09/22/2022    Kevin A. Kirby, DPM

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

I have been reading the comments on custom foot
orthoses and different theories of biomechanics
here on PM News for the last week and feel I need
to offer some additional thoughts on the subject. I
am well aware of all the different podiatric
biomechanics theories and know very well the
individuals who promote their own orthosis lab’s
method of making foot orthoses as being the “best
orthoses” for all individuals. With that in mind,
I recommend that any time a new theory or foot
orthosis technique is being promoted, the
podiatrist needs to be very skeptical of these new
ideas and techniques before they “jump in with both
feet” believing that they have now found the newest
and best “foot orthosis guru”.

One of the most disturbing comments I saw in this
thread was the comment: “I believe in the MASS
theory so much that 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.” Personally knowing the many fine
faculty that teach biomechanics and foot orthosis
therapy in our nation’s podiatry schools, I believe
this bold statement to be somewhat insulting to
podiatry school faculty and the knowledge and
dedication that they bring to our nation’s podiatry
students in teaching the latest theories and
orthosis techniques. That would be like saying: ““I
believe in the minimal incision surgery so much
that 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 foot and ankle
surgery.” Really?!

Yes, MASS theory is relatively new compared to the
theories offered by Dr. Root and his colleagues,
but it is not without fault and issues. In the
greater Sacramento metropolitan area where I
practice, there have been a few podiatrists who
have used the MASS orthosis technique and I have
seen some successes and also many failures from
patients who have seen me for a second opinion with
their orthoses. That being said, there are other
podiatrists in my area who adhere to Dr. Root’s
theories and orthosis manufacturing methods which
have also produced some successes and some failures
for their patients.
The bottom line is that every foot orthosis theory
and manufacturing technique, regardless of who has
promoted these theories and techniques over the
years, will have some successes and some failures.
That is the nature of making custom foot orthoses
for patients. In other words, not all types of
foot orthoses work for all patients, regardless of
how slick the promotional animations and videos
seem when seeing them for the first time on a
“cruise ship seminar”.

The bottom line is that the foot is a very complex
biomechanical structure with large amounts of
structural and functional variability between one
person and another. Custom foot orthoses can be
made by many methods and techniques to help heal a
patient’s injuries and improve their gait function.
However, custom foot orthoses can also be made by
many methods and techniques that will cause so much
irritation to the patient’s foot, lower extremity
and lower back to prevent the patient from even
wearing the foot orthosis long enough to determine
whether the foot orthoses will be therapeutic or
not for them.

This is why the podiatrist who wants to become an
expert in custom foot orthosis therapy will not
just adhere to one person’s ideas about how to make
the “best” foot orthosis for their patients, but,
rather will try learn from multiple experts in
custom foot orthosis therapy, and experiment with
different techniques, until they find how to best
make their patients comfortable and satisfied with
their custom foot orthoses. Our patients deserve
this type of dedication to continuing biomechanics
and custom foot orthosis therapy education from
their treating podiatrist.

Kevin A. Kirby, DPM, Sacramento, DPM

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