Insurers: What You Need to Know

The College of Pedorthics of Canada (CPC) is a national body that exists to ensure all patients across Canada receive safe, competent and ethical Pedorthic care from a Canadian Certified Pedorthist with the designation C. Ped (C).

We ensure that our certified registrants are accountable to high standards of practice through our certification process, the monitoring of continued education and the enforcement of ethical conduct.

The CPC is continuously dedicated to focusing on the requirements & competencies of a C. Ped (C). The Scope of Practice is the ‘overview’ and the C. Ped (C) Competencies are ‘detailed view’ of what C. Ped (C)’s do. Please navigate the links below to learn more:

To verify if an individual is an active Registrant (member) in good standing with the CPC, use our Find-A-Pedorthist tool. If you can’t find the individual you are looking for, please email info@cpedcs.ca to confirm yes or no.

The CPC has created standards for C. Ped (C)’s to follow in their pedorthic practice. These standards are, first and foremost, tools designed to help professionals assess their practice relative to the expectations of peers, colleagues and the profession as a whole. The standards are performance baselines against which professionals may be measured if any part of their pedorthic practice is called into question.

The CPC is charged with the responsibility of protecting the public through the investigation of allegations of misconduct committed by a registrant and to discipline registrants accordingly. The CPC Complaints and Discipline Process is subject to the By-Laws of the CPC. If there is any discrepancy between the below process and the By-Laws, the By-Laws will take precedence.

Insurers are encouraged to contact the CPC if you have any questions or concerns related to a C. Ped (C). Please navigate the drop-down boxes below for more information on complaints & discipline.

Click HERE to navigate to the Complaints & Discipline page.

Please contact us if you would like to share information regarding the practice of a Canadian Certified Pedorthist in Canada. If you believe a C. Ped (C) is not following the standards and practicing unethically it is important to inform us so we can follow up as required.

If you have questions regarding the investigations process, or would like to share a tip, please contact:

The College of Pedorthics of Canada
(E): info@cpedcs.ca
(T): 866.819.4354

Click HERE to file a complaint online against a CPC registrant.

Canadian Certified Pedorthists, also known as (C. Ped (C)s, specialize in treating musculoskeletal injuries, medical conditions, disabilities, and diseases affecting the entire lower extremity and feet.

C. Ped (C)s play a key role in the multidisciplinary management of these conditions by applying their extensive knowledge, training in biomechanics, and bracing to enhance patient mobility, function, and quality of life.

Canadian Certified Pedorthists: Training

C. Ped (C)s receive extensive training in lower extremity biomechanic conditions and treatment strategies that provide them with the expertise necessary to effectively assess, diagnose, and manage a patient’s needs.

C. Ped (C)s are highly knowledgeable on bracing and medical-grade orthotic devices and their effects on biomechanics and function. They understand how braces can provide support, offload pressure, stabilize joints, and facilitate proper movement patterns. C. Ped(C)s also assess the impact of bracing on gait mechanics and consider overall treatment outcomes.

Below is an outline of C. Ped (C)’s ‘above the ankle’ training requirements:

Hours Description
10 Anatomy Review: lower extremity, hip (SI joint), leg, knee, lower leg, ankle, foot – muscle, bone, joint, ligaments, tendons, nerves (introduction to dermatomes), veins, arteries.
10 Applied Anatomy within Biomechanics: levers and moment arms (SI joint function (nutation/counternutation)
10 Applied Anatomy within Physiology: forces and moments.
10 Medical Conditions & Injuries: covers knee injuries, ankle & foot signs & symptoms, pathology, assessment, special tests, differential diagnosis.
10 Medical Diseases: covers the signs and symptoms, pathology, assessment, and special tests of OA (same as above), Neurological Diseases such as CMT (same as above), and stroke.
10 Assessment: non-weight-bearing and weight-bearing posture, muscle activity, kinetics, and kinematics.
10 Pathomechanics: covers knee and hip throughout this course in most units,
20 Treatment Course: bracing types including drop foot, joint unloading, ligament stability, and compression.

