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Offering one kind of orthotics?

Posted by Kathy G on 9/24/04 at 09:52 (160437)

I have posted on the Orthotics Board that my fourteen-year-old nephew has been diagnosed with acute Achilles tendonitis and PF in one foot. The Pod he is seeing offers just FootMaxx orthotic, nothing else. He says that eventually my nephew will need them.

This Pod is the partner of my Pod and I have FootMaxx orthotics and they work well for me. My sister, the mother of the child in question, went to this doctor and had successful surgery for a Morton's Neuroma. His partner, my doctor, wouldn't even consider surgery for my atypical neuroma. My point being that they they both have excellent reputations and are not surgery happy or anything.

I just wonder if it's common to offer only one type of orthotic. And interestingly, price them at the usual and customary for Blue Cross, $396. My sister, a widow, doesn't have good medical insurance and it will never cover orthotics.

My son, who lives in a neighboring state, had PF, and his Pod made him custom orthotics from a graphite material. He can't remember what he paid but it wasn't over $300.

I hate to think that we're all paying for their investment in the Foot Maxx program.

I welcome your comments.

Re: Offering one kind of orthotics?

Ed Davis, DPM on 9/24/04 at 22:04 (160461)

Kathy:
Footmax had sued a podiatrist, Nick Sol, DPM for comments he made on an online forum about FootMaxx so we may feel a bit 'constrained.' Nick toured the FootMax factory and according to him, 'discovered' that FootMax orthotics are modified prefabricated devices. Now, that type of device can work for a lot of individuals BUT such devices generally are 'sold' at a significantly lower price than an orhtotic that is made from 'scratch,' that is, from a mold or scan of the foot and molded to a modified model of the foot. Many would simply ask that if one provides a pref-fab device, that it be called what if is, irrespective of efficacy.

I beleive that the majority of podiatrists will work with more than one lab, trying to find the best products for their patient and the profit motive should not be the overriding concern.
Ed

Re: Offering one kind of orthotics?

Julie on 9/25/04 at 01:52 (160470)

Kathy, I know you want doctors' opinions, but I have to say that I would wonder why a foot doctor recommended only one orthotic device, particularly one that is not made precisely for the patient's foot. His or her motives for doing so are what I would wonder about. I think I would suspect a kickback.

That's an horrific price for a non-custom, machine-made device.
.

Re: Offering one kind of orthotics?

Darlene on 9/25/04 at 11:17 (160489)

It seems that podiatrists who offer Footmaxx don't offer true custom orthotics. I tried a Footmaxx orthotic and it didn't work for me. Interestingly, it took over 5 weeks to receive it. When I went to my pedorthist it only took a few days and she did adjustments on the spot. To me it makes more sense for a podiatrist to write a prescription and send the patient directly to a pedorthist for the fabrication. The pedorthist's knowledge and skills are irreplacable. I'm not sure what impact this would have on the financial side of the practice.

Re: Offering one kind of orthotics?

Ed Davis, DPM on 9/26/04 at 12:34 (160517)

Darlene:
There is no specialist in America who spends more course hours learning the biomechanics of the foot. Thousands of podiatrists are very capable and willing to make excellent orthotics. Finding one of the 'bad apples' should not impact the fact that podiatrists started the current concepts behind orthotics and remain the experts in that field, irrespective if some have thrown their knowelege to the wind for profit.

That being said, I want to emphasize that Pedhortists often make fine orthotic devices and really are a relatively new profession that has stepped in to fill the gap between podiatrists (including those who are not doing their job), othopedic shoe providers and orthopedic surgeons. There have been a number of podiatrist who have obtained the CPed degree in order to re-learn much of the knowledge they may have neglected and better understand the role of shoegear in the process of healing feet. After all, the best orthotic in the world will not work in the wrong shoe.
Ed

Re: Offering one kind of orthotics?

Ed Davis, DPM on 9/26/04 at 12:40 (160518)

Julie:
You can say some things which I cannot. I am sure that Dr. Sol paid dearly to defend himself from Footmax's lawsuit against him. Nick Sol practices in Colorado, I believe in Colorado Springs. My profession is small enough that news of the lawsuit spread quickly. I would assume that the lawsuit was an attempt, in part, to hush the rest of us.

This is sometimes the issue and difference between what a licensed, non-anonymous practitioner can say and one who is not. So, unlike Pauline, I can see a role for a physician posting anonymously on a board as to remove constraints...
Ed

Re: Offering one kind of orthotics?

Dr.David S. Wander on 9/26/04 at 15:25 (160523)

Ed,

I vivdly remember the lawsuit concerning Dr. Sol. During that time I was considering using the FootMaxx system in addition to other labs. Prior to considering using FootMaxx I contacted the company and had FootMaxx send me a letter from the president assuring me that the product was indeed a custom made orthoses, and not simply off the shelf. I was told that they do use a template that is then formed and pressed according to the scan data. I have no way of knowing if this is true, but if it is formed/pressed onto a mold than I believe that would be considered custom vs off the shelf.

Re: Offering one kind of orthotics?

Julie on 9/26/04 at 15:41 (160524)

Ed, yes, I did realise that, and that was why I entered the discussion.
.

Re: Offering one kind of orthotics?

Dr. Z on 9/26/04 at 16:12 (160525)

I was one of the first to use footmaxx when it first came out years ago.. The fit into the shoe was excellent . Patient satisfaction was very very high.

Re: Offering one kind of orthotics?

