Pedorthics - Pedorthic Association of Canada

A Periodical of the Pedorthic Association of Canada
A Periodical of the Pedorthic Association of Canada
Quarterly
Fall 2010
Pedorthics
Focus on Casting...
In this Issue...
President’s Message 3
Board Updates 4
Executive Director’s Report
7
Pedorthic Association of Canada’s
Position Statement on Casting
Techniques for Custom Foot
Orthoses
8
Overview of casting techniques
10
Casting Definitions
13
Article Review: A Comparison of
Four Methods of Obtaining a
Negative Impression of the Foot
14
Member Profile: Casey Bjorgum 15
Member Profile: Vanessa Carnovale 16
How proactively are you building
your reputation capital?
17
The newest Mississauga clinic located at 2000 Credit
Valley Road has seen tremendous success since it opened
it’s doors on March 1, 2010.
A special “Thank You” goes out to PAC for their help
in getting the word out to it’s members.
Career Opportunities
With ten clinics and growing, Walking Mobility Clinics is looking
for Pedorthists who would enjoy managing a new corporate clinic
or owning a Walking Mobility Clinic of their own.
Our focus is clinically based (not retail based) and staffed with
a dynamic team of Pedorthists, Physicians and Chiropodists.
If you are interested in joining our comprehensive team
approach and would like to discuss a new opportunity
with Walking Mobility Clinics, please contact:
Ryan Robinson, Pedorthic Director
Walking Mobility Clinics
[email protected]
www.walkingmobilityclinics.com
A Periodical of the Pedorthic Association of Canada
President’s Message
Fall 2010
The world of footwear, foot care and foot orthotics is constantly
changing. I like to think that pedorthists drive a lot of this change
as we are the only profession that specializes in both foot orthotics
and footwear.
Change can be beneficial to us and our patients and it can be
By Graham Archer,
frustrating.
I cannot count how many patients I have seen finally
C. Ped Tech (C), C. Ped (C)
find a pair of shoes that fit, only to have that shoe model change the
following season.
One thing is certain though - as manufacturers seek an edge over competitors, as consumers
demand innovation and increased performance from their shoes and foot gear and as retailers
seek the “next best thing”, there will always be change.
Change is going to happen, with or without involvement from us as pedorthists. It is up to all
of us to be aware of developments that affect our business practices, assessment techniques,
manufacturing techniques or patient care. When I first started in pedorthics, manufacturing
orthotics using a CAD/CAM system was cutting edge; now it is common place. This development
has allowed manufacturing labs turn product quicker, keep manufacturing costs under control
and allowed for storage of patient’s positives on a simple digital storage device. The result:
quicker turn around for the patient and efficiency for the practitioner.
Many innovations we take for granted. Where would we all be without our computerized point
of sale or accounting tools? Some innovations get over used. Ever send an email when a phone
call is more appropriate?
However we look at it though, not many of us would willingly give up our cell phones,
computers, PDAs or email. As professionals providing a service to the public we must all
embrace change, get educated and use it to appropriately further our practices and services.
I have been involved in many passionate conversations about changes in the running and
footwear world. Visit any online running or biomechanics forum and there will surely be
a lengthy and sometimes heated discussion on barefoot running. You will see educated
professionals arguing for it and others arguing against it. You will see lay people saying it is
the best thing they have done and others saying it is the worst thing they have done. Does a
forefoot strike that is seen in barefoot running overload the forefoot while trying to reduce
HF impact? Does it cause too much eccentric strain on the achilles complex? Shoes are being
designed to mimic barefoot running. Does this mean that barefoot running on its own is not
appropriate?
Fitness shoes have grown incredibly in the market place. Old staples such as Earth shoes and
MBT are being joined by New Balance, Reebok, Xsensible, Skechers, Easy Spirit and many
others. Massive marketing campaigns are in place to tell the consumer why they need to buy
these shoes. You will hear words such as toning, fitness, anti-gravity, minimalist and instability
when referring to this type of footwear. Pedorthists are looked on as the professionals for
footwear choice and fitting and as such we all need to be aware of what is out there so we
are able to communicate any shoes appropriateness for our patients. Talk to your local shoe
reps, retailers and colleagues about new changes in footwear, be aware and be prepared to
communicate your thoughts to your patients.
I realize I have asked more questions in this message that provided answers. It is not up to
any one of us to have all the answers, it is up to all of us to know where to find them and to
generate and opinion.
Hope to see you all in Orlando!
Help Us Be Green!
If you would like to receive Pedorthics
Quarterly electronically instead of
the paper version, contact the PAC
office at [email protected].
To those of you who are already
receiving the online version, thank
you for helping us be green!
Did you know you can read past
issues of the Pedorthic Association of
Canada quarterly publication online?
Go to www.pedorthic.ca and log in to
your member record.
Publisher Information
Pedorthics Quarterly
A Periodical of the Pedorthic Association of Canada
Pedorthics Quarterly is published by:
Pedorthic Association of Canada
Suite 503 – 386 Broadway Avenue
Winnipeg, Manitoba R3C 3R6
Toll Free: 1-888-268-4404
Fax: (204) 947-9767
Email: [email protected]
Printed by Kendrick Printing ISSN 1922-9429
Communications Committee
Co-Chairs
Linda Deschamps, C. Ped (C)
Nancy Kelly, C. Ped Tech (C), C. Ped (C)
Committee Members
Doug Benoit, C. Ped Tech (C)
Grace Boutilier, C. Ped Tech (C), C. Ped (C)
Jim Pattison, C. Ped (C)
Michael Ryan, C. Ped Tech (C), C. Ped (C)
Subscriptions: $199 per year in Canada
All articles published in Pedorthics Quarterly are the property of
the Pedorthic Association of Canada. Copyright ©2010 Pedorthics
Canada All rights reserved. Reproduction in whole or in part is
permitted only with the prior written consent of the Pedorthic
Association of Canada. Address all requests to the PAC office.
Trademarks and Registered. Trademarks used in this publication
are the property of their respective owners and are used only for
the purpose of information.
3
Quarterly
Pedorthics
Board Updates
Communications
Chair – Linda Deschamps, The Communications Committee
continues to provide research/
C. Ped (C)
scientific-based articles of interest
Vice-Chair – Nancy Kelly,
to PAC members. We are always
C. Ped Tech (C), C. Ped (C)
looking for new and interesting
ideas for articles and themes for PQ. Please submit any ideas for
themes for future issues to Linda Deschamps at ldeschamps000@
sympatico.ca.
We would like to thank committee members and contributors for
their continued efforts and support in PQ.
