When Those In-Store Shoe Inserts May Not be Right for You

Summer 2012
When Those In-Store Shoe Inserts
May Not be Right for You
Custom versus Off-the-Shelf
A
BY MIKE BERTALAN, L.P.O., C.P.O.
s a licensed orthotist, I design,
manufacture and apply braces
and orthotic devices that
support or correct the function
of a patient’s limb or torso. Patients can have
physical impairment from a stroke, spinal
cord injury or a congenital abnormality
like spina bifida or cerebral palsy. They are
referred to us by a physician, and we create
the best, and sometimes very complicated,
orthotic solutions to address their needs.
Many patients need less complex orthoses,
such as custom wrist splints, ankle and
knee braces and corrective shoe inserts. All
of these devices control, guide, limit and/
or immobilize an extremity, joint or body
segment for a particular reason.
Being in the medical field, I am frequently
asked by friends and family about the various
joint and muscle pains they have, especially in
their ankles and feet. It’s no coincidence that
this also is the most common area of the body
seen for orthotic management in our Westcoast
offices by our orthotists and pedorthotists
(specialists in orthoses for feet).
The foot and ankle complex is an intricate
engineering feat -- no pun intended! Our feet
and ankles are designed to support extreme loads
and keep us balanced. Because of the constant
bombardment of weight and pressure that feet
endure, even slight biomechanical abnormalities
can get progressively worse, causing pain.
The majority of patients have conditions that
cause the foot to pronate, or collapse inward.
This causes the arch to flatten when bearing
weight, which adds stresses to other parts of the
foot and ankle (even the knee). Many people
with flat feet, for example, do not experience
discomfort immediately, but over time they
can develop plantar fasciitis, heel spurs, shin
splints, posterior tibial tendonitis and bunions.
Foot orthoses, also known as corrective shoe
inserts, are used to treat many different kinds
of foot issues.
How do you know when you need custom
foot orthoses, or if those drugstore shoe inserts
are good enough? I get asked this question
even more frequently since the appearance of
so-called “custom fit” kiosks in drugstores and
shoe stores. (By standing on a weight-sensitive
plate, the machine promises to determine which
pre-made inserts you need.) Off-the-shelf shoe
inserts may be fine for people with mild forms
of misaligned feet or those with sore feet from
prolonged walking or standing. However, if
you are in significant pain or notice changes
in your arches or other areas of your feet, it’s
always best to consult a professional, such as a
podiatrist, who specializes in issues of the foot
and proper foot care.
Custom orthoses have many advantages
because they are made specifically for your feet -exactly your shape and size. Impressions of your
feet are made while positioned for maximum
correction. This ensures an intimate fit, usually
allowing for inserts of thinner yet more rigid
material. Custom orthoses provide greater
control of each foot’s position to effectively
-- and sometimes permanently -- treat painful
conditions. Because these devices can be made
of thinner, stronger materials, they fit into a
greater variety of shoes and last much longer
than off-the-shelf products.
An orthotist also can customize indentations
in your orthoses, called “reliefs”, to accommodate
any sensitive areas you have, and can add a variety
of cushioning materials depending on your needs
and activity levels. Over-the-counter insoles
are mostly padding, so they cannot provide
corrections or the specific accommodations for
a patient who is experiencing flat feet, arch or
heel pain from plantar fasciitis or heel spurs.
Custom orthoses require a prescription from
a physician who has diagnosed your condition.
We will then custom make an orthosis to
conform to your foot, to assist with any needed
corrections and make certain your foot is not
forced into a position that makes a condition
worse. Custom orthoses take about two weeks to
be made to your specifications, and are covered
by most insurance policies if the foot issues are
related to diabetes. For other conditions, our
Case Managers consult with your insurance
provider and advise you as to your options.
Initial evaluations are offered at no cost at all
of our offices -- in Palm Harbor, Brandon, North
Tampa, St. Petersburg and West Tampa. We don’t
charge for follow-up visits or adjustments. Please
call us at 1-888-552-2555 for an appointment
with one of our experts. We also specialize
in fitting the very latest in stylish orthopedic
footwear.
Mike Bertalan is a licensed and certified orthotist and prosthetist in Westcoast’s Palm Harbor office. He earned his BS degree at University of Florida and
completed Northwestern University’s prestigious orthotic and prosthetic certification programs.
813-985-5000 | 1-888-552-2555 | www.wcbl.com | www.facebook.com/wcbl1
So, What was it Like for Me
Growing Up with a Limb Difference?
