09/21/2022    Jeff Root

Why Aren’t Orthotics Covered By Insurance? (Ivar Roth, DPM, MPH)

I’m glad to hear that Dr. Roth has had success with
the MASS theory of foot orthotic therapy. I have
spoken to other podiatrists who claim to have had
success with it and others who did not experience
adequate success and abandoned the MASS approach as
a result. I have also spoken to podiatrists who
have had tremendous success with Root’s approach
and others who have had less than satisfactory
results. How can one explain these contrasting
experiences and outcomes? Part of the answer to
that question is the fact that there is variability
between and how clinicians examine a patient, cast
or scan the foot and in the devices that they order
for their patients. In addition there is
variability between custom foot orthotics made by
different manufactures, who in many cases, claim to
subscribe to the same manufacturing theories and
protocols.

Fortunately, my father Merton Root did not have a
vested interest in the commercial manufacture of
foot orthotics in the years that he was developing
his theories, biomechanical examination techniques
and his custom foot orthotic manufacturing
protocol. He was driven by the desire to see his
profession advance and to make biomechanics and
foot orthotic therapy better and more scientific.

That’s why he attempted to create a standard system
of biomechanical examination of the foot and lower
extremity and a system of prescription foot
orthotic ordering and manufacturing that was
reasonably reproducible and also teachable. At the
core of this effort was his recognition of the need
for standard terminology and techniques.
Biomechanics goes well beyond foot orthotics and we
need to use generally accepted biomechanical
terminology and techniques.

This discussion began with the question about why
foot orthotics aren’t always covered by insurance.
It is easy to see why some insurance companies are
reluctant to cover foot orthotics when outcomes are
so variable from clinician to clinician. This
situation is not likely to change so long as labs
claim to have a secret recipe for success based on
things like a proprietary orthotic flexibility
calibration system and some secret formula for
applying it. How can foot orthotic therapy advance
when the manufacturing techniques are not
published, can’t be tested and when those who
practice foot orthotic therapy don’t have agreed
upon biomechanical terminology, techniques and
treatment systems?

I’m proud of the fact that my father, even after
opening his own foot orthotic laboratory in the mid
1970s, continued to support his profession by
training his “competitors” and by helping to
educate their clients (his profession) in the
interest of the advancement of podiatry and foot
orthotic therapy. While some of his theories and
techniques have rightfully come under scrutiny with
advancements in biomechanics and in light of newer
research, I believe his opinion that “Advancement
of clinical treatment and knowledge of the foot
have been seriously impaired by a lack of
specifically defined and commonly accepted
terminology” still holds true today.

When I read Dr. Shavelson’s statement that
“Subtalar joint neutral, rearfoot valgus, and over-
pronation have had their runs” I had to ask myself
what better terminology, techniques and systems are
there to replace it and where can others learn
about them. I hope Dr. Roth’s son, who he said is
in podiatry school, is being exposed to these new
terms, techniques and systems. Dr. Roth wrote “I
have told my son who is in podiatry school that
once he joins me in practice he can throw away all
he was taught in school about biomechanics.” What
does this statement say about the future of
podiatric biomechanics or about the success of
these new and supposedly better techniques? If the
MASS approach is so efficacious, why is it not the
dominant theory being taught today?

Jeff Root, President, KevinRoot Medical

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