Education
Chair – Lisa Irish,
The main goal of the education
committee is to support
Vice-Chair – Ryan Robinson, the Diploma in Pedorthics
program at the University
C. Ped Tech (C), C. Ped (C)
of Western Ontario. Ryan
Robinson, Jonathan Strauss and myself recently met with Chris
Thompson, the new program coordinator at Continuing Studies
and the outgoing coordinator to discuss the program. It was a very
productive meeting and I look forward to keeping you apprised of
the outcomes of that meeting as they come to fruition.
In order to meet the demand for certified pedorthists we must
continue to aggressively promote the Diploma in Pedorthics
program at UWO. The education committee recruits members
to attend career fairs so that prospective students have active
pedorthists that can give them a better understanding of what a
career in pedorthics involves. If you are interested in manning a
booth at a career fair to encourage students to pursue a career in
pedorthics then contact the education committee and we will keep
you on our list for opportunities in your area.
We are also looking for committed certified pedorthists to act as
practicum supervisors for the pedorthic program. It is through
supervised placements that pedorthic students truly learn to apply
their course work to real people. It is so important that we have
excellent placement opportunities for students so they are well
prepared to enter the pedorthic industry upon graduation. If you
feel you could supervise a student for a placement opportunity or
need more information then contact UWO for information on the
necessary requirements for a placement location and supervisor.
This fall there are 18 students registered for the Diploma in
Pedorthics Program. We wish them every success in their studies this
year. I would also like to extend my appreciation to the instructors
and the placement supervisors in this program who work hard to
provide a good pedorthic foundation for the students. Have a great
academic year!
C. Ped (C)
4
Fall 2010
Ethics
Chair – Vanessa Carnovale, There are no new cases or
concerns before the ethics
C. Ped Tech (C), C. Ped (C)
committee. We encourage
Vice-Chair – Nancy Kelly,
everyone to remain familiar with
C. Ped Tech (C), C. Ped (C)
the Code of Ethics, available
through the PAC office.
Insurance and Government Relations
Chair – Brad Gibbs, In the spring of 2010, PAC learned that
BC’s Ministry of Housing and Social
C. Ped (C)
Development (MHSD) had changed their
coverage for foot care and were only covering foot orthoses for
those individuals that were in immediate risk of full or partial foot
amputations. Graham Archer sent a letter to the Minister of MHSD,
Rich Coleman, explaining how this did a disservice to those who need
orthotics for long-term daily mobility.
In June, we received a response from the Minister explaining that at
the present time there will be no change to their policy. That is, that
the province’s financial situation predicates the provision for foot
orthoses only if the person is at risk for partial or full foot amputation.
In response to Graham’s offer to have the PAC participate in the
development of future guidelines, Canadian Certified Pedorthists are
now formally listed as recognized providers of orthoses and footwear.
Of note, our profession is a valued partner in servicing the clients
dependent on funding from the BC government.
Another issue that began this past spring is the PAC’s application
to WCB Alberta to be recognized as contracted providers of foot
orthotics. Some members’ claims were being rejected due to the fact
C. Ped (C)s are not contracted services providers of orthoses. We
received a response to our application indicating that WCB Alberta
is not open to including pedorthists as CFO providers at this time.
Their numbers reflect a very small percentage of claimants needing
custom orthoses and until they can be convinced that there is value to
adding additional suppliers, they are happy with Certified Orthotists
being the sole supplier. WCB Alberta will continue with the status
quo of including C. Ped (C)s as footwear and footwear modifications
suppliers, with C. Ped MCs as suppliers of custom footwear.
Sun Life recently released a statement indicating that a written
recommendation for orthoses or orthopaedic shoes, including
diagnosis, fully-paid receipt, date of service and a detailed lab invoice
will be required. They took this measure to try to combat an increase
in fraudulent claims. Additionally, Sun Life will also be requesting
a description of the casting technique and raw materials used in
fabrication of the orthoses.
We have heard from many members concerned about the requirement
of a lab invoice as many PAC members manufacture their own products
and lab invoices do not reflect the cost of service component from
the provider for either orthoses or custom footwear. With the help of
IGR committee member Kim Rau, I have been in contact with officials
at Sun Life about this concern. As per the recent communication to
members sent out about this, Sun Life will accept receipts with blacked out fees.
In summary, with respect to foot orthoses claims, provide the client with:diagnosis
from referring practitioner as well as conditions apparent, the casting technique, a
list of raw materials used in the fabrication of the orthoses, a brief description of the
manufacturing process, the dispensing date and your certification number from The
College of Pedorthics of Canada.
With respect to custom footwear claims, include the following: the lab invoice,
costs blacked out, the casting technique, the dispensing date, and your certification
number from The College of Pedorthics of Canada
The claims department at Johnson Group has also been inundated with claims
for modified footwear and orthoses and needs help clarifying the legitimate from
fraudulent claims. They have asked Jonathan Strauss and Brian Scharfstein to help
with this. Jonathan and Brian met with officials at Johnston Group in mid-July
bringing a variety of samples to help them with the terminology and to get a visual
of what modifications and materials look like, as well as non-custom and custom
orthoses.
Membership
Chair – Ryan Robinson, PAC membership continues to increase. There has
been a lot of activity in the “Candidate Membership”
C. Ped Tech (C), C. Ped (C)
class due to the upcoming fall exams. As you may
know, in order to be eligible to write the exams, candidates must have obtained this
membership in this category for a minimum of 30 days prior to writing the exam.
Our current membership in the Candidate class stands at 50 members.
Other current membership numbers:
Certified members: Non-Practicing members: On-Leave members: Sustaining members: 475
12
11
18
Total membership 566
One of the main goals of the current PAC board is to increase our membership numbers
across all categories. We are working very closely with the University of Western Ontario
to increase enrolment in the Pedorthic Program offered through the university. There
are a number of interesting and exciting ideas currently being discussed to help in this
cause.
The Pedorthics profession has made tremendous progress in establishing itself as a
legitimate health care field. It is essential that we have a strong educational platform
to allow for continued growth in this area. Having a direct link to a university of the
calibre of UWO is not something that should be taken lightly. We need to ensure
that we, as a membership, are doing everything possible to support the university.
Professional Development
The professional development committee
has just seen two new members approved
C. Ped Tech (C), C. Ped (C)
by the board of directors, and is in the early
Vice-chair – Vanessa Carnovale,
planning stages for the 2011 PD events. As
C. Ped Tech (C), C. Ped (C)
the existing committee had strong Ontario
representation, we have just included one member from Nova Scotia and one from
BC. The committee members will soon be contacted in order to start discussing
ideas and roles for the upcoming term. The new members are Benoit Boyer from
Kintec and Terry Laurence from the Nova Scotia Rehabilitation Centre.
Chair – Patrick Bergevin,
5
6
A Periodical of the Pedorthic Association of Canada
Executive Director’s Report
“We should be driven by ethics as principles,
not rules to exploit for what you can or
cannot get away with.”
