How To Overcome Obstacles With Custom Orthoses

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How To Overcome Obstacles With Custom Orthoses
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Author(s): 
Guest Clinical Editor: David Levine, DPM, CPed

   Dr. Warkala says patients who fail orthotic therapy after multiple adjustments get a refund of any money and the orthotics are discarded. Since devices are custom-made, Dr. Levine says one should offer a guarantee to the patient. He says the guarantee should state that the patient will be more comfortable with the orthotic devices than without or he or she will get a refund.

   Dr. Fritz has never had to refund a patient’s money. He says there is always an option or orthotic type that the patient will find comfortable. Dr. Fritz finds it “much more rewarding to proceed with a second attempt in spite of the time to achieve the successful outcome. Successful outcomes in difficult cases are always priceless in terms of the reputation of the practice and future referrals.”

   

Q:

How do you determine when orthotic devices need to be replaced other than in situations where they are obviously worn out or broken?
   

A:

Dr. Fritz says if a problem is significant enough to require an orthosis, it is worthwhile to reevaluate the orthosis a year later. He uses one year as a follow-up time since he feels orthotic labs should generally guarantee their work for at least a year. At the follow-up visit, he evaluates the patient, the problem and the orthotic, which may have some changes due to wear. Dr. Fritz says DPMs may address orthotic changes or repairs during the follow-up, noting that patients often request a new orthotic during that visit.

   “Most patients in my experience would rather proceed and have a second pair of orthotics fabricated rather than give up their old orthotics for repairs even though it may only be for one week,” says Dr. Fritz. “People appreciate the benefits of their orthotic devices and are rarely willing to part with them even for a short period of time.”

   The clinical symptoms of the patient will usually indicate whether one needs to evaluate the orthotics for refurbishing or replacement, according to Dr. Warkala. Often, he says one can easily replace the heel post to help reduce the patient’s discomfort, adding that the podiatrist should place the orthotic against the foot to ensure adequate contouring.

   The lifespan of orthotic devices varies, says Dr. Levine, noting some patients require replacement of devices more often than others. As he points out, some patients will present with orthotic devices that are over 15 years old and they are still holding up well. He advises comparing the positive casts (which one can dispense with the orthotic devices) to the orthotic devices themselves. If the orthotic device no longer conforms to the cast, Dr. Levine says the shape of the orthosis may have changed enough to require fabrication of new devices. If new biomechanical complaints arise, he notes this may also warrant making new orthotic devices.

   Dr. Fritz reminds that patients often keep old orthotics as back-up devices that they use sometimes for less demanding activities. He notes patients do choose additional orthotics.

   “I believe in this day and age people are engaged in many activities and they often have many shoe styles,” says Dr. Fritz. “No one orthotic is perfect for all activities and all shoe styles.”

   In addition, having two or three types of orthotics increases the spectrum of shoes that an individual can wear. As Dr. Fritz mentions, acrylics and graphites are sleek enough to fit in almost any shoe while patients may sometimes reserve full-length composites for heavy duty working environments as well as various sports.

   Dr. Fritz’s discussions with patients do not center around the functionality of one device. He emphasizes increasing the range and use of orthoses as opposed to replacement. Dr. Fritz says clinicians should avoiding replacing something that works and encourage patients to upgrade and expand into a new orthotic that may better address a specific need in regard to activity or shoe fashion.

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