Orthotics For the Aging Foot | KevinRoot Medical
  1. Forum
  2. Dr. Feldman
  3. Practical Pearls
  4. Orthotics For the Aging Foot

Orthotics For the Aging Foot

  • Stefan Feldman

    L3000 is the HCPCS code for the vast majority of the orthotics we provide for our patients in need of a biomechanically based treatment plan. Despite the fact that Medicare doesn't cover this service (Dr Kesselman, please correct me I am wrong) for the 65 years old and over crowd, it doesn't mean you should disregard utilizing a functional orthotic device in this age group.

     

    The privilege of retirement from full time employment provides increased opportunities for leisure activities. Many people with systemic conditions such as hypertension, heart disease and diabetes are being urged to “just walk more” or “get off the couch”. Many Medicare recipients enjoy covered health club membership through programs such as Silver Sneakers, senior golf tournaments are very popular, and pickleball courts are sprouting up everywhere. Podiatrists, physical therapists, chiropractors, orthopedic specialists of all kinds are positioned to be of great service in providing an enhanced quality of life as well as quantity of life to our mature patients.

    It is very important to take the chronological, as well as the biological age of the patient when determining how to approach orthotics in this population. First and foremost a very careful and thorough gait analysis should be performed. Ask the patient to walk at several different speeds, shuffle from side to side in each direction as well as twisting their upper bodies in both directions with their feet firmly on the floor. A single limb squat, as well as simple tests for balance should be considered. Examine the range of motion of critical joints and muscle strength on both sides. Limb length inequalities should be investigated. 

    If you find the patient has moderate to severe limitations or weaknesses consider a more accommodative device that provides comfort rather than a functional device. If the patient has only minor restrictions or limitations in their functionality, a more flexible or padded device may be easier to tolerate than a rigid one. It is also helpful to ask the patient what their goals as far as weight bearing activities are for the next 5 years. Discuss their shoe choices to correctly partner with their orthotic devices.

    The team at KevinRoot Medical is in it with you for the long haul!

    0 likes
  • Stefan Feldman

    Hello Dr. Feldman,

     
    Unfortunately, I couldn't figure out how to post a public reply, however I would like to make a few comments about your essay on orthotics for the aging foot.
     
    I think we need to quit thinking of the aging foot as requiring a some sort of "kid glove" approach, in that we don't want to concentrate on improving function that much.  I recently retired from the VA system, where a good 50% of our patients were considered geriatrics.  Some of my observations and opinions after working for 23 years with a high number of geriatrics are:
     
    1.  Yes, the geriatric foot often has PVD,  decrease muscle mass, loss of fat pad thickness as well as glycation of all the collagen tissues.  None, of these, though, indicate that we shouldn't try to do everything possible to help them walk with a more propulsive gait.  It does mean that we need to take more time in evaluating all the variables they may present, something which may irritate the officer in charge of time-management. (They only count beans, not human satisfaction)
    2.  I would refer you to the writings of Howard Dananberg on how the upper body responds to failure to undergo a normal 3rd rocker phase of gait.  The more we can do to improve posture, the more active the patient may find themselves, and the slower will be the aging process.  The literature documents well that physical activity is so important in decreasing serum AGE levels, which means that there is a decreased risk in both cardiac and peripheral vascular events.
    3.  Orthotics for the geriatric, then, must have both kinesiologic control of the patient's foot as well as supporting any loss of soft tissue in muscle mass or loss of fat pad or increase in durometer of the fat pad on the bottom of the foot.  "Rigid' orthotic materials may still be advisable, but may need additional cushioning on the top to replace the loss of fat pad.  The simple fact is that a 70 kg geriatric patient will need to put 70 kg of weight on an orthotic, whether it is made of iron or foam.  Substituting foam for the rigid materials while giving the illusion to the practitioner and the patient that more comfort will be achieved, actually decreases the overall abilities of the patient to perform at maximum levels with minimum stress to the foot and superstructure.
    4.  Much more time needs to be spent in evaluating muscle strength in the geriatric. patient.  Weaknesses will be found more often and more effort may be needed in controlling abnormal pronation,  e.g. patients are more likely to need Blake orthotics, UCBLs and AFOs and other modifications.  Fortunately, most geriatric patients are wearing shoes that are more amenable to an orthotic wearing condition.  However, expect to spend extra time with your geriatric patients in following up with their orthotic use as adjustments will be more often needed.
     
    In summary, I often think of the lecture by Mert Root so many years ago to an audience I was in, when he noted that geriatric podiatric medicine should not be focused on proper toenail care and making sure that the feet are cleansed properly, but instead should be focused on increasing stability, decreasing risk of falling and improving walking endurance.
     
    With best wishes,
    Robert D. Phillips, DPM
    Orlando, FL  32828
    0 likes
Please login to reply this topic!