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PROPER TERMINOLOGY
Orthotic or orthosis (singular) Orthoses (plural)
“Orthotics” while commonly spoken, is an incorrect way to pluralize the singular form orthotic (and is your first clue to their orthotic education when reading advertisements)
If a practitioner uses the word (or spells) “orthodics”, run away,!
CAVEAT EMPTOR (BUYER BEWARE!)
Have you noticed that every neon sign, on every street corner, advertises “foot orthotics” in their list of services? Are you curious as to why?
Unlike many health care services, foot orthoses are not a regulated device. In other words, the dispensing of a foot orthosis is not a “controlled act” under the Regulated Health Practitioners Act.
(http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/91r18_e.htm)
Accordingly, this fact “allows” (or more specifically, does not disallow) indiscriminant dispensing of this medical device by any person who chooses to advertise foot orthoses.
Current research suggests that proper foot orthoses do alleviate certain musculoskeletal complaints by altering both mechanical and proprioceptive input.
The prescription of a proper, full contact, custom-made foot orthosis is the culmination of a biomechanical exam (including inherent foot flexibility, and arch characteristics), understanding material properties (plastics, rubbers, foams) and having specific education and experience to offer sound clinical advice.
MANY PEOPLE WHO THINK THEY RECEIVED A CUSTOM-MADE ORTHOTIC, IN FACT, DID NOT!
While most people have taken all reasonable steps to receive proper care (including referral from medical practitioners), the reality is that they don’t have what is defined as a true custom-made orthotic device.
The difference between custom-made and non-custom-made is not one of mere semantics. It is one of real substance regarding the actual custom-made nature of the product and the efficacy surrounding its fabrication.
Many people receive a pre-fabricated arch support sized to their foot length and basic arch height (the “best fit” system used by many orthotic laboratories). The only “custom” aspect of the device is often a cover in the preferred choice of colour with, or without, the clinic’s name imprinted on it.
THE BEST WEAPON AGAINST FRAUD IS PUBLIC EDUCATION.
If this area of health care operated properly, patients who required orthotic therapy would be assured of being treated by a practitioner who specialized in the biomechanical analysis of foot conditions, including the use of properly researched methods and materials.
“Specialization” usually equates to hours of education specific to the area of foot orthotic fabrication.
The Professional Comparison Chart cites information taken from the websites of each profession’s educational curriculum, specific to the area of foot biomechanics and orthotic fabrication. Even within foot care professionals, there is different emphasis with respect to orthotic therapy.
THE LITMUS TEST FOR YOUR ORTHOTIC:
1. Place your orthotic on a table top and press down at the centre of the arch. If with nothing close to your body weight in effort, the arch flattens, you can be certain the orthotic does little to control your mid-foot as your body weight passes over it.
2. Now take the orthotic and place it on the floor with your foot on it. Without standing, rise up onto your toes and allow the orthotic to come up to meet the foot. If you can stick several fingers into the hollow between your arch and the orthotic, then the orthotic has not been custom-made to fully contact your arch.
3. Stand up in bare feet and look down. Do your feet look exactly the same? Is one longer, wider? Is one big toe veering off more than another or is one arch significantly flatter than the other?
The majority of people have feet which look (and act) differently.
Now look at your orthoses. Are they perfect mirror images of each other? Or do they reflect the differences you see in your feet.
4. When you were casted for the orthotic, was a 3-dimensional cast taken (either with foam or plaster bandage)? Alternatively, did you just walk across a mat?
A true custom-made orthosis requires a 3-dimensional model of the foot.
5. Did the professional who casted your feet for orthoses specialize in conditions of the foot?
Only those professionals who have a certification/diploma/degree in foot care (2- 4 years after an undergraduate degree) can truly claim to have a specialty relating to the foot.
While other health care professionals have extensive knowledge in other areas, only a certified pedorthist, chiropodist, orthotist or podiatrist, have expertise relating specifically to problems of the feet.
THE FALLACY OF “ORTHOTIC SHOES”.
There are:
1. therapeutic shoes,
2. orthopaedic shoes and
3. foot orthoses
There is no such device as an “orthotic shoe”.
By definition custom-made shoes (or sandals) are selected for patients who have a condition which cannot be accommodated by off-the-shelf therapeutic or orthopaedic shoes (modified). Custom-made shoes accommodate bony/structural abnormalities resulting from trauma, disease or congenital deformity…reserved for the most serious foot problems. Fortunately, they comprise a very small portion of the population.
