In looking at the application of additional products or services to your practice, it is important to consider both the positive effects on the health of your patients and the financial feasibility of implementing the additional service.Does the new product or service improve the whole-body health of your patients? Does the new product or service provide proper compensation for the clinic's time and effort?
If the answer to both questions is yes, you should consider how best to implement the new service or product into your practice.
Where Orthotics Fit In
Custom-made orthotics are an excellent example of a product that improves the whole-body health of your patients, can easily be implemented in your practice, can provide an additional source of revenue for your practice, and can also compensate or the time and effort the clinic (you) put into evaluating and recommending orthotics.
Determining Need Through Evaluation
The first step in the process is determining how best to evaluate a patient's need for orthotics. We can then review how to demonstrate the need for custom-made orthotics to the patient to increase the likelihood of the patient following your recommendations. Finally, you can assess how adding custom-made orthotics can positively affect the bottom line of your practice.
By far the easiest tool for evaluation of the feet is a digital scanner. As I often tell my patients, this is a way for us to see what the bottoms of our feet look like while weight-bearing, something that we cannot normally see. A digital scan also provides us with an image whereby imbalances can be easily visualized by both doctor and patient.
If digital scanning has not yet become part of your practice, there are additional methods for quickly determining a patient's need for stabilizing the feet with custom-made orthotics. A basic physical evaluation of the patient's feet (including observation of the gait) can be done quickly and effectively to determine if there are signs that orthotics should be included in the patient's care plan.
Start out by observing the patient for foot flare. This can be done even before the patient has entered the examination or treatment room, and provides an effective pre-check.
Observe the patient's feet as they walk and what is going on with their gait. Ideally, the toes should be pointed straight forward while walking. Also note what is happening during the swing phase of the gait cycle. If the patient's toes point laterally and not forward during the swing phase, then further evaluation is necessary. Keep in mind that while indicating the potential need for orthotics, there also is the possibility of a hip and/or knee condition that might be causing lateral flare of the foot.
Classic Wear Patterns
At the beginning of the physical evaluation, ask the patient to remove their shoes. This serves two purposes: We need the shoes off to evaluate the feet and also to evaluate the shoes. Flip the patients' shoes upside down in your hands and check the wear pattern in the heels. A balanced gait should yield a heel wear pattern that is fairly well-centered.
If the wear pattern significantly favors either the medial or lateral side, we will have an indication of imbalance during gait. It's also advisable to check the heel counter of the shoes, as an asymmetrical breakdown of the heel counter's firmness is another sign of imbalance.
Evaluate The Feet
Once the shoes have been checked, we can evaluate the feet themselves. Have the patient stand with their feet approximately 6 inches apart. Kneel down behind the patient and check for any bowing of the Achilles tendons, as this would be a sign of excessive arch drop.
Once you've checked the Achilles, evaluate the arches themselves. Try sliding one of your fingers under the foot at the highest point of the weight-bearing medial arch.
If the finger does not go under as far as the distal phalangeal joint, this is a sign that the arch has collapsed to some degree. Check the medial arches of both feet to determine if there is a difference in finger-under-arch depth, as this will indicate asymmetry between the left and right feet.
Keep in mind that the procedure listed above should take no more than one or two minutes to complete if it is done in a time-efficient sequence.
Keeping the evaluation both simple and effective will minimize the time impact of the evaluation while giving you the most significant information for making a good decision on whether the patient in question is in need of orthotics.