Orthotics Labs

[bloxxeeey]

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What orthotics labs are people using? Our resident clinic is looking to reach out to a few companies as potential suppliers and I've been tasked with it but don't know where to start.

 

[Pronation]

I just send everybody to the good feet store

 

[Feli]

There is pretty much ProLab and then all of the others... in terms of quality.

There are literally dozens of mail order ones available, though. Just go to any APMA meeting 😛

Orthotics have a role, but they are such a customer service nightmare that it is often best to just Rx them out (best info possible on Rx regarding the foot pathology, accomod vs functional, etc) if you have good custom DME places nearby. Those places will respect you and send you surgical stuff that is failing insoles/shoes/brace in return. It is not worth trying to save a few bucks with Value-Thotics or pushing custom orthotics and dealing with the many orthotics customer service issues that may follow, jmo. You will lose patients. If you do too much grinding of heel posts and fiddling with sweet spots, you will have to apply for a vanity license plate with TFP on it.

...So yeah, I do pre-fabs (PowerStep, Spenco, PureStride, soft DM prefab insoles, etc type), add a pad if useful, let pts go buy those from running or sports store (accomodative at drug store), etc for the majority. The research for custom orthotics being superior to prefab for most fairly regular foot types and common deformities is conflicting at best... hence very few payers covering customs.
Second choice, in my hands, is give written Rx for custom orthotics out for ortho store for tougher situations (cavus, advanced flatfoot, big deformity, prior surgery, amp/filler, AFOs, etc).
Third choice is that I make a custom cast for someone who did good with prefabs but wants something more durable (basic arch/heel, metatarsalgia, etc). That can still backfire for even the easiest plantar fasciitis patients... expectations are often just way too high for the $300 $400 $500 etc... buyer remorse, not quite perfect, etc. I side step that whenever reasonably possible.

Another thing worth mentioning is that it is nice to re-cover or re-surface orthotic shells people have and like. So yeah, any DPM needs a lab or good place to send them. That re-surfacing's almost a slam dunk to work well and be cost-effective, so every DPM office should have a lab that does that service well.

Like the nail care, I just don't think custom DME in-office is a huge part of any modern podiatry practice. There are rare exceptions of DPM practices employing an orthotist with a mini-lab, but those are fading away. And frankly, a real dedicated custom shop with good orthotist(s) is going to be better than nearly any DPM nowadays... this isn't CCPM in the 1970s anymore (but you can re-cover those shells). 🙂

 

[air bud]

Powersteps.com is a great orthotics lab.

99.XXX percent of people don't need custom orthotics. People that have true deformity and need custom should be having them made by a real professional ie a orthotist. It is just a cash grab. But hey that's Podiatry.

Fight me.

 

[Feli]

Powersteps.com is a great orthotics lab.

99.XXX percent of people don't need custom orthotics. People that have true deformity and need custom should be having them made by a real professional ie a orthotist. It is just a cash grab. But hey that's Podiatry.

Fight me.

This dude always says what I say in 5-10% of the words.

Thank gawd my mom got me a Type-Right when I was a youngster. 😆

 

[PeaJay]

I have decent luck with allied labs.

I however avoid customs. Only really do new customs for people that already have a set and swear by them . Otherwise powersteps for adults and superfeet for kids.

 

[billBOB213]

Used to send everyone to Powerstep’s (as I agree with the above that MOST people do great with them and anything with true deformity send out to Hanger)
But recently I have been sending people to Move.one for their inserts. The Game Day Pros are what I use myself. I bought them on a Black Friday deal ha.
I used to use p-steps but the moves hold up better and the topcover doesn’t wear out as fast. Little more expensive than p-step but I personally like them.

 

[heybrother]

If you ask this question on IPED the universal answer will be Forward Motion. Starting cost is an ipad + 3-D scanner. They'll sell you a pair of functionals for like $90. It makes up a tiny portion of my business (like 6 pairs in 3.5 years). I left residency very hostile to customs, but my experience with the above was patients were pleased. I'm more than happy to refer out anything complicated and I have zero interest in ever making an AFO.

