06/03/2013    Robert D. Phillips, DPM

IL Podiatrist Makes His Own Orthotics

I was both happy and sad to see that Dr. Frank
Bongiovanni makes his own orthotics for his
patients. I was happy because I know that his
patients are receiving the personal care that I
would want to receive from my own podiatrist. I
was sad because this is now a news item.

I was fortunate that when I was in podiatry
school, students had to do rotations where they
had to make the orthotics for the patients and
then dispense the devices and follow the patients.
I think that most of my classmates learned enough
that they could fabricate basic orthotics for
their patients. At that time, a great many
podiatric physicians still had small areas in
their offices to fabricate orthotics on site.

I continued to do this my first few years in
private practice, and in so doing I continued to
learn a lot more about the prescribing and
fabricating process for various types of feet.
When I could see what the results were of my own
work, I could then make corrections in my
understanding of the foot and also the prescribing
process. I maintain still that if you want to
learn how orthotics work and how to prescribe
them, make them yourself. I have never had a
patient refuse to wear a pair of orthotics because
they didn’t look pretty, they only refuse to wear
them when they don’t feel good.

Today, I do utilize a commercial laboratory for
making my patients’ orthotics, though I still take
goniometric measurements, write the prescriptions
and make all my own orthotic adjustments. I see
too many physicians blame orthotic failures and
orthotic problems on the laboratory when in fact
it is the failure of the physician to spend time
examining the patient, writing a good
prescriptions and following up with the patient.

Dr. Bongiovanni correctly stated it: the
laboratory has never seen your patient. There is
only so much information that the physician can
convey to the laboratory, and it is unrealistic
for any physician to expect the laboratory to make
any decisions about how the orthotic should be
designed. Finally I explain to all my patients
that there are still many variables about each
foot that cannot be measured, therefore all
orthotic prescriptions are still initial
estimates, and for many patients there may be much
fine tuning of the device needed. I try to make my
patients understand that they are not buying a
product, they are buying a service.

Robert D. Phillips, DPM, Orlando, FL,
Robert.Phillips9@va.gov

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