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A full reading of an article in the January 2018 of The O&P Edge written by Phil Steven's, MEd, CPO, FAAOP concerning "Medicare's Strategy to Reimburse for Value Over Volume".

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3/6/17 O&P Historical Progress Note 3/14/2001

02/22/17 - Historical O&P Progress Notes 3/13/2001

Click Here for Podcast #1 11/2/16 - Supramalleolar Orthotics

X1 Blade RTL to High Plains Podiatry - McCook, NE

Published on Dec 26, 2015

Rx: X1 Blade Light Model

Diagnosis: Hallux Rigidus with Bone Spurs

History: Male 50+ years has pain in left great toe due to Hallux Rigidus.

Plan: Fabricate one light weight orthotic to fit in work boot. X1 Blade Light RTL model. Orthotic should not to exceed 18g weight nor 1mm thickness. The shell should be flexible in zone 2 (midfoot) stiff in zone 1 forefoot with a deep relief well under great toe. Line great toe relief well with ShearBan and pad heel with 1/8" moleskin.

Sx: Call in order from High Plains Podiatry 12/15/15 / shipment 12/22/15 USPS Priority Mail.

FU: Customer satisfaction questionnaire by email January 10, 2016.

• Category

  • Sports

• License

  • Standard YouTube License

Clyde's AcuStep Athhletic Foot Orthotics

Contact Name: Jacqui H. Phone: 317-xxx-xxxx Email Address: jh@iuhealth.org Comments or Questions: Clyde, I ordered my daughter Emily another pair of orthotics. Please let me know if I completed everything correctly. Thanks again for these great orthotics. My daughter's whole basketball career changed when she had the foot support she needed. Thanks, Jacqui H.

AFO-Ground Reaction Repair

The patient's father dropped off a right AFO-GR with SVSP trimlines for repair. The medial screw is backing out. Again, the top section is again wider than the bottom section. I heated the top section in several places and brought it in to match the bottom section. I allowed it to cool for several hours and it remained in place. I trimmed the joint surfaces to make them more congruent. I replaced the screws and Lok-Tited them in place. I tested this several times, and the screw did not back out. The parent will pick up the brace this afternoon.

prosthesis, preparatory, endoskeletal, PTB insert, distal end pad, cuff suspension, and SACH foot.

This is a 54-year-old black male who had his left BKA done in August of 1996 secondary to insulin dependent diabetes mellitus and peripheral vascular disease. This began by having his small toe amputated in 1993, he then went on to have his great toe amputated in January of 1996. This failed to heal and osteomyelitis set in. At that time he also began having problems with his right foot. He went on to have his amputation in August. He has a Charcot foot on the right side. Patient denies any problems but does wear an orthosis on this side attached to a shoe. This is not a custom molded shoe but does have a molded insert. He has in addition to the amputation hypertension, congestive heart failure, and proteinuria. He takes Lasix and Capitril. He takes approximately 7-8 other medications but does not recall their names. He has had knee and foot surgery done to his right side to correct problems. He has had eye surgery done bilaterally. He has had a lumbar laminectomy. He has had bilateral rotator cuff surgeries. He states that the left has failed. He has had heart catheterization which revealed no blockage. He had a penile prosthesis installed which became infected and had to be removed. He also has mild right hemiplegia secondary to a stroke which he suffered in March of 2006. He is wheelchair and scooter mobile and does not ambulate using a walker or crutches at this time. He states that the stroke has limited his ability to balance well.
Fabricate a left PTB temporary prosthesis with soft insert and SACK foot and cuff suspension made of ultra lightweight construction.
Cast and measurement today.
Approximately 2-3 weeks for a return visit and fitting.

Abducting R-Foot in AFO - Correction

The patient was seen today for a recheck of her bilateral WHOs and her bilateral solid-ankle AFOs. Everything is still fitting appropriately. She has not outgrown these devices. The nurse and the father understand how to apply the devices correctly. The patient was abducting her foot in the right AFO more than we wanted her to. I added a pad along the lateral 5th metatarsal. This straightened out her foot nicely. Everything else was appropriate. She was not getting any red marks from the braces. They are concerned about the fungus that is grown on her right toes. The brace is not touching the toenails in that area. She is also not wearing shoes, and not able to take any medication to treat the fungus due to numerous seizure medications. Other than keeping clean socks on her feet, I did not have any other advice for them. I advised them to contact their doctor with their concerns. The patient will be seen as needed.