Everything everyone has said above is true. The vast majority of patients who want to try an orthotic should try a prefab. Customs are "sold" in the vast majority of cases. I briefly employed an MA who saw another podiatrist about a month before working for us. The other podiatrist literally casted her at her first visit for the world's tiniest bunion and she told me she never used the customs.

The financials of customs are complicated.

-Even when insurance pays for them - they often spend months reviewing the claim.
-There is a drawer at my office - not kidding here - full of custom orthotics people never picked up. If you don't collect cash up front you may be paying money to have orthotics made that you never get paid on.
-There are labs out there that make quality custom products but charge you accordingly ie. my partner at some point had a variation being made that almost cost $200.
-The most common insurance that pays for customs in my area believes that if the patient qualifies for the custom the fee schedule price should be about $215. If you pay the custom company $160 to make a pair you are looking at less than a 99213 of profit. If you pay $90 to have them made then you made a little over a hundred bucks - is that really worth going on about? Will that really affect your financials at the end of the month 🙂?
-Medicare does not pay for custom orthotics
-Your reimbursement through insurance may be a reflection of your underlying rate/fee structure. Consider, awhile back I charged a patient with United for a post-op shoe. My office buys these shoes for like $13-15. United reimbursed me $6 for the shoe which means I lost money on it. I would bet that if I got a pair of customs paid for by United I would lose money on them. They would be reimbursed at less than cost.
-You will hear of stories of insurances providing high reimbursement at absurd rates. Someone in Dallas told me a company paid them $700 a pair. NYC pods will make people $900 customs once a year for union transit workers and accept 30% of Medicare from 2002 and other sad ridiculous things. I don't think that's common outside of big cities and weird insurances.
-A friend of mine told me her office checked everyone's insurance before the visit to see if custom orthotics were covered and then offered them at the first visit if they were. Think about that when you wonder why insurance costs so much or you wonder if a practice evaluation makes sense.

Here's the heart of it. This is one of those stupid podiatrist things that is blown out of proportion. Most people don't need it. I can straight tell you that if you don't push it or say anything about it - almost no one will ask about it. Only people who already had them made are fixated on them. I personally wish no one covered them because then the cost could just be set at cost + a reasonable profit margin. Its a small service like everything else we do. Sometimes it works. Sometimes it doesn't. But if you massively push it and overcharge for it then assuredly it can become a sticking point with patients.

 

[HardRoadPaved]

The financials of customs are complicated.


-Even when insurance pays for them - they often spend months reviewing the claim.
-There is a drawer at my office - not kidding here - full of custom orthotics people never picked up. If you don't collect cash up front you may be paying money to have orthotics made that you never get paid on.

Definitely always check benefits and have patients sign a form knowing that just because you get it checked is not a guarantee itll be covered.

-There are labs out there that make quality custom products but charge you accordingly ie. my partner at some point had a variation being made that almost cost $200.

Fine to use those labs for more complex deformities, but otherwise I'd just send it out at that price.

-The most common insurance that pays for customs in my area believes that if the patient qualifies for the custom the fee schedule price should be about $215. If you pay the custom company $160 to make a pair you are looking at less than a 99213 of profit. If you pay $90 to have them made then you made a little over a hundred bucks - is that really worth going on about? Will that really affect your financials at the end of the month 🙂?

Wow My lowest payer is like $325. Seems to be region specific then.

-Medicare does not pay for custom orthotics

Secondary (not supplements) to Medicare may still pay with a -GY modifier when claim gets passed on. I have several BCBS and Cigna plans covered by school districts, government employees that pay when submitted.

-Your reimbursement through insurance may be a reflection of your underlying rate/fee structure. Consider, awhile back I charged a patient with United for a post-op shoe. My office buys these shoes for like $13-15. United reimbursed me $6 for the shoe which means I lost money on it. I would bet that if I got a pair of customs paid for by United I would lose money on them. They would be reimbursed at less than cost.

I have this issue with many L-code braces. Sucks to have to send it out but not worth losing time and effort on.

-A friend of mine told me her office checked everyone's insurance before the visit to see if custom orthotics were covered and then offered them at the first visit if they were. Think about that when you wonder why insurance costs so much or you wonder if a practice evaluation makes sense.

