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Hi Doctor Pelto here. 
I am going to share now talking 

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about DME or durable medical 
equipment stuff and this is 

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going to be the the custom stuff
stuff that we that has made 

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custom. 
So a few things to realize, 

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custom things that can't be 
returned. 

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So once they're made they're 
stuck with the patient we try to

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modify them. 
It's usually covered by most 

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insurances under DME Blue Cross 
Blue Shield. 

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Currently anyway when I'm 
recording this needs to be sent 

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out, usually saying it tended to
hangar. 

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You have to check Same or 
similar for Medicare to make 

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sure they haven't had one in 
five years. 

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May go to the deductible they 
have to fill out the forms needs

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to last at least five years 
unless it's lost foot changes or

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like a dog ate it or something 
else like that. 

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You have to be careful for 
hotspots from the brace rubbing 

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and for shoes you might have to 
go up a half to a full size. 

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Yeah, there's a couple of ortho,
ortho feet or different types of

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shoes. 
We do many different types. 

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I'm going to go over the most 
common ones, Arrow, Spring, 

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Arizona Crow, Lateral Blaze, 
Meso, Medial blaze, Dorsey 

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Assist and more. 
Balance brace and then the 

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Ritchie Blaze. 
Some of these are kind of 

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interchangeable and I'll explain
that in a little bit. 

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Let's start here with the arrow 
spring Arrow spring is a brace, 

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it's called a carbon fiber 
brace. 

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So it has this carbon fiber on 
the front goes around to this 

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carbon fiber plate on the 
bottom. 

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So what happens is when when the
when the when the tibia or the 

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front of the leg goes forward, 
it it, it kind of causes a 

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spring loaded thing as it goes 
backward and that takes stress 

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off the middle of the foot, off 
the Achilles and off the plantar

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fascia. 
This is made for people that may

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have been wearing a walking boot
for a long time or for chronic 

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issues of Achilles tendonitis, 
mid foot arthritis or plantar 

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fasciitis or even drop foot. 
It. 

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It uses the body movement to 
spring the foot forward. 

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It's applied to the front of the
leg. 

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It's hard for patients that have
a really big front of leg. 

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So just be aware of that. 
There's a lot of girth there. 

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It's going to be hard. 
It's good for patients that are 

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wearing a walking boot for a 
long period of time and there's 

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some kind of more information 
about it right there. 

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Here is the prescription for it.
There are the main areas. 

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They come for our Achilles mid 
foot arthritis, drop foot, 

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plantar fascia and then just the
brace only. 

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Usually you put an orthotic on 
top of it. 

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So if have a patient has an 
orthotic, usually an orthotic 

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can be made or should be made a 
pair of orthotics Achilles. 

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They tend to add these heel 
wedges to it to reduce pulling. 

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The Achilles mid foot as well 
has a heel wedge. 

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Sometimes those can be hard to 
fit in shoes. 

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I want to be clear. 
OK so sometimes that can be a 

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challenge. 
Arizona AFO this is a common AFO

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brace. 
Basically it's a leather. 

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It's almost like a leather glove
that has laces. 

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There's laces or speed laces as 
well. 

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It can be articulated, which 
means it can move at the ankle 

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or not. 
This one's not moving. 

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It reduces abnormal movement and
and basically it's a way of 

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fusing the joints, the painful 
joints without fusing them. 

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It's a test fusion. 
It's good for ankle and rifid 

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arthritis. 
It's good for severe tendon 

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injuries like peroneal tendon, 
posterior tibial tendon tendon 

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stuff. 
That's really bad, really big 

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feet. 
It's made custom. 

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It's it takes a little bit more 
space in the shoe. 

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But for patients for example, if
they get out of a crow boot, 

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will go over a crow boot in a 
second. 

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That's for a charcoal foot. 
It can help maintain the foot 

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stability afterwards. 
So it's a very good brace. 

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It's custom once again needs to 
be modified occasionally, and if

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their foot changes, you may have
to change it. 

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Here's the different types. 
There's a standard Arizona, 

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which we do. 
There's a tall one if you want 

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more protection up top. 
There's a one with Velcro, A 

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hinge and a foot. 
This is kind of like the meso 

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brace, along with a higher up 
one. 

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This is good if you have a if 
you your ankle is not arthritic.

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This one even goes up higher if 
they have kind of a really 

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unstable foot. 
Here's a sport one, which is a 

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little bit lower profile and 
only restricts the ankle. 

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And this is kind of a slim one, 
depending on the foot type. 

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And this is a breeze which looks
very similar to the balance 

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brace, but it's just a kind of a
breathable material. 

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It's a lighter material. 
It's not as rigid as these 

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leather ones. 
So those are the different types

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that we do here in the office. 
When you fill it out, you're 

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going to have to put in what 
foot and then kind of any other 

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additional things that you're 
going to want for these braces. 

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This is another company that 
does similar braces. 

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So there are Ritchie braces 
which are similar, but they have

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a stirrup on the outside and 
they help prevent inward and 

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outward kind of like that other 
velocity brace that I talked 

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about. 
And they also have the the 

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Achilles offloading system with 
this arrow spring and it talks 

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about different modifications. 
You have to be aware of cup, 

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heel, cup depth and stuff like 
that. 

