Orthotics in Practice

Discussion in 'Podiatric Residents & Physicians' started by cool_vkb, Jan 4, 2009.

  1. cool_vkb

    cool_vkb Member
    2+ Year Member

    Joined:
    Jun 24, 2006
    Messages:
    1,590
    Likes Received:
    3
    Status:
    Podiatry Student
    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.
     
  2. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    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
     
    #2 NatCh, Jan 4, 2009
    Last edited: Jan 4, 2009
  3. histreetken

    2+ Year Member

    Joined:
    Dec 27, 2008
    Messages:
    25
    Likes Received:
    0
    Status:
    Podiatrist
    @Nat:
    can you please briefly describe bottom block method compared to others.

    @everyone:

    What is the average cost for orthotics?
    Including shipping I pay $75.

    Do you get charged extra for modifications once the patient has tried them for a month or so? I dont have to pay.

    Are orthotics covered by insurance where you are located?

    thanks
     
  4. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    I couldn't explain it all here, other than to say that it allegedly uses the full range of motion of the foot rather than the neutral position casting method

    Best to catch a seminar or get the training video. He kind of comes off sounding like an infomercial, but Dr. Glaser (an Engineer and DPM) seemed to make sense of the principles when I heard him lecture. I know some traditional biomechanists disagree (yet admit to using his technique on occasion). All I know is that most (19 out of 20) patients love the result, but when they don't love it they hate it.

    http://www.solesupports.com/training.htm

    Depends on which lab I use. I'd rather keep my costs off the internet though. I'll PM you for specifics.

    Depends on the lab and how far after the initial casting date is the modification. I'm not one to make too many modifications though (see my dissertation above).

    Varies by insurance plan, but most seem to cover at least part of it.
     
  5. rom3o

    rom3o New Member
    7+ Year Member

    Joined:
    Mar 25, 2004
    Messages:
    157
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    All I have to say is Nat hit the nail right on the head with his response. As a c.ped, I see the above mentioned on a daily basis.

    This is a great, accurate statement:

    I am really looking forward to becoming a podiatrist, and even though they are probably a decent source of revenue, I am unsure if I would incorporate orthotics into my practice because of the headache that comes with them. It is probably better to send the patient to an orthotist or just to hire a c.ped on your staff.
     
  6. evander

    2+ Year Member

    Joined:
    Oct 24, 2006
    Messages:
    21
    Likes Received:
    0
    Status:
    Podiatry Student
    I'm interested what podiatrists think about orthotics in terms of evidence based medicine. From cochrane and pub med searches, I get the impression that orthoses have either not been shown to be effective and/or are no more effective than over the counter inserts.

    Do you think the evidence is insufficient or do you believe that orthotics isn't good medicine?
     
  7. OrthosisPOD

    Joined:
    Jun 23, 2008
    Messages:
    7
    Likes Received:
    0
    Status:
    Podiatrist
    I prescribe between 50 - 90 orthoses per month, and though I do a lot of adjustments to orthoses, I do not find it frustrating whatsoever. If you exclude dermatological issues, a majority of foot problems are mechanical. For any podiatrist to exclude orthotic therapy from their practice - or even to limit it - is akin to a an optomitrist saying that they will not prescribe eyeglasses or contacts because some patients have discomfort and need adjustment. Like everything else, success with orthotic therapy is determined by the practitioners education and experience. In every city, those podiatrists who stay up-to-date with orthotic therapy, who focus on evidence based orthotic therapy and have excellent orthosis troubleshooting skills will will have the most satisfied patients and the most successful practices.

    As far as patient understanding of orthotic therapy, it's just a matter of communication. Our patients understand from the beginning that the orthoses are only part of a complete treatment plan. If the role of orthoses is communicated effectively, patients understand their role and complaints are few.

    If you have an interest in orthotic therapy, start nurturing it now. Spend time with podiatrists who have successful orthosis practices. Take a month after residency and visit 5 or 6 of the top biomechanics practices around the country - it will pay off clinically and finanically for the rest of your career. If you need names, let me know.
     
