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How do custom orthotics work, if they are made from your 'improper' standing foot?

Posted by Mary A on 1/27/03 at 08:50 (106946)

I have a heel spur on my left foot. I have read the effects of pronating, and understand the need for supports. I am considering the custom made ones...I am wondering, however, if I stand in the impression material, won't it make an impression of my foot the way it is now, which must be incorrect, as I have this condition! I want to help correct the alignment of my feet, and prevent the pronating. I am concerned that the custom made supports will just keep the 'status quo' so to speak, as they would be made from the impression of a faulty stance.
HELP?!

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Ed Davis, DPM on 1/27/03 at 14:27 (107021)

Mary:
Usually, custom made orthotics would not be made by having you stand in an impression material since you would, as you mention, capture the incorrect alignment of your foot. The procedure involves performing a biomechanical exam in order to determine your foot function and what needs to be done to improve/correct it. Your foot is then manipulated into a 'corrected' position, while you are laying on a table, and it is that position that is captured by a plaster of paris mold to start making the orthotics.

It is possible, at times, depending on the accumen and methods of the individual providing your orthotics to take the mold from a standing position. By rotating your leg outward you can 'un-pronate' your foot and your foot can be manipulated somewhat in a standing position. This mehtod is less preferable to me but works under the right circumstances, especially with softer orthotics.

I would hope that your doctor has explained exactly what you are going to be getting in some detail, the process and how the orthotic is supposed to work.
Ed

Re: What if the Dr doesn't watch you walk/stand?

paulas on 1/27/03 at 14:56 (107024)

Hi Dr. Ed, your comment just made me connect something. I have 2 pair of custom orthotics, made by the casting method you described, both of them sitting in a box in the closet because they didn't help at all. Neither doctor watched me walk or stand - I was sitting in a chair when they came in, and sitting when they left. My orthotics are a good cast of my feet, but don't control my pronation at all and have no effect on my pain level. Is it because I'm missing the biomechanical aspect? So, there is more to orthotics than just casting the foot. I have asked to have them looked at by both of the doctors and been told that since they are a good cast, they are fine.

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Richard, C.Ped on 1/27/03 at 15:00 (107026)

I personally think that in order to get the best impression, either a semi weight bearing (seated) or non weight bearing is the best. I am not a fan of standing in the box method. Standing will cause the foot to bottom out in the box, thus causing a 'flat' effect.
Richard

Re: What if the Dr doesn't watch you walk/stand?

Carole C in NOLA on 1/27/03 at 15:27 (107031)

Well yes, there is more to making orthotics than just brainlessly casting the foot. That is why you need a foot professional to make your orthotics, someone with certification or a degree that shows you he has the training he needs. I'm not a foot professional but I'll describe how my custom orthotics were made.

They watch you walk before making the orthotics, and determine where the pain is and how your foot moves and a lot of other things so that they know what you need. They also watch you walk in the orthotics after they are made, and adjust them if necessary to correct any remaining biomechanical problems.

At least, that is what my C.Ped did. She cast my foot in a foam box while sitting down, not standing up. Then she made the orthotics. Then she watched me walk and adjusted them on the spot until she felt they were perfect for me, before she would let me go home. That's part of what makes the orthotics custom, in my opinion anyway.

Carole C

Re: Wow, that's different

paulas on 1/27/03 at 16:36 (107034)

Thanks for the info, Carole. Both of these doctors were M.D. podiatrists; I thought they would be qualified to diagnose and fix my p.f. problem. In fact, none of the 4 podiatrists I have seen over the last 5 years for p.f. has watched me walk or stand--that's why I thought my diagnostic appointments were typical. I guess they were not. I'm inspired to search out a C. Ped. and see if I have different results.

Re: Wow, that's different

Carole C in NOLA on 1/27/03 at 16:43 (107035)

Paula, I'm quite surprised. Even the rheumatologist who first diagnosed my PF, and who sent me to a C.Ped with a prescription, watched me walk and manipulated my feet and legs to see how they moved or didn't. He x-rayed my feet and showed me the heel spurs.

He knew that the C.Ped was top notch, so the prescription read something like, 'Patient has heel spurs; heel cups? orthotics?' rather than being very precise. But my C.Ped requires a prescription before doing anything.

