a whole.

If we want to be the 'go-to' profession for foot orthoses and lower limb musculoskeletal pathologies. Prescribing orthoses for foot pain with minimal history taking, almost no assessment (one lap down the corridor does not count as an assessment), with the clinical justification of ‘you pronate’ is lazy and is just wrong. Oftentimes the prescription is simply incorrect or unwarranted.
The counterargument of ‘I have X years of experience and just know’ or ‘I just knew they needed them’ is invalid, we need to be able to apply sound clinical reasoning as to why we are recommending a treatment intervention, especially to the client. They need to be involved in shared-decision making. 

This approach is what retail businesses mimic.
So if there are health professionals who are utilising the same images & misinformation, have a lazy assessment system and provide little-to-no education or clinical reasoning regarding why the devices are required, I’m sorry but you need a good look in the mirror as you are damaging an entire profession that you are part of.

There are quite a few podiatrists I have spoken with and there is a relative consensus that these images may give a person an unrealistic expectation. These expectations can create a misguided view on what the devices should do or should look like.

Orthoses are not a panacea for all foot ails and they're not going to magically align everyone to this false ideal of perfect/neutral/ideal posture.

One such experience, though not an isolated experience… A lady with Stage IIB Posterior Tibial Tendon Dysfunction was upset that her daughter said her foot wasn’t straight when she stood on them so they obviously weren’t working *insert me crushing my skull with a facepalm*. So just a reminder for those relatively unfamiliar with Stage IIB PTTD – there is a hindfoot valgus present that is becoming rigid, that calcaneus isn’t moving ‘in to neutral’.

Pain had improved, ambulation had improved, quality of life improved… but one comment from her daughter had this lady booking back in weeks down the track blowing up about these devices because her daughter read some bulls*** with this pic included. After a solid 30 minute re-education session on the devices that fire was extinguished.

Overall I personally feel we need to ditch these images because we sure as hell can do better.

I love that there are more and more podiatrists that are calling things like this out. It shows that we care, we want to do good by our profession and (most importantly) by our clients.

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Last night I ran a free training for podiatrists - Exercise Prescription - What to do When Things go Wrong?

The recording is available in our free portal P3 for FREE. This webinar will also count towards your Category 2 CPD (Australian Podiatrists)

If you'd like to access the webinar & receive your free CPD certificate head to https://www.progressivepodiatryproject.com/freecpd to sign up to P3 for FREE or log in.