From: Steven J. Kavros, DPM
I am writing to clarify the misrepresentation and inaccuracies of James McGuire, DPM in a recent article in Podiatry Management.
The American Professional Wound Care Association® (APWCA) is a non-profit medical association welcoming medical providers from all disciplines involved in prevention and treatment of difficult wounds. Through a synergy of disciplines, APWCA has been a worldwide leader in clinician advocacy and education for the prevention and treatment of acute and chronic wounds since 2001. This association provides an informational and educational forum for healthcare providers, while promoting...
Editor's note: Dr. Kavros' extended-length letter can be read here.
From: Robert Scott Steinberg, DPM
I have been fitting ski boots and making ski boot orthotics for 33+ years. I am a certified ski instructor. Dr. Huppin listed many of the reasons skiers call me for ski boot orthotics and custom boot fitting. There is a lot he got right, and went into great detail in doing so, but I caution podiatrists about making ski boot orthotics without being able to check the center of knee mass over the orthotic/ski boot.
Further, it is most often the compensated forefoot varus that is the cause of foot pain in ski boots, as well as...
Editor's note: Dr. Steinberg's extended-length letter can be read here.
From: Susan Bartos
I have done considerable research in 3-D printing as it relates to medical applications, and found Dr. Hochstein's article very concise and informative. Its application in custom orthotic fabricating will require the coordinating software to not just replicate the model, but to add the appropriate correction to the device to address the patent's deformity. Software developers will need to adapt their CAD-CAM software to conform to 3-D printers. The two most significant issues in adopting 3-D printing for orthotics in its present technological stage are 1.) having quality software available from established developers such as Sharp Shape, Oretek, and/or Delcam and 2.) reducing the manufacturing time, which is much longer than current machining methods.
Currently, the CAD-CAM software used by many orthotic labs functions by merging prescription information with the negative model to create an electronic, corrected positive model. It is very sophisticated software and requires exacting technical precision, just as the precision required to create a manually-corrected plaster positive. But its patient-specific capacity to balance gait and to integrate and apply patho-mechanical accommodations, goes beyond what can be done manually. Most DPMs who prescribe orthoses have become accustomed to dispensing this type of high-quality device over the last 20 years.
I think that there is little doubt that 3-D printing has enormous potential in fabrication of medical appliances in the very near future. It will give orthotic laboratories an additional process to offer their customers and give doctors more choices as to how they want their orthotics fabricated. Keep in mind that there is no one right way to make a prescription orthotic, just several alternative options in the processes used to create it. The art lies in the skills of the technician, rather than the process.
Susan Bartos, President, Earthwalk Orthotics, Inc.
From: Richard M. Maleski DPM
I agree so much with what Drs. Hultman and Rosenblatt have stated in the article and post in response. However, I would make one suggestion. Just like a good attorney, who never asks a question in a courtroom unless he already knows the answer, I recommend the following. The APMA should work with the colleges of podiatric medicine and have groups of students, or even whole classes take the licensure exams in that particular state. Let's make sure that our education is truly giving our students the ability to pass the exam before we open this up to official scrutiny. I have been involved in residency training for my entire career of 26 years, and I am absolutely certain that our graduates can be competitive in almost all aspects of medicine, but I would like to be absolutely certain that they can compete in ALL aspects of medicine.
Richard M. Maleski, DPM, Pittsburgh, PA