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| Functional
Orthotics © 1999-2001 by Seth A. Rubenstein, D.P.M. Foot Function In addition to providing a means of locomotion, the foot functions as a shock absorber for the body. This is a very demanding job. Thousands of years ago, men and women walked through forests on soft earthen floors. Since prehistoric times, the human foot has slowly evolved, adapting its 26 bones into a flexible arch. This arch is capable of absorbing the repetitive jolts of walking, and protecting larger joints in the legs, hip and even back from wearing out and injury. Consider that the average person will walk 115,000 miles in a lifetime, the equivalent distance of walking halfway to the moon! Then add the stress of modern living, with its concrete floors and streets. Even a perfectly formed foot can complain if an individual "works on his feet" for long hours. Tired achy feet can benefit from an arch support to limit the stress which the foot must absorb in a day. Indeed there is no shortage of commercially available arch supports, such as Spenco or Dr. Scholl's insoles. For many people, these devices work very well.
Now consider a foot which is not perfectly formed. One possibility is a foot which is flattened out (pes planus, first example, left)... ...or stuck in a high arch position (pes cavus, second example, left). The foot structure can also be twisted toward the midline of the body (varus) or away from it (valgus).These and other structural variations can adversely affect the foot's ability to perform its job. The result can strain of the ligaments in the foot (plantar faciitis), lead to mechanical deformities such as bunions, and hammer toes, pinched nerves (neuroma), or result in aches and pains in the knees or back. Functional Orthotics Dependent upon an individuals activity level, such anatomical variations may not respond to an arch cushion. Instead a more rigid arch support, capable of supporting body weight and accommodating the structural imbalance is needed. This is the purpose of a functional orthotic. Functional orthotics are made from rigid plastic or layered graphite. In order to assure comfort and function, rigid orthotics must be custom made to the individual, usually by way of a plaster cast taken of the foot in what is called "neutral position." Such rigid devices allow for pronation or flattening out of the foot, necessary to absorb the shock of walking, yet prevent abnormal extremes of motion, associated with foot fatigue and over use injury. Shoe Gear and Orthotics To perform well, an orthotic must fit snugly into a shoe and not shift around. Open heeled shoes do not accommodate orthotics, which can slide out the back of the shoe. There is also great variation between the width of a sneaker and a woman's dress shoe. Dress shoes for women and some styles for men are snug fitting slip-ons, leaving little room for addition of an orthotic. Orthotic design can be varied to fit the narrower slip on style shoe. However, such a device may be to narrow for a fuller style shoe. For some people, two pair of orthotics make more sense, providing the greatest variety of shoe wear for different shoe types and activities. Wear and Tear Even when used properly, the synthetic materials of an orthotic can wear out. As long as the plastic plate has not deformed, the device can be reprocessed by replacing worn out top covers and heel post stabilizers. The usual life span of an orthotic plate is four to five years. This may be extended with extra padding placed under the arch. Cost Functional orthotics are custom made devices. They can not be returned and later used by another patient. The cost of the devices include the casting material, laboratory costs and one office visit in the month following dispensing the device, should adjustments be necessary. Our fee for a pair of orthotics is $550.00, with a discount of $100.00 for a second pair made within six months of the original casting process. The discount is provided as the orthotics lab will store the original foot casts at no charge for six months, after which they are discarded. The office payment policy regarding orthotics can be viewed in the insurance section of our Web site. Insurance Coverage Precertification Form Insurance companies may cover functional orthotics. When coverage is provided, your insurance plan may also require special pre-authorization and/or a letter of medical necessity from our office. In order to expedite orthotic production, we will ask you to inquire with your insurance to find out if benefits are provided under your plan, and whether any action from our office is needed to ensure such coverage. Please use the Orthotics Precertification Form when contacting your insurance company. We recommend you complete all questions on page one and bring the form with you to your appointment to be casted for orthotics. If we need to obtain prior authorization, please fax the form to our office before your visit. Our fax number is (703) 264-3983. A diagnosis code list is provided on the second page. If you are already an established patient, you may ask the office which diagnosis code best applies to you. Please note the procedure code for functional orthotics is L3000. Thank you in advance for your cooperation. |
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