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Follow-up to orthotics post below (Richard and everyone)

Posted by francesc on 1/05/04 at 22:43 (141462)

hi everyone,

just wanted to let you know that i saw my podiatrist and he decided that i was not tolerating the hard orthotics so he's having them recast in a less rigid and more cushioned material. so, he said he was putting a rush on them and i should get them in 1-1.5 weeks. (BIG SIGH)

he said he prefers the hard plastic ones becuase they offer more control. does that sound right to most of you? i wasn't sure what that meant but i remembered most of you saying that hard orthotics hardly seemed to work for most PF sufferers!

i did ask him about going to a CPed and he said whatever worked for me was fine. he was not against them but, he wasn't about to recommend one. the CPeds i have found are mostly associated with a shoe store which specializes in orthapedic shoes. if i got that route, are there any specific questions i should ask before i plunk down the $$ for another pair of orthotics?? how do i know this person is experienced and what kind of guarantee should i get from them?

he seemed optimistic about my relapse in the right foot (i had a cortisone shot in it back in july and it was pain-free until now) and felt that my left would be better too once i had the proper orthotics.

it is the best i've felt in 2 weeks as far as having hope that i can recover.

oh yeah, and he is getting me a night splint. i haven't tried them but, i've read about them here. what do you feel the effectiveness of the night splint is?

thanks for your help and support. it is nice to bounce my questions off of all of you.

frances

Re: Follow-up to orthotics post below (Richard and everyone)

Carole C in NOLA on 1/06/04 at 00:54 (141464)

What a turkey to not recommend a C.Ped! I would like to think that was not out of his self-interest, but who knows. Certainly if he is a podiatrist, he knows (but is not telling you) what C.Peds in your local area have good reputations.

I think it's probably very important to find a C.Ped with experience who knows what he/she is doing. My rheumatologist (who diagnosed my PF) recommended a C.Ped. He told me to get THAT C.Ped, not one of her associates or any other one. I did, and I got some excellent orthotics. Most C.Peds require prescriptions from a doctor or podiatrist, so I believe you really do have to get one through a doctor or podiatrist as opposed to just walking into the store.

At least your podiatrist is going to try some less rigid orthotics even though he isn't willing (or else isn't able) to make anything for you on the spot. I am less patient than you, and I'd have been long gone and at another podiatrist.

Night Splints are supposed to be really good, if you can sleep with them. Some are easier to sleep with than others, apparently. People here say that the one for sale on this website is a really good one. I never used a night splint although my C.Ped said that one would be a good idea for me. She suggested I could start with the gentle stretching and see if that was enough, before shelling out for a night splint. And then, I never went back or ordered the night splint though I probably should have.

Carole C

Re: Follow-up to orthotics post below (Richard and everyone)

Richard, C.Ped on 1/06/04 at 08:55 (141471)

I have spoken to many Pods in our area and the impression I receive from them is that C.Peds do not have much respect. Another of many reasons the schooling should be a two to four year degree and we should be licenced. I think they also see us a competition because orthotics are large source of income.

I still think 1 to 1.5 weeks to receive your orthosis is still to long. I sure hope you are not paying for that second pair. Many C.Peds do offer orthopedic shoes. I do...even though I don't like doing them very much. We guarantee that we will do what we can to provide a good and proper fit. It is very hard to guarantee a custom item. Ask what type of material they use and see if your insurance will cover. If not, see what discounts they offer and if you are able to be put on a payment plan. I do that for my customers.

The hard plastic does provide good control, but there are wonderful alternatives to that as well. I love EVA. The 60 durometer offers excellent control and provides a wonderful functional orthosis. Some pods disagree because they are taught hard plastic. I look at it this way, someone with a flat foot will have a much, much harder time adapting to the orthosis than a normal or even high arch foot. I would never start someone with flat feet in a hard plastic orthosis. Another thing is, more money can be made from the hard plastic than any other material.

Re: Follow-up to orthotics post below (Richard and everyone)

Rick R on 1/06/04 at 11:36 (141476)

Richard,

How do you prevent the natural balance of forces from slipping the orthotics to the inside of the foot? It's like stepping on a wedge. The net result for me has been to destroy my shoes as the orthotics slide inward and my foot slides outward. I'm going to make my own because I think I can do a better job. One alternative I'm thinking of trying is just an arch support that I'll tape in place.