BY JENNIFER ROBINSON
WESTCOAST PATIENT PROGRAM DIRECTOR
W
hen I tell people I was born
with a limb deficiency and have
been wearing an above knee
prosthetic leg since I was two years old, I'm
often asked questions, such as:
What was it like growing up with a limb deficiency?
For me, it was a 'plus' because very early on
I was forced to adapt. I also was in the right
place at the right time, having been born to a
very open-minded, supportive family. I enjoyed
‘experimenting’ with life, whether it was trying
out for volleyball (didn’t make the team) and
cheerleading (was captain), or trying to get
my first music gig (which I did when I was
sixteen). My family never placed limitations
on me—the sky was the limit.
For any kid, growing up means a newer
sense of self awareness and, sometimes, selfconsciousness. I can honestly say I never felt
self-conscious about my prosthetic leg, but
waves of shyness would sometimes hit me
when I would take my prosthesis off in public,
like at the pool or the beach. This shyness only
began once I hit my early teen years. I found
that taking a deep breath and just ‘going with
it’ helped. The more I did it, the easier it was.
For me, it was easier to not deliberately ignore
onlookers. Instead, I would meet their eyes and
smile. Then, the moment was over and we could
get on with the fun. I think allowing that level
of vulnerability really helped me develop as a
person and as a musical performer.
2
How has technology changed since you received your
first prosthetic device as a child?
Until I was in sixth or seventh grade, my
prosthetic legs were always exoskeletal (hard
on the outside and looking like they’re made
of wood). The knee was a free-swing joint,
which I had little control over, and the foot
was a solid piece of rubber. When I returned
to my prosthetist as a pre-teen, I was surprised
and thrilled to find that my new prosthetic leg
was designed with more complex components
and a soft, life-like foam cover. Despite the
increased amount of upkeep that this newer
design required, I loved it. It looked great and
my walking pattern improved tremendously. I kept this realistic design until I was in
high school, when my rebellious and creative
nature inspired me to rip off the foam cover
and let the mechanical components show.
At that point in my life, being different was
more ‘cool’. I still feel that way. It wasn’t until
I started working at Westcoast Brace & Limb,
13 years ago, that I learned the nuts and bolts
of prosthetic components and realized there is
an entire world of technology blossoming more
each day. When I was younger, I threw off my
prosthesis the minute I got home from school
because it was so uncomfortable by the end of
the day. Now, it’s the last thing I take off before
I hop into bed. I’ve got the best technology that
meets my needs and, most importantly, my leg
feels like it’s a part of me. I still have most of
my older prosthetic legs, some stored away and
some of them decorating my house. These tiny
legs are like snapshots of my history. My own
children are fascinated by them.
Did your friends treat you any differently because of
your limb difference?
My physical difference encouraged me to
select open-minded, compassionate friends.
It was like a filter. If someone was going to
judge me because of my limb difference, that
person probably would have been a lousy friend
anyway. I was always a confident kid. I think
that confidence put other people at ease. If my
limb difference wasn't an issue for me, then it
was less likely to be an issue for them.
How did you learn to drive?
I learned to drive like most people, with a
panicked parent in the passenger seat! Every
person's comfort level is different. I use my
left foot for the gas and break pedals, with my
right prosthetic leg tucked back. I was approved
by the DMV to drive this way, as long as I
drive an automatic. Other options were pedal
modifications or hand controls, but I drive just
fine without any modifications. Comfort and
safety are key, and the DMV is a great resource.
What advice would you give to kids who may be struggling
with their limb differences?
Kids can be very judgemental sometimes, but
don't let that affect how you feel about yourself.
Confidence is a skill that you can develop over
time. All kids have challenges, whether it's
how they feel about their appearance, family
issues, or grades in school. The trick is to find
the grace to meet your challenge and take it
on at full force.
STEVE FARQUHAR: PROSTHETIC TECHNICIAN
Steve is known for
his superhuman
focus and attention to
detail when creating
any kind of lower
extremity prosthesis
“from start to finish”
in Westcoast’s central
fabrication lab. He’s
been perfecting his technique for more
than 12 years. “Communicating as a team,
technicians with practitioners, means we get
the design right and deliver the best to our
patients,” he says. Originally from upstate
NY, after high school Steve spent six years as a
non-commissioned officer in the USAF. Steve
has three children and four grandchildren,
which may partially explain his passion for
enjoying water parks on weekends. “But
when it comes to work,” Steve says, “what I
really like is when someone comes here in a
wheelchair, and then walks out on something
I made. That gives me a lot of satisfaction.”