  8. OrthosisPOD

    Joined:
    Jun 23, 2008
    Messages:
    7
    Likes Received:
    0
    Status:
    Podiatrist
    Evander,

    Over the past two decades a tremendous amount of literature has been published supporting the use of foot orthoses for many foot and lower extremity pathologies. This page lists just a few:
    http://footankle.com/Orthotic-Research.htm

    All good orthotic therapy education, whether in the schools or at seminars, is evidence-based. The evidence is there and orthotic therapy should not be taught any other way.
     
  9. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    Orthotics are just one treatment modality in podiatric medicine, and one can choose how to use his or her armamentarium. One should use whichever modalities with which he or she can get good outcomes, whether it be writing prescriptions, manual and physical manipulation, using a scalpel, or prescribing an orthotic. If your strength is in using orthotics, then by all means use it, but please don't judge. We all have our strengths and weaknesses, and I'll be brave enough to admit it.

    I think the optometry analogy doesn't quite fit because an optometrist has only one treatment modality (correct me if I'm wrong), but a podiatrist has numerous modalities from which to choose.
     
  10. OrthosisPOD

    Joined:
    Jun 23, 2008
    Messages:
    7
    Likes Received:
    0
    Status:
    Podiatrist
    Hi Nat,

    I apologize if I sounded judgmental - my primary point was to encourage students and residents to learn everything they can about orthotic therapy in order to promote both clinical and career success.

    A better analogy may have been an ophthalmologist. They have a number of modalities available, but must certainly be experts (or hire experts) at fitting glasses and contacts.

    Take metatarsagia as an example. If most metatarsalgia is due to excessive force on the metatarsal heads, then orthoses should be a primary treatment option. A total contact orthosis has been shown in numerous studies to reduce plantar forefoot force significantly - and far more than prefabricated devices. Only rigid rocker soles on shoes come close to total contact orthoses at reducing forefoot force.

    I discuss all treatment options with my metatarsalgia patients, but always discuss the benefits - and drawbacks - of custom orthoses. If the problem has been recalcitrent at all, most patients choose custom devices.
     
  11. rom3o

    rom3o New Member
    7+ Year Member

    Joined:
    Mar 25, 2004
    Messages:
    157
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    You must be damn good then, because all I do all day is orthotics and it usually takes me anywhere from 15-45 minutes to adjust, not to mention all the materials you have to purchase:

    Trautman sander
    heat gun
    poron - 1/16'', 1/8'', 1/4''
    neoprene
    barge cement and thinner
    pre-made scaphoid, met pads/bars, dancer pads etc....
    crepe
    etc...

    The point I'm getting at here is that it is very time consuming, and I know what it takes to adjust these things -- I just hope you're not one of those podiatrists that uses moleskin to increase posting, etc. not only does it not hold up well, it looks damn tacky too.
     
  12. OrthosisPOD

    Joined:
    Jun 23, 2008
    Messages:
    7
    Likes Received:
    0
    Status:
    Podiatrist
    I agree - not only is moleskin tacky, but it doesn't hold up.

    We have a small, but nice, lab with 3 grinders (sanigrinder, ticro cone to polish poly and a stone grinder for graphite/fiberglass), all of the modification materials, a carbon filter for fumes and, most important, a very well trained staff.

    Orthotic therapy is our specialty and the majority of our business, so we want to do it right.
     
  13. OrthosisPOD

    Joined:
    Jun 23, 2008
    Messages:
    7
    Likes Received:
    0
    Status:
    Podiatrist
    One other point:

    We have a smaller percentage of devices that require much adjustment as we take superb casts (only the doctors take the cast - never staff), write pathology specific prescriptions based on evidence based medicine, and and we use a very high quality lab who provide exceptional positive cast work.
     
