Chiropractors Guide to making money with Orthotics by a Podiatrist

Chiropractors do lots and lots of orthotics.  As a chiropractor there is no need to tell you that the foot and the back are intimately related.  So, getting a patient into a pair of orthotics is usually a necessity to curing what is bothering the patient.  Whether you have diagnosed a limb length discrepancy, flatfeet or over pronation, many causes of back pain can be emanating from the feet.

Additionally, orthotics can be used as a revenue generator by a chiropractor, so at the same time you are helping patients, you can generate revenue for yourself.  Now there are two types of orthotics Chiropractors can use over the counter or custom.

Over the counter orthotics are similar to orthotics that can be purchased at Wal mart or any drug store.  The only thing unique to the orthotic is the size of the foot the orthotic will be placed on.  These can be ordered over the Internet and placed for sale in your office.  I do not believe personally it is wise to offer an orthotic for sale for any amount greater then thirty dollars.  Over the counter orthotics are not covered by insurance anywhere, so these are strictly an out of pocket expense.  Generally, it is best to have display that the patients can see, and a stock of enough of the most common sizes.  I would avoid using Dr. Scholls products as those are available in most pharmacies and Wal Mart.  I have listed a couple brands below.  Remember, most of these brands when you buy in quantity will lower their price.

Now Custom Orthotics are a whole different ball game then over the counter orthotics.  These can be covered by insurance but they also require a great deal more of work.  One of the keys to these orthotics is to make a mold of the patients foot.  This can be done one of three ways.

One way is to purchase a bio foam box.  The patient places their foot in the box, in subtalar neurtal position.  The chiropractor then mails the orthotic to the orthotic lab of their choice or have an orthotic created.  The biofoam boxes are fairly inexpensive and can be purchased many places.  I have placed two such places beneath these paragraphs.  You can generally charge between 200-300 dollars for these orthotics and your foam and lab fees should not exceed anything greater then seventy dollars

Another way, to cast the orthotic is via actual casting with plaster.  This is considered the most accurate way to cast orthotics.  However, the person doing the cast must know what they are doing, otherwise you will produce a bad orthotic.  The key to the cast is the subtalar joint must be kept in neutral position.  You can actually bill for the casting process of the procedure.  Like the biofoam process, the cast is sent to an orthotic lab for manufacture.  You can charge for casted orthotics as much as 300-400 dollars.  However, if you have no experience casting you need to practice and get experience with a practitioner that casts already, before attempting to cast for a patient.  Casting for an orthotic is very operator dependant.  Here are some places where you can purchase casting material.

The third way to create a orthotics is via a scanning method.  Their are multiple companies that have created gait scans to capture a patients pathology on their feet and biomechanical issues.   These scanning machines typical cost a couple hundred to thousand dollars depending on the model, the chiropractor chooses.  Generally, you have to use the company to fabricate your orthotics that you purchased the gait scan from.

Now billing for custom orthotics can be difficult, so I have provided some links for the chiropractor and billing for orthotics.
http://www.casd.us/Files/casd_orthotic_billing.pdf
http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=52105

Chiropractor's Guide to treating an Ankle Sprain by a Podiatrist

Chiropractors should not fear ankle sprains.  99% of ankle sprains are self limiting and will get better regardless of the treatment that is rendered.  The Chiropractor approach to the ankle sprain should be about treating the acute injury and then strengthening the effected ligaments via Physical Therapy.

An Ankle sprain's initial presentation generally are from a sporting event such as basketball or soccer.  The player cuts and turns his ankle.  Generally the ankle will appeared swollen with possible discoloration.  Purple discoloration does not mean that the ankle is fracture it only means there has been some trauma to  the area.  Initial treatment of the sprained ankle should include ankle X-rays.  If you are not confident in reading Ankle X rays to check for fracture, you should not be treating ankle sprains, refer them to a podiatrist.  Other signs that would indicate fracture are extreme pain and the complete inability to place weight on the effected extremity.  Following that a Chiropractor should palpate the ankle ligaments, with specific attention paid towards the Anterior Talo Fibular Ligaments and Calcaneofibular ligaments, those are the two most likely to be torn.  A torn ligament does not require surgery it is a normal pathology present in an ankle sprain.  Here is an example of an Ankle Sprain examination:

Following the exam the first treatment of an ankle sprain, is to have the patient initiate the RICE formula, which means Rest Ice Compression and elevation all of which can be accomplished easily.  Here are some products you might stock to help the patient, most of these insurance will not reimburse for:

Following that the goal is to reduce the swelling, the Chiropractor should not perform physical therapy while the ankle is still swollen.  The swelling will generally reduce in 48-72 hours post injury.  But to be safe wait a week before being the ankle physical therapy.  Prior, to the Chiropractor beginning Physical Therapy, he should place the patient in an ankle brace of some make, in order to give compression and support to the injured ligaments.  Some of these braces are reimburse from insurance greater then 100 dollars.  Here are some examples:

In addition to the brace, the Chiropractor at this time should begin Physical Therapy and the sprained ankle as demonstrated here:

Now if after 4 weeks the patient still complains of pain at the time the Chiropractor should refer that patient to a Podiatrist.  As other issues may be going on with the patient such as an undiagnosed fractures, or ligaments that need to be surgically repaired.

