Orthotic Devices

Settlement Question for You?

I have been rated by the doctors and the court date is set to next month. It is an injury at work PPD claim. If I accept the one-time payment offer do I get it when I go to court or is it prolonged a certain amount of time? Will the insurance company most likely make an offer before then? I looked up the PPD charts for my State. Do I just get what it says on the chart or do I get other relief from pain & suffering, etc? My doctor that my attorney picked rated me a 39% with voc. rehab, and orthotic devices. The insurance companies doctor rated me a 15% with no rehab or anything else. What will the claims administrator most likely rate me then?

If you accept their offer, you will be paid normally within 30 days, not right away.

We cannot determine how much you'll get, since we don't know the situation. Odds are the adjudicator will choose some level between what your doctor says and what the insurance doctor says.

Orthotics and Your Feet

Orthotics are devices which fit into the shoe to aid the foot. "Functional orthotics" are rigid and designed to control motion and correct the function of the foot. Individuals with flatfeet, tendonitis, plantar fasciitis, certain foot deformities, knee, hip and back problems may benefit from functional orthotics. "Accommodative orthotics" are soft and designed to reduce pressure and prevent excess friction. Diabetics and those with a loss of sensation or circulation in their feet will benefit from accommodative orthotics. Both types of orthotics are custom made by taking a mold of the foot.

Functional Orthotics

The goal of the functional orthotic is to improve the mechanics of the foot, control the abnormal motion in the foot, decrease the pain in the foot, ankle, knee, hip or back and to add support. The orthotic should make standing, walking, jogging or running more comfortable. The orthotic must be rigid to help control the motion in the foot and add support. If the orthotic is soft, the weight of the body would collapse the device and it would no longer function.

Abnormal motion is typically in the form of pronation. Pronation is the rolling in of the foot and collapse of the arch. The motion starts at the rearfoot, or heel area. When the heel turns in, it allows the arch to collapse. This puts undue stress on the ligaments and tendons in the arch area and contributes to the development of tendonitis, plantar fasciitis, bunions and hammertoes. The functional orthotic helps to control the abnormal motion in the rearfoot. This is accomplished by taking a mold of the foot in its neutral position. The neutral position is the position the foot should be in when walking. When standing, the over-pronated foot is in the uncorrected position. The mold of the foot should be taken with the patient sitting so the foot can be placed in the neutral position.

The molds are sent to a lab and scanned into a computer. A reverse image is produced and the computer generates an image of the foot in neutral position. The computer adjusts the image based on the corrections recommended by your podiatrist. A model of the foot is then cut out, in some cases out of wood. The orthotic material is pressed over the foot model and the orthotic is created. The most common material is polypropylene, but other materials, such as graphite are used. In some cases, hand-made molds are created out of plaster. This was the classic way orthotics were made until newer technology made the process much less labor intensive.

Functional orthotics are a successful treatment for many problems affecting the lower extremity. In a recent article in the Journal of the American Podiatric Medical Association, 75% of patients surveyed had good to excellent results from functional orthotics. This includes 17% who felt the orthotics "cured" their pain. Less than 10% had no relief. The most commonly treated condition in the study was a painful heel. Over 20% of patients surveyed were treated for a painful heel and 20% were treated for a painful arch. Fourteen percent of the individuals were using orthotics for flatfeet. Other conditions treated with orthotics were knee, hip and back pain, foot arthritis, bunions and high arches. Tendonitis was not specifically evaluated.

Individuals with plantar fasciitis (heel and arch pain) who also have flatfeet usually respond best to orthotics. The plantar fascia is a ligament type structure on the bottom of the foot which helps to hold up the arch. When the foot collapses, the weight of the body stresses the ligament and results in tearing and inflammation. This results in plantar fasciitis. These individuals typically respond well to orthotics in combination with other treatments. Certain types of tendonitis respond well to orthotics and other types require orthotics. Posterior tibial tendonitis is the tearing and inflammation of the tendon that helps to hold up the arch. When this tendon is overstressed by arch collapse it cannot heal. Orthotics are essential in the treatment of this condition.

