Frequent Questions (FAQ's)
Frequently Asked Questions
(See also Insurance Issues)
1) What does my provincial health plan cover?
2) What's the process for WSIB, RCMP, DVA, etc?
3) I'm on assistance, What am I covered for?
4) What's the difference between a podiatrists, chiropodists, pedorthists and orthotists.
5) How do I break in my new orthotics?
6) Which casting technique is best... gait plate, computer scan, slipper cast or foam impression?
7) Do I need more than one style of orthotic for different shoes?
8) Are the "orthotics" I see in TV infomercials, at the mall, in trade shows & offered on the internet any good?
9) I was told these were custom orthotics so why do they look like the ones on TV?
10) What about the computerized orthotics some stores are offering?
11) How do I know if I really need custom orthotics?
12) Why does a little bit of plastic cost so much?
13) How long will my custom orthotics last?
1) Provincial Insurance (OHIP, RAMQ, etc.) What does my provincial health plan cover?
Your provincial health plans cover the services of medical doctors and facilities. Your consultations with your medical doctor regarding foot health issues will be covered. If your doctor refers you to another medical doctor such as an orthopaedic surgeon, that will be covered.
All other foot care specialists including podiatrists, chiropodists, pedorthists, orthotists, & foot care nurses are not covered under provincial health plans and you will be charged on a fee for service basis unless you have other coverage.
Generally, medical devices including orthotics & orthopedic shoes are not covered under your provincial health plans.
2) WSIB, RCMP, DVA, Military. What's the process?
At Foot-FX, we are approved suppliers and direct bill for all of the above programs, once approved. Approval usually requires a medical doctor's diagnosis and treatment prescription along with our estimate to be sent to them. Once they issue us an authorization, we can proceed with filling the prescription and direct bill them for your products and services.
3) Other Coverage. I'm on assistance, what am I covered for?
In January 2013, the Ontario government quietly changed their policy of covering orthopaedic footwear & custom foot orthotics for people covered under their programs administered at the municipal level such as ODSP, Ontario Works, Social Services, etc. Shoes & orthotics are no longer covered.
4) Podiatrist, Chiropodist, Pedorthist, Orthotist. What's the difference?
Basically, Pedorthists are the technicians doing shoe fitting, constructing orthotics and modifying shoes under a doctor's prescription. Chiropodists are more medical doing "non-invasive procedures" such as ingrown toenails and foot care. Podiatrists are the traditional foot doctors doing corrective foot surgery. Orthotists make orthotics and prosthetics.
The terms Podiatrist & Chiropodist are used interchangeably in some parts of Canada, often with the local "podiatrist" having very little formal education. Only a DPM is a podiatrist! Historically, a Podiatrist was trained in the U.S. with approximately 9 years of schooling & residency and recognized to perform medical & surgical procedures in all 50 states. A Chiropodist was trained in the U.K. and since 1993 in Ontario with a reduced scope of practice limited to non invasive procedures.
The scope of practice of Podiatrists varies by province. In Ontario, a Doctor of Podiatric Medicine (DPM) is licensed by the College of Chiropodists of Ontario. If licensed prior to 1993, they may perform foot surgeries similar to their scope of practice in the U.S and other parts of Canada (only 2 remain in Ottawa, 43 in all of Ontario). Note that most of their services are not covered under OHIP as they are not medical doctors. Until recently, all DPM's were trained in the U.S. In 2008, the first DPM's graduated in the province of Quebec which has accepted that standard for podiatric care.
Chiropodist: D.Ch, D.Pod.M., B.Sc(Pod), M.Sc(Pod)
The practice of Chiropody is the assessment of the foot and the treatment and prevention of diseases or disorders of the foot by therapeutic, non-invasive surgical, orthotic and palliative means. D.Ch (diploma in chiropody) is the Canadian trained designation, D.Pod.M. was the United Kingdom designation now replaced with B.Sc(Pod) but all three designations are recognized by the college.
Pedorthist: C.Ped, C.Ped(c) A Certified Pedorthist is an individual who is trained and certified in the assessment, design, manufacture, fit and modification of foot appliances and footwear. C.Ped is the internationally recognized designation of a pedorthist credentialed by the American Board for Certification in Orthotics, Prosthetics & Pedorthics. In 1990, the C.Ped(c) was created as a Canadian designation credentialed by the College of Pedorthics of Canada.
Orthotist: C.O., CPO An orthotist technician supports practitioners in providing patient care by fabricating orthoses and prostheses and their components.
5) Breaking in my new orthotics. How do I break in my new orthotics?