Professional Development

C. Ped (C)s actively pursue professional development and continuing education opportunities to stay current with advancements in foot and lower extremity biomechanics, bracing technologies, and evidence-based practices. This commitment enables C. Ped (C)s to continually enhance their skills and expertise, ensuring high-quality care for their patients. Additionally, C. Ped (C)s participating in evidence-based training supports improved decision-making and patient outcomes.

Patient Assessments

C. Ped (C)s routinely conduct comprehensive assessments, where they address the entire lower extremity of the patient because pain is normally not isolated to the foot alone. This comprehensive assessment is important for several reasons including:

  1. Holistic Understanding: Examining the entire lower extremity including the foot allows for a broad understanding of biomechanical alignment, muscle strength, and joint function. As issues in one area can impact on the overall function and health of other areas.
  2. Identifying Root Causes: Many foot-related problems stem from the knees, hips, or lower back. By assessing the entire lower extremity, C. Ped (C)s can identify the root cause of the issues and provide targeted treatment.
  3. Preventing Compensation: When there’s dysfunction in one part of the lower extremity, the body often compensates by altering movement patterns, which can lead to overuse injuries in other areas. By assessing the entire lower extremity, including the foot, C. Ped (C)s can identify compensatory mechanisms to prevent further injury.
  4. Customizing Treatment Plans: Each patient is unique, as are their lower extremity  biomechanics. By assessing the entire lower extremity, C. Ped (C)s can customize treatment plans to address individual weaknesses, imbalances, and functional limitations.
  5. Improving Outcomes: By addressing issues throughout the entire lower extremity, C. Ped (C)s can improve patient outcomes by promoting optimal biomechanics, reducing pain, and enhancing function.

Patient-Centric Care and Continuity of Care

Patient-centered care and continuity of care ensure a patient’s overall well-being and safety. By focusing on the patient as the central figure in the healthcare process, C. Ped (C)s prioritize the patients’ specific needs, preferences, and goals, while fostering a collaborative and empowering environment.

C. Ped (C)s are equipped with the knowledge, skills, and qualifications needed to assess and treat a wide range of lower extremity and foot-related conditions. Their specialized training enables them to offer tailored interventions, including bracing, orthotics, and footwear modifications, to address biomechanical issues and promote optimal function and mobility. Additionally, the expertise of trained Pedorthists in bracing and its effects on the lower extremity is essential for delivering effective and safe treatment.

Patients who entrust their care to qualified and experienced C. Ped (C) can be confident that safety and efficacy standards are always upheld. These standards are governed by The College of Pedorthics of Canada (CPC) and are designed to protect the public from potential harm or ineffective treatments. Patient-centric care, combined with a continuity of care involving trained C. Ped (C)s, is essential in safeguarding patients from inadequate or unsafe future interventions.

Device Coverage Eligibility

Canadian Certified Pedorthists, also known as C. Ped (C)s, are recognized in Canada as qualified clinical providers of custom foot orthotics. C. Ped (C)s are leading healthcare experts in their field, possessing expertise and specialized training that enables them to conduct thorough lower extremity assessments. These assessments produce accurate and effective treatment plans for patients suffering from conditions related to the lower extremity.

Education and Certification Process: Canadian Certified Pedorthists | C. Ped (C)

Candidates are required to obtain education and specialized training to effectively provide healthcare services. Education requirements consist of an undergraduate degree followed by an estimated 1,584 hours of clinical and fabrication training, combined with 1,120 hours of course related work offered by          Western University.

Candidates are then eligible to challenge the certification examination process conducted by The College of Pedorthics of Canada (CPC) to become a Canadian Certified Pedorthist, C. Ped (C).

The Pedorthist Assessment

The lower extremity assessment performed by a C. Ped (C) is comprehensive and includes multiple components that are considered in the development of an effective treatment plan. Treatment plans can include custom foot orthotics, custom footwear, footwear modifications, exercise protocols, bracing, footwear recommendations, and patient education.

