10/08/2014    Jeffrey Root

APMA Enters into Agreement With PFA (William Deutsch, DPM)

I’m glad that my letter regarding the affiliation
between the APMA and the Pedorthic Footcare
Association (PFA) sparked a response from Dr.
Deutsch since the primary purpose of my letter
was to bring this poorly defined relationship
further into the spotlight for additional
consideration and discussion. I have been a
staunch supporter of podiatry my entire adult
life as my career with a prescription foot
orthotic laboratory began while I was in my teens
over forty years ago.

On several occasions, I have voiced my concern
here on PM News about the future of prescription
foot orthotic therapy in podiatry and I have
argued with those who have suggested that
orthotic therapy should be left to others,
including “shoe sales people” and other non-
medical providers. Because of their unique
education and training, I see no other profession
as qualified as podiatry to treat lower extremity
related pathology with foot orthoses. In
addition, foot orthotic therapy is often used in
conjunction with other methods of medical
treatment that can’t be provided by non-medical
providers.

Personally, I was shocked that the APMA was not
defending and protecting prescription foot
orthotic therapy as a part of the podiatric
domain. However, my reasoning isn’t based on
economics but rather on the quality of patient
care. Foot and lower extremity pain can be a
symptom of many conditions. How can non-medical
providers of foot orthoses diagnose and treat the
cause of pain without proper medical training,
licensing and the necessary diagnostic tools and
equipment such as X-ray or the ability to refer a
patient for lab work or other diagnostic
procedures such as an MRI?

It is clear that if podiatry voluntarily or
involuntarily evacuates a niche, those necessary
services will be filled by other providers.
Prescription foot orthotic therapy, when done
properly, requires an understanding of
biomechanics and other aspects of medicine and
science. Foot orthotic therapy does not exist in
a vacuum. One must consider the entire patient
and not just the symptoms as evidenced by the
podiatrist’s critical role in diabetic foot care.

While some podiatrists may refer their patients
out for orthoses, why would they not send them to
another podiatrist who specializes in orthotic
therapy rather than to a lesser qualified, non-
medical provider? The reason is they fear they
might lose the patient entirely. Just like
podiatrists, pedorthists provide many valuable
services and the two can have a symbiotic
relationship. However, if pedorthists are to
become direct providers of foot orthotic therapy
then I believe they must become properly
qualified. It seems irresponsible to refer
patients to any provider who isn’t qualified.
While pedorthists are qualified to fabricate
orthoses, they are not truly qualified to
examine, diagnose and prescribe like a
podiatrist. My previous letter was meant to
elucidate this dilemma in the interest of proper
patient care.

Although some foot orthotic laboratories embrace
the affiliation between the APMA and the PFA at
the National Conference because it has the
potential to increase their business and
consolidate marketing expenses, I am deeply
concerned about the quality of patient care. Just
as podiatry has evolved over the years, so too
has pedorthics. I applaud the PFA’s effort to
improve their certification requirements and the
quality of their continuing education programs.
However, I believe the APMA and the profession of
podiatry need to take a good hard look at the
role of orthotic therapy in podiatry and just who
is most qualified to provide this service. I hope
this affiliation leads to some healthy discussion
and a more clearly defined role and relationship
with pedorthists and the PFA. For the record,
this letter represents my personal opinion and
does not necessarily represent the position of
PFOLA or some of our member laboratories.

Jeffrey Root, President, PFOLA, jroot@root-
lab.com

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