[Interview] Talking with Dr. Ben Pearl about Biomechanics

Hello and welcome to Podiatry practice Mastery. My name is, Don felt. Oh, and I have dr. Ben Pearl here. Welcome Ben. Hey, thanks, Don and to be best nice to have you back. And today we're going to focus all about Orthotics and and also biomechanics. I think that's a passion of

yours. So, you know, let's kind of Dive Right In what I'm really excited about is you're going to talk today about kind of these little things that we can modify in our practice implementing, these little things of biomechanics and kind of make big changes. With our patients. So, tell me a little bit about this upcoming conference, and your shoe tips. And where do you want to start? Yeah, let's start with just biomechanics in general.

I think that Podiatry is losing a little bit of ground to the sports industry Health gurus. So what I mean by that is that there are a lot of podiatrists like you and I that are curious and they're in there are Also, a lot of podiatrists that are in the algorithm of what they learned from Merton, root and weed. And there's nothing wrong with some of those precepts as a starting point, but we've evolved so much into the marriage of shoe Foot orthotic

sock. All those things come together in a seven-layer cake to make the the result in terms of friction fit bail instability. And I think that that's where Podiatry needs to hone back in, start reading more articles. Start attending more things like the Seminary you're putting here on today. No, listen to those Snippets. Don't listen, just to Podiatry. Listen to some of the biomechanics information that is out there in biomechanics land via an onp person, be it biomechanics PhD, like been

oneg. Be it a podiatrist from another country. That may have a different band, like Simon Barr told, or Simon Spooner or you know, many others that are that are out there. So, I think that If we look at doing things in a stepwise fashion, and this is, this is like a precept, right out of Richard Blake's Playbook, you know, he just wrote a very lucid book. Practical biomechanics for the podiatrist. You couldn't get any more elegantly simple than that.

And if we take the variables that we have and add 1, small variable at a time. We will then know, right? Right, what biomechanically we did to make the change? Yeah, it's so I think these are great and I think a lot of us are probably like me your little bit more advanced and biomechanics. How does someone I'm thinking like, we're all I think that one of the biggest changes we've gone so surgical right? We don't we do mostly surgery. A lot of we're trained, surgical right?

We're not training biomechanics and our residencies. So if someone wants to kind of shift things back and you mentioned a lot of great names, but I'm a busy podiatrist, you know, seeing my 30 patients a day. Is there a resource? I know there's this conference coming up. Like, what do you do, or what? Should a podiatrist do? Because we don't have all this time. We're like maybe reading this between patients. So, what are some good tips? Yeah, I think like you say, identifying.

Professionals that are interested in disseminating information. That is available on stoop roach. So look at the look at the agenda. Look at the faculty, make sure that it is not just to promote an afo. For instance. There's nothing wrong with a good based lecture that talks about afos. I applaud that it's just that we want to make sure that we're approaching. Both the pros and cons of the various Orthopedic appliances, that were that were using.

For instance. Let's say an afo, we all know we've had our Medicare age population. Come in with an afo that they got from let's say another podiatrist or hanger Labs or some other prosthetic source that has been sitting in the closet. So what? We have to determine is number one. We're looking at the patient right in front of us. Do they have the skill set to

apply the brace properly. Are they going to use it more than just, you know, for the time frame that you teach them to how to apply it in your office. And is this going to be a six-month measure or a long-term measure? And then, of course, it gets down. Also to making sure when we dispense them. From a practical standpoint that we take into mind the same and similar. If they've had a cam boat. For instance. We then have to enter the discussion of even though this

may be better for you. Mrs. Jones. We see that you've had a can both. This may be a problem and then it's up to you to determine you want to just give them an avian, or you going through the Appellate levels and and documentation that will be required to get that device that you want covered be an ankle brace. Or Some type of a fo one of the things that I just picked up from a colleague of mine just

recently. I like this idea of not just referring to a cam boot for offloading, the ankle or a fracture. So let's say we have a stable fracture. We know that when we put the cam Bhutan we're going to have an inequity there with with the leg lengths. So and I have no affiliation with these folks whatsoever. But I really like the idea of this take. Oh, brace, that is external to the shoe. So instead of having a differential of, let's say half an inch three quarters of an

inch, whatever. The cam boot, differential is an inch. Now you have minimal because it's a, it's an external skeleton. That goes around the shoe. And we've also taken out some of the Compliance issues with having something internal in the shoe where now you have something you're jamming into the shoe creating more volume and now it becomes a shoe fit issue. Yeah, in some cases. It's a it's a it's a great. It's a great tip. You had some other kind of real practical biomechanical tips.

