How does one deal with a disgruntled patient who newly presents to your office with a shopping bag full of foot orthotics?
This scenario happens all too often to many orthotic providers, especially if your practice is geared toward biomechanics.
Patients may migrate to you from other practices upon another provider’s referral or from one of your patients. Patients who present with these types of issues, often have complex pathologies which have previously failed to be properly addressed. Some simple examples which result in foot orthotic failure (and there may be hundreds) are lack of properly addressing a more proximal pathology, not identifying the primary etiology of the biomechanical issue, improper shell durometer or posting for patient’s age, failure to add proper modifications, wrong type of shell durometer for the sport etc.) or the patient may have rejected the idea of an AFO.
This column does not have the bandwith or space to address all the possible modifications and simple repairs to make to a foot orthotic which could adequately address the patients’ needs. Suffice it is to say a thorough history; appropriate physical and thorough biomechanical examination must be performed prior to offering the patient any remedies or further treatments. You may wish to consult with another specialist such as a neurologist or order advanced imaging if not already done.
Once these are conducted and the results properly interpreted, one can determine whether some modifications to the various parts of the existing foot orthotic may be able to address the patient’s needs. These can either be temporary fixes which you can fashion in your office using simple materials such as cork, felt, etc. or they can be more permanent, performed in a laboratory. There is another C&C in podiatry which applies here. Be both Careful and Creative making these initial corrections/modifications comes to mind. Don’t bite off more than you can chew. Making modifications and corrections to only one pair of orthotics (or even one side at a time) comes to mind.
What you may charge for these services should be based on time and materials.
Assuming that foot orthotics are not the answer, is the subject of the next installment.
