The measurements
Medisteps is a subsidiary of CRRP (Centre for Research & Physiotherapy Practice), a first degree health providing unit (Medical Rehabilitation Centre) with a purpose to offer complete medical rehabilitation by a team of skilled professionals. Medisteps’ purpose is the complete therapeutic intervention using custom made orthotics (soles and footwear) for a series of medical conditions that orthotics are indicated.
A successful therapy with custom made orthotics MUST include four stages:
1) Data and readings collection
2) Diagnosis
3) Design of the orthotic
4) Manufacturing of the orthotic
All these stages are fundamental, and none of them can be overlooked nor omitted by each steps’ specialist.
1) Data and readings collection
Data and readings collection is a delicate and technically challenging procedure that must be ONLY undertaken by a graduate doctor or physiotherapist.
Data collection depending on the condition of the patient for the purpose of using orthotics is medical procedure recognized by ΕΟΠΠΥ and known us “Gait Kinetic Analysis” and “Gait Kinematic Analysis”. ΕΟΠΠΥ gives the right to carry out the procedure and charge for it (ΦΕΚ 98/31-1-2002) only to specialized centers (such as rehabilitation centers, hospitals) and not to shoes retailers, sportswear retailers, pharmacies or other places.
Data and readings collection include collecting
–Static readings (collecting readings with patient in standing posture)
–Dynamic readings (readings are collected using a baropodometric treadmill; (normal or accelerating gait, racewalking or running at various speeds and slope angles for simulation of different sports)
-Morphological analysis (recording of the shape of the feet in 2D or 3D using specialized equipment)
-Biomechanical analysis (ancles, torque, force vectors calculated using photo and video analysis software; very important stage for conditions like knee osteoarthritis, bone fractires and post surgery malformations)
-Clinical assessment (joint health, range of motion inhibition, malformations of the spine and anything that the health professional caring out the assessment considers important to include)
The above clinical and laboratorial data then needs to be analyzed from our biomechanics team. Results are then summed up to a signed pronouncement of the patients examination, just like any medical examination. The pronouncement includes the presentation of all the data acquired in graphs and tables, interpretation of the recorded gait model, technical data of the methodology used, and a summary/conclusion of the results. The biomechanics team performing the tests is at the disposal of doctor for any further elucidation needed.
2) Diagnosis
Usage of orthotics is a non-invasive treatment for a medical condition the patient is facing. Therefore, diagnosis of the condition is required by a specialized physician is required, as well as guidelines for the orthotic’s design.
Anyone that relies of his/her insurance provider to cover the cost of the examination and the creation of orthotics needs to provide:
-Medical diagnosis and referral for examination/measurements
-Payment receipt by the centre caring out the examination/measurements
-Medical referral for creation of the orthotic
-Payment receipt for the requested orthotic, based on the physician’s prescription
Your physician has a key role in this stage
3) Orthotic design
The main stage to create a fully custom made orthotic requires the following:
-The sum of the computer data that have been accumulated so far (the data that get to be printed are a fraction of the total and not enough)
-The data from the additional clinical tests depending on the condition of the patient
-Analysis of the condition, and setting a goal for the treatment. This requires both the medical pronouncement and the personal opinion of the specialist designing the orthotic, which is based on his scientific and technical knowledge.
The above data are inserted onto a special 3D CAD (computer-aided design) program, so that a practical simulation of the loading and pressure to the foot can be created. The professional can adjust every parameter he considers important and fine tune the crafting with millimeter precision.
As you can understand, the person behind this stage is responsible not only for the orthotic’s design but for the outcome of the whole treatment! It is critical for the patient to be informed who is actually behind the creating of the orthotic!
Who would you choose for your treatment?
Your physician and a specialized centre; or a shoe retailer, a shoemaker or some assistant in a pharmacy?
In Medisteps we refuse to compromise in any of those stages, and especially in the design of the orthotic. Both the insole orthotics that are manufactured by Medisteps and the products offered by our partners, are under the scientific responsibility of Dr. George Georgoudis, professor of physical therapy in TEI Athens, specialized in rehabilitation of musculoskeletal pathology. With a post-graduate degree in biomechanics from University of Salford, a PhD in from University of Manchester’s School of Medicine, a continuous research publication record, and a rich clinical expertise of over 5000 orthotics designed, Dr. Georgoudis guarantees the best possible result for your treatment.
4) Manufacturing
The manufacturing procedure for an orthotic used to be a “secret” recipe based on imagination and some experimental ways to gather data. Using only static baropodometry data or even gathering information from a footprint on a foam material without even loading the limb are some examples.
Digital technology, in combination with scientific knowledge, renders those techniques obsolete. In our day and age there is no place for orthotics not created using data accumulated with digital equipment (see stage 1, data collection). Importing digital data to a computer and using computer numerical control (CNC) to manufacture the orthotics is the optimal use to technology and the basis on which research is made.
However, it is necessary that the manufacturing process is overseen and evaluated by a specialized professional!
This is the main reason why the treatment with orthotics must be reevaluated occasionally by a professional. The full procedure must be repeated after some time has passed to guarantee a best result (3 month up to 2 years).
CNC (computer numerical control) technology allows the manufacturing of an orthotic that is the exact physical copy of the CAD design. There is no human intervention in this stage, other than to import the CAD files to the CNC controlling terminal, so the process is flawless.
Selection of the proper materials depends on the goals set by the health professional. The choices are numerable, and the raw material for the structure layers of the orthotic can be:
Thermoplastics (polypropylene, polyethylene, co-polymers or combinations), foamy polyethylene, open structure foamy polyurethane, closed structure foamy neoprene, ethylene acidic vinyl, carbon fiber synthetics, natural or synthetic cork and more)
The material for the coating can be:
Leather of various colors and processes, alcantara, suede leather, nubuck leather, EVA, anti-fungal lining, plastizote, foamy neoprene and more.
The selection of the proper material depending on its native density, hardness, and elasticity is critical, and depends on the patient’s condition and his activity. The professional responsible for the orthotic takes into account how the material reacts under load, and selects the ideal one for each activity profile (everyday comfort, sports usage and such).
Unfortunately, in order to cut costs and maximize profits, various companies manufacturing orthotics tend to neglect the importance of material density. For example, when it comes to comparing same density materials, a low quality Chinese EVA type polymer while most certainly have much less durability and will lose its elasticity faster than a high quality German one, due to the fact that the later contains a greater amount of miniscule air pockets (bubbles) in its structure; thus the treatment benefits will not be the same.
Medisteps uses exclusively high quality material, usually of German or American origin, or at least same quality European ones.