Hi, Doctor Palto here. I want to go a little bit over
the DME products. DME means durable medical
equipment that are non custom that we have in the office and
this is going to be for the staff just to understand a
little bit about these products. And yeah, so a few things to
know. Durable medical equipment is
something that's not specific to a Podiatry office.
It's something that we offer patients more for convenience
because the more places that we have our patients go, the more
challenging it is. If we have them go to, for
example, an outside vendor like Hangar, it has to make an
appointment. They have to be seen.
They have to be fit. There are some doctors that have
them go out for walking boots and for other things like that.
It's a little bit of a hassle having it in the office.
But in the long run, I think our patients get better care with
that. They are usually covered by
insurance. What we're finding now is some
patients depending on their deductibles they may even look
for it on Amazon. It's not something that we
actively encourage, but some patients do that to see well
what would be on Amazon for a similar product it it can go to
the deductible. So for some patients they might
be quite expensive for some of these products.
But for the majority of patients it's it's pretty much well
received and we do a lot of it. If they have Medicare, I would
just remind you to check same and similar those are meaning if
they've had a device within five years, that's kind of the the
lifespan of most of these products.
And if something else changes like the severity of the
condition changes or like their leg changes, the form of the
leg, the swelling, things like that, that the previous one
couldn't fit or if it's a new condition, those are all kind of
reasons or if it gets lost or eaten by their dog or something
else like that. They have to fill out some forms
and I'll give you some examples of those forms as well here.
So what we have here in the office, we have a collagen wound
dressing. We have an ankle brace called
the Exoform. We have a walking boot, a tall
and a short night splint, A surgical shoe, surgical shoe
with peg assist offloading insole and A and A and a
velocity brace. So I'm going to go over those
today. Those are the most common DME
items that we have here in the office.
There's something that needs to be filled out every time we see.
It's called proof of delivery, So DME durable medical
equipment, proof of delivery. This needs to be signed saying
that they got them, that they were in good condition, that we
can build the insurance and if they're custom made that we
can't return them. OK, if they're non custom we
can, but if they're custom we can't.
So these are some of the custom ones we have for DMV forms.
There are other ones for non custom.
So this one has, you can see the braces, it also has the Cam,
boot, night, splint, things like that, has the quantity right and
left of kind of what they're getting.
So we're going to go over a lot of these, these devices.
So first of all, let's talk about AMAREX.
AMAREX has a number of products that we carry in the office such
as Amira Gel Red and Amira Gel Blue.
Those creams, these are the wound care kits that we use
called Helix, which is a collagen, A collagen powder.
So if you look at it, it's a powder, there's gauze 2 by two
gauze and there is some bordered, bordered gauze.
So we do the bordered gauze and the collagen, that's the one
that we tend to do. It can either be a 15 or 30 day
supply. It helps to heal ulcers.
You have to make sure that they're not getting VNA or
visiting nurses or home health because if they do that these
programs, they have to cover all the dressings as well for their
care. So we cannot have a patient
getting home health get this, otherwise insurance won't cover
it. What we sometimes do is we give
them enough for 15 or 30 days and then we send them to
visiting nurses or VN as or home health.
We order that for them, in which case they're happy because it
doesn't have to come out of their their funds that they get
to take care of the patient. We usually do it for 15 or 30
days. I tend to do 15 days until it
looks like it's doing really well.
Then I might do 30 just because I'm usually having to evaluate
that ulcer. You apply one pack per day, so
they come in these little individual packs.
You apply water or saline. This comes with a saline spray
in there. And then you mix it with the
collagen and use a tongue depressor to put it on the wound
and you cover it with a secondary dressing.
So here's an example of using a tongue depressor to put it on
the ulcer. This is exactly what we would
do. And then you would put on the
border to gauze the secondary dressing on it.
So you do the wound spray to kind of clean it off and then
you do the the, the collagen inside of there, see how you get
it wet. So with this, each one of these
is made for one day, so they'll get thirty of those per day.
So that kind of goes on. And then you use the the
secondary dressing that goes on top of it for the patient.
This is an example of the gauze that's stuck on.
We have the border gauze here in the office.
Here's the DME sheets for the collagen.
So there are a lot of different devices and wound care things
that they carry. We do this, this 15, this 30 day
supply with the bordered gauze or this 15 with bordered gauze.
Now there are other things that they have, they have rolled
gauze. They also have other things that
are not collagen. They have calcium alginate and
other types of things foam. So foams tend to be more for
draining wounds. We don't see a lot of those that
are like venous stasis ulcers that are draining a lot.
We don't see a lot of those. We'll put like a una boot on and
then the calcium alginate might be a kind of a more of a
draining wound as well or kind of an infected wound.
For that we usually use like Betadine or we're going to use
like an Amerigel Red on those. OK This is an example of whether
DME or durable medical equipment item, it's a, it's an ankle
brace or an extra form brace it can be.
So usually when we see a really bad sprain we'll get an X-ray.
Initially we might put them in an UN boot and a Cam boot to
really kind of rest rest the foot and then you transition
them to this ankle brace or this Exiform brace at at the two week
follow up if there's no fracture and then after the ankle brace
then we'll transition to them to a compression sleeve.
So those are that's kind of how we transition.
And then occasionally for a really bad ankle sprain, we may
do some shockwave to help get down the swelling and help speed
up the recovery for the ankle. Here is an example of a walking
boot. There are tall and short ones.
I want to kind of explain the difference.
The tall one goes up a lot higher.
