Orthotics for Correction and Pain Relief
When treating a foot and ankle problem there are 2 options. We can either change the environment around the foot or change your foot. Otherwise Protection vs Correction. OK, the third option is to do nothing. If you are reading this or coming to my office, this is not really a choice. Our preference is to avoid “changing the foot”. Changing the foot means using a surgical procedure to fix the issue. Instead, we first try to “change the environment” using conservative treatment options. Being able to avoid surgery depends on the degree of injury and length of inflammation. Both of these factors determine the extent of damage. We have many different tools we use to achieve this goal. One of these tools is custom orthotics.
Custom Orthotics Program
We try to use conservative treatment whenever possible and appropriate. To that extent, we have created a Custom Orthotics Program to inform patients how custom orthotics may be an option to treat heel pain, bunions, and ankle pain.
What Are Orthotics?
Simply put, orthotics are shoe inserts (low profile braces) that improve the way the foot works. Faulty biomechanics will lead to structural or mechanical problems. A foot that collapse inward (click the link to see the flat foot video) has the same effect as trying to hold a heavy bag of groceries with your arm extended far out to the side (click the link to see how this works) instead of close to your body.
Unfortunately, most of the over-the-counter inserts are glorified foam fillers. If you can fold an insert in half, they will have little mechanical control. There are a few OTC (Over the Counter) inserts that are solid enough to provide some control of the foot. If a foot only requires a small amount of correction, an OTC device may be helpful. These devices are not the same as orthotics prescribed by a doctor. Unfortunately, by the time a patient comes to see me they are usually past this stage.
Will Orthotics Work for Me?
Unfortunately, not everyone responds to orthotics. These devices are labor-intensive to make and are not inexpensive. Wouldn’t it be nice if we could find out who will and who will not do well with Orthotics? That is exactly what we do. There is a test to see if Orthotics will be beneficial. We use athletic taping (also called strapping – not the Boomer type of strapping. OUCH!). This changes the way the foot works that is very similar to an orthotic. Typically, the taping is a 5-day trial, and changes are recorded in a taped diary. There is a certain percentage of improvement that indicates if biomechanical control is a good long-term option.
More aggressive bracing may be required if there is a severe collapsed foot. This is called Foot Ankle Orthosis. (AFO) is for the aggressive collapse of the foot and ankle.
Does Insurance Cover Orthotics?
Many patients are surprised to learn that insurance does not cover modern custom orthotics, and we understand how frustrating that can feel—especially when orthotics are prescribed to relieve pain, improve mobility, or prevent further foot problems.
Our practice uses the latest generation of custom orthotics, created from a precise 3D scan of your feet and manufactured using advanced 3D-printing technology. This allows us to design a lighter, more accurate, and highly customizable orthotic that matches your foot structure, diagnosis, and activity level far better than older designs.
Unfortunately, insurance coverage for orthotics has not kept pace with technology. Insurance plans require a specific billing code (L300) to provide coverage. At this time, no insurance code accurately represents modern 3D-scanned and 3D-printed custom orthotics. Without an appropriate code, insurance plans are unable to offer coverage—regardless of medical necessity.
The orthotic code most commonly recognized by insurance (L3000) applies to a traditional design developed decades ago (1960s), often referred to as a University of California, Berkeley (UCBL)–type device. While some insurance plans may still cover this older style of orthotic, it is not the same device we prescribe or fabricate and does not reflect current materials, manufacturing methods, or customization options.
For this reason, our custom orthotics are provided as a self-pay service. This approach allows us to recommend the orthotic that is truly best for your condition—without being limited by outdated insurance requirements or design restrictions.
Many patients choose to use HSA or FSA funds for their custom orthotics when eligible.
If your insurance plan specifically covers a traditional UCBL-type orthotic, we can provide a prescription so you may pursue that option through a pedorthist or other covered provider. Remember to look for a “Charlie’s Angels” or “Brady Bunch” poster on the wall.
Decisions Decisions Decisions…
After we see how much improvement there is from the taping, we will discuss Orthotic therapy as well as other options. Although Orthotics may not be the only treatment, they are a simple option with a very high success rate.