For a growing number of chiropractors, custom-made orthotics are becoming an important part of their treatment arsenal. Orthotics come in various shapes, sizes, and materials—all designed to help correct a patient's overall alignment while still allowing them to live their lives to the fullest.

In many cases, poor posture—which leads to the need for adjustment—begins with the feet. "I typically stand in front of patients and overpronate my foot—push in and then flatten it out—showing them how the knee is dropping in and the hip is dropping and rotating, and explaining how this affects the spine," says David H. Mruz, DC. "The patients see, in real terms, the problem. If you only look at the spine—and not the feet—the lack of orthotic support will start to undo their adjustment as soon as they walk out of the office."

In the last 3 years, Mruz has built a substantial niche business by prescribing orthotics to his patients. He has found the most success with Foot Levelers' products.

Mruz says about 85% of his patients demonstrate a need for orthotics. "[The need for orthotics] is much more common than you may think," he says. Many times, the patients do not even realize they are having challenges with their feet. They have no obvious pain or deficit in their gait—and this may be part of the cause of their spinal complaint or be the prelude to another problem that may develop in the future.

For Mruz's patients, the most typical overt conditions that cause the need for orthotics include: dropped arches, plantar fasciitis, and heel spurs.

Foot Levelers' Spinal Pelvic Stabilizers allow Mruz to correct the problem in a way that fits the patient's lifestyle. The company's different product lines include those designed for workplace environments, for everyday wear, for a diabetic foot, or those that will help competitive athletes. The choice of a particular orthotic is a function of a number of parameters—all of which Mruz evaluates during the patient's initial visit.

Evaluation

David H. Mruz, DC, left, introduces the idea of orthotics to the patient as part of the first visit.

Before Mruz determines whether a patient even needs an orthotic, he will consider his or her chief complaint first. "I look at all the variables concerning their condition, then determine if they need an orthotic," he says.

Mruz introduces the idea of orthotics to the patient as part of the first visit. "I educate them about the need for support," he says. "I get people thinking about orthotics—by illustrating what normal feet look like while in a weight-bearing position."

To that end, Foot Levelers supplies a series of laminated flash cards with normal and abnormal foot scans on them. This makes his presentation more powerful and meaningful to the patients. "The illustrations are hugely important," Mruz says.

He scans the patient's feet with Foot Levelers' Associate™ digital scanner after he performs the initial examination. And if the patient needs orthotics, getting them to agree to purchase them "is the easiest part of my job," Mruz says.

Mruz shares the scan, which is a computerized, graphic image of their feet, with the patient. And, in an echo of the Foot Levelers flash cards, using the Associate software, he places the patient's scan next to a normal one. It usually drives the point home, and a sale is made.

Mruz's Greenville, SC-based practice, Eastside Chiropractic, PA, currently has four scanners—two from Foot Levelers and two built into the Pro-Adjustor chairs he owns. Foot Levelers also supplies orthotics specific to the Pro-Adjustor customers.

The easy part of Mruz's job is educating patients about the need for orthotics. The orthotic selection process is a bit more involved because there are a number of factors to consider when choosing the best orthotic for each patient.

Prescription

Foot Levelers' orthotics are custom made for the patient. Each of its product lines reflects the lifestyle needs of the patient. All of the patient parameters—shoe size, foot width, overall height and weight, and lifestyle—are sent electronically from Mruz's digital scanner to the Foot Levelers laboratory in Virginia.

The most important criteria are the patient's physiology and activity, Mruz says. "There's a huge palette in the Foot Levelers product line—and I have to determine what the patient's lifestyle is like in order to prescribe the right one for them," he says.

For instance, a woman in her late 70s who is not very active—apart from attending church or going to the grocery store—is not looking for a high-performance orthotic. Instead, she will want something that stresses comfort while still providing support, Mruz says.

On the other hand, a factory worker will want something that allows him to be on his feet all day. In that case, Mruz will prescribe the WorkWear™ for Industry orthotic. The WorkWear product line also features specialized orthotics for health care professionals and those in the hospitality industry.