I hope that you are able to find a good C.Ped like I did. I think she was a miracle worker! :)

Carole C

Re: Wow, that's different

Ed Davis, DPM on 1/27/03 at 18:12 (107049)

Paula:

Watching people stand and walk is part of the exam. Skipping that part of the exam is, in my opinion, taking a short cut. The thing about taking short cuts is... sometimes you get away with it and sometimes you don't.
Ed

Re: Recommend a Dr north of San Francisco?

paulas on 1/27/03 at 18:39 (107057)

Well, I can't help feeling a little ripped off, since I paid for both sets of orthotics myself! Live and learn, right? Since I've already been through a few doctors with little help, does anyone have a recommendation for a good doctor in the north-of-San Francisco area? Insurance carriers will not be an issue since I pay out of pocket (I have insurance but I've already been through all their doctors.) Thanks again for the information.

Re: Recommend a Dr north of San Francisco?

Ed Davis, DPM on 1/28/03 at 00:53 (107090)

Paula:

You live in what I consider to be somewhat of a difficult area to find good care becuase of all the managed care in your area. For better or worse, doctors practice can be influenced by that. There is a lot of talent out there that limits exposure to managed care so if you are paying out of pocket, I would go in that direction.

Are you in Santa Rosa County?
Ed

Re: Recommend a Dr north of San Francisco?

Ed Davis, DPM on 1/28/03 at 01:00 (107091)

I am going to work backwards.... My favorite orthotic lab is Northwest Podiatric Lab. My bias is that providers who use them are generally better than average. Also, it is one of the most expensive orthotic labs so docs who subsist on a lot of mangled (oops, I meant managed) care will not pay their lab fees for orthotics. Their telephone number is 800-443-7260 -- ask them who they recommend in your area.
Ed

Re: Recommend a Dr north of San Francisco?

Julie on 1/28/03 at 02:39 (107100)

Mangled care! I love it! This has to be the funniest and most appropriate slip ever.

I'm glad you let it stand and didn't delete it, Ed! Thanks a lot for my first (probably best) laugh of the day.

Re: Recommend a Dr north of San Francisco?

Mar on 1/28/03 at 07:34 (107106)

All of my orthotics were made from a cast taken in the pod's office and sent out to a lab to be made. Do most people actually go to a CPed's office to have them made? It sure makes more sense to me. Perhaps they would work better and not have to be sent back so many times. Can I just go to a CPed's office with a script even if my pod doesn't normally do it that way??? Mar

Re: Recommend a Dr north of San Francisco?

Carole C in NOLA on 1/28/03 at 07:38 (107108)

Mar, there's nothing at all wrong with having orthotics made in a lab, but I think your pod should have watched you walk in them and should have offered free adjustments.

You can't go to my C.Ped without a prescription. I think that's true for all of them. Sorry. So, ask your pod for one.

Carole C

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Carole C in NOLA on 1/28/03 at 07:39 (107109)

Mar, there's nothing at all wrong with having orthotics made in a lab, but I think your pod should have watched you walk in them and should have offered free adjustments.

You can't go to my C.Ped without a prescription. I think that's true for all of them. Sorry. So, ask your pod for one.

Carole C

Re: Recommend a Dr north of San Francisco?

Richard, C.Ped on 1/28/03 at 08:21 (107111)

Mar, we require prescriptions because if we made orthotics for someone with a diagnosable foot problem, that would make us seem as if we are diagnosing the problem ourselves. This is what makes me so mad about companies that do not use prescriptions.......but thats a whole other story.

You have the right to go anywhere you want to have your orthotic prescription filled. If you have a medication prescription, you can go to any pharmacy you choose...I see this as the same.

The good thing about having the orthosis made in an office such as mine, we do the work right here. If by chance you need an adjustment, we do not have to send the orthosis off. Also, you do not have to wait 2-4 weeks for the orthosis to be made, I have mine done the next day, and sometimes even the same day if needed.

Richard

Re: mangled!

paulas on 1/28/03 at 12:31 (107143)

Three of the four doctors I mentioned are from a mangled care organization that I won't name...and the horrors only start with not being checked out properly. I quit seeing their doctors after hearing the suggestion that I should wear walking casts on both legs and push a rolling walker around for the rest of my days because they were out of other ideas to treat my p.f. Thanks for the number Dr. Ed, I will give them a call and see what they recommend! And, yes, I live about 10 miles south of Santa Rosa.

