Prescription Orthotics

[hijinxx7]

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Can someone please help me clear up the confusion I have towards prescription orthotics?..

I am not talking about off the shelf ones from the good feet store or anything like that, but I am hearing so many different things about prescription orthotics and exactly WHO is allowed to prescribe them.

In Ontario I hear its MDs, DPMs and Chiropodists.

... How about DCs? .. Because I DO see many many DCs advertising prescription orthotics on their sites.

 

[Dr_Feelgood]

I do know that DCs prescribe orthosis but usually they alter pre-fabs. Most have never been trained on how to make a negative cast or how to place the foot into STJ neutral. The same can be said for 99.9% of MDs/DOs. I have a terrible experience with an MD selling my parents orthotics when I was a kid. But MDs/DOs don't usually cast but they will send them to a pedorthotist.

This is one area that I think is a huge tragedy b/c most people who I have seen with custom molded orthosis from DCs and Good Feet store are usually not extrememly happy. While sometimes they work the aren't happy when you tell them that as a DPM you could have taken a cast and have better custom molded inserts for 50% less.

 

[hijinxx7]

... So DCs are NOT supposed to be able to do this? I hear it is not a regulated act (prescribing orthotics), and even a high school dropout with some training can do it... ?

..misinformation or truth?

I do know that DCs prescribe orthosis but usually they alter pre-fabs. Most have never been trained on how to make a negative cast or how to place the foot into STJ neutral. The same can be said for 99.9% of MDs/DOs. I have a terrible experience with an MD selling my parents orthotics when I was a kid. But MDs/DOs don't usually cast but they will send them to a pedorthotist.

This is one area that I think is a huge tragedy b/c most people who I have seen with custom molded orthosis from DCs and Good Feet store are usually not extrememly happy. While sometimes they work the aren't happy when you tell them that as a DPM you could have taken a cast and have better custom molded inserts for 50% less.

 

[Dr_Feelgood]

... So DCs are NOT supposed to be able to do this? I hear it is not a regulated act (prescribing orthotics), and even a high school dropout with some training can do it... ?

..misinformation or truth?

It is not that they cannot do it. As you stated orthosis are a durable good not a prescription item. What they make many times are more about the money or a believed ability to help spinal health. The issue is most orthotics they give are pre-fabs or heel lifts (everyone has a limb length issue). Pre-fabs with a heat gun can be called a "custom orthosis" but it is not a true custom orthosis.

As we have discussed before, orthotics cannot not only hurt a pocket book (especially if they do not help) they can also cause serious damage. So should it happen probably not. They can provide OTC orthotics (which help 80% of people), but for high risk patients (DM, neuropathic, ect.) they should not be allowed to sell custom orthotics.

Going back you your original question, a "presciption" for orthoticsis not making or sometimes even casting for orthotics. It is a script for a durable good.

 

[krabmas]

prescribing orthoses is not regulated. this is for foot orthoses, ankle, knee, back - any kind of brace. All the doc (almost any kind) has to do is write on a little pad what they want and send it with the patient to the orthotist or prosthitist

The orthotist/prosthitist makes the device.

like feelgood said, many DC's that sell orthoses do not sell presciption/custom orthoses. They sell pre-fab or heat molded for way more money than they should.

I think the APMA would benefit podiatry by lobbying to regulate who can and who cannot prescribe orthoses. That would be an interesting discussion...

Who should be allowed to prescribe custom orthosis?

 

[Dr_Feelgood]

prescribing orthoses is not regulated. this is for foot orthoses, ankle, knee, back - any kind of brace. All the doc (almost any kind) has to do is write on a little pad what they want and send it with the patient to the orthotist or prosthitist

The orthotist/prosthitist makes the device.

like feelgood said, many DC's that sell orthoses do not sell presciption/custom orthoses. They sell pre-fab or heat molded for way more money than they should.

I think the APMA would benefit podiatry by lobbying to regulate who can and who cannot prescribe orthoses. That would be an interesting discussion...

Who should be allowed to prescribe custom orthosis?

My answer is the same to all question in medicine when it comes to scope-like issues (i.e. Who should be able to perform bunion surgery?) My answer is anyone that has recieve training, will manage the disease and any sequale of the treatment.

 

[NatCh]

At least one Chiropractor in my town uses the same orthotics lab as I do, with the same training and casting technique. Several Physical Therapists here prescribe orthotics and a few orthotists have labs here too. The four Foot & Ankle Orthopods send their patients to a local orthotist. Plenty of competition obviously.

My feeling on it is that instead of trying to tell the public that the others are less qualified, I just have to make sure I do a good job with mine and take care of my patients well. Mind my own business, so to speak.

