Re: Functional Orthoses (Sept. 2026)

I read with interest the article by Dr. Toback, "Functional Orthoses: Improving Patient Acceptance Through Effective Presentation."  I am not going to disagree with any of the points that he brought up, as they are all valid. However, I would like to add some points to help as well.

—It is important that we not become "orthotic salesmen." We are not selling a product, we are selling a service.  The orthotic is part of the service.  The service includes gathering the data, making the diagnosis, prescribing the right orthotic that best fits the patients goals and their finances, then providing the actual device and following up to assess the results and make adjustments and changes to the device.  The patient needs to know all of this in agreeing to the therapy.  Follow-up with orthotic therapy is just as important as it is with surgery.

—Patients and physicians need to be aware that orthotic therapy is still an imprecise science and they should expect a certain amount of trial and error before the perfect device is achieved. Most changes in the orthotic device can be achieved in a small office lab. I recommend that a doctor have a sanding device, a heating gun, several different types of materials to add postings, coverings, cushionings, accommodations, and stiffening. The patient should be aware that you can do these adjustments at the point of service.

—The physician needs to sell their own self as a biomechanics specialist. This means having some goniometers fo take at least a handful of measurements. I have had countless instances of patients bringing in a bag of custom-made orthoses, and when I lay the patient down to just take one or two measurements, or have them stand up and measure heel-to-ground relationship, that the patient has said, "No one has ever taken a measurement before." I never criticize another physician, but my actions of taking a measurement sells that patient that I want to take a more scientific approach to solving their problem.

—It is important that we recognize that not every patient needs a custom-made orthotic. However, there are many foot types that do not respond well to pre-formed orthotics. I do recommend that the physician have a few different types of pre-formed orthotics in the office to try on some patients.  Some of these will work out of the box and some can be made to work at a low cost with modification in the office lab.

—Technology is great in building patient confidence and in increasing your knowledge base as you use it. At the very least, goniometers should be available and used.  Simple footprint analysis systems can give additional knowledge about the function of the foot. Pedobarograph technology can give even more information and can assist in the treatment decisions and also nn the follow-up analysis. Everyone has a cell phone these days that can be used to take video of the patient walking.  Use these, ensuring that patient confidentiality and privacy is paramount. It could be wise to have an office-dedicated phone that never leaves the office. Foot scanning technology is always impressive for patients, however, it is important to recognize that an orthotic made from a scan will be no better than an orthotic made from a physical mold of the foot.

It is important that patients recognize that no one knows everything about biomechanics of the foot, so be careful in selling yourself as the all-knowing expert on foot function. What patients need to recognize is that you are a scientist who will provide the best scientific approach for their feet. When you sell yourself as the humble but persistent scientist who will not be satisfied until the patient is 100 percent satisfied, you will build a relationship that the patient will be more than happy to pay for.

Again, thank you, Dr. Toback, for providing insights that will help each practitioner.  Best wishes to you and to all those that continue to pursue excellence in understanding and improving foot function.

—Robert D. Phillips, DPM