First, the orthotics are not breaking in, you are. We have constructed your orthotics to correct for the misalignments and pressure points in your feet that have been causing you discomfort. It usually takes time for your body to adjust to this new alignment. Your body didn't get the way it is overnight so accept it will take some time to become accustomed. As a rule of thumb, we suggest you wear your new orthotics for only 1 hour the first day, 2 hours the second day, 3 hours the third day, and so on. Within 2 weeks, you should be wearing your orthotics comfortably all day.
If the orthotics are not causing you any discomfort, you can continue to wear them, but please be aware it is not unusual to have some foot, leg or back pain as you become accustomed to them. If you cannot wear them after 2 weeks, please call and make an appointment to see us. Making custom orthotics is an art, not a science and because there are many steps in the process that require judgement calls, we don't always get it right. No orthotic maker does. However, please be assured we will adjust them or completely remake them to your satisfaction.
6) Casting Techniques. Gait plate vs computer scan vs. slipper cast vs foam impression.
Most practitioners have a preferred method of taking the impression of your feet and all methods can be effective if done correctly by a qualified professional.
The computerized gait plate system requires the patient to walk over a pad connected to a computer a number of times to capture an average image of the bottom of the foot in uncorrected full weight bearing position. This is not a true 3 dimensional image of the foot and most insurance providers and foot professionals agree the end product is little better than an off the shelf arch support.
The computer scan, most commonly the Amfit system, can be effective for less complex cases if done correctly by a qualified professional. A 3 dimensional computer image is captured while the practitioner holds the foot in correct position during the scan. Adjustments are made using the computer software and the orthotic is milled from a standard blank of semi-rigid materials.
Using foam impression, the practitioner either presses your foot into the soft foam while you are seated (semi weight bearing) or has you step into the foam while standing (full weight bearing) to leave a true 3 dimensional image of your foot. A plaster model is then made from this impression and shaped accordingly to meet the goals identified. The orthotic is vacuum pressed over these plaster casts using various materials and then ground and covered. This method is the most effective for capturing any foot abnormalities as the foot is in weight bearing position.
Most professionals agree the slipper cast is the gold standard for taking foot impressions. The foot is in a non weight bearing position while a plaster cast is made over the foot. Since there is no weight on the foot, the practitioner must position the foot by holding the lower ankle in correct alignment (neutral position) while simulating weight bearing by applying pressure to the bottom outside of the foot while the plaster sets. As with foam impressions, a plaster model is then made and shaped accordingly. Although very effective, this casting method is the most difficult to do correctly and may result in an over corrective orthotic that the patient cannot get accustomed to.
7) Styles of Orthotics. Sport vs. dress vs. everyday wear vs. diabetic. What's the difference?
A custom orthotic can be made from an endless combination of materials to meet the goals of the practitioner. Generally speaking, a rigid foot requires soft materials which are bulky and a flexible foot can tolerate stiff materials which are much slimmer and more durable.
Fitting an orthotic in a man's shoes is seldom an issue as they usually have the room & support to simply replace the shoe manufacturer's footbed with the orthotic. Ladies shoes are another issue often requiring delicate negotiations to meet our pedorthic goals to eliminate your pain while allowing you to wear the shoes you want to wear. Although we can make a custom orthotic to fit just about any shoe, the orthotic/shoe combination could be so compromised as to render the results ineffective. The first time, we usually set a goal of having at least one good orthotic & shoe combination in your closet to correct your problems and go from there. Once that is working for you, there is nothing wrong with "3 hour shoes" for those special occassions.
As for orthotic styles, we make each orthotic individually and really don't have fixed styles. Part of our assessment is to discuss the goal of the orthotics and your lifestyle to make the orthotic wearable as much as possible. There is no point making an orthotic you will not wear. In most cases, the same orthotic can be worn for all of your activities.
As noted above, orthotic materials vary greatly. Many people have the perception that an orthotic must be soft to be comfortable, a property promoted by the shoe & after market insole industry. Think of your mattress. Yes, you can buy a very soft mattress but very few people can tolerate that sagging feeling all night. The box spring and the coils give the support while the top cover gives the softness. Orthotics are the same. The underlying support must be strong & durable with the padding coming from the top cover. Although a very soft orthotic may feel good initially, it quickly breaks down and won't support your foot.
8) "Snake Oil" Orthotics. Are the "orthotics" I see in TV infomercials, the Shopping Channel, at the mall, in trade shows, on cruise ships & offered on the internet any good?
In a word, YES, they can be effective. First, some definitions. An "arch support" is an off the shelf foot support that is not custom made for you. An "orthotic" is a foot support custom made for you.
