06/08/2016    Richard Stess, DPM

When capturing casting for orthotics, should you bill a casting fee? (Robert Steinberg, DPM)

As president of the STS Company, I have refrained
from entering the discussion regarding casting with
plaster, scanning, or casting with the STS casting
socks for obvious reasons. When my partner and I,
whom were in practice for thirty five plus years and
attendings at the VA Medical Center in San Francisco,
developed the idea of casting socks and slipper casts
for obtaining negative models of the foot it was done
to provide practitioners a method that was not only
clean and efficient but also accurate.

We knew it would save money because of the reduce
time required to cast and clean up but soon learned
that there are other factors to make a successful
cast for each foot orthotic device and AFOs besides
casting time. We have since learned from many
podiatric orthotic laboratories that often the
impressions whether plaster, STS, or scans that they
receive can be un-satisfactory and result in poor
outcomes. Evidence has proven to us that often the
position that the foot is held during casting process
rather than the shape itself dictates a successful
device with the desired clinical results.

We also came to understand that often a practitioner
did not take the “time” to obtain a satisfactory
impression but often relegated this task to
assistants whom they did not adequately train. The
gift that some of us had in our podiatric education
was that we were taught the skills in taking a good
consistent negative cast. This skill was not
necessary how best to apply plaster but rather the
various methods of positioning the patient and
maintaining a desired foot position in order to
hopefully achieve the type of device that supports or
controlled motion/moments of force.

I have observed that the practitioner who possesses
this skill can obtain excellent impressions with any
of the modalities. Merely obtaining the shape of a
foot with an anatomically accurate plaster model or
3D scan does not necessarily guarantee the
anticipated clinical outcome. Despite the technology
of scanning which can be done by other non-
professionals and in other than medical related
facilities (i.e. shoe stores, big box stores,
pharmacies, etc.) , the reimbursement of the
materials in addition to the therapeutic positioning
of the foot must be continued.

I know of no studies thus far that have proven that
merely scanning a foot shape can provide any
significant beneficial therapeutic outcome as
compared to neutral suspension casting (STS or
Plaster) to achieve a custom functional foot
orthosis.

Richard Stess, DPM, President, STS Company

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