Rick

Re: Follow-up to orthotics post below (Richard and everyone)

Richard, C.Ped on 1/06/04 at 12:35 (141481)

Maybe it is lack of sleep due to our newborn...but I am not sure what you are asking Rick. Are you saying that the orthosis slides inside the shoe?

Re: Follow-up to orthotics post below (Richard and everyone)

Rick R on 1/06/04 at 13:27 (141486)

Yes, they tend to slide to the inside the shoe (right slids left, left slides right)causing among other things, a lower effective arch profile and thus less support than intended. Also, this pushes the foot to the outside of the shoe. They do work for me, but not for any aggressive activity or for a major flare up.

Rick

Re: Follow-up to orthotics post below (Richard and everyone)

francesc on 1/06/04 at 15:17 (141494)

carole and richard,

the way it is around here, most podiatrists do not do the othotics in their offices. they usually send them out. is it different where you are?

i doubt that insurance will cover any othotics thru the CPed. they wouldn't even cover the ones thru the podiatrist! the only way they'd cover it is if i was a diabetic.

no, he's not charging me for this new pair. and yes, i am almost at the end of my rope. however, since i had gone this far with the orthotics, etc., i didn't want to have to go to another podiatrist and get fitted AGAIN for orthotics and pay for another set. do you think it's worth it for me to visit another podiatrist? i'm not sure how these things usually go (the orthotics fittings, etc) because i've never done this before.

am i being too patient?

frances

Re: Follow-up to orthotics post below (Richard and everyone)

Carole C in NOLA on 1/06/04 at 17:09 (141499)

From what I've read on these boards, most podiatrists don't do orthotics in their office. I think probably that is because the majority of their practice is things like bunions, corns, diagnoses, and so on.

However, I think most C.Peds do have the capability of making at least some of their orthotics in their office. There are some advantages of having orthotics made on the spot. First is the obvious... you get the orthotics immediately before your feet get any worse. Second, the person making the orthotics can immediately watch you walk in them, and adjust them until they work perfectly before you leave. You might need more adjustments later, but at least you have a good shot at getting orthotics that work well for you.

I don't know a whole lot about this stuff... I'm just a patient! And I've never seen a podiatrist myself. How many have you seen? I just think you got a rotten deal with the one that you went to. I think that most of the art that went into making my orthotics was due to the one-on-one interaction where a C.Ped that really cared was examining my feet, talking to me about my lifestyle with respect to my activity and strain on my feet, repeatedly watching me walk, making my orthotics and putting them in the shoe she thought would work best in my case, and meanwhile teaching me about self treatments such as those we discuss here. Then she adjusted and readjusted them (wathing me walk each time), to the point that I told her I felt as comfortable standing in them as I did sitting.

You may be right about insurance. I do seem to recall Richard mentioning that insurance covered some orthotics that he has made. But on the other hand, my C.Ped's helper/cashier did not want to deal with insurance so I just paid the $250 or so and walked out with my orthotics and new shoes on my feet.

That was just a drop in the bucket compared with the entire sum of money that PF has cost me, over $1500.

Carole C

Re: Clarification of the facts from an old timer

Drr. G or G, for some on 1/06/04 at 21:24 (141519)

When it comes to making orthotics podiatrist's wrote the book on that area. Podiatrists have been the primary providers of foot orthotics to the public since the mid 1800's.

Abraham Lincoln had Marfan's syndrome, a condition in which tissues are too elastic. Folks with Marfan's often have weak arches as the tissue has trouble supporting one's weight. William Zachary, a podiatrist, was Mr. Lincoln's favorite doctor since he had a lot of foot trouble and Dr. Zachary kept him on his feet. No, I was not practicing at that time!

Until the early 70's the majority of orthotics were called 'leather laminates' as they were formed over casts of people's feet either by the podiatrist or by a lab. If a person is so inclined he may do good work making them in his office or a lab can often do a better job. Where they are made is irrelevant. Saying that there is something better when they are made on the spot is analogous to saying that an optometrist who does eye exams and dispenses eyeglasses from his office is better than an optometrist who provides a prescription and sends his patient to an independent optician. I would not want to go to a dentist who took an impression of my mouth and then came back in an hour with the finished product he made. I would rather go to a dentist who sends the impression out to a professional laboratory. That being said, some states have allowed dental labs to market directly to the public to sell dentures, bypassing the dental exam. Often the patients of the denturists are happy.
But sometimes things get missed.

