Hi Doctor Pelto here. I am going to share now talking
about DME or durable medical equipment stuff and this is
going to be the the custom stuff stuff that we that has made
custom. So a few things to realize,
custom things that can't be returned.
So once they're made they're stuck with the patient we try to
modify them. It's usually covered by most
insurances under DME Blue Cross Blue Shield.
Currently anyway when I'm recording this needs to be sent
out, usually saying it tended to hangar.
You have to check Same or similar for Medicare to make
sure they haven't had one in five years.
May go to the deductible they have to fill out the forms needs
to last at least five years unless it's lost foot changes or
like a dog ate it or something else like that.
You have to be careful for hotspots from the brace rubbing
and for shoes you might have to go up a half to a full size.
Yeah, there's a couple of ortho, ortho feet or different types of
shoes. We do many different types.
I'm going to go over the most common ones, Arrow, Spring,
Arizona Crow, Lateral Blaze, Meso, Medial blaze, Dorsey
Assist and more. Balance brace and then the
Ritchie Blaze. Some of these are kind of
interchangeable and I'll explain that in a little bit.
Let's start here with the arrow spring Arrow spring is a brace,
it's called a carbon fiber brace.
So it has this carbon fiber on the front goes around to this
carbon fiber plate on the bottom.
So what happens is when when the when the when the tibia or the
front of the leg goes forward, it it, it kind of causes a
spring loaded thing as it goes backward and that takes stress
off the middle of the foot, off the Achilles and off the plantar
fascia. This is made for people that may
have been wearing a walking boot for a long time or for chronic
issues of Achilles tendonitis, mid foot arthritis or plantar
fasciitis or even drop foot. It.
It uses the body movement to spring the foot forward.
It's applied to the front of the leg.
It's hard for patients that have a really big front of leg.
So just be aware of that. There's a lot of girth there.
It's going to be hard. It's good for patients that are
wearing a walking boot for a long period of time and there's
some kind of more information about it right there.
Here is the prescription for it. There are the main areas.
They come for our Achilles mid foot arthritis, drop foot,
plantar fascia and then just the brace only.
Usually you put an orthotic on top of it.
So if have a patient has an orthotic, usually an orthotic
can be made or should be made a pair of orthotics Achilles.
They tend to add these heel wedges to it to reduce pulling.
The Achilles mid foot as well has a heel wedge.
Sometimes those can be hard to fit in shoes.
I want to be clear. OK so sometimes that can be a
challenge. Arizona AFO this is a common AFO
brace. Basically it's a leather.
It's almost like a leather glove that has laces.
There's laces or speed laces as well.
It can be articulated, which means it can move at the ankle
or not. This one's not moving.
It reduces abnormal movement and and basically it's a way of
fusing the joints, the painful joints without fusing them.
It's a test fusion. It's good for ankle and rifid
arthritis. It's good for severe tendon
injuries like peroneal tendon, posterior tibial tendon tendon
stuff. That's really bad, really big
feet. It's made custom.
It's it takes a little bit more space in the shoe.
But for patients for example, if they get out of a crow boot,
will go over a crow boot in a second.
That's for a charcoal foot. It can help maintain the foot
stability afterwards. So it's a very good brace.
It's custom once again needs to be modified occasionally, and if
their foot changes, you may have to change it.
Here's the different types. There's a standard Arizona,
which we do. There's a tall one if you want
more protection up top. There's a one with Velcro, A
hinge and a foot. This is kind of like the meso
brace, along with a higher up one.
This is good if you have a if you your ankle is not arthritic.
This one even goes up higher if they have kind of a really
unstable foot. Here's a sport one, which is a
little bit lower profile and only restricts the ankle.
And this is kind of a slim one, depending on the foot type.
And this is a breeze which looks very similar to the balance
brace, but it's just a kind of a breathable material.
It's a lighter material. It's not as rigid as these
leather ones. So those are the different types
that we do here in the office. When you fill it out, you're
going to have to put in what foot and then kind of any other
additional things that you're going to want for these braces.
This is another company that does similar braces.
So there are Ritchie braces which are similar, but they have
a stirrup on the outside and they help prevent inward and
outward kind of like that other velocity brace that I talked
about. And they also have the the
Achilles offloading system with this arrow spring and it talks
about different modifications. You have to be aware of cup,
heel, cup depth and stuff like that.
