Orthotics made by other professionals

[doclm]

Hello All,

I wanted to get your view on who's making orthotics in todays marketplace. I came across a couple chiropractic ads for making orthotics. Is this for real? Also, I see ads about getting foot neuropathy and biomechanics problems alleviated by a physical therapy group.

Is orthotics still in the future outlook for Podiatrists? Is this kind of foot work done by other groups going to hurt our future outlook on conservative foot care or our we going to be primarly involved in surgery? Seriously, are these people stepping on our feet?

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[Podman]

Hello All,

I wanted to get your view on who's making orthotics in todays marketplace. I came across a couple chiropractic ads for making orthotics. Is this for real? Also, I see ads about getting foot neuropathy and biomechanics problems alleviated by a physical therapy group.

Is orthotics still in the future outlook for Podiatrists? Is this kind of foot work done by other groups going to hurt our future outlook on conservative foot care or our we going to be primarly involved in surgery? Seriously, are these people stepping on our feet?

doclm,

the orthotics market has been utilized by the professionals you listed above for quite some time so this definately isn't a new phenomenon. In fact, you find them advertised everywhere these days because:
a) people will always have foot problems (age, activity, obesity, diabetes, etc)
b) people will always prefer conservative treatment over getting cut up with a knife on the OR table.

However, keep in mind that you are the Foot and ankle specialist - so for foot and ankle related problems, the patient will probably seek you first before seeking the chiropractor or the other professionals - so you get the first crack at evaluating and fixing the patients problems.

The good news is that those orthotics and some of the braces (i.e. the richie brace) are covered by insurance companies so the whole thing won't cost the patient money, but rather - he gets a top quality asessment and service by a foot and ankle physician and specialist.

I personally have problems with any professional expanding beyond his/her scope of practice. If a chiropractor or physical therapist has sufficient training in making orthotics the same way that podiatrists do, then I'm all for it by all means because the patient benefits with more options - since there aren't that many podiatrists to begin with. However, I would have a problem if the orthotics were done wrong and if they end up harming the patient due to a lack or competence on the part of the other health professional.

 

[gustydoc]

Hello All,

I wanted to get your view on who's making orthotics in todays marketplace. I came across a couple chiropractic ads for making orthotics. Is this for real? Also, I see ads about getting foot neuropathy and biomechanics problems alleviated by a physical therapy group.

Is orthotics still in the future outlook for Podiatrists? Is this kind of foot work done by other groups going to hurt our future outlook on conservative foot care or our we going to be primarily involved in surgery? Seriously, are these people stepping on our feet?

I have a brother in law who is a chiropractor in a group practice who just recently added orthotic dispensing to his practice. The way he explained it to me the orthotic manufacturing company (based out of Canada) supplied him with all of the diagnostic equipment and even paid to send him to a training session to learn how to use the equipment. It is essentially just a pressure plate hooked up to a computer that suggests a orthotic based on a patients weight distribution.
Obviously a far cry from what the patient would receive from a trained podiatrist. Right now insurance companies and the government do not reimburse chiros for orthotics so it would be an out of pocket expense which is discouraging to most patients. I do think there is cause for concern if people who do not have the proper training are dispensing orthotics with the potential to do more harm than good if they are misdiagnosed. The key is informing the public on the facts about who is and is not trained sufficiently to treat biomechanical disorders of the lower extremity. A recently trained podiatrist will not rely as much on orthotic dispensing as far as revenue, but we owe it to the public and our patients to make sure that anyone else who wishes to treat people with these problems has the proper training.

 

[Dr_Feelgood]

It all goes back to money. Some literature states that about 80% of the population would benefit about the same from OTC inserts compared to custom orthotics. Of course the orthotics last longer but when you compare $400 to $25, you can waste a few OTC inserts.

