04/13/2026 Paul Kesselman, DPM
When Did Buying Arch Supports Become a Medical Visit? (Jeffrey Klirsfeld, DPM)
Over the past week(s) there have been many posts
addressing this issue, all of which have focused
on retailers allegedly providing diagnostic
services to consumers without a medical license.
In my humble opinion if an untrained individual
tells a consumer/patient that they have a specific
issue and then they treat it with something they
provide, that is both diagnosing problem and
treating it. It doesn't matter whether they
dispense a cream or an arch support. But that is
my opinion and not necessarily fact.
But as you will see from my explanation (from a
non-attorney's perspective) is that the state
statutes addressing this may or may not agree with
those sentiments.
Solely from the DME perspective from which I can
offer expert advice, custom fabricated orthotics,
in some states require a licensure to provide.
Unfortunately this is where things start to become
both murky and confusing as to what agency
in each state should be addressing legal action,
if any against the retailers. Is it the state
board of podiatry, medicine, O/P, etc or is
it the Dept of Consumer Affairs, Dept of Health,
etc.? It may depend on the state and the alleged
infractions.
In most if not all states, retail store can sell a
wide array of pre-fabricated orthotics without any
issues or conflicts with state law. So one
question to raise here is the retailer selling OTS
devices only after they have scanned and offered a
diagnosis to the patient? If they are, then
perhaps despite our chagrin, the state law may not
preclude them from selling a prefabricate device.
But does the state stature preclude them from
scanning? From diagnosing? Those are another
complex matters which may differ by state.
If the retailers are selling pre-fabricated
orthotics but telling their customers that the
devices they are selling are custom, then perhaps
they are defrauding their customers, yet another
legal infraction. And if state law only allows
licensed professionals to provide custom
fabricated orthotics, yet another potential
infraction of state law.
I may be out of touch with current usual and
customary fees, but I don't know of any
podiatrists, orthotists or pedorthists who are
being direct reimbursed $1500 for a single pair of
"custom orthotics" and if that is 150%or 200% more
than normal or even more, than perhaps
it becomes an issue for each state's dept of
consumer affairs. If the retailer is in fact
dispensing OTS devices at those prices, well for
sure that is price gouging and again something for
another state agency to deal with.
Using my home state as an example, New York where
there is no legal requirement for custom orthotics
to be furnished by a licensed provider, the
regulatory issue is quite different then in New
Jersey, Florida, Texas or PA (and about 19 states)
where there is a licensure requirement to provide
custom orthotics.
Podiatrists, licensed orthotists and pedorthists
in those states where licensure requirements are
in place, should be demanding that any retailer
where custom orthotics are being provided, prove
that licensed individuals are in fact on the
premises and dispensing custom orthotics.
And if those who are orthotists or pedorthists are
not basing the provision on a prescription from a
provider licensed to diagnose and treat patients,
that too becomes an issue. The orthotists and
pedorthists in those states know that state law
requires an order (prescription) in order to
provide custom fabricated orthotics. Can you
imagine a pharmacist providing prescriptive
medications without a prescription? I think not.
This becomes both a question of whether or not the
retailer has employed someone who can diagnose (I
think not), treat (again NO) and provide a custom
orthotic (questionable depending on the state). I
hesitate to simply single out the Good Feet Store
(GFS), but they be the most glaring example.
One well reputed pedorthic facility I know not too
far from my home, has a GFS location within eye
shot of their facility. While they may be
reluctant to get involved on a personal level,
they also tell me that many disgruntled patients
from the GFS often end up in their facility, where
they charge much less for custom orthotics than
GFS. And again because NYS is like the majority of
states, no prescription is required. Hence here
the question then is if the pedorthist is proving
a custom orthotic in NYS are they thus providing
medical treatment without a license? Apparently
the law says no.
As for the pricing, if GFS (and others) are truly
not making custom fabricated orthotics but
charging those $1500+ amounts, that should be
sending off all kinds of alarm bells in every
state's consumer affairs division.
APMA should be assisting in this matter, but this
is far more of a state by state issue and hence
APMA should not be singled out for little or no
action on this.
The other issue is that other than in this column,
there is not much noise from my colleagues about
this. In fact, there are only a few pedorthists
and orthotists with whom I am acquainted with, who
are speaking up on this issue.
In my opinion, there needs to be a ground swell of
voices complaining to a myriad of state agencies
by the various State Boards of Podiatry, State
Boards of Medicine, State Board of Pedorthists and
Orthotists to address these issues:
1) Practicing medicine, orthotics or pedorthics
without a license
2) Advertising custom fabricated orthotics but
dispensing pre-fabricated orthotics
3) Charging excessive fees which gouge the
consumer
Until that happens, and to my chagrin, nothing
will change on this matter.
Paul Kesselman, DPM, Oceanside, NY