Skipping the podiatrist exam is similar. Pedorthists are a relatively new profession. Perhaps Richard can tell us when their profession got started.
I don't believe they are licensed to examine feet. They don't do x-rays, order tests, nor MRI's. Many do a fine job in making orthotics.

No professional has more training in the exam of feet, biomechanics, biomechanical correction of feet than the podiatrist. If any one has doubts, the number of course credit hours are public knowledge for anyone to research. That being said, I agree that there are some podiatrists that are so wrapped up in surgical treatment that they neglect their biomechanical skills to the detriment of their patients. The happy ones, which are the majority, usually don't come to forums looking for answers.

Happy New Year
Dr. G or just G for some

Re: Follow-up to orthotics post below (Richard and everyone)

Richard, C.Ped on 1/07/04 at 09:20 (141563)

It sounds like the orthosis is to narrow for your shoes. It is hard to say without seeing what is going on.

Re: Clarification of the facts from an old timer

Larry T on 1/07/04 at 13:59 (141576)

Old Timer I respect your opinion but some of your points are waayyy off. I work in a PT clinic and I am sad to say but I see way too many junk orthosis from Podiatrists. The standard hard plastic 3 quarter device with the Dr name on it for somtimes over $400 is a rip. There are many great Podiatrists but also many that are nothing more than a strip mall Chiropractor when it comes to making orthosis.

I would rather have a person cast and fabricate it then sent to a faceless lab where 7 guys that dont speak english all help make it

good day

Re: Clarification of the facts from an old timer

francesc on 1/07/04 at 16:56 (141585)

hey larry,

those sound like MY orthotics!! :-/

i just think that the response time is terrible. 2 weeks minimum to send them out, get them made/adjusted, and returned to me. so in the meantime, what the heck do i do for 2 weeks while i'm waiting? i have been trying to get my orthotics since August! since then, the initial imprints got damaged so i had to be re-imprinted and i have had 2 adjustments since then. now he's having them re-made again and again, i have to wait a couple of weeks.

oh he says he's putting a rush on it but, i bet i don't get them any sooner.

anyway, i didn't mean to get anyone upset. i'm just trying to find the right solution for myself and get some relief.

frances

Re: So what is your point Larry?

Dr. G on 1/07/04 at 22:50 (141605)

Larry:

Tell me which points specifically are way off. I have seen PT's take a weekend course on foot orthotics and voila, they are in the foot orthotic business.

There are poor practitioners in all professions, bar none. So how does that make my points way off?

There are some bad dentists out there but that would not stop me from finding a good one and getting my dentures fitted and dispensed by that doctor.

Dr. G

Re: Clarification of the facts from an old timer

Dr Kiper on 1/08/04 at 10:35 (141628)

In all cases for paid services, some people guarantee their work (and there's no reason you shouldn't ask for that up front), some people simply charge for their efforts regardless of outcome.
You can always in a nice way ask the doctor for your money back, citing that his efforts have not worked for you, and that you still need further help. In most cases labs will reimburse him his lab cost, so he would just be out his time and there's no reason you couldn't continue to see him for other general services.
If he's uncooperative, inform him that you will be writing a letter to his Board of Medical Examiners and the BBB and complain to them about your dissatisfaction. It may or may not get you anywhere, but he will not be happy (even if he doesn't give you your money back).
If everyone did that, those people performing poor services may become more cooperative in cases where they failed to satisfy as complaints started to pile up as they do become part of public record.
Anyone can go to a web site in their state and check the credentials and disciplinary actions against any type of doctor. In Calif it is: http://www.medbd.ca.gov/
By the way, I give a money back guarantee up front, so that you don't have to ask.

Re: So what is your point Larry?

Larry T on 1/08/04 at 14:42 (141643)

My point was that there are far too many Podiatrists providing poor devices. I have even seen pre made cheap shells that were billed as custom. I dont know how much actual time is spent in podiatry school making orthotics, casting, material choices etc.