The above quote is from an advertisement
that the CFA Institute has been running
in Canadian magazines over the last two
years. This quote should be applied to all
Jonathan N. Strauss professionals, not just Chartered Financial
Analysts.
When members ask my opinion if something they are doing or want
to do is “right” or “wrong” I often think of this statement. The way
pedorthists practice should be driven by principals of ethics and not
what is specifically written in the Code of Ethics (I in no way mean to
suggest to ignore the Code; it is the authority) from The College of
Pedorthics of Canada.
If pedorthists and all other providers of healthcare services followed
this statement I would not have spent the last couples of days
representing the PAC at the annual conference of the Canadian
Healthcare Anti-Fraud Association.
Your success is defined in many ways by the ethics of your fellow
pedorthists. All pedorthists need to follow ethical principals in order to
ensure that the profession continues to be seen positively by referrers
and insurers. If you don’t view the Code of Ethics in the way the quote
described, I urge you to reconsider for your own benefit and for the
benefit of your fellow pedorthists.
The CFA Institute ad goes on to say:
“A financial advisor who is a CFA charterholder has devoted years
to intensive study, completed at least four years of relevant work
experience, and passed three rigorous examinations. The designation
represents a commitment to manage a client’s interests with integrity,
a willingness to set for realistic expectations that are attainable, and
a fundamental belief that principles are a not a luxury. They are
everything”.
The first sentence of the quote is very similar to the description we
use for pedorthists. I hope that all pedorthists can confidently describe
their work and the work of fellow pedorthists in the way the second half
of the above quote does. For the profession to continue to prosper and
grow pedorthists need to be seen as qualified and ethical and need to
put the patient’s care first.
I hope you will reflect on these quotes and discuss them with your
colleagues. It is together that we will continue to cement pedorthists as
the top choice for the services that you provide.
I look forward to seeing all of you in Orlando!
7
Quarterly
Pedorthics
Pedorthic Association of Canada’s
Position Statement on Casting
Techniques for Custom Foot Orthoses
Custom Foot Orthoses (CFO’s) are an essential element used by
Pedorthists to relieve foot pain related to biomechanical misalignment
of the feet and lower limbs. Orthoses can also accommodate foot
deformities and redistribute forces applied to the foot.
The aim of this position statement is to help clarify some of the
rationale that may be used in choosing one casting technique over
another.
It is widely accepted in both the research and clinical literature that
a three-dimensional model of the foot is required to fabricate a truly
custom made device.
Debate continues as to which three-dimensional casting technique is
most effective. More specifically, each technique has its own merits
and the casting technique chosen by a trained and certified clinician
is but one component in a comprehensive treatment protocol.
To choose one specific casting technique as the “Standard” is to
ignore the expertise of the clinician and the needs of the patient.
It is the opinion of the Pedorthic Association of Canada that it should
be the judgement of the clinician as to when to use a specific threedimensional casting technique.
Foam box casting requires a great deal of skill to be performed
successfully and reliably and it is necessary for a trained clinician to be
involved for casting and manufacture of an appropriate device.
Contact Digitizing
The use of contact digitizing employs the mechanical placement
of many small pins to capture the plantar contour of the patient’s
foot. When done correctly, the “Subtalar Neutral Position” or NCSP
is maintained while the client’s foot is scanned into the software
program where all modifications to the image of the foot are executed.
This technique uses a milling machine to carve a foot orthosis from
the corrected image. As with plaster casting and foam box casting,
reliability is improved with education and practice.
Laser Scanning
Recent innovations in the use of optical laser scanning techniques
have shown great promise. Combining the techniques employed
in Plaster of Paris slipper casting with the functionality of computer
modeling is designed to eliminate the reliance on messy plaster as
well as speed turn around times by removing the need to modify
models by hand prior to orthosis fabrication.
At this time the accuracy of laser scanning has been shown to be equal
to the other techniques, and can be prone to human errors if not
completed by a properly trained clinician.
Casting Techniques
Our Position
Slipper Casting (Plaster of Paris, Foot Impression Wax, STS
Casting Sock)
The use of a slipper cast has been employed for many years in the
provision of CFO’s. Maintaining a “Subtalar Neutral” or Neutral
Calcaneal Stance Position (NCSP) during the casting technique, the
clinician is able to reproduce the position typically used to assess
foot alignment. A negative cast is taken with either plaster, wax, or
a polyurethane embedded sock. This is then used to yield a positive
mould for further correction or modification before fabrication.
This method works well in capturing the plantar contour of the foot,
as well as the forefoot-to-rearfoot relationship. It does require a great
deal of skill, and requires considerable training and practice to obtain
reliable results from patient to patient.
While some organizations may be attempting to limit the type of
casting techniques used by clinicians and manufacturers of these
custom made medical devices, doing so would put a limit on the skills
and treatment palette available to the health care provider.
It is the position of the Pedorthic Association of Canada that the
limiting of accepted providers to those groups that exclusively
dispense orthotic devices in conjunction with a referring practitioner
would be a far more effective means of ensuring quality care and in
controlling the provision of these devices.
This would ensure the treatment of patients by professionals who
retain a formal education in foot mechanics, pathology and treatment,
and would eliminate the conflict of interest that can arise when the
individual prescribing the device is also the individual providing the
device.
Semi-Weight Bearing Foam Box Casting
The use of a semi-weight bearing casting technique, employing a low
density foam block for capturing the three-dimensional contour of
the foot is widely utilized by many foot care practitioners.
It also employs the “Subtalar Neutral Position” or NCSP during the
capture of the foot contour. This technique requires less cast dressing
prior to manufacture of the foot orthosis, and is also useful when the
patient requires an accommodative device, or is unable to maintain a
prone or supine position due to injury or medical condition.
8
Fall 2010
The Position Statement on Casting
is available online at
www.pedorthic.ca
Designed to limit stress at the areas of
the foot most susceptible to pain, Ambulator
Biomechanical Footwear provides unsurpassed
comfort and protection with unique features
such as SmartGrip™ slip-resistant polyurethane
soles, state-of-the-art removable comfort
orthotics and soft leather linings. Recently
updated with eye-catching styles, Ambulator
Biomechanical Footwear is often recommended
for diabetes, arthritis or for those seeking a
shoe that provides maximum comfort, stability
and added protection.
STOP BY AETREX PFA BOOTH 1303 AND MEET YOUR LOCAL CANADIAN REPRESENTATIVE
New Mens/Woms O&P Amb Ad.indd 1
9/23/10 12:17 PM
Quarterly
Pedorthics
Overview of casting techniques
As pedorthists, we know that a
BSc (Kin), C. Ped Tech (C), C. Ped (C) cast’s quality determines how
successful the foot orthosis
will be in alleviating the client’s symptoms. It has been determined
that intra-caster reliabilities (using two different casting techniques)
are better than inter-caster reliabilities.1 This means it is easier for
a trained clinician to reproduce the same cast, while two clinicians
are hard-pressed to achieve the same final product. Studies such as
McPoil and Hunt2 have also indicated that finding subtalar neutral is
less important than what we had originally anticipated.
