I appreciate the opportunity to speak for PRESENT. I know they always put on some great topics here.
Today I would like to talk a little bit more about Biomechanics and the use of a Custom versus a prefabricated orthotic, and I really want people to start thinking about "is a Custom orthotic always needed?"
As a disclaimer, I am a Key Opinion Leader and consultant for PowerStep, but everything that I always speak about at these lectures I really try to make just strictly about Clinical and my opinions and interactions with my patients.
So, what’s the objective that we have here? Well, Biomechanics is the foundation for many podiatric problems that we have. When treating early, utilizing an orthotic may relieve the pain, or slow or stop the progression of symptoms and preclude the need for a custom orthotic. I know that a lot of times we all get patients in our practices who have conditions that are early in their onset and, thinking about it from a little different tact, thinking about it from a prefabricated orthotic versus everybody-needs-a-custom orthotic, is really where I want to go with this.
In reality, everybody who is attending this lecture knows when a patient’s complaint is related to the biomechanics of their feet, whether it’s hallux valgus, plantar fasciitis, pes planovalugus. At some point in our treatment of this patient the protocol deals with biomechanics and will deal with the use of an orthotic to treat this patient’s biomechanics, because the first thing we are going to do is discuss the long-term outcome that we offer our patients and then talk about what we are going to do right now. And a lot of times early-on in that treatment plan is going to be the use of an orthotic.
What’s the question we have to ask ourselves?
Is it, “Does every patient need a custom orthotic at the onset?” A lot of times we think about that exact question. Well, I really think we need to ask a better question. I don’t think we need to ask, “Does a patient need a custom orthotic?” I think, “Does every patient need to invest in the use of a custom device or is there something that would benefit the patient first?”
I always like to talk about investing in something, especially in today’s day of healthcare and what goes on with our insurances. Patients have very large deductibles and have to pay large co-pays and sometimes they have to invest in not only the investment of the orthotic from a financial standpoint, they have to also think about the investment of the use of an orthotic from a clinical standpoint. Sometimes the device that the patient needs will necessitate some investment of time and adjustment into the use of a custom, functional device.
What if you are able to provide a patient with a prefabricated device that they can leave the office with that you feel comfortable enough with, that‘s going to provide them with the stability, the functionality, the biomechanical control that they need. That’s the better thing that we have to think about, not that we just have to give everybody a custom orthotic, but what they would need to invest in to treat their biomechanical problem right then and there.
Prefabricated vs. Custom
Can a prefabricated device help our patients? That’s what we have to ask ourselves. Let’s be very honest with ourselves. PowerStep orthotics are clinically proven, and I will talk about that, to improve foot function and decrease foot pain. Whether pes plano-valgus, pes cavus, plantar fasciitis, metatarsalgia, any one of these biomechanical conditions can be addressed with your patients with the use of a prefabricated, good device, good orthotics. Yes, I believe the PowerStep orthotic is the best prefabricated orthotics on the market.
Let’s just talk about use of prefabricated versus custom. It’s not about believing me. It’s not about believing PowerStep or any sales pitch. What we have to start thinking about is Clinical Studies. We all believe in studies. We should be; we shouldn’t be believing just any company. A study that was done by Springer, Otter and Barry looked into the use of a prefabricated, semi-rigid orthotic to improve foot function and improving foot function in all the different areas that we just spoke about. In this study that published back in 2007 (I don’t think the age of the study really makes any difference), the patients were evaluated at baseline, 4 weeks and after a year.
They found that:
- There was an initial marked decrease in foot pain with the use of a prefabricated device
- Patients stated that there was a good fit
- There was good stability with the use of these devices
- They were comfortable
- There was some minimal increase in pain after 4 weeks, but with an equal increase, the patients described, in their mobility, that the minimal pain didn’t make enough difference because they were happier with the increase in their mobility.
- At 15 months, 73% of patients found the orthotics to continue to be beneficial.
Again, don’t believe me. Believe your patients. When patients come in with pain, we have to provide them with a device that can bring them to a better biomechanical place which will decrease pain.
Let’s talk about Why PowerStep
I personally always believe in doing conservative treatment with a prefabricated device before the use of a custom if it is warranted. Again, the PowerStep device is clinically proven. You are able to have these devices in your office to provide a same-day solution to your patients. In my opinion, they are
- Convenient - you don’t have to scan or mold with the use of plaster, while I still continue to do that in my office.
- High quality - I think that’s important because anything you do in your practice, and I talk about this all the time from a business-management standpoint, if you’re going to ask your patients to invest in something, they are going to invest in it based on your opinion of it and it’s your reputation. If you’re going to dispense something that is not a quality device, ultimately they’re going to look at your reputation of recommending that device.