My point is that too many of them have forgot what they learned in regards to orthosis. Sad to say but there are too many making little 3/4 shell leather top with a bit of posting for $350+

Re: Clarification of the facts from an old timer

Andy on 1/08/04 at 15:15 (141645)

These comments assume that the Podiatrist is primarily concerned with the welfare of his patients. I find that the Podiatrists whom I have seen (two) are more concerned with making money and prescribing expensive orthotics.
I found that the inexpensive, temporary foam orthotics which they give you to tide you over until your custom orthotics arrive work perfectly for me. They are nothing more than expanded polystyrene (EPS), also known as styrofoam. They must cost all of five cents each to mold.
I recently had a flare up of PF and went to my Pod to request a new set of these devices. He refused to discuss them, but suggested making a new set of orthotics. I agreed, but told him that the softer, cork type were the only custom orthotics which helped me (mine are worn out). Guess what he delivered, after two weeks! The hard plastic type. He wasn't even listening to me.
If this guy actually wanted to help alleviate my pain he would have given (or sold) me the ones which I originally had asked for. But there probably isn't much profit in giving or selling styrofoam inserts to your patients.

Re: Thanks, I'll keep this in mind.

francesc on 1/08/04 at 15:17 (141646)

Thanks Dr. K.

Yes, I will keep this in mind. Next week I'm going to see my PCP to talk to him about my PF and see what he recommends. I just want to make sure that I explore any and all avenues. I will talk to him about what the podiatrists in his medical group do for orthotics (I am currently seeing a podiatrist that is not in his medical group). But, I'm afraid that for the pods in my area, i won't get orthotics very quickly.

Thanks again,
Frances

Re: Clarification of the facts from an old timer

Dorothy on 1/08/04 at 15:31 (141648)

You might really like the PowerStep (sold here and on Footsmart.com) for under $30.00. Lots of folks here like this one; Dr. Wander has recommended it. It sounds like it might be similar to what you have liked from your podiatrist and not at all like what you did not like. Another good one is SuperFeet (available from REI.com) that folks here (see Suzanne's posts especially) have liked and that you might also find comparable to what you have been using and also, I forget exactly, around $30.00. Good luck.

Re: Clarification of the facts from an old timer

Dr. Zuckerman on 1/08/04 at 19:47 (141653)

The powerstep is an excellent insert that is very cost effective.
I would give thema try.
As for podiatric orthosis. I agree with Dr. G. A podiatrist knows how to make an orthosis. The cost is something that we can talk about forever. The money back return policy is just smart business. Any time you give a money back return policy you are going to make the patient feel more comfortable in their decision.
The casting is very important when making an orthosis. The evaluation to determine such factors as forefoot varus, equinus are very important. I have never been a big fan of hard plastic orthosis except maybe with children

Re: Clarification of the facts from an old timer

Dr Kiper on 1/09/04 at 09:35 (141676)

A money back policy is not only smart business, but it let's the patient know you are confident it will work and are willing to make it a win-win situation rather than Dr. wins-patient loses.

After all, it's hard to stay in business if you're not successful at what you do.

Re: Clarification of the facts from an old timer

Richard, C.Ped on 1/09/04 at 13:01 (141700)

man..I had a nice long post regarding pedorthics and darned if the stupid computer did not save it!

Here is the short version. Pedorthics has been around since the late fiftys. I am a strong believer in licencing C.Peds due to the potential 'dangers' of making an improper orthosis.

We do not diagnose, but we (that is, any good C.Ped) do know anatomy and should be aware of the cause of the condition in which we are supplying the orthosis.

Anyone that blindley supplies a crappy orthosis just for the sake of the almighty $$, should have their plantar fascia partially cut at the met heads then hung by the calcaneous upside down for a week.

that is my very humble opinion though. hahaha
Richard

Re: Clarification of the facts from an old timer

Dorothy on 1/09/04 at 14:26 (141706)

Yow! Ow!

Re: Clarification of the facts from an old timer

Pauline on 1/10/04 at 22:37 (141807)

Dr. Zuckerman,
I agree with you that the casting for orthotics must be very important, but if this is so, why are so many Pods having their staff do the casting instead of doing it themselves.

Of the orthotics I've had made, not one Pod did the work himself. A tech casted each and everytime. The order was sent out and all the adjustments were done by a tech merely grinding down the bottom of each arch. I basicly ended up paying over $350 for ground up distorted sheets of flexible plastic with a moderate at best foam layer on top.

Not one of these compared to the single pair the German guy in Calif made for my nephew. Now those were a labor of love and a work of art by comparison. They were beautifully crafted like a piece of art. He needed only one adjustment and is running again.