  14. rom3o

    rom3o New Member
    7+ Year Member

    Joined:
    Mar 25, 2004
    Messages:
    157
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    Out of curiosity, what % of your business (revenue-wise) is foot orthotics? Do pods frequently prescribe AFOs too? Do you also adjust the orthotics or do you have the techs do it?
     
  15. OrthosisPOD

    Joined:
    Jun 23, 2008
    Messages:
    7
    Likes Received:
    0
    Status:
    Podiatrist
    Our practice is by no means the norm, as we specialize in orthotic therapy. But just about 50% of our revenue for 2008 was orthotic devices.

    We also provide custom and prefab AFOs. But AFOs are a relatively small % of business.

    I think the take-home on this is that the most successful podiatrists will be those who specialize and are seen as THE expert in something. That could be orthotic therapy, wound care, sports medicine, pediatrics, surgery, etc. The key is to be seen as the go-to person for a particular specialty area of podiatric practice.

    For those who are still in school and have an idea what specialty area of podiatry interests them the most, I would start spending as much time as possible with podiatrists who have that type of practice. For the most part, most residencies train you to be podiatric surgeons. If you want to become an expert in these other areas, you will need to find one of the few available fellowships or find the training on your own.
     
  16. OrthosisPOD

    Joined:
    Jun 23, 2008
    Messages:
    7
    Likes Received:
    0
    Status:
    Podiatrist
    I have trained my medical assistants to do about 90% of our orthotic adjustments. I do the rest and continually train them to do more. We base a portion of their pay on the number of adjustments with which they are proficient.
     
  17. PADPM

    Removed 2+ Year Member

    Joined:
    Feb 22, 2009
    Messages:
    1,659
    Likes Received:
    26
    Status:
    Attending Physician
    First of all, I think that the first post written by NatCh was an EXCELLENT post that really hit the nail on the head. I really could not have stated my feelings any better than NatCh.

    Obviously, OrthosisPOD has a "niche" practice so is an exception to the rule. However, in many cases I believe that a lot of DPM's simply over-prescribe custom orthoses with little to no true understanding of biomechanics, and really end up using a "one size fits all" approach to orthotic therapy.

    I know of many DPM's who simply recommend orthoses for every ailment from ingrown nails to bunions and everything in between. And ever pair of orthoses that is dispensed looks exactly the same, despite the patient's pathology. Unfortunately, many of our colleagues see orthoses as an excellent money maker since there is a very good profit in this modality.

    Unlike OrthosisDPM, who obviously has made this his specialty and takes pride in his product and practice, and understands the "science" of what he is doing and prescribing, there are unfortunately others that aren't quite as ethical.

    So, there is no easy answer to your original question. The bottom line is that you must prescribe orthoses to patients when YOU truly believe they are indicated and IF you understand the pathology and understand the underlying biomechanical etiology you are attempting to address.

    Yes, orthoses will increase your bottom line, but that can not be your motivation.
     
  18. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    Here we go again...

    Just this morning my receptionist gets a phone call:


    Receptionist: "Good morning. Dr. NatCh's Foot Parlor. How may I help you?"

    Caller: "Is there a money back guarantee with these orthotics? I hate them. My feet still hurt."

    Receptionist: "I can schedule you to come in so that the doctor can take a look at them to see if they need to be adjusted, or to see if something else needs to be done."

    Caller: "But they really hurt my feet!"

    Receptionist: "It usually takes awhile to get used to them [I dispense both written and verbal instructions detailing a three week break-in period, by the way] and you just got them two weeks ago, but if they really hurt the doctor can examine you to see if there's something that needs to be done."

    Caller: "I don't want to come in! I just won't wear them! They don't work! I hate them, I hate them! [click...dial tone].


    Lovely.
     
