03/18/2026    Gregory T. Amarantos, DPM

Who casts for orthotics? (Greg Caringi, DPM)

Dr. Caringi asks a simple question with a
multitude of answers and/or reasons. I too
graduated in the early 1980s (1982) from Scholl
College and had excellent instructors teaching me
biomechanics. What happened?

3-year residencies focused on surgery. There is a
certain panache when called a “surgeon” and we all
have egos. Schools changed their marketing
strategies focusing on surgery Follow the money,
as always. In the ‘80s and into the ‘90s surgery
was fairly well reimbursed. Colleagues became lazy
and had/have the medical assistant cast/scan and
use Biofoam (what a joke) to build orthotics.
Orthotics are not covered by insurance

The surgical portion of my practice was never more
than 15% of my revenue. I loved the biomechanical
aspect of my practice and it provided me with an
above average quality of life, while in practice
and in retirement. I never cared if orthotics were
covered by insurance. I was providing a value to
the patient and the patient perceived the value
and was willing to pay for the value/professional
service provided.

It is incumbent on the schools to return to the
basics and teach biomechanics. I performed a
biomechanical exam on all patients for whom I
provided orthotics and held the foot in the
corrected position while casting or scanning. It
took more time, but paid dividends over and over
again for 41 years.

How about the schools teacher a class in practical
podiatry 101? A simple curriculum…focus on
surgery, become beholden to 90-day global period,
worry about malpractice for the following 2 years,
get to the hospital/surgery center at 7:00 a.m for
a 7:30 case, get paid $600-$700 for a
bunionectomy (for a decreasing reimbursement year
after year), spend time after the case
documenting, get after hour phone calls and get to
the office for a 9:00 patient.

The alternative…learn biomechanics, educate your
patients as to the value of orthotics, get to the
office at 8:45 (you need time for coffee and to
greet your team). See your patient at 9:00,
cast/scan for orthotics and walk out of the room
10 minutes later. Orthotic charge is approximately
$500/pair, minimal, comprehensive documentation,
no malpractice worries, no 90 day global, you
determine the fee for your services, no emergency
phone calls on the weekends.

I am forever grateful to my instructors in school
and my residency directors who educated me to
provide comprehensive care to my patients.

Gregory T. Amarantos, DPM, retired, Lake Forest,
IL

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