In my mind that man deserved every penny he got, but the Pods that collected from me didn't deserve a dime for the junk I was handed.

I could post a few names and perhaps these guys should have their names plastered on this site along with many others for poor workmanship while reaping a good income from poor products. Personally I think many P.F. patients have run into a similar course of events on their search for a cure.

Re: Clarification of the facts from an old timer

Dr. Zuckerman on 1/11/04 at 04:35 (141809)

Pauline
It is possible that the techs were certified orthotists like Richard. Many podiatrists with very large practices have them on staff right in the office.

Re: Clarification of the facts from an old timer

Andy O on 1/11/04 at 04:52 (141810)

Personally, I have lost faith in Podiatry and am now simply trying to cure myself through trial and error.
I had the exact same experience as above. A technician casted my feet (unweighted, made the inserts, and adjusted them once. I was surprised at how quickly the adjustment was made, considering that there was a soft cover on top which I assumed had to be removed and later replaced. Until I found out that she had simply ground some material off the bottom. So the thing will flex like a diving board as I walk on it.
I had first asked for simple 3/4 length styrofoam inserts (they have a box full). When these were refused, I asked for cork inserts like the ones that helped me back in 1993. What I got was hard plastic. Since I had already informed him that I had already tried hard plastic without success, he made another pair..this time full length hard foam. These were the ones which were later 'adjusted'.
For some reason, this Podiatrist seems compelled to deliver anything BUT what I asked for. Maybe he is just anal retentive, or maybe it is a power struggle over who is going to dictate the treatment. Anyhow, I got tired of this and quit going back. My insurnce will not cover another pair of inserts, so the next set are on me (which also means that I get to go to whomever I want).
The best 'orthoses' I have found so far are my Birkenstock clogs and sandals. If I could wear them to work, I'd wear nothing else. It's a shame their shoes aren't made with the same footbed.

Re: I can do this, Andy, if you would like...

Suzanne D. on 1/11/04 at 08:17 (141812)

Andy, you missed getting my Superfeet inserts, and I continue to read your posts about your frustration with orthotics and your wish that you could have shoes with footbeds like your sandals or clogs.

I had this thought: I have the Footprints footbeds which came in my new Maderas just sitting in the closet. I am wearing the modified footbeds from my Annapolis shoes in my Maderas.

So...I could send you these new footbeds (size 43 narrow) if you want them, and perhaps you could find someone to modify them for you, to make them fit like your sandal's footbeds do.

At least you wouldn't be out an expensive pair of Birks to find out. The footbeds would be free from me, and you would pay for the modifications. Then you could take the footbeds with you to try on shoes to find some that you could wear to work.

Not trying to beat a dead horse here, just trying to help! :) If you are interested, e-mail me at sdennis @ hardin.k12.ky.us (without the spaces, of course) and send me your mailing adress, and I'll get them right out to you.

Suzanne :)

Re: I can do this, Andy, if you would like...

Andy O on 1/11/04 at 09:32 (141813)

Thanks for the thought Suzanne. I already am awash in Birkenstock footbeds. I have emailed Birkenstock Express to see if they will modify my existing footbeds to make them like my Tatami very high arch sandals. Let's see what they say.
Thanks again,
Andy

Re: Good luck!

Suzanne D. on 1/11/04 at 11:23 (141819)

I hope this works for you! I was pleased with what they did to modify my footbeds.

Suzanne :-)

Re: Clarification of the facts from an old timer

Pauline on 1/11/04 at 13:33 (141821)

Dr. Zuckerman,
Not these babes. They are the ones that show you to the room and put a clean sheet of paper on the chair. If you attempt to have any conversation with them, you know immediately that's the extent of their capabilities, although I must admit they do know how to turn the grinder on. This was very apparent from the product that was returned to me.

Re: Clarification of the facts from an old timer

Pauline on 1/11/04 at 13:50 (141822)

Andy,
Your experience makes me ask the following question.

Do orthotic manufacturers offer monetary incentives to doctors to use/select their particular product instead of one from their competitors?

With soooo many products available, it make one begin to wonder how these pieces of plastic are marketed to various doctor's offices.

I know how drugs are marketed, but just how to orthotics get marketed?