An assessment and subsequent treatment plan serves as an essential resource for patients, helping them manage their diagnosis by alleviating symptoms and enhancing their mobility and overall quality of life.

Assessment and treatment plans provided by a C. Ped (C) may involve, but are not limited to the following components:

  1. Patient History – A comprehensive collection of data including applicable patient demographics, full understanding of symptoms, mechanism of injury and/or etiology, medical conditions, activities of daily living, footwear choices, treatments to date, aggravating and relieving factors.
  2. Weight-Bearing Evaluation – Static bilateral assessment of the position of the head, shoulders, trunk, pelvis, hips, knees, patellae, tibias, ankles, toes and bilateral rearfoot, midfoot and forefoot.
  3. Non-Weight Bearing Evaluation – Bilaterally identify forefoot position relative to rearfoot and foot type, bony and/or soft tissue prominences, skin temperature, texture and circulation, skin conditions such as corns, calluses, warts, or blisters.
  4. Range of Motion Testing – Bilateral assessment of the range and quality of motion of the ankle, subtalar joint, midfoot, 1st ray, 1st MTP joint, 2-5 rays and lesser MTP joints. (Quality of motion includes end feel, crepitus, painful vs pain-free movement)
  5. Special Tests – Performed bilaterally on structures and areas relevant to the client’s condition.
  6. Gait Analysis – Bilateral assessment of the dynamic position, range, and quality of motion of the following structures during all phases of the gait cycle: head, shoulder, arm, trunk, pelvis, hip, knee, patella, tibia, subtalar joint, calcaneus, midfoot, forefoot, hallux, and lesser toes.
  7. Footwear Analysis and Recommendations – Evaluate the appropriateness and fit of current footwear, including upper deformities, tread wear pattern, sock liner wear patterns and any abnormalities noted when standing and walking bilaterally. Subsequently, recommendations for footwear modifications are performed as needed.
  8. Treatment Plan – Educate clients on how assessment findings and/or lifestyle contributes to current symptoms. Discuss treatment options with an explanation as to how each option would address the client’s needs. Discuss follow-up protocol. Based on the findings of the assessment, the C. Ped (C) will specifically outline the parameters of design, materials, composition, and fabrication of foot orthotics intended to treat the patient’s unique medical needs when this treatment is indicated.
  9. Casting of Foot (3D Scan, Foam Box, Wax, or Plaster) – Selecting the appropriate casting technique is a crucial aspect of the orthotic process. Pedorthists recognize the importance of using various 3D casting methods to accurately capture the patient’s anatomy, helping to determine the most suitable style of orthotic for effectively treating their symptoms. This expertise ensures that patients receive a truly custom, comfortable, and functional orthotic as part of their treatment plan. The use of a 3D cast allows a true custom fit to the patient’s foot.
  10. Orthotics Dispensing – When orthotics are dispensed by a Pedorthist, fit, comfort, and function issues of the product(s) provided can be addressed directly. With their extensive knowledge in the manufacturing process, C. Ped (C)s or their trained staff are able to adjust and modify the devices they provide.
  11. Follow-Up Care – Follow up care is crucial as a patient’s symptoms may change, which may require their orthotic device to be adjusted. Pedorthists can make these adjustments on-site with the patient, ensuring that the patient is progressing through the treatment plan and that the orthotics, along with other medical products and protocols, are achieving the desired results.

Establishing insurance coverage for this comprehensive assessment and treatment protocol for custom foot orthotics is vital for delivering optimal and effective care to patients, while safeguarding public health and managing insurance costs. This should be addressed by either including C. Ped (C)s in paramedical services or by making the services eligible for reimbursement under the custom orthotic benefit itself.

Ineligibility of Pedorthic Services

Under current insurance policies, patients must pay out-of-pocket for assessment fees and related services provided by a Canadian Certified Pedorthist. Similar services are covered when seeing other orthotic providers. These other orthotic providers including chiropodists, podiatrists, chiropractors, and orthotists have paramedical coverage that reimburses patient assessment fees, even if no medical grade product is provided.

