01/14/2026    Robert Kornfeld, DPM

The Quest for Non-Covered Services

Many podiatrists are working hard to find as many
non-covered services as possible to add into their
practice to improve income over the abysmal
insurance payments. And I completely understand
that. Surviving on what insurance is willing to
pay is a huge challenge. To that end, we have
lasers, shockwave, regenerative medicine injection
procedures, peptides and supplements to name a few
that have become very popular as an adjunct to
covered services. And there is no doubt all of
these modalities can be extremely helpful when
used on the right patient at the right time.

The trap many are falling into is recommending
these treatments without fully understanding the
mechanism of action. Again, I have no problem with
improving your practice’s bottom line. This is how
we make a living and we all have a right to make a
really good one. But we have an obligation to our
patients to recommend treatments in a prudent way.

What we all know is that these treatments and
protocols are designed to stimulate innate healing
pathways. In order to see clinical improvement, we
need a responsive immune system since it is the
immune system that governs repair pathways. When
we apply these treatments to patients with a
burdened immune system (not only specifically
immunocompromised, but burdened by refined carbs,
poor eating habits, alcohol, poor sleep, lack of
hydration, chronic stress, food sensitivities,
oxidative stress, chronic nsaid use, SNPs,
medications, comorbidities, etc.) outcomes are
unpredictable and often fail. Or they work, but
only for a short period of time.

And what we wind up believing is that these
treatments are not reliable or they don't work.
That could not be further from the truth. All of
these treatments represent tremendous progress in
how we can heal our patients. But WHO we are using
it on and WHEN is left out of the equation and the
meta-analysis statistics.

Being a great surgeon is wonderful. But in the
same way, operating on someone who does not have
efficient reparative capabilities can lead to
post-surgical sequelae. Since 1987, I began my
shift to a holistic/functional medicine paradigm.
It was not long before I saw the amazing power in
finding underlying mechanisms of pathology and
addressing them prior to treating the presenting
pathology. I have worked with many brilliant MDs
and DOs through the past 38+ years and I have
greatly benefitted, as have my patients and I
continue to learn so much from them.

Functional medicine is likely now the fastest
growing sub-specialty in medicine. That paradigm
includes lifestyle medicine and patient
optimization and naturally feeds into the
utilization of regenerative medicine therapies.
When you “optimize” your patient, meaning you have
lifted as many underlying causes/burdens as you
can, the use of all of these progressive and smart
therapies lead to far better and more reliable
outcomes.

I strongly believe in order to move podiatry into
the 21st century, a functional medicine education
is a must. If we are to survive as a profession,
we need to treat PATIENTS, who happen to have a
foot problem, and not just attack the foot problem
with little regard for why that patient crossed
the morbidity threshold.

I invite dialogue on this subject. It’s a really
important conversation for this profession to
participate in.

Robert Kornfeld, DPM, New York, NY

There are no more messages in this thread.