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04/09/2018 Allen Jacobs, DPM
Costco Selling Custom Orthotics (Harry A. Harbison, DPM, Elliot Udell, DPM)
I wanted to share some thoughts with regard to the issue of what to do when individuals present to an office with orthotics made at Costco, the good feet store, or similar non-podiatric facilities.
Simply stated, you have completed undergraduate and postgraduate training including training in biomechanics and kinesiology. Your’ decision as to the nature and type of orthotics to be utilized, and the specific corrections to be utilized in those orthotics, are unique and individualized based upon an examination of that patient and a determination of multi variant factors resulting in your orthotic prescription decision.
I simply tell the patients when such orthotics are nonfunctional and ineffective that they have received the wrong device. It is a simple as that. I will not be responsible nor take on a financial burden from a device that was prescribed by some type of ridiculous orthotic determining device without the benefit of a podiatric examination. If there has been no weight-bearing or nine weight- bearing examination, and the device continues to fail to resolve the patient’s pain, I simply tell them the device is not working because it is the wrong device. The patient may have my sympathy for spending money unnecessarily, but this was their decision not mine. I will not be responsible for “correcting or adjusting“ such devices.
On a similar note, we are seeing the same thing as the result of the work at urgent care centers. I for one am tired of patients presenting to my office with cam walker boot and x-rays for a fractured metatarsal that has been evaluated and treated at an urgent care center. Or a patient who comes in with a big toe in gauze having undergone some amateurish attempt at removal of an ingrowing toenail. Or a patient with a collapsed Charcot joint who received IV antibiotics at an urgent care center for treatment of an “infection”.
If Costco, the good feet store, or urgent care centers, wish to receive the money for treatment of foot and ankle disorders, they must also accept follow up responsibility. In my mind, it is that simple as that.
If it is my opinion that the patient has been utilizing an incorrect device or has had poorly performed interventions performed on the foot or ankle, I do not hesitate to inform the patient of my opinion regarding such matters.
The fact is, there is a reason you attended podiatry school for four years followed by three years of residency. Non- podiatrists attempt to provide foot care services. Simply stated, they do not know what they do not know. If you had an ingrown toenail, who would you prefer to administer a local anesthetic in the most painless manner? A podiatrist? Or a nurse practitioner or general practitioner? If you had a fracture at the base of the fifth metatarsal, who would you rather make a determination as to the appropriate treatment? A PA?
I’ve heard others tell me, and publicly state, that our services as podiatrists can be duplicated by others. In some instances that might be correct. However, to a large extent, it is my experience a more proper statement of fact would be that there are others who attempt to provide the services that a podiatrist provides, but do so in an inferior manner with a less than optimal outcome in many circumstances.
The issue of Costco, the good feet store, urgent care centers, NP’s and PA’s foot and ankle care will not go away. Non-podiatrists have the legal authority to provide such services. I, however, do not have any legal obligation nor ethical responsibility to accept follow-up care for any ineffectively rendered at times negligently provided services by non-podiatric healthcare providers.
If other healthcare providers want to play podiatrist, they must accept the responsibility of a podiatrist adhering to the same standard of care. And that includes follow up care.
Allen Jacobs, DPM, St. Louis, MO
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04/09/2018 Dennis Shavelson, DPM
Costco Selling Custom Orthotics (Harry A. Harbison, DPM, Elliot Udell, DPM)
I reviewed the RESA website. They have a homogeneous proprietary plan using software, an algorithm, a technician and a scanning method developed by a cyclist + engineers to create what they value as a $199 product. Remember the Soles 3-D printed orthotics that DPMs were dispensing that is now out of business having lost $30 million.
I welcome the competition from Costco that will help educate the foot and postural suffering public towards the need for customized orthotic props. My insult comes from Costco stating that the DPM product is worth $300 when mine are $950.
Orthotic authorities lack consensus but state that subtalar joint neutral casting is not enough. State that a thorough exam and diagnosis is imperative. State that add-ons to the shell must be incorporated for custom device excellence: https://www.podiatrytoday.com/current-insights- neutral-casting-and-biomechanical-exams-orthotic- prescriptions
My opinion is that the RESA product is competitive to most STJ Neutral cast, post to cast podiatry products. This holds true when taken by staff and not the DPM and not prompted by a modern bioeval.
Podiatry orthotics have stagnated for decades. The competition has gotten better. No customized insole has evidence to back up marketing claims as to usefulness and value. That is the milieu of this discussion
Podiatry needs to offer more than the fact that our orthotics are being dispensed by a licensed professional. We need to find a way to make our biomechanics and orthotics great again rather than try to eliminate the competition as suggested.
Dennis Shavelson, DPM, NY, NY
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