I am not a fan of anyone handing out orthotics. I am ignorant on the prescription writing abilities of PTs and DCs but custom orthotics are prescriptions. That has been the basis for shutting down many of the "Good Feet"stores. I think that training on making and molding orthotics is only half of the information. If you are not trained in the bio-mechanics than your training is lacking. Also, these claims that orthotics can cure everything from bunions to diarrhea is nonsense. If the patient use orthotics from birth then yes any pathology would be prevent, but this is never the case. Post-pathology they are told that these orthotics will help or even cure. This is misleading and never the case.

So to make a long story short, even as a pod in training I'll send my patients to get OTC Spenco's not $500 orthotics and PTs and DCs need to understand and research what they are doing or they are not better than those traveling snake oil salesmen ie the "Good Feet" stores.

 

[BackTalk]

I have been prescribing orthotics for years. There are quite a few insurance companies out there that cover custom molded orthotics (the kind we provide). I am not aware of Medicare paying for orthotics. I understand your concern with regard to turf. We have the same problems with physical therapists attempting to make spinal manipulation part of their scope. I can tell you that not every chiropractor provides orthotics but it is within our scope of practice and training. For patients with severe problems in the foot and ankle we refer to the podiatrist. I agree that you are the specialist when it comes to the foot and ankle. As a chiropractor our main concern is addressing excessive pronation or supination which many times will lead to knee, hip and or lower back complaints.

 

[oldManDO2009]

I purchased one of those pre-formed chiro orthotics and they are okay. After about 8 hours my feet are killing me. I just saw a pod and he took a mold of my foot and ordered custom orthotics and I have high hopes.

I am not sure I would see a chiropractor for foot problems - seems that is the realm of a pod and I would feel far more comfortable with the pod's evaluation.

 

[Dr_Feelgood]

I'm not concerned about turf, my concern is training and understanding how those inserts can effect the patient. If you put a diabetic in a ridgid misform insert and they get an ulcer, then we have real problems.

 

[BackTalk]

oldman, you shouldn't wear them 8 hours straight. You need to break them in first. Use a golf ball and gently glide your foot over it. Our orthotics are custom molded (at least the ones I prescribe). We make a cast.

 

[krabmas]

oldman, you shouldn't wear them 8 hours straight. You need to break them in first. Use a golf ball and gently glide your foot over it. Our orthotics are custom molded (at least the ones I prescribe). We make a cast.

can you explain what custom molded is? pods rx costum made functional orthotics.

 

[oldManDO2009]

oldman, you shouldn't wear them 8 hours straight. You need to break them in first. Use a golf ball and gently glide your foot over it. Our orthotics are custom molded (at least the ones I prescribe). We make a cast.

my ER shifts are 12 hours - by 8 hours I am in a very uncomfortable place. I started with jyst a couple of hours a day...

 

[BackTalk]

can you explain what custom molded is? pods rx costum made functional orthotics.

We take a weight bearing impression using a very light weight foam block for each foot. The cast is then sent to a company that does an analysis of the mold and then fabricates the orthotic.

 

[krabmas]

We take a weight bearing impression using a very light weight foam block for each foot. The cast is then sent to a company that does an analysis of the mold and then fabricates the orthotic.

then they are custom made/fabricated.

custom molded implies that the orthotic is prefab then heat molded in the office.

 

[Dr_Feelgood]

I would feel more comfortable w/ this if a pod prescribed and a PT or DC made and distrubuted. I just don't think they see enough pathology to do their customers right.

 

[krabmas]

I would feel more comfortable w/ this if a pod prescribed and a PT or DC made and distrubuted. I just don't think they see enough pathology to do their customers right.

why would you feel better if the PT or DC made the inserts?

we have pedorthists and other technical people to make the products. PTs and DC are not technically trained in materials and equipment to make orthotics.

I would feel better if orthotics were looked at like any other Rx. Do not prescribe something that you are not prepared to handle the mishaps of.

 

[Dr_Feelgood]

That is my point that they cannot prescribe or cast the patient, they can only make the orthotics. Pedorthotist are not that highly trained. I have a good friend that is a pedorthotist. He did most the training over weekends.