Many many many DPM groups are heavy O's for every darn pathology. Templates for LMNs for every type of DME. Part of the hustle sadly and you wonder why some practices say their non-op pods are bringing in 750k+. Cant do that on C&C alone.

 

[Adam Smasher]

Ivar Roth wrote in to pm news saying he charges $1000/pair for cfo, iirc. He also charges $2k cash for a matrixectomy. Honestly, good for him if he can do it.

And yes, if anyone is wondering, he has a mustache

 

[DYK343]

There is no reimbursable CPT code for orthotics fabrication for wRVU based providers (at least where I work).

I get paid a whopping $0 as the cost of the orthotics is included in the cash payment to the hospital (Cant bill an office visit - included in price) and this also inclues the follow up visits for modifiction/adjustment. I get $0 as its all in the "global".

I called my billers and told them they need to let me bill L3010, L3020, or L3030 so I can get reimbursed fairly wRVU wise. They said there is no assigned value to those codes and they didnt seem big on trying to fix this. The hospital system is multi state and large. Billers are not on site/out of state and I dont think they really care about the whiny DPM trying to get paid to pedal his wares...

So....... All get sent out. Not messing with it. Also, If I send them out I can bill an office visit for the discussion.

This is an example of another nuance of the wRVU system not being as good as private practice/fee for service. Might be specific to my hospital but I know in residency the DPMs who trained me were also always complaining about it. So I suspect its common in many hospitals. I remember cutswfury saying he didnt get paid for orthotics in his prior hospital either/sent them out.

Luckily for me I dont care for orthotics (or nail care) so I dont really mind. Fill those slots with pathology I can fix with my hands.

 

[Adam Smasher]

What orthotics labs are people using? Our resident clinic is looking to reach out to a few companies as potential suppliers and I've been tasked with it but don't know where to start.

I use Langer. They charge $120/pair, customer service is tip top. Better labs may be out there, appreciate everyone else's input.

 

[Adam Smasher]

One more bit of advice. If you like powersteps, they have a "Grow" program or something. You enroll and basically hand the pt a "rx" which is really just an order form. Check off whatever they might need. Pt then goes online, enters your code, they get 10% off and you get a 5% commission (don't spend it all in one place, haha).

I use it when people ask about orthotic sandals, bedroom slippers, as well as devices for their dress flats.

This may be good for @DYK343 and anyone else getting paid goose egg for dispensing in clinic

 

[heybrother]

Ivar Roth wrote in to pm news saying he charges $1000/pair for cfo, iirc. He also charges $2k cash for a matrixectomy. Honestly, good for him if he can do it.

And yes, if anyone is wondering, he has a mustache

His negative reviews on Yelp speak volumes about his practice. I've thought about starting a thread about his magic cures because I'm sure he's doing the same crap all the rest of us are doing and calling is magic$$$sauce.

 

[Adam Smasher]

Well you know you've made it when you have a foot cream with your face on the tube

 

[air bud]

I would like to retract my previous statement. Everyone needs a Richie Brace (decided to not @ him.....).

 

[deleted1138023]

“Most doctors convince patients that there is nothing to be done about nail fungus. Dr. Roth knows better and to the benefit of thousands of his patients, has been able to cosmetically correct the condition (usually in three to six months).

Dr. Roth’s medical training has gifted him with surgical skills that are rarely evident in the podiatric profession. He trained in foot and ankle surgery at Mt. Sinai Hospital of Chicago with world-renowned podiatrist Dr. Lowell Scott Weil Sr. It is not unusual for patients who have endured multiple unsuccessful surgeries to finally be healed at the hands of Dr. Roth.”

 

[deleted1138023]

Dr. Roth is the Jesus of podiatry

 

[Feli]

I would like to retract my previous statement. Everyone needs a Richie Brace (decided to not @ him.....).

Arizona braces are better tolerated and look much cooler. Just sayin.

(I might be biased as I worked in Arizona for a few yrs... but ortho Rx's them a ton more for good reason)

 

[DYK343]

I looked up his reviews. He has eight 5 star and two 1 star giving 4 stars total.

