May 2004

It's checkup time

by Dr. Mark Charrette

Eye doctors, dentists, and other health care professionals have long stressed the importance of coming in for a once a year routine exam. There's no reason why chiropractors can't establish the same concept with their patients. Creating a procedure to annually evaluate the custom made, flexible orthotics you've issued makes sense from a postural perspective, and it shows patients that you are concerned for their long term health and comfort.

Plant the Idea Early A pair of custom made orthotics may be one of only a very few physical items that a patient takes from your office. Wouldn't it be wonderful if, every time a patient removed her shoes, she remembered the care you had given? When you give the orthotics to your patient, I recommend saying something like this:

"It's important to have your orthotics evaluated at least once a year, to make sure they're still doing their job properly. Let's get you into our annual re exam program today."

It then becomes very important to schedule the exam in your calendar or in the patient's file. Send a reminder and call to schedule this important visit approximately eleven months after providing the custom made orthotics.

We try to educate our patients about lifetime spinal wellness. Some simply choose pain relief and discontinue visits when their symptoms improve. Regardless of how long patients remain under your active chiropractic care, the annual exam provides the opportunity to renew your relationship and offer additional care.

Items for the Annual Agenda I recommend that the annual orthotic exam be part of a general health and spinal checkup. In addition to the spinal evaluation, here are some items you should also consider:

1. Check the shoes. Because of gravity, plastic deformation, and the effects of time, our feet become longer and flatter as we age. However, because of habit, we rarely change the size of shoes we purchase. Have patients bring 2 3 pairs of their favorite shoes and evaluate them for a proper ball fit. It is important to see the kinds of footwear they have. You can quickly spot improperly fitting and worn out shoes.

2. Fashions change. Has their shoe style preference changed? If so, make sure the custom orthotic is still appropriate. It may be necessary to order additional orthotics to accommodate all their footwear. Orthotics are specifically designed to work in only certain shoes for maximum support and performance. When an orthotic won't fit, consider custom made shoes or sandals.

3. Factory inserts out. Custom orthotics work best when they lie on a flat surface not on factory made footbeds. The factory insert can be used as a template to trim the length of the orthotic, at the toes, for a secure fit.

4. Any changes in activity level or weight? Patients' activity levels change with time    improved health, injury, or pregnancy are just a few reasons. Since weight can also fluctuate, recommending new orthotics should take into consideration any significant changes and provide greater support.

5. Look for damage or abuse. Custom orthotics need special care. Reminding your patient to remove them nightly allows the orthotics to dry naturally and avoid the accumulation of moisture. Furthermore, wiping the orthotic with a damp cloth will prevent any grit from wearing the surfaces prematurely. Minor changes in the coloring or surface of the orthotics will not affect performance; however, any excessive wear that affects the placement of the corrections suggests the need for replacement.

As time goes by

Indications for orthotic need often change with time. There is no set pattern for this change, and it varies with each individual. Such changes usually occur during developmental or age related stages or as a result of evolving chiropractic care plans. The most important evaluation you will make during the annual exam is a review of the indicators that prompted your recommending orthotics in the first place. These indicators will help you decide when it's time for a new pair (or pairs) of orthotics. Most importantly, whenever patients stop holding their adjustments, take another look at their feet.

Establish a plan to have all your patients receive an yearly exam. This can be a special opportunity to recommit them to follow through on spinal care for a lifetime of better health. Although you don't need an excuse, because custom made orthotics are such specialized devices, they are a perfect justification for reestablishing an active relationship with former and current patients.

(Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic. Over the past 18 years he has lectured extensively on spinal and extremity adjusting throughout the U.S., Europe, the Far East, and Australia. In 1976, he received a Bachelor's degree from Illinois State University [summa cum laude] where he was an NCAA All‑American in 1974.)