A Walk in Their Shoes

Pedorthists must have a wide range of inventory in order to strike a balance between catering to their patient’s wants and providing what their patient needs.

We have all endured the agonizing pain at least once in our lives. We have all looked down at our feet and asked ourselves, “Why did I ever buy these shoes?” It could be high heels at a wedding reception, wingtips at a job interview or sneakers during a basketball game with friends. The scenario is interchangeable but the pain is unforgettable. Ill-fitting shoes can be an annoyance for a night, or cause blisters and sores that could jeopardize long-term foot health. For the pedorthist, providing orthopedic shoes that relieve pain while also satisfying the consumer’s call for style is the ultimate challenge.


“Those of us who have the inventory, can provide for all lifestyles and we can do that because we are carrying shoes that fulfill the needs of people that other stores do not carry,” Robert Schwartz, CPed, president and chief executive officer of Eneslow Pedorthic Enterprises Inc., said.

Schwartz, a certified pedorthist for 36 years, integrates his knowledge of the industry, customer base and location into his choice of inventory.

“New York is a city of walkers and it is a concrete city, so you have to wear shoes that are comfortable,” Schwartz explained to O&P Business News. “What separates the pedorthist is the ability to give the customer a correct fit and provide the right ancillary products to give them even more comfort, function and support. You will not be able to take care of your customers, either with or without a prescription, if the pedorthist does not have the proper inventory.”

Is the pedorthist finding solutions for the patient and thus enhancing their experiences, or are they simply dispensing footwear?

“We are not retail shoe salesmen,” Dale Cohen, CPed, at George Allen Shoes said. “We work with medical problems of the foot. We do not sell that many pretty shoes here.”

Cohen contends most of his patients are at risk or have serious foot problems, such as diabetes or neuropathy; therefore they are not as concerned with the style of their orthopedic shoes. Most patients simply want pain relief.

“A lot of people come in here with different types of foot problems because they wear inappropriate shoes,” Cohen said.

Still, Cohen has a selection of more than 500 shoes at his store and he has heard the negative feedback of orthopedic shoes, in terms of style. He cautions his patients – health before vanity.

“We tell our patients that we are a medical shoe store and if they have come to see us then they did so because they are having distinct medical problems with their feet or they have been referred to us by a physician because of those medical problems,” Cohen said. “This is not a fashion contest. We are doing this to save their feet.”

A Better System?

According to Dale Cohen, CPed, at George Allen Shoes, a new Medicare billing service requirement has changed the way pedorthists can provide care for their patients. The Provider Enrollment Chain and Ownership System (PECOS) is an internet-based Medicare provider enrollment process that is available to physicians, non-physician practitioners and provider and supplier organizations in all 50 states, according to the Centers for Medicare and Medicaid Services (CMS). Starting Jan. 4, 2010, if the ordering or referring durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provider is not in the new PECOS system, the claim will not be paid and will be rejected, according to CMS’s Web site.

If a patient comes to Cohen with a prescription for orthopedic shoes from a doctor that is not in PECOS, Cohen will have to inform the patient that Medicare will not pay for the shoes. This will be a major blow for the patient, who may not be able to afford the shoes out-of-pocket. For the pedorthist like Cohen, this could hurt his business’ bottom line. Also, investigating whether the doctor who wrote the prescription is in PECOS will be time consuming. This will ultimately take time away from their practice. As a pedorthist, Cohen is used to jumping through hoops and understands the beureacratic process but he is doing everything he can to comply with the new system.

“We are going to be proactive and tell our doctors that they better sign up for PECOS otherwise their prescriptions will be worthless in January,” Cohen said. “We think about everything, but right now, our hands are tied.”


Consumer compliance

“I tell my patients that you won’t go home, wear the shoes for 8 hours and be cured,” Cohen explained. “I tell them exactly what I want them to do. I describe in detail what I expect them to be experiencing.”

Education is an important aspect of a pedorthist’s job. Pedorthists must be able to talk openly with patients about circulatory problems, sores, infections and amputations. Before the sales process and dispensing footwear for his customers, Cohen explains wearing instructions and his own goals and expectations for the orthopedic shoes. According to the Practice Analysis of Certified Pedorthists conducted by the American Board for Certification in Orthotics, Prosthetics and Pedorthics, 36% of a pedorthist’s primary work is patient care. This would include patient assessment, treatment plan formulation, implementation and follow-up patient care.

According to Schwartz, the educated patient will have more options and greater control over their own destiny. The pedorthist gives the patient the tools to manage themselves. This is a great responsibility for the patient.

“The majority of my patients are senior citizens and they are willing to listen,” Cohen said. “We do have some trouble with younger patients, but if someone is at risk of trauma to their feet or in great pain, they will listen.”

The patients that do listen generally have one thing in common – pain. An individual who heeds the advice of a pedorthist is usually one that is seeking pain relief or a new and comfortable type of shoe.

Cohen sits down with his patients and finds the specific location of the pain and type of pain. He then works with the patient to find the right shoe or orthotic to alleviate the pain.

“Pain is the doctor inside all of us,” Schwartz said.

But what if you can not feel the pain? This is the case for patients with neuropathy and diabetes. One of the major symptoms of neuropathy is a loss of sensation in the feet. Diabetes patients with neuropathy who discover sores or blisters must immediately contact a doctor. Sores and blisters on a neuropathic foot can cause major foot damage and even amputation if ignored or left untreated.

“I tell my diabetic patients, either wear my shoes or risk an amputation; the rest is up to them,” Cohen said.

Personal responsibility

Cohen discusses compliance with his patients and reminds them that once the orthopedic shoes are broken in, they must always be worn.

“If you wear my shoes one day and your shoes the next day, we’ll never know if what I am doing is working,” Cohen said. “Your body will not have a chance to adjust to the new situation.”

Schwartz understands that not all customers will follow his every word and that once they walk out of his shop, there is nothing he can do.

“Some people will upset you because you see them deteriorating and you have no control over it; some of them will make you feel like you accomplished something very special and unique,” Schwartz said. “You really care about their health and well being, but you are not them. It is all about discipline and personal responsibility. You do not change [the patients], they change themselves. We just provide the tools for them to do it.”

When dealing with a patient who wants not only pain relief but also style, Cohen is reluctantly willing to compromise.

“If you meet me halfway in what I am trying to do medically, I will try to meet you halfway in the looks department,” he said.

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Anthony Calabro is a staff reporter for O&P Business News.

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