I dont think its fair to bash him based on two 1 star reviews.

But face on cream tubes (almost certainly OTC 40% UREA) is hilarious as is using bags from the grocery store.

 

[wakaflocka88]

Either SuperFeet or the PowerStep pinnacle with the met pad. Solves 99% of issues for under $55.

Edit: in residency we did make custom plaster molded orthotics via ProLabs and I would say for the most part, patients are happy with it for about $300 cash. There will always be the ones that return over 5 times nit picking every adjustment and you’ll have to live with it. If it’s worth the hassle to earning potential go for it.

 

[DYK343]

Arizona braces are better tolerated and look much cooler. Just sayin.

(I might be biased as I worked in Arizona for a few yrs... but ortho Rx's them a ton more for good reason)

I like arizona braces too but man are they bulky. IME compliance with use is limited.

 

[Adam Smasher]

On the subject of AFOs and vaguely on the original topic, does anyone have experience with Allard AFOs?

I've prescribed a few articulating gauntlet style AFOs as well as the dual uprights and pt's generally don't like how bulky they are. Allard is sleek but seems too good to be true

 

[shadesofgrey]

I mainly use Northwest or Bergman.

Apparently an unpopular opinion on here, but I feel there is a place for custom orthotics. 1) I find cavus and flat feet do better with custom rather than OTC, even with additional pads. 2) I also hated when I would send someone out with a prescription for custom orthotics for PTTD for example and they would come back with more of an accommodative device, despite my Rx. 3) Around our area, about half of patients have some sort of coverage. Oftentimes its a choice of $50 for the OTC orthotics or ~$120 out of pocket for the custom orthotics. In fact, one insurance company just upped the reimbursement (after 15 years of staying the same) to over $600. Medicaid patients all have coverage, and generally I will do anything to avoid elective surgery on that population, so if a custom orthotic works 5% better on that flat foot, we are getting custom orthotics.

If a patient has no orthotic coverage and has to pay cash, I try a OTC first because I'm not the sure the added cost is worth the benefit. However, if it's a close cost comparison or a covered benefit, then custom it is.

I saw a second opinion on a patient from Chicago, she had paid cash for custom orthotics from a guy out there, to treat a bunion. For the low low price of $1400! I guess its easy to sleep at night on your gold pleated sheets...

 

[air bud]

D Br

Arizona braces are better tolerated and look much cooler. Just sayin.

(I might be biased as I worked in Arizona for a few yrs... but ortho Rx's them a ton more for good reason)

do braces work in other states? Never tried a Nebraska brace before may look into it.

 

[thefootfixer]

How is everyone handling orthotics in the office? In terms of prior authorization (does patient get this and back in confirmation or does office get it), deposits (how much), refunds (when given out, after insurance pays?) and cash adjusted price for non covered orthotics?

 

[Pronation]

How is everyone handling orthotics in the office? In terms of prior authorization (does patient get this and back in confirmation or does office get it), deposits (how much), refunds (when given out, after insurance pays?) and cash adjusted price for non covered orthotics?

Cash up front. If insurance doesn’t cover it then no cash back.

 

[Feli]

How is everyone handling orthotics in the office? In terms of prior authorization (does patient get this and back in confirmation or does office get it), deposits (how much), refunds (when given out, after insurance pays?) and cash adjusted price for non covered orthotics?

 

[NatCh]

Orthotics have a role, but they are such a customer service nightmare that it is often best to just Rx them out

Yep. They're such a pain in my cacahuetes. You know that moment when the patient tries them in their shoes for the first time, makes a scrunchy brow, and says, "Hmmm... my foot still hurts."

 

[dtrack22]

I called my billers and told them they need to let me bill L3010, L3020, or L3030 so I can get reimbursed fairly wRVU wise. They said there is no assigned value to those codes and they didnt seem big on trying to fix this. The hospital system is multi state and large. Billers are not on site/out of state and I dont think they really care about the whiny DPM trying to get paid to pedal his wares...