You're going to like what you use every day in the office. What are some of those other other tips? You talked about a ball or something like that? What are those? Those things. Yeah. Yeah. I'm going to review those. I just wanted to finish with one little caveat that that I think people should understand when we wear a cam boot or one of these take over racist when we're talking about offloading. Offloading vertically. We're really as measurements go with those devices offloading.

Approximately 30% that's supported in the literature. So just bear in mind that although you're It's not like 100% offload with those devices. So even though people think in their mind. Oh Cambodia is the gold standard. We're really only offloading 30% on the you know, the vertical forces going through the the Foot and Ankle as far as some of the things that I'm not always going to be. We're going to go down these. Now, we're going to go down as we're gonna go even more.

So do you have any good options? So I've been struggling with this like a lot of my patients. I see, let's say posterior tibial. Tendonitis, peroneal, tendon, itís, even plantar, fasciitis. I don't want to put them into a can boot. I'm going to do Shockwave on them. Okay, but then I want to offload it. So, I've tried like a velocity brace to offload a little bit, which is like, kind of a non-custom a fo. But I would love to have an

offloading brace. That worked really well, that would put the pressure into the lower leg and offload the fash or these tendons during the course of the Shockwave. You have anything that works great as a non customer customer. You is frequently. I would say that I'm very eager to see what the compliance rate will be with the take old brace, because I think it's lighter. And from a standpoint of compliance. They've actually worked with some of the workman's comp folks

that don't have, for instance. Osha Osha will restrict them with a cam boot to return to the workplace, but they've actually now been able to get these take o braces and it's an example of one brace. There's other braces out there that aren't exactly the same. In terms of the offload, is it? There's an awful more than 30% or is it only 30% in offload? So it's a 30. It's the 30% brace. Yeah. I was talking to this gentleman. I interviewed him a while ago. I forgot which one it was.

He's in Colorado, but it's a Race that almost offloads, eighty to ninety percent to the lower leg. And I don't, I haven't found anyone locally. Like hanger doesn't do it for me. They were a local lab that did it for them. I just thought that was an Eda. There are, there are other races that offload more. Those are going to be a compliance issue because they're more restrictive. Okay. So we've heard of things like Crow braces and other things that are very, you know, they

encumber the limb. So sometimes it's, it's so I guess none. A friendly for patients to wear that they defer out of that. Yeah, there are little things though that we can do within the shoe to use. For instance. Let's just say a shoe that has a nice roller. This is a Zeller. Oh, shoo. So this I, this is like a tank.

I mean, so we used to be thinking about shoes, like the Brooks Beast or the New Balance 1980 as, you know, our best support shoes, but The fact of the matter is that, and I'll see if we can grab the Cutaway on that Zorro shoe. The nice thing about that. It's got a carbon Morton's extension built into the actual sole of the shoe. So not only does it have the roller. Okay, but it's got an inner carbon layer that helps propulsion as and built as a Morton's extension and this is a

cutaway of the shoe. It's a brilliant. Zayn. And I actually borrowed this idea because not everybody has that for what hallux limit is for. Yes. Yes. Recovering some pre dislocation syndrome submit to recovering stress fracture recovering, hallux fractures, you know, so these things that don't require a fixation or if they do require fixation, you're now in week 2, and let me tell you something, I think. As long as there's not swelling, once the stitches are out.

I would bet you that this is going to be a lot more supportive than a surgical shoe. Hmm. Good idea. That's good. Now, as far as price point, we're now approaching, you know, with gasping what we're getting up into what 575 a gallon. So now we've got economic pressures on patients. That's why I came up with a concept that I call small ball. So let's just get a base hit or a double.