Re: Recommend a Dr north of San Francisco?

Carole C in NOLA on 1/28/03 at 12:34 (107145)

Yes, Richard! When my C.Ped made my custom orthotics, she did it right there. I had to wait two weeks for an appointment, but I was glad that I didn't give up.

I was in the worst PF agony imaginable by the time she saw me, and she stayed and worked on my orthotics and with me for several hours until she was sure that my orthotics were the best possible for me, and until she was sure that I knew the basics of how feet work, what caused my PF, and what to do for it.

I thought that was wonderful. Talk about an unsung hero!

Carole C

Re: Recommend a Dr north of San Francisco?

Mar on 1/28/03 at 15:27 (107155)

Richard -
This makes so much more sense than sending them to a lab. The pair that I wear all the time took about a month and then had to be sent back for adjustments - another 2 weeks. I am having another pair remade -- it has been since the end of October and I still don;t have them! The ones I wear all the time I have been using for a year and probably need to be spruced up, but I can't send them to the lab because I need them! Where do you practice - I forgot? I am in northern NJ. I would love to be able to talk to the person doing the work and explain how they fit my feet, etc. Mar

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

D.Thomas on 1/28/03 at 15:30 (107156)

Mar,

I have had orthotics made from both labs and C.Peds. Having a good lab experience is highly dependent on your doctor. They are the one who makes the mold and then puts the prescritption into the orthotic - usually termed 'posted' (I think that's what it is called - someone can correct me if I am wrong).

In my experience, if the doctor or the C.Ped doesn't watch you walk and take other measures, do not buy orthotics from them - period. I have been to two doctors who didn't watch me walk and take other measures and told the nurse mark the orthotic 'post to cast' which like Dr. Davis wrote can be a hit and miss judgement.

I have had both good and bad experiences from both (labs and c.peds) situations.

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Mar on 1/28/03 at 15:31 (107157)

Carole -

Yes, my pod offers free adjustments to the orthotics but it takes so long to get them back and the lab doesn't always do what they are supposed to and then we send them back again. I have one pair that the lab keeps doing wrong since October! I still don;t have them! I told the doc that i was glad it wasn;t a pacemaker I was waiting for!! Mar

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Mar on 1/28/03 at 15:35 (107159)

I don;t even remember if my pod (either one -- I had orthotics from 2 different pods) took measurements or watched me walk. I don;t think so though. My ESWT pod watched me walk but I haven't yet gotten orthotics from him (he does adjustments in his office as well). He seems to think my orthotics are okay though, although I don;t think so or why would I continue to have so much pain!? Mar

Re: Recommend a Dr north of San Francisco?

nancy s. on 1/28/03 at 16:42 (107173)

dr ed's 'mangled' care comment is what kept me up so late, julie -- laughing. i did manage to get a whole 3 hours of sleep before spending 9 hours at an auction today!

i had plenty of mangled care through mangled care health organizations. or, more accurately, i had very little, but it mangled A LOT. i'm always complaining here how i can't afford health insurance anymore, but maybe i should knock it off. at least i can choose what doctor to see and possibly get less-mangled care!

now that i think of it, when i finally found my sports med doc -- 8 months after we ran out of insurance (and our insurer left the state) and over a year into pf & the other lovely foot afflictions -- he was absolutely thrilled that i had no insurance. it meant he could make decisions based on his own education & experience and on my needs rather than on what the hmo would approve.

nancy
.

Re: Recommend a Dr north of San Francisco?

Pauline on 1/28/03 at 16:56 (107178)

Let us know if you purchased anything at the auction, but we'd better move it to the social page. Don't you just love auctions? Have you ever attended one with stuff taken during police raids?

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

nancy s. on 1/28/03 at 16:56 (107179)

mar, i'd run (or scoot) from any pod who doesn't examine your shoes and watch & evaluate your gait, at a minimum, especially one who is casting you for orthotics and ordering them from a distant lab. of course, mine didn't do these things either, but i didn't know until i found this site -- after i'd wasted 8 months with him! -- that these were basics.

nancy
.