I farm out all orthotics and AFOs and DM shoes, but my hospital will always generate dummy codes for me if there is a service like that or cash pay stuff I want to do and get credit for. Basically they add a CPT code (obviously a number that doesn’t already exist) that would then have a charge and wRVU value attached to it. Every hospital system is capable of doing this, many just refuse to do it.

I like arizona braces too but man are they bulky. IME compliance with use is limited.

Yeah Arizona braces are fine when your patient actually wears them. I find hinged AFOs are generally much more likely to be tolerated and worn by tendinopathy patients. I use Arizona’s for late stage ankle and/or STJ arthritis, but around here over the summer patients don’t wear them as often, even the mesh style outer cover as opposed to the vinyl/leather.

 

[heybrother]

I looked up his reviews. He has eight 5 star and two 1 star giving 4 stars total.

I dont think its fair to bash him based on two 1 star reviews.

But face on cream tubes (almost certainly OTC 40% UREA) is hilarious as is using bags from the grocery store.

Here's why I disagree with you. The first thing is - reviews in general are meaningless garbage. Small practices routinely rely on friends and family. Practices with large numbers of reviews are usually paying some sort of service. The reason these are meaningful is because they reveal the underlying behavior of the practice. Its predatory. The patient is always in a tremendous disadvantage when they are at a doctor's office. No one will tell them what anything costs. They have to speak to the doctor to be offered something to know a service exists, but they don't know what is and isn't a covered service and they don't know what anything is going to cost. Everytime a doctor speaks a skeptical patient should wonder - am I signing up for an additional cost and how much is it going to be? These patients show up and pay more than $200 to then be pitched an endless myriad of unnecessary, overpriced services. This office isn't staying in business based on the volume of their 99213s. If you walked into an applicance store and said - this place seems overpriced - you'd just walk out and try again at another place. But the patient has no way of knowing that at the next office the prices are going to be any different and they are already $200+ in the hole. It seems like sunk cost. This guy charges $1000 a matrixectomy and has written before that he views opposite borders as a new procedure, not a toe is a toe. If you went somewhere and had no idea about surgical pricing and someone offers you $1000 a matrixectomy then how are you going to know that where I come from no insurance pays more than $320 for a matrixectomy. His office is very clear that they don't accept insurance, but there is no pricing information anywhere that is public facing.

If you really want a laugh, read about his "guaranteed" Paincur.

You will be ineligible for the Pain Relief Money Back Guarantee if you experience at least an overall 20% improvement by the 10th injection or have an improved level of activity. Your refund request will be determined from your completed Evaluation Form.

https://www.paincur.net/_files/ugd/ed908d_6aa72a60ee7e4318b712eb083111e66a.pdf

https://www.paincur.net/_files/ugd/0da0fa_82c43ed2eb2c4502b1bcd072a6a0f5d1.pdf

Every one of us is a miracle worker. We've all done an injection for someone that was magical and special. We just didn't charge the patient a fortune and make them come back 7 times.

 

[DYK343]

Here's why I disagree with you. The first thing is - reviews in general are meaningless garbage. Small practices routinely rely on friends and family. Practices with large numbers of reviews are usually paying some sort of service. The reason these are meaningful is because they reveal the underlying behavior of the practice. Its predatory. The patient is always in a tremendous disadvantage when they are at a doctor's office. No one will tell them what anything costs. They have to speak to the doctor to be offered something to know a service exists, but they don't know what is and isn't a covered service and they don't know what anything is going to cost. Everytime a doctor speaks a skeptical patient should wonder - am I signing up for an additional cost and how much is it going to be? These patients show up and pay more than $200 to then be pitched an endless myriad of unnecessary, overpriced services. This office isn't staying in business based on the voluem of their 99213s. If you walked into an applicance store and said - this place seems overpriced - you'd just walk out and try again at another place. But the patient has no way of knowing that at the next office the prices are going to be any different and they are already $200+ in the hole. It seems like sunk cost. This guy charges $1000 a matrixectomy and has written before that he views opposite borders as a new procedure, not a toe is a toe. If you went somewhere and had no idea about surgical pricing and someone offers you $1000 a matrixectomy then how are you going to know that where I come from no insurance pays more than $320 for a matrixectomy. His office is very clear that they don't accept insurance, but there is no pricing information anywhere that is public facing.

