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Do you sell or prescribe orthotics ?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Oct 4, 2010.


do you sell or prescribe orthotics

  1. I prescribe orthotics

    22 vote(s)
  2. I sell orthotics

    2 vote(s)
  3. I guess I do both sell and prescribe

    18 vote(s)

  1. Members do not see these Ads. Sign Up.
    Don´t know if we had this thread or not - could not find one.

    Do you sell orthotics to patients or do you prescribe ?

    Now most are in business - ie we need to make money , some are paid employers whoose boss wants to be paid. Orthotics are part of what we make maney on, BUT and It a important question- do you sell them or prescribe.

    To me to prescribe an orthtoic there must be a reason for it, that can be explained through mechancial or with evidence. So one way you can explain the mechancial principle of what your trying to achieve to the patient or other medical person involved with treatment or you can show evidence that this treatment works.

    ie Most people may not be able to explain the mechancial forces when thinking about lateral wedge with medial knee pain concept, but there is evidence for this prescription.

    The problem is that we are learning new concepts about how the foot works and the effects of foot orthotics all the time - sometimes what we though was correct is not.

    So are we all somewhat orthotic sales people ?

    Whats you views ?
  2. Alright I´ll get things started I beleive that I prescribe orthtoics with the best available evidence. As I base my treatment around Tissue stress most of the work is already done.

    ie What tissue is stressed ?
    What is the mechancial reason for why the tissue is stressed ?

    Then once you know this the orthotic is built to reduce the forces acting on the stressed tissue. But the orthotic device is only part of treatment and by using tissue stress theory may not be required. Some of my favourate success stories are those patient who we not prescribed an orthotic device or a device was removed.

    But looking back in time I would say there was a time that I sold orthotics, at the time I would not have said so but I see it now.

    I´ll leave it for now see if anyone else has anything to say .
  3. pgcarter

    pgcarter Well-Known Member

    Having been a retailer of various things for many years before I was a pod this is an issue I've thought about a fair bit. When you are a retailer what you do is "sell stuff". You buy stuff at one price, mark it up and sell it at a higher price. You hang
    around your shop front and talk to customers....your time is free and you "sell stuff".
    As a podiatrist you are selling knowledge and expertise which is the result of a significant learning process which cannot easily and quickly be copied by others without basically going through the same learning process you did.
    As far as treating foot problems that requires in room work that is done by some one who has the skills training and knowledge to do it.....you are selling expertise and the results of your learning.
    As far as orthoses go I have a view that is perhaps a little different to most?? I believe that any podiatrist should be making their devices themselves because the process of doing so brings insights and knowledge which cannot be replicated or gained any other way. This not an educationally trendy or currently politicaly correct point of view. When I make them myself I am selling my own hard won expertise for which I can ethically charge whatever I choose.
    When you are charging an appointment fee that is you selling your expertise and is ethical....what are and who are when you are charging appointment fees and markups of hundreds of percent on orthoses that you pay a factory to make for you?? Where the people who do the work are low paid bench work labourers, or computers?? Personally I don't know how they sleep at night.....
    The whole movement to factory based manufacture and CAD CAM systems is a drive to take the longterm expertise out of the equation. If you can do that then labour stays cheap and the people in the equation are worth very little in money terms. Maybe my socialist slip is showing? Making orthoses is a little like being a concert pianist.....if it was easy everyone would do it....and for everyone who does not do it is in their interests to deny that there is anything extra gained by it....and until they've done it they won't begin to understand the benefits.
    I'll get down off my soap box now....here endeth the sermon
    regards Phill Carter
  4. Phil Wells

    Phil Wells Active Member


    I am going to jump on my soap box in response to your posting. (I work for a CAD orthotic company)

    I believe that orthoses have too much 'mystery' around them and should be a lot simpler to prescribe. The need to make them yourself is fine but I don't believe it is any better or worse than using a lab. There are equal levels of skill required for both and I am sure that the outcomes for patients will be similar.
    Back to the question of sell or prescribe, I sit in the prescribe camp and only put a 25% handling fee on orthoses.
    I heavily involve the patient in deciding whether to use bespoke or OTC insoles based on commercial considerations - e.g. a CAD polyprop will last longer than an EVA OTC. This is only after I have decided what forces I want the insole to apply and if then appropriate we have the above discussion.
    However my wife is setting up a high street podiatry practice and we are going to be retailing a lot of OTC insoles so in this case we will definatley be selling insoles.