Re: Clarification of the facts from an old timer

Dorothy on 1/11/04 at 17:13 (141832)

I'm not sure if this would be what you need or want, but do you know that Birkenstock makes/sells an insole/insert separate from their shoes? I have seen it for sale at one or two places. If you are interested, I will try to locate where it was that I saw them.

Re: Clarification of the facts from an old timer

Andy O on 1/11/04 at 19:45 (141839)

Sorry, I don't have a clue as to how they are marketed.

Re: Clarification of the facts from an old timer

Dr Kiper on 1/13/04 at 09:55 (141938)

Podiatry is not the problem, the paradigms of traditional 'control' with traditional orthotics is.
There are several new technologies available today, i.e
semi-custom heat molded--
1-'Formthotics', which uses a hair dryer to soften (available at my site),
2-'Sole' makes a semi-custom (although they call it custom), heat molded that you heat up in the oven, per instructions.
3-semi-custom water injected-- (not sure of this name--'Biosole'??)
and mine
4-'Silicone Dynamic Orthotics' which are custom fitted, based on fluid mechanics.
The other 3 are good products but not as precise as the silicone, because the other 3 still do not precisely match the way the muscles walk (they are semi-custom, but generic in that they are sold by shoe size).

You and many others have spent unknown sums of money and time without success.At the risk of sounding like a salesman,I invite you to try the Silicone Dynamic Orthotic RISK FREE for 6 months--you have nothing to lose except the $20.00 S&H and some more time.

Re: Clarification of the facts from an old timer

Ed Davis, DPM on 1/13/04 at 20:40 (141981)

Dr. Z:

Pauline makes a valid point here. Her experiences concern me greatly as their is a subset of individuals who are practicing below the standard of care in this area. We have had intensive training in biomechanics, the biomechanical exam which is an integral part of making the casts and taking the measurements. I just don't agree that that function should be delegated and I was one of the people writing licensing laws I would forbid it unless the person was a CPed. It is a very time consuming process and I can think of few things that get me more behind schedule than having to do a bunch of such procedures but I am determined to apply the skills we have been so thoroughly trained in to make top notch orthotic devices.

We, as podiatric physicians, have the know how to 'do it right.' If we don't then I don't want to hear colleagues complain about all the untrained 'entrepreneurs' setting up shop. We need to set the standards and lead by example. Patients need to realize that orthotics don't always lead to a cure but they need to know that if they don't work it was not because they recieved an inferior device but because orthotics, as a modality, were insufficient to lead to a cure. Orthotics are a treatment just like any other treatment. Like other treatments, they will lead to cures in a certain percentage of the population. If we place guarantees on orthotics, why not place guarantees on the rest of medical treatments?
The guarantee itself includes a price tag ( a guarantee is a commodity), so anything one places a guarantee on raises the price of the service or product (unless, of course, their already exists a high markup on the product -- something true for a number of prefab orthotics).
Ed

Re: Clarification of the facts from an old timer

Ed Davis, DPM on 1/13/04 at 21:10 (141986)

Dr Kiper:

I am just curious about a few of your comments. Why have hundreds of thousands of patients been successfully treated via traditional orthotics if the 'pardigm of traditonal control' is incorrect. There are scores of orthotic labs out there, doing lots of business. Don't you think they would be out of business if their products simply did not work?

With all due respect, I would not consider the technologies you have listed to be new. I am willing to accept that traditional orthotic design, like any other treatment, does not cure everyone and that there are a subset of patients that may do better with alternative designs. I cannot accept that the needs of that subset set the paradigm for the majority. The differrence between an average practitioner and an excellent one is often based on the willingness to learn about a diversity of modalities so we need to accept that there is a place for your product in the spectrum of treatments. I am not convinced that your product is a substitute for conventional orthotics but can see its potential benefits. It would be great if you could 'mainstream' the product more but understand you may have been discouraged by resistance. If you believe strongly in it, you should not let that resistance discourage you from continuing to try. I am not the first person to mention that the heel pain sufferers who wind up on chat boards like these include those whom have not had proper or complete treatment, have treatment needs that are not adequately served by conventional treatments or have 'intractable' cases. They do not represent a cross section of heel pain sufferers, the majority of whom are effectively treated and return to their day to day activities. An 'excellent' practitioner will welcome the 'intractable' cases in their practice, taking them on as a challenge to potentially enhance his/her skills and learn more.
Ed

