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Predicting is a patient will benefit from orthotics

TBL Complex Foot & Ankle Clinic

The Biomechanics Lab Complex Foot and Ankle Clinic

At The Biomechanics Lab, we see 1000’s of patients every year debilitated by pain and dysfunction from conditions such as arthritis, painful flat feet, tendinopathy and stress fractures. Our patients are often referred to us from within our health network as a last resort after often seeing multiple health practitioners, numerous podiatrists, have tried surgery, yet ultimately still suffer daily pain and poor quality of life.

What we see the role of The Biomechanics Lab in our typical patient’s journey is to provide them a place where patients can go to get true understanding and diagnosis as to the cause of their pain, and to benefit from the years of experience we have in offering tailored treatments to reduce pain and improve function.

However, when we looked at our patient population and how they made their way to us, there was a glaring omission in the accessibility of our services for the wider public. Over 96% of our patients are referred to our services by local  foot, ankle and lower limb surgeons, by local sports and musculoskeletal doctors, by their radiologist or rheumatologist or by their sporting club.

In 2020 we set about changing the accessibility of our high-end services and as a result, we are proud to launch the TBL Complex Foot & Ankle Clinic.

What is the TBL Complex Foot & Ankle Clinic?

Led by renowned Orthopaedic Podiatrist Dr Chris Bishop PhD, the TBL Complex Foot & Ankle Clinic provides members of the public with complex foot and ankles problems priority access to a consult and 3D gait analysis to better understand the treatment and management options available to them.

Dr Bishop has dedicated a large portion of his career to managing complex orthopaedic and sports related foot and ankle problems. He considers this clinic as his ability to provide back to the community and offer them a level of analysis and service not available anywhere else in Australia.

Initial TBL Complex Foot & Ankle Clinic appointment

The initial part of a TBL Complex Foot & Ankle Clinic appointment is spent with Dr Bishop. Prior to your appointment time you will have completed a pre-assessment questionnaire and provided a detailed medical history relating to your current problem. Dr Bishop will review this information with you, establish your goals for treatment, review any relevant imaging, tests or surgical reports, perform a detailed functional assessment of your foot and ankle and finally establish questions to be answered by the gait analysis.

Following this initial assessment by Dr Bishop, you will move into our flagship 3D gait analysis lab and meet our Biomechanics team. You will be changed into appropriate clothing and have markers attached to your feet, ankles and legs. You will then walk in our lab with your movement tracked by 3D cameras and the forces applied to your feet are measured by special sensors in the floor. For more information on the 3D gait analysis process, click here. Once we have the data we need, you will be changed back into normal clothing and walked back to reception. 

Review of results

An appointment will be made within one week to review with Dr Bishop. At this appointment he will have the results of your analysis, and together with his initial assessment findings, will be in a position to recommend the best path forward to reduce your pain and improve function.

So how can the TBL Complex Foot & Ankle Clinic help you?

The Biomechanics Lab’s mission is to use 3D Biomechanics to inform treatment decisions of the foot and ankle. The TBL Complex Foot & Ankle clinic provides you the ability to obtain the detailed information you need to better understand the cause of your pain and symptoms. This includes:

  • Measuring the movement (angles and velocity of movement) of the joints of your foot and ankle in three dimensions as you walk (note that most gait analysis offered by health practitioners are performed in 2-dimensions).
  • Measuring the forces applied to your body when your foot hits the ground. This includes not just the vertical force (i.e. the biggest force and one directed up on your body) but also the breaking force applied when you hit the ground, the medial force trying to roll your foot inwards and the force you generate when you push off the ground in the later phase of gait.
  • Measuring the function of your muscles, the work they do and the power the absorb and generate as your walk.

The detailed information collected in the initial TBL Complex Foot & Ankle Clinic appointment can then be used to inform management of your condition. Some examples include:

Using 3D gait analysis to design strength and conditioning programs for your specific needs.

Note that the information we collect in a 3D gait analysis relating to the range of motion of a joint and the velocity of movement allows us to better select exercises to improve functional control of movement and to prescribe load to increase muscle strength. The muscle power analysis provides us additional information as to the control of our joints through the entire range of motion, and often informs more progressive and complex exercises targeted to the entire range of movement the joint performs. 

Using 3D gait analysis to prescribe footwear.

Based on research and working with global footwear manufacturers, we know footwear can have a large impact on the function of the foot and ankle when we walk. Some examples of where we use specific footwear to treat complex foot and ankle problems include:

  • Changing the materials of the midsole to improve comfort in patients who have a very high rate of force loading.
  • Using specific geometric footwear designs to improve the stability of the foot during loading and midstance.
  • Using specific rocker forefoot designs to improve function in patients with reduced joint motion as a result of arthritis or in those patients who have high propulsive forces causing problems such as neuromas or plantar plate injuries.

Using 3D gait analysis to design custom orthotics.

Orthotics are designed to influence the forces applied to the foot. Yet, given standard analyses cannot measure force, without 3D gait data, there is no way to precisely understand what forces are applied, where and how large they are. We measure force in the TBL Complex Foot & Ankle clinic and can then use orthotic design principles to target and manipulate the forces applied to the body.

Using 3D gait analysis to design appropriate foot & ankle surgery.

In some situations we identify in the gait analysis that there is no function or control of a particular joint(s) and despite any best efforts in strength and conditioning or foot and orthotic prescription, the function of your foot is unlikely to improve without surgery. In this case, we work with our team of surgeons to develop the most appropriate procedure for you. We can also use the gait data as a baseline measurement to compare to in the rehab phase that occurs post-operatively.

When we look at what we can provide, what an appointment in the TBL Complex Foot & Ankle Clinic does is really take the guess work out of management and allows our team to make informed decisions based on real biomechanical data. It allows patients who have undergone surgery the ability to consult with Dr Bishop as to the best rehabilitation path forward.

At TBL we take great pride in this clinic. To conclude in the words of Dr Bishop:

“As a health professional, there is nothing more satisfying that seeing in front of your own eyes the clinical transition of a frustrated patient, a patient in pain who thought they needed to live with it for the rest of their life, and through our clinic, are transformed to a patient that can walk and function pain free. That’s what drives me to do what I do everyday.”

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