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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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