This lack of coverage may drive patients away from one of the most qualified professionals in the orthotic industry, as they seek to minimize out-of-pocket expenses. This could potentially lead to diminished patient care and the delivery of low-quality orthotics.

See table below for a list of providers that are eligible for patient assessment and clinical time reimbursement under insurance policies.

Healthcare Provider Eligible Orthotic Provider? Paramedical Health Care Coverage?
Pedorthist (C. Ped (C)) Yes No
Chiropodist Yes Yes
Podiatrist Yes Yes
Chiropractor Yes Yes
Orthotist Yes Item specific (e.g. prosthetic repair)

Recommendations to Current Insurance Policies

Coverage of Pedorthic services provided by a C. Ped (C) would lead to a reduction in both the number and average cost of orthotic claims. Patients would be able to submit claims for specific services, such as assessments, reassessments, modifications, and refurbishments of orthotics, rather than solely for new medical grade devices.

Coverage of Pedorthic services provided by a C. Ped (C) may effectively manage insurance costs, while ensuring quality patient care and protection of public health. This outcome could be achieved by including C. Ped (C)s under paramedical coverage in insurance policies, allowing for services such as assessment fees, follow-ups, orthotic adjustments, and other treatment plan modifications to be covered. Alternatively, these fees could be applied to orthotic medical grade device coverage already listed under insurance policies, which would be consistent with other orthotic providers.

Protecting Public and Insurance Spending for Orthotics

Canadian Certified Pedorthists possess extensive clinical and fabrication training in orthotics, making them an ideal choice for patients seeking assistance with their orthotic and other orthopedic needs. C. Ped (C)s ensure patients receive properly fitted medical grade orthotics, which increases the likelihood of successful treatment outcomes.

Improperly fitted orthotics are a significant concern that is often overlooked. Such improper fittings can lead to poor treatment outcomes and may cause soft tissue irritation or pain due to misalignment. Even when orthotics are properly fitted, custom-made foot orthotics may still require adjustments, which C. Ped (C)s are highly trained to perform. Many C. Ped (C)s have on-site workshops that allow them to make these adjustments immediately, resulting in improved patient care.

Challenges of Current Insurance Landscape

Efficient, high-quality care is crucial to ensure public protection. The College of Pedorthics of Canada (CPC) believes that the current prescription requirement by Canadian insurance companies may act as a barrier to immediate care.

Requiring a prescription from a physician or other primary care provider for custom orthotics can delay the start of treatment and consume valuable Physician time. With many Canadians lacking a Physician and experiencing long wait times at walk-in clinics, these delays can be significant.

Canadians who do have a Family Physician often have to wait multiple weeks to see their Physician due to their Physician’s busy schedule. Delays in the commencement of Pedorthic treatment, may lead to conditions worsening or becoming chronic in nature.

Pedorthists Add Value

The education, training, and standardized testing that Canadian Certified Pedorthists, also known as C. Ped (C)s undergo are more than sufficient to provide a clinical impression, develop an appropriate treatment plan, design, and fabricate custom orthotics, and offer any additional recommendations for optimal patient care.

Recognizing C. Ped (C)s as trained healthcare professionals capable of assessing, treating, designing, and prescribing custom medical grade foot orthotics is essential for protecting the public from malpractice, misuse, or inappropriate prescriptions.

Requiring a prescription from a primary care provider (such as a Physician) offers no added protection to the public and is not necessary for determining the clinical diagnosis and treatment involving custom-made medical grade foot orthotics.

Primary care providers such as Family Physicians do not have the time allotment to provide in-depth assessments for their patients.

Orthotic Prescribers, Providers and Public Protection

The current distinction between “Prescriber” and “Providers” within most insurance companies does not accurately reflect the process involved in the assessment, treatment planning, and manufacturing of custom-made foot orthotics.