Individuals with high arches may require orthotics as well, but they do not respond as well. Orthotics can help slow the progression of bunions and hammertoes, but they will not prevent this process. Orthotics may help with some pain at a bunion, but they will not "cure" the bunion. When the motion in the foot is contributing to the problem, orthotics are generally recommended. If the foot is stable and does not require support, the bunion, hammertoe, neuroma, tendonitis or even plantar fasciitis may not require custom made orthotics for treatment. These individuals may do well with a pre-fabricated orthotic.

Accommodative Orthotics

Diabetics can develop numbness and loss of circulation in the feet. This numbness and circulation loss puts them at risk for developing open sores on the feet called ulcerations. To help prevent excess rub and friction in certain areas on the feet, accommodative orthotics are recommended. Diabetics who do not have numbness or circulation loss (as diagnosed by their doctor) do not need to have accommodative orthotics. If the foot has a deformity, like a bunion or hammertoe, then accommodative orthotics are necessary.

Accommodative orthotics are made from many different types of material. Some are made of a foam type material, others made from cork and others have covers ranging from soft spongy material to leather. The type of material depends on the type of foot. Many accommodative orthotics, made for diabetics, have two or more layers that form around the foot once they are worn. Three pairs are dispensed every year and they are replaced every 4 months. Other materials are longer lasting. A mold of the foot is taken by stepping into a foam box. In this case, it is important to take the mold standing, so that the orthotic can be made to form around the foot.

The Cost

Many insurance companies cover orthotics for certain diagnoses. The most commonly covered diagnoses are plantar fasciitis (heel and arch pain), flatfeet and diabetes. Many insurance companies cover the orthotics at 80%. This means the patient is responsible for 20% of the cost unless they have a secondary insurance. If the deductible has not been met, then the amount is applied to the deductible and the patient must pay the full amount. Orthotics are not cheap. They range from $250 to $600.

Medicare covers orthotics for diabetics with neuropathy (numbness of the feet). Medicare does not cover orthotics for any other type of foot problem. Secondary insurance will not cover orthotics if Medicare does not cover them.

Podiatrists most commonly prescribe orthotics, but pedorthotists, orthotists, physical therapists and sometimes orthopedists will also provide orthotics.

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AAOS Atlas of Orthoses and Assistive Devices List Price: $219.00 Sale Price: $203.87 You save: $15.13 (7%)   Eligible for free shipping! Availability: Usually ships in 24 hours See Reviews For This Product Description Here's all the guidance you need to overcome the most difficult musculoskeletal problems using orthoses and assistive devices! With new coverage of postpolio syndrome, cranial orthoses, and now incorporating the perspectives of renowned physiatrists, this is a one-stop rehabilitation resource. Tips and Pearls in every chapter and a new 2-color format make accessing information a snap.Includes Chapters on biomechanics of spine, upper limb and hand and lower limb to help you understand the factors that determine the orthoses available for these joints.Incorporates chapters on the Orthotic Prescription, Strength and Materials, and the Normal and Pathologic Gait help you understand your role in the rehabilitative process.Contains information about the specific science behind the construction of orthoses-perfect for the Certified Prosthetist/Orthotist and the interested physician.Carries the authority and approval of AAOS, the preeminent orthopaedic professional society.Uses a new 2-color format to make the book easier to use and information easier to retain.Includes Tips and Pearls boxes in every chapter so you can quickly access expert guidance.Contains new chapters on: Orthoses for Persons with Postpolio Paralysis; Orthoses for Persons with Postpolio Syndromes; and Cranial Orthoses.Incorporates evidence-based recommendations into the chapters on spinal, upper- and lower-limb orthoses to help you select the most proven approach for your patients.

