Offering Support: Walking in My Shoes
One way to view the orthopedic market is that it involves three long lists: the number of products included in this category, the amount of clinical specialties involved and the extensive customer-base the orthopedic market serves. Products can include back braces, wrist braces, knee supports, immobilizers, pregnancy supports, cervical collars, pediatric supports and special footwear and special inserts. Clinical specialties include physical and occupational therapists, orthopedic physicians and specialists, podiatrists, spine surgeons, athletic trainers, fitters and orthotists. Potential clients can include athletes, people with diabetes seeking special footwear; children with cerebral palsy needing special splints; people with arthritis seeking special footwear; people with back problems in need of special braces and people seeking ankle-foot support following a stroke. To narrow the focus, we will primarily focus on the orthotic market.
Taking a Look at the O&P Market
The orthotic and prosthetic market is a specialized allied health profession which combines both clinical and technical skills. Typically, orthotists and prosthetists acquire a bachelor's degree in O&P in addition to computer science classes. Often there is a one-year residency program following college and then O&P practitioners can become certified through the American Board for Certification in orthotics and prosthetics. Most HMEs establish a consultative relationship with O&P specialists, while some employ O&P professionals on staff. Many do utilize a fitter that has completed some formalized training.
Almost anyone can benefit from orthotics, which like eyeglasses, can adjust imperfections that prevent people from functioning at their maximum physical potential, according to the Podiatry Channel, Health Communities.com Inc., North Hampton, Mass.
As fall approaches and people trade their sandals and flip flops for closed-toe shoes, many people may recognize their need for orthotic products to prevent and alleviate any foot discomfort. Some people will seek orthotics to correct a foot misalignment.
Orthotics, or orthopedic products designed to treat or adjust a variety of biomechanical foot disorders, include cushioned heel cups or insoles for shoes. Many orthotics are individually designed to the shape of a user's foot by making an impression of the foot called a cast. The cast creates a duplicate of any misalignments in the foot and specialists in an orthotic laboratory can correct these misalignments with compensation and stabilization techniques.
To find out if a client needs orthotics, there are several signs of foot misalignments.
Signs of Foot Misalignment
- One side of the sole of a shoe wears out faster than the other
- Frequent sprains to the ankle
- Chronic heel, knee or lower back pain
- Shins that hurt
- Toes that are not straight
- Feet that point inward or excessively outward when walking
- Feet hurt in general
According to experts at Podiatry Channel, Health Communities.com Inc.,
most podiatrists categorize orthotics into four main categories:
- Functional Orthotics — special wedges to adjust to the heel or forefoot, correcting defect in the arch that cause poor shock absorption, such as excessive pronation (flattening of the arch) or supination (an arch that is too high).
- Weight-dispersive — typically feature padding designed to relieve pain caused by excessive pressure on the metatarsal heads. Other accommodative orthotics are designed to treat pain and pressure on the sesamoid bones, collapsed tarsal bones, sores and chronically inflamed toes.
- Supportive — arch supports usually prescribed to treat problems of the plantar arch.
- Early Childhood Orthotics — special devices designed to correct biomechanical walking problems identified in young children including splints, gait plates and night bars designed to hold a child's feet and legs at a proper angle while sleeping in order to promote corrective adjustment for excessive toe-in or toe-out walking.
Pediatric Prosthetics Inc. Management to Attend World-Wide Symposium
The Technical Aspects of Walking
To explain how orthotics function, it is important to understand the mechanics of walking. Healthcommunications.com provided the following information. With each step, the vertical axis of the heel ideally should land almost perpendicular to the ground, with a slight inclination of only a few degrees toward the outside of the heel. From there, the weight is distributed progressively toward the lateral (outside) side of the foot. As the little (or fifth) toe starts to touch the ground, the arch of the foot should flatten slightly, shifting the body's weight toward the medial (inside) side of the foot. The heel then should start to lift off the ground, shifting the weight to the medial forefoot, principally the ball of the foot and the first.
This coordinated motion occurs in much less time that it takes to describe. It is, nevertheless, a complex process in which many things can go wrong. If a structural problem is present, the foot can collapse under the body's weight. Runners in particular exert much greater forces on their feet than those generated by simple walking. This can lead to more severe injuries, such as sprained ankles, shin splints and even fractures.
Over time, stresses on the feet can deform them. One of the foot's main functions is to absorb shock as the body's weight shifts with each step. It does this through a complex process in which the arch of the foot flattens slightly. This absorbs and distributes the weight throughout the entire foot. There are two major problems that can occur in this mechanism.
The first occurs when the arch does not flatten at all. This typically occurs in a person with a high arch, called a cavus foot. Because the arch does not flatten, it absorbs shock poorly. Instead of spreading it throughout the entire foot, the weight of the body falls only on the heel and the bases of the toes. This increases stress on the foot, especially the heel. Furthermore, because the weight is not absorbed well in the foot, it radiates up the leg to other joints. Over time, this can cause pain in the knees, hips and lower back.
