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Need input on buying 1st pair of orthotics

Posted by Linda V. on 8/07/04 at 16:51 (157166)

Hi,
Looks like stretching, icing, superfeet in NB879's, and the cortisone shots aren't enough. Better, but still need to go to next step of orthotics. Trouble is, my podiatrist wants to cast me (sitting) for a hard pair. He believes feet need firm support. I love the guy, but stopped in at a cobbler shop to se a pedorthist who wants to do a foam box and cast(he manipulates, no weight bearing) and make me a pair of leather over cork. He swears he will make me the foot I had when I was 12 years old. Cost is the same. What to do, what to do?????

Re: Need input on buying 1st pair of orthotics

Carole C in NOLA on 8/07/04 at 18:29 (157172)

(I am not a foot expert, but just another person who had a bad case of PF).

If it was me, I'd go for the pedorthist and stay away from those hard orthotics. From what people have said on this message board, hard orthotics often are awfully difficult to handle if you have a lot of PF pain.

I've never had leather over cork, but that sounds reasonable. My orthotics are semi-rigid and made of various layers of eva (sort of rubbery plastic stuff) on top of a harder plastic, and they worked outstandingly well for me. The eva is softer and cushioning. Mine were made by my pedorthist.

Carole C

Re: Need input on buying 1st pair of orthotics

Richard, C.Ped on 8/09/04 at 08:35 (157244)

I am no fan of starting someone off with hard orthotics. I really do not care for leather or cork as well. I have heard complaints that leather seems 'slippery' and the cork retains smell.

Check and double check to see if insurance will pay for the orthosis. Check to see if the C.Ped takes insurance. Find out what you will have to pay out of your pocket. Ask how long each will take to get back to you. One day? Two weeks? Ask how long adjustmets will take if needed.

If the C.Ped swears that he will make your foot feel like that, get a guarantee. If if does not feel like that, you want them free. Think that is extreme? If he can make a statment like that, he needs to be prepared to follow up on it. If I say something to a customer, I am going to back it up.

Make sure the C.Ped uses a prescription from the doctor. If he says he does not need one, do not use him. C.Peds are to make custom orthotics only with prescriptions. This prevents practicing without a licence. Also, insurance will not even look at a claim without a doctors prescription. You will be stuck with the full charge.

Find out if you can get a discount if your insurance does not cover. I do that quite often.

Re: Need input on buying 1st pair of orthotics

DavidW on 8/09/04 at 14:16 (157279)

Linda V.

I am no doctor either, just a PF sufferer. My 1st pair of orthotics was the hard type made from a plaster cast of my feet (about $300). I did not do well with them and had several modifications to them at my expense and time. They basically made my feet hurt in different ways, and never relieved the pain. Initially, I had severe heel pain and after wearing the orthotics for several months, the pain migrated into my arch. I had several adjustments made, but they never worked well for me.

I abondoned my custom orthotics (after more than 1 year) and started wearing PowerSteps. My main reasoning was 1)my feet hurt already, how bad can it get, 2)they are cheaper so I can buy several pair and put them in all my shoes, 3)if they don't work, I only wasted $30, and 4)I don't have to go to the POD to get them!

I have been wearing them for 5 months now and I feel pretty good.

Re: Need input on buying 1st pair of orthotics

Ed Davis, DPM on 8/09/04 at 14:46 (157282)

Linda:
I am not sure if this helps but I feel that it is the accuracy of the prescription that matters more than the material used. I would be a bit uncomfortable with the 'promise' made by the one individual. I tend to use something in between which is a semi-rigid orthotic made of graphite with a soft top cover (see my post below answering the 'hard orthotic' string). The accuracy of the prescription is related to the skill of the provider and I don't know who you are dealing with. I wish I had more information to help make the decision. If you have a good repoire (it sounds like you do) with your podiatrist, try to talk things over, including your concerns.
Ed

Re: Need input on buying 1st pair of orthotics

Linda V. on 8/09/04 at 16:24 (157288)

Hi,
You gave me a lot to think about. The pedorthist i have thought about using claims he REFUSES to make orthotics from prescriptions or casts made by someone other than him. his words...'i want to see the patient, not the cast so i know its done right.' therefore, no podiatrists use him, only orthopods send their patients there. does this sound right to you? glad you mentioned about the cork retaining odor and the leather being slippery. i saw my pod today..he did some build-ups on my over the counter superfeet that might help. i still have to think before shelling out the $300.00...for either his hard plastic orthotics or the softer ones..thanks for your help. any more input GREATLY appreciated. linda

Re: Making orthotics without a prescription....is it ok?