Orthotics: Clinical Practice and Rehabilitiation Technology Sale Price: $178.55 See Reviews For This Product Description University of Kansas, Kansas City. Concise reference relating orthotics to clinical diagnosis, for physicians, orthotists, and other members of the rehabilitation team. Illustrated. 19 contributors, 17 U.S. DNLM: Orthotic Devices.

Lower-Limb Prosthetics and Orthotics: Clinical Concepts List Price: $55.95 Sale Price: $50.35 You save: $5.60 (10%)   Eligible for free shipping! Availability: Not yet published See Reviews For This Product Description   Lower-Limb Prosthetics and Orthotics: Clinical Concepts is a comprehensive overview of lower-limb prosthetics and orthotics, covering normal and pathological gait, lower-limb biomechanics, clinical applications, as well as prosthetic and orthotic designs and components. Joan Edelstein and Alex Moroz have written Lower-Limb Prosthetics and Orthotics with the clinician’s perspective in mind. Clinical management is incorporated throughout the text, including basic surgical concepts, postoperative management, preprosthetic care, and training in the use of devices. Additionally, this text incorporates unique features relevant to physicians such as prescription writing and prosthetic and orthotic construction and modification, as well as, the latest research regarding energy consumption and long-term utilization of prostheses. Chapters Include:   Orthotics in neuromuscular diseases Orthotics in pediatrics Functional expectations Gait and activities training Transtibial and transfemoral prostheses and components Transtibial and transfemoral biomechanics, evaluation, and gait analysis Disarticulations and Bilateral Amputations   With over 150 line drawings and photographs to supplement the text, Lower-Limb Prosthetics and Orthotics: Clinical Concepts is ideal for clinicians in the fields of physical medicine and rehabilitation, orthopedics, vascular surgery, physical therapy and occupational therapy.

Atlas Of Orthotics And Assistive Devices List Price: $192.00 See Reviews For This Product Description University of Southern California, Downey. Text/atlas on the scientific basis for orthoses, with emphasis on the restoration and preservation of movement and function, for orthopedists, orthotists, occupational therapists, and physical therapists. Previous edition 1985. 84 contributors, 80 U.S. DNLM: Orthotic Devices.

Orthotics: A Comprehensive Clinical Approach Sale Price: $60.95   Eligible for free shipping! Availability: Usually ships in 24 hours See Reviews For This Product Description Orthotics: A Comprehensive Clinical Approach is an innovative and comprehensive new text that provides essential information about contemporary orthoses to guide the student and clinician in prescribing and utilizing these appliances in neuromuscular, musculoskeletal, and integumentary rehabilitation. Written by recognized authorities in the field, Joan Edelstein, MA, PT, FISPO and Jan Bruckner, PhD, PT, this is a prime resource for practitioners and clinicians. Individual chapters cover orthoses for the foot, ankle, knee, hip, trunk, neck, shoulder, elbow, wrist, and hand. Orthoses for patients with paraplegia, burns, and soft tissue contractures are detailed and illustrated. Prescription guidelines, evaluation techniques, goal setting, and training procedures are presented. Each chapter has interesting "thought" questions and case studies to promote clinical reasoning and problem-solving skills. A unique feature of this text is the inclusion of a point-counterpoint discussion to demonstrate how clinicians can manage the same patient in different ways. This approach inspires broader thinking about clinical management.

Foot Orthotics in Therapy and Sport List Price: $29.00 See Reviews For This Product Description Features background information for beginners in foot orthotic therapy, outlining the latest theories, approaches and techniques for making braces and supports. The book also provides ideas for more practised sports clinicians. The highly-illustrated format is designed to help practitioners to customize orthotic devices for athletes and patients, improve the quality of their orthotics and save time by creating orthotics in-house. The advice given also helps to promote healing, allowing athletes to return to the game more quickly. The book offers easy, hands-on instructions for making state-of-the-art orthotics.