Get sound advice from our experts in offering orthotics in your secondary profit center

Feet are the foundation of a good posture and a healthy spine. Consider investing in orthotics for your practice. High or low arches, heel spurs, and basic wear-and-tear can all lead to problems for the feet. Constant misstep can eventually lead to problems with the spine. Encourage patients to step their way into a healthier body by taking care of their feet.

Here to help chiropractors with the details of a transition into orthotics are four professionals:

Kent S. Greenawalt is president and CEO of Foot Levelers Inc of Roanoke, Va. He is also editor of Success Express, a quarterly journal for the chiropractic profession. Greenawalt is the recipient of several awards from the Chiropractic profession, including the American Chiropractic Association’s (ACA) Humanitarian of the Year award, the highest honor the ACA can award to a non-chiropractor.

Kenneth W. Marich is the director of clinical development at Amfit Inc. His 30 years of experience includes medical research at the University of California and Stanford University medical schools. Marich holds MS and MBA degrees and has authored more than 60 scientific publications and two books.

Amy L. Palladino, DC, has a private chiropractic practice in Sarasota, Fla. She also holds her certification in pedorthics since 1995. She has been working with foot abnormalities and manufacturing custom foot orthotics for 13 years.

Linda A. Zender, C Ped, has been at Birkenstock for 18 years, currently serving as the Technical Research Manager organizing research studies and developing training and education seminars.

What are the most important features chiropractors should know about orthotics/biomechanics products?
Greenawalt: First and foremost, it is essential the patient be cast in a position of function (ie, weightbearing). Just as we take weightbearing x-rays, it is imperative to have a proper weight-bearing cast so deficiencies can be analyzed and corrected in the final orthotic. Because human gait is divided into three phases—heel strike, full plantar contact, and springing off with the big toe—the orthotic should be designed in a manner to absorb shock, stabilize, and help propel the patient forward.

Marich: Foot impressions must be carefully taken in a semiweightbearing position using either foam or a computerized contact scanner to maintain the corrected position established after manipulation/adjustment. Custom orthotics made of semi-rigid or rigid materials will provide the individualized support required for effective therapy.

Palladino: Know your product. You should know if the foot orthotic or biomechanical product is truly custom made for the patient. Many orthotic laboratories categorize foot types, meaning if two people wear the same shoe size they will have the same orthotic. A truly custom orthotic is specific to the person.

All orthotics or biomechanic products should have a break-in period. Patients should be notified that they may feel some aches and pains due to the use of different muscles. With foot orthotics, we are changing the foundation that the patient may have had for 20, 30, 40 years. With any device being fitted to patients, follow-up visits are needed to monitor the effectiveness, as well as to add or decrease support or make changes accordingly.

Zender: Over the counter (OTC) products can be a wonderful alternative for those in need of additional support in their footwear. Many consumers need to be shown that good arch support in their footwear can help them with aches and pains in other parts of their bodies, such as the knees, legs, hips, and back. It is an affordable way to help a patient seek some relief from their symptoms.

How can DCs incorporate orthotics into their practices?
Greenawalt: The cost to implement orthotics into a practice is minimal. Often, a simple starter kit is provided, which gives information for both doctors and patients as well as issue the orthotics. Casting/scanning is a very efficient process and can easily be done by trained chiropractic assistants. Space is minimal, and the cost/benefit ratio is huge. It is a very small cost for a huge effect on the patients’ health, postural stability, and practice income.

Marich: For foot casting, there is something called a foam impression box and an automated contact digitizer. Costs for this package can be about $13,000, depending on the company. Prescribing five pairs of custom orthotics per month will more than pay the lease costs for a digitizer. Foot casting and modifications with the contact digitizer can take only 5 to 10 minutes per patient and provides doctors with permanent digital files of the patients orthotic design for subsequent review or reorders.

Palladino: Sometimes the best thing to do is learn how to do a good evaluation and casting, and then send the casts out to a laboratory to be manufactured. A good evaluation and casting should take anywhere from half-hour to an hour, depending on experience and complexity of the individuals condition. When casting, a floor mat, a bucket, a goniometer, gloves, and a towel are the basic tools needed to cast.

Zender: Orthotics/prefabricated OTC arch supports do not take much room to store a decent inventory. Two to three styles in sizes to fit both men and women can be stored in 3 to 4 square feet. In about 1 hour, chiropractic assistants can be trained on how to fit the style doctors recommends. Doctors can learn the differences and benefits of several arch supports in about 1 hour or less. Margins are usually very good and can be a nice profit center for doctors—in addition to offering more ways to help the patient.

