CUSTOM VS. OVER THE COUNTER ORTHOTICS

By Steven Lebow, Pedorthist

When should a physician be prescribing an over the counter orthotic verse a customer orthotic to assist with alleviating foot, knee, hip or back pain?

As a Pedorthist I am often approached by people stating that they have purchased custom orthotics from their doctor only to wear the orthotics once or twice and put them in the closest because “they didn’t fit their shoes correctly” or they “were too uncomfortable to wear”.

While custom orthotics do have a place in a treatment plan one should question where that place is. To do that you must first understand the normal “gait cycle”.

The gait cycle begins when one foot contacts the ground and ends when that foot contacts the ground again. After heel strike the foot will pronate or roll inward about four degrees – this amount of pronation is normal and is necessary in order to absorb shock. Problems occur when you over pronate or the inward roll is in excess of four degrees.

By Steven Lebow, Pedorthist

When should a physician be prescribing an over the counter orthotic verse a customer orthotic to assist with alleviating foot, knee, hip or back pain?

As a Pedorthist I am often approached by people stating that they have purchased custom orthotics from their doctor only to wear the orthotics once or twice and put them in the closest because “they didn’t fit their shoes correctly” or they “were too uncomfortable to wear”.

While custom orthotics do have a place in a treatment plan one should question where that place is. To do that you must first understand the normal “gait cycle”.

The gait cycle begins when one foot contacts the ground and ends when that foot contacts the ground again. After heel strike the foot will pronate or roll inward about four degrees – this amount of pronation is normal and is necessary in order to absorb shock. Problems occur when you over pronate or the inward roll is in excess of four degrees.

By Steven Lebow, Pedorthist

When should a physician be prescribing an over the counter orthotic verse a customer orthotic to assist with alleviating foot, knee, hip or back pain?

As a Pedorthist I am often approached by people stating that they have purchased custom orthotics from their doctor only to wear the orthotics once or twice and put them in the closest because “they didn’t fit their shoes correctly” or they “were too uncomfortable to wear”.

While custom orthotics do have a place in a treatment plan one should question where that place is. To do that you must first understand the normal “gait cycle”.

The gait cycle begins when one foot contacts the ground and ends when that foot contacts the ground again. After heel strike the foot will pronate or roll inward about four degrees – this amount of pronation is normal and is necessary in order to absorb shock. Problems occur when you over pronate or the inward roll is in excess of four degrees.

The sub-talar joint is the joint between the talus and the calcaneus (or heel bone). The talus is the foot bone that sits between the tibia and fibula of the leg to make up the ankle joint and sits on top of the calcaneus. If pronation describes the foot rolling in after the heel hits the ground, the opposite motion or supination describes the foot rolling outward after heel strike. An ankle sprain is an extreme example of supination. Orthotics are used to control sub-talar joint motion and thus control pronation and supination.

There are two types of orthotics, functional and accommodative.

By definition a custom orthotic is a functional foot orthoses. They should be used to treat some medical problem with the foot. A good example of this would be a patient diagnosed with diabetes. They have had a toe or several toes amputated due to poor circulation. A functional orthotic would be prescribed by a doctor with a “toe filler” to take the place of the missing toes. Another example would be a patient who presents with Rigidus Hallux. In this case a custom orthotic would be used to assist the patient during the toe off phase of the gait cycle.

An accommodative orthotic is used to “accommodate” the foot in the shoe. In other words there is no attempt to treat any medical disease of the foot but rather allow the foot to function as it was intended to in a shoe.

So that draws us back to the question when should I use a custom orthotic verse an accommodative?

“Are orthotics overprescribed?” said Robert Eckles, a podiatrist and a professor at the New York College of Podiatric Medicine. “I would probably say yes. But look at guys in their 40’s and 50’s, overweight and riding a $5,000 bicycle though Central Park. Do they need that? Of course not.”

The average cost of making a custom orthotic is $78, said Ms. Thorson of Burns Laboratory. Customers often pay two and even eight times the cost of production. “It’s doctors’ business to mark up accordingly,” said Frank Mancuso, a spokesman at Solo, another maker of prescription orthotics.

Still, not every podiatrist is convinced that prescription orthotics outperform store-bought ones. David M. Davidson, a podiatrist in Buffalo, N.Y., who focuses on sports injuries, said he solves 99 percent of his patients’ problems without a custom orthotic. Stretching, anti-inflammatories and off-the-shelf insoles are treatments he suggests.

A 2004 study by the American Orthopaedic Foot and Ankle Society that tested the effectiveness of various inserts in preventing injury in active, healthy people found no statistically significant difference between prefabricated inserts and custom orthotics in the incidence of stress fractures, ankle sprains and foot problems.

So if a physician is deciding whether to prescribe a custom orthotic at the cost of $400 to $800 the first they should ask is what the orthotic is being used for.

If the doctor is prescribing an orthotic because the patient presents with tired or achy feet, or pain in the knees hip or back then a good over the counter orthotic that is designed to accommodate the foot and take the pressure off the hot spots or areas that may be causing pain. As a pedorthist I have found that the over the counter product works most of the time.

An independent study conducted by Armstrong Atlantic State University, part of the University of Georgia system showed that participants that used the Symmetry showed a marked increase in balance and a marked decrease in pain in their feet, knee’s hip and back. There was no effect on ankle pain.

The Symmetry Endurance is a great starting place for physicians. The Symmetry is coded with an L3060 code and is reimbursable up to $130.00. Any physician can contact me at Foot Efx to purchase the orthotic wholesale for dispensing in the office or they can send their patient to www.footefx.net to purchase the product themselves. The Symmetry comes with a 100% satisfaction guarantee and a life time warranty.

For more information contact Steven Lebow at 702-259-0955 or steve @footefx.net.