Re: Mangled insurance system

Julie on 1/29/03 at 02:35 (107228)

Nancy, everything I've read about health insurance here over the past couple of years has persuaded me that it is mangled. And that it appears to be mangling the health of millions of people.

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Ed Davis, DPM on 1/27/03 at 14:27 (107021)

Mary:
Usually, custom made orthotics would not be made by having you stand in an impression material since you would, as you mention, capture the incorrect alignment of your foot. The procedure involves performing a biomechanical exam in order to determine your foot function and what needs to be done to improve/correct it. Your foot is then manipulated into a 'corrected' position, while you are laying on a table, and it is that position that is captured by a plaster of paris mold to start making the orthotics.

It is possible, at times, depending on the accumen and methods of the individual providing your orthotics to take the mold from a standing position. By rotating your leg outward you can 'un-pronate' your foot and your foot can be manipulated somewhat in a standing position. This mehtod is less preferable to me but works under the right circumstances, especially with softer orthotics.

I would hope that your doctor has explained exactly what you are going to be getting in some detail, the process and how the orthotic is supposed to work.
Ed

Re: What if the Dr doesn't watch you walk/stand?

paulas on 1/27/03 at 14:56 (107024)

Hi Dr. Ed, your comment just made me connect something. I have 2 pair of custom orthotics, made by the casting method you described, both of them sitting in a box in the closet because they didn't help at all. Neither doctor watched me walk or stand - I was sitting in a chair when they came in, and sitting when they left. My orthotics are a good cast of my feet, but don't control my pronation at all and have no effect on my pain level. Is it because I'm missing the biomechanical aspect? So, there is more to orthotics than just casting the foot. I have asked to have them looked at by both of the doctors and been told that since they are a good cast, they are fine.

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Richard, C.Ped on 1/27/03 at 15:00 (107026)

I personally think that in order to get the best impression, either a semi weight bearing (seated) or non weight bearing is the best. I am not a fan of standing in the box method. Standing will cause the foot to bottom out in the box, thus causing a 'flat' effect.
Richard

Re: What if the Dr doesn't watch you walk/stand?

Carole C in NOLA on 1/27/03 at 15:27 (107031)

Well yes, there is more to making orthotics than just brainlessly casting the foot. That is why you need a foot professional to make your orthotics, someone with certification or a degree that shows you he has the training he needs. I'm not a foot professional but I'll describe how my custom orthotics were made.

They watch you walk before making the orthotics, and determine where the pain is and how your foot moves and a lot of other things so that they know what you need. They also watch you walk in the orthotics after they are made, and adjust them if necessary to correct any remaining biomechanical problems.

At least, that is what my C.Ped did. She cast my foot in a foam box while sitting down, not standing up. Then she made the orthotics. Then she watched me walk and adjusted them on the spot until she felt they were perfect for me, before she would let me go home. That's part of what makes the orthotics custom, in my opinion anyway.

Carole C

Re: Wow, that's different

paulas on 1/27/03 at 16:36 (107034)

Thanks for the info, Carole. Both of these doctors were M.D. podiatrists; I thought they would be qualified to diagnose and fix my p.f. problem. In fact, none of the 4 podiatrists I have seen over the last 5 years for p.f. has watched me walk or stand--that's why I thought my diagnostic appointments were typical. I guess they were not. I'm inspired to search out a C. Ped. and see if I have different results.

Re: Wow, that's different

Carole C in NOLA on 1/27/03 at 16:43 (107035)

Paula, I'm quite surprised. Even the rheumatologist who first diagnosed my PF, and who sent me to a C.Ped with a prescription, watched me walk and manipulated my feet and legs to see how they moved or didn't. He x-rayed my feet and showed me the heel spurs.

He knew that the C.Ped was top notch, so the prescription read something like, 'Patient has heel spurs; heel cups? orthotics?' rather than being very precise. But my C.Ped requires a prescription before doing anything.