What services should DCs expect from their orthotics/biomechanics company?
Greenawalt: Having access to chiropractors and trained customer service experts to discuss difficult cases is mandatory. Often, an alleged problem in the field can be solved with a quick phone call to the laboratory where expert advice can be given. Customer support is paramount and something doctors should demand. Quick turnaround is also something to look for. Finally, make sure your satisfaction is 100% guaranteed before making any orthotic purchase.

Marich: Quality products and support from orthotics companies is key in developing a successful and profitable foot orthotics program. Companies should provide 1) training on foot casting techniques, 2) rapid fabrication turnaround time—less than 10 days, 3) low level of returns and remakes, less than 5% and 4) a price structure, less than $70 a pair.

Palladino: First and foremost, technical support is very important. Doctors should be able to contact the laboratory when they are unsure of what materials to use or when a complicated foot problem arises. A warranty, such as premature breakdown or wear and tear of the product, should be included.

Zender: Doctors should expect that the vendor will provide training tools and be available to answer questions as the need arises. Also, inventory should be easy to replenish as sales are made.

Are seminars/CE courses recommended before offering these products? What kinds of topics? Any hands-on training?
Greenawalt: Hands-on training is very helpful: How to evaluate the patient, as well as how to properly cast. These are very important, whether you pick that up from a colleague, a seminar, an instructional video, or a telephone call with the company’s doctors/customer service experts.

Marich: Doctors interested in incorporating orthotics in their practices should attend specialty seminars and workshops on foot anatomy/pathology, biomechanics, and foot adjustment. Hands-on training in casting techniques and software modifications is generally available from equipment manufacturers.

Palladino: I highly recommend taking a seminar before selling or fitting your patients for orthotics. Just as chiropractors feel proper education is needed to adjust the spine, we should give the same respect to other professions. There are several courses on evaluating and casting for foot orthotics. The biomechanics of the ankle and foot is also a recommended course. There is a certification course in pedorthics to further knowledge in this area.

Zender: Hands-on training is always better. Doctors can pick up most of what they need to know on how to fit an OTC arch support by reading and speaking with a representative from the vendor when an in-service cannot happen immediately.

What patient education tools should companies offer?
Greenawalt: Different doctors have different styles, so a wide variety of patient education tools should be offered. These tools can be anything (patient education video, booklets, or brochures) that helps doctors communicate with their patients.

Marich: Companies should provide doctors with educational materials such as patient-oriented booklets, videotapes, orthotic samples, and wall posters.

Palladino: At the very least a diagram or model of the foot is needed to help the patient understand the intricacies of their feet. Also, a video on the anatomy and/or biomechanics of the body. After all, treating the foot biomechanically has a direct effect on the spine and posture.

Zender: Brochures showing the available arch supports with features and benefits.

What other marketing techniques do you recommend for DCs to create a market niche?
Greenawalt: I have phenomenal results to report by doctors who use a patient evaluation and foot screening system. The patient can receive a personalized custom report that relates to them, helps explain why they need orthotics, and how they fit in with chiropractic.

Marich: The doctor needs to spread the word about his specialty in the community via lectures, noon presentations, free clinics in specialty stores and health clubs, direct mail to targeted audiences and other medical professionals. It is important to be known as the “foot specialist.” Lastly, write a patient newsletter that promotes all phases of your practice and shares success stories.

Palladino: Get involved with school athletics and promote a healthy spine and biomechanics. Do talks at local assisted living facilities. Promote alternative care for the healing of plantar fasciitis and heel spurs.

Zender: Have a display in the waiting and examining room with brochures the patients can read on their own. Explain the reasons for arch supports to your patients. Increasing patient knowledge is always a good first step.

What new technology do you wish to see in the future?
Greenawalt: I see orthotics of the future with computerized chips in them that can communicate an immense amount of data to both doctors and patients.

Marich: The future of custom orthotics will include increased use of computer-based CAD/CAM technology to enhance providing the best orthotic therapy. Automation will replace manual techniques, promising better products, and a higher level of patient satisfaction.

Palladino: Custom made shoes for everyone with supportive arches, heel wedging, and forefoot correction all built into the shoes.

Any last words of advice?
Greenawalt: Chiropractors are known for the love and service they provide to their patients. Even though a patient’s foot does not hurt, the foot can be responsible for causing subluxations and spinal instability. It is so important for doctors to take the time to look to the feet to see if there is a problem that can be eliminated so their adjustments can have more permanency and hold better. Usually this takes a few seconds to evaluate, but it is time well spent in the best interest of both the doctor and the patient.

Marich: Create a competitive advantage by using a computerized, high-technology scanner.

Palladino: Make sure you take the entire body into consideration when casting, evaluating, and fitting your patients for custom foot orthotics. Remember, the feet are the foundation!

Zender: Retail items, such as excellent OTC arch supports, can be a beneficial and profitable addition to a practice. CP

Julie Z. Lee is a contributing writer for Chiropractic Products.