10/31/2024    Paul Kesselman, DPM

Would you support a class action lawsuit against retail stores selling "custom orthotics" for practicing podiatric medicine without a license?

Each state has or does not have licensing laws
pertaining to the regulation of certain services.
Orthotics and Prosthetics are no different.
Providing custom fabricated, custom fitted or over
the counter orthotics are prime examples where
state regulations not only differ but often
completely clash.

One example, here in NY where just about
everything is highly regulated, one may scratch
their head when they find out that there are no
state licensing requirements for providing custom
orthotics or prosthetics. Which means anyone can
hang a shingle out and sell custom orthotics and
prosthetics. No formal schooling, training or
certification or license required, Across the
Hudson River, you cannot provide custom orthotics
or prosthetics without having either a license to
practice medicine (MD/DO/DPM/DDS) or have a
certification in orthotics or prosthetics. The
latter two require training in a formal program
and then licensing by the state and facility
accreditation by a formal certifying board.

There are many more examples. As a non-lawyer, I
suspect that any legal action limited against
providing orthotics and prosthetics without a
license would likely fail in NY, but could succeed
in NJ. Furthermore, in states like NJ and there
are about 18 others, the state licensing board
would shut these entities down. Unfortunately that
leaves approximately 30+ other states where the
laws are so lax that just about anyone can
dispense orthotics.

The issue of practicing podiatry of course is very
different. When I was in clinical practice just
about every week a patient or two would remark
about a nail salon creating a problem and asking
if they were possibly going beyond the limits of
the law. Some patients with paronychias were
wrongly treated, often resulting in osteomyelitis
of the digits. Reporting these to the state
authorities was no easy task, but nevertheless,
action was needed and our office had a templated
form which patients would complete and send off to
the appropriate authority.

Trimming someone's toenails without a license is
not against the law.Sadly to say providing
orthotics and prosthetics may not be either, at
least here in NY. Where does one draw the line
between orthotic prosthetic provider and
biomechanical expert unfortunately may be a bit
trickier.

No doubt what is needed are stronger laws
regulating the practice of O/P, and we should
applaud states like NJ (and the 18 or so others)
where there are more stringent laws in place.

Recently I reached out to the NYSPMA and asked
them to work with the NY O/P component to see if
stronger laws could be enacted. You would think
protecting the patient's welfare would be easy for
a politician to understand and swallow. Think
again!

Paul Kesselman, DPM, Oceanside, NY

Other messages in this thread:

---

10/25/2024    Irv Luftig, DPM

Would you support a class action lawsuit against retail stores selling "custom orthotics" for practicing podiatric medicine without a license? (Greg Caringi, DPM)

I graduated from OCPM in 1980 with Greg and
practiced near the Toronto area for over 40 years
until I retired in 2002. My practice was a
successful one with thousands of loyal patients,
standing out from almost all of the others within
a 50 mile radius using the same mantra as Greg's.
Proper biomechanical exam, non-weight-bearing
plaster casting of each and every orthotic patient
whether they were 8 years old or 80 years old. I
was lucky enough to have a 3 year residency,
surgically trained (with fellowship) podiatrist
come up from the U.S. to take over my practice
when I retired. He practiced in the U.S. for 5
years before coming up here to settle.

It took a full year of hammering away at the
importance of Biomechanics as an adjunct to all
his surgical training. It took awhile but it sunk
in. He had virtually no training in Biomechanics.
I was shocked but was relentless, teaching and
mentoring about the principles of gait analysis, a
thorough biomechanical exam, and CAST, CAST, CAST
.

The local GPs whose patients he sees are thrilled
with him taking care of their patients and
continue to refer. He also has many existing
patients referring their friends and family,
probably the most important marker of a great
practice. Plaster casting set him apart from all
the chiropractors, physiotherapists, foot clinics,
etc. who scan or even worse, have a patient step
in a foam box. His office schedule is jammed with
patients wanting to be cast for proper orthotics
after having been elsewhere.

Orthotics are not a legislated act in Ontario so
technically anyone can do it. However, because
there were are those of us who only did plaster
casting, that led to private insurers who cover
Orthotics to limit coverage to podiatrists like
us. The chiropractors, physiotherapists, etc. who
saw a quick buck in foam impression " orthotics"
were removed from coverage and those patients
quickly migrated. It's unfortunate to see what has
happened with young graduates in the U.S. , and I
have to agree with Greg that it may be too late to
save orthotics as being a service belonging to
podiatry down there. It's a shame.

Irv Luftig, DPM (retired), Toronto, Ontario

---

10/24/2024    Greg Caringi, DPM

Would you support a class action lawsuit against retail stores selling "custom orthotics" for practicing podiatric medicine without a license?

After closely following PM News for many years, I
know my commentary is not new and unfortunately
reflects the feelings of many podiatrists who are
now at/near retirement age. These thoughts have
been woven into many previous threads.

Many say that the early growth of podiatry was
because our profession filled patient needs not
being adequately addressed by other medical and
surgical specialties. When podiatry was still
struggling for recognition and parity, we were all
encouraged to learn and use those skills to make
us stand out as specialists who could offer
options that were not readily available from other
medical specialists, such as orthopedics and
dermatology.

As a student in the late '70s, biomechanics was
taught as a science and a skill which was unique
to podiatry. I felt like we were on the cutting
edge of a new technology. As part-time faculty at
PCPM/TUSPM in the early '80s, I worked in the
orthopedics department in the gait lab and taught
2nd year students how to perform a comprehensive
biomechanical exam, impression casting and the
actual fabrication of rigid and accommodative
orthotics.

When I retired about one year ago, I believe we
were the only office in our area still doing gait
analysis, taking measurements, using plaster for
impressions and having true prescription custom
molded orthotics made for our patients. Our
younger colleagues were using non-prescription
premolded/prefab orthotics exclusively or made
some smoke-and-mirrors claim that their orthotics
were custom although there was no evidence to
support this. Gradually, over a period of many
years, podiatry gave away this special and unique
skill to chiropractors, physical therapists, shoe
stores and now chains like The Good Feet Store. I
don't think Root biomechanics is copyrighted.

We had something special to offer our patients and
freely gave it away. Our younger colleagues are
not properly trained in biomechanics and have
little interest. When is the last time you
attended a seminar that offered a "biomechanics
track"? It may be too late to close the barn door
now that the horse has escaped.

Greg Caringi, DPM, North Wales, PA