Foot Orthoses For Chronic Ankle Instability
In light of an increasing body of research on the
As with anything in life, people don’t always want to take your advice. When it comes to orthotics, there can be all sorts of reasons for patients to say “no”. Even if you did establish excellent rapport with your patient and they like you, even if you were thorough in your history and physical examination. It’s not always about the money.
Patients may have preconceived ideas about you or orthotics before they even walk in your door. There are many reasons for people to say no. We’ll go through some of those reasons and how to deal with them appropriately and effectively, turning the negatives in to positives.
Turning a "no" into a "yes"
Here are some typical comments from patients and how you can respond.
• "I've tried arch supports and they didn't help"
Arch supports only push up against your arch when you are standing. Your feet aren’t held in the correct position and pronate right over them. You can show them this by having them stand on their arch support. Or (in the case of a rigid cavus or high arched foot type), the arch support doesn’t match up to your high arch and there is a big space between your foot and the arch support. It just doesn’t work well enough.
Orthotics are designed to precisely control the mechanics of your gait cycle from the moment of heel strike through the midstance phase to the push-off phase of your walking. They realign your bone structure precisely into the correct position with every step. This is accomplished comfortably mile after mile of walking. An arch support cannot do that.
As well, arch supports are made from an “average” arch profile for each foot size, and not everybody shares the same arch profile.
• "I already use arch supports and they help, so I don't need orthotics"
That’s good that those supports help. It shows you that you need some correction, but they don’t do enough. Again, have the patient can stand on them. Show them their neutral position and the space between the foot and the arch support.
The orthotics should therefore do even more for you if your feet were really held in their corrected position with walking and running. If the patient is being seen in your office for a foot problem, the arch supports obviously aren’t doing enough.
• "My friend told me that foot specialists just want to sell orthotics"
Talk about preconceived negativity!
As you can see we are concerned with your feet functioning properly. All of the other modalities that the practitioner offers indicate that there are a number of ways to treat foot problems. It just so happens that a lot of foot problems are caused by abnormal foot structure. Orthotics correct this problem and address the cause to prevent recurrence. Yes, a lot of people wind up getting orthotics from foot specialists, but the orthotics work.
After all, a lot of people wind up getting glasses from an optometrist, because they are indicated and they work. Ensure your patient that if their feet weren’t biomechanically imbalanced, you wouldn’t be recommending orthotics.
• "Orthotics are just a gimmick""
It’s true that a lot of places are selling orthotics because orthotics have an established reputation for working well. Unfortunately, there are a lot of “knock-offs” or pre-made arch supports that are being sold as orthotics. These are no better than the insoles you can buy at a pharmacy.
Research in the past 30 years has shown that a properly made orthotic will work well and the excellent results over all of these years have proven that they are not a fad.
• "My doctor told me not to get orthotics"
Your doctor may have heard from horror stories about orthotics, just as I have. In some cases, orthotics have been known to do more harm than good if they are not prescribed correctly. In some cases, they were made with an improper technique, or perhaps they came from people who were not trained as foot specialists. If there is too much correction placed into an orthotic, or if they are incorrect, then they can not only be uncomfortable but could cause additional problems, such as knee pain.
Ask if their doctor told them why they have this specific foot problem. Chances are the family doctor didn’t do nearly as thorough of a foot exam as you have done, given that this is not their area of expertise or specialty. If the doctor didn’t explain the cause of the problem perhaps they didn’t know it was biomechanical in nature. Biomechanical foot imbalances are best treated with orthotics in order to correct the problem.
• "My friend has orthotics and said they were terrible"
This is similar to the doctor’s comments above. You can respond by saying that you can understand the patient’s frustration and obviously something went wrong for them. But, in your hands, orthotics work very well when they are indicated and should be very comfortable. Your knowledge and experience have proven to you that they work well. In the friend’s case there must have been something wrong with the process involved in making them or perhaps they weren’t sold by a trained foot specialist.
Dr. Lloyd Nesbitt, DPM
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