Custom-made footwear is made from a last (ie. 3 dimensional model of wood or plastic) constructed from a cast of the patient’s foot. This footwear is fabricated from 100% raw materials such as sheets of leather, rubber soling and lining material.
There are relatively few facilities which make custom-made shoes/sandals and the cost for such footwear is $1200-$1500 per pair of shoes. Sandals may run from $600-$1000 per pair.
While a custom-made foot orthosis may be incorporated into a custom-made shoe, the two items are defined independently, and billed for separeately.
Simply adding a custom-made orthosis to an orthopaedic shoe, does not make the combination of the two “a custom-made shoe”.
The term “orthotic shoe” has been popularized by unscrupulous orthotic labs, and practitioners, who attempt to fool their patient and Insurers into paying for something that sounds acceptable.
THERAPEUTIC/ORTHOPAEDIC SHOES:
This category of footwear is most often recommended by pedorthists for patients who may require minor modifications to their footwear or the ability to include an orthotic.
These shoes are off-the-shelf footwear available at higher end shoe stores. Therapeutic shoes include the following features:
• Removable sock liner/insert.
• Accommodative toe shape and widths that allow for the proper fitting of both broad and narrow feet.
• High, broad toe shape which accommodates forefoot shape and deformities.
• Adjustable closure (i.e. laces, Velcro) to secure foot position inside of the shoe.
• Broad sole (through the heel, the shank and the forefoot) of adequate density to provide a foundation for prescribed devices.
• Easily modifiable upper and sole materials.
• Upper material that is breathable, mouldable and durable.
• Smooth, protective lining.
• Sole design with sufficient toe spring to allow normal propulsion.
• Sufficient torsional stability along medial longitudinal arch.
• Heel stability via a firm and or extended heel counter
Orthopaedic Shoes include all of the above features PLUS:
• A minimum of .5cm (3/16”) for women’s or .8cm (5/16”) for men’s additional depth in the last.
• A sole tread that is graded to suit the upper width
(above definitions according to the Position Statement of the Pedorthitic Association of Canada)
THE REAL DEAL: THE CUSTOM-MADE ORTHOTIC DEFINED
A device made from a three-dimensional model of an individual’s foot and made from raw materials (not prefabricated/shaped).
The foot is 3-dimensional, therefore only a 3-dimensional cast of the foot can be used to manufacture a custom-made device. Walking across a pressure mat affords only a 2-dimensional representation of the foot and results in a “best fit” orthotic, not a custom-made device. A footprint, whether computerized, or via an “inked” version does not give enough information.
CUSTOMIZED FOOT ORTHOSIS
This is not custom-made as it is not fabricated from a three-dimensional model of an individual’s foot or from raw materials. It is a prefabricated device, modified to improve its function for a particular client. Simply cutting or trimming a prefabricated insole does not constitute a customized product.
PREFABRICATED PRODUCTS
Any mass-produced foot care item that is sold over-the-counter and is readily available without any modifications.
INCREASING YOUR ODDS OF GETTING A REAL CUSTOM-MADE ORTHOTIC
1. True foot care professionals focus exclusively on feet.
If someone selling orthoses is also selling pillows, supplements, back rests, and Swiss Balls, chances are good that foot orthoses are not a specialty, but rather a sideline.
2. The practitioner should have an in-house laboratory to make timely modifications and repairs to orthotic devices and their coverings.
If the practitioner can’t manage minor alterations to the device, they likely won’t be able to handle larger modification issues.
3. It takes a minimum of 2 days to fabricate an orthotic device from raw materials.
This is certainly a consideration before visiting the “Orthotics While U Wait” or “Minute Orthotic” clinics and mall kiosks.
4. In Ontario, the average fee for an examination, orthotic device and 1 year warranty for modifications on the product is $450 (with a range of $50 either direction). Beyond $500 is considered expensive so enquire as to whether the fee includes extra warranty coverage to justify the extra expense.
A device less than $400 is unlikely custom-made.
5. Call your Insurance Company before agreeing to buy an orthotic, orthopaedic shoe or custom-made footwear.
Insurers often have a list of qualified professionals with whom they exclusively deal. While it can be a significant amount of research, it is your responsibility (and benefit) to be informed.
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