Sole Patrol
February 20, 2008
The Show
Is that thing in your shoe worth the money you paid?
(Click here to watch the video)
When your chiropractor suggests that your bad posture should be treated with a corrective device, chances are good you listen, even if that corrective device costs hundreds of dollars.
So it may surprise you to learn that what's behind many of the devices currently sold as custom orthotics may have as much to do with cashflow as with your health.
February 20, 2008
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Orthotics 101
The practice of foot care and foot health has its own vocabulary. Here are some definitions to help you make sense of it all.
| Term | What it means |
|---|---|
| Orthotic | A shoe insert, shaped to the foot, which is promoted as a way to prevent or cure foot, leg and back pain. |
| Pedorthist | A foot care professional who does not diagnose but more precisely assesses and offers therapy. Pedorthists fill prescriptions from physicians and podiatrists/chiropodists for specialty footwear and foot orthoses. See www.pedorthic.ca for more details. |
| Podiatrists and Chiropodists | Chiropodists and podiatrists are primary health care providers who are experts in the management of foot problems. They treat patients in a variety of ways including the use of braces, casts, shields, orthotic devices, physical therapy or surgery. Podiatrists and Chiropodists work to help patients eliminate foot pain, gain mobility, and maintain healthy feet. They treat sports injuries; common foot conditions such as corns, warts, ingrown toenails or calluses; foot infections that may result from medical conditions such as diabetes; and foot deformities and misalignments. See www.podiatrycanada.org and www.cocoo.on.ca for more detail |
| Orthotist | A certified specialist in the design, fabrication and fitting of orthoses (braces or splints) intended to prevent or correct deformities, protect a painful part of the body or improve the function of a weakened extremity. This may include anything from custom fabricated arch supports to braces for the knee, back, shoulder or arm. The designation is awarded by the Canadian Association of Prosthetists and Orthotists. See www.oandp.com for more details. |
| Custom-made | A term used to describe a device that is manufactured from raw materials. In the case of a custom foot orthotic or custom-made footwear, the term custom-made can only be used when a three dimensional image of the foot is used to capture bony alignment and shape, and the device is manufactured from raw materials. |
| Customized | A term used to describe a pre-fabricated/over-the-counter device that has been modified by the addition or deletion of material in order to modify movement or accommodate pain or dysfunction. |
| Custom-moulded (non-casted) |
A term used to describe a device moulded directly to the foot from raw materials that are warmed until soft. This device can be further modified and used to provide cushioning, pressure relief, redistribute load and accommodate deformity (a self-moulded product is not considered custom moulded). |
For more detail, see this glossary of orthotic terms, provided by the Pedorthic Association of Canada.
| Term | What it means |
|---|---|
| Chiropractic | A non-invasive, hands-on health care discipline that focuses on treatment and preventative care for disorders related to the spine, pelvis, nervous system and joints. |
| Chiropractors | Chiropractors are primary care practitioners, trained to develop and carry out a comprehensive treatment/management plan, recommend therapeutic exercise and other non-invasive therapies, and provide nutritional, dietary and lifestyle counselling. |
| Canadian Memorial Chiropractic College | A fully accredited, limited enrolment, self-supporting, professional educational institution funded by the chiropractic profession in Canada. It receives no direct government funding and relies on membership, tuition and donations for support. www.cmcc.ca |
| College of Chiropractors of Ontario | The government appointed body that regulates Ontario chiropractors through the Chiropractic Act, which is part of the Ontario Regulated Health Professions Act. It enforces the Orthotics Standard of Practice and is responsible for investigating complaints made against chiropractors. www.cco.on.ca |
| Ontario Chiropractic Association | A voluntary professional association that represents approximately 81% (2,700) of Ontario's practicing chiropractors. Its mission is to serve its members and the public by advancing chiropractic health care. www.chiropractic.on.ca |
| Canadian Chiropractic Association | An association representing the profession in Canada through the co-operation and co-ordination of information and programming among its provincial divisions. There are approximately 6,000 chiropractors in Canada of whom 85 per cent are members of the association. www.ccachiro.org |
February 20, 2008
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Q and A with Leslie Trotter, Pedorthist
What advice would you give to someone who thinks they might need an orthotic?
