Muhaaa! Shill here.
I'm now carrying a prefab manufactured by a custom company. Its a custom killer - semi-rigid, lasts years, all the podiatry built ins. Customs dispensed in 2 years of practice? Zero.
I offer patients the chance to try mine ie. walk the halls, no pressure, but always give them maps to stores in town where they can buy Spenco Full Arch or Powersteps if they want to. People who work at McDonalds need to know there are products that are sub-$30 out there.
The Spenco full honestly works pretty well for non-cavus foot stress/strain, PTTD, TMTJ arch strain, PF, tiredness, etc. Add metatarsal bar for predislocation / metatarsalgia.
Call me crazy - I don't feel like Powersteps have longevity. I've pulled out quite a few Pinnacle or a Pulse Performance that have been flattened...
The prefab functional orthotic we carry is made by a custom manufacturer. When purchased in bulk it costs us $14. We sell it for $55 which is cheaper than anything in town except the Spenco above. It produces very angry reactions from people who paid for customs as most can't tell the difference between it and their custom. I have everyone who wants customs try it first and my custom-to-prefab-conversion ratio would have me fired if I was a NYC associate.
I hate customs. That said, for a time I would have said I had only seen quality customs. Now - everyone is prescribing customs. Chiropractors. Podiatrists. PT. There are some crap crap crap customs being stuck into peoples shoes. I semi regularly see heat molded non-custom crap pushed for $300-500. I've seen a patient pay over $1K for a "set" of orthotics that were all different neutral prefabs (if I recall this is a trick that the Good Feet store or something like that pulls - there's one in Des Moines). Even more frustrating is people paying through the nose for junk accomodative stuff that isn't going to last a year. Its as frustrating as people buying diabetic shoes/inserts and not realizing they were supposed to change out the insert or weren't actually provided more.
The only customs I've had ordered were on patients so complicated that I don't want to be the person stuck adjusting them. Call me terrible, I dump them on an pedorthist. Even at like the $350 that I think the bedworth is charges I don't really see how they make money on this unless they are amazing at adjusting them.
The number one reason a patient believes they need customs - a podiatrist already made them for them.
An MA in my office went to another DPM in town a few weeks before working for us. They had a mild bunion with no real pain and were prescribed customs on the spot, molded without a word, without a discussion of cost. First visit. The patient told me her insurance paid for them. They were uglier than my prefab.
Now for my ridiculous thing - when I look at other peoples customs, even good ones - they are honestly all the same. Like seriously, most customs are the same old crap that goes into everything - a heel cup, some medial skive, some posting. Its like we go through all this podiatry frou frou magic talk and then everyone produces the same looking product most of the time. There's a drawer in my office of customs that were prescribed years ago where the patients never picked them up. I really think you could stick them in like almost anyone's shoe who is mildly overpronated and they'd say they liked them.
Shill out.
