Practice Perfect 877
Simplifying the Orthotic Prescription

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Jarrod Shapiro, DPM, FACFAS, FACPM

Practice Perfect September 5, 2023

For the new podiatric provider, writing prescriptions for foot orthoses can be intimidating. When I first started in practice, I had already learned biomechanics, much like anyone else going through podiatric training, but when I started writing actual prescriptions for my patients, each of the forms to fill out appeared highly complex and unique. I made a number of mistakes at first but finally got the hang of it.

Over the years, working with various foot orthosis companies, I’ve simplified the process for myself with a basic thought structure so I can be sure to capture all the important parts of the prescription to best communicate what I want to the laboratory. I’d like to share this thought process with the intent to make your next foot orthosis prescription a little easier.

The Use of Technology and Other Tools to Help Improve Your Practice

Alan Bass, DPM, FACPM, CPC

Founder and Medical Director
Central Jersey Foot & Ankle Care
Manalapan, NJ
Co-Principle
PARE Coding and Compliance

The use of technology and other products in your office help to make your practice more efficient and increase your bottom line. This lecture discusses a variety of methods to introduce new technology into your practice without overwhelming your staff or patients.

Available Credits: CPME 0.5

This thought process is based on the general anatomy and considerations of a foot orthosis, which are as follows:

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For each of these components, there are a large number of options, which, although overwhelming for the new provider, allow many variations to the orthoses themselves. Deciding which modifications to apply is the biomechanics part, which is beyond the purview of today’s editorial.

• Patient information – This includes information such as height, weight, shoe size, shoe type, and goals for treatment. 
• Cast modifications – Arch fill, skives (medial or lateral heel skives), Blake inversion, expansion, among others, determine the overall shape of the orthosis shell. 
• Shell – Type of material and thickness are important to relate to the manufacturer and may include materials such as polypropylene or graphite and thickness of the device, depending on how stiff or flexible the shell should be. It’s also important to communicate the shell width. 
• Posts – It is important to communicate if posting of the orthosis is intrinsic or extrinsic and whether one plans for inversion, eversion, or flat posting of the forefoot and/or rearfoot. 
• Extensions – This portion of the prescription involves any additions or extras applied to the orthosis. For example, Morton’s or reverse Morton’s extensions are popular additions, as are cut-outs to offload prominent areas. 
• Top covers – A number of new materials are available to create both a professional appearance and modify foot function. The top cover can modify friction, how the orthosis fits in the shoe, and provide some extra cushion. Don’t forget to indicate the length of the top cover, which is commonly available in full length, sulcus, and shell lengths. 

With a basic framework in which to approach the prescription, it becomes much easier to communicate one’s orthosis desires and provide high-quality patient outcomes.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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