From the research we can summarize that it is the clinician’s job
to master a few casting techniques to provide the desired level of
care for their clients, whether that be in subtalar neutral or not,
using full-weight bearing, semi-weight bearing, or a non-weight
bearing casting method. The type of weight-bearing casting
method (full, semi, non) is in large part easier to break down the
casting techniques as opposed to what medium is being used. The
different mediums being direct mould, foam box, wax and sand,
computer-generated contact digitizer, plaster casting, plaster sock
and computer-generated laser foot scan.
In this article, I review the different methods and the mediums of
foot orthoses casting. Each has pros and cons. It is up to the clinician
to decide which of these techniques best suit their clientele and to
master them.
By Kim Nicoll,
Full-weight bearing and semi-weight bearing casting
Full-weight bearing casting is achieved in a standing position with the
client using their own body weight to produce the cast. This method
produces a fully compensated, closed kinetic chain cast impression in
which the foot is not in subtalar neutral. It is used when cushioning
is the goal and motion control is not of much concern. Examples of
when this method could be chosen are a client with diabetes who has
a Charcot Joint or a client with severe rheumatoid arthritis.
Semi-weight bearing casting is achieved in a seated position with the
hip, knee, and ankle all at 90° angles. This is still a closed kinetic chain,
semi-compensated position. The most common method is to cast
the foot in subtalar neutral. This is achieved by the clinician holding
subtalar neutral by using one hand to landmark while the other hand
externally rotates the client’s tibia. Semi-weight bearing casting allows
the clinician more control in the foot positioning, which allows for
an orthosis with more components of motion control. Semi-weight
bearing casting has been used for clientele where the amount of
correction has to do more with foot position, shell material selection,
and posting principles.
To capture both a full- and semi-weight bearing cast, a direct mould,
foam box, wax and sand or computer-generated contact digitizer can
be used; which medium a clinician uses depends on the criteria.
10
Fall 2010
Direct mould casting
In the direct mould process, the heat-mouldable material used to
cast the foot becomes the shell of the orthosis. The weight-bearing
client may wear an insulated sock to protect the foot from the heat.
The material is heated and placed on a foam block or in some sort
of footwear. The client holds the foot in the same position until the
material has cooled. For semi-weight bearing direct moulding, the
big difference is that the clinician compresses the cast/shell material
into the desired shape. This is more labour intensive and has a greater
margin of error for optimal foot positioning.
Options of making a more controlling shell are very limited due to
the nature of the heat-mouldable materials that can be heated directly
against the skin. Higher durometer materials need to be heated at
too high of a temperature to allow direct molding against the foot.
Moreover, common posting materials would be also be too high of a
durometer to be used in conjunction with the materials used to make
a direct mould cast/shell. This technique is used extensively in the
retail industry, such as in ski shops.
Advantages of direct mould
•Quick method of orthotic manufacturing.
•Good technique if a flexible device is required.
•Very clean cast; not as messy as plaster.
•Fewer supplies are required.
•Can still work with the shell when it comes off the foot.
•Inexpensive.
Disadvantages of direct mould
•Plantar pressure of the foam tends to supinate the foot around
the longitudinal mid-tarsal joint axis, elevating the first and
exaggerating a forefoot varus.
•First and fifth rays can both “float” if the casting foam is too rigid.
•Difficult to get the material tight to the foot, allowing too much
tissue expansion.
•Difficult to know if the mid-foot is locked and subtalar neutral
has been obtained.
•Must be aware of the temperature of the material before placing
against foot.
Foam box casting
The foam box medium is one of the most common casting mediums
in pedorthic clinics. When the clinician uses foam box in a full-weight
bearing cast, the client places a foot lightly on top of the foam and
slowly applies weight as the foot sinks into the foam. The clinician
attempts to hold subtalar neutral in this process; however, this is
difficult to achieve due to lack of strength to hold the desired position
while the client is applying pressure. The full-weight bearing foam
box method works great for rigid foot structures.
Semi-weight bearing foam box is the more common of the two weightbearing techniques. Even though it takes the strength of the clinician
A Periodical of the Pedorthic Association of Canada
to push the foot into the foam, they can use different techniques to
achieve their desired cast results. One of these techniques is the gait
referenced casting, which was developed by Edward Glaser, DPM.3
For both weight-bearing methods, it is common to use “foam art” to
modify the cast. For example, the clinician uses a finger to take away
foam from an area of a bony prominence to increase offloading.
Advantages of foam box casting
•Fast and clean.
•Easily transportable.
•Adequate soft tissue displacement.
•Good pressure from the foam helps load the lateral column.
•Allows soft tissue expansion to occur.
•Client can remain in chair for casting and does not have to get
on a plinth.
Disadvantages of foam box casting
•Any positioning is usually lost with even partial weight bearing.
•Force of foam can distort hyper-mobile forefoot alignment.
•Poor visual confirmation of the foot position.
•Too much help from the patient can distort the impression.
Sand and wax casting
The wax and sand medium is used in some pedorthic clinics. A thin
sheet of wax is heated in water and placed on a metal tray that holds
levelled sand. The client then stands or sits in front of the casting box
and places the foot in the box until the wax has cooled. Once the wax
hardens and becomes brittle, the cast is removed from the sand box
and the client’s foot.4 This is a form of direct moulding.
Advantages of sand and wax casting
•Allows soft tissue expansion to occur.
•Yields a positive that is extremely clean.
•No clean-up on the patient.
Disadvantages of wax and sand casting
•Can be time-consuming.
•Requires storage of the sand box and materials.
•Clean-up is needed for any spilt sand.
•Any positioning is usually lost with partial weight bearing.
•Poor visual confirmation of the foot position.
Contact digitizer casting
The computer-generated contact digitizer is the technologically
advanced casting method for full- and semi-weight bearing. This
technique uses CAD/CAM software to obtain the three-dimensional
cast. With the contact digitizer, the client stands on or sits in front of
the unit and the digitizer elevates numerous pistons that contact the
foot’s plantar surface. The 3-D image is then transferred electronically
and viewed on a computer, where the image can be modified on the
screen. This system is commonly used in pedorthic clinics.
Advantages of contact digitizer casting
•Accurate plantar contour measurement.
•On-screen cast modifications with software.
•No distortion by operator or materials between scan and
fabrication of orthosis device.
•Quick and clean scanning and manufacturing.
•Cast storage and duplicate orthoses greatly simplified using
available software.
