So, you’ve made a great orthotic for your patient, now what? Having a system in place for maintaining a thriving orthotic practice is easy to do and can be very beneficial to your patient's welfare, your reputation as an expert in your field, as well as your bottom line.
The doctor or therapist and the staff should work as a team, with each team member having a defined role. Cross training staff members can always be beneficial in case of employee absence or just being a busy office.
Oftentimes orthotics are used in conjunction with other forms of treatment. Make sure during the visit for orthotic dispense, adequate time has been reserved. Sometimes it is preferable to have a dedicated appointment just for orthotic dispense. Review the orthotic prescription to determine if the orthotic was manufactured correctly, the orthotic conforms to the patient accurately, and fits in the patient's shoes. (Make sure the patient is told ahead of time to bring their shoes!) Allow and instruct the patient in placing the orthotics into the shoes, adjust if necessary. Have the patient walk briefly with their new orthotics, advise them they may not be totally comfortable in the beginning. Address any questions or concerns at this time. Go over break in procedures, advise that the benefit of the orthotics may not be apparent instantly.
Generally, a two week follow up appointment is advisable. Once again, remind the patient to bring their orthotics and shoes. Repeat all the procedures of the previous appointment. Adjust the orthotics if you or the patient are not completely satisfied with the performance of the devices. Advise patients that oftentimes second pair orthotics are recommended for different purposes. Review ongoing care and maintenance of the orthotic devices.
Annual or semi-annual evaluations of the orthotics should be scheduled whether the patient is symptomatic or asymptomatic. Check for excessive wear and tear. Monitor outgrowth in children. Evaluation and management of the orthotics, and the underlying diagnosis, is reasonable and customary, and should be reimbursable.
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Someone asked how I check to make sure the orthotic was made correctly. That's a great question! Understanding that the process of orthotic treatment plan can be complicated and errors by both the doctor and the lab are fairly common. During the dispense visit, in addition to what is stated in the article, I like to make sure the orthotic fits properly within the patient's shoe, trim the extension if necessary, and check for width of the orthotic versus the shoe. I verify with the patient about their shoes and activities for which the orthotics are intended. With the patient seated, I put the patient's foot in neutral position, ankle at 90 degrees, if possible, I hold the orthotic against the plantar surface of the foot with my thumb under the distal medial aspect of the orthotic plate and put the 1st MTPJ through full range of motion. I like to see the foot and orthotic maintain conformity throughout the full ROM. I also check the heel cup conforms to the shape of the patient's heel pad.
The two week follow up appointment is the more important evaluation. Now the patient can offer credible feedback on the orthotics after having gotten used to them. I repeat all of the above, plus check for damage to the device, on how the orthotic is leaving an imprint within the shoe and how the foot is leaving an imprint on the orthotic. I adjust if I see anything I don't like, or the patient has comments or complaints. I try to watch the patient walk when they are not self-conscience. I remind the patient that we are still in the process of treating their condition and further evaluations and corrections may be warranted.
Like everything else in medical practice successful orthotic therapy is based on both art and science. Having an awareness of when "something doesn't seem right" and then acting upon the problem until is right is what makes for consistent positive outcomes.
Interesting question! I believe that the next step should be increased collaboration between researchers and doctors to ensure that new treatments are introduced as soon as possible. It is also important to consider patient needs and quality of life when making decisions about new protocols.
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