How To Maximize The Efficacy Of Orthotic Prescriptions

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Q: What is your feeling regarding OTC foot orthotic devices and prescription orthotic devices?
In Dr. Wernick’s opinion, OTC orthoses work well as temporary devices or in cases in which the patient has a minimal degree of pathology. However, he cautions DPMs to ensure that the device’s medial architecture matches the foot’s medial architecture. “(A failed match) is the main reason that these devices do not work,” explains Dr. Wernick.

Both OTC foot orthoses and prescription foot orthoses “serve valuable purposes” in Dr. Kirby’s practice. He notes that OTC orthoses are readily available to the patient and one may easily mold them in the office to improve the patient’s function and comfort.

Prescription orthoses are more durable and deform less quickly than OTC devices, according to Dr. Kirby. Furthermore, Dr. Kirby says prescription orthoses are much better than OTC orthoses when it comes to conforming exactly to the foot and one may modify the prescription devices “in nearly infinite ways” for optimal function and comfort. He points out that most of those who receive prescription foot orthoses in his practice have already failed OTC orthosis therapy and need “the much greater potential therapeutic benefits” of prescription foot orthoses.

Dr. Spencer notes some people may only need nominal orthotic control for foot function and do very well with OTC inserts. Some OTC inserts may be useful for pediatric patients who need some control of foot function and he says they will outgrow a prescribed foot orthotic device quickly. The efficacy of an OTC orthosis depends on the device itself, according to Dr. Spencer, who says they are not all created equal. Since cost is a factor with orthoses, Dr. Spencer feels one must offer patients a cost-effective alternative and he feels a well-made OTC orthotic can meet that need.

Here is a medial heel skive. Dr. Kirby has used this device to facilitate more effective treatment of symptoms and pathologies caused by excessive subtalar joint pronation moments. (Photo courtesy of Paul R. Scherer, DPM)
Guest Clinical Editor: Scott Spencer, DPM

     Dr. Spencer is interested in some of the different ways one can assess patient function and prescribe a foot orthotic device. He is “especially intrigued” by using the F-Scan to assess and prescribe foot orthotics by looking at the distribution of pressure and progression of the center of mass. By modifying an orthotic shell to create a more symmetrical presentation of those two factors, one can alleviate pathology. As Dr. Spencer says, the F-Scan method eliminates “much of what we do now in orthotic assessment but it is more time consuming.”

Dr. Kirby is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College. He is also the Director of Clinical Biomechanics for Precision Intricast Orthosis Laboratory. Dr. Kirby has a private practice in Sacramento, Ca.

Dr. Spencer is an Associate Professor of Orthopedics/Biomechanics at the Ohio College of Podiatric Medicine. He is also a Diplomate of the American Board of Orthopedics and Primary Podiatric Medicine.

Dr. Wernick is Professor and Chairman of the Department of Orthopedic Sciences at the New York College Of Podiatric Medicine (NYCPM). He is also a Diplomate of the American Board of Podiatric Orthopedics and is the Medical Director of Eneslow Comfort Shoes and Langer, Inc.

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