Hip Displasia - Rhino Hip Abduction Brace

Right hip dysplasia. This 7-year-old female has no allergies, is not taking any medications and has had no surgery. I measured her today for a rhino brace. She will fit in a size extra small. I trimmed the foam down to appropriate size. I explained donning, doffing, wear, and care procedures as well as how to assist the patient in sleeping in the brace by propping up her feet and legs with a pillow. We could not release the brace to the patient today due to insurance issues.

Preparatory Prosthesis

The patient is in the office today for final fit and delivery of his preparatory prosthesis. The device fit very well. We achieved a 3-ply fit. He was able to hold suction quite well. He understands sock ply management. He understands that if there are any irritations to the limb, he should contact us immediately for adjustment. The patient walked quite extensively in the office utilizing his prosthesis. At today's visit, as expected, he is slightly hesitant on weightbearing on his prosthesis. I expect that this will resolve over time. Additionally, he noted after ambulating quite significantly here in the office he was sore in the hamstring area. I felt that this was due to stretching them out. I feel as though in 2 weeks he should be ambulating without crutches. He ambulated in the parallel bars and out utilizing forearm crutches. He also went up and down steps here in the office. I feel very comfortable with the fit and function of the patient's prosthesis. He noted no discomfort. All bolts and nuts were Lok-Tited and torqued to manufacturer's specifications. I provided him with 6 single ply and 6 multi-ply socks with two 3-mm suspension liners and 2 silicone gel liners. We will follow up in 2 weeks for further adjustment.

Clubfoot

The patient has returned to the office today. He was here earlier today for fitting of his clubfoot orthosis. It was too small because he had grown. Because it had never been delivered, I remade it adding material in the appropriate areas. He returned this afternoon for the fitting. It fit very well. Appropriate trimlines and proper clearances were established. Donning, doffing, weaning, and wearing was discussed with his mother. Of note today was that the patient has the presents of chaffing and mild irritation of the skin on the calcaneal area and on the 1^st metatarsal area. I think this is because he sweats a lot within the orthosis. I recommended that his mother change his socks at least 2 times per day. I also drilled a vent hole in the heel of the orthosis to provide him with air circulation in this area. Followup as needed. They will be returning to the physician for a checkup.

SWASH Hip Orthiosis

The patient was seen today for measuring and fit for a SWASH hip orthosis.

Cerebral Palsy - Swash Hip Orthosis

SWASH hip orthosis

Cerebral palsy.

This patient will be 7 years old in a few more weeks. She will be receiving Botox injections in the adductor muscle groups in both legs in the next couple of weeks.

Measurements were taken of the patient today and an appropriate SWASH hip orthosis was fit to the patient. Proper donning and doffing instructions were given to mom. Several adjustments were made to properly fit the patient. Growth adjustments can be made to this orthosis. While she was wearing the orthosis, standing and attempting to take steps, she could adequately clear her feet without scissoring. When she was sitting, she had very good sitting balance. Mom informed me that the therapist also wanted her to sleep in this orthosis. I instructed the mom to begin the patient on a gradual wearing schedule starting with 2 hours today, 4 hours tomorrow, 6 hours the next day and 8 hours the following day. Once she has reached the 8-hour point, she was told to allow the patient to sleep in the orthosis. I encouraged her to allow the patient to wear something snug fitting under the orthosis, possibly tights. The patient appeared to tolerate the device well. I gave mom the Alien wrenches if changes needed to be made in therapy. I marked the initial spots of the settings. I told mom if she has any problems or questions, or if she did not feel comfortable making changes, or if the therapist did not feel comfortable making the changes, to please return. The patient will be seen as needed.

Evaluation, measurement and fitting.

AFO-Free Ankle

The patient was seen today for a recheck of her bilateral AFO-FAs. The patient reports that these are much more comfortable now and she is not having any problems with them except that she and her husband are having difficulty donning the shoes. They report that the back is crumpling even with the use of the shoehorn. I added leather loops to the posterior of both shoes to help pull the heel of the shoe out during donning. I instructed the patient's husband on how to don the shoes again, and he successfully donned the shoes today in the office. The patient is going directly to therapy today, and they will contact us should they have any further problems or questions.