Ensuring that the clinician or health professional performing the assessment and developing the treatment plan (including custom orthotics) is properly qualified is crucial for protecting the public and ensuring appropriate orthotic and product recommendations.

“Prescribers” (e.g., Physicians, General Practitioners, MDs) often provide a prescription for custom medical grade foot orthotics to satisfy insurance claim requirements. Most “Prescribers” rely on the “Provider’s” clinical assessment to establish medical necessity or confirm the need for custom medical grade foot orthotics.

When a Physician issues a prescription, there are no regulations governing from whom or where the policyholder obtains custom made orthotics. While Physicians may offer recommendations, they typically do not have a rigorous vetting process to ensure the legitimacy of the company providing the orthotics.

“Prescribers,” typically refer patients to “Providers,” (i.e., Canadian Certified Pedorthists or those in related healthcare fields) who then conduct the assessment and manage the treatment process. “Providers” are considered lead healthcare professionals. Normally, it is the “Provider,” not the “Prescriber,” who performs the clinical assessment, determines the clinical need, develops the treatment plan, and develops the key design and manufacturing decisions to ensure effective treatment. “Providers” offer adjustments to the foot orthoses and footwear based on the assessment results and the patient’s aims of treatment. This knowledge and expertise optimize enhanced treatment outcomes.

Canadian Certified Pedorthists: Certification

To attain certification as a Canadian Certified Pedorthist, C. Ped (C), prospective candidates must fulfill the following requirements:

  • The College of Pedorthics of Canada (CPC) written examination (must earn passing score)
  • The College of Pedorthics of Canada practical examination (must earn passing score)
  • Complete an estimated 1584 hours of training through affiliated University diploma program offered at the Western University Continuing Studies department
  • Maintenance of member in good standing with The College of Pedorthics of Canada and membership with the Pedorthic Association of Canada

Scope of Practice: Canadian Certified Pedorthists scope of practice varies in terms of clinical assessments, treatment plans and design and fabrication of medical grade devices.

See below for details regarding the scope of practice.

  • Clinical Assessment: Theory: 265 hours | Practical: 380 hours

A Pedorthist must perform a clinical assessment as it is necessary to determine the clinical presentation(s), diagnosis and/or condition(s), and determine need and type of treatment. A comprehensive assessment of the lower extremity generally includes postural and gait analysis, range of motion testing, palpation, special testing, footwear analysis, a detailed history and review of potentially complicating health factors

  • Treatment Plans: Theory: 139 hours, Practical: 380 hours

A treatment plan for musculoskeletal injuries, medical conditions, disabilities, and diseases affecting the lower extremity is developed following a comprehensive assessment and incorporates non-invasive treatment options to improve patient biomechanics, comfort, and mobility. Pedorthists generally develop treatment plans that consist of over-the-counter products, custom-made orthotics, bracing, splints, custom and orthopedic medical grade footwear, and footwear modifications. Treatment plans are generally defined by The College of Pedorthics of Canada within their Scope of Practice.

A treatment plan is normally implemented with a patient-centered approach, which includes educating the patient and fostering a shared decision-making environment. The treatment plan is then normally evaluated over time in conjunction with other healthcare professionals as needed.

  • Design and Fabrication: Theory: 40 hours | Practical 380 hours

The design and fabrication of medical-grade foot orthotics, aligning with the treatment plan, are created following a comprehensive assessment. This process requires 1) theoretical knowledge, in Pedorthic lab materials, and manufacturing techniques and 2) practical expertise in casting methods and modifications.

FAQ’s

No, the CPC does not require a referral to see a C. Ped (C) for an assessment or to dispense most products, including custom made orthotics.

Yes, the CPC’s Standards of Business Practice outlines the invoice and billing requirements for C. Ped (C)’s.

All Pedorthist’s who are Registrants in good standing with the CPC can be found on our website using the find a Pedorthist Tool. If you cannot find the Pedorthist you are looking for, please contact the CPC at info@cpedcs.ca.