•Positive perception by client of the procedure.
Disadvantages of contact digitzer casting
•What you cast is what is manufactured; a poor cast is a poor
orthosis.
•Systems are quite heavy, making mobility difficult.
•Expensive, especially if equipment fails.
Misconceptions
•Office scanners provide diagnostic information.
•Result is more exact because it’s done with computers.
•Technology replaces the skill of the practitioner.
•CAD/CAM technology is only for large institutions due to cost.
Non-weight bearing casting
Non-weight bearing casting is achieved with the client lying prone,
supine or in a seated position. Whatever position is used, the most
common method is to cast in a subtalar neutral position. This is an
open kinetic chain, in an uncompensated position.
To achieve subtalar neutral, the clinician places their thumb
between the sustentaculum tali and the medial malleolus with the
index finger in the sinus tarsi cavity on the lateral portion of the
talus. The thumb of the other hand locks the calcaneocuboid joint
by applying a dorsiflexion force to the fourth and fifth metatarsal
heads until resistance is felt in the ankle joint. When the client lies
in a prone position, the clinician is best able to see the forefoot and
rear foot position. However, prone position is harder for the client to
manoeuvre into.
The other method of casting in non-weight bearing is the hang
technique,5 which is not used very often. With this method, the client
lies supine or prone and the cast is taken with no loading of the
forefoot, and subtalar neutral positioning does not occur. All types
of orthoses can be produced from non-weight bearing casts. This
method of casting is most used when motion control is the primary
objective.
Plaster casting
Along with foam box casting, plaster casting is the other most
common casting medium in pedorthic clinics and the medium used
in the pedorthic certification exam. It requires the most skill in how
to apply and position the foot in the desired alignment. Plaster casting
allows a lot of control and flexibility in making the negative cast.
11
Quarterly
Pedorthics
Advanced casting techniques are commonly used that mimic what
occurs with intrinsic posting. An example of this is pressing the
medial calcaneus with the fleshy part of the palm while the plaster is
drying, thus mimicking the Kirby Skive technique in rear foot intrinsic
posting. Clinicians will commonly add pressure to the forefoot to
obtain a tripod with the first, fifth and heel when the client has a
flexible forefoot varus.
Plaster casts are either a full-length slipper cast that covers the toes
and will hold plaster to do a manual positive cast or a three-quarter
slipper cast that is not as deep and does not include the toes. The
three-quarter slipper cast is often done when a cast laser scanner
is going to be used to make a computer-generated positive cast or
shell. To achieve good and workable casts, training and time for the
clinician are required.
Advantages of plaster casting
•Easy to manipulate the subtalar joint into a neutral position.
•Can load the lateral column and neutralize longitudinal axis to
provide good mid-foot and forefoot stability.
•Good visual confirmation of foot position.
Disadvantages of plaster casting
•Need to modify positive model of cast to compensate for soft
tissue expansion during weight bearing.
12
Fall 2010
•Requires water and creates a mess.
•Can be time consuming.
Common errors
•Poor positioning of the subtalar joint: either too much pronation
or too much supination.
•Insufficient or excessive loading of the lateral column.
•Allowing the metatarsal heads to elevate (and the toes to sag),
which distorts the position of the first ray.
Plaster sock casting
The plaster sock medium is very similar in pros and cons to plaster
casting. The plaster sock is one unit where the clinician matches
the client’s foot size to the sock size. During the drying process, the
plaster sock heats up and requires a plastic bag to act as a barrier
between the foot and the cast. A plastic tube is inserted in the dorsal
aspect of the foot and acts as a vacuum, taking away any air pockets.
Once the cast dries, the clinician cuts the cast, usually where the
channel tube was inserted, which allows the cast to come off easily.
The socks come in many different heights. the most common used
for orthosis being the slipper sock, which ends below the malleoli
and covers the toes. Casting with the sock requires less manipulation
of the wet plaster than with the strips, which allows for a tidy end
A Periodical of the Pedorthic Association of Canada
product. Once the clinician becomes familiar with the medium,
this technique is very fast. Like plaster casting, the clinician can use
advanced casting techniques and use a laser cast scanner after the
negative is off the foot.
Advantages of plaster sock casting
•Easy to manipulate the subtalar joint into a neutral position.
•Can load the lateral column and neutralize longitudinal axis to
provide good mid-foot and forefoot stability.
•Good visual confirmation of foot position.
•Cast is one unit, less manipulation of wet plaster.
Disadvantages of plaster sock casting
•Need to modify positive model of cast to compensate for soft
tissue expansion during weight bearing.
•Requires water and creates a mess.
•Storage required for casting materials due to different cast foot sizes.
Common errors
•Poor positioning of the subtalar joint: either too much pronation
or too much supination.
•Insufficient or excessive loading of the lateral column.
•Allowing the metatarsal heads to elevate (and the toes to sag),
which distorts the position of the first ray.
Laser foot scanner casting
Computer-generated laser foot scanner is the technologically
advanced medium for casting in non-weight bearing. This technique
also uses CAD/CAM software to obtain the 3-D cast. With any laser
scanner, the clinician produces a digital image of the foot/cast using
laser or white light.
The laser foot scanner is not used regularly in pedorthic clinics. The
pedorthist must either give up a hand to hold the device or work
around a bulky piece of equipment to hold the foot in position. Most
commonly, a cast laser scanner is used in lieu of the laser foot scanner.
Advantages of laser foot scanner casting
•Accurate plantar contour measurement.
•On-screen cast modifications with software.
•No distortion by operator or materials between scan and
fabrication of orthosis device.
•Quick and clean scanning and manufacturing.
•Cast storage and duplicate orthoses greatly simplified using
available software.
•Positive perception by client of the procedure.
Disadvantages of laser foot scanner casting
•What you cast is what is manufactured; a poor cast is a poor orthosis.
•Expensive, especially if equipment fails.
Misconceptions
•Office scanners provide diagnostic information.
•Result is more exact because it’s done with computers.
•Technology replaces the skill of the practitioner.
•CAD/CAM technology is only for large institutions due to cost.
As you can see, there are many different options of casting. Most
pedorthists become great at casting either a semi-weight bearing
or a non-weight bearing cast. Then they become good at the other
weight-bearing methods. This way, the clinician can achieve any
result they and their client like. Research indicates that introducing
an orthosis will not necessarily change foot alignment to the degree
we had originally thought, and that the use of an orthoses, is mainly to
provide comfort to the client.6 So it is the client’s comfort level, which
they associate with alleviation of pain, that determines if a pedorthist
is doing his or her job well. The first step in orthosis fabrication is a
great cast!
References
Trotter LC, Pierrynowski MR: “Ability of foot care professionals to
cast feet using the non-weight bearing plaster and the gait-referenced
foam casting techniques.” JAPMA 98: 1, 2008.
