Clinical technology in practice

Andrew Schox

Podiatrist, software developer, technologist and futurist

Andrew is a podiatrist in private practice. He is also a software developer, technologist and futurist. He is a former Chair of the Australasian Podiatry Council as well as Advocare, and is the current chair of Melville Cares. He is a former director of the Australian and New Zealand Podiatry Accreditation Council (ANZPAC) and the Australasian College of Podiatric Deans (ACPD). Andrew is a graduate of the Australian Institute of Company Directors.

Alongside new developments, when it comes to our understanding of the lower limb and its problems, an ever-growing number of gadgets can be used to help assess and treat patients. Section editor Andrew Schox explains how we might choose, use and review these technologies in clinical practice.

As podiatrists, we have been using some technology for decades; such as nail drills or Doppler ultrasound. We also know that many more options exist in the marketplace.

Types of technology 


Here are some options that you may be very familiar with, mixed in with other examples that may not yet be on your radar.



Most of us have used ultrasound for treating musculoskeletal injuries and Doppler ultrasound for vascular assessment, but more recently podiatrists are using diagnostic ultrasound. There are a number of products available now which make this an affordable option in private practice. You may already be familiar with increasingly capable devices where the whole machine sits inside the handpiece and sophisticated software can help with image processing and interpretation.



Broadly speaking, there are two main applications for lasers in podiatry. The first is to treat musculoskeletal problems, where the goal is pain relief as well as settling inflammation and promoting healing. This may include trigger point therapy as just one example we would be familiar with as podiatrists. The second type of laser application involves using energy to burn, cut or otherwise damage tissues or organisms. Examples in this latter group include the treatment of verrucae or onychomycosis. More powerful lasers require licensing of practitioners before use.


Extracorporeal Shock Wave Therapy (ESWT)

This is no longer really ‘new technology’ since it’s been around for almost 40 years. But the use of ESWT has proliferated because of the treatment of various soft tissue pathologies in recent years. As with all clinical technology, best results are obtained by carefully screening patients to ensure that they are suitable candidates for this type of treatment.


Microwave therapy

This relatively new technology can be used in the treatment of warts. It heats the tissue (rather than burning it) and there are many benefits. These include a good success rate and short treatment times with no need for the patient to do anything in between treatments – and no wounds to look after.


Gait analysis

Here we can use video, pressure sensors and other methods to assess gait and movement. This can be as large as a treadmill with multiple videos, or as small as an in-shoe pressure plate. Increasingly, there is also wearable equipment and sensors available which can be used outside the practice and during the patient’s real-world activities and sport.


3D scanning

For the most part, our profession has embraced 3D scanning of the feet and legs, rather than the use of plaster and foam box casting. These scans consist of a topographical surface map of the structure, and in some cases can be overlaid with a photo, which can show surface features of interest. Scans can be sent to the lab over the internet – something which is hard to do with a plaster cast!


Orthotic manufacture

Practitioners can manufacture orthoses on-site using milling or printing machinery. Milling refers to removing material from a block of Ethylene Vinyl Acetate (EVA) for example, in order to produce an orthosis. Whereas 3D printing is an additive process, in that you start with nothing and add material until you have a finished product. Milling machines have been around for a long time, but 3D printing is an emerging area, which has huge potential as machines get cheaper and faster.

These scans consist of a topographical surface map of the structure, and in some cases can be overlaid with a photo, which can show surface features of interest. Scans can be sent to the lab over the internet - something which is hard to do with a plaster cast!

The process involved


Step #1: Choose

Once you’ve decided you might introduce a new type of clinical technology then you need to decide which particular product will be the best fit for you and your patients.


Like any clinician, you’ll want to dig deeper into the underlying technology and read some literature on clinical applications on real patients. No equipment is a magic bullet with a 100% success rate, but if you see good quality evidence that there is a significant improvement for specific problems, then it is more likely that you will find it a useful addition to your tool kit.


Step #2: Buy

The next step is to pay for this new equipment and the return on investment of course matters here. You would already be familiar with the payment options between buying it outright with your own funds or leasing the technology, and your accountant will be able to guide you through this process.


Back to the need for a return on investment though: If you are realistic about the costs of service provision (i.e. business overheads) as well as the cost of the equipment, then it might take some time for your new toy to start making money for you. Bear in mind that there may be additional benefits to your patients and practice which allow you to provide a better service. These things might help your positioning and reputation in addition to the prospect of earning more money.


Step #3: Use

Once you get the hang of using the equipment according to the instruction book, it is frequently tempting to then tweak how you use it – maybe as a result of your experience with it or perhaps as a result of something you’ve seen other users say online. A word of warning here: as tempting as it might be to experiment, if you ever get a complaint related to the use of your equipment and you haven’t been using it according to the manufacturer’s instructions, then you better have a convincing explanation as to why not.


Step #4: Market

There are several angles you can consider when designing a marketing strategy for your equipment.


  • It provides a new service or treatment option you didn’t have before
  • It enhances or synergises with your existing treatment approach, and;
  • It positions you (and your practice) as a forward-thinking, modern and cutting-edge service.


How to market services is outside the scope of this article, but in general, it’s good practice to describe the features of your product and what benefits can occur as a result of using it. Start with the benefits and then go into how the features create this outcome. Realistic, rather than grandiose descriptions of outcomes are also more likely to get satisfied patients who might refer others to you.


Step #5: Review

Now that you’ve read the evidence, tried the product and seen the results, how do you assess whether your experience is what was expected? Consider a small audit of your cases. Auditing your activity has several benefits:


  • You can give definitive data to future patients about actual outcomes of treatment
  • You can see if your equipment is matching the literature and meeting expectations, and;
  • You can claim some CPD points for it!


Key points:

  • Choose clinical technology which has a good probability of helping you to become a more effective clinician and serve your patients better. Avoid fads or equipment which does not have a reasonable evidence base for its use.
  • Ensure that there is a good business case (or at least a good marketing case) for getting it.
  • Market it in a way that enhances your practice and reputation, rather than chasing units of treatment.
  • Use it appropriately and with the patient’s best interests in mind.
  • Review your experience to make sure that it is working as expected.
  • Well-chosen clinical technology can enhance your practice, provide better outcomes for patients and position you as a modern, up-to-date practitioner. It is good for the profession to keep abreast of emerging technology and incorporate it into our practice where appropriate. Even if you are not in the market right now, keep an eye on developments in this area.