12/20/2023    Keith L. Gurnick, DPM

NY Podiatrist Defies Modern Trends with Handmade Orthotics (Robert Scott Steinberg, DPM)

At CCPM in San Francisco (1976-1980), we were
taught biomechanics by the best on the West and we
spent time in the mechanical orthotic lab learning
how to prescribe and make foot orthotics for our
clinic patients. I arrived at my opinions from this
and my 41 years of private practice, and my
experience both as a practicing podiatrist who
prescribes and also often makes many of his own
orthotics "in house" and also I was hands-on in the
orthotic manufacturing industry business back in
the 1980s as a co-founder and co-owner of a local
orthotic lab where at its peak we were
manufacturing about 100 orders daily. I honestly
think I personally applied more rearfoot acrylic
posts than any one podiatrist in the country, but I
could be wrong.

It is always frustrating when I see any patient
that has poorly prescribed or poorly manufactured
"custom prescription foot orthotics" irrespective
of the profession who prescribed and the method of
capturing the image of the feet. These patients
have been cheated in so many ways. Often, the use
of such orthotics can lead to the need for
foot surgery, that might have been avoided had a
proper orthotic been prescribed and manufactured
first time around. There can be many reasons those
patients received foot orthotics where the heel
cups are too shallow, the rearfoot posting is too
short or under prescribed, or too soft to do
anything at the heel contact phase of gait, and or
the medial or lateral arch contours are poor, or
what I see most often is an improper or under
balance of forefoot deformities.

Even more disturbing is when I see what appears to
be two identical mirror imaged orthotics (exactly
equal left and right) for feet that are visibly and
measurably asymmetric in structure, shape and size.
Orthotic labs have the responsibility to accurately
fill prescriptions that doctors send in, but they
also do not want to get orthotics returned for
adjustments or modifications. Some labs do not
trust their doctors know what they are doing but
some doctors simply do not know what they are
doing, or how to evaluate the finished product that
they receive back from the lab. We used to always
get our casts back. How many out there ever see the
cast when the orthotics are received?

It has always been my belief that left and right
foot casts or impressions for one patient should be
sent to the lab individually, not two at a time, so
that the labs would not be able to equalize the
left orthotic to the right foot orthotic for those
reasons stated.

When I see patients who already have orthotics made
elsewhere, I check the orthotics the same as if I
made or prescribed them myself. I check them
against their feet, I check them in their shoes,
and I check them standing and walking. If they are
proper, functioning and in good shape, I tell the
patient. If they are not, I explain why to the
patient and the issues, and make them new orthotics
a huge percentage of the time. Sometimes simple
posting modification, which can be done fairly
quickly in my office can improve existing
orthotics.

Properly prescribed and well-made foot orthotics
can be life improving for our patients. We all see
this daily in our offices and clinics. Improving
foot function can lead to elimination of foot pain,
improvement or resolution of joint pains in areas
like the feet, ankles, knees, hips and also help
with postural symptoms including low back and neck
pain. The resolution of pain that occurs with good
foot orthotics can often lead to a return to normal
activities of daily living, return to sports and
exercise activities, work and occupational
activities and can make such a huge improvement in
the lives of our patients that they go nowhere or
do nothing without their orthotics in their shoes.

Keith L. Gurnick, DPM, Los Angeles, CA

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