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So there's different other 
things that you can add orthotic

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modifications or or or brace 
modifications as well. 

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So there's different types of 
braces that can be made. 

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These are kind of similar to the
Arizona, but they are, they're 

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more like athletic. 
They're for a younger type of a 

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patient that they're easier to 
get on and off and things like 

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that. 
OK. 

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A crow boot is a charcoal 
restraint restraining orthotic 

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Walker. 
It's for charcoal, for like a 

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collapsing foot and it's used if
it's in this chronic state which

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are the acute state, which is we
really swollen and red. 

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And so you'd put them in this. 
I had one patient that had both 

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of these and you put in there 
till it calms down. 

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The padding might have to be 
adjusted based on the swelling 

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as it goes down. 
They wear it for six months and 

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then you transfer them into an 
Arizona brace. 

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Usually we send these braces out
due to the frequent adjustments 

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that are needed for these. 
That's called a crow boot. 

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Here's the crow boot 
prescription. 

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These are some of the more 
advanced ones, so these are like

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thermoplastic AF OS. 
These could be used for drop 

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foot as well. 
Here is a similar to like an 

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errors, a Ritchie brace. 
And this is the crow boot. 

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So you have to put in what side.
You have to put little markers 

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on these when you do these as 
well. 

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So just be aware of that. 
This is a lateral blaze. 

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So there's medial blaze, lateral
blaze and a drop foot brace by 

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this company. 
It's used for lateral ankle 

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instability, high arches, ankle 
sprains, things like that. 

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So it protects it from going on 
the outside. 

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So here's the media one on the 
inside that protects it from 

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flattening in cuboid lock is the
one that protects it from the 

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outside and the drop foot one. 
So there's different different 

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ones from this company going 
back. 

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This is the meso brace. 
So basically it's just a portion

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of the Arizona brace that's just
in the middle of foot. 

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So it's good for mid foot 
arthritis for patients. 

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It looks right here. 
Meso brace, it's used to 

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restrict mid foot movement. 
It can also be used. 

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Another option would be the the 
arrow spring brace, which 

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doesn't restrict the movement as
much as it just takes the 

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movement and and and uses the 
the brace to to move the middle 

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of the foot as it takes strain 
off of it. 

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It's a little bit difficult 
fitting in shoes. 

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Similar to the other Arizona 
braces, you have to go up a half

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size. 
It's used in conjunction many 

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times with a cortisone injection
into the joint or shockwave or 

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something else like that to 
reduce some of the swelling in 

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that area. 
Here's that medial blaze. 

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This is when we do a lot for 
collapsing flat foot patients. 

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You use it when an orthotic 
isn't enough. 

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So a lot of our patients they're
going to get an orthotic and 

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this brace and so they'll wear 
this if they're doing a lot of 

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standing and walking and then if
there's everyday they might use 

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their orthotic and it's 
excellent for a prominent medial

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malleolus on the inside of the 
ankle, if it's very prominent or

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if they're collapsing really, 
really badly, it won't irritate 

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this, unlike a Ritchie brace 
that many times will be 

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irritated. 
Here kind of an example and 

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here's the link to their to 
their websites. 

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Here's a Dorsi assist brace. 
This is for someone that has a 

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drop foot. 
It's a little bit lower profile 

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than than some of the other 
ones. 

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That's why our patients like it.
It has like this leaf spring. 

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It has these little little 
things in here like Jelly things

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that go in there that lift it 
up. 

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So when you bend it back, when 
you bend it down it it, it it 

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tightens these and then it as 
you take away it lifts it up the

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foot, it kind of assists the 
foot and going up, this is a 

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more balance brace or a balance 
brace. 

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It's used to help produce 
postural sway and walking. 

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It's used for patients with 
neuropathy and balance issues, 

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those that have lack of feeling.
It works well and they come as a

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pair for patients and they just 
leave them in their shoes and 

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they and they fit them in there.
So here's some example of some 

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of the the balance brace 
information as well. 

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You have to choose if you want 
most people do the Velcro in 

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black. 
Here is another example very 

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similar to the There's an Optima
brace by one company, which is 

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the Arizona, and then there's 
the Ritchie brace, which is 

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this. 
Now the medial Blaze one allows 

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a lot more flattening out. 
This one doesn't allow it 

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because it hits the inside here 
and it hurts them. 

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That's why there's that medial 
Blaze AFO. 

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But it's similar thing used for 
kind of ankle sprains, 

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tendonitis, flat foot, not too 
too bad like the other one, it's

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articulated so it keeps the 
ankle joint moving, good for 

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posterior tibial tendon 
dysfunction. 

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They may have orthotics as well,
similarly that they can wear 

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orthotics for certain 
activities, but wearing this for

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long periods of activity. 
So those are the custom DME 

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items that we have to scan that 
we either scan the patient or do

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a custom, it's called Asts sock 
where we put this like kind of 

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this casting around there and 
then we make different marks on 

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where it goes, OK. 
So hope that was helpful.