  19. 215512

    Joined:
    Jul 24, 2008
    Messages:
    629
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    its like when someone doesnt like their burrito at taco bell
     
  20. cool_vkb

    cool_vkb Member
    2+ Year Member

    Joined:
    Jun 24, 2006
    Messages:
    1,590
    Likes Received:
    3
    Status:
    Podiatry Student
    Parlor?:)
     
  21. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    Parlor, Emporium, Mercantile...take your pick.
     
  22. streetsweeper

    10+ Year Member

    Joined:
    Dec 5, 2008
    Messages:
    83
    Likes Received:
    45
    Status:
    Podiatrist
    :thumbup: I want to shadow this pod
     
  23. rom3o

    rom3o New Member
    7+ Year Member

    Joined:
    Mar 25, 2004
    Messages:
    157
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    Meh, I get a few of those patients every now and then... fortunately for the time being, as an orthotist, once I've adjusted them as much as I can, I just refer them back to their doctor, lol.
     
  24. Podmeister

    2+ Year Member

    Joined:
    Mar 8, 2009
    Messages:
    125
    Likes Received:
    1
    Status:
    Podiatrist
    Orthotics are fun to cast and I can't believe some pods are using the foam impression boxes.
     
  25. Podmeister

    2+ Year Member

    Joined:
    Mar 8, 2009
    Messages:
    125
    Likes Received:
    1
    Status:
    Podiatrist
    Aside from Valmassy's text on Biomechanics, any good books on sports medicine? Feedback appreciated.:thumbup:
     
  26. rom3o

    rom3o New Member
    7+ Year Member

    Joined:
    Mar 25, 2004
    Messages:
    157
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    Haha, I probably use foam boxes 98% of the time, only cast if they have severe varus/valgus deformity; severe pes planus/cavus.

    Too time consuming to cast
     
    #26 rom3o, Apr 14, 2009
    Last edited: Jun 17, 2009
  27. PlainsPod

    PlainsPod Junior Member
    7+ Year Member

    Joined:
    Feb 12, 2006
    Messages:
    10
    Likes Received:
    0
    Status:
    Attending Physician
    To be honest I did not do much in the way of orthotics during residency, but the other doctors in the group I joined are great with it and I went back to the basics on casting, etc. I now utilize them quite frequently and have enjoyed great success with all types of orthotic devices (this includes AFO's).
     
  28. footguru

    Joined:
    Jun 11, 2009
    Messages:
    1
    Likes Received:
    0
    Status:
    Other Health Professions Student
    I just used a scanning system that was easier than plaster splints or bio-foam. Patient just walked across 3 times and done. This is a must for me and i will be doing orthotics by the truck load when I get started.:thumbup:
     
  29. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    Ooof.
     
  30. PADPM

    Removed 2+ Year Member

    Joined:
    Feb 22, 2009
    Messages:
    1,659
    Likes Received:
    26
    Status:
    Attending Physician
    Comments like this are simply scary and I certainly hope that the poster is "just kidding".

    First of all, when you go into private practice, patients aren't simply lined up at your door waiting to spend several hundred dollars so you can "do orthotics by the truckload". Practice 'ain't that easy.

    Secondly, I hope that when you get into practice you aren't one of those doctors that makes the patient fit the treatment. There is a great profit in custom orthotics, and many DPM's abuse the trust the public places in us by over-prescribing custom orthotics for every ailment patients have.

    Orthotics definitely have their indication, but many patients don't need them. Never make a pair of custom orthotics simply to add to your income. Once you cross that line, you'll set a practice pattern that will continue and roll over to other areas of your practice.

    And although walking across a mat 3 times is certainly quick and easy, did you ever follow up to see if the quality and fit of the orthotics dispensed was up to par? Speak with those that are well versed on biomechanics and see what THEY think about the Metascan system.

    Quick and easy is just that, but doesn't always equate with quality.
     