McPoil TG, Hunt GC: “Evaluation and management of foot and ankle
disorders: present problems and future directions.” JOSPT 21: 6, 1995.
Decker W, Albert S (2002) Contemporary Pedorthics. Seattle,
Washington: Elton-Wolf Publishing.
Michaud, T.C. (1993) Foot Orthoses and Other Forms of Conservative
Foot Care. Baltimore, Maryland: Williams & Wilkins.
Nigg BM: “Impact forces and movement control - Two new paradigms.”
PAC Conference April 15–17, 2005.
Nicoll KD: PEDS 6012 Advanced Orthosis Systems. University of
Western Ontario, 2010.
Casting Definitions
•Casting – The act or process of taking a 3-D impression
of the foot. This can be done in a number of ways, e.g.
off-weight-bearing slipper casts, semi-weight-bearing
impression foam.
•Subtalar Joint Neutral – The point at which one feels
congruity of the medial and lateral edges of the talus to
the calcaneus.
•Lateral Column – Consisting of the calcaneus, cuboid,
fourth and fifth metatarsal bones and the joints formed
by these bones. When plaster casting we lock the lateral
column to simulate the ideal stance foot alignment.
•Negative Impression/Mould – The actual 3-D impression
of the foot. This is used to produce a positive mould.
•Positive Mould – The cast or mould made from the
negative impression. This may be modified. This is the
cast on which the orthotic shell material is formed to
obtain the shape of the shell.
13
Quarterly
Pedorthics
Article Review: A Comparison of Four
Methods of Obtaining a Negative
Impression of the Foot
By Michael Ryan
PhD, C. Ped (C), Research Associate, University of Wisconsin
Department of Orthopedics and Rehabilitation
Original article by Laughton C, Davis IM, Williams DS. Journal of
the American Podiatric Medical Association 2002; 92(5):261-268.
The method a clinician uses to capture the foot for the provision
of a functional foot orthosis has obvious importance. Clearly the
shape of the orthosis to the foot with which it is matched must be
similar; a failure of congruity can result in poor device performance,
discomfort or injury. The pedorthic profession has maintained that
three-dimensional (3-D) volumetric impressions are the gold standard
in obtaining a negative of a client’s foot shape.
However, there is some debate as to which 3-D impression method is
best. For that matter, what defines “best” is itself subject to scrutiny.
Do the best methods most accurately replicate a positive of the foot, or
result in the best clinical outcomes? The long standing implication here
is that the former will lead to the latter, but this has yet to be proven.
Laughton’s robust study provides useful insights into these questions
with their comparison of four different 3-D impression methods: plaster
14
Fall 2010
cast; partial weight bearing foam
box; and partial- and non-weight
bearing laser scans. Thirty feet
from 15 subjects (12 women,
3 men) between the ages of
20 and 34 were used in their
sample.
The same physiotherapist
performed
initial
clinical
measurements of forefoot and
rear foot width, and forefoot to
rearfoot angle, using metric calipers with the subject lying prone - with
impressive intra-tester reliability (r values not lower than 0.93). Each
foot then underwent the four different negative impression methods
after Velcro markers indicated the head of the first and fifth metatarsal
bones and the bisection of the calcaneus.
As their names suggest, laser scans were performed with the subjects
either in a long-leg sitting position (with knees extended and ankles
dorsiflexed) for the non-weight bearing scan, or sitting on a stool with
hips, knees and ankles flexed to 90° for the partial weight bearing
scan. The foam box impression was taken with the subject sitting on
a stool with their lower extremity in the same flexed position while
the tester applied a downward force on the knee and foot holding the
subtalar joint position constant. The plaster cast was taken with the
A Periodical of the Pedorthic Association of Canada
subject lying prone with the examiner loading the mid-tarsal joint
after the plaster of Paris splints had been applied. The subtalar joint
was palpated while the cast was drying.
All of the impressions were uploaded into an Automated Orthotic
Manufacturing System (AOMS) software program (Sharpshape)
which processed a 3-D graphical image of each foot’s contour.
Numerical values were given for the same measures taken clinically
(forefoot and rearfoot width, and the forefoot to rearfoot angle).
Statistics were performed to determine: a) whether any of the
respective values from each of the impression methods differed
from each other, b) how reliable each measure was when captured
from each impression method, and c) how closely the measures
from each impression method were compared to those measures
taken clinically (a test of validity).
The results certainly have a bearing on clinical practice. The major
findings were:
•All impression methods significantly overestimated (by as
much as 9mm) the “true” rearfoot width (i.e. the measure
taken clinically using calipers), except the plaster cast which
underestimated it (by on average 1.9mm).
•The plaster cast, foam box and non-weight bearing laser scan all
significantly overestimated forefoot width (by as little as 1.7mm
for the laser scan and as much as 3.4mm for the foam box)
relative to the clinical measure.
•NONE of the impression methods differed significantly from
each other, or relative to the clinical measure, for the forefoot
to rearfoot angle.
•All methods had excellent reliability in capturing rearfoot and
forefoot width.
•Only plaster and partial weight bearing laser scans had excellent
reliability capturing the rearfoot to forefoot angle, and only these
two methods had good reliability in capturing arch height.
At its most basic level, a negative impression should do two things:
accurately capture the shape of the foot (to minimizing device
discomfort) and accurately capture the relationship between the
forefoot and the rearfoot (to maximize device effectiveness at
addressing foot malalignment). Based on the results from Laughton’s
study, all of the impression methods have their limitations when it
comes to replicating foot shape, particularly at critical areas such as
forefoot and heel width. The authors had predicted that the plaster
impression method would produce smaller width values as the tissue
is being compressed upon application. While none of the impression
methods differed statistically in their ability to produce accurate
forefoot to rearfoot angles, values from the plaster cast method had
the closest agreement with those derived from clinical measurement.
Based on this strong forefoot to rearfoot angle agreement and robust
reliability in capturing rearfoot and forefoot widths, the authors
recommended plaster casting as the most valid and reliable method
of taking an impression of a foot in the design of a functional orthosis.
It is worth mentioning limitations within Laughton’s study to put the
outcomes in perspective. As the authors themselves acknowledge, it
would have been beneficial to take the impressions one step further
and construct a device taken from each method. Subject-centered
evaluation of the support and comfort from the device could then be
included, without which we are left to make assumptions of the clinical
effectiveness stemming from high scores in each of the parameters
in this study. In addition, this study assumes that caliper-based
measurement of the non-weight bearing foot is accurate for estimating
the validity of a device that is used in a weight bearing context.
Nevertheless, the outcomes from Laughton’s paper serve as an
effective reference for the global limitations that may be experienced
with each of the four impression methods used. Of course, as
impression methods evolve to make use of better laser and optical
scanning technologies, updated research in this area will most
certainly be needed.
