|
February 2007 • Vol. 3, No. 1
|
Advancing Orthotic and Prosthetic
Care Through Knowledge
|
Frank Bostock, MBA, CO, FAAOP
|
In 1960, Theodore Levitt published a paper in the Harvard Business Review titled “Marketing Myopia.” Its publication marked a paradigm shift in how companies and industries assessed their products and services, and what they needed to do to remain competitive in an ever-changing marketplace brought about by new competitive forces and product innovation. Levitt believes that most “organizations endanger their futures because they improperly define their purposes, and they too narrowly define the businesses they are in.” Levitt emphasizes that most companies tend to so narrowly focus on their products, services, and “know-how,” they create a culture that almost guarantees their premature senescence.1 By focusing primarily on a company’s core competencies, the company inherently limits not only the size of the potential market for the company’s products and services, but also future growth opportunities. It is for this reason that many companies have seen their opportunities for growth stalled—not because a particular market segment has become saturated, but rather due to a failure to see the opportunities that exist to meet potential customer wants and needs.2
Do some O&P professionals today have myopic vision where footwear is concerned? Based on the profession’s reluctance to embrace and provide new products or product extensions, such as footwear, many patients and healthcare professionals would say yes. With a growing patient demand for providers of comprehensive footwear, many O&P professionals have failed to recognize patient needs and the potential market opportunities that are now available to them through the dispensing of specialty footwear. Most O&P professionals have remained on the sidelines as other healthcare professionals and non healthcare providers have stepped in to fill the demand for footwear created by a growing diabetic patient population, an active aging population, and an underserved pediatric population.
Every day, orthotists and prosthetists fit patients with advanced custom orthotic and prosthetic devices. Utmost care is given by orthotists and prosthetists to ensure that the best possible orthotic or prosthetic devices are provided to their patients and that the fit and function of these devices meets the highest possible standards of care. However, once these devices are fit, most practitioners delegate the fitting of the footwear to someone else. In many instances, O&P patients are left on their own to find the appropriate footwear. O&P patients who are in need of accommodative footwear usually purchase their shoes at outlet malls, off the rack at a Wal-Mart, or are fit by a shoe salesperson at a department store. In each of these cases, patients are not receiving the same attention to their footwear needs that qualified orthotists and prosthetists provide in the delivery of the patients’ orthoses and prostheses. A publication of the National Shoe Retailers Association estimates that only 5 percent of all persons who sell shoes have any significant training or experience in fitting footwear. The number of individuals with specialty training for the fitting of accommodative footwear for patients with unique pathologies is significantly less than the 5 percent within the overall shoe fitter category. These statistics only serve to emphasize the need for orthotists and prosthetists to take on the responsibility of providing appropriate footwear for their patients.
While the O&P profession continues to ignore the needs and opportunities that currently exist within the accommodative footwear market, demand for footwear and footwear products is increasing dramatically within the United States. Today, there are more than 18 million Americans who have diabetic conditions, and that number is expected to skyrocket to more than 30 million over the next three decades. Approximately 15 percent of patients with diabetes will develop a foot ulcer during the course of the disease. Of those people with ulcerations of the foot, approximately 15 percent will require amputations. The three-year survival rate for diabetic patients who sustain foot amputations is 50 percent.3
Prosthetists routinely fit diabetic lower-limb amputee patients with prostheses, and in many cases the prosthetists, during their patient evaluations, ignore the footwear their patients are wearing on their non-prosthetic limbs. One of the primary concerns of a lower-extremity diabetic amputee patient is making sure that he or she does not become a bilateral lower-extremity amputee. However unilateral diabetic amputee patients have a high probability of losing the other limb if appropriate education is not provided to them regarding the management of their diabetes, and no one makes sure that they are wearing appropriate footwear. In research conducted by Dr. Peter R. Cavanagh, PhD, DSc, there is evidence to support that inappropriate footwear is the cause of many foot ulcers in patients with diabetes and that appropriate footwear can significantly reduce the incidence of primary and secondary ulcerations.4 Based upon Cavanagh’s research, and the studies conducted by other researchers, every prosthetist should include foot exams and footwear evaluations as standard protocols in prosthetic patient clinical evaluations.5,6
Orthotists routinely fabricate and fit patients with uniquely designed custom lower-extremity orthoses. However, after the fitting of the orthoses by an orthotist, patients are oftentimes sent out into the marketplace to find footwear to fit over their AFO, KAFO, or foot orthotic that has been provided to them. Trying to find appropriate footwear can be an extremely frustrating experience for patients, as they go store to store or log on to the Internet in an attempt to find footwear that will fit over their orthoses. Listed below are several quotes from patient postings on Internet chat boards that exemplify both the frustration experienced by patients trying to find appropriate footwear, and the joy when they find a solution to their footwear problems.