  31. SportPOD

    SportPOD Arizona Sports Pod
    Lifetime Donor Verified Account 10+ Year Member

    Joined:
    Feb 19, 2007
    Messages:
    214
    Likes Received:
    1
    Status:
    Attending Physician
    Nothing like prescribing a flat piece of plastic! :thumbdown:
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  32. Podfather

    7+ Year Member

    Joined:
    May 10, 2009
    Messages:
    455
    Likes Received:
    7
    Status:
    Attending Physician
    Oh the "magic shovels". Less than a hundred dollars to buy and sold for 300-1000 dollars. Many patients who never had a foot problem get plantar fasciitis once and bam they are told you need a prescriptive device for life. Utter nonsense. I have been in practice for 24 years and find that for the most common foot conditions an OTC device works 95% of the time. Now I will be told how wrong I am and that I disgrace the profession with their dominance in biomechanic but the majority of my honest peers admit to foam boxes, scanning and posting to the deformity. Solid biomechanics! How many DPMs actually look at the rest of the chain to the spine. Most do not even look for tibial varum....... I reserve prescriptive devices for hard to control feet (hypermobility, cavus feet) or as a device to offload a specific area.
    For the rest Spenco works fine.................
     
  33. rom3o

    rom3o New Member
    7+ Year Member

    Joined:
    Mar 25, 2004
    Messages:
    157
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    Podfather, what OTC FOs do you like the best and recommend to your patients? The best I've seen, IMO, are superfeet. Most others seems to compress and collapse upon weight bearing.

     
  34. PADPM

    Removed 2+ Year Member

    Joined:
    Feb 22, 2009
    Messages:
    1,659
    Likes Received:
    26
    Status:
    Attending Physician
    I am personally not a huge fan of Superfeet, since my patients haven't given me great feedback with this product. My patients have had great results using PowerSteps, which I personally believe are an excellent product and a product that has financially supported our profession (so has Spenco).

    From a practice management standpoint, I tend to attempt to stay away from recommending products that a patient can walk into a store and purchase. They can purchase Superfeet and Spenco in many stores. Although they can purchase PowerSteps in some stores and online, there is a medical professional line that is sold exclusively to medical professionals that can not be purchased anywhere but in doctor offices.

    I don't do this just to make an extra buck. I do this for two reasons; the first reason is that I personally believe SOME patients feel "short-changed" when they come to your office and you send them to the local pharmacy or sporting goods store to buy a product. I feel that sometimes these patients then believe they could have simply done that without having to come to your office. Secondly, if that patient has a friend or relative with a similar problem, he/she will tell the friend or relative that there is no need to make an appointment with you, since all that the person has to do is go to the store and purchase the same product you recommended.

    By having a product in your office that is not available in the stores or online, it simply seems more professional and gives patients a reason to be seen in your office.

    Of course this is my opinion regarding the practice management issue, but I still believe that the PowerSteps are a great product. Although I have several pairs of custom orthoses, I am presently wearing a pair of PowerSteps in my shoes as I'm writing this note.
     
  35. Podfather

    7+ Year Member

    Joined:
    May 10, 2009
    Messages:
    455
    Likes Received:
    7
    Status:
    Attending Physician
    They can purchase Superfeet and Spenco in many stores.

    My Plantar fasciitis patients have done well with the Spenco devices and I like the fact that they can be bought in many stores. We actually give the patient a list of local merchants who carry them.

    Although they can purchase PowerSteps in some stores and online, there is a medical professional line that is sold exclusively to medical professionals that can not be purchased anywhere but in doctor offices.

    I don't do this just to make an extra buck. I do this for two reasons; the first reason is that I personally believe SOME patients feel "short-changed" when they come to your office and you send them to the local pharmacy or sporting goods store to buy a product.

    The Spenco device is usually just a portion of the treatment plan. Injections, strapping, NSAIDS, occasionally night splints are often utilized. I do not feel that most feel short changed. They appreciate the fact I am offering a lower priced OTC rather persuading them to purchase prescriptive devices.

    I feel that sometimes these patients then believe they could have simply done that without having to come to your office. Secondly, if that patient has a friend or relative with a similar problem, he/she will tell the friend or relative that there is no need to make an appointment with you, since all that the person has to do is go to the store and purchase the same product you recommended.