Member Profile
Becoming a pedorthist was, quite literally, in
Casey Bjorgum’s blood, as her family has now
been in the industry for three generations.
After studying Kinesiology at the University
of British Columbia, Casey moved fully
into a career at Generation 2 Orthotics,
which was a family-owned business before
it was purchased by Össur. The company
had originally been owned by Casey’s
grandfather and father, and even before
Casey Bjorgum
she had completed her studies, she seemed
destined to continue in the family practice.
“I was doing knee-bracing and odd jobs through university, and then
as soon as I was done, I started training for pedorthics,” she says. “I
was always around it. It always looked very interesting to me.”
Her path began simply enough by job shadowing and as she began
to take a more active role at Generation 2, she felt confident enough
that this was her destined career. Rather than take physiotherapy,
she continued in what she describes as an apprenticeship before
pursuing certification in pedorthics.
Working with family, as anyone who has gone on such a career path,
can be strenuous at times as attitudes can change from when a son
or daughter is a helping hand to being a fully-certified professional.
Casey comments that this wasn’t the case at all, however, working
with her father.
“I don’t think he looked at me any differently at all,” she says with a
laugh. “He was always pushed me quite a bit, which was good, and he
was always there if I had any questions.”
That dynamic changed, however, when the family business was bought
out. No longer having her father with her in the company meant that
she would be going forward, in essence, on her own; but rather than
shy away from her new surroundings, Casey embraced the change.
“It was quite different when Össur bought out G2,” she says. “It was
15
Quarterly
Pedorthics
a little bit different not having him there, but I think it was good
because I gained my independence. It was a different transition but
it has been positive for me.”
Despite the change in company, Casey has found that the two
companies have similar goals, in that they are both very patient
driven – committed to ensure that their clients have successful
outcomes, ensuring that patients leave her care happy.
Another element that hasn’t changed is her location. Throughout her
career, Casey, who was recently married, has stayed close to home
(admitting that a major factor in her decision to do her training at
UBC was the proximity), and for several reasons, has chosen to stay
on the west coast.
“To be quite honest I consider myself very lucky to live in what I
consider to be one of the most beautiful cities in the world,” she
says. “I would be crazy to leave a city where I can ski on Saturday and
golf on Sunday. How great is that?”
Being in B.C. also gave Casey a once-in-a-lifetime opportunity this
past winter, as Össur worked with several athletes during the 2010
Winter Olympic and Paralympic games. “It was a great challenge to
work with such high caliber athletes who take such an active interest
in their bodies and their overall health,” she says. “It was a hugely
positive and motivating experience for me!”
Member Profile
As a student at the University of Western
Ontario, Vanessa Carnovale had no idea
that her career would turn out the way it
has. Young Vanessa, however, can hardly
be blamed for this. After all, the success
that she has now enjoyed with BioPed is
an amazing feat.
In actuality, Vanessa seemed destined for
a career in chiropractics when she caught
sight of a booth about pedorthics at a job
Vanessa Carnovale fair UWO was hosting.
“There was someone there from Pedorthic Services who was
discussing the new pedorthic program that was going to be available
at Western, and it was through that discussion that I decided to
apply to the program,” she recalls.
Despite already being registered for chiropractic college (a program
that she went on to complete), Vanessa spent that summer in the
pedorthics program, and upon completion of her in-class time in
the chiropractics program, she did her clinical hours in pedorthics.
After completing her studies at UWO (based in London), Vanessa
moved back to her hometown of Etobicoke, and immediately began
working with the same company she is with today.
“There was a job opening at the BioPed Scarborough location. One
of the employees had gone on maternity leave,” she recounts. “Once
I had stopped filling in I decided to stay.”
16
Fall 2010
Vanessa would continue at the Scarborough location for two-anda-half years before the company came with the call for her to move
to BioPed’s head office in Oakville. The position now brought on a
new dynamic to Vanessa’s career, one that hadn’t crossed her mind.
“If you’re in university you always think there’s a career path for
yourself that’s very specific, and then once you’re actually out in the
workforce, you tend to realize there’s other things that also interest
you,” she explains. “This is a good way to incorporate the clinical as
well as what I would now consider to be an interest in business.”
Of course, with the shift in her career, so too has the composition of
her daily life in pedorthics. What was once a fairly regular schedule
now sees Vanessa assuming various duties in any given week.
“I’d say no two days are alike,” she says. “Originally I was doing allclinical work and managing a centre, but now I’m doing everything
from medical education to conducting a large number of seminars
on a yearly basis for family physicians as well as other referring
professionals.
“I’ve spent a lot of my days supervising medical representatives
and I’ve spent other days training a lot of our pedorthists in new
processes and providing them with further clinical education.”
But is there one segment of her portfolio that sticks out to more
than others?
“The one I probably enjoy the most is working with our franchisees
and sharing ideas of best practices,” she remarks.
The franchisees she refers to are primarily across Ontario, but there
are also BioPed outlets in Surrey, B.C., Bedford, Nova Scotia and
Moncton, New Brunswick. This has meant that Vanessa has added
another aspect to her job – travel, which takes her out of BioPed
headquarters for the majority of the work week.
“I could be anywhere from Oakville to B.C.” she says. “Whenever
a centre requests that I come out and assist them or provide a
presentation to their physicians, they’re booked into my calendar
and off I go.”
When she does have spare time, Vanessa enjoys spending time with
her family and friends, travelling and salsa dancing.
Stocking Your Pedorthic Toolbox
Pedorthic Symposium
The PAC Symposium is returning to Ottawa,
Ontario, March 25 – 27, 2011!
This year’s Symposium, Stocking Your Pedorthic
Toolbox, will provide attendees with knowledge that
can be taken home and immediately applied in their
everyday practice. The theme will focus on current
concepts, footwear, business development, multidisciplinary approaches, and new clinical research.
A Periodical of the Pedorthic Association of Canada
How proactively are you building your
reputation capital?
By David Nour,
Author – Relationship Economics and Keynote Speaker at the
2010 North American Pedorthic Congress Keynote Speaker
Reputation: 1a: overall quality or character as seen or judged by
people in general b: recognition by other people of some characteristic
or ability or 2: a place in public esteem or regard: good name.
Merriam-Webster Dictionary
When it comes to business relationships, one of the foundational
components to elasticity in your success is your reputation capital: the
quantifiable and strategic significance of the value you’ve promised and
delivered, consistently over a period of time. By the way, this isn’t speed
dating! By definition, the development, nurturing, and protection of
this reputation – in essence, the building of your reputation capital
– is an investment of time, effort and resources (human and capital).
