Tread wisely when choosing orthotics

Angie’s List member Joan Kaylor of Canonsburg, Pa., needed a solution for her 80-year-old mother-in-law, who was unable to wear regular shoes due to a foot deformed by severe arthritis.

“She was wearing slippers because they were the only things that were comfortable,” Kaylor says. “She couldn’t go anywhere without shoes.”

Kaylor checked Angie’s List before turning to highly rated Union Orthotics & Prosthetics, near Pittsburgh. “They came out, took a mold of her foot and within 10 days we had new shoes,” she says, noting the $485 expense for the custom-made, soft orthotic wasn’t cheap but worth it. “It was just fabulous!”

What are orthotics?

Orthotics, worn in shoes to provide support and realignment for the feet, can help relieve pain for people of all ages who suffer from ailments such as plantar fasciitis, heel spurs, diabetes, arthritis and walking imbalances resulting from flat feet or high arches. The term “foot orthotic” refers to everything from prefabricated insoles available at your local drugstore for $50 or less to more expensive, custom-made devices that cost on average from $300 to $500.

A licensed podiatrist can prescribe orthotics and some will cast the custom mold. A pedorthist, certified by the American Board for Certification in Orthotics, Prosthetics & Pedorthics, specializes in fitting the footwear. Eight states require pedorthists to be licensed, and they need a prescription from a physician or other licensed provider to make custom orthotics, says Steve Fletcher, ABC’s director of clinical resources.

While most insurance plans cover a visit to the podiatrist, coverage for orthotics is variable, depending on an individual’s exact plan and state regulations. Insurance often covers inserts used for diabetic-related conditions.

“The upfront cost may seem expensive, but they last a minimum two to three years and in most cases much longer,” says Dr. Jim Christina, director of scientific affairs for the American Podiatric Medical Association. He says 80 to 85 percent of patients who use custom-fit orthotics get relief from their symptoms. “Foot pain is not normal,” Christina says.

Custom to each patient and condition

The process of making a custom orthotic typically begins with an assessment by a podiatrist or a pedorthist working from a prescription. Both might conduct a biomechanical exam, which may include hip measurements and a gait and leg rotation analysis. They make a cast impression of the foot using plaster or fiberglass, a foam box or a computerized scan.

The mold, along with the correct material needed to achieve desired flexibility, is sent to a lab. Once the orthotic is ready, patients return for a fitting to make any final adjustments. “We’ll have the patients come back after they wear them for couple of weeks to make sure everything is all right,” says highly rated podiatrist Dr. James Koon of Cypress Podiatry Associates in Winter Haven, Fla.

Angie’s List member Arthur Smith of Beaverton, Ore., says he’s one of the 15 to 20 percent of patients who didn’t fi nd relief with custom orthotics. After experiencing pain from plantar fasciitis, a common cause of heel pain in which ligaments in the foot become infl amed or torn, Smith purchased custom orthotics from his podiatrist, but says they didn’t work.

At the urging of his massage therapist, he later visited highly rated Foot Solutions in Tigard, Ore. He says the pain is gone thanks to bigger shoes and custom arch supports. “I can’t believe the difference,” says Smith, who paid about $300 for both.

Angie’s List member Denis Quintero of San Antonio, Texas, says he paid nearly $450 for prefabricated arch supports from Ideal Feet of San Antonio, but he felt more pain after wearing them. After several failed adjustments, he asked for a refund, which the store denied. Quintero gave Ideal an F, the company’s only report on the List.

He also asked Angie’s List for help through the complaint resolution process, but the case ended in stalemate after Andy House, a spokesman for Ideal’s corporate office, declined Quintero’s refund request. In his written response, House says Quintero was informed about the store’s no-refund policy, and Ideal’s free, lifetime adjustments. Quintero says he’s now receiving care from a podiatrist.

Avoid one size fits all

Dane LaFontsee, a certifi ed pedorthist and past president of the Pedorthic Footcare Association, says consumers need to be wary of a one-orthotic-fits-all sales approach. “An over-the-counter may help some people, but if there’s a biomechanical issue, it should be a custom orthotic married with proper footwear,” he says.

Dr. Andrew Schneider, a highly rated podiatrist at Tanglewood Foot Specialists in Houston, says his patients often try the over-thecounter insole fi rst. “I can put it in their shoes the fi rst visit and if it works, we go with that,” he says.

But Dr. Kristin Titko, a highly rated podiatrist at The Center for Foot Care in the Cincinnati area, says she doesn’t use prefabricated inserts because most patients have already tried them. She cautions that not even custom orthotics last forever. “Our feet change throughout our entire life,” Titko says.

Despite high success rates, how orthotics work remains a mystery. “It’s often assumed [they] align the skeleton,” says Dr. Benno Nigg of the Human Performance Laboratory at the University of Calgary in Alberta and leading researcher on orthotics. “However, we have shown that this is not the case. We really don’t know how they work.”

The “how” isn’t important to member Mary Dummer of Wellesley, Mass., who owns custom orthotics prescribed by highly rated Dr. Richard Cullen of Needham, Mass. “I’ve reached for them every morning,” she says. “[They have] relieved me of my symptoms.”