Most of the corrective arch supports on the market today evolved from a product developed by Georg Alzner (or Alznner), first patented in Canada in 1969. Originally marketed at trade shows and such (for $20!), thousands of people have worn and still wear this arch support. It is different from a custom orthotic in that it has an aggressive semi-rigid shape that puts your foot into it's ideal position. This concept works very well for some people but certainly not all. The correct fit is critical and is not always based on shoe size. Although still made in Canada, the original Alznner is now the property of Bio Orthotics in Plano Texas and sold primarily through Good Feet and Foot Efx franchises. With the expiration of the patent, many companies have attempted to copy the Alznner including Good Feet themselves with their Classic line, Neovita, Phase IV, Walk Fit, K-Mac, Step Forward, and many others.
Are they effective? Yes, for about 50% of the people they work very well. Another 25% might wear them but are not totally satisfied and the remaining 25% just cannot wear them and have even done serious harm by attempting to do so. Most of the people selling these products have no training in pedorthics and at best only have some basic training in fitting them based on shoe size. But they do give a very convincing sales pitch!
Are they worth the often inflated price of up to $350? Probably not when contrasted with a custom made orthotic with assured results. But if they solve your problems and you are willing to take the risk, it could be a small price to pay.
9) Orthotic Fraud. I was told these were custom orthotics but they look like the ones on TV?
You may be surprised to hear there is no legislation in Canada regulating who can provide you with custom orthotics. This leaves the door open to many fraud artists. Some operators in Toronto were recently caught selling fashion shoes and electronics while invoicing them as custom orthotics for the insurance claim. Some operators in mall kiosks will lead you to believe they are fitting you for a custom orthotic by taking an impression and then supplying you with an inexpensive arch support. Some operators in trade shows will tell you your orthotic is custom made for you since they stuck some material under a standard arch support. As CBC Marketplace uncovered in 2008, even some medical professionals were caught on camera prescribing and selling custom orthotics when they weren't necessary.
Basically, understand the qualifications of the person you are dealing with. Only pedorthists, chiropodists, orthotists and podiatrists have the necessary training to dispense custom foot orthotics.
10) What about the computerized orthotics some stores are offering?
The computerized scan of your feet suggests which product to buy from a choice of 2 or 3 ready made products. The "orthotics" are not customized in any way for you. Just as you can test your own eyes at the drugstore & select from a number of reading glasses to correct your vision, you may get lucky and find a pair of arch supports that give you comfort and meet your needs.
11) Do I need Orthotics? How do I know if I really need custom orthotics?
At a certain age, our arms seem to get too short and we admit its time for reading glasses. In the same way, the muscles in our feet get to the point that they need a little help as well. In many cases, like the trial & error reading glasses from the drug store, an inexpensive arch support or other foot device can be just as effective in solving your problem as a custom made orthotic. Because they are a standard products, we cannot always be certain of the results but for under $50, they may be worth a try and will always be better than what comes with your shoes. If the corrections required are more complicated, a custom orthotic might be necessary and we will give you our opinion but the final decision is up to you.
However, if you arrive at our clinic with a doctor's script prescribing a device for treatment, be it a heel cushion, arch support, orthopaedic shoes or custom orthotics our role is to fill that prescription for you. Your medical practitioner has already determined the course of treatment.
12) Why are Orthotics so Expensive? Why does a little bit of plastic cost so much?
Most of the orthotics we make contain about $25 of materials and we use better materials than most. Then why the high price? Like any hand crafted medical device, you are paying for the expertise and time of the person assessing, making, fitting and following up to get you moving comfortably again. Many hours of work go in to making your custom orthotics. Some people spend thousands searching for the Holy Grail of foot comfort by buying different shoe brands with the latest theories and technologies promising comfort. Even at that, they are made to be as comfortable as possible for as many people as possible which only works for the average foot. How often do you hear someone say "they felt great in the store but now I can't wear them".
A custom orthotic will last many years and move from shoe to shoe while giving you consistent comfort and support. Most would agree its a small price to pay to eliminate pain and quite literally change your life.
13) How long will my custom orthotics last?
A properly casted & constructed orthotic will last many years despite what many practitioners will tell you. An "orthotic" is a device to control bones in the body. The bones in the feet do not change a great deal once your feet have finished growing at about age 15. Usually we construct your orthotic with a polyethylene shell that will stand up to many years of wear. The cover material will wear depending on use but the underlying shell is very durable & can even be reformed back to the original casts. Covers can be replaced as needed.