Cost of Orthotics/ Alternative Treatments for Plantar Fasciitis

[Jolie, BSN]

Hi All,

I am looking for some input for my sister. This is her story: She lost her job a few months ago, and with it, her insurance coverage. She is now employed in a new field, but has a 3 month wait for insurance benefits. Her new job requires her to be on her feet all day, which is new for her. She began experiencing severe foot pain, and made an appointment with a local orthopedic group which is a multi-specialty practice. She THOUGHT her appointment was going to be with a podiatrist, but it wasn't. It was with a new, and rather pushy orthopod, who diagnosed her with plantar fasciitis, and told her that her treatment would consist of custom orthotics which would cost $800. No discussion of stretching exercises, icing, flexion boots at night, taping, NSAIDS, OTC or semi-custom orthotics, or PT. Just straight to very expensive custom orthotics.

When my sister relayed her insurance information and asked to wait a few months for insurance coverage to begin, she was told that the group didn't accept her future insurance plan, but would discount the orthotics to $500 if she paid in cash. When she questioned the cost of the orthotics, she was told that it was justified since casting was necessary. My sister indicated to the doc that she might want to "shop around" for price on orthotics, and was told that no respectable group in the area would accept her future insurance, so she just needed to make an appointment and get going on the orthotics.

Now, I hate to be a skeptic, but I think I smell money grubbing here. My mom recently had custom orthotics made by a reputable podiatrist in a near-by town, and was charged roughly $300. This group my sister saw used to have a good reputation (I saw them 2 years ago when I blew out my knee.), but they lost some experienced docs, hired on some new ones, let other employees go, and stopped accepting a number of local insurance plans. I can't help but think that they must be experiencing money problems which might be eased by over-charging cash patients for services.

I suggested that my sister call the orthopod back and request a PT referral. One or two sessions ought to be enough to learn some exercises, icing, positioning, and taping techniques that might be sufficient to relieve her discomfort while she awaits insurance coverage. She is also checking with her future plan to see if they have any participating podiatrists in her area.

Any thoughts?

[steelcityrn, RN]

S.A.S. makes a great shoe that can have a lift placed in it . A store near me molds the foot and builds up the shoes for free! The shoes are around 90 - 100 dollars a pair, and never seem to wear down. All leather shoe. And another thought I had was your sister is working her feet hard on this job, its going to take time to get used to that. A good support hose and see if her dr will allow her to take osteo-biflex (1500 mg per day).

[tvccrn, ASN, RN]

I think your sister has a very intelligent sibling. It does sound like this MD is out to make some money somehow and doesn't care about the patient one bit. Every time I have gone in for my foot problems (and I have chronic achilles tendonitis so that's quite frequently), the first thing they mention is the PT, NSAIDS, icing, etc. I would advise your sister to run (as fast as possible with the pain LOL) not walk to another doctor.

tvccrn

[P_RN, ADN, RN]

Dr Scholl's arch supports $10.00 at Walmart and a frozen water filled plastic pepsi bottle to roll her painful arch on. Now do I get the other $790?

[TracyB,RN, RN]

Hey Jolie. Sounds like your sis is seeing a money hungry jerk!!!

Anyway, my little tumbler has Sever's, dx'd after she was casted for a broken heel. The pain still occurs, but mostly with growth spurts...Rest, stretching, icing & NSAID's were the first recommendations. She wears Tuli's Cheetah Neoprene supports with a heel cup sewn into it when she's tumbling. They even sent an extra pair of the heel cups for her shoes, which she uses religiously. One of the dad's at tumbling is a chiropractor, who does electronic accupressure on her heels when she's having a bad flare up. She will ice before & after practice. We try to avoid the NSAID's whenever possible.

http://www.orthomedicalsupplies.com

This site has some good info on plantar fasciitis.

MediDyne also makes a product called the dual step stretch, which has worked ABSOLUTE wonders for my little one's heel problems. With the daily stretches & icing before & after practice, she has only had one flare of pain severe enough to sideline her tumbling in the last 4 months. And she's in the gym for 6 hrs a week, sometimes more.

Maybe a good chiropractor can fit her for something.

[cdunn1014]

I know this sounds crazy but my plantar fasciitis NEVER hurts while I wear my CROCS at work. I learned this from a fellow traveler in California, where 95 % of the nurses wear them. They are only $29.95, cheap in comparison to all the medical routes. It is amazing the relief I got. Try it !!!

[EricJRN, MSN, RN]

I used to work for an FP who recommended cowboy boots for mild to moderate heel spurs or plantar fasciitis. We're in Texas, but that treatment might not be as readily accepted in some places.

[TLC RN]

Tell her to get a new doctor. Don't even bother with that last orthopod or whatever they are. What Dr cuts his price when you tell him you want a second opinion?

I had PF and went to the a podiatrist. He had me do stretches, Icing, gave me some steroids for a couple weeks and made custom orthotics from casts of my feet. He said the orthotics will last a lifetime and I should only have to recover them. I think my insurance at the time paid for the visit but I had to pay out of pocket for the orthotics...total cost $300.00.

A good Dr would give her some ideas on how to deal with the problem till her insurance kicked in or offer her a payment plan on the orthotics.

Have her call her insurance company to be and find out who are some podiatrists her insurance covers and start over with them.

Tell her good luck and get away from the shyster!

[brewerpaul]

Glad to hear so many kind words for podiatrists, since I AM one :-)

(going for my RN at night school with an eye toward semi-retirement)

$800 is 'WAY too much for orthotics, and you're right that other things should be tried first or in addition to orthotics. For a new PF patient I prescribe stretching, NSAIDs if there are no contraindications. I also do adhesive strapping of the foot and place felt pads on the shoe's insoles as a sort of temporary and experimental orthotic. All heel pain is NOT PF, and I'd rather make sure my treatment rationale is correct before I recommend orthotics ($325, including a full biomechanical exam, impressions for the devices and follow up visits for dispensing, adjustments and repairs for a year {and I'm flexible about that}). I haven't had much luck with night splints-- patients hate them.

Spenco medical makes a very good OTC orthotic. The one you want is a green layer of the Spenco cushioning material, and a black plastic semi-rigid shell underneath. They cost somewhere in the $20s, and for people with mild foot defomities, they work quite well. For people who really can't afford custom orthotics, I'll often add padding to these to customize them. Check http://www.spenco.com/ for a local dealer.

[BittyBabyGrower, MSN, RN]

Tell her to also always wear shoes, even in the house! I have a pair of isotoner slippers that have arch support in them, and I wear New Balance or Birkies. I have to use arch support in my other shoes too.

[Jolie, BSN]

Thanks so much for all the info! It's been 20 years since I've worked Ortho, so I think my sister is a little wary of my advice, but she'll probably accept the input of total strangers :)

She's going to check the dress code to see if she can wear Crocs to work. I agree they're wonderful!