CODG Blog

Our feet are one of the most spectacular feats of engineering – although composed of only 26 bones, some muscles, tendons and ligaments, the structure of each foot works to accept forces up to two or three times the weight of your body, and act as shock absorbers and adaptors to uneven surfaces.  All of the structure and mechanics of the foot is then covered with skin – a living tissue that can withstand all the forces and then sense the tiniest of touch of a tickle. 

The bony structure of the foot is designed to allow for force to load down the body on a small pillar (your leg bone – tibia) into the small stacked bones of the foot, the talus and calcaneus.  Weight and forces are then transmitted to the smaller bones of the ball of the foot.  The bones act like the frame of a house – the big solid beams that hold things up.  But the bones are not static like the beams in the house. They move small amounts like a spring compressing to allow for shock absorption when your foot hits the ground and then move further to work like a lever to propel you forward when your foot pushes off to take the next step.  The pattern is repeated often thousands of times a day.

We all need to look after our feet – wearing proper shoes, caring for the skin and nails, gentle massage and stretching and just everyday pampering will help us keep our feet healthy and strong. However, when something goes wrong with the foot – take care and look after it right away; see your doctor or foot care specialist – we can help you keep the Freedom to Move!

Everyday we see many different patients, all with unique concerns and issues.  As practitioners who treat people with physical impairments of all the different body parts, Certified Orthotists often are required to create new and innovative solutions.  One example is the case of baby Christopher in Chicago that our colleague, Stewart Young C.O.(c), C.Ped.(c) had the opportunity to treat.

Christopher was born missing several ribs on either side of his body.  The ribs work to support the chest wall and protect the lungs and heart.  Without the ribs, the baby's chest wall collapsed in and he required a respirator to survive.  Christopher was lucky as a couple of weeks earlier, his doctor had seen a presentation from the Hospital for Sick Children in Toronto about a special orthotic device that had been designed for a baby with a similar condition.  When the Certified Orthotists in Chicago were not able to create such a device, Christopher's doctor called Stewart to see if he could go to Chicago and help with Christopher's treatment.

After Stewart had the opportunity to assess Christopher, he was able to design a device that would address the unique issues.  Stewart created a special plastic protector for the chest area that was held in place with strapping.  The part of the treatment that was unusual was that the support had to protect the chest from outside forces like the ribs do and prevent the chest wall from caving in when Christopher took a breath.  Stewart used a special material, DuoDERM, that stuck to the inside of the brace and also to Christopher's skin.  The rigid plastic held the chest wall out in place and the baby was able to breathe on his own. 

Christopher was able to leave the hospital a couple of weeks after getting the vest.  Several weeks later, as Christopher's muscles got stronger, the vest was trimmed down and when he was strong enough to breathe on his own, he did not have to wear the device at all.  Thinking of solutions to new and unique problems is what we do as Certified Orthotists, caring for people is what we do as part of the healthcare team.

Once you have booked an appointment to have an assessment at Custom Orthotic Design Group Ltd., you may wonder what you need to bring to your appointment.  The nature of your appointment will determine what you need to have with you. Think of the things that relate to the body part we will be examining (ie. bring shorts for a knee assessment).  Here is a general list of items to think about:

- a prescription from your doctor

- any notes from other health care professionals such as your physiotherapist, occupational therapist, chiropractor, chiropodist

- any devices that you may have worn in the past (previous foot orthoses or braces)

- if you are coming in for an assessment of your feet or legs: your regular shoes

- make sure that you know your insurance information

- your schedule in the case that you need to book another appointment

- any other information that you think may help us do our job better

If you do have specific questions, please do not hesitate to call us toll free 1-(866) 829-2969 or (905)828-2969 or email at lindalaakso@customorthotic.ca

When the weather starts getting warmer, our winter boots and coats are put aside to make room for light shirts, shorts and of course, sandals.  Sandals provide some protection for our feet while allowing us keep cooler and less constricted.  While sandals are very popular, they do cause some concern for people who wear foot orthoses or who have foot or leg problems.  For people who do have foot problems or who do wear foot orthoses, there are a few choices that you can make.

Choosing the right sandal: Like choosing the right shoe for your foot type and activity, there are different options to choose from for sandals.  If you know that you will be walking or running quite a bit, it is usually better to wear your running shoes with your foot orthoses, but for hanging around and going out there are choices available that do provide good support for the feet.  Always pick a sandal that fits your foot shape well and is comfortable.  For those people who need a lot of support, something like the Birkenstock or Mephisto are good choices.  The Mephisto Zach also provides a bit of a rocker sole for those people who need protection of the ball of the foot.