Linda V. on 8/09/04 at 16:38 (157289)

Hi..
C-ped and POD..please read my previous entry and comment..thanks

Re: Making orthotics without a prescription....is it ok?

Dr. Z on 8/09/04 at 17:00 (157291)

Hi

I agree that plastic hard orthosis are at times very difficult to wear and adjust. I like non-weight bearing orthosis, casting the lower extremity in a neutral position. The prescripton will depend on the gait evaluation and the biomechanical evaluation that is done. The method of casting is very important. I guarantee all of the orthosis I make in writing

Re: Need input on buying 1st pair of orthotics

Richard, C.Ped on 8/10/04 at 07:43 (157357)

Am I reading this correctly??? He refuses to make orthotics from prescriptions???? If that is so....STAY AWAY. In the pedorthic field, that is practicing medicine without a licence.

This is not meant to sound cocky at all, but even if I know exactly what is wrong with the patient, I do not make a custom orthosis without a prescription. Custom meaning using a cast of the foot to fabricate the orthosis. That is unethical, and aganist the pedorthic standard of practice.

We will make direct mold (not using a cast) inserts without a presctiption. We do that on a daily basis in our snow ski shop. With this type of insert, you are not targeting a diagnosable condition. You are just trying to get better balance in the ski boot.

Again, check and recheck your insurance about paying for orthotics. I have learned that you may get a customer service rep that tells you one thing, then call back and talk to another who tells you something totally different.

Re: Need input on buying 1st pair of orthotics

Linda V. on 8/10/04 at 19:53 (157456)

yes, you read me correctly. he does the fitting in a foam box in a neutral position...then makes the cast and the orthotic from it. he said he let his license lapse because he has enough work without having to juggle his practice around medicare regulations. he says when he does it his way, he can make adjustments without it taking so long having the patient go to the doc, doc writing adjustments, sending the orthotics,doing the work, sending it back, etc. it just sounds like he is cutting out the middleman..is that such a bad thing?

Re: Need input on buying 1st pair of orthotics

Richard, C.Ped on 8/11/04 at 09:26 (157499)

Yes it is a bad thing. It is against the pedorthic standard of practice and ethics. Custom orthotics should always be made with a prescription.

Without the prescription, he is practicing without a medical licence.

If I ever have to do adjustments to an orthosis, I call the doc and get the apporoval. I always do what I can to make it easier on the patient. I do all the work in the office too, but only by prescription.

Also, insurance will not even consider paying for an orhthosis without a prescription.

I did not like the 'make your feet feel like a 12 year old again' comment in the first place.

I would find a properly qualified certified pedorthist.

Re: for RIchard, C-Ped

Linda V. on 8/11/04 at 14:35 (157567)

Is there a web site with a list of certified pedorthists? I am in NH, not too many around here except ones that work in 'chain Stores' that seem to be cropping up a lot. And i think most of those places only sell the product they represent...which also scares me. thanks, linda

Re: for RIchard, C-Ped

Richard, C.Ped on 8/11/04 at 15:15 (157578)

Try this search link:
http://67.94.103.35/bcp_search.htm

Please let me know if you have any questions at all after talking to anyone.

Re: Need input on buying 1st pair of orthotics

Pat on 9/12/04 at 21:39 (159800)

I can't comment on the soft orthodics because until i started reading this board I didn't know they existed. Last year I had PF and with Physical therapy, cortisone etc it went away. I was fitted for Orthodics that never did feel right. My foot just didn't feel balanced and I walk kind of lopsided a little (hard to explain). Needless to say they were hard and uncomfortable as anything. And this year, almost a year to the day, I got the PF back. The past 4 months I've had Physical therapy, stretching, icing, ionfresis (spelling), ultrasound etc. Now I have my cast in a foot to take the weight off it. They don't want to give me any more cortisone shots because I've had way to many of them over the years and my insurance doesn't pay for ESWT. And I had to take the ortodics out of my shoes because they were just to painful to walk in. I think as the PF came back it needed a soft surface and the hard orthodics didn't help. Of course when I got them they told me that my PF wouldn't come back if I wore them faithfully and I did - digusted, you bet your life!