- The PowerStep ProTech device is exclusive to medical professionals. Can certain PowerStep devices be purchased over-the-counter in other places? Yes, but the ProTech device is exclusive to you and your practice.
Desirable properties of a prefabricated orthotic
The shell is fit for a purpose:
- It achieves the desired functional control on foot and locomotor system.
- Provides stability in controlling foot joint range of motion
- Semi-flexible (or semi-rigid, depending on how you want to look at it) to allow tolerance in prescription
- Adjustable to allow for modifications by practitioner, including adding pressure redistribution materials
- Slim enough to go in a range of footwear
- Not so hard as to be more readily tolerated by wearer
- Has very good shock absorption
Material covering is:
- Does not increase skin surface coefficient of friction (increasing risk of moist fissures, blistering)
- Able to absorb excess sweat
- Cost (Investment)
Again, when you are recommending the use of an orthotic, talk about the use of an orthotic as an investment. An investment has a return. If something just costs something there’s no return on that. Now this may be the interim solution needed before a functional device. Or if not, for instance, this past week in my office, I had somebody come back in who loved the devices and got a second pair just because he didn’t want to keep switching them back and forth between shoes.
Comparison of the ProTech Orthotics to a Custom Fabricated
There are a lot of prefabricated devices on the market. Why this one?
- The semi-rigid shell leads to less breakdown for pain relief and prevention
- Semi-rigid arch comes in 12 different sizes
- Foam material is a medical grade foam for longer duration of use
PORON® Performance Cushioning
Let’s talk a little bit about Poron. It’s medical-grade cushioning for
- Superior shock absorption
- Superior compression set resistance
- Superior resilience
The material that they use on the top, the PORON, is really the defining thing that they have on the ProTech device versus other ones done over the counter.
There are adjustments that are also available. From PowerStep you can get:
- Medial longitudinal arch padding
- Adjustable heel lifts
- Forefoot wedges
- 2-degree and 4-degree heel wedges
- IPK cushioning
- Metatarsal padding
It’s not like you are just handing them a device. You can also “customize” that device before that patient leaves the office.
Patient Benefits of PowerStep ProTech
What are the patient’s benefits of PowerStep?
- Clinically proven to relieve pain
- Treats the problem not just the symptoms – Remember, ultimately we want to do something to control the biomechanics of the foot which will then decrease the pain.
- Fraction of the cost of custom orthotics, as we know. Some practices can charge anywhere from $400 to $600 to $700 for a pair of custom orthotics.
- Patients get immediate pain relief; there’s no waiting.
- Comfortable for greater patient compliance
Physician Benefits of PowerStep ProTech
And what are the benefits to you?
- Only available to you; ProTech can’t be purchased elsewhere
- Convenient to dispense off the shelf
- Saves the staff time and you time without the need to mold or scan
- Secondary revenue stream for your practice as cash sales
- Ultimately leaves open the opportunity to progress to a custom device.
PowerStep Sandals/Slides and Slippers
What’s been going on a lot now in our world is the use of other things to provide support because patients have been working from home. With the pandemic and life changing, people are working from home. These are things I recommend for people to use at home:
- PowerStep Slippers and Sandals – You don’t want to get them into a device and then have them barefoot at home. I call that “getting on the hamster wheel” – you get them better, they stop using the device because they are working at home and they get worse again. The use of PowerStep sandals or slides is definitely something that should help your patients when used at home. They can also just use them for the beach or warm weather better than the $2 flip-flops they find at store. It will provide them with some support to the plantar fascia if they need that temporary device.
Other Products Available for Dispensing
Remember one thing, you are “dispensing” products and you are explaining why they need them, even though they are investing in them from you. You see I continue to use the word “investment.” I always tell patients we need to invest in our foot health.
- Night Splints – If you don’t dispense night splints through the DME program through Medicare, this is a good alternative to your patients who require it and you are unable to bill insurance.
- Kids Orthotics – size changes rapidly and if they don’t require a lot of biomechanical control, this is a great alternative
- Different prefabricated Ankle Braces, like the Air Ankle Stirrup Brace (L4350) and Figure-8 Ankle Brace (L1902). This could be an opportunity to have an additional cash flow into your practice if you are not dealing with it from an insurance standpoint.
- Compression Socks and Sleeves - How many times do we recommend patients use compression socks and sleeves for other problems?
What I want you to think about here is: put your head on your pillow at night knowing you did the right thing for your patients. What does that mean? Always put your patients first. Feel confident about the products and services you provide. If you do that, your reputation will grow and patients will continue to follow.
By Dr. Alan L. Bass, DPM, FACPM, CPC
Central Jersey Foot and Ankle Care, PC