If you really want a laugh, read about his "guaranteed" Paincur.

You will be ineligible for the Pain Relief Money Back Guarantee if you experience at least an overall 20% improvement by the 10th injection or have an improved level of activity. Your refund request will be determined from your completed Evaluation Form.

https://www.paincur.net/_files/ugd/ed908d_6aa72a60ee7e4318b712eb083111e66a.pdf

https://www.paincur.net/_files/ugd/0da0fa_82c43ed2eb2c4502b1bcd072a6a0f5d1.pdf

Every one of us is a miracle worker. We've all done an injection for someone that was magical and special. We just didn't charge the patient a fortune and make them come back 7 times.

I did read about the paincure. I didnt see anywhere what it actually was other than a FDA approved injection.

 

[heybrother]

I did read about the paincure. I didnt see anywhere what it actually was other than a FDA approved injection.

Its not entirely clear what it is. He starts off with an injection and does admit the injection contains steroid. He states if the injection is helpful then you can begin treatment that day. Presumably the injection is steroid and anesthetic - since diagnostic blocks are usually effective - that's probably what it is. Then whatever else he does is pretty meaningless - the patient has already received a steroid injection.

 

[Feli]

There is no reimbursable CPT code for orthotics fabrication for wRVU based providers (at least where I work).

I get paid a whopping $0 as the cost of the orthotics is included in the cash payment to the hospital (Cant bill an office visit - included in price) and this also inclues the follow up visits for modifiction/adjustment. I get $0 as its all in the "global".

I called my billers and told them they need to let me bill L3010, L3020, or L3030 so I can get reimbursed fairly wRVU wise. They said there is no assigned value to those codes and they didnt seem big on trying to fix this. The hospital system is multi state and large. Billers are not on site/out of state and I dont think they really care about the whiny DPM trying to get paid ...

Might as well go for the gusto and try L3000 in a RVU situation?

For PP, it simply doesn't matter... over 99% will be uncovered and cash pay in most places. For RVU setup, it's significant.

I don't think the vast majority of pod office orthotics are L3000 (UCBL, 10mm+ heel cup)... L3020 seems most fitting to me. Its debatable, though, and I've worked with groups/billers who pushed L3000 (typically same folks doing custom codes for non-custom night splints, etc).

 

[HardRoadPaved]

Here's why I disagree with you. The first thing is - reviews in general are meaningless garbage. Small practices routinely rely on friends and family. Practices with large numbers of reviews are usually paying some sort of service.

I'm solo and have hundreds of reviews. This is a major driver of new business. I had someone leave an urgent care center unhappy and googled me and booked right away based on reviews alone.

 

[NatCh]

Google reviews are what drives your website to the first page when someone searches. Content doesn’t matter so much as long as you don’t have like a 1.3 star average. If you get bumped off the first page then you will get overlooked.

 

[Feli]

Google reviews are what drives your website to the first page when someone searches. Content doesn’t matter so much as long as you don’t have like a 1.3 star average. If you get bumped off the first page then you will get overlooked.

Yeah, it's really an "all of the above thing" for any specialist with rep/refers among local PCPs, marketing web/sign/radio/etc, and patient/community rep/refers.

Ideally, one wants to do well on all three fronts.

 

[Creflo]

I've had patients tell me the Good Feet store charged them over 1 thousand dollars for 2 pairs of foot orthotics. They seem to be OTC, not truly custom made. People who walk out of the Good Feet store are happy because they don't know a $50 product would have done the job as well. Sort of like people who go to the well known national hospital who does not use podiatrists and end up with a BKA when all they needed was a competent podiatrist to save their foot. They are satisfied because they believe they got the best care due to the name of the hospital system. All about perception and marketing...

