Pedorthists Optimistic About Renewed Educational Pathway to Certification

Requirements for pedorthic certification have been in flux over the past several decades. Whether or not to increase the amount of education required to become a certified practitioner has been the subject of much debate throughout the 1990s and into the 2010s. In its infancy in the early 1990s, there was little structure around the educational framework for pedorthic certification. By the late 1990s, more formalized training proposals emerged. These programs were commonly presented by manufacturing companies and had no formal education requirements attached to them. In 2003, the industry developed a standardized curriculum, based on efforts made by the Board for Certification in Pedorthics (BCP) and the Commission on Accreditation of Pedorthic Education (CAPE) to implement a competency- and outcome-based model. The Pedorthic Education Alliance then created a curriculum that was adopted by all certifying educational institutions. Ultimately, full certification required attendance of two to four weeks of hybrid online and in-person training, and a requirement of 1,000 hours of clinical certification to gain hands-on experience was added. Following the dissolution of CAPE as a separate entity, the National Commission on Orthotic and Prosthetic Education (NCOPE) absorbed its functions as a committee to oversee the requirements. In 2021, after much discussion in the profession and several transitional steps and endorsement from NCOPE and its sponsors, the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) and the American Academy of Orthotists and Prosthetists (the Academy), the decision was officially made to increase the requirement to two years of education through an accredited institution. The Commission on Accreditation and Allied Health Education Programs (CAAHEP) reviewed the standards. Proponents of the increased education requirements cited many benefits. Among them, the new educational standards would position future pedorthists to be more respected within the holistic healthcare landscape, while also being better equipped to serve their patients and remaining credible in the medical community. Additionally, an expanded scope of practice would broaden options for insurance reimbursement, leading to higher salaries for those in the profession. Opponents of the increased educational requirements, however, cited a potential decrease in candidates for certification based on the more rigorous—and more costly—criteria. There was also concern about forcing a requirement that could interfere with students’ ability to maintain full-time employment while participating in the program. Although the increased standards were eventually adopted, a lack of accrediting institutions and programs caused NCOPE to put the two-year requirement on hiatus in 2022. Paving the Path Back to Pedorthic Certification Following that decision, ABC assumed the task of creating and managing revised standards for pedorthic precertification education. Its board of directors approved a new proposed set of standards in July, which will provide a pathway to pedorthic certification that was unavailable in the absence of approved pedorthic educational programs. We asked ABC to share details of the standards, and pedorthists to share their thoughts on what these standards mean to the profession going forward. “The new pedorthic precertification course standards were created based on several sets of previous education standards,” says Steve Fletcher, CPO, ABC director, professional credentialing. “The pedorthic task force, who were charged with creating the new standards, used the CAAHEP/NCOPE pedorthic education standards to guide their work. The ABC board of directors felt that the new standards were comprehensive and encapsulate all the entry-level elements needed for pedorthic practice.” In terms of what’s different from the previous requirements, Fletcher says the main change is the removal of the mandate that the educational course provider be affiliated with an accredited educational institution, and of the requirement that all students graduating from the course have an associate degree. Since this new pathway was created outside of the context of higher education, NCOPE was not part of the team that generated these latest standards. The Pedorthist’s Perspective Dennis Janisse, CPed, president and CEO of National Pedorthic Service, Wisconsin, has been in the profession for more than 50 years and served on the ABC board for 12 years. Janisse wasn’t opposed to the longer education requirement proposal. “As pedorthists, we assume a responsibility for some of the most at-risk feet,” he says. “And if O&P is a master’s program, I could see a benefit to us being more than a certification.” Janisse said he doesn’t blame the schools for the lack of traction on the proposed two-year education requirement. “I think some of the people at the schools didn’t get all of the information they needed on the associate program to remove the lack of faith they had in what enrollment would look like,” he says. Janisse was on the committee that developed the new certification standards, and he says the new standards will ensure students get a better education than they would have under the former certification guidelines. “There will be more hands-on experience and a minimum requirement for more generous fabrication experience to gain a better understanding of that process,” he says. “Both didactic and hands-on education will be more robust than in the past.” Quality Education and Investment Are Key Ultimately, the success of the new standards will rely on quality institutions getting involved and investing in the tools students need to succeed, Janisse says. That includes a mix of newer technology, as well as traditional fabrication equipment and tools. “I hope to see good schools getting involved in this,” Janisse says. “The standards and guidance are there for this to be successful, and the technology is there for us to use as long as the schools take this seriously.” After a long lull in new certifications, Janisse and many other pedorthists are ultimately optimistic about how this restored path to certification will help to reinvigorate the profession. “I think there are a lot of people that want to become certified,” he says. “I hope the new standards ensure that these students are going to have a good foundation.” He believes there will be a flood of new pedorthists as a result of the certification path once the schools get up and running. He points to the Department of Veterans Affairs medical care as an area where the profession can offer a lot of needed support. He hopes O&P facilities will begin hiring more pedorthists as well. “It’s a challenging field, but it’s so rewarding to help people, so I hope we can continue to get a lot more people into pedorthics,” he adds. Janisse also hopes the new standards will drive increased interest in the profession and will help to educate people about it because he believes there is still a lot of misconception about what pedorthists do. “It’s not just diabetic shoes and inserts through Medicare,” he says. “There are a lot of