Severe Equinovarus deformities and ambulation: Responses page 2

Severe Equinovarus deformities and ambulation: Responses page 2

Randy McFarland

1/10/2016

I have done it. I can't bill for it but I think it's worthwhile to do a
check fit along the way. I use durplex or polyethylene for the checks like
I was doing a prosthesis. I've done a polyethylene flexible boot insert
with polypro over it for strength and a walking sole. The polyethylene
provides a nice flexible material to lessen the chances of skin breakdown.
You can do one side and see how she does with it before doing the other. I
would do that and tell her you're proceeding carefully because of her
contractures and other issues. Make sure her goals are realistic-this is
for limited gait in therapy and transfers. Also make sure the therapist's
goals are realistic as well. As far as payment I don't know. I do check
fits in these situations knowing that yes it's taking time and money but it
does give you a sense of 1. will this work and 2. it really does cut down
repeat visits for adjustments after delivery. My concern would be also: how
well will the SNF monitor and work with the patient in wearing the brace?

Don't forget orthopedic surgery may be best option for her in long run. We
have an Ortho in the area who specializes in ankle. Have patient consider
referral. We end up still doing AFOs for residual drop foot with good
outcomes post op.

I have had a few patients with similar presentations. On one gentleman we
did a traditional double upright AFO with a huge heel lift and a t-strap. He
was in therapy and did have some botox treatment. We did have some success
with the AFO since his ability to ambulate did improve--not great but
better. I fit another patient with a Valga-Noodle from Kinetic Research. I
added an additional t-strap and some heel lift on top of the footplate and
it worked really well. She also undergoes botox therapy.

I have had a few patients like this. Some cases I fabricated the AZ AFO
Neuro walker boot. We of course, used the ddx of ankle instability, ankle
deformity and equinovarus. Check out the AFO design. it is well padded and
the sole had to be modified with lateral wedge and buttress to limit the
varus moment.

Ortho America makes the Fusion afo that is custom total contact all foam
interface. it is a wrap around design that would work great for this
application. You would have to post the heel to get N base of support.

I have seen custom made (in Italy) Espadrille wedge-styled high-heeled boots
for both men & women. The main issue to fit is the varus. If the varus
cannot be even partially corrected, you will also need notable lateral
flairs built into the wedge.

I have had a few folks like this and usually it comes down to how well are
the devices donned each and every time, AND do they call when the fit is
less than perfect due to physiologic change. Who knows with Medicare?