Three orthotic company experts advise on how best to increase profits and educate patients by offering orthotics in your practice

In the profession, it is understood that chiropractic and the feet have a fairly intimate relationship when it comes to musculoskeletal health. Malfunctions happening at a person’s feet fire a chain of negative reactions to the spine, which in turn may impinge on the well-being of the entire body.

But try explaining this to a patient when all they want is a spinal adjustment. Terms like oversupination or overpronation are not likely to take their minds off their back pain—even though it might be related to the feet.

Yet a patient’s reluctance to listen to new health information is no reason to exclude orthotics from your practice. Instead, it could be sign that you are not using the best approach to sell your product. Chiropractors need to educate themselves fully on the subject of orthotics, the devices available, and the educational materials that can raise awareness in patients.

For the orthotics neophyte in all of us, Chiropractic Products invited three experts from the field to discuss the best way to incorporate orthotics into your practice.

Kent S. Greenawalt is president and CEO of Foot Levelers Inc located in Roanoke, Va. He is also publisher of Success Express, a 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 nonchiropractor.

John J. Kasik, MS, ATC, CPed, is national accounts manager for Foot Management Inc, Pittsville, Md. He has 22 years of athletic training experience in the National Football League, having worked with the Baltimore Colts, Seattle Seahawks, and then as head trainer for the Carolina Panthers for 8 years. Kasik is a certified pedorthist and has conducted orthotic workshops for numerous health care providers throughout the country.

Bruce Marrison is senior vice president of The Orthotic Group, based in Markham, Ontario, Canada. Marrison has been working in the orthotic industry for more than 10 years. He has degrees in kinesiology and business administration, and lectures on the business and marketing of orthotics all over the world.

What are the three most common mistakes DCs make when offering ortho-tics/biomechanics products?

Greenawalt: From my experience, I would say that chiropractors forget to examine the feet and lower extremities before orthotics are ordered. There are three easy ways to conduct this exam: 1) visually (looking for foot flare, bowed Achilles tendons, low medial arches, internal knee rotation, or excessive shoe wear); 2) measurement based (checking for navicular drop); and 3) condition based. Secondly, DCs forget to instruct their patients in the necessary break-in techniques for supportive products. And finally, they don’t remember to help patients properly fit the new orthotics into their shoes by removing any factory inserts or trimming the orthotics as needed.

Marrison: 1) Not having enough information about the different types of orthotics and assessment techniques available. Chiropractic college courses provide an excellent starting point, but a practitioner can only learn about advances in the field and the choices available to their patients by attending seminars and speaking to a variety of orthotic laboratories.

2) Excluding a foot examination as part of their initial assessment and not including this information on their assessment forms. If a DC does not look for abnormal foot function from the start, they may miss this as a part of the treatment plan. Clients with the most successful orthotic therapy have added a foot examination and gait analysis to every initial assessment and to each assessment form.

3) Not taking advantage of the marketing materials and experience available from their orthotics laboratory. Posters, sample feet, patient brochures, sample orthotics, and footwear can all help introduce and educate patients to the benefits of orthotic therapy. In addition, an experienced account manager can help DCs grow their practices.

What marketing strategies do you recommend for DCs offering these products?

Greenawalt: Many patients are unfamiliar with the importance of postural support when they first come to a chiropractic office. I recommend that every chiropractor utilize eye-catching, interactive displays in their waiting rooms. These displays should allow patients to physically examine orthotics and supportive footwear, as well as provide informative literature.

I would also recommend hanging educational posters in various areas of the clinic and having testimonials at hand from satisfied patients. Chiropractors and their staffs should also wear orthotics in their own shoes, and be ready to offer assurances from personal experience that such products genuinely help and feel comfortable.

Marrison: Display a variety of orthotic samples, brochures, posters, and footwear in their clinic. When a patient approaches a chiropractor about orthotics, it is much easier to move forward when the chiropractor has samples to demonstrate the treatment. Also, focus on the patient’s understanding of how the orthotics will help. When patients understand how it will help, they will comply with orthotic therapy much better.

How important is patient education? What literature, research, or tools do you recommend/offer?

Greenawalt: Patient education enhances patient satisfaction tenfold. Once patients know why, they’ll gladly comply. Knowing that postural support and musculoskeletal health starts at the feet allows them to take an active role in their health care decisions. I recommend professionally produced patient brochures, posters, educational videos and DVDs—anything that helps a chiropractor explain postural wellness concepts to his or her patients.

Kasik: Educating patients on their health care is one of the most important aspects of treatment. Knowledge of the course of treatment lowers anxiety and anticipation. This is especially true in custom orthotics. Knowing what to expect from a custom orthotic helps the patient follow through with the break in period and maximizes compliance.

Education can also help patients understand the difference between a custom foot orthotic, from a qualified health care professional and a customized inlay from an arch support store. Your orthotic laboratory can supply an informative brochure for patients to read in the waiting room. Brochures aimed at the golf-enthusiast population is also helpful. This brochure uses research that shows increased club head velocity and longer drive distance with the use of custom orthotics. Of course, this is more than likely based on the increased proprioception by the subjects from the orthotic.

Marrison: Patient education is extremely important. We recommend that chiropractors work closely with their orthotic laboratory to ensure they learn how to communicate clear and realistic outcomes of orthotic intervention. We offer our clients patient brochures, sample orthotics, sample footwear, foot models, posters, access to our library of research papers (monitored by our PhD in biomechanics and a DC), and computerized gait analysis software and hardware.

Do you recommend seminars/CE courses before offering orthotics/biomechanic products? What topics?