specializations. And once these schools are opened, there will be a new influx, because there has been no path to get certified for two or three years now.” Other pedorthists echo the sentiment that the success of the new certification path will depend on the quality of the institutions involved. “You have to have the right people involved in these trainings, not a team of sales reps or people pushing products,” says Brian Lane, CPed, director of education at Dr. Comfort. “It does rest on ABC’s shoulders to ensure the legitimacy of the overall program, and to make sure the students are getting everything they need.” Lane says the low number of pedorthists in the United States—fewer than 2,000 at his last count—is concerning and he’s hopeful that number will now rise. “Without training courses and that pathway for certification, pedorthics as we know it was likely to fizzle out,” he adds. “That’s not good for anyone, especially patients. This is an opportunity to expand on the pedorthic profession and, in turn, help more patients.” Robert S. Schwartz, CPed, executive director of the Pedorthic Footcare Association (PFA) and president and CEO of Eneslow Pedorthic Enterprises, New York, is excited about the potential for future expansion of the profession. He says he believes that the previously adopted two-year associate degree requirement created an unnecessary obstacle to certification. “For me, the only thing they were doing was shutting down the schools whose livelihood depended upon it,” he says. “It was a professional pathway without a problem looking for one.” PFA’s mission is to end footwear-related ulcers and amputations, and Schwartz is eager to see more people trained in pedorthics so that mission can be accomplished as soon as possible. “Both pedorthists and ABC believe these revised standards will bring the pedorthic profession back to life, and it will grow exponentially,” he says. “As first responders for people with diabetes and footwear-related ulcers and amputations, pedorthists can dramatically reduce this epidemic facing millions of Americans.” From his perspective, it is the individual person and his or her background and aptitudes that provide the basis for becoming a pedorthist, not their formal education. Schwartz says that pedorthists practice a combination of art and science, and no two practice the same way. “Pedorthists are like Leonardo da Vinci creating their Vitruvian Man with each client,” he adds. Since most insurance does not cover pedorthics, generating enough profitable revenue is often challenging. “The profession is a ‘practice.’ Learning comes from each experience, and each person’s biomechanical, comfort, and endurance needs are unique,” Schwartz says. For many pedorthists, the need to attract professionals is even more amplified as the practice expands. Pedorthics was historically focused on the needs of diabetic patients. While that continues to represent the most significant need, the practice has placed more emphasis on interdisciplinary collaboration with podiatrists, orthopedic surgeons, and physical therapists over the past decade. As a result, pedorthists have become essential members of the healthcare team, contributing to the management of a wide range of foot and lower-limb conditions. To that end, Teresa Alpert, CO, CPed, PMAC, University of Colorado Anschutz, is among those who are pleased to see a renewed path to certification. “It’s a wonderful opportunity,” she says. “Pedorthic footwear has taken a global angle.” Alpert says that in recent years, the combination of the pandemic and the cost of the two-year education requirement was a one-two punch deterring potential new candidates from the profession. “Universities were not going to get filled up, and it was also cost-prohibitive for someone to go into the industry because there is no one paying commensurate with the cost of the education,” she says. Alpert echoes Schwartz’s sentiment that the role of pedorthists is really as first responders. “We are an allied healthcare team member, and often we really are the first line of treatment,” she says. “Everybody wears shoes, but if you’re a diabetic, and you’re not in properly fitted footwear, a minor rub can turn into a medical catastrophe.” Alpert sees huge opportunity for this renewed certification path to help fill the existing consumer need. She says the shoe businesses that serve this population are going to want to hire pedorthists. Additionally, she says, we’ll see an uptick in O&P facilities hiring pedorthists. “I started as an orthotist, and I was making all of these braces that didn’t fit into shoes, and that’s how I got into pedorthics,” she says. “The best prosthesis doesn’t help you if you can’t wear a shoe, or if it’s not sitting on the right foundation—pedorthics is key.” Echoing Janisse’s sentiments, Alpert says she thinks the renewed path to pedorthic certification will result in an increased number of people getting certified. “If you’re an orthotist, you can become cross-trained as a pedorthist, or if you’re an athletic trainer, you can be cross-trained on pedorthics,” she says. “The employee market will drive the profession, the consumer market will drive it, and the allied health market will drive it.” The Role of Technology Like O&P, the pedorthics profession is also growing and benefitting from the use of technologies such as CAD/CAM. In addition to a certification path, Alpert says new technologies will continue to be key to the advancement of the profession. “Technology and ecology go hand in hand,” she says. “When we’re using scanning and 3D application and fabrication programs, we are also reducing our use of products and things like traditional plaster and minimizing our environmental footprint.” Speed is another benefit. “These technologies give us an opportunity to do things so much faster,” Alpert says. She believes the need for human expertise will always remain, of course. “As far as shoes are concerned, and modifications for the very deformed foot, we still need a very defined skill set to be able to manipulate those materials, and you have to know how to do it.” Like Schwartz, Alpert says that it is the person that makes a great pedorthist more so than the details of the certification path they took to get there. “You don’t need to be a doctor, you need to be a kind person and have patience and take the time to be with these people,” she says. For those in the pedorthic profession, educational enhancements over the past several decades have been transformative. From humble beginnings of informal training, to structured programs and more stringent certifications of today, pedorthics has made major strides. These advancements have not only elevated the quality of care provided to patients but have also elevated the status of pedorthists within the larger healthcare landscape. With adequate support and renewed interest in the profession, pedorthists will be positioned to meet the evolving needs of their patients with unwavering expertise. Tara McMeekin is a writer and editor based in Colorado.

Pedorthists Optimistic About Renewed Educational Pathway to Certification

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