                               Birkenstock Florida                                                      Mephisto Zach

Another choice for people who have foot orthoses is the sandal that has a  removable foot bed.  The insole is removed from the sandal and replaced with the custom made foot orthosis.  The sandal then provides the appropriate support and is customized to the individual.  And Yes! the foot orthosis can work with the thong sandal of the Finn Comfort Wichita.

              Mephisto Ularia                                        Finn Comfort Wichita                                       Naot Karaoke

The final choice for sandals is the custom made sandal.  A plaster impression and several measurements are taken of the feet and sandals are constructed from raw material to reflect the size, proportions and the support that the individual requires.  The custom made sandal works well for hard to fit people. 

Like of all of our posessions, our foot orthoses and braces need to be maintained on a regular basis.  It is a rather simple process and with regular inspection small imperfections can be caught and repaired before they become big problems.  Taking care of your device will help it to last longer and perform better.  Here are some things that you can do:

- Look over your device everytime you use it for any cracks, tears or imperfections.  If you see anything unusual, call your provider for an appointment.  Often small defects can be repaired easily.  Larger defects may require the fabrication of a new brace.

- Plastic orthoses may be cleaned by wiping them inside and out with a damp soapy cloth.  Make sure all of the soap is wiped out of the orthosis.  Dry with a towel.  

- Do not place orthosis near a heat source - anything that is too hot for your hands is too hot for the orthosis. 

- If you have squeaking of your brace or foot orthosis inside of your shoe, a small amount of baby powder inside the shoe may stop the noise.

- If you have metal joints on your brace, follow the specific instructions from your provider for care of the joints.  Some joints require lubrication.  All joints should be kept clean and dry.

For more specific information check the Use & Wear page on this site.

Pain in the joint of the big toe is quite common and can be caused by many things including gout, arthritis and injuries.  The main thing that often makes the joint more painful is increased movement in the joint by bending the joint upwards (dorsiflexing).  The unfortunate thing about big toe and dorsiflexing is that in order to walk, we need to dorsiflex the big toe joint.  As we walk, we go from having the foot flat on the ground to a position of "push-off" where the heel lifts off the ground and the toes push down.  We need the push-off to propel us forward.

The question is: "How do we get an efficient push-off without dorsiflexing the big toe joint as much?"  Here are some solutions which can be used individually or altogether, depending on your case.

1. Foot Orthoses

With the pain in the big toe joint, sometimes the foot rolls in too much (over-pronates), and then puts too much pressure on the toe.  If that is the case, a custom made foot orthosis (orthotic) will help to prevent excess pressure at the big toe and elevate the joint to reduce the amount of dorsiflexion required in walking. 

2. Rockered Sole

If the alignment of the foot is good but there is still pain, a rockered sole will help to reduce the amount of bending at the toe.  A rockered sole works like the bottom of a rocking chair - the shoe and the foot roll along rather than bending.  Most running shoes have a rockered sole and many new types of "exercise shoes" such as the MBT have a rockered sole.    The rockered sole can also be added to the bottom of most shoes.  It is very effective at reducing excess force at the big toe and is often used in combination with a custom made foot orthosis.                        

                                                                    MBT Tunisha

3. Sole Stiffener

If the rockered sole and the custom made foot orthosis is not enough to control pain the big toe joint, the third option is a sole stiffner.  By adding a piece of stiff material into the shoe, under the orthosis or to the sole of the shoe, there is a reduction of motion at the big toe which will also help to reduce pain.

As always with any medical condition, it is important to discuss your concerns with your physician and obtain a proper diagnosis.  Once it is known what is wrong, it is always easier to treat!              

Custom Made Foot Orthoses are specially designed medical devices that are used by many different people for many different medical reasons.  In general, orthoses are designed to support, align, protect, prevent deformity and/or to enhance mobility of a part of the body.  Foot orthoses can influence not only the feet, but the knees, hips, back and neck.  It is therefore very important to ensure that the person who assesses and treats someone with foot orthoses understand the past medical history, the biomechanics and the pathology of the person being treated.

There are two broad categories of foot orthoses, often with overlap in between.

Corrective Foot Orthoses are designed and fabricated to improve function by correcting biomechanical concerns.  People who have Plantar Fasciits, tibialis posterior tendinitis, patellofemoral syndrome (PFS), or bursitis in the hip may be candidates for corrective foot orthoses.  In some people, the foot may hit the ground and then over pronate (the arch flattens as in flat foot).  When the foot over pronates, there is a corresponding internal rotation of the leg (the leg actually turns in) and the muscles and tendons will no longer work as they are supposed to.   Some of the muscles and tendons will have to work harder than they are designed for and they become over used and cause over use injuries such as those mentioned above