What a Full Podiatry Clinic Day Taught Me About Systems, Orthotics, and Revenue

READ TIME – 3 MINUTES

Hello down here—welcome to Podiatry Practice Mastery.

Today I recorded a full clinic day, start to finish. Nothing fancy. No unicorn cases. Just real patients, real decisions, and a few small systems that quietly move the practice toward the million-dollar mark.

I’ll walk you through the highlights and, more importantly, the thinking behind them.

Start With Simple, Repeatable Wins

My first patient was a 21-year-old female with bilateral bunions. My usual bunion framework:

• Shoes – anatomical shoe recommendations
• Orthotics – we scanned her for customs
• Corrective options – discussed but not pushed

One orthotic order down.

My personal goal is two pairs of orthotics per day, which gets me to about 40 per month. That one decision alone adds up fast.

Ancillary Treatments That Actually Work

A 61-year-old male came in status post Swift for plantar warts—those improved nicely. He also had bulbous Achilles pain. We did six sessions of shockwave, and he’s significantly better. He still has some lingering discomfort, so we added physical therapy.

Nothing exotic. Just stacking treatments that complement each other.

A Quick Word on Qutenza

Another patient is on Qutenza (treatment #7). Reminder: you can’t do Qutenza and nail care on the same day.

One thing we’ve learned—using a specialty pharmacy is key. It avoids inflating your production numbers. The $4,000 drug cost is essentially a wash, and what you’re really paid for is the application. It’s still worthwhile—but only if you understand the math.

Why I Now Offer OTC Orthotics

I used to never offer over-the-counter orthotics.

That’s changed.

For a younger patient with pronation and toe pain, we started with OTC inserts—specifically a rigid shell option around $60. They work well, even in dress shoes.

Here’s the key shift for me:

• Customs are still the gold standard
• But some patients want to start conservatively
• Offering OTC keeps them in your ecosystem instead of Amazon’s

The Power of the Second Pair

A patient with a cavus foot came in for an orthotic follow-up and was doing great.

I told her something I learned from another doctor:

“I don’t care if you have two pairs or 100 pairs—but having a second pair dramatically increases compliance.”

She ordered a second pair.

That was orthotic #2 for the day.

Track the “No’s” Too

Later, a patient declined orthotics for met head pain.

I still track it.

Not every recommendation lands—and that’s okay. Knowing your conversion rate is just as important as celebrating the wins.

A Line I’m Stealing (and Using Daily)

I was talking with a colleague who does more orthotics than anyone I know. His phrase stuck with me:

“I want to do the least expensive thing that gets you 100% relief.”

He often starts with OTC orthotics, then modifies them:

• Medial posting
• Reverse Morton’s extension

If it works, then it becomes the blueprint for a custom device.

That approach builds trust—and sells more orthotics long-term.

Big Picture Takeaway

This wasn’t a flashy day.

It was:

• Orthotics
• Shockwave
• Wart care
• Nail procedures
• Follow-ups
• Small decisions, done consistently

That’s how practices quietly cross seven figures.

Key Takeaways

• Set a daily orthotic goal and let it compound
• Use OTC orthotics strategically, not defensively
• Educate patients with phrases that build trust
• Understand the real math behind ancillaries
• Consistency beats complexity—every time