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Tuesday, March 27, 2018

Heel Pain: Are Pricey Orthotics Better than OTC Inserts??

What type of orthotic should you try? I think the better question is do I think my doctor wants me well or just cares about their cash register if they are prescribing orthotic devices. I want my doctor makes money by treating me when I give my trust to that doctor. I also think patients should try home solutions to get well, also follow the Keep It Simple Stupid rule, and to be actively involved in their treatment's success. 

https://consumer.healthday.com/bone-and-joint-information-4/foot-problem-news-320/are-pricey-orthotic-insoles-worth-it-for-heel-pain-732124.html

     As a podiatrist, I treat pain. The more pain, the faster patients will come in to see me. When it comes to heel problems, and particularly plantar fasciitis the most common culprit, the need is there to try to shift the weight into the arch and off of the heel. If the OTC insert does it, but the more expensive custom one does not, then wear the OTC insert. It is typically simple mechanics. 

    I have made my own orthotics for our 35 years, so the buck stops with me. I can make 20 versions of our custom orthotics, each for different purposes, so it is easy to change prescriptions based on the present need of the patient. At times they made need full arch support, and at other times, may need more cushion and less overall support. If you walk into my practice to get orthotics, I have no standard pair. If I did I would be no better than a store selling over the counter inserts. I need to figure out what the problem is, how a certain type of orthotic might help, and then go to my workshop and make that. If the patient has a different problem next year, I may be able to adjust the present orthotics, or I have to go back to the drawing board. This is what it is like to have a biomechanics practice.   

    I do not want to be known as just someone who makes orthotics. I want to be known as someone who helps patients get better. My orthotics get people better overall, but they are part of a big range of techniques I have available, and I have spent years mastering. I love to keep things simple, do the simple things if effective, so OTC inserts are used plenty in my practice. It also takes many years to develop the sense when OTC will work, and when custom is needed. 

    Any case of plantar fasciitis should be centered around 3 things that I offer (someone else may offer 3 other things): orthotics to shift the weight into the arch, stretching of the calf and plantar fascia to take tension off the tissue, and icing to cool the tissue down. These can change if there is a tear in the fascia, the patient is not responding to the treatment, or there are 2-3 injuries at once to deal with. The better doc I am, the more I want to find answers to help that patient. To look at the big picture. I have never thought that I sell a patient or an insurance company orthotics. It is not a product so much as it is what it takes for me to help the patient get healthy. The pricey orthotic suggested in the article above is as a part of me as my stretching program, my return to running program, who I am. 

2 comments:

  1. Thank you for this excellent and , why not, motivational post!
    Daniel

    ReplyDelete
  2. Something similar: "Expensive orthotics no better than a 'sham', review finds"
    https://www.theage.com.au/national/expensive-orthotics-no-better-than-a-sham-review-finds-20180331-p4z788.html

    ReplyDelete

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.