09/09/2022    Paul Kesselman, DPM

OTC Orthotics Problematic for Patients (Jordan Stewart, DPM)

I for one, would like to thank Dr. Stewart for
bringing this mater to PM News. He is a trusted
colleague and valuable member of the APMA DME
Workgroup.

Why do some find it so surprising that the power of
the media is so convincible that so many otherwise
sane people pay insane prices for unproven
products/treatments? Why do these same consumers
make the Home Shopping Network and other channels
selling consumer goods 24x7 have so many people
addicted to purchasing items they don't really
need? It’s no accident that media outlets hire
psychologists and marketing personnel who know who
to manipulate the messages often sent by highly
paid well known celebrities. So if these celebs say
something is reputable, then it is and the consumer
appears to have more faith in the messenger of the
ad than their own doctor.

Unfortunately the media has created a generation of
shopaholics who will buy anything at almost any
price. Our patients are being deceived. I too, when
I was in practice, had many patients coming in with
shopping bags of worthless OTC "orthotic"
appliances they paid more for than the custom
fabricated devices I provided.

It is time to put an end to the manipulative
practices of the high school salesman who think
they know more than physicians (all DPM/DO/MD) as
well as licensed orthotists and pedorthists about
biomechanics.

Unfortunately, there are only 19 states requiring
licensure for the practice of orthotics/prosthetics
(DPM and all physicians by their licensure are
included). And OTC devices are often excluded from
that requirement. To ban the practice of unlicensed
individuals from providing OTC orthotics would be a
massive challenge requiring all 50 states enacting
appropriate legislation.

State insurance commissioners should also be
notified of the unprofessional action and price
gouging of any business who charges over a certain
percentage of the usual and customary fee for a
specific service.

Each state and municipality often have price
gouging regulations, which can penalize businesses
with huge fines and these entities should be
reported.

Additionally, APMA and each state component can be
part of the solution. Fighting fire with fire by
hiring psychologists and marketing experts who can
and provide better PR and educational forums which
can serve to refute the claims made by these
amateurish non-scientific salesman.

Lastly, we too need to be professional and provide
patients with the appropriate level of device
required and for a fair price.

Paul Kesselman, DPM, Oceanside, NY

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09/12/2022    Keith L. Gurnick, DPM

RE: OTC Orthotics Problematic for Patients (Jordan Stewart, DPM)

As podiatrists, we are all very aware that there is
available to the consumer a plethora of shoe
inserts to help alleviate pain. This includes non-
custom, non-prescription products that can be
purchased off-the-shelf in retail stores or on-line
and can include flat cushioned insoles, contoured
cushioned foot supports, and hybrid devices that
are both supportive and padded. Also, available are
products from retail "foot comfort" stores where
salespeople can guide the consumer towards
purchasing various pre-manufactured products that
also might be soft, padded, or more often made of
semi-rigid plastics and are more supportive. These
"salespeople" are not doctors and cannot diagnose
nor prescribe custom orthotics. Frankly, I don't
know how they get away with what they do.

Custom prescription foot orthotics are only
available from licensed professionals and doctors
or laboratories with a prescription. Therein lies
the difference that should be explained to the
patient and to the public. They simply are not
getting a custom prescription foot orthotic at a
Foot Comfort store. There cannot be a diagnosis and
there is not a prescription; it would be against
the law for them to do so.

All of these products have the potential to improve
or alleviate pain and many of our patients come to
us with these "non-prescription, non-custom"
products that sometimes are helpful for their
conditions. Custom prescription orthotics can be
life changing for our patients. We have all
experienced this many times. It is sad when
patients waste time and money and suffer with
ineffective products they deemed to be "custom-
prescription", when they can benefit much more from
true custom prescription orthotics, patient- and
diagnosis-specific foot orthotics, the type that we
as podiatrist can provide.

Keith L. Gurnick, DPM, Los Angeles, CA