A Guide to Chiropractors who treat Diabetic Neuropathy by a Podiatrist

The question is should Chiropractors treat Peripheral Neuropathy that is metabolic in nature and not occurring due to a spinal deformity.  These type of Neuropathies would include Diabetic, Cancer, Syphilis, Vitamin deficient or Alcholic Neuropathy.  All those conditions arise from a metabolic condition in the body that no spinal adjustment with correct.  Is there anything a Chiropractor can do for Diabetic Peripheral Neuropathy? The answer is yes and no.  The only proven treatments for Peripheral Neuropathy are drugs such as Lyrica, Cymbalta or Neurontin.  So when the patient presents the first question should be; have they tried these medications, and if the answer is no.  The patient should be referred to a Podiatrist or PCP so they can get on these medications.  However, that does not mean adjunct treatments cannot be performed in the mean time to help the patients.  Additionally, when the patient is on the medications, the Chiropractor can offer other treatments to help relieve the symptomatology of painful Diabetic Peripheral Neuropathy.  For further information on Peripheral Neuropathy, the Chiropractor may want to read the following books:

Now the first treatment, the chiropractor should start with is physical therapy, or stretching for the Neuropathy.  One of the worst problems that develops with neuropathy is an atrophy of the legs, due to the pain and not walking.  So any exercises and movement for the patient who suffers from Neuropathy is a positive.  Here are some examples of possible Neuropathy exercises to be performed:

Now another treatment that does under physical therapy is Anodyne treatment for the lower extremity.  Anodyne is not covered by Medicare but can be billed under a physical therapy code.  Anodyne has been shown to demonstrate improvement in the Neuropathy symptoms.  Anodyne is simply lasers directed at the feet to warm them an increase sensation as seen here;

The machines are not that expensive anymore, and they do require the patient to come in for regular treatments.  Here is a machine that only retails for about 130 dollars so after one patient and eight treatments, you will already be making a profit.


Another option for treating Neuropathy would be to sell a patient, vitamins to help suppliment their treatment.  Regardless of what you have heard there no facts, that vitamins are successful in the treatment of Neuropathy.  That does not mean they cannot be tried and sold to the patient for a reasonable profit.
Here an example of a few vitamins you can offer to patients:

Chiropractors Guide to Treating Achillies Tendonitis

Achillies Tendonitis should be a natural condition for Chiropractors to treat, but for some reason they get nervous and the term "achillies".  There is no reason to be.  Achillies Tendonitis is a simple condition that almost always responds to conservative treatment.  The presentation of Achillies tendonitis is pain on the posterior portion of the heel where the Achillies inserts into the Calcaneus.  The patient will often complain of difficulty and aggravation in the Achillies when climbing hills or descending hills or stairs.

Upon presentation to the Chiropractor it will be important to get them on some kind of anti inflammatory such as Motrin or Ibuprofen.  Then begin a stretching regimen such as above.  Then you will want to get the patient into a heel lift of some sort they can generally be purchased and then re sold to the patient for a small profit, such as these
Personally I would purchase the Spenco brand for Achillies Tendonitis.  If this is unsuccesful in treatment send them for an MRI, and if it does not further respond.  Then refer to a Podiatrist for further intervention, but the key here is that 90% of Achillies Tendonitis will resolve with simple conservative treatment as listed above.

Chiropractors guide to treating Pump Bump, Haglund's deformity or Retrocalcaneal exostosis

Chiropractors sometimes recoil and the sight of treating a Retrocalcaneal exostosis or Haglund's deformity.  What they are essentially are is a growth on the posterior portion of the heel where the Achillies Tendon inserts into the Calcaneus.  They can be extremely painful and ruin shoes.  This video here explains the condition very well:

Now the first thing one should do as with most treatments chiropractor's perform is it to start the patient on stretching exercises, a great deal of pain can be caused by the Achillies just being tight, by stretching out the Achillies you may reduce the pain.  Here are some stretching exercises. (above)

Now after you perform that the next thing is to address the etiology of the pain, which is caused from the bump on the patients heels rubbing against the back of the shoe.  One of the simple treatments is to insert a heel lift into the patients shoe as seen here
After that if that is not successful is get the patient into some crocs, by taking away the back of the shoe, that will take away the etiology of the pain and will allow you some residual income.  You can even have a croc display to sell to your patients.  Crocs are a revenue sources that no Chiropractor should be without, here is an example, if you mark these up just 5% it should help with revenue

I hope this helps Chiropractors in their treatment of Retrocalcaneal exostosis.

More Chiropractor Solutions to Plantar Fascitis

There are many things that Chiropractors can use in addition to Night Splints by patients for Plantar Fascitis. An Arch pad is something that wraps around the foot and supports the plantar fascia during gate can be used and give relief from Plantar Fascitis.  These tend to be inexpensive and widely available, as seen here:

One can offer these to a patients for under ten dollars and still make a profit. What can you do in the office what exercises and equipment can you use in your office. There are multiple options and equipment, you can use. This equipment all works the same way by strengthening and extending the plantar fascial ligament.

As one can see there are many options for the Chiropractor who is treating plantar fascitis to use and no reason, that a chiropractor can not be successful in treating plantar fascitis.

A guide to Chiropractors on the use of Night Splints in Plantar Fascitis

So, you have tried orthotics, advil and stretching for plantar fascitis or heel spur syndrome with little to no success with the patient.  If you are out of idea consider the use of a Night splint to help with the plantar fascitis.  Night Splints are inexpensive and occasionally covered by insurance.  The night splint holds the plantar fascitis at ninety degrees, thus relaxing the ligament and stretching the ligament to help with the discomfort.  These tend to have a great deal of success and there are multiple brands of plantar fascitis.  As said you can bill the insurance of the patient for 5-10 dollars over cost.