I hope that you are able to find a good C.Ped like I did. I think she was a miracle worker! :)

Carole C

Re: Wow, that's different

Ed Davis, DPM on 1/27/03 at 18:12 (107049)

Paula:

Watching people stand and walk is part of the exam. Skipping that part of the exam is, in my opinion, taking a short cut. The thing about taking short cuts is... sometimes you get away with it and sometimes you don't.
Ed

Re: Recommend a Dr north of San Francisco?

paulas on 1/27/03 at 18:39 (107057)

Well, I can't help feeling a little ripped off, since I paid for both sets of orthotics myself! Live and learn, right? Since I've already been through a few doctors with little help, does anyone have a recommendation for a good doctor in the north-of-San Francisco area? Insurance carriers will not be an issue since I pay out of pocket (I have insurance but I've already been through all their doctors.) Thanks again for the information.

Re: Recommend a Dr north of San Francisco?

Ed Davis, DPM on 1/28/03 at 00:53 (107090)

Paula:

You live in what I consider to be somewhat of a difficult area to find good care becuase of all the managed care in your area. For better or worse, doctors practice can be influenced by that. There is a lot of talent out there that limits exposure to managed care so if you are paying out of pocket, I would go in that direction.

Are you in Santa Rosa County?
Ed

Re: Recommend a Dr north of San Francisco?

Ed Davis, DPM on 1/28/03 at 01:00 (107091)

I am going to work backwards.... My favorite orthotic lab is Northwest Podiatric Lab. My bias is that providers who use them are generally better than average. Also, it is one of the most expensive orthotic labs so docs who subsist on a lot of mangled (oops, I meant managed) care will not pay their lab fees for orthotics. Their telephone number is 800-443-7260 -- ask them who they recommend in your area.
Ed

Re: Recommend a Dr north of San Francisco?

Julie on 1/28/03 at 02:39 (107100)

Mangled care! I love it! This has to be the funniest and most appropriate slip ever.

I'm glad you let it stand and didn't delete it, Ed! Thanks a lot for my first (probably best) laugh of the day.

Re: Recommend a Dr north of San Francisco?

Mar on 1/28/03 at 07:34 (107106)

All of my orthotics were made from a cast taken in the pod's office and sent out to a lab to be made. Do most people actually go to a CPed's office to have them made? It sure makes more sense to me. Perhaps they would work better and not have to be sent back so many times. Can I just go to a CPed's office with a script even if my pod doesn't normally do it that way??? Mar

Re: Recommend a Dr north of San Francisco?

Carole C in NOLA on 1/28/03 at 07:38 (107108)

Mar, there's nothing at all wrong with having orthotics made in a lab, but I think your pod should have watched you walk in them and should have offered free adjustments.

You can't go to my C.Ped without a prescription. I think that's true for all of them. Sorry. So, ask your pod for one.

Carole C

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Carole C in NOLA on 1/28/03 at 07:39 (107109)

Mar, there's nothing at all wrong with having orthotics made in a lab, but I think your pod should have watched you walk in them and should have offered free adjustments.

You can't go to my C.Ped without a prescription. I think that's true for all of them. Sorry. So, ask your pod for one.

Carole C

Re: Recommend a Dr north of San Francisco?

Richard, C.Ped on 1/28/03 at 08:21 (107111)

Mar, we require prescriptions because if we made orthotics for someone with a diagnosable foot problem, that would make us seem as if we are diagnosing the problem ourselves. This is what makes me so mad about companies that do not use prescriptions.......but thats a whole other story.

You have the right to go anywhere you want to have your orthotic prescription filled. If you have a medication prescription, you can go to any pharmacy you choose...I see this as the same.

The good thing about having the orthosis made in an office such as mine, we do the work right here. If by chance you need an adjustment, we do not have to send the orthosis off. Also, you do not have to wait 2-4 weeks for the orthosis to be made, I have mine done the next day, and sometimes even the same day if needed.

Richard

Re: mangled!

paulas on 1/28/03 at 12:31 (107143)

Three of the four doctors I mentioned are from a mangled care organization that I won't name...and the horrors only start with not being checked out properly. I quit seeing their doctors after hearing the suggestion that I should wear walking casts on both legs and push a rolling walker around for the rest of my days because they were out of other ideas to treat my p.f. Thanks for the number Dr. Ed, I will give them a call and see what they recommend! And, yes, I live about 10 miles south of Santa Rosa.

Re: Recommend a Dr north of San Francisco?