It also has comparable value as your reputation is often compared
to those of others at equal or greater business stature. I equate this
to building a house. Few will recognize the painstaking labor of love
dedicated to the intricate details and investments you make in beams
and supporting infrastructure, or the long-term viability, sustainability
and protection you expect for you and your family. It’s a far greater
asset than a simple structure; it’s a home you’re proud to call yours.
Regardless of the investments you make in building your home, it
will always have a comparable value. If the street or neighborhood
is perceived to be undesirable, your home will likewise suffer from
reputation by association. Similarly, the business relationships you
painstakingly invest time, effort and resources in to develop over the
years, whether you like it or not, directly contribute to your reputation
capital. The employees you attract, the suppliers you utilize, and the
customers and investors you serve all contribute to your reputation
capital.
One of the biggest challenges with reputation capital is that very few
executives really know how they are perceived! And you simply can’t
do anything about a reputation you’re unaware of.
In working with clients such as Disney, Siemens, Assurant, HP and
KPMG to name a few, we’re coaching the next generation of leaders
in a proactive, systematic, disciplined process to develop, nurture
and leverage their reputation capital. They understand that corporate
reputations are earned daily by the market’s perception of the value
their respective companies delivered from their promises yesterday,
and the realistic expectations of what these organizations will deliver
tomorrow. So what are the key ingredients of building, validating, and
fostering your reputation?
17
Quarterly
Pedorthics
The image of the industry you work within: Beyond products,
services, and even brands, keep the focus of the industry on the
overall experience or perception based on a degree of confidence
in predictability of behavior (“what you’re going to get”). Also, be
aware of guilt by association – missed opportunities to engage and
transform typical transactions into memorable relationships.
Your corporate image and identity: “Image” is a person’s beliefs
about an organization and “identity” is the attributes used to describe
the organization. For example, Character describes organizational
culture & competitiveness; Ability describes the CEO, employees,
and resources; Products & Services are evaluated by quality, value,
and range; Behavior is defined by leadership and profit. All of this is
based on the individual’s relationship with the organization, its past
behavior, and what other people have said about it.
Your stakeholders: Values and perceptions vary greatly by how
much the organization’s character, respective beliefs and values
about appropriate corporate behavior are aligned. Stakeholders are
becoming more sophisticated as they look for their expectations to
be exceeded, not simply met. Customers are looking for dependable
products and services today and an organization to fix them when
they are broken tomorrow. Employees are looking for a salary today
and skills development and reserved funds for retirement tomorrow.
Investors are interested in meeting today’s cash flow requirements
while building equity and increased shareholder value tomorrow.
Individual reputations are often described in terms of esteem,
respect, trust, and confidence (or lack thereof). The outcome of
the perception from the above ingredients is inherently simple:
Good or Bad. The results of one forming an opinion from this
perception is the notion that it’s “safe” to do something with you
or your organization such as apply for a job with your firm, buy your
products or services, purchase your stock, or invest in your company
and not boycott you during times of crisis.
According to Professor Thomas J. Kosnik at the Harvard Business
School, visibility and credibility are the key components of
measuring an organization’s reputation. Similarly, your visibility in
the marketplace, measured by the number of quality and diverse
stakeholders who are aware of your characteristics and capabilities,
as well as your credibility, which is the quality of your reputation
amongst those who know it, determines your current market
reputation. Recent college graduates often have low visibility and
credibility – they simply haven’t had the chance to earn it yet. As
such, their reputation is predominately unknown. With increased
visibility, your reputation becomes unparalleled. An undesirable
scenario is a highly visible role with a diverse group of stakeholders,
but low credibility in the perception of your vision or ability to
execute.
So, when considering an individual, team or organization’s
reputation, what are the sources of these reputations and the
quantifiable outcomes of reputation capital?
An individual’s reputation comes from personal characteristics, (when
was the last time you did a personal SWOT – strength, weakness,
18
Fall 2010
opportunities and threats – specifically around your reputation?),
professional development efforts, non-working activities, and the
company you keep! The quantifiable returns become individual
and peer-level recognition, broader appeal and visibility / more
interesting and demanding work, personal & professional growth,
and personal rewards for performance.
A team or group’s reputation is derived from HR practices which
determine how the team recruits, develops, rewards, and terminates
its employees; clear goals and objectives (KPIs) of the team; a clear
understanding of “part” of bigger objectives; and the executioncentric skills of the team leader. Reputation capital dividends
include business unit, departmental, or company-wide recognition;
current “A Players” attracting other A players; reduced involuntary
attrition and cost of position replacement; captured and shared
best practices; and strong intra-company relationships that attract
resources (both capital & human).
The organization derives its reputation largely through the
personalities of the senior management, shared corporate values,
and the financial stewardship of the organization. Viable examples
include Steve Jobs’ consistent knack for innovation at Apple, Johnson
& Johnson’s credo, IBM’s values including respect for the individual,
customer service and commitment to excellence, and HP’s seven
corporate objectives including profit, customers, field of interest,
growth, people, management and citizenship. The quantifiable value
of reputation capital at an organizational level can manifest itself in
preferential access to market opportunities previously deemed
improbable, unconditional support in times of business crisis, and
lifelines when the bottom falls out of your company.
So, I ask you again, how proactively are you building your reputation
capital? Join me at the 2010 North American Pedorthic Congress in
Orlando, Florida to learn more. http://www.pedorthiccongress.org
© 2010 The Nour Group, Inc. All Right Reserved.
David Nour is a Keynote Speaker at the upcoming North American
Pedorthic Congress in Orlando, Florida. For more information,
please visit www.pedorthiccongress.org
PAC Membership invoices
will be sent out in November.
Check your inboxes.
Membership payments will be
due by January 1, 2011
FINN PAC NOVEMBER 2010.pdf
16/09/2010
5:34:48 PM
The Finest Walking
Shoes On Earth.
Savannah
Finn Comfort shoes are meticulously
handcrafted in Germany. Renowned for
their supreme comfort and unparalleled
orthopedic support, Finn Comfort footwear comes highly recommended by leading health professionals worldwide.
All Finn Comfort footwear feature
removable footbeds for custom
orthotics.
Pretoria
Finnamic’s gentle rocker soles promote
natural rolling motion when walking yet
provide both stability and comfort when
standing.
Prevention Footwear by Finn Comfort
offers numerous features and benefits
which address the problems of tender and
pressure sensitive feet.
96103
Exclusive Canadian distributor:
Tel: (450) 625-8511 Fax: (450) 625-8895 E-mail: [email protected]
Visit our web site: www.serum.ca
www.pedorthiccongress.org
PEDO R T H I C S & the
2010 North American Pedorthic Congress
Thursday, November 18 to Sunday, November 21, 2010
H ilton Walt Disney Wor ld R esor t, Or lando, Flor ida