How often do Pod residents and Physicians prescribe Orthotics in their practice or rotations. We finished Biomechanics and now are studying Orthotics (casting, modifications, prescription,etc ) and i love the whole stuff.
I am observing a Podiatrist who has is own Orthotics Lab in the last week of february.
Please give me more insight about the orthotics, DPEMOS,etc in real life practice or during our residency.
I prescribe between 5-10 per month. I actually discovered podiatry because I was a biomechanics major in undergrad, so I (used to) love orthotics. While I still like biomechanics, orthotics are a pain in my butts.
The reason it causes me arsealgia is that:
1. Patients see orthotics as a product rather than as a treatment. Patients understand that not all treatments work all of the time, and are willing to move forward with more aggressive therapy if more conservative treatment does not provide adequate improvement. When you prescribe a pill and it doesn't work, you try a different pill or treatment. When an injection doesn't work, you try something else. When a topical doesn't work, you try something else. When a procedure doesn't work you might try it again.
When an orthotic doesn't work, the patient asks for their money back because they see it as something they bought rather than as a modality with which you treated their condition. When you try to remind the patient that orthotics are a custom device and can't simply be shelved and dispensed to someone else, you suddenly put yourself in the position of being the opposition rather than the facilitator. It's not a good place to be when you're trying to help heal someone. Something immediately dies in your doctor-patient relationship, whether the patient says so out loud or not.
2. Patients fixate on the orthotic as the main line of treatment. For instance, for heel pain let's say you prescribed rest, ice, stretching, NSAIDS, shoe changes, no barefoot ambulation, steroid injection, weight loss, and orthotics (not necessarily all at one visit). Then two months later their heel pain exacerbates. Guess what they schedule? "Orthotic check." "Hey Doc, these orthotics aren't working any more because my heel hurts again." Never mind that they gained 5 pounds, wore blown-out shoes, stopped stretching, went barefoot at home in their tile kitchen. It must be that the orthotics stopped working.
Of all the treatments I listed above, the orthotic is the only treatment that people can actually hold in their hands and see with their eyes. How quickly people forget the half-dozen other things you did. They fixate on the tangible devices in their shoes. Then they want you to adjust the devices over and over again, in hopes that you'll hit upon just the right tweak to "make them work again." Since they "already paid a lot of money for the orthotics" they object to paying a co-pay and to your billing for an office visit. However, if they were there for a medication, injection, or some other treatment they expect to pay their co-pay and to get billed.
3. I used to enjoy thinking about the forces and vectors and weights and measures, but in practicality when I see the product of all that mentation get placed into ill-fitting, poorly constructed, fit-for-the-trash bin $20 Keds from Wal-Mart, I ask myself, "Why bother?" Maybe podiatrists with more talent and/or patience than I can tolerate the back-and-forth tango, but I've grown wary of it. During my evaluation if think I see a sure bet, I'll prescribe the orthotics. Even then, when I've been certain orthotics would help I've had patients back in my office disappointed.
I have to add that even though some of the well-known biomechanists poo-poo the Bottom-Block (aka, M.A.S.S. or Sole Supports) method of making orthotics, I've had more success and ease with them than with Root, Blake, or other traditional methods. I'm sure a biomechanist would love to jump in here right about now and declare that it's just because I don't know what I'm doing, and that may be the case, but I've had enough dinking around with the grinder and Barge cement.
Nat