 

[Feli]

I've had patients tell me the Good Feet store charged them over 1 thousand dollars for 2 pairs of foot orthotics. They seem to be OTC, not truly custom made. People who walk out of the Good Feet store are happy because they don't know a $50 product would have done the job as well. Sort of like people who go to the well known national hospital who does not use podiatrists and end up with a BKA when all they needed was a competent podiatrist to save their foot. They are satisfied because they believe they got the best care due to the name of the hospital system. All about perception and marketing...

Good feet are OTC... they get 3 pairs of plastic 3/4 shells ("orthotics"... about $300 or $400 for the 3pr in my area): one stiff, one extra extra stiff, and the third way too stiff for 99.9%. They're just done by shoe size.... generally won't work to be that stiff without custom casting. I have seen a few people who can tolerate them... usually only if they use an accommodative insole or original tennis shoe insole over top of them.

...some sales ppl think that you're going to get a price objection from many customers regardless. So with that in mind, you might as well shoot for the moon (if you have a unique product - or at least one perceived to be unique). For example, people would object to a $100 book, so it could just as easily be a $500 book which is half off at $249. They object to the price either way, but the latter actually seems to be of high value and possibly a good steal of a deal. If you're selling the same PowerStep or Spenco or Coke can or Snickers bar as everyone else, that obviously doesn't work so well... price (range) is largely decided on those.

 

[DYK343]

Sort of like people who go to the well known national hospital who does not use podiatrists and end up with a BKA when all they needed was a competent podiatrist to save their foot. They are satisfied because they believe they got the best care due to the name of the hospital system. All about perception and marketing...

Youre totally spot on. I really have not met a general surgeon or ortho surgeon who knows how to properly debride an infected foot. Does one exist? Yes but not common. Thats one thing a DPM can do really well. Ive seen a lot of hack jobs on bunions too done by our competetors. I think we pretty much own the bunion game. (conversly ever seen an ankle fx post op done by a DPM on insta? Scary lol).

Good feet are OTC... they get 3 pairs of plastic 3/4 shells ("orthotics"... about $300 or $400 for the 3pr in my area): one stiff, one extra extra stiff, and the third way too stiff for 99.9%. They're just done by shoe size.... generally won't work to be that stiff without custom casting. I have seen a few people who can tolerate them... usually only if they use an accommodative insole or original tennis shoe insole over top of them.

Where I am at they are $1000 but "guarenteed for life" bascially they can come back in anytime and get a new pair of OTC insoles.
Im sure they have different plans but that place is a scam.

 

[icebreaker32]

Youre totally spot on. I really have not met a general surgeon or ortho surgeon who knows how to properly debride an infected foot. Does one exist? Yes but not common. Thats one thing a DPM can do really well. Ive seen a lot of hack jobs on bunions too done by our competetors. I think we pretty much own the bunion game. (conversly ever seen an ankle fx post op done by a DPM on insta? Scary lol).





Where I am at they are $1000 but "guarenteed for life" bascially they can come back in anytime and get a new pair of OTC insoles.
Im sure they have different plans but that place is a scam.

Prices start incredibly high, but come down a little I have been told if you don't get the whole OTC package....still incredibly high for what they are.

 

[Pronation]

Youre totally spot on. I really have not met a general surgeon or ortho surgeon who knows how to properly debride an infected foot. Does one exist? Yes but not common. Thats one thing a DPM can do really well.

Doesn’t know vs doesn’t care? Whittling away vs lobbing off?

 

[DYK343]

Doesn’t know vs doesn’t care? Whittling away vs lobbing off?

A partial 5th ray amp can last many years.
A BKA is dead in 5.

Had a patient the other day who could have healed with a fem-pop but vascular said "if you just do a BKA then no surgery needed".
That person lost their leg because it was a friday.

 

[deleted285117]

A partial 5th ray amp can last many years.
A BKA is dead in 5.

Had a patient the other day who could have healed with a fem-pop but vascular said "if you just do a BKA then no surgery needed".
That person lost their leg because it was a friday.

It’s sad how many docs don’t consider post-op CHF.

 

[wakaflocka88]

Speaking of vasculopaths, I’ve never had good success with any kind of bypass if it’s true below the knee disease. It’s either find the rare competent caring endovascular trained doc willing to be aggressive with below knee disease or keep chipping away.