It's used if someone has an A fibula fracture or an ankle
fracture or a post op of a fusion or a big surgery, a
bigger surgery, they're going to get the tall boots patients that
tend to transition out of casts, they're more frequent to get it
the tall boot or a tendon issue. So if the tendon is up here,
even though it affects the bottom of the foot, if we want
to immobilize the peroneal tendon, the posterior tibial
tendon, or the Achilles tendon, we might put them in a in a
bigger boot. Also, if they're getting that
Achilles lift thing that we talked about before that to lift
up to reduce the pull on the Achilles for Achilles tear or
Achilles surgery, you might use a taller boot like this.
It moves the pressure to the lower lower leg and ankle, and
moves it moves the pressure away from the lower leg and ankle by
putting the pressure up here, the short one.
Another type of boot that we do, It's used for foot and ankle
issues. It's not usually used for bigger
ankle fractures because you want more protection up top, used
after typical bunion surgery and hammer toe surgery.
And also it's better for shorter patients that have a shorter
leg. And also for amnio patients,
we're doing an amnio then we can do this for patients as well
after the amnio to kind of protect that area.
This is a night splint. So the night splint is something
that we use very frequently in the office.
It's used to treat Achilles tendonitis and Aquinas.
So Aquinas just means tightness in the calf and we don't
primarily use it. And I'll explain that not
specific to plantar fasciitis. Plantar fasciitis is in the
bottom. But secondarily, most of these
patients have tightness in the calf, which is Aquinas, and this
is used to to to loosen the calf along with foam rolling and the
morning stretch. Like I said here, there are some
Velcro side straps right here that can be tightened or
loosened here on the side. So that's something we want to
teach patients when we're giving it to them, these side straps.
Also there are some straps that can be tightened or loosened
here to keep their heel down. If these are too tight, it could
cause some numbness in the foot. And there's also a cheese wedge,
which is right here, this cheese wedge that can be pulled out if
there's some discomfort or numbness in the toes.
Other common options would be something called an anterior
night splint, which is a splint that goes in the front of the
foot. We do not have those in the
office. Or a sock called a Strasburg
sock, which is a sock that goes around the toes and the foot and
then pulls things up. Those tend to make things pretty
numb as well, so just be aware of toe numbness and pain.
That's pretty common. Most patients can't wear this
all night long. I tend to recommend I call it a
stretch splint instead of a night splint.
So a stretch splint, They're wearing it for three hours a
day. And if they have issues on both
feet, you're going to use it on the right foot one night and the
left foot the other night. So they kind of alternate very
rarely doing to give to give both or bilateral night splints.
And another thing, they're not supposed to walk with them.
They have a tread in the bottom, but the tread isn't to walk on.
So just be aware of that. Here's some examples of surgical
shoes. The only surgical shoe we have
in the office is this top one. This is the traditional flat
surgical shoe. Ours have open toes.
This is just kind of an example. There's two straps.
Be careful where the straps hit based on where the wound is.
Sometimes the IT may hit the area of the wound or the ulcer
that the patient has. Can be used for wounds, can be
used for fractures, for painful feet, for infections.
But you don't want someone to be in a shoe or ulcers.
This is an example of an ortho wedge shoe.
If you've heard this, it's used to offload the front of the foot
so you can see it has a heel on it but no front of the foot.
So as they're walking you have to be careful of balance, but it
just puts pressure on the heel and then not on the front.
And then there's something called reverse ortho wedge,
which uses is used to offload the heel.
So you had only puts pressure on the front and takes pressure off
the heel. That's for heel ulcers as well.
And then in conjunction with that surgical shoe, there's
something called a peg assist, which is this thing, it's a,
it's a, it's a peg assist, it's a pegs, they called pegs right
here. It's used to offload painful
foot areas specifically. We use it a lot to offload
ulcers or infections or areas. You mark the area with lipstick
and then you take out the pegs in that area.
It's not usually covered by insurance.
It's reasonable. There are instructions here if
you want to look at it. Here's a little a little video
that kind of explains if there's an ulcer let's say on the first
met head you you mark it with a with like a a marking.
What's that? A lipstick.
You mark it with lipstick and then you take the the liner and
and most of these surgical shoes have a a liner area that that
the bed comes out and you put in this peg assist and then what
they do is they they stand on that area where and it makes it
it kind of transfers where the where the high pressure area so
they step on there and it transfers where the ulcer is
with this area of the lipstick and it and it transfers it on
there And then what you do is this area you you take it out
and you push out the pegs in that area.
So that's the high pressure area.
You kind of pull it out, you you remove the black pegs that are
underneath it, so you can see it here, it's marked and then you
just kind of flip it around and you push those, push those out
on the other side. And then there's also, so in the
past we we've done this, but now they added something to this
where there's a another sheet that goes in the bottom.
So once you get everything out and that's going to offload it
without allowing things to drop down.
We used to use a lot of felted foam and so you put the foam on
the top and the felt underneath and this is just kind of a kind
of a speedier way of doing this. And then there's another kind of
a stabilizing board because what happens to ours is that the, the
ulcer can suck through that hole.
It can kind of like drop down and it can spread things out.
So this kind of stabilizes it in the, in the surgical shoe for
that type of a patient. This is something called a
velocity brace. So a velocity brace is basically
an A non custom AFO. So we use a lot of Afos that'll
be in the other lecture, but it's a non custom.
AFO helps reduce frontal plane rotation.
Frontal plane is this plane right here.
So the the front of it, so either pronation or supination
or flattening of the foot. You could think of it that way.
It prevents that, doesn't allow it to flatten in because it has
these stirrups on the side. It's very good for ankle sprains
or flat feet, for posterior tibial tendonitis or tendon
dysfunction and for Achilles tendonitis that's made worse by
flattening of the foot. The neat thing about this is you
can heat mold them, this little arch support here, you can put a
little heat, heat it up there and there's instructions right
here as well. So those are the non custom DME
items. The next things we're going to
go over are the more custom ones.