And it is not just those involved in everyday activities of living that Mruz counts among his patients. "I do a lot of work with cyclists—that's my sport niche," he says. "In cycling, there is no need for a shock-absorbing orthotic. Cyclists wear a very rigid shoe, which in essence becomes an extension of the pedal. So for them I prescribe the Profile® orthotic—it's super slim and fits easily in those shoes."

Many of his patients are professional women who insist on wearing high-heel shoes as their day-to-day footwear. "In women's dress shoes, full-length orthotics won't fit properly," he says. For these women, he prescribes the 5th Avenue™ Luxury and Lady Luxury orthotics. These fit 7/8 and 3/4 of the patient's shoe, respectively, and are held in place by Velcro dots.

Though every patient has different needs, Mruz says that for the majority of his orthotic patients, he prescribes the UltraStep® XC, which, according to Foot Levelers' Web site, is the company's most popular product. The UltraStep XC features the company's Gait Cycle System®. "It has Propacel™ in the forefoot," Mruz says. "And on the heel area contains Zorbacel®, which is an excellent shock absorber and gives good energy return. The UltraStep XC does a lot of things and works well for most patients." The UltraStep XC also features StanceGuard™, which gives full weight-bearing support during mid-stance. In addition, the top has a layer of TechCel™ for step-by-step comfort.

In some cases, a single orthotic will not be the answer for a patient, particularly if he has a very active lifestyle. In that case, Mruz will prescribe multiple orthotics to fit each aspect of their life. So a factory worker who is also a competitive cyclist may be prescribed the Profile and the WorkWear for Industry at the same time.

Perhaps the biggest challenge that Mruz sometimes faces is getting patients past the cost of the orthotic.

Since 2006, Mruz has been averaging a total of 30 pairs of orthotics sold per month.

Budget Plan

Mruz says that he confronts the costs of the orthotics up front. "I'm very comfortable talking about money with my patients," he says.

Mruz does not allow reimbursement to factor into his recommendation for orthotics. He treats the orthotic purely as a cash transaction. No matter the wholesale cost of the orthotic, Mruz marks the price up $100 for the retail sale.

He explains to his patient that the orthotic is a valuable investment for his/her health and that custom orthotics can last for years with proper care. He also notes that the orthotic can be moved from shoe to shoe.

To help alleviate the financial impact of their treatment (both the orthotic and the chiropractic treatment), Mruz has implemented a budget plan. This involves the patient and Mruz' office determining a monthly fee that the patient can afford within his family budget before he begins care. The patient then provides a credit card number to the office, and that card will be charged that fee—usually about $200 per month—until the patient has paid off his account in full. This arrangement allows Eastside Chiropractic to collect the full fee for service, remain compliant, and yet maintain affordability for the patient.

The budget plan is designed strictly as a convenience and a means to increase patient compliance. There is no interest charged and no carrying fee. It has been a successful courtesy that Mruz has extended. "The patient knows the monthly expense, and that remains fixed," he says.

Though orthotics are an integral part of Mruz's practice, this was not always the case.

Seeing the Light

Mruz says that the "tipping point" that convinced him to make orthotics an integral part of his practice occurred in 2005. He was attending a state chiropractic convention and heard a Foot Levelers presentation about the importance of orthotic stabilization.

Mruz says that the speaker was soft-spoken, which he saw as a match to his own personal style. The message—that orthotics were a good patient-management tool as well as an additional source of revenue for a practice—came at the right time. Mruz was in the process of bringing an associate on board, and he realized that using orthotics as adjunct to his care could offset the cost of adding the new chiropractor.

To learn how to market orthotics to women, see "Gender Specific" in our July 2007 issue.

Before jumping in, Mruz asked Foot Levelers to give him his yearly numbers. In 2004, he sold just four pairs of orthotics. In 2005, that number increased substantially—to 15 pairs. "I wasn't lighting the world on fire," he admits.

But that has changed. Since 2006, he has been averaging 30 pairs per month. In addition to scanning all of his new patients—a practice that continues to this day—Mruz evaluated all of his existing patients as well. "It became a big part of the patient's [evaluation]," he says. "It became a big part of the way we do business."

Financial Sense

High patient satisfaction has helped to generate many new patients through referrals. Making orthotics a fundamental part of the practice has benefited his patients and business as a whole.

C.A. Wolski is a contributing writer for Chiropractic Products. For more information, contact .