David Cloud, CPed, CFo, CPAO, wears many hats in his practice, but pedorthics is his passion.
The Tennessee certified pedorthist even calls the profession the love of his life.
“I grew up in O&P,” said Cloud, who is employed by A Step Ahead Orthotics and Prosthetics in Nashville.
“My dad worked for Hanger in Knoxville, and when I was a kid I spent a lot of time in the summers with him in his office. I loved it.”
Nonetheless, Cloud concedes that some orthotists and prosthetists are less than passionate about feet. “They don’t like dealing with feet,” he said with a grin. “You know, smelly feet. I’ve seen some really nasty feet, but it doesn’t bother me.”
He said about 80% of A Step Ahead patients are children, and he mostly fits children’s footwear and orthoses. Cloud loves to give away kids’ shoes, too.
“We send used shoes and braces to developing countries where people are in need. Also, when children come to us for braces or inserts, they get a free pair of shoes. We consider the shoe a part of the brace or the insert.”
A Vanderbilt University outpatient rehabilitation facility is across the street.
“We do a lot of work with the rehab center. I would say that 50% of our business is from them. We see patients here and over there.”
Path to pedorthics
Before his career took him to Nashville earlier this year, Cloud worked at Hanger in Knoxville, his hometown, and at an O&P facility in North Carolina.
“When I was at Hanger, they asked me if I wanted to be a CPed and I jumped right on it. I was the only CPed they had.”
Certified in 2009, he is the sole pedorthist at A Step Ahead.
Cloud took his first step toward certification by taking courses at the Robert M. Palmer, MD, Institute of Biomechanics in Elwood, Ind. “Because of my O&P background, I was able to help the other students with their lab work,” he said.
As an ABC-certified prothetist and orthotist assistant and orthotics fitter, Cloud works often with the orthotists and prosthetists at A Step Ahead.
He said triple certification “allows me to see more than just foot and ankle issues. I get to help with the orthotic and prosthetic side.”
Cloud has considered seeking certification as an orthotist and prosthetist. “But the fields have changed a lot. There are a lot more requirements. Right now, I’m happy with what I am doing.”
His job includes helping craft and fit upwards of 170 ankle-foot orthoses a month. “We see a lot of children with Down syndrome and cerebral palsy. But we also get kids with pes feet and flat feet.”
Diabetes patients — children and adults — come his way, too. “Patient education is so important,” Cloud said. “A lot of people don’t understand the disease. So you have to tell them the horror stories and how to prevent them.”
He cited a man with diabetes who worked in an auto parts store. “He stepped on a radio, and it made an ulcer on his foot. He couldn’t feel it and didn’t know he had an ulcer until he saw blood in the shower. People need to check their feet periodically every day.”
Cloud stresses to his patients that proper footwear can prevent the amputation of toes, feet and even legs. Flip flops are out, he said.
“They offer no protection. You can stub a toe or if you step on a rock or a nail, it can go right through the bottom of the flip flop.”
No such footwear is to be found in the stock room at A Step Ahead. “We measure adults for shoes and then order them. But we stock children’s shoes from infant size 3 to a child’s 7.”
All castings and custom inserts are made in the facility’s in-house lab.
Cloud said many of the therapeutic shoes A Step Ahead dispenses combine comfort and style. “When I first got into this field, the shoes were black and brown for men, lace or Velcro, and black, brown and beige for women, also lace or Velcro.
“Now, we can give patients a choice. That makes it easier for us and better for the patient.”
One of the choices, he adds, is a footwear line that is not strictly therapeutic — New Balance. He said the popular athletic footwear often can accommodate orthoses.
“That really helps with compliance. The patient sees everybody wearing New Balance, a name brand that is in style.”
He said fashion is not much of a problem with his older patients. “I don’t get a lot of resistance with them. But fashion is more of an issue with diabetes patients in their forties or late thirties. They want style.”
At the same time, he said, women of almost all ages sometimes balk at having to wear a larger size shoe. Cloud confesses it is not always easy convincing a woman she needs the extra room in what she puts on her feet. But he added that most of his patients trust him for his expertise and accept the size he says they need.
Gratitude gladly accepted
Several of his patients are more than just accepting; they are outright grateful to him and the staff at A Step Ahead. Some of their gratitude is framed and on the wall.
Cloud and the other A Step Ahead staff are proud of the handmade thank-you notes from kids and photos, several autographed, on display. “We get a lot of that. One little girl made me a finger painting.”
Other forms of gratitude quickly disappear into staffers’ stomachs. “Around Christmas, especially, patients bring us cookies and pies.”
Cloud, an avid runner, is able to burn off those extra holiday calories. Although he enjoys pounding pavement, he said he is most fulfilled straddling a fitting stool, casting for orthoses or running a lab grinder. “Being able to help people is the greatest thing about my job. I wouldn’t want to do anything else.”