Carole C in NOLA on 1/28/03 at 12:34 (107145)

Yes, Richard! When my C.Ped made my custom orthotics, she did it right there. I had to wait two weeks for an appointment, but I was glad that I didn't give up.

I was in the worst PF agony imaginable by the time she saw me, and she stayed and worked on my orthotics and with me for several hours until she was sure that my orthotics were the best possible for me, and until she was sure that I knew the basics of how feet work, what caused my PF, and what to do for it.

I thought that was wonderful. Talk about an unsung hero!

Carole C

Re: Recommend a Dr north of San Francisco?

Mar on 1/28/03 at 15:27 (107155)

Richard -
This makes so much more sense than sending them to a lab. The pair that I wear all the time took about a month and then had to be sent back for adjustments - another 2 weeks. I am having another pair remade -- it has been since the end of October and I still don;t have them! The ones I wear all the time I have been using for a year and probably need to be spruced up, but I can't send them to the lab because I need them! Where do you practice - I forgot? I am in northern NJ. I would love to be able to talk to the person doing the work and explain how they fit my feet, etc. Mar

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

D.Thomas on 1/28/03 at 15:30 (107156)

Mar,

I have had orthotics made from both labs and C.Peds. Having a good lab experience is highly dependent on your doctor. They are the one who makes the mold and then puts the prescritption into the orthotic - usually termed 'posted' (I think that's what it is called - someone can correct me if I am wrong).

In my experience, if the doctor or the C.Ped doesn't watch you walk and take other measures, do not buy orthotics from them - period. I have been to two doctors who didn't watch me walk and take other measures and told the nurse mark the orthotic 'post to cast' which like Dr. Davis wrote can be a hit and miss judgement.

I have had both good and bad experiences from both (labs and c.peds) situations.

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Mar on 1/28/03 at 15:31 (107157)

Carole -

Yes, my pod offers free adjustments to the orthotics but it takes so long to get them back and the lab doesn't always do what they are supposed to and then we send them back again. I have one pair that the lab keeps doing wrong since October! I still don;t have them! I told the doc that i was glad it wasn;t a pacemaker I was waiting for!! Mar

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

Mar on 1/28/03 at 15:35 (107159)

I don;t even remember if my pod (either one -- I had orthotics from 2 different pods) took measurements or watched me walk. I don;t think so though. My ESWT pod watched me walk but I haven't yet gotten orthotics from him (he does adjustments in his office as well). He seems to think my orthotics are okay though, although I don;t think so or why would I continue to have so much pain!? Mar

Re: Recommend a Dr north of San Francisco?

nancy s. on 1/28/03 at 16:42 (107173)

dr ed's 'mangled' care comment is what kept me up so late, julie -- laughing. i did manage to get a whole 3 hours of sleep before spending 9 hours at an auction today!

i had plenty of mangled care through mangled care health organizations. or, more accurately, i had very little, but it mangled A LOT. i'm always complaining here how i can't afford health insurance anymore, but maybe i should knock it off. at least i can choose what doctor to see and possibly get less-mangled care!

now that i think of it, when i finally found my sports med doc -- 8 months after we ran out of insurance (and our insurer left the state) and over a year into pf & the other lovely foot afflictions -- he was absolutely thrilled that i had no insurance. it meant he could make decisions based on his own education & experience and on my needs rather than on what the hmo would approve.

nancy
.

Re: Recommend a Dr north of San Francisco?

Pauline on 1/28/03 at 16:56 (107178)

Let us know if you purchased anything at the auction, but we'd better move it to the social page. Don't you just love auctions? Have you ever attended one with stuff taken during police raids?

Re: How do custom orthotics work, if they are made from your 'improper' standing foot?

nancy s. on 1/28/03 at 16:56 (107179)

mar, i'd run (or scoot) from any pod who doesn't examine your shoes and watch & evaluate your gait, at a minimum, especially one who is casting you for orthotics and ordering them from a distant lab. of course, mine didn't do these things either, but i didn't know until i found this site -- after i'd wasted 8 months with him! -- that these were basics.

nancy
.

Re: Mangled insurance system

Julie on 1/29/03 at 02:35 (107228)

Nancy, everything I've read about health insurance here over the past couple of years has persuaded me that it is mangled. And that it appears to be mangling the health of millions of people.