Shoe and Orthotic specialty stores are popping up everywhere. These stores carry imported shoes that may not be found in conventional shoe stores and tout the ability to make custom orthotics. Several national chains of these stores can be found in every major city. These franchises advertise heavily and claim to be able to treat a variety of medical and biomechanical conditions of the feet. The advertising and sales tactics of the stores worsened some years ago when The Centers for Medicare Services (CMS), in their infinite wisdom, decided that they would accept and pay claims by these stores for Diabetic Shoes and Diabetic Inserts.
Once the Orthotic Stores had the ability to bill Medicare directly instead of being the middle man everything changed in the Diabetic Shoes and Orthotic industry. Prior to this happening, typically the Doctor saw the patient, deemed it necessary that the patient wear special Diabetic Shoes due to certain deformities of the feet or certain other conditions that may cause foot problems and then wrote a prescription for those certain shoes and inserts for the special needs of his/her feet, and sent the patient to an Orthotic and Prosthetic Specialist who fitted the patient for those particular shoes and inserts. This is no longer the chain of events. Now, the patient may see an ad in a local newspaper touting the fact that Medicare pays for one pair of shoes per year and the patient can take advantage of that by going into the store directly. The patient may now seek care directly from the shoe salesman. No need for a medical work-up.
In most cases, the people taking advantage of this benefit are older. They intend to go to the store for the special shoes advertised. Once they are in the store, they fall prey to the hard-selling clerks who explain that they should have more than one pair of shoes and also various over-the-counter inserts. It is not unheard of to have a patient come into my office after having spent one thousand dollars for shoes and orthotics they did not need. They have already spent one thousand dollars out-of-pocket and have not yet seen a medical professional.
It is hard to understand why people choose to seek care in a shoe store rather than going to see their medical doctor or seek the advice of a foot and ankle specialist. While most health insurances will cover a visit to the doctor’s office, the visit to the neighborhood Orthotic Store is strictly self pay. Additionally, all of these stores have a no refund/store credit only policy. That means if you buy a pair of shoes or orthotics and find they do not fit well after a few days, you can return the item, but only for store credit. You must then choose something else in the store to buy.
The ability to service Medicare patients allowed the stores to then start advertising to other people. They propound the ability to make Custom-Molded Orthotics for everyone. They tout special computer systems that analyze foot structure during gait and design special orthotics. In reality, the orthotics that are dispensed at these stores are off-the-shelf devices that are bought in bulk. They are fitted according to shoe size never taking into account differences in structure from feet to feet. I am appalled when patients present and take these orthotics out of their shoes and are certain that they are custom molded. I then turn the device over and show them the European sizing on the back. These same devices that can be ordered from a Foot Specialist’s office for as little as $25 a pair are being sold for $280 a pair at the Orthotic Stores. Additionally, if the patient continues to have pain and goes back to the store, often they are told that although the orthotics fit well, they need a different type. They are then sold a second pair of orthotics that are also over-the-counter. This is hard to imagine but it is happening every day. The Chain Orthotic Stores are reaping huge profits. Their ad campaigns are extensive and very successful.
Because these stores carry various types and brands of shoes found nowhere else, their ads will make unrealistic claims about special shoes that are designed to do various things. Some examples: shoes that specifically treat Plantar Fasciitis, shoes that specifically treat Hammertoes, shoes that treat Tarsal Tunnel Syndrome, shoes that give you a workout while you do your everyday walking, shoes with springs in the heels or the entire sole of the shoes, shoes with rocker (rounded) bottoms that will energize your feet and legs and many more. If you want to see more, just read their ads. None of these claims are true. There are no such benefits to these shoes.
There is no evidence of these unethical practices being challenged in the near future. For now, this is a large problem facing all Doctors of Podiatric Medicine. Most will not or cannot (financially) advertise as much as these stores. Therefore the “sale” of medical services is lost to the Orthotic Shoe Store.
The bottom line:
The people at the Orthotic Shoe Store have very little medical knowledge. They are, after all, shoe salesmen who work on a commission basis. They intend to make the biggest sale they can. Buyers beware.