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BMJ Study Showing Custom Support Orthotics No Better Than Static Support

Dr. Foot Solutions - Thursday, May 03, 2018
There is a story currently in the media looking at the British Journal of Sports Medicine (March 2018) review on over 20 papers on orthotic therapy being used for heel pain, in which custom orthotics came in as no better for treatment of heel pain than the ready-to-wear. Further to this story, there are some really important issues that warrant further discussion.

1. Did you know, our biggest health fund, BUPA, has influenced the nature of orthotic treatment back as far as 2010 by ceasing to pay rebates to their contributors for ready-to-wear orthotic therapy? They are the only health fund to do so, and in effect are snubbing their noses at clinicians and indicating that they know better than health professionals (podiatrists, medical practitioners, physiotherapists, chiropractors, osteopaths etc.) what treatment the patient needs, or indeed, what the patient can afford!

2. Since that time there has been a steady rise in custom orthotic fees, with the highest fees being over $800, according to the fee survey of orthotic therapy published by the Australian Podiatry Council June/July 2016. The average custom orthotic fee comes in at around $500-550 a pair.

3. With the advent of new technology, many clinicians have moved to CAD/CAM orthotics, which can be milled and dispensed on the day of the first appointment, in the rooms of the clinician. One disadvantage of this is that this procedure is usually charged at the higher end of the fee range. More importantly, patients do not have an opportunity to go away and research other available treatment options, before being asked to commit to a more expensive procedure and often a non-refundable deposit. Many who have undertaken this treatment without success have indicated that they were not given adequate information to make a choice between custom or ready to wear orthotics, begging the question as to whether informed consent was able to be given by the patient. There are also a number of important clinical considerations as to why custom orthotics should not be commenced at the initial appointment.

4. We have also moved onto the next generation of footwear (physiological, wellbeing), where in a type of ‘orthotic effect’ device is built into the soles of these shoes. This has been done in Switzerland for over 20 years with the brand MBT, which has been available in Australia for the last 14 years. Other brands that are utilised as orthotic-effect footwear include FitFlop, KyBun and HOKA. This modern shoe technology is more potent than even a neuromuscular orthotic within a regular, conventional shoe e.g. in the case of heel pain, at push off in gait, the plantar fascia is not being tractioned.

According to rehabilitation Podiatrist and consultant in chronic pain and footgear, Bronwyn Cooper, there are over 250 preformed orthoses models in the Australian market for health professionals to use in patient care. Cooper was quoted, only last month, in Good Health magazineon new development in treating foot pain, included next generation neuromuscular preformed orthotics and photobiomodulation (laser) therapy. She is a clinical educator in these areas, and on the clinical effects of footwear. She is a member of AMLA and will present on these treatments at the AMLA winter seminar in Melbourne this June- the first podiatrist to be asked to do so. She is also the convenor of the Podiatric Laser Special Interest Group.

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