Plant the idea of an annual visit when the patient first receives his or her orthotics. An orthotic may be one of the only tangible items a patient takes from your office. Wouldn't it be nice if each time a patient removed his or her shoes, he or she remembered the better health you had helped provide? As you initially fit your patient with orthotics, say something along the lines of:
"Although these orthotics may last for many years with proper care, it is important to have your feet and orthotics evaluated at least once a year. We will be reminding you about your checkup, to make sure your orthotics help you hold your adjustments."
The next important step is to schedule the exam in your calendar or in the patient's file. Send a reminder and call to schedule this important visit approximately 11 months after providing the orthotics.
My practice tries to educate its patients about lifetime spinal care. Some simply choose pain relief and discontinue care when their symptoms improve. Regardless of how long patients remain under your active chiropractic care, the annual exam provides the opportunity to renew your relationship and offer additional care and services.
I recommend an orthotic and foot exam be part of a general health and spinal checkup. In addition to the spinal evaluation, here are some additional considerations:
- Shoe size and fit. Because of plastic deformation and the effects of time, the foot becomes longer and flatter with age. Because of habit, we rarely change the size of shoes we purchase. Have patients bring two or three pairs of their favorite shoes to be evaluated for proper ball fit. It is important to see the kinds of footwear they own. You can quickly spot improperly fitting and worn-out shoes.
- Different shoe styles need different orthotics. Have any of your patients shoe-style preferences changed? If so, make sure the custom orthotic is appropriate. It may be necessary to order additional orthotics to accommodate all their footwear. Orthotics are specifically designed to work in specific shoes for maximum support and performance. When an orthotic won't fit, consider custom-made shoes or sandals.
- Make sure factory inserts are removed. Custom orthotics work best when they lie on a flat surface. The factory insert can be used as a template to trim the length of the orthotic, at the toes, for a secure fit.
- Take a brief history related to changes in activity level and weight. Patients' activity levels change with time - improved health, injury or pregnancy are just a few reasons. Since weight can also fluctuate, recommendations for new orthotics should take into consideration any significant changes and provide greater support.
- Look for damage or abuse. Custom orthotics require special care. Reminding your patients to remove them nightly allows the orthotics to dry naturally and avoid the accumulation of moisture. Furthermore, wiping orthotics with a damp cloth will prevent any "grit" from wearing the surfaces prematurely. Minor changes in the coloring or surface of the orthotics will not affect performance; however, any excessive wear that affects the placement of the corrections suggests the need for replacement.
Even with proper care, orthotic prescriptions change with time. There is no set pattern for this change, and it varies with each individual. Most prescriptions change during developmental or age-related stages, or as a result of changes in chiropractic treatment plans. The most important evaluation during the yearly exam is a review of the indicators that prompted your initial recommendations. This will help you decide when it's time for a new pair (or pairs) of orthotics. Most importantly, whenever patients stop holding their adjustments, take another look at their feet.
Your dentist expects to see you each year, even if you don't need a cavity filled. While this is a beautiful marketing tool, we know that prevention also helps patients avoid more serious (and costly) procedures. Establish a plan to have all your patients receive a yearly exam. This can be a special opportunity to recommit them to spinal care for a lifetime of better health. Although you don't need an excuse, because custom-made orthotics are such specialized devices, they are a perfect justification for re- establishing an active relationship with former and current patients.
Mark N. Charrette, DC
Las Vegas, Nevada
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