Ramon G. McLeod
Orthotics are a major chiropractic product and more companies, --particularly consumer shoe manufacturers--have recently entered the field. But your best choices, and your patients', are those companies that make professional grade products.
To that end, we've sought out experts for their advice on what to look for when researching products and also asked them for tips on how to properly present the benefits of these devices to patients.
Obviously, an expert allied with a particular company will tend to be biased to that company's products. Therefore, in this series, Dynamic Chiropractic PracticeINSIGHTS provides comments that reflect a consensus on the general characteristics that make for a good product in order that you may make an informed decision.
First Steps: Company Characteristics
Kent S. Greenawalt, President and CEO of Foot Levelers, Inc., Roanoke, Virginia, said that the first question a practitioner should ask is what kind of research does a vendor to have to back up claims.
"It's very important to choose a company that has published research in peer-reviewed journals to validate its product," he said. "Actual studies proving the effectiveness of the product are critical. In today's world saying the product is 'used by a lot of people,' or 'we have good results' isn't acceptable."
"Research conducted by professionals and published in research journals separates the leaders and innovators from the rest. Your practice should offer - and your patients should receive - products that are proven to be effective," Greenawalt asserted.
How the vendor actually produces orthotic products was also described as a critical factor by several of our experts. According to Paul Smith, President of Integrated Orthotic Lab Inc., Brownsburg, Indiana, the majority of manufacturers use similar manufacturing concepts and materials. Therefore, he said, a practitioner should question a vendor about on factors such as "product turn around times - patients don't want to wait 3 to 4 weeks from the date of casting to receive their devices."
"Does your lab of choice offer advanced technology? Systems to allow proper scanning can increase turn around times, save material costs and enhance the patient experience," he said.
Practitioners also need to ask about the variety of devices available, said Bruce Marrison, President and CEO, The Orthotic Group, Markham, Ontario. "Practitioners should partner with an orthotic laboratory that has a solution for every type of patient," he said.
"Every custom laboratory worth its salt should be able offer a wide variety of orthotic solutions for a wide variety of foot types," Marrison remarked. "For example, some patients require more of a flexible, stabilizing, type of orthotic device while patients in need of more support will benefit from a semi-flexible or semi-rigid orthotic device. Our Chief Medical Advisor puts it best when he stresses 'Different people are different', and a "one flexibility fits all" solution just will not cut it."
One test to discover whether the lab can really do the job, and whether you should keep the vendor or look elsewhere, is how they respond to the prescriptions you send them, said Louis J. DeCaro, a podiatrist and co-owner of Nolaro24, an orthotics manufacturing firm located in Massachusetts.
"The most important factor to me as a practitioner is actually seeing what the lab will 'accept' as a cast and prescription," DeCaro said. "If a lab accepts a simple cast without any feedback I know the lab cannot possibly make a good orthotic for my patient.
Biomechanical workups need to include detailed patient biomechanical evaluation and medical history, weight bearing foot tracings, digital photos and digital gait video with the patient walking on the floor or on a treadmill for 20-30 seconds. This assures that at least the lab has all the important information needed to assure a successful orthotic outcome," he said.
Even with a meticulous approach to making your choice of vendor, the extreme variability in human anatomy that doctors encounter in the clinic should also be the cue that it's unlikely that any one vendor can meet every need, said Verne Bintz, founder of the Verne Bintz Company, Wheaton, Illinois.
[pb]"One orthotic company will probably not be able to fill all the needs of the chiropractor," he said. "Patients' orthotic needs vary depending on the type and severity of their problem. Some will require custom molded orthotics and others are served well with a pre-molded orthotic."
Explaining Value to Patients
Feeling confident in the company you've selected is vital, of course, but how do you next make your patient feel confident that orthotics can really help them?
All our experts agreed that there is obvious starting point: an explanation that the purpose of orthotics goes way beyond their feet.
"Show the patient examination findings that illustrate why they could benefit from these applications. It is important that the patient understands that the use of orthotics along with their treatment plan will enhance the effectiveness of care that they receive, making the patient more apt to purchase," said Nate Schneider, Director of Education Science for Human Motion, Evergreen, Colorado.
"There are many musculoskeletal conditions that are caused by improper foot structure and function including knee, hip and low back pain and often accompanied by varying postural distortion." Schneider said. These issues should be included with the presentation of how the patient will benefit from the orthotic(s), if the orthotic assessment occurs at a time other than the initial visit (later on during the treatment plan)."
Greenawalt generally agreed with that approach: " I would start by showing patients how foot problems can affect not only feet and ankles, but also the knees, hips, pelvis and spine. An easy example that most patients understand is fallen arches: if the feet are unbalanced the pelvis shifts, creating an asymmetrical base for the spine. Stretching of the ligaments that help support the feet is permanent, so adjustments alone are usually not enough to restore normal arches.
Explain to patients that a five-to-ten-minute adjustment is usually not enough to overcome long-term osseous misalignments, soft tissue imbalances, postural faults and counter-productive lifestyle habits," he said. "The patient's body grows accustomed to experiencing these conditions as 'normal.' After the adjustment, it wants to return to the misaligned state. Flexible, custom-made orthotics help stabilize the foundation and keep the body in structural alignment between adjustments."
Patrick Malleret,Vice President, Barefoot Science, Mississauga, Ontario, said patients will understand that the feet are like all parts of the musculoskeletal system, in that they are strengthened by exercise. "We know that cultures where people spend all of their time barefoot are able to function normally...the foot does not require man-made supports, braces or cushions."
Therefore, it should be explained that if the feet benefit from exercise, then orthotics which exercise them will produce stronger feet that are less dependent on foot devices, he said.
Visual aids can also be helpful in the education processes, Marrison said. " They need to see and understand the condition of their feet and how this may impact their treatment plan."
"The end goal is a stable body less susceptible to mal-alignment, subluxations, and free of painful symptoms, orthotics can help your patients achieve these goals."