So there's different other things that you can add orthotic
modifications or or or brace modifications as well.
So there's different types of braces that can be made.
These are kind of similar to the Arizona, but they are, they're
more like athletic. They're for a younger type of a
patient that they're easier to get on and off and things like
that. OK.
A crow boot is a charcoal restraint restraining orthotic
Walker. It's for charcoal, for like a
collapsing foot and it's used if it's in this chronic state which
are the acute state, which is we really swollen and red.
And so you'd put them in this. I had one patient that had both
of these and you put in there till it calms down.
The padding might have to be adjusted based on the swelling
as it goes down. They wear it for six months and
then you transfer them into an Arizona brace.
Usually we send these braces out due to the frequent adjustments
that are needed for these. That's called a crow boot.
Here's the crow boot prescription.
These are some of the more advanced ones, so these are like
thermoplastic AF OS. These could be used for drop
foot as well. Here is a similar to like an
errors, a Ritchie brace. And this is the crow boot.
So you have to put in what side. You have to put little markers
on these when you do these as well.
So just be aware of that. This is a lateral blaze.
So there's medial blaze, lateral blaze and a drop foot brace by
this company. It's used for lateral ankle
instability, high arches, ankle sprains, things like that.
So it protects it from going on the outside.
So here's the media one on the inside that protects it from
flattening in cuboid lock is the one that protects it from the
outside and the drop foot one. So there's different different
ones from this company going back.
This is the meso brace. So basically it's just a portion
of the Arizona brace that's just in the middle of foot.
So it's good for mid foot arthritis for patients.
It looks right here. Meso brace, it's used to
restrict mid foot movement. It can also be used.
Another option would be the the arrow spring brace, which
doesn't restrict the movement as much as it just takes the
movement and and and uses the the brace to to move the middle
of the foot as it takes strain off of it.
It's a little bit difficult fitting in shoes.
Similar to the other Arizona braces, you have to go up a half
size. It's used in conjunction many
times with a cortisone injection into the joint or shockwave or
something else like that to reduce some of the swelling in
that area. Here's that medial blaze.
This is when we do a lot for collapsing flat foot patients.
You use it when an orthotic isn't enough.
So a lot of our patients they're going to get an orthotic and
this brace and so they'll wear this if they're doing a lot of
standing and walking and then if there's everyday they might use
their orthotic and it's excellent for a prominent medial
malleolus on the inside of the ankle, if it's very prominent or
if they're collapsing really, really badly, it won't irritate
this, unlike a Ritchie brace that many times will be
irritated. Here kind of an example and
here's the link to their to their websites.
Here's a Dorsi assist brace. This is for someone that has a
drop foot. It's a little bit lower profile
than than some of the other ones.
That's why our patients like it. It has like this leaf spring.
It has these little little things in here like Jelly things
that go in there that lift it up.
So when you bend it back, when you bend it down it it, it it
tightens these and then it as you take away it lifts it up the
foot, it kind of assists the foot and going up, this is a
more balance brace or a balance brace.
It's used to help produce postural sway and walking.
It's used for patients with neuropathy and balance issues,
those that have lack of feeling. It works well and they come as a
pair for patients and they just leave them in their shoes and
they and they fit them in there. So here's some example of some
of the the balance brace information as well.
You have to choose if you want most people do the Velcro in
black. Here is another example very
similar to the There's an Optima brace by one company, which is
the Arizona, and then there's the Ritchie brace, which is
this. Now the medial Blaze one allows
a lot more flattening out. This one doesn't allow it
because it hits the inside here and it hurts them.
That's why there's that medial Blaze AFO.
But it's similar thing used for kind of ankle sprains,
tendonitis, flat foot, not too too bad like the other one, it's
articulated so it keeps the ankle joint moving, good for
posterior tibial tendon dysfunction.
They may have orthotics as well, similarly that they can wear
orthotics for certain activities, but wearing this for
long periods of activity. So those are the custom DME
items that we have to scan that we either scan the patient or do
a custom, it's called Asts sock where we put this like kind of
this casting around there and then we make different marks on
where it goes, OK. So hope that was helpful.