Again, when I say make the orthotics, they must get the same training as a pedorthotist. They can't just get some felt, poron and graphite and start making inserts.

Sam, I think we are on the same page. I think that only pods and F&As should prescribe inserts and then I don't care who makes them as long as they are trained. I don't think that PCP should prescribe inserts either, just like we don't prescribe diabetic prescriptions. Yeah we see the patients and we have unlimited prescription license, but we are not trained to care for that pathology. The same is true for orthotics.

 

[whiskers]

The more professionals that sell these things the better in my opinion. It's better for the patient because, in my opinion, they are outrageously priced and it isn't because of the fancy plastics etc used.

We're as qualified as the next guy in another profession to cast these little gems.

 

[Dr_Feelgood]

Casting - yes
Prescribing - no

Even though biomechanics of the lower extremity is imperfect. What we do know is extremely valuable. I also have heard mixed things about casting in w/ the biofoam. That STJ neutral is difficult to achieve making the orthotics fail.

 

[krabmas]

Casting - yes
Prescribing - no

Even though biomechanics of the lower extremity is imperfect. What we do know is extremely valuable. I also have heard mixed things about casting in w/ the biofoam. That STJ neutral is difficult to achieve making the orthotics fail.

yeah the biofaoms are crap. it is very hard to acheive anything other than a flat foot unless the patient has a rigid cavus foot.

there is a way to capture the foot in maximum supination or less - it is what solesupports uses to cast in biofoams but I think those orthotics are way too aggressive and painful.

a good way to acheive an arch is to tell the lab to not fill the arch.

 

[fpr85]

First off, I don't think pods, DC's, or PT's should be making orthotics (of course I'm a bit biased ). The biggest concern being, where does the patient go when they need adjustments made? The orthotics aren't necessarily set in stone, they CAN be adjusted! And why not let the person that works with orthotics day after day work on them, don't you guys have surgeries to worry about, do you really need a patient coming in complaining about something as minor as adjustments made to FO's? -- do you have the necessary equipment/materials to do so?

You don't know how many patients I've had come in to me (who have had their orthotics made by someone other than an orhotist/pedorthotist, whatever) and say
"Well I had this one pair, but they hurt like hell even after I broke them in".
(me) "Did you go back and have them adjusted?"
"No, they never mentioned that".

krabmas -- I only use the biofoams (plaster in severe deformities). You can easily achieve varying degrees of arch heights by manipulating the knees while the patient is seated. Then just slap on some M/L postings if needed.

I would say that L3020's are probably covered 20-30% of the time.

 

[Dr_Feelgood]

First off, I don't think pods, DC's, or PT's should be making orthotics (of course I'm a bit biased ). The biggest concern being, where does the patient go when they need adjustments made? The orthotics aren't necessarily set in stone, they CAN be adjusted! And why not let the person that works with orthotics day after day work on them, don't you guys have surgeries to worry about, do you really need a patient coming in complaining about something as minor as adjustments made to FO's? -- do you have the necessary equipment/materials to do so?

You don't know how many patients I've had come in to me (who have had their orthotics made by someone other than an orhotist/pedorthotist, whatever) and say
"Well I had this one pair, but they hurt like hell even after I broke them in".
(me) "Did you go back and have them adjusted?"
"No, they never mentioned that".

krabmas -- I only use the biofoams (plaster in severe deformities). You can easily achieve varying degrees of arch heights by manipulating the knees while the patient is seated. Then just slap on some M/L postings if needed.

I would say that L3020's are probably covered 20-30% of the time.

I can say the same for pedorthotist. Again, I don't care who makes them, I think that they should be controlled like a prescription. A pod or F&A needs to prescribe them. We have more people come in complaining about the inserts they got at "Good Feet" stores than from other pods, F&A, ect.

