Beyond Dispensing, Part 1 feature The importance of having an orthotics follow-up program O rthotics are medical devices that correct improper foot mechanics. Many of us dispense custom orthotics as a part of our clinical practice and understand the positive impact that properly fitted orthotics can have on helping our patients with foot, knee, hip and low back pain. Common clinical practice involves the dispensing of orthotics with instructions as to how the orthotic should be gradually broken in. However, how many of us have a follow-up program following dispensation? The importance of a follow-up program, which significantly helps with quality of care and patient satisfaction, cannot be understated. Follow-up calls should be made: • two weeks post-dispensation • at recurring yearly intervals • to schedule re-exams Dr. Martin Dziak is a chiropractor and certified pedorthist. He is the creator of ORTHOTRACK.ca, a customizable orthotic practice management software. For questions and information, visit ORTHOTRACK.ca, e-mail [email protected], or call 519-954-6100 or 1-888-337-7362. TWO WEEKS POST-DISPENSATION Follow up calls should be made: two weeks post-dispensation; at recurring yearly intervals; and to schedule re-exams. Two weeks gives patients enough time to determine if the orthotics are helping them in the way they were designed. In my practice, about 90 per cent of two-week follow-up calls are positive and patients report significant pain relief. However, in about 10 per cent of my first follow-up calls, the patient feels no change or may even feel worse. These patients are then scheduled for a follow-up ap-pointment to determine if it is a problem with incorrectly breaking in their orthotics, an error of improper fit into their shoes or a problem with the orthotics themselves. Clinical Note The most common complaint that I receive in the two-week follow-up call is that new pain is now present that was not there pre-orthotics. First, I check to make sure that the orthotic is sitting in their shoe properly and second, I ask if they have fol-lowed the proper break-in instructions to get their feet used to their new orthotics. I sometimes find that they have moved their orthotics into a new pair of shoes and they are not sitting in this new shoe correctly. Alternately, I may find that they have worn the orthotics for too long, or have gone for a long run or intense workout prematurely, which has caused the discomfort they are experiencing. In this situation, I ask them to stop wearing the orthotics for a week or so and then start all over again with the correct instructions. I then make another follow-up call two weeks later, to see if they are feel-ing better. If their new pain has returned, the problem is most likely with the orthotic itself: most commonly the arch of the orthotic is too high or the apex of the arch of the orthotic is slightly forward or backward from where it should be (this could be due to a casting error or a lab error). The patient will complain of a hotspot of high pressure in that area of their arch. The orthotic will require a slight adjustment and then be redis-pensed followed by another two-week follow-up call. Occasionally, the arch of the orthotic is not high enough. This is most commonly found in patients who have previously had a pair of rigid and high-arched orthot-ics from another provider, to which the patient had become accustomed. Patients that come in for an orthotic casting appointment should bring their most commonly worn pairs of shoes as well as their old orthotics with them to their appointment. If they like the orthotics that have been previously dispensed to them, the orthotics I make will be as similar as possible to the pair that they have and like. I am often surprised by patients’ previous orthotics – they tend to be overly rigid or have overly high arches – and not www.canadianchiropractor.ca Martin Dziak, DC, CPed(C) 8 • CANADiAN CHiROPRACTOR | APRiL 2013
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