Re: Clarification of the facts from an old timer

Dr Kiper on 1/14/04 at 11:02 (142003)

Stating that the paradigm of 'traditional control is incorrect is probably a little too strong, and I should be slammed for that, I stand corrected. It's true many people have responded well to traditional orthotics. I presume your numbers of 'hundreds of thousands is an opinion and not necessarily an accurate statistic, although it probably is even more. I would be willing to say that in my opinion, probably an equal number of patients have not been successfully treated. In my 30 plus years at this I would say 50% of people within 3 months give up or throw out the traditional orthotics made for them. 25% probably derive benefit but find them uncomfortable to wear, but wear them because it's better than nothing at all. And 25% are ecstatic over the comfort and their success.

I'm willing to bet that in your practice [like every practitioner, including orthotists etc] you have seen patients who have come in, been worked up and orthotics presented as a remedy to their biomechanical condition, whereby you are then informed they've already had one or more pairs already attempted. Their last doctor who has now lost this patient probably thinks that this case was a 'success' because the patient is no longer coming back. This case may add in to your statistics of hundreds of thousands of success stories.

Personally I don't like to state my success ratio, because it doesn't sound possible. I've had failures, but they are not because the orthotic isn't working, it most of the time is because the patient is frustrated or disappointed that it didn't work quickly enough for them, and this being a risk free offer, they don't want to chance losing their money. The funny thing is, is that if they give up, it is right around the three month period and my coaxing to work with me the full term of 6 months is wasted on deaf ears (for my failures). No doubt, any one product is for all people, but problems secondary to overpronation, barring any radical pathologies can be successfully treated by one type of orthotic if that orthotic works the way an orthotic should work. That means it has to meet certain criteria in the fit and ALL the criteria must be there for it to fit precisely, be comfortable to wear and ultimately work. The percentages of a traditional orthotic that does not meet all the criteria of a custom fit is very poor in my humble opinion.

Because patients are desperate for relief, they continue to look for the doctor or gadget that will give it to them. If all the labs and doctors gave a money back guarantee up front I wonder what the success ratio of traditional orthotics would be then?

I wonder if Scott could come up with some form of poll of patients that would have asked for their money back and how many pairs of orthotics they tried.

Re: Clarification of the facts from an old timer

Larry T on 1/14/04 at 15:25 (142021)

Personally I don't like to state my success ratio, because it doesn't sound possible. I've had failures, but they are not because the orthotic isn't working, it most of the time is because the patient is frustrated or disappointed that it didn't work quickly enough for them, and this being a risk free offer, they don't want to chance losing their money.

Sorry I had to read the above statement a few times. You are saying if a few patients were more compliant with your instructions you would have about a 100% cure rate or you would have no patient ask for refund?
Those are some pretty great numbers but I dont think offering a refund means they are the best possible device available.

Getting squish boxes maile to you eliminates the office visit and some overhead costs as well. I assume you charge over $300 so you can afford to refund a few pairs.

Re: Clarification of the facts from an old timer

Ed Davis, DPM on 1/14/04 at 21:57 (142044)

Dr. Kiper:
I see a lot of patients from other practitioners who have had substandard orthotics made. Often those patients are convinced that orthotics, as a modality would not work because they had a bad experience. As such, those practitioners often make my job harder. They often ask for a guarantee but as we all know there are no real guarantees in medicine. As for giving money back, I would be curious to know why you would not consider extending that to all facets of health care? For example, if a surgery does not work, the fee is refunded.
Ed

Re: ps

Ed Davis, DPM on 1/14/04 at 22:03 (142046)

Dr. Kiper:

I am asking that question to you both as a real question and as a rhetorical question. My philosophy is that treatment of PF involves a multifactorial approach with orthotics only being one potential modality.
So, if a patient has intractable PF, was it the orthotic that failed, the stretching, the physical therapy and so on? So do you then refund everything?

I think that the philosophical thing I am getting at is that you are viewing the orthotic as an isolated commodity with an intrinsic value that can be separated from the treatment plan. I view it as one component of a comprehensive treatment plan.
Ed

Re: ps

Dr Kiper on 1/15/04 at 19:36 (142146)

It pains me that you state you see a 'lot of substandard orthotics.
I don't see it as a fault of the practitioner or the lab. I see it as a fault of the traditional orthotic.

