10/03/2014    Jason Kraus

APMA Enters into Agreement With PFA (Robert Scott Steinberg, DPM, Frank Spinosa, DPM)

While I recognize there is some controversy
surrounding the APMA decision to work
collaboratively with the PFA (Prescription
Footcare Association), I think we should not
ignore the positive aspects of this developing
relationship. We live in a collaborative world
where great efforts are being made to streamline
the delivery of healthcare services. There are so
many notable examples of physicians of all
stripes employing or deploying ‘physician-
extenders’ (nurse practitioners, physicians
assistants, physical therapy assistants,
pedorthists) to the great benefit of both patient
care and practice performance.

Many very capable and successful podiatric
practices have added certified pedorthists to
their patient care teams while others have taken
advantage of programs similar to OHI's Central
Casting program. (This innovative service enables
podiatrists to schedule a C.Ped into their
practice on an as-needed basis thereby extending
services without taking on added professional
salaries.) In both instances, incorporating well-
trained professionals into podiatric practice
settings are a net positive, as well as a nod
toward innovation and a thriving future for all
stakeholders.

Dr. Steinberg's conviction that foot orthotics
should be exclusive to podiatry is well known,
but the reality simply doesn't support such a
rigid belief. In truth, there are a great number
of podiatrists who choose not to prescribe
devices of any kind to their patients. They’re
far more comfortable referring patients to other
practitioners - many of whom are not podiatrists.
There are also many non-podiatrists who are very
knowledgeable and skilled in the area of foot
orthoses.

As I wrote several years ago in my Podiatry
Management article, “Retail Foot Orthotics - The
Big One That Got Away”, the need for foot
orthotics will never fade, but the preeminence of
podiatry in their prescription and dispensing may
very well diminish. If that happens, it won’t be
as a result of the APMA's pilot program with the
PFA. Instead, the blame will fall on the
profession's myopic concentration on surgical
training, the educational institutions’ response
to this narrow focus and practitioners diminished
regard for innovation and appreciation for the
craftsmanship and high technical standards of
their suppliers.

Jason Kraus, President, COO,
Orthotic Holdings, Inc.,
Jason.kraus@orthoticholdings.com

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10/04/2014    Jeffrey Root

APMA Enters into Agreement With PFA (Robert Scott Steinberg, DPM, Frank Spinosa, DPM)

As the owner of a prescription foot orthotic
laboratory and as the president of the
Prescription Foot Orthotic Laboratory Association
(PFOLA), I would like to respond to the letter by
Robert Steinberg, DPM and the response by APMA
President Frank Spinosa, DPM concerning the
APMA’s decision to collaborate with the Pedorthic
Footcare Association at the 2015 National
Conference. Over the past few decades, podiatry
has become more and more focused on foot and
ankle surgery and less focused on some forms of
non-surgical treatment, including foot orthotic
therapy. Not surprisingly, retailers and other
providers of foot orthoses such as pedorthists
have capitalized on the need and opportunity to
provide foot orthoses to the public.

As part of our mission, PFOLA has attempted to
promote quality prescription foot orthotic
therapy and improved patient care through
continuing education. In fact, PFOLA is
partnering with the Pedorthic Association of
Canada in April to promote education at their
national symposium in Vancouver, B.C.

Pedorthists are not able to diagnose and
prescribe as they are not licensed medical
practitioners. However, many pedorthic facilities
provide custom foot orthoses directly to the
public without a prescription from a referring
physician. In other cases, patients are referred
by their podiatrist, orthopedist or their primary
care doctor for custom orthoses. Often these
“referrals” do not include a diagnosis nor a
specific orthotic prescription. This places the
pedorthist in the awkward position of having to
examine and diagnose before providing orthoses or
having to provide orthoses without the benefit of
an examination and diagnosis. We at PFOLA are
concerned about the best interest of the patient.
Our member laboratories welcome the business
opportunity that this collaborative effort
between the APMA and the PFA might bring but we
remain concerned about the future direction of
prescription foot orthotic therapy and the APMA’s
position on the role of foot orthoses in
podiatry.

It would be naive to think that the public is
well served by this poorly defined relationship
between podiatrists and other providers of so
called prescription foot care, including
pedorthists and orthotists. I can understand how
Dr. Steinberg and other well trained podiatrists,
who have spent a significant amount of time and
money on their podiatric education and training,
would be concerned about the APMA’s decision to
collaborate at the National. It would seem that
pedorthists need to be trained to examine,
diagnose and treat or the APMA should work with
the PFA to better define the referral process,
the pedorthist’s role and the PFA’s relationship
with podiatry in order to preserve and ideally to
improve the integrity of prescription foot
orthotic therapy in the future.

Jeffrey Root, President, PFOLA