Instead of trying to get the home run all the time with, like we were talking before a colonoscopy out of me, a triple who has time now to take out of their, you know, their their kid has just got over covid and you know, the other kids struggling with IB program or AP program in school. And so are, you know, we have to be there for our kids and for our for our extended families, Etc. So here's for example, something that I designed.

It's Called the turf toe splint, but it's really more about using it for something like hallux limit. Its because that's much more common for our practices than turf toe. So the premise is not to stop the range of motion, but to slow down that torque, slow down that moment, and then also to get compression, because this is like a compressive midlife device and then in doing so, being adhered to the foot, I've had patients. Tell me that it feels like their big toe is now like wolverines

toe like that. It's like one long bone. Instead of a segmented ipj or MTP that it gives them a sense that they're now getting a full linear axis of strength through the whole toe joint. So that's that's another example of something that I use everyday. I'm going to show another example, and there's great places to get these. I get mine from juvy. Jill's, these carbon plates, you know, it's such an easy thing to use. And yet how many people actually stop these in their, in their office.

And by the way, I'm all about getting the patient better. So the patient doesn't have, let's say, 40 bucks or whatever, whatever you decide to sell these carbon plates for the pair. If it's just in one foot, why not? Just sell them one and just keep that, that other one for the Next, you know, size 10 patient. So I think if we open up our Paradigm and approach to not be a one size fits all for our patients.

We can then customize and get more patient compliance, you know, both from from what it feels like standpoint and also an economic and realistic standpoint for application. Yeah, that's great. That's great. Hey, we're coming towards the a little bit of the end here in terms of time for us. Tell me a little bit about this this how you guys put together this kind of biomechanics Workshop or this, tell me a little bit about this and if people are considering they want to learn more about

biomechanics. Would this be good for ya? This is actually good from student resident all the way up to season practitioner because Don, there's so much new that's coming out if you look at Magazines, like lower extremity review, the biomechanics journals, especially things that are being published in the UK, and Australia. There's just so much going on and why do they focus on it more over there? Because they're not, as surgically focused. Yep.

They don't do as much surgery. I'm sure there's some surgeon is I'm going to offend somebody. There might be some Australian surgeons, but it's just not as prevalent as it is here in the US. So even in so far as things like the subtalar joint neutral, Bet on it talks about how it's very difficult to measure this. It's not that we have to throw that concept out the window, but there are other things. Let's think about, not just what it looks like.

Kinetics can kinematics. Excuse me, but what the torque forces are through the joint. Benno has published a study where he found that you can do various wedges and shoes. And for some people, those medial and lateral wedges will influence the knee and to of more of a valgus moment and that same in another patient. It'll induce a varus moment and more torque through the outside of the knee.

So because because we're multi segmented, we cannot just have our eyes on the feet as Richard Blake, dr. Richard Blake notes, he starts from the head. He starts looking at head tilt. He looks at shoulder drop. How does that affect the lumbar? Then? We've got a referral to our osteopathic Chiropractic Orthopedic back. Dr. Colleagues, you know detecting something in the hip, or the back so it's all

connected. And I think that what someone is going to get out of this seminar is more connectivity, more assurance and validation. What they're doing is the correct protocol and it's going to change their mind about a few things based on the evidence. That's out there. That's great underneath this. I'm going to be putting just the

information. If you're listening to it's coming up in June, but then they'll be information about probably the replay and things like that where they will be at in the future so good and you can email me directly at Arlington foot at gmail.com and you can get more information and make a decision if you want to sit in virtually and we will be offering a You edited version after the fact that will be a pay-per-view just because we want to encourage people to participate live. Cool, cool.

So that's that's that's a benefit than so. Yeah. I'm going to be sending out this tweet to the list and see what people say and to see if anyone's interested and it's great. You know, I think the trend. Now what I feel is people are giving stuff for free for people that want to be present in kind of the early adopters. And then those that maybe are too busy which is a lot of us than, for a Small fee. You can watch it afterwards, have access forever.

And I think that's a great way of doing it for people, giving out that information. So, thanks, but I appreciate your tips here and I'll put your information underneath this video and I appreciate your enthusiasm and energizing me for my lunch hour. Thanks again, Don. Yep.