Asking the APMA to regulate who can prescribe orthotics might lead to someone else lobbying to prevent DPM's from doing surgery, providing camwalkers, administering ultrasound, prescribing meds, etc.

Everyone just do your own job well and leave others alone. Whoever provides the best care will receive the most business. Patients talk.

 

[krabmas]

Asking the APMA to regulate who can prescribe orthotics might lead to someone else lobbying to prevent DPM's from doing surgery, providing camwalkers, administering ultrasound, prescribing meds, etc.

I'm not trying to start a fight. Just pointing out that this is why podiatry is always on the defensive end of lobbying.

 

[pod2222]

LoL....... back a live.... whats up with this dead topic

 

[347932]

Asking the APMA to regulate who can prescribe orthotics might lead to someone else lobbying to prevent DPM's from doing surgery, providing camwalkers, administering ultrasound, prescribing meds, etc.

I hate to tell you this, but there are people lobbying for this all the time. The APMA fights these people daily.

Krabmas,

The APMA has been fighting that fight for a long time. But as long as there are three day courses where they certify just about anyone to make prescription orthotics, it will be encumbent on us to find the bad orthotics out there and point out to the buyers why they overspent on a device that isn't really helping them.

This is capitalism to the core. We just have to deal with on an individual level and stop asking everyone else to intervene. I have a shpeal for this when discussing this with my patients in the office, do you?

 

[PADPM]

Aha, but there are also a lot of DPM's that are constantly over-prescribing custom orthoses, making unsubstantiated claims that orthoses cure everything, with no literature to support those claims.

I do believe in custom orthoses WHEN indicated, but don't believe that every patient that enters my office with "heel pain" requires a custom orthoses. Of course, not every patient with heel pain has plantar fasciitis, and not every patient with plantar fasciitis requires a custom orthoses.

As I discussed in another thread, I know of a local doctor who prescribes custom orthoses for EVERY patient who walks into her office with a chief complaint of heel pain. I "guess" she just figures that all heel pain MUST be plantar fasciitis, and that all these patients require custom orthoses to relieve their symptoms.

I would be able to prove her wrong with a very large percentage of my plantar fasciitis patients who obtained relief without custom orthoses.

Yes, I have a canned speech when I believe a patient would benefit from custom orthoses, but I don't worry about any other profession prescribing, selling or making these devices. I'm more concerned with the abuse within our own profession, which ultimately makes it harder for the honest docs to convince a patient that he/she needs a pair when they are truly indicated.

 

[krabmas]

I hate to tell you this, but there are people lobbying for this all the time. The APMA fights these people daily.

Krabmas,

The APMA has been fighting that fight for a long time. But as long as there are three day courses where they certify just about anyone to make prescription orthotics, it will be encumbent on us to find the bad orthotics out there and point out to the buyers why they overspent on a device that isn't really helping them.

This is capitalism to the core. We just have to deal with on an individual level and stop asking everyone else to intervene. I have a shpeal for this when discussing this with my patients in the office, do you?

I wrote that 3 years ago.

Thanks for your reply.

Why do I pay APMA dues if I can't ask them to lobby for the profession? Do you read the PMnews email? on almost a daily basis there is a post about joining APMA so you don't have to fight it alone on a patient by patient basis.

If I wrote a script for a back brace because the patient's flatfeet were hurting their back this would be considered out of scope, but for the DC to write for or dispense foot inserts is not out of scope?

I stand by what I wrote 3 years ago, only foot and ankle specialist should be permitted to write for presciption custom orthotics and the other molded types should have to be clearly marked as not custom.

Have you seen the display in walmart for Dr. Scholl's "custom" orthotics? they are clearly off the shelf. what false avertising.

 

[347932]

I wrote that 3 years ago.

Thanks for your reply.

Why do I pay APMA dues if I can't ask them to lobby for the profession? Do you read the PMnews email? on almost a daily basis there is a post about joining APMA so you don't have to fight it alone on a patient by patient basis.

If I wrote a script for a back brace because the patient's flatfeet were hurting their back this would be considered out of scope, but for the DC to write for or dispense foot inserts is not out of scope?

I stand by what I wrote 3 years ago, only foot and ankle specialist should be permitted to write for presciption custom orthotics and the other molded types should have to be clearly marked as not custom.

Have you seen the display in walmart for Dr. Scholl's "custom" orthotics? they are clearly off the shelf. what false avertising.

LOL Krabmas,

If you read my post careful, I alluded that the APMA does fight that fight for you already. Ask and ye shall receive.