Getting patients to use custom orthotics

[Frank Stephens]

Anyone having trouble getting patients to use custom orthotics?
I find that I am having trouble getting patients to use custom orthotics. They feel that they are not comfortable. So they don't wear them. Or they have had them in the past and didn't wear them and are not willing to pay the cost for customs.
As an alternative I find that they are happy with the Spenco brand arch supports. I find that when given a choice of something comfortable, they wear them. And as a result they get support that they need.
My feeling is that by wearing support, they are getting the correction, and that is what is important.
I found a great source on them where I order them online, mark them up, for handling, and the patient is still ahead $$$ as they only pay about $50. My cost is about $26.00

http://www.spenco-arch-supports.com



What are your thoughts?

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[Dr_Feelgood]

Anyone having trouble getting patients to use custom orthotics?
I find that I am having trouble getting patients to use custom orthotics. They feel that they are not comfortable. So they don’t wear them. Or they have had them in the past and didn’t wear them and are not willing to pay the cost for customs.
As an alternative I find that they are happy with the Spenco brand arch supports. I find that when given a choice of something comfortable, they wear them. And as a result they get support that they need.
My feeling is that by wearing support, they are getting the correction, and that is what is important.
I found a great source on them where I order them online, mark them up, for handling, and the patient is still ahead $$$ as they only pay about $50. My cost is about $26.00

http://www.spenco-arch-supports.com



What are your thoughts?

EBM states that OTC is as good as custom for most people. So why use them is you are treating everyday pathologies such as heel pain, pes planus, or metatarsalgia? I would reserve them for very specfic populations and then you must take the time to explain a slow "break in" schedule; adding no more than 1 hour each day.

At BMC they give away Alimed orthotics, but in a private setting I would sell OTC inserts to customers.

 

[SportPOD]

Anyone having trouble getting patients to use custom orthotics?
I find that I am having trouble getting patients to use custom orthotics. They feel that they are not comfortable. So they don’t wear them. Or they have had them in the past and didn’t wear them and are not willing to pay the cost for customs.
As an alternative I find that they are happy with the Spenco brand arch supports. I find that when given a choice of something comfortable, they wear them. And as a result they get support that they need.
My feeling is that by wearing support, they are getting the correction, and that is what is important.
I found a great source on them where I order them online, mark them up, for handling, and the patient is still ahead $$$ as they only pay about $50. My cost is about $26.00

http://www.spenco-arch-supports.com



What are your thoughts?

Do you use plaster or foam boxes? Does your orthotic company fabricate for specific pathologies or do they have one size fits all. Do you examine the old orthotics and see if you can modify them to fit the patient properly?

I've had no problems prescribing custom orthotics to my patients. 80% of my patients request orthotics at the time of the visit (without even getting my opinion on if they need it or not). I mainly prescribe orthotics to a patient who if failing my usual conservative approaches.

 

[NatCh]

I'm not a big fan of those Spencos. When I recommend an OTC device I send patients to get Superfeet. If you're having really poor patient tolerance then maybe a different lab would be worth looking at. If that's not the case then could it be your casting technique or prescription?

Having travelled around the country I've noticed different prevailing attitudes in general patient populations, so maybe your local populace is particularly challenging. Athletic populations are more open to an expensive orthotic, whereas some beat-down areas (Leavenworth, KS instantly comes to mind) pretty much aren't open to anything.

Edit: This brings up a point, something not really taught but something gained (hopefully) after interacting with people for a long time-- When you first meet a patient you have only a few minutes in which to "size them up." You need to be able to get a feel for a person and "where they're coming from" in order to propose a treatment plan that will work for them. Some people will find a custom orthotic for several hundred dollars is ludicrous, and others will find it a great idea. Some people want you to decide for them what to do, others want to be involved in the decision-making. We are taught to do conservative measures prior to surgery but if the patient doesn't want to follow your conservative advice and he or she never comes back, then you haven't really gotten anywhere.

Nat

 

[doclm]

Anyone having trouble getting patients to use custom orthotics?
I find that I am having trouble getting patients to use custom orthotics. They feel that they are not comfortable. So they don’t wear them. Or they have had them in the past and didn’t wear them and are not willing to pay the cost for customs.
As an alternative I find that they are happy with the Spenco brand arch supports. I find that when given a choice of something comfortable, they wear them. And as a result they get support that they need.
My feeling is that by wearing support, they are getting the correction, and that is what is important.
I found a great source on them where I order them online, mark them up, for handling, and the patient is still ahead $$$ as they only pay about $50. My cost is about $26.00

http://www.spenco-arch-supports.com



What are your thoughts?

I've seen many patients happy with accommodative OA's casted partial weight bearing using Biofoam. These can be adjusted to the patient, feels comfortable to the patient within days, and do change the function of the patients foot. Although they are not hard plastic "functional" , you got to know that they do change the function of the foot. However, if your looking to compensate a large frontal deformity or flexible flat foot, those hard plastics will have to be your first choice. (functional non-weight bearing plaster/STS sock or UCBL respectively)

However, if you are not really good at biomechanically adjusting these custom OA's to the patient's concerns or shoe gear, your probably better off sticking with spenco, superfeet, or some "non-custom orthosis" just to redistribute plantar pressures.

 

[Dr_Feelgood]

FYI: No matter how you cast many of the large custom orthotic companies use premade inserts. This is especially true if they use laser scanning. They have the most common foot types saved in a computer. They scan the positve cast and the computer picks out the most appropriate insert. Really custom huh?

 

[doclm]

FYI: No matter how you cast many of the large custom orthotic companies use premade inserts. This is especially true if they use laser scanning. They have the most common foot types saved in a computer. They scan the positve cast and the computer picks out the most appropriate insert. Really custom huh?

You must be talking about the PedAlign system that will scan patients feet full weight bearing and send back a pair of OA's via mail. Many DPM's will just have their patient stand on the glass and scan both feet at the same time in RCSP. However, there is one method that I seen that does incorporate some type of biomechanics into this scan. There is an option to scan one foot at a time, where you have the patient invert their foot and slowly roll it back to NCSP, and then try to place the foot in STJn and MTPmp(which is just about impossible). After you scan one foot, you do the same to the other foot.

 

[theszak]

"There is an option to scan one foot at a time, where you have the patient invert their foot and slowly roll it back to NCSP, and then try to place the foot in STJn and MTPmp [Metatarsolphalangeal mp? Position] (which is just about impossible)."

"MTPmp"... please explain acronym, particularly lower case part of acronym "mp"!

 

[de Ribas]

"MTPmp"... please explain acronym, particularly lower case part of acronym "mp"!

this thread is 10 years old.