    I am happy to differentiate the 2 approaches to my customers based on 'you pay your money and make your choice'.

  5. pgcarter

    pgcarter Well-Known Member

    Prescribing orthoses is a bit like playing chess.....a simple game, easy to learn, but a lifetime to master. It is not the orthoses that are mysterious it is the skills required to assess the huge variation in human anatomy that presents and have some better idea about what to actually try to do in response to what you are seeing. Like the Rosetta stone there are so many levels of complexity that can be responded to......or not......depending on circumstance such as age, health, activity level, presenting symptoms, bony anatomy, muscular strength etc etc. And as most will accept, there is no one right answer.....but there may be better answers that give more long term improvement.....
    As far as lab vs self made goes, happy to accept that lab made devices work really well for lots of people, but do not accept that for the genuinely odd ones a technician who has not even seen the patient will get a result a good as an experienced pod who makes lots of stuff and is hands on with the patient. For all the value of double blind studies you just cannot double blind that stuff.
    regards Phill
  6. Phil , Phill and others

    I would seem to me that OTC device is seen as selling , which seems somewhat strange if it´s that you decided that the OTC is the best fit for the patient . If you glue on a post does that mean the device has been prescribed ?

    as a side not . As Phil knows I looking at changing from hand - plaster -pressed made device to CAD/CAM and one of the big things I see is that I must be more specific with my orthotic design with CAD/CAM. When you bring out the surform blade there is ´art´component to making the +ve. (which I have complete control over )

    I also see that there will be time when the ´art ´+ve will be necessary to get a better fit for me.
  7. alan murchison

    alan murchison Welcome New Poster

    I work in an NHS podiatric biomechanics department where I see patients with lower limb MSK problems. After the assessment and examination I will prescribe and orthotic device if I feel that it is appropriate to treat/manage the presenting condition. This device may be casted or non casted, bespoke or semi-bespoke. My choice will depend on the presenting condition, foot type, foot function, activities, footwear, previous treatment and relevent medical conditions. I will also consider the likely outcome and whether I am expecting to resolve, reduce or manage the problem. I will also consider whether I expect the patient to have to use the device in the short, medium or long term as the prescription will have to reflect this. As it is the NHS, the patient does not have to directly pay for the prescribed device. When I work in private practice, I charge for both my time and the prescribe device.

    Alan Murchison
  8. pgcarter

    pgcarter Well-Known Member

    I had no intention of inferring that out of the packet devices should not be used, I frequently use preformed devices often with some further customising added to them. It is not really fair to your patients to rule out a host of treatment options just because you make more money out of a cast device. My position on making stuff yourself is not about the money it's about what you learn from doing it, and the extra ability it gives you to handle the more rare weird ones that need something definitely different. Also in public health in Aus there are cost benefits to your low income patients when the on the spot pod can actually make something.
    regards Phill
  9. Peter G Guy

    Peter G Guy Member

    Hi Everyone
    This is a great topic.
    I think we prescribe treatment plans(knowledge) which may or may not include a custom foot orthotic(CFO). I have many products available in my practice for patient convenience because I know that some patients may not completely follow your prescribed treatment plan because there is an extra step of going to the pharmacy to pick up products. For instance I will have tape available for low-dye self taping or felt. / Coban / Elastoplast. If they cannot tape I have prefabs available. Sometimes the prefabs work and there is no need for a CFO.
    With the short term treatment most patients usually get better and they will see the value of the CFO. Most patients already know about CFO and are expecting this as part of the treatment plan. I think it depends on how you present everything.
    I learned a lot about providing a service when I worked in a department store selling men’s suits. You had to find out what was required and then present the options and let you customer decide what they required. Sometimes the product just sells itself because of the referral source. Sometimes people have researched something and they know what they want or need. Sometimes people need to be convinced. Great topic
  10. rodmack

    rodmack Welcome New Poster

    Hello everyone,
    Interesting topic. When I started my own practice as a pedorthist after several years as a physiotherapist in a government facility, it seemed a bit strange to be 'selling' a product alongside my expertise. Of course some patients are a bit skeptical when you suggest they need something...then offer to sell it to them. I agree how you present it makes all the difference. As a pedorthist in Canada we require a referral from a podiatrist, physician, or other health care provider, which eliminates the perception of a conflict of interest. Of course, most of those referrals say just "Assess and treat" or "Orthotics" so we're often the ones making the decision whether or not the patient needs CFO's or over the counter foot orthotics, or something else in our practices. Interesting topic, thanks for posting!

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