I hope that readers of this Forum have learned as much about the contemporary methods for prescribing custom foot orthotics as I have in writing it. I started my practice of podiatry in 1980, and having some cursory knowledge of biomechanics of the lower extremity from school at that time, I was two years removed from that education after participating in a residency program which emphasized surgical skills above all else. I was very confident in my abilities with surgical instruments, but having moved across the country and preparing to open a private practice, it became readily apparent that I needed more expertise in other areas involving foot care. In suburban Southern California, my interests gravitated towards a clientele much like myself, actively involved in sporting activities, particularly working with runners, walkers and hikers. Fortunately for me, I partnered with one of my residency colleagues, Chuck Kelman, who shared that interest. He was more well rounded in biomechanics than I was, having attended podiatry school in San Francisco and being exposed to the thought leaders in biomechanics. So, with his help, and plenty of OTJT (on the job training), I was able to develop skills in treating many foot conditions outside of surgical procedures including the use of custom foot orthotics. Prescribing orthotics back then was fairly straightforward, with very few “options” available. We used a plexiglass called Rohadur almost exclusively and posted with acrylic in both the rearfoot and forefoot, very few bells and whistles. I was “blessed” with poor structure in my own feet, so I was able to use myself as a guinea pig as new technology came along and different orthotic labs offered their products to me. I have personally used dozens of orthotic devices over the years, experienced many of the same issues as my patients have, and strongly believe in the principles of lower extremity biomechanics as initially taught by Dr. Root and practiced today many podiatrists, physical therapists, chiropractors and others. It has allowed me to pursue my interests in running, having participated in 5k, 10k and longer races and hiking for miles in the beautiful Santa Monica Mountains where I lived for many years. Why do I share my story? Now that I have retired from practice and consult with KevinRoot Medical, I have found many current practitioners, especially younger ones, are in the same position I was many years ago. Custom foot orthotics are much more sophisticated today, and treatment options can be overwhelming. This is where the FootID Pro app comes into the picture, particularly the configurator feature of the app.
I assume, as I write this, many of you have very busy schedules, and are constantly looking for ways to be as productive as possible during your hours in the clinic. In my experience, two main impediments to maximum productivity are bottlenecks in work flow and miscommunication between people, be it the doctor, the assistant, the patient, or some other entity, such as an orthotic laboratory. Traditionally, orthotic cases are very time consuming, especially when done correctly. A biomechanical exam and gait analysis with documentation, consultation, plaster casting of each foot, filling out prescription forms, packing and shipping the casts definitely qualifies as a bottleneck in productive work flow in a busy clinic. In today’s environment of limited reimbursements and increasing overhead expenses, efficient use of time and resources is critical to not only thrive in practice but survive. This process also lends itself to errors and miscommunications. Today’s emphasis on documentation of every aspect of clinical practice, applies added pressure to the practitioner to delay doing paperwork until a later time in order to stay on schedule, including the writing of orthotic prescriptions. Mislabelled or incomplete prescription forms, order forms submitted with the wrong set of casts, damaged or lost shipments are all common errors that frequently occur, which impedes or frustrates the ability to have a smooth flowing biomechanics based practice.
Today’s economy is becoming more and more technology driven, and the custom foot orthotic industry is no different. The ability to optically scan and digitally record a neutral position model of the foot is a revolutionary upgrade over plaster casts and foam box impressions. It can be performed accurately and reproducibly in seconds, rather than minutes, thus eliminating a major bottleneck in clinical time management. No shipping is involved, thus additional time and expense is spared. Information is stored digitally, no need for physical molds or casts. Alterations to the impressions are performed digitally as well, and can be manipulated multiple times to exact specifications.
Paper forms are no longer needed. All information is recorded via phone app or computer and can be done quickly and contemporaneously during the patient encounter. No interpretation of illegible handwriting or abbreviations is required. Additional documentation such as photos or videos are easily attached to the prescription, as well as special requests or instructions. In situations where there may be a delay in submitting an order, such as awaiting insurance approval, there is no need to reschedule the patient, the scans and order form can be stored and easily submitted at a later time. Similarly with multiple devices, duplicate or additional devices can be ordered easily within the app.
I strongly urge all KevinRoot Medical clients to spend time and familiarize themselves with the FootID Pro app and webpage. Like all other acquired skills, the more familiar you are with the process, the more proficient you become. There are multiple ways to use the app and webpage within your practice, either as a one person process, or as a team. Whatever method you choose, this OTJT with the FootID Pro technology will only serve to enhance your biomechanics practice into the future.
