Podiatry: Orthotics

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Orthotics - the Good, the Bad and the Ugly

Foot orthotics come in many different shapes, sizes and prices.

They are prescribed, not only by Podiatrists and Chiropodists, but sometimes by Physiotherapists, Chiropractors and Osteopaths, to treat a variety of conditions, which range from painful heels to chronic knee, hip or back pain. Confusing, isn't it?

This week I'm going to attempt to bring a little clarification to the murky area of orthotic prescribing.

Practitioners.

First of all lets look at the practitioner. You may ask how a Chiropodist, Physiotherapist, Chiropractor or Osteopath can also be trained to prescribe orthotics. This is a perfectly reasonable question, but the answer may worry you a little. The fact is that currently there is no legislation in the UK to stop your friendly barman, dustman (or street vagrant for that matter) setting up as a Podiatrist, Chiropodist or Physio tomorrow. Once he or she has set up shop it's a simple matter to enroll as a student for the weekend on an orthotics laboratory beginners course. (One well-known lab is not remotely interested in checking to make sure proper qualifications are in place!).

The professions of Chiropractic and Osteopathy are regulated and protected, but even then, a Chiropractor or Osteopath may have only attended the same weekend course as the aforementioned barman, dustman or vagrant.

OK - but surely Chiropodists and Podiatrists, if they are properly qualified, have done more than a weekend course in orthotics - after all, aren't feet their business? The answer to this is yes and no. Yes, they should know what they are about re feet, but don't take it for granted. The problem here is one of Continuing Professional Development (the regular updating of the practitioners knowledge base). Continuing Professional Development (or CPD) is mandatory for Doctors and Dentists, but Podiatrists and Chiropodists can simply not bother. You could, for arguments sake, have a Chiropodist who qualified fifteen years ago but has not opened a book since. He or she decides that now is the time to increase earnings. How? Enroll on a weekend course with Osteopaths, Chiropractors, Barmen, Dustmen and the odd Street Vagrant of course!. It's a great weekend by the way, and you can be sure the lab will provide you with everything you need to start selling their orthotics. By the end of the course you even sound like an expert!

Orthotics.

On to orthotics - I'll touch on practitioners again a little later. The two main types of orthotics are non-prescription (or over-the counter 'OTC'), and prescription (or custom-made orthotics).

The main difference is that non-prescription 'OTC' orthotics are inexpensive and are prescribed by everyone, including the patient, the chemist, the GP, the physio etc etc. They can be likened to cheap drugstore reading glasses - they may work for some people or they may cause more problems - pretty hit and miss really.

Custom-made 'prescription orthotics' are made from a plaster cast of the foot. They are expensive, and are usually (not always) prescribed by a practitioner who has some idea about what they're doing. There are specific types of orthotics for specific activities.

As a practitioner with over 20 years of experience in prescribing orthotics, here's what I look for in a prescription orthotic;

• Well-made, with a lifetime guarantee from a reputable laboratory (and not 'Orthotics-U-Like' which, in spite of the glossy brochure, turns out to be three guys and a pot of glue on a trading estate somewhere).
• Comfort for the patient, together with the ability to correct the problem.
• Computer records at the lab (ie the "cast" is stored electronically) so that if an orthotic is lost or broken and needs replacing, it can be re-ordered without the patient having to be re-cast.
• A varied choice of orthotic types so that the orthotic can be chosen to fit the patient comfortably without the patient having to change all their footwear.

And here's what I would look for in a practitioner:

• A chiropodist or podiatrist, with, as a minimum requirement, a BSc(Hons) Podiatry or Podiatric Medicine degree.
• A practitioner who works to a fixed cost. In other words, an agreed fee is given before treatment commences. Sometimes patients have to attend for several sessions after the orthotics have been fitted. In my view its not really fair to expect the patient to pay for these sessions. After all, you wouldn't expect your optician to keep charging you for visits if your spectacle frames needed adjustments.
• A relevant practitioner for the condition. I would be happy to let an experienced Podiatrist/Chiropodist prescribe orthotics for my foot problem. For my knee, hip or back problem I would prefer to be referred to a Podiatrist by my Physio, Chiropractor or Osteopath. I would not want my Podiatrist to treat my back problem with orthotics without having been referred by a relevant practitioner. Also, I would not want the Physio, Chiropractor or Osteopath who is treating my back to fit my orthotics.

A couple of thoughts to end with.

Good orthotics may be expensive, but are a great investment - as long as they work. Badly made or over-the-counter orthotics may seem cheaper, but actually are downright expensive if they don't work!

Time and time again, in both Private Practice and NHS work, the team approach has been shown to be far more effective than a single practitioner trying to do everything. Just because I'm good with feet doesn't mean I can fix knees, hips, backs, pour a good pint, or run a dustbin route !

As always, my website (www.ortho-pedclinic.com) enquiry form is open for any foot or foot related query. If you look on the links page you'll find a link to the laboratory I use for most of my prescription orthotics, Allied OSI. This will give you some idea of the type of service offered by a really good orthotics lab.

Please feel free to use the enquiry form at www.ortho-pedclinic.com for all foot-health and foot-related matters.
David Holland BSc(Hons), MSc(Dunelm), MChS
Consulting Podiatrist.