Published on Mar 22, 2017
Order Taken: Verbal Order 3/21/17 / Hand Delivered 3/22/17
PA: Butler University Sports Medicine/ Indianapolis, IN
RX: Clyde's X5 GoBlade for 5th Met Discomfort - Left Foot
DX: 5th met ossicle formed by abnormal ossification of previous fracture
ICD-10-CM Billing Code : S92.353A
Plan:
Fabricate X5 GoBlade men's size 13 with StifFlex midfoot for
unrestricted ankle motion during basketball activity. Stiffen lateral
forefoot with .003" unidirectional composite tape on the bottom
surface of X5 Blade covering 5th and 4th metatarsals ending just distal
to the base of 5th metatarsal. Add 1/8" plastizote unloading material
to the lateral top surface along the length of the 5th and 4th
metatarsals ending distal to the base of the 5th metatarsal to unload
base of 5th met. Maintain rocker shape forefoot for natural toe off.
Place under insert provided in basketball shoe for comfort. Specs:
thickness and weight of X5 GoBlade - 1/25" (.04") - 1.235 oz.
Sport: D1 Basketball
Comments: Player presents with limp on left.
Website: www.indianabrace.com
Contact: Call: 800-253-6217 Text: 317-445-1475 Email: clyde.peach@gmail.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321
American Board for Certification in Orthotics & Prosthetics
11/27/16
RX: X1 Blade for right Jone's fracture.
Diagnosis: Jone's fracture of right meta-diaphyseal junction of 5th metatarsal. S92.351D
Plan: Fabricate X5 Blade with stifflex zones - zone 1-5 stiff - zone 2&3 flexible with unloading modification at zone 1-5.
Sx: Order received 11/27/16 @ 5:42 PM via website www.indianabrace.com - shipped 11/29/16 USPS Priority Mail expect delivery to Germantown., TN in 2 days.
FU: Customer satisfaction survey mailed 12/10/16
History: Young female soccer player sustained Jone's fracture while playing soccer. She has been in a walking boot for several weeks. Transitioning to soccer shoe (women's size 7) with a light weight orthotic for continued support. May
Rx: Playing Orthotic for Jone's Fracture Left
Diagnosis: Left Foot Jone's Fracture / CPT 825.25
History: Young female soccer player sustained Jone's fracture while playing soccer. She has been in a walking boot for several weeks. Transitioning to soccer shoe (women's size 7) with a light weight orthotic for continued support. May resume soccer competition with orthotic in left shoe.
Plan: Fabricate X1 Blade with 5th metatarsal modification to unweight the Base of the healing fracture at 5th metatarsal. StifFlexX1 layup for unrestricted support, F1 sport profile with rocker contour to fit into a narrow soccer shoe.