To correct this condition, an orthotic is used to bring the ground into even contact with the rest of the foot. This allows the entire foot to support the weight of the body. Extra cushioning can be built into the orthotic so that some of the force does not even reach the foot.
A different problem results if the arch flattens too much. This is known as a planus or flat foot. In such cases, the weight distribution on the foot is too far on the medial side. A flat foot is unstable and cannot maintain a proper arch. Over time, the weight of the body on an unstable foot will cause the bones of the foot to become misaligned. This can lead to the development bunions, hammertoes and other foot deformities, as well as knee and lower back pain.
To address this problem, an orthotic with an increased arch will be prescribed to distribute the weight laterally. Depending on shape of the foot, the heel of the orthotic can be slanted to shift the weight more toward the center of the heel.
Orthotics are often considered custom orthotics or pre-molded orthotics. Custom orthotics are specifically crafted to meet the individual needs of a particular user and pre-molded often use hi-tech polymer shells that never lose their shape and are pre-molded according to show size as opposed to an individual's foot.
In addition to special footwear, orthotists also provide braces and splints to help patients with movement challenges and to relieve discomfort. Most products need to be fitted to the patient by correct sizing, which includes adjusting stays for ankle, shoulder, hand, wrist, back, and knees molding inserts to the patient's back. Sizing ensures that the back, wrist and hand are in the needed anatomical position and providing an optimum outcome.
"We manufacture professional products in HME dealers, pharmacies and high end products used by O&P providers," said Linda Ashton, vice president of Scott Specialties/CMO/Ginny, Belleville, Kan.
"We see a trend by dealers and distributors toward more retail consumer selected and cash sale products due in part to Medicare reimbursement issues and in part to the fact that many orthopedic products appeal to a broad demographic group ? everyone from the elderly with arthritis to young athletes ? and provide excellent gross profit margin to the HME dealer / distributor," Ashton said.
Aston advises HMEs to do the following when marketing and selling orthopedic products:
"When the HME provider looks at adding orthopedic items, look at the store demographics and pick a core group of products that sell well for that market. Look at quality verses price — the mass merchandisers provide price — but will the product function as it should?" Ashton said.
- Work with a manufacturer that can provide a planogram of core items that fir the store and the demographics.
- Make sure the products are well displayed and not hidden in a corner, especially if they are entirely self-selling.
- Create awareness by hiring a fitter to work both the customer base and the area physicians, trainers, orthotists, etc.
- Offer quality products and value-added services to bring the customer back to your store; this will set you apart from the mass merchandisers.
- Look at other ways to promote these products through community-based involvement such as participation in health fairs.
Experts believe that the O&P HME market will grow each year with baby boomers aging but desiring to remain active.
Pediatric Prosthetics Inc. Management to Attend World-Wide Symposium
Pediatric Prosthetics Inc. will be attending the Myo-Electric Prosthetics Symposium, Aug. 15-19 in New Brunswick, Canada.
Pediatric Prosthetics management offers expertise in the developmental aid afforded to infants and children by myoelectric technology.
According to Kenneth Bean, vice president of operations, "All too often the socio-emotional consequences of limb loss are overlooked entirely by the prosthetics profession and the broader medical community as well. With infants and children, a limb loss impacts the child's entire family, and the crucial question becomes how the family views the child, because inevitably that is the way the children will view themselves."
Bean continued, "If a child is viewed as handicapped, he or she must inevitably be handicapped...by a lack of confidence and a willingness to 'take a back seat' to the 'whole' children around them. The ultimate purpose of Pediatric Prosthetics Inc. is to change those views from 'Isn't that sad!' and move the viewpoint to 'Isn't that wonderful!' We accomplish that by properly applying the finest technology but also by embracing the whole families and creating a 'can-do' approach to each child's future."
Bean concluded, "There are over ten thousand small children in the United States alone with a limb loss. Perhaps one out of four of them do not have adequate insurance. With the advent of the Pediatrics Prosthetics Foundation, we can begin to address the needs of every one of these families. It is there where we expect to achieve the company's overwhelming success."
Orthotic Products
Shoes
Orthofeet's Men's Fisherman shoe is lined with a smooth fabric and padded with foam to prevent irritation.
Stocking
The Activa® soft fit graduated therapy 20-mm to 30-mm Hg knee high stockings with open toes are constructed of a microfiber that transports and evaporates moisture away from the skin to keep it dry and cool.
Insole
Sroufe Healthcare Products' Tri-Laminate insole is designed with three integrated layers for the diabetic foot.
Apex Foot Health Industries
Apex Foot Health's Aetrex® performance footwear line is designed to provide equal distribution of pressure throughout the gait cycle by unloading pressure.
Splint
The A-Force? dorsal night splint from Bell-Horn is designed to hold the foot in a neutral position during sleep, and to prevent plantarflexion versus uncomfortable active dorsiflexion.
Foot Scanner
Apex Foot Health's iStep F.I.T. foot scanner uses footwear integration technology to measure and analyze a user's feet and provide footwear and insert recommendations based on arch type and pressure points.
This article originally appeared in the September 2005 issue of HME Business.