If people have muscular pain of a lower leg and think that they might need an orthotic, they should probably consult with a foot care professional. Find out who in the community is considered a foot care professional for your area of concern.
A person could be a diabetic. There are people who are specializing in diabetic care. A person could be an athlete. There are foot care professionals who deal specifically with athletes. They should be trying to see the professional specific to their concern.
What are the names of the professionals that they should see?
If you’re talking about someone who fabricates orthoses you’d be looking at an orthotist who specializes in the foot or a pedorthist who is specifically trained in foot care. Podiatrists and chiropodists also deal with orthotic devices and they also deal with soft tissue problems of the foot like corns, calluses that sort of thing.
These people are trained for many thousands of hours past just the general science degrees that all health care professionals have and it’s specific to the function of a foot.
What else? How do you know if you’ve got the real thing?
The insurance companies are looking for a prescription from the family doctor, so I would start with that. Some are also looking for a three-dimensional cast of the person’s foot. Check with your insurance company to find out what you’re covered for.
What if a professional recommends orthotics for every member of your family?
Get a second opinion. It never hurts to get a second opinion.
Can you count on your insurance company to pay for these devices?
Insurance companies are getting much more restrictive about who is allowed to prescribe and who is allowed to dispense orthotics, so you should call their insurance company and ask "who is allowed to sell me this product?" because some people are being excluded from the policy wording and patients will be stuck with the bill.
And also: Foot specialists often have equipment on site to adjust orthotics once produced in labs. This could ensure that your orthotic is a custom-made to your feet as possible.
February 20, 2008
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A collection of orthotics documents
These documents (all in PDF format) offer a glimpse into a wide variety of areas related to the sale, manufacture, and insurance coverage of orthotics. Clicking any of the thumbnail graphics will open the document in a popup window.
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A brochure from The Orthotic Group promoting a seminar on orthotics and gait analysis software. You can find The Orthotic Group at www.theorthoticgroup.com. |
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An audit of health products and services marketed on chiropractic websites in Alberta and consideration of these practices in the context of chiropractic codes of conduct and ethics |
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An open letter from the Pedorthic Association of Canada to insurers and third-party payers. |
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An announcement from Great West Life that its coverage for orthotics will no longer apply to prescriptions from chiropractors and physiotherapists. |
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The Ontario Chiropractic Association 2008 recommended service codes and fee schedule |
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A guide for patients from Manulife Financial indicating that only custom-cast orthotics will be eligible for coverage. |
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Reminders for claimants and customer service representatives on orthotic claims, prepared by the Pedorthic Association of Canada. |
February 20, 2008
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The Ontario Chiropractic Association responds to our story
The following three documents were provided to Marketplace by the Ontario Chiropractic Association. Clicking any of the thumbnail images will open the document in a new popup window.
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An open letter to Marketplace from the OCA. |
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A backgrounder brief prepared by the OCA for chiropractic stakeholders in Ontario. |
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A letter from the OCA to Manulife Financial following an orthotics industry roundtable meeting. |
February 20, 2008
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Links to more information (orthotics)
These sites are useful sources of information about orthotics, including traditional and newer methods of making prescribing and selling the devices.
- Foot Facts, from the Foot Knee Back clinic in Ancaster, ON.
- A slideshow showing how an orthotic is traditionally made.
- Selection Criteria for Custom Foot Orthotics
- The official site of The Orthotic Group.
- A GaitScan video intended for patients.
- Insurers put a foot down on orthotics abuse, a news story from the trade publication Benefit News.
- A Foot Orthotics Advisory from the Ontario Podiatric Medical Association.
- The Orthotics Standard of Practice of the College of Chiropractors of Ontario
February 20, 2008
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