My most recent post on this forum was regarding “Back to Basics” orthotic devices, similar to those used when podiatric biomechanics was in its infancy and early adolescence. I believe there are contemporary uses for these devices, in selected situations. Now, I want to travel back even farther in time and discuss corrective foot devices that originated pre-Dr. Root, and how they may still be useful tools in the foot clinician’s toolkit. I am purposely excluding discussion of the Schaeffer plate, the Whitman plate, the Roberts-Whitman device and the various other specific devices invented over the years to treat different aspects of the suffering foot, primarily in pediatrics. For an excellent overview of this subject, I will refer you to an article by Steven J. Levitz DPM and Ellen Sobel, DPM entitled “Prescribing Foot Orthoses” in the September 2002 issue of Podiatry Management Magazine
The vast majority of custom foot orthoses prescribed are characterized as functional foot orthoses, the purpose for which is to realign the foot into a more optimum position in order to enhance a more normal function of the feet. On the other hand, accommodative orthoses are used to more or less bring the ground up to the feet, increase the weight bearing surface of the bottom of the feet, and hopefully alleviate symptoms. In cases of fixed, rigid deformity including subluxation and/or severe weakness,accommodative type orthosis should be given consideration. Many, if not most over the counter “orthotics” would be classified as accommodative orthoses, however they should be considered generic as opposed to customized to a mold of the patient.
KevinRoot Medical offers several devices that may be configured as accommodative devices.
The A6 model, Cork and Leather can be configured without posting, and modified in a number of ways such as Scaphoid pads, metatarsal pads Cuboid pads, and either medial or lateral heel skives. Patients who have previously worn these type devices for years, with success, may be best served with a facsimile replacement, rather than reinventing the wheel.
The A8 model, Dynamic Arch Support, may be configured when aggressive medial arch support is the predominant goal of the orthotic device, and customized to the individual patient needs.
The T1 Care Soft and T2 Care Firm devices are somewhat hybrid functional/accommodative devices depending upon how much biomechanical control is desired based on frame rigidity and the use of posts.
The T3 Premium Diabetic is manufactured on an EVA frame with a plastazote cover offering the ability to support the high risk diabetic foot with firm, yet forgiving materials.
Please note, if you will be billing an insurance carrier for these types of devices, be aware of the qualifications for the use of billing codes L3000, L3010, L3020 and L3030.
It is critical to have knowledge of the various types and configurations of custom foot orthoses available today. There are appropriate uses of more classical or vintage types, less corrective and more accommodating devices. Conversely, the vast majority of our patients require accurate biomechanical control in order to achieve optimum correction of deformity, enhanced performance and alleviation of symptoms. Dr Richard Blake is currently presenting a series of posts on this forum on how to accurately achieve various degrees of biomechanical control with functional foot orthotics. I invite you to not only read these posts, but study them! (Here is the first one).
