Confusion Over Over-The-Counter Inserts and Prescription Orthotics

The ongoing confusion involving expensive prescription custom orthotics and relatively inexpensive over-the-counter arch supports lies not only in their purported efficacy but in the plethora of choices offered on-line and in retail stores as well as in medical offices.  Foam molds to make foot impressions are available from on-line marketers, and Amazon lists no fewer than twenty different arch supports, wraps, and braces proven to resolve your foot pain. A Parade Magazine advertisement touts a reflexology- like device guaranteeing weight loss with frequent use. CVS stores have partnered with Dr. Scholl’s to prescribe a specific arch device based on data obtained from stepping on an in-store pressure measuring machine. There are also many varieties of prescription custom orthotics that are made at ski shops by boot fitters, in specialty shoe stores by shoe salesmen or orthotists, by chiropractors, physical therapists, or podiatrists. Over-the-counter (“OTC”) arch supports are often sought out or recommended as a first line of treatment since they are much less expensive and readily accessible. The best OTC devices are the ones modelled after prescription ones; but their limitation is an inability to modify it to address a person’s specific pathology. OTC’s may also need to be replaced every few months compared to most prescription orthotics that last for years with minimal refurbishment, so custom orthotics may actually be more economical. Prescription orthotics are usually classified as accommodative (more flexible) or functional (more rigid), and are patient-specific, prescribed to address more serious problems derived from a detailed clinical and biomechanical exam. The orthotic fabrication is usually done at an outside lab from both the prescription as well as an impression of the patient’s foot.  Different professionals accomplish this utilizing different methods with varying degrees of success.  I have found that many so-called prescription orthotics are really "pseudo prescription-like," such as those typically dispensed widely by chiropractors, that although expensive are actually no better than generic soft insoles.  The pressure plate at CVS has potential to individualize arch supports for each patient's needs, but their devices reveal little perceptive differences and are no better than other mass produced cushion insoles - a far cry from custom. Many ski shops and specialty shoe stores commonly use more supportive and rigid materials made from a foot impression, but without a medical professional to take into account specific patient issues, produce devices that often lack functionality. When discussing orthotics with my patients, I commonly use the ‘OTC reading glasses’ versus ‘prescription glasses’ analogy. Minor needs may be improved with a quick, easy off- the-shelf fix, whereas more significant issues need to be addressed with a prescription.  More specifically, OTC arches are effective with the average person (average weight, foot type, low activity and minor symptoms) and prescription orthotics are preferred in those with higher or lower arches, higher weight, greater activity, specific shoe fit issues, or significant bone or tendon problems. Both types are meant to be an integral part of a comprehensive treatment plan to get patients better.  With so many options available to the public, it is difficult to do it alone.  Before wasting a lot of time and money on inappropriate products, see a podiatrist, who remains the expert in foot biomechanics and can best help figure out what is ideal for each individual. – Adam Spector, DPM Dr. Spector practices in the Wheaton (301-949-3668) and Shady Grove (240-268-7450) locations. 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Foot and Ankle Specialists of the Mid-Atlantic, LLC Podiatrists Selected as 2016 Top Doctors in Northern Virginia Magazine

Foot and Ankle Specialists of the Mid-Atlantic, LLC (“FASMA”) is proud to announce that two of its podiatrists, Seth Rubenstein, DPM, and Eric Masternick, DPM, were recently selected by Northern Virginia Magazine as 2016 Top Doctors. This is the third consecutive year that Dr. Masternick has been chosen for this award, and the fourth consecutive year for Dr. Rubenstein. The annual list is made up of over 1,000 peer- and hospital panel-nominated doctors ranging from allergists to vascular surgeons. The Top Doctors list is carefully compiled and selected each year. “Along with asking all the doctors in Northern Virginia who, in their expert opinion, should be dubbed a Top Doctor, we take the process a step further by working with local hospitals and Kaiser Permanente/Mid-Atlantic Permanente Medical Group to put together panels to discriminately look at doctors who are affiliated with their institutions,” said Lynn Norusis, Managing Editor. “We asked the panels to nominate doctors based on internal evaluations, patient reviews and overall quality of care." Congratulations to our doctors!

Dr. Spector Discusses Proactive Treatment of Diabetes in Chesapeake Physician Magazine

 Adam K. Spector, DPM, was recently featured in the January/February 2016 edition of Chesapeake Physician. In the article, titled “Proactive Approaches for Treating Diabetes,” Dr. Spector comments on the importance of a multidisciplinary team approach for optimal treatment of diabetic patients. “In my opinion, neglecting to include any one discipline is a high predictor for undesirable outcomes,” he says. “As a vital member of the wound care team, podiatrists have multiple roles to play; they are usually the first physicians to recognize the significance of the ulcer. Podiatrists surgically debride necrotic tissue or drain infections when necessary – an often neglected, yet fundamental tenet of treatment.  I make sure my diabetic patients have all the other pieces of the puzzle in place. We can’t achieve long-term success for these complex patients by ourselves.” Dr. Adam Spector is a co-founder of the popular Montgomery County Road Runner Club Stride Clinic that provides a multi-disciplinary evaluation of runners; he was invited to the White House to do the same.  Dr. Spector is currently the chief of podiatric surgery at Holy Cross Hospital, and is a director of the only in-office JCAHO-certified ambulatory surgery center in the DC/MD/VA area. He has served on a local podiatric residency training program. Dr. Spector was recently voted one of the top podiatrists by his physician peers (Washingtonian Magazine, 2012). Dr. Spector is a native Washingtonian with a special interest in sports medicine. He attended George Washington University on a swimming scholarship and is presently a nationally ranked Masters swimmer.  He also has competed in triathlons, tennis tournaments and running races. He is an experienced and entertaining speaker who has published articles on topics ranging from running injuries to bunions to reconstructive surgery of diabetic foot.  Dr. Spector is bilingual in English and Spanish.