Treating the asymptomatic flat foot

[HardRoadPaved]

https://www.hmpgloballearningnetwork.com/site/podiatry/case-study/point-counterpoint-custom-molded-versus-prefabricated-orthotics-children

If every pediatric 'flatfoot' that walked into my office got an orthotic, I'd def be a hell of a lot richer.

Does anyone have any payers that are covering orthotics for asymptomatic flat foot issues? BCBS just asks for medical necessity and loose definition that they dont cover 'flat feet.'

Aetna:

Cigna:

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[Hybrocure]

It’s definitely payer specific but if the patient is under 18 it tends to be covered more often. Orthotics do really work well for pediatric flat feet moreso as a preventative measure especially if they’re in sports. Jumping right to surgery on an active, relatively asymptomatic kid just because they have flat feet is crazy

 

[Feli]

Personally, I don't really trust peds pts.
Their default is "no" when you ask if something's painful.
They want to sweep any problem under the rug. They want to avoid a procedure, inject, DME that'll make them different from peers, avoid being in trouble with parent for having an issue or injury, whatever. They tend to minimize everything.
Bottom line is to have a way lower threshold for imaging, adv imaging, treating stuff (non-invasive tx) in peds.

I do arch supports (pre fab) for most peds flat foot, but customs are seldom necessary unless near skeletal maturity or oddball foot shape.

In reality, we know that flat is often pain. Pain is often less active... which is often overweight/obese.
Adults will flat out tell you that; peds often will not.
When you look at adult flat foot, even if they say the flat foot doesn't hurt, many are overweight, many are less active than normal... makes you think, to say the least.

 

[HardRoadPaved]

Yea I tend to rely on objective findings like poor single limb raise, pain over the tendon/medial eminence, poor balance/coordination.

I think the one type of visit is the helicopter parent that sees the deformity but kiddo is like 'I'm fine mom, leave me alone.' Those can be annoying to sit there as the kid/parent argue.

 

[dtrack22]

Personally, I don't really trust peds pts.
Their default is "no" when you ask if something's painful.
They want to sweep any problem under the rug. They want to avoid a procedure, inject, DME that'll make them different from peers, avoid being in trouble with parent for having an issue or injury, whatever. They tend to minimize everything.
Bottom line is to have a way lower threshold for imaging, adv imaging, treating stuff (non-invasive tx) in peds.

I do arch supports (pre fab) for most peds flat foot, but customs are seldom necessary unless near skeletal maturity or oddball foot shape.

In reality, we know that flat is often pain. Pain is often less active... which is often overweight/obese.
Adults will flat out tell you that; peds often will not.
When you look at adult flat foot, even if they say the flat foot doesn't hurt, many are overweight, many are less active than normal... makes you think, to say the least.

I generally counsel the parents to watch for limping, not keeping up with peers or disinterest in athletic activities/play. Most of them time my peds patients (I believe) genuinely don’t have pain and mom is worried that the foot is flat or the kid in-toes when they walk or run in which case I tell them not to worry about it if it’s not painful or slowing them down. But I definitely get kids with pretty well documented symptoms that sit there and tell you nothing hurts. I don’t really like peds outside of pediatric injuries which virtually always heal without me having to do anything. Other than collecting the paycheck…

 

[heybrother]

Both of the authors above are in ACFAP. I went to a lecture by the current president of ACFAP years ago. It was supposed to be educational, but it was just scare tactics that you can use to manipulate parents into buying custom orthotics for their children. Part of it involved having the parents take their shoes off and then convincing them that their children's feet would be as bad as their's if they didn't purchase custom orthotics.

 

[air bud]

Both of the authors above are in ACFAP. I went to a lecture by the current president of ACFAP years ago. It was supposed to be educational, but it was just scare tactics that you can use to manipulate parents into buying custom orthotics for their children. Part of it involved having the parents take their shoes off and then convincing them that their children's feet would be as bad as their's if they didn't purchase custom orthotics.

Sir these are medical professionals. Doctors. Professionals

 

[Carpe Phalanges]

Personally, I don't really trust peds pts.
Their default is "no" when you ask if something's painful.
They want to sweep any problem under the rug. They want to avoid a procedure, inject, DME that'll make them different from peers, avoid being in trouble with parent for having an issue or injury, whatever. They tend to minimize everything.
Bottom line is to have a way lower threshold for imaging, adv imaging, treating stuff (non-invasive tx) in peds.

I do arch supports (pre fab) for most peds flat foot, but customs are seldom necessary unless near skeletal maturity or oddball foot shape.

In reality, we know that flat is often pain. Pain is often less active... which is often overweight/obese.
Adults will flat out tell you that; peds often will not.
When you look at adult flat foot, even if they say the flat foot doesn't hurt, many are overweight, many are less active than normal... makes you think, to say the least.

I feel much of this trend is obesity causing overpronation and foot pain rather than the reverse. Speaking from observation and experience as someone who’s gained 80 lbs since getting married lol (I know, I know, need to work on self-control!)

 

[Feli]

I feel much of this trend is obesity causing overpronation and foot pain rather than the reverse. Speaking from observation and experience as someone who’s gained 80 lbs since getting married lol (I know, I know, need to work on self-control!)

It's possible either way. No doubt.

 

[air bud]

Oh well shoot first ozembic is going to ruin Walmart stock price and other things like McDonald's. Now it's also going to ruin podiatry.