One of the problems you mentioned earlier were the intractable pain patients. The nightmare of any practitioner. There can be only a few reasons why they exist.
1-their pain does not originate from their biomechanical alignment or condition (this is probably the toughest to determine in my opinion).
2-their problem has been neglected and therefore present for years and years and they are in a chronic state, so it becomes difficult at best to retrain those muscles with any proper fitting orthotic.
3-they've had invasive procedures and/or injections, distorting or even damaging their proprioceptive senses.

For these patients, to me it is never a question of what failed. The PT, massage the stretching etc, cannot fail, it has to help. It only fails to help soon enough so that they feel the benefit and because the PT etc only addresses to the symptoms and not the underlying cause.

If an orthotic fits correctly and the patient can wear it comfortably, it is working regardless if they feel any benefit. For me, it is not a question of if it will work, but when. Because the patient is unaware that the orthotic is working, and because they become disappointed or frustrated that it's not working as they hoped or expected I don't hold any credibility, because they've heard it all before. It's the patient who fails, at least this is the case with me. Because I know when my orthotic is fitting correctly. With a traditional support, you can never be sure if the casting is precise, did the lab do it exactly,
or is it that the orthotic is too static for them.
As for guarantees, since I no longer practice general podiatry,
I didn't give guarantees when I did and am in no position to say that anyone should. I am able to guarantee the silicone orthotic, because fortunately the intractable pain patients are in the minority.
I am willing to give patients a night splint, recommend PT, all that stuff. I am a firm believer in stretching as a part of life, not just until you are better. I've developed a stretching and acupressure technique for the intrinsic muscles of the feet (which no one ever seems to address).

So you see my approach is also multifactorial and since podiatric problems are primarily biomechanical in nature I do see the orthotic as an isolated commodity, as it is the only thing that addresses the underlying cause.

Re: Clarification of the facts from an old timer

Dr Kiper on 1/15/04 at 19:42 (142147)

Don't be concerned with how to interpret what I meant. What I'm saying is that I offer a 6 month risk free trial.
If you're not satisfied, I will refund the full purchase price of the orthotics. The most you can lose is the $20.00 S&H.

If you've suffered, if you've tried countless and costly other things, if you've been to the best there is and failed, give me a chance--you have nothing to lose.

Re: ps

Ed Davis, DPM on 1/15/04 at 22:10 (142155)

Dr. Kiper:
A lab can only make what the doctor or other practitioner prescribes. When you see patients with forefoot valgus get orthotics with forefoot varus posts, that is either due to a casting error or because the wrong thing was ordered. That is one of the more common mistakes I see. Those same patients obtain dramatic improvement once they obtain the proper prescription, via a 'traditional' orthotic.
Ed

Re: ps

Dr Kiper on 1/19/04 at 18:05 (142393)

I was trying to take some pressure off the podiatrist. What you just said is that only the practitioner makes the mistakes.
Either way, I'm OK with how you feel.

Re: ps

Ed Davis, DPM on 1/19/04 at 22:48 (142415)

Dr. Kiper:
I see a lot more mistakes from non-podiatrist, non-CPed made orthotics but it is just that I hold the 'pros' to a higher standard.
Ed

Re: Clarification of the facts from an old timer

Connie A. on 2/07/04 at 12:33 (143863)

Pauline,

I've been reading this thread with great interest, as I've been through a number of orthotics myself (two pairs of rigid, two pairs of semi-rigid, three different makers) and am still searching for the right pair, for a chronic tendinitis problem and arch pain.

Your reference to a German guy in California piqued my curiosity. I will be returing to CA, to the East Bay/ San Francisco area (where I'm from) in May after my current job ends. I know that CA is a huge state, but could you tell me more about him: where he's located, and, if it's allowed on this web site, his name?

Thanks!

Re: Clarification of the facts from an old timer

Connie A. on 2/07/04 at 13:07 (143868)

Pauline,

I've been reading this thread with great interest, as I've been through a number of orthotics myself (two pairs of rigid, two pairs of semi-rigid, three different makers) and am still searching for the right pair, for a chronic tendinitis problem and arch pain.

Your reference to a German guy in California piqued my curiosity. I will be returing to CA, to the East Bay/ San Francisco area (where I'm from) in May after my current job ends. I know that CA is a huge state, but could you tell me more about him: where he's located, and, if it's allowed on this web site, his name?

Thanks!