    I do not have a problem with a friend or relative trying the OTC device. If it works great if not then they come to see me. I wish more Americans would try to letting nature take it's course and try some common sense treatments before running off to the doctor and demanding antibiotics for a cold.
     
  36. PADPM

    Removed 2+ Year Member

    Joined:
    Feb 22, 2009
    Messages:
    1,659
    Likes Received:
    26
    Status:
    Attending Physician
    Podfather,

    I've been in practice a long time, and hope you didn't take my post out of context. It was not a critique of your post or the way you practice. In case you didn't notice, I'm in complete agreement that custom orthoses are completely over-prescribed and often unnecessary, and that's why I often dispense OTC devices.

    Naturally, I never implied that your only treatment regimen was to recommend Spenco devices to your patients without also providing other treatment choices such as tapings, strappings, injections, night splints, change of shoes, stretching exercises, etc.

    I think comparing a patient coming to my office or your office for treatment for heel pain or another condition is not a valid comparison to a patient running to a doctor to demand antibiotics for a cold, etc. I personally believe that heel pain is not a one size fits all treatment plan, and often when patients "self treat" other diagnoses can be missed.

    My point was that in MY OPINION when a patient is told to go to a store to buy an OTC device and his/her friend has "the same problem", that friend really does not know if he/she has the same problem until a professional evaluates the situation. Not all heel pain has the same etiology, and as you know, it's very simple for one patient to tell another patient "I've got the same exact problem" when in fact the two diagnoses differ.

    However, we may obviously disagree on this point, though we obviously agree that custom orthoses are often over-prescribed and not necessary. In my practice I have found that patients benefit greatly by utilizing PowerSteps at a fraction of the cost. Additionally, by having them dispensed in my office I can make sure the product fits correctly and is placed in the proper shoes, etc.
     
  37. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    I do not recommend to my patients any specific OTC insole. What feels good to one person may feel bad to the next since they are made to fit the masses, and if they happen to feel bad they blame you for recommending them. For instance, Podfather likes Spencos but I've tried them myself and think they feel terrible. I think Superfeet are "okay." I do not know of Power Steps.

    If I feel inclined to suggest an OTC device, I suggest a couple of different retail stores that have knowledgeable staff. There are numerous brands that people seem to like, such as Sole and Downunders.

    I agree with PADPM that people feel shortchanged if you offer an OTC treatment or home remedy. As far as orthotics are concerned I sometimes phrase it, "You can try an over-the-counter arch support first if you'd like, and I can recommend a couple of stores, but if that's unsatisfactory then we can pursue a prescription device." I like to make it the patient's decision.

    I don't push orthotics because of the glutealgia they cause me (see post #2 in this thread).
     
  38. Podfather

    7+ Year Member

    Joined:
    May 10, 2009
    Messages:
    455
    Likes Received:
    7
    Status:
    Attending Physician
    My point was that in MY OPINION when a patient is told to go to a store to buy an OTC device and his/her friend has "the same problem", that friend really does not know if he/she has the same problem until a professional evaluates the situation. Not all heel pain has the same etiology, and as you know, it's very simple for one patient to tell another patient "I've got the same exact problem" when in fact the two diagnoses differ.

    I did not take offense or consider it a critique. As far as above if they have the same problem or a different problem and a Spenco devices cures it then great. If they have plantar fasciitis or another cause of heel pain and they don't improve then they will come to me. Again my patients appreciate that I try these first rather than prescriptive orthotics and don't feel short changed. I do spend considerable time explaining their condition.
     
  39. PADPM

    Removed 2+ Year Member

    Joined:
    Feb 22, 2009
    Messages:
    1,659
    Likes Received:
    26
    Status:
    Attending Physician
    NatCH,

    Prior to recommending any product, I always give it a "test drive" myself, since I've had recurrent plantar fasciitis and I'm very active. In one of our offices I have a huge basket filled with at least 40-50 different brands that I've tried over the years from Superfeet, to Lynco, to Soles, to Downunders, to Vasylii to Alimed, etc.