Dr. Z on 9/26/04 at 16:15 (160526)

Why do you think that it is the same orthosis.? What is stopping you from getting these orthosis when you have experience with your doctor and personal experience with the device. I don't use footmaxx anymore but it has nothing to do with the product.

Re: Offering one kind of orthotics?

Dr. Z on 9/26/04 at 16:19 (160528)

PS: That is a great price for a footmaxx orthosis. The only person that is paying more for the device is the podiatrist. he has to purchase the computer/ gait plate and pays alot more for the fabrication costs. Not sure what the purpose of your post is. Please explain

Re: Offering one kind of orthotics?

Richard, C.Ped on 9/27/04 at 10:28 (160570)

'The only person that is paying more for the device is the podiatrist. he has to purchase the computer/ gait plate and pays alot more for the fabrication costs.'

Call me crazy, but I thought good business was to supply a great product at low overhead, with quick turn around time.

Kathy: There are other small modifications here and there that can be done to the shoes, or even a set of powersteps (or similar device) that can help if your sister can not afford a custom orthosis. The powerstep can provide good support. The C.Ped (by prescription) can add to the powerstep such as wedges or even a heel lift to reduce stress on the Achilles. There is always something that can be done to save money and help out the customer/patient. I wish they lived near me. I would help them in a heartbeat.

Re: Offering one kind of orthotics?

Julie on 9/27/04 at 10:53 (160573)

Dr Z, it's difficult to tell, from the way posts appear in the order in which they were posted, which post is a reply to what, but I think your question ('Not sure what the purpose of your post is: please explain.') was addressed to me.

No particular purpose, I simply wanted to give my friend Kathy my opinion. Given Ed's and Richard's prior and subsequent comments, I don't think I was entirely wrong to be a bit suspicious. It would take a lot to convince me that the Footmaxx is a better product than a genuine custom orthotic, i.e. one is made from start to finish for a particular foot; but you are a foot doctor and I am not, and it's not something I care enough about or have enough knowledge of to argue about. If you think the Footmaxx is a great product, great.
.

Re: Offering one kind of orthotics?

Dr. Z on 9/27/04 at 11:08 (160575)

Julie,
It was addressed to the original post. It appeared that the Kathy G was very happy with both the footmaxx orthosis and the doctor. I couldn't understand what the purpose of her post was.

Re: Offering one kind of orthotics?

Dr. Z on 9/27/04 at 11:32 (160576)

Richard,
It is true the cost to the lab is much higher when prescribing the footmaxx. In addition the podiatrist/and other specialists will have to purchase the equipment to do the scanning.
I agree the success in business is to supply a great product with low overhead and a quick turn around. I was just pointing out to the poster that the podiatrist has to send more money to beable to distribute the product.

Re: Offering one kind of orthotics?

Julie on 9/27/04 at 11:52 (160580)

Ah, I see. Thanks.
.

Re: Offering one kind of orthotics?

Richard, C.Ped on 9/28/04 at 10:32 (160634)

Sure thing Dr. Z. You know I am not jumping on ya.

Re: Offering one kind of orthotics?

Dr. Z on 9/28/04 at 11:03 (160636)

PS: You get a better orthosis with a non-weight bearing cast made by a professinal such as you Richard

Re: Offering one kind of orthotics?

2ndopinion on 9/28/04 at 14:37 (160644)

FootMax is not custom. It is 'customized' meaning it is a shell that is selected closest to the patients scan, then modified. IMHO they cahrge too much for them wholesale for what they are. The cost of the scanner depends on how much you order. If you look at them they almost all look the same. The depth of the heel cup is non existent. They would make a decent dress type insert and should cost about $150 based on how custom they are not

Re: Offering one kind of orthotics?

Ed Davis, DPM on 9/29/04 at 23:31 (160726)

Dr. W and Dr. Z:
I asked the Footmax people to leave their device at my office for a trial. I was very interested in what seemed like a fairly comprehensive gait analysis. I used it for about a dozen gait analyses but was concerned about what I saw. Some of the gait analyses had data that was questionable. For example, a patient with a hypermobile first ray came back with a report stating that he had a rifidly plantarflexed first ray -- simply incorrect. I finally called Footmax HQ to discuss the discrepancies and was transferred to their 'tech' department. All the tech department could do was read me a 'scripted' message about how sophisticate their analysis system was but could not explain any discrepancies. I, at that time decided not to use them.

The few Footmax devices I made were comfortable and one practitioner, who signed up in the neighborhood, a PT was making a number of devices. Comfortability and efficacy are not exactly the same things. There are a lot of devices that are comfortable or tolerable due to their relative softness but is the necessary therapeutic functionality there?
Ed

Re: Offering one kind of orthotics?

Ed Davis, DPM on 9/29/04 at 23:36 (160727)

You are correct in your definition. There are non-custom (pre-fabs), customized prefabs and true custom devices made from scratch. They all have their role and can be efficacious under the right set of circumstances. The importance is honesty in providing the description of the device one is getting.
Ed

Re: Offering one kind of orthotics?

Dr. Z on 9/30/04 at 21:54 (160802)

It is my opinion as I stated before a non-weight bearing casted foot in neutral position will gave you the best orthosis fabrication. That being said I used the footmaxx years ago and found that alot of patients did very very well. I actually did a study of 100 patients with heel pain and found that 13 out of 100 were satisfied with the footmaxx. To make the study interesting I gave a money back 100% return policy if not satisfied with the footmaxx device. 13 out of 100 return the device. What is the conclusion. I guess I know how to make patients happy,?????