Again, as previously posted I am friends w/ a pedorthotist and I'm not bagging on the profession (I'm not going to make orthotics) but the training is not extensive. I do agree that numbers give experience, but I think that all custom made inserts should be prescription.

 

[krabmas]

First off, I don't think pods, DC's, or PT's should be making orthotics (of course I'm a bit biased ). The biggest concern being, where does the patient go when they need adjustments made? The orthotics aren't necessarily set in stone, they CAN be adjusted! And why not let the person that works with orthotics day after day work on them, don't you guys have surgeries to worry about, do you really need a patient coming in complaining about something as minor as adjustments made to FO's? -- do you have the necessary equipment/materials to do so?

You don't know how many patients I've had come in to me (who have had their orthotics made by someone other than an orhotist/pedorthotist, whatever) and say
"Well I had this one pair, but they hurt like hell even after I broke them in".
(me) "Did you go back and have them adjusted?"
"No, they never mentioned that".

krabmas -- I only use the biofoams (plaster in severe deformities). You can easily achieve varying degrees of arch heights by manipulating the knees while the patient is seated. Then just slap on some M/L postings if needed.

I would say that L3020's are probably covered 20-30% of the time.

I am not disagreeing that it is possible to acheive an arch with the biofoams but most people/pods do not know how to do this.

just sticking on medial and lateral postings can royally f_ck up the knee so be careful with that. I had a pair of running shoes posted at 3 degrees varus and got knee pain everytime I wore them. my orthotics are not posted.

and the pods prescribe the orthoses and techs usually make them I do not think that everyone in every lab is a pedorthist or orthotist. I know for fact at Langer they are not all C. peds. many times the orthotics come into the office not fitting the patient 100% and the pods have grinders and materials to make minor adjustments on the orthotics.

 

[Dr_Feelgood]

many times the orthotics come into the office not fitting the patient 100% and the pods have grinders and materials to make minor adjustments on the orthotics.

Bingo. PT, DC, and PCP don't general have the equipment or know how to alter the insert to make it work.

 

[xTinaBna]

Hello All,

I wanted to get your view on who's making orthotics in todays marketplace. I came across a couple chiropractic ads for making orthotics. Is this for real? Also, I see ads about getting foot neuropathy and biomechanics problems alleviated by a physical therapy group.

Is orthotics still in the future outlook for Podiatrists? Is this kind of foot work done by other groups going to hurt our future outlook on conservative foot care or our we going to be primarly involved in surgery? Seriously, are these people stepping on our feet?

I'm not in podiatry school..but i can tell you that my podiatrist gave me orthotics. He took a plaster casting of my feet, then sent those to a lab with his specifications, then i got them back after 3 weeks. Granted, he did have to send them back again to give me a softer cushion..but that is how the process was done from what i experienced this summer. i actually just hate orthotics (they hurt too much even with the softest cushion) and frankly it is not realistic that girls wear gym shoes all the time for orthotics.

 

[fpr85]

Everything we do is by prescription.

cbenedic there are many other options out there; UCBL's, Arizona braces (I read some of your other posts - arch reconstruction? - you may want to look around some because orthotics shouldn't be painful to wear after you break them in)

 

[xTinaBna]

Everything we do is by prescription.

cbenedic there are many other options out there; UCBL's, Arizona braces (I read some of your other posts - arch reconstruction? - you may want to look around some because orthotics shouldn't be painful to wear after you break them in)

thanks fpr85, yeah i'm looking around...my underlying problem is abnormal bone structure..that's why intuitively i didnt think orthotics would work anyway..but i gave it a shot for a month and couldnt stand it. i'll bring those options (ucbl, braces) up next time i go in

 

[Dr_Feelgood]

You can also pick up some over the counter inserts and see if they help. As for shoe gear. We suggest to women who want a dressier shoes to either a) look for the OTC "dress shoe/heels" inserts. They are much smaller and don't have a real heel cup or b) use velcro w/ sticky tape on the back and velcro the insert to sandals/dress shoes.