    I have NO financial interest in the company, but have found PowerSteps to consistently be the most well tolerated product and the product that provides the greateast relief for my patients and for me.

    They make a variety of products both for the consumer that can be purchased online and a specific line that can be purchased only by medical professionals. And as stated before, the company gives a nice amount back to the profession and I know the owner recently donated money for a lab for OCPM.

    They make full length and 3/4 length products and just came out with a product that actual has a rearfoot post and it comes with "snap on" pieces similar to Legos that can change from zero degrees, 2 degrees or 4 degrees varus.

    If you call the company, they'll be happy to send you a couple of samples. It's a great product for your patients, even if you don't want to sell them in the office, the products they can purchase online are excellent. You should check out their website.

    I actually wear them in my loafers, running shoes and soccer cleats instead of my custom orthoses.

    Hey, maybe I should quit practice and join their sales force.
     
  40. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    This one?
    http://www.powersteps.com/_medical/medical.asp?page=1

    Thanks for the tip. I just sent off for a sample.
     
    #40 NatCh, Jun 16, 2009
    Last edited: Jun 16, 2009
  41. PADPM

    Removed 2+ Year Member

    Joined:
    Feb 22, 2009
    Messages:
    1,659
    Likes Received:
    26
    Status:
    Attending Physician
    Yes, that's the product. I use the full length in my running shoes and the 3/4 "slim tech's" in my casual loafers and soccer cleats.

    Now you'll have to give me credit if you start running faster, jumping higher......

    Seriously, I hope you like the product because my patients have had tremendous success and relief with this product without having to spend hundreds of dollars on custom orthoses. Naturally, there are still patients that will require custom orthoses, but this certainly fulfills an important role in my office.

    Many of my colleagues and even my partners don't understand why I offer these to my patients, since there isn't much profit vs. custom orthoses. But I believe that if I can make my patient comfortable at almost 1/10 the cost, I've done my job well.

    It's not always about the $$$.
     
  42. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    If I find myself on the podium I'll be sure to give you a shout out. "I'd like to thank my sponsors and also PADPM..."
     
  43. rom3o

    rom3o New Member
    7+ Year Member

    Joined:
    Mar 25, 2004
    Messages:
    157
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    I never recommend OTC FOs to patients. Number 1, because I have to follow the rx written by the doc. Number 2, I only ever will recommend a pair of OTC FOs to patients if they ask what they can use for their dress shoes, etc.

    You guys keep referring to spenco. As far as I know, spenco is just the top cover, aka, neoprene, correct? What is the framing like -- don't these FOs usually just compress upon weight bearing? Sure they are good for cushioning and shock absorption, but how do they hold up for pes planus, PF, etc?

    Only reason why I've recommended Superfeet is because their L.A. seems to hold up pretty well. I have seen powersteps come through our office before, I can't remember them too well though. I should probably start testing out some of these products too.
     
  44. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
    Spenco has a few different versions including a three-quarter length model with a plastic arch support and a full-length model with the yellow rubbery arch support. I've tried both and did not like either one.
     
  45. rom3o

    rom3o New Member
    7+ Year Member

    Joined:
    Mar 25, 2004
    Messages:
    157
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    So it's a brand name?
     
  46. NatCh

    10+ Year Member

    Joined:
    May 20, 2007
    Messages:
    1,263
    Likes Received:
    325
    Status:
    Podiatrist
  47. Podmeister

    2+ Year Member

    Joined:
    Mar 8, 2009
    Messages:
    125
    Likes Received:
    1
    Status:
    Podiatrist
    I was at the Western Conference (Anaheim,CA), stopped by the Powerstep booth and picked up a sample of the "slim tech". I've tried it out and so far so good.
     

Share This Page