Greenawalt: Absolutely. Continuing education courses and license-renewal seminars are invaluable educational tools. Fortunately, the chiropractic profession has the opportunity to attend biomechanics-related programs throughout the year, at locations within easy reach. I recommend such topics as extremity adjusting, structural management, spinal and extremity analysis, and care for special populations.

Kasik: There are numerous workshops and seminars for health care professionals to gain a basic understanding of biomechanical assessment, common ailments, and subsequent orthotic intervention. Many do not get extended instruction in foot orthotics while in school. Access to hands-on workshops in slipper casting, foam impressioning, and digital scanning boosts confidence when dealing with patients.

Marrison: Seminars and continuing education courses are highly recommended. From a seminar perspective, courses in foot and lower limb biomechanics and orthotic therapy are most helpful. We also strongly recommend that chiropractors partner with a laboratory that has account managers with a biomechanics or orthotics background.

What should DCs expect from their companies in terms of customer service?

Greenawalt: I would say this to any chiropractor: Look for companies that understand and value the unique services you provide to your community. A company that is based in the philosophy and practice of chiropractic care, that knows what you are trying to achieve for your patients, that provides prompt and courteous service, and will do whatever it takes to make you and your patients happy—that’s the kind of company you’ll have the most satisfaction with.

Kasik: From the chiropractor’s perspective, customer service is second only to the quality of the product. If an orthotic lab isn’t taking care of its customers, then the customers will find another lab to fabricate their orthotics. At our company, we not only offer a full line of products, we also offer a line of off-the-shelf products and other foot-related supplies. All of our products are reasonably priced and come with the highest customer service standards in the industry. Our standard is 5 to 7 working days in the lab with rush service available for a nominal fee. We also have orthotic technicians available during business hours to answer any question about our products and services.

Marrison: DCs should expect technical support by phone, an account manager that is readily available, and a customer service liaison that is live and able to advise orders. Beyond that you will see more and more companies offering online tracking of orders and other Web-based services that link with CRM (customer relationship management) and ERP (enterprise resource planning) software.

What products are the most popular and why?

Greenawalt: Most patients look for products that are comfortable, easy to care for, and offer extended guarantees of effectiveness and durability. Full-length orthotics that provide support throughout the entire gait cycle are in big demand, especially among patients who are used to leading very active lives. Women patients appreciate styles that accommodate to their fashion shoes.

Kasik: There are essentially two styles of orthotics available in the marketplace: rigid and semirigid foot orthotics. Two of the most popular devices used at our company when a rigid orthotic is indicated is a rigid thermoplastic device that has an extrinsic rear foot posting. This posting helps to control the calcaneus while in weight bearing. Normally this device is made to the met-heads but can also be made full length. Our graphite orthotic is very rigid in its control, but is lightweight and thin to allow it to be used in most dress or street shoes where there is little room for an orthotic. It can be made with or without an extrinsic rear foot post.

We also manufacture semirigid custom foot orthotics. These devices are milled from solid blocks to create full contact custom orthotic appliances that work throughout the gait cycle. After working with professional athletes and the health care providers in all of the major sports for 18 years, we have found that our semirigid orthotic allows the foot to be a mobile adapter and therefore much more accepted by the patients. They’re perfect for all weight-bearing activity, allowing for shock absorption and biomechanical control.

Marrison: When patients order one pair of orthotics they need something that is corrective and thin enough to be moved from shoe to shoe. Thermoplastics are the most common material used because they are thin and strong. Thermoplastics have largely replaced orthotics made in leather, foam, and cork. They simply work better and take up less space. They are available as thin as 1 mm and as thick as 5-mm-plus. Thermoplastics offer a choice of flexible, semiflexible, and rigid correction.

What technological advances do you see for the future?

Greenawalt: I see orthotics and supportive footwear becoming more involved in safety issues as time goes on, especially as safety relates to a patient’s on-the-job health and protection. Industrial workers deserve to work in safe conditions, and orthotics will soon play a much larger safety role than ever before.

Kasik: The gold standard for custom orthotic fabrication has always started with the plaster slipper cast of the subtalar neutral foot. Though very effective in capturing the model of the foot, it is also very time consuming, messy, and takes a great deal of practice. We’ve been utilizing a digital laser foot scanner in addition to slipper casts and foam impression trays to manufacture custom orthotics. This saves time with the patient, in shipping to the lab, and in expediting the orthotics back to the doctor. After an initial investment it also saves money by alleviating shipping charges, material costs, and time spent casting. Digital non–weight-bearing foot scanning is the wave of the future.

Marrison: There is no question that computerized gait analysis is making huge inroads in foot care. It is a diagnostic tool that can help quantify the amount of pronation so DCs do not have to rely only on qualified eyeball findings. Easy to understand quantified findings help chiropractors determine the degree of abnormal foot function and communicate the findings with the laboratory. From a patient education standpoint, the DC is armed with a patient education tool to help communicate the need for orthotics with the patient.

Any last words of advice?

Greenawalt: Our bodies weren’t designed to stand or walk on concrete, steel, or other hard surfaces, but that’s how most of us spend our days. Your patients deserve the support, protection, and comfort that custom-made, stabilizing orthotics provide.

Kasik: As in most things, you get what you pay for. And sometimes you pay too much for lesser quality. When it comes to your patient’s health care needs, don’t settle for anything but the best. When you use an accredited lab for your custom orthotics, you’re getting a quality product with years of experience in the field.

Marrison: Raise the bar when it comes to orthotic knowledge in your clinic. Learn more about the feet and orthotics. The feet are the base of the kinetic chain. With an aging and active population, Chiropractors can estimate an increase in the patients they see with symptoms that can be helped with orthotic therapy. Make sure you are partnered with an orthotic company that can help you learn and grow your practice. Educate yourself on the computerized gait analysis software on the market. Learn about your choices.

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