813-985-5000 | 1-888-552-2555 | www.wcbl.com | www.facebook.com/wcbl1
AMBER BAEZ MURPHY:
ORTHOTIC & CERTIFIED MASTECTOMY FITTER
Amber joined
Westcoast in 2006
as an administrator,
just in time to help
open our office in
St. Pete. She’s now
a certified orthotic
and mastectomy fitter
there, and among
other responsibilities
sees patients for orthotic bracing and breast
prostheses. “I enjoy everything I do. I like
prosthetic case management most of all,
because it allows me to be really involved in a
patient’s rehabilitation process,” says Amber,
who’s known for her compassion and going
“above and beyond”. An amputee herself and
co-facilitator of Amputees Together, Amber
really connects with patients. “I want to make
sure patients walk out of our office feeling they
had a positive experience and have been taken
care of to the best of our abilities.” She and
husband Greg live in Tampa with their two
dogs: Mya, a pitbull and Johnson, a cocker
spaniel. Amber and Greg are expecting their
first child in early October.
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TOM SALLEN: CERTIFIED ORTHOTIST
Tom calls himself “the
Original Westcoast
On-the-Road
Guy” after 13 years
driving hundreds of
thousands of miles
to care for patients
as a member of
Westcoast’s Mobile
Unit team. Tom travels equipped with all
the latest technology so he can make critical
adjustments and provide specialized care for
adult and pediatric patients who are home
bound, in a hospital, nursing home or assisted
living facility in West Central Florida. Tom
and wife Susan live in Tarpon Springs, and
have 3 grown children. “I love working with
pediatric patients and the therapists,” Tom
says. “Working closely with them in our team
approach to patient care, yes, we’re great
professional colleagues -- but over the years
we’ve also become great friends.” The cards
and notes Tom receives from patients and
practitioners clearly show these feelings are
mutual and that they hold him in high regard!
Steven Budd:
TAKING CARE OF
BUSINESS
“I
was on the job working the
ground for a private flight line in
September 1993, when an airplane’s
propeller ran into me and my right foot
was amputated right there. My right arm
was broken and dislocated and I almost lost
my left foot from injuries. My rehab was
really rough. I fought multiple infections
and ended up having two revision surgeries
to my residual limb. I didn’t get out of the
rehab hospital until December. Right after
amputation, it’s hard to see your future.
But, things do get better.
“I’ve been with Westcoast Brace & Limb
since ‘forever’, it seems. A good prosthetist
listens to you, and mine does. And you need
to listen to your prosthetist. I learned the
right questions to ask, especially why new
prosthetic technology is important. Well,
look at what it’s done for me. A year after
my accident I was back to work, wearing
my prosthetic leg. I’ve been at my current
job for 7 years and I’m good at what I do
— I run circles around the young punks.
“My Westcoast team communicates with
my workers’ compensation carrier in a
professional way, and gives me suggestions
about how to address my needs and discuss
questions with my work comp adjuster.
Westcoast helps me avoid any 'bumps'
in the road.”
Steven Budd
Westcoast Patient
3
Upcoming Continuing Education Courses
Advancements in Prosthetic Technology for the Lower Limb October 20
& Interface Socket Designs and Prosthetic Gait Deviations
Pediatric Overview
Intercontinental Hotel
4860 W Kennedy Blvd Tampa Fl 33609
November 14 Palm Harbor TBD
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our courses and special events throughout the year.
Westcoast Brace & Limb Locations
Corporate Office
North Tampa
Mon.-Fri. 8:30 a.m.-5 p.m.
Ph: (813) 985-5000
Fax: (813) 985-4499
5311 E. Fletcher Avenue
Tampa, FL 33617
West Tampa
Mon.-Fri. 9 a.m.-5 p.m.
Ph: (813) 354-0100
Fax: (813) 348-0629
2727 MLK Jr Blvd
Suite 690
Tampa, FL 33607
Brandon
Mon.-Fri. 9 a.m.-5 p.m.
Ph: (813) 684-5525
Fax: (813) 653-3730
620 Oakfield Drive
Brandon, FL 33511
Palm Harbor
Mon.-Fri. 9 a.m.-5 p.m.
Ph: (727) 785-0100
Fax: (727) 785-7773
3343 Tampa Road
Palm Harbor, FL 34684
St. Petersburg
Mon.-Fri. 9 a.m.-5 p.m.
Ph: (727) 323-9500
Fax: (727) 327-7626
4021 Central Avenue
Suite C
St. Petersburg, FL 33713