“Just wondering if anyone would be able to help me at all. Laney just got her first pair of AFOs yesterday, and I can’t find any type of shoes to put the AFOs in. I was ready to pull my hair out at the stores today. I tried the less pricey shoes to expensive shoes, and I still couldn’t find a pair of shoes that worked with her AFOs. Can anyone offer any wonderful advice on getting a pair of children’s shoes that will work with AFOs?”
“It made me so upset looking for shoes. There’s a market for this need, and I wish I had the resources to do something about it.”
“Hi, my son has some neurological problems that are similar to CP, and he also wears two-step AFOs. It has been a pain to find shoes that will fit over them.”
“There is a new specialty shoe that is made. You can probably get them wherever you got your AFOs. They are awesome. Called Answer2™ shoes. They look just like regular tennis shoes. (The ones we got for Ryan have little lights on the back!) They are extra wide to fit the brace without having to buy a ‘HUGE’ shoe to go over the brace. They stretch over the top and have Velcro to close. They are adorable! Ryan hasn’t been wearing his braces because we had trouble finding shoes for them, so then we had soles put on the bottom, but the rainy season is coming up, and I didn’t like him wearing ‘just braces.’ So anyway, thought I would share the information. We are really excited. Ryan is much more stable on his feet while wearing these. We got them yesterday. He isn’t falling as much!”
“The shoes are simple! We found a brand called Answer2. We had so much trouble with that for over a year until we found out about these wonderful shoes. They are made for AFOs! You don’t have to buy big elephant shoes at all! They are made extra wide and extra tall. (They stretch at the top—with long Velcro straps. The kids shoes are adorable and have lights that light up…etc.) Several to choose from. They are cute, and you can’t even tell a child is wearing special shoes. They are easy, easy, easy to put on. (The tongue pulls all the way up to the TOES!) They have been such a blessing to us. They are cuter than any other shoes I’ve found, too!”
The Children’s Hemiplegia and Stroke Association (CHASA) devotes a page on its website to purchasing shoes. The website states, “You may think it rather odd to have a page devoted to how to purchase shoes, but it is a major issue for parents of children with hemiplegia. Many children with hemiplegia wear orthotics on their feet, and finding shoes that are attractive, yet fit with the orthotic, is often challenging.”
As exemplified by the Internet postings above, patients who wear orthoses and prostheses are in dire need of assistance in solving their footwear problems. Orthotists and prosthetists need to take the time to educate themselves and their patients on appropriate footwear. Orthotists and prosthetists should have a good understanding of footwear design, construction, and modifications, and they should educate their patients on the need for appropriate footwear in order to achieve the best possible outcomes with their orthotic or prosthetic device. O&P practices should also stock a small fitting inventory of shoes for patient and practitioner convenience. By having a limited inventory of shoes in stock, practitioners can fit the patient without having to special order several pairs of shoes for each patient. Patients appreciate the convenience of not having to shop endlessly for shoes as well as knowing that their practitioner has taken the time to ensure that the appropriate footwear has been provided.
Patients deserve the same attention to their footwear that is provided in the design, fabrication, and fitting of their orthoses or prostheses. Practitioners should not fall victim to becoming myopic in the delivery of O&P patient care. Theodore Levitt’s prescription for success includes expanding a company’s core competencies in the delivery of its products and services. Having the vision to provide patients with accommodative footwear provides O&P practitioners with the opportunity to meet customer expectations and seize upon a commercial niche that can provide a practice with increased financial returns.
Levitt, T. (1960) “Marketing Myopia,” Harvard Business Review, July-August, 1960. “Senescence refers to the combination of processes of deterioration which follow the period of development of an organization.” Levitt, T. (1960) “Marketing Myopia,” Harvard Business Review, July-August, 1960. Frykberg, F.G., Armstrong, D.G., Fiurini, J., et al. (2000). Diabetic Foot Disorders. Journal of Foot and Ankle Surgery, 39, s8-S17, S45-S46. Cavanagh, Peter R. (2004) “Therapeutic footwear for people with diabetes,” Diabetes/Metabolism Researchand Reviews, December, 2004. Ahmet Erdemir, Jeffrey J. Saucerman, David Lemmon, Bryan Loppnow, Frie Turso, Han S. Ulbrecht, Peter R. Cavanagh. (2004). “Local plantar pressure relief in therapeutic footwear: design guidelines for finite element models.” Journal of Biomechanics, September 2004. Jan S. Ulbrecht, Peter R. Cavanagh. (2005). “Shoes and insoles for at-risk people with diabetes.” Clinical Care of the Diabetic Foot (2005).
Take the quiz at the Academy's Online Learning Center.
|
|
