By Denise Napoli

For practitioners and facility owners all over the country, trade in shoes and foot orthoses is busier than ever. But the reality of the shoe business, as O&P facility owners know well, is that profits aren’t nearly as big as in O&P. 

“We all know where we make the money, and it’s not the foot orthoses,” says Debra Anderson, CO, owner of Sawtooth Orthotics & Prosthetics Inc. in Boise, Idaho. After her on-staff C.Ped. left the practice some time ago, she made a business decision not to replace him and to stop doing shoes altogether. 

Looking back, it was a bad choice. Some doctors thought she was dropping the ball by narrowing her practice’s scope, and many of her O&P patients went elsewhere for their shoe needs. “Kicking and screaming, I’ve been led to the point where we really do need to see this patient population,” she says. 

Though reimbursements are low, there may be much to gain from expanding your shoe business with an on-staff certified pedorthist. More and more facilities are finding the demand for shoes great enough to warrant hiring a practitioner who deals exclusively with feet. And often, practices are looking to pedorthists—not just orthotists—to fill that role. 

Right for your practice? 
John H. Reynolds, CPO, FAAOP, can’t believe how fast his Maryville, Tenn. practice’s shoe trade has grown, no thanks to him. “I don’t market shoes,” he says. “We do not promote shoes at all, and yet it’s become a huge part of our business.” 

His solution? “We do have plans to hire a pedorthist. We are moving in that direction,” he says. 

“With the rise of diabetes and traumatic foot and ankle issues, you need to be as best educated and as well-armed to care for the lower extremity patient as you can be,” says Roger Marzano, CPO, C.Ped. Judging by the 1.5 million new cases of diabetes in people 20 years or older in 2005 (according to the American Diabetes Association), being “well-armed” will likely mean making important changes to your practice. 

Anderson’s decision to hire a new pedorthist came about after some rigorous number crunching, when she realized that not having a pedorthist on staff was costing her more in referrals and business than her practice could afford. 

“For the sake of the business, this just had to happen,” she says. “There is a critical point where you need to either get a C.Ped. or, in my case, do what I’m doing, training one of my technicians.” 

From both a business and a clinical perspective, the practitioners interviewed for this article are making the case for integrating a pedorthist into an O&P practice. Below are some of their best reasons. Should your practice be making the same move? 

1. Increase your referral sources. On the business side, one of the best reasons to add a C.Ped. certification to your roster is illustrated by Marzano, who recently attended a podiatry seminar in Cleveland, Ohio. Marzano was the only invited speaker who was not a doctor. “There are probably 75 referring physicians in this crowd who are saying, ‘Boy, Roger really knows what he’s talking about,’” he says. “If they’re inclined to refer a patient, they’re probably going to refer to me. 

“The field of pedorthics helped me be asked to speak at a program of this magnitude,” says Marzano, who works for Yanke Bionics. For his practice, integrating C.Peds has resulted in a drastically expanded referral source pool. 

2. Step out from your competition. Having a certified pedorthist on staff is a good way to stay competitive with other practices that may not boast that credential. “To find someone who can construct a well-made custom shoe or manage a rheumatoid patient, that’s not something that can be done at every O&P practice,” says Marzano. Having a certified pedorthist on staff makes a practice stand out from the crowd of competing O&P businesses. “Yanke Bionics has nine [competitors] within a 30-mile radius. We’re thriving in spite of that.” 

3. Good for the bottom line. But why not hire another orthotist who’ll be able to perform multiple tasks for your company, not just those that are foot-related? According to anecdotal evidence as well as a 2001 Board for Certification in Pedorthics (BCP) study, pedorthists are often paid less than orthotists (likely due to lower reimbursements and a specialization that limits their workload). Therefore, if your practice does a brisk shoe business, or a brisk brace business and a moderately busy shoe business, hiring a pedorthist could be a significantly cheaper investment—for now. See “Looking For A Few Good C.Peds,” below , to find out how this is changing. 

4. Keep connected with patients. “There are O&P facilities that basically tell people to go out and get a shoe,” says Dennis Janisse, C.Ped., past president of the Pedorthic Footwear Association (PFA). “With a C.Ped. on staff, a business can bring more revenue into a facility and keep control of their patients. You want to be one-stop shopping, to be able to offer everything [O&P-related].” 

5. Let orthotists do the work for which they’re uniquely qualified. Dan Tysver, CPO, co-owner of Great Steps Orthotic & Prosthetic Solutions in Sartell, Minn., does not currently have a C.Ped. on staff. “We feel our orthotists are qualified to see patients for the diabetic shoe program,” he says. But as his practice encounters an increasing number of these types of patients and his business grows, he says he’ll likely think about hiring a C.Ped. to help keep up with the workload. Staffing a pedorthist will free up Tysver’s four on-staff orthotists to do the work no one else on staff can do. 

Anderson takes it a step further. “I can only speak for myself and from 30 years in the field, but I did not go into orthotics to do feet. It’s a rather unusual CO who will be satisfied seeing the bulk of his or her patient population from the ankles on down.” 

6. The patient wins. For some, having a pedorthist on staff leads to a totally new outlook, one that embraces shoes as part of a well-rounded approach to patient care. “I think the biggest benefit of incorporating pedorthics into an O&P practice goes to the patient, because it allows our practitioners look at the foot as part of the whole body instead of as a separate entity,” says Marzano. “We feel that we’re better O&P practitioners because of our pedorthic background.” 

Janisse agrees. “The shoe is such a necessary part of any lower limb orthosis or prosthesis. The shoe is the foundation. If what’s on the bottom—the shoe—isn’t proper, there’s a good chance that that device may not function properly.”