C-5 Tetraplegic - Spinal Cord Injury

Spinal cord injury C-5 tetraplegic.

This 21-year-old male is allergic to AMOXICILLIN. He takes Neurontin and medication to control his bladder muscles. He had a motorcycle accident in July 2000. He had spinal fusion of C-4-5 and a trach. He is nonambulatory and will begin physical and occupational therapy after he receives the braces, and his parents stated they have changed insurance companies and are working out the details with the prescriptions with the insurance. He has bilateral dorsal WHOs.

The patient was left-handed but his right arm now has greater strength. He is able to raise his arms at the shoulders, the right to 90 degrees and the left to 75 degrees. He has bilateral elbow flexion on the right. On the right it is grade 4, and on the left it is grade 3. The patient requests black straps with his orthoses. I have contacted the occupational therapist, and have received a complete description of the type of brace that she wants. She requested a tubular-type static WHO with C-bars bilaterally.

Fabricate tubular-type WHOs with C-bars bilaterally. Casting and measurement. In several weeks for fitting.

WHO with Tool Attachments

The patient was seen today for casting and measurement for a left static WHO and right static WHO with tool attachments, swivel fork, spoon and standard fork.

Shoe Fitting

The patient was seen today for an initial fit of his shoes. A good fit was achieved. The shoes will be used in the fabrication of a brace for the left side. He ambulated in the hall and commented that they felt very comfortable. The shoes appeared appropriate; therefore, we will proceed with the brace.

Soto's Syndrome and Planovalgus

Bilateral UCBs.

Planovalgus and Sotos' syndrome.

This is a 9-year-old female with no known allergies. She is taking Ritalin. She is an active community ambulator, and she does not us any assistive devices. She had bladder reconstruction in 06/2000 and she had 2 hernias prior. Her previous devices were bilateral SAFOs made by Muilenburg Prosthetics.

The patient presents as a pronator. Her heels are in valgus but correctable bilaterally. Her forefeet are abducted and correctable. She presents with no knee recurvatum. Range of motion at the ankles with the knees flexed is to +10 degrees. With the knees straight, the range of motion is to +5 degrees bilaterally. The casting procedure went well. Mom knows what to expect in regards to overall design of the braces.

Fabricate bilateral UCBs.

Cauda Equina Syndrome - Hypotonic No Clonus

Bilateral AFOs. – Orthopedic Surgeon Referral

Cauda equina syndrome with bilateral drop-foot.

This 71-year-old male has no allergies. He is currently taking Xanax and is an insulin-dependent diabetic. He has had many surgeries, spine surgery in December 1999 and June 2000 to relieve pain in his lower limbs. However, his wife reports that this was unsuccessful and they discovered a syrinx at this time. He also had surgery for a broken hip. He has had the 2^nd toe on his left foot amputated. He has had surgery for cataracts and glaucoma. He also has a history of an ulcer on the 2^nd toe of his right foot and on his right heel. He has had no ulcers on his left foot. Today the patient has a small sore on the middle of his right tibia. The patient is a limited household ambulator, uses a walker. Out in the community, however, he does use a wheelchair. He will begin physical therapy after he receives the braces. He has had no previous braces.

The patient's feet present as pronated bilaterally. He is hypotonic with no clonus. Range of motion at his ankles is to 90 degrees with his knees straight. His heels are in valgus and his forefeet are slightly abducted. His right foot is flaccid, and his left foot has a trace of dorsiflexion. His quads are 3+. His skin appears to be somewhat thin. He has some peeling of the skin over his left heels. He has pitting edema in his feet and lower legs. The sensation stops at the top of the left calf and at the middle of the right calf. Traced the patient's legs for conventional AFOs, took impressions for custom inserts, and measured his feet for extra-depth shoes to be attached to the conventional AFOs. I observed the patient's gait with a walker in the office today. He has a very crouched gait and he takes small shuffling steps and drags his toes.

We will order Drew men's doubler shoes for the patient and fabricate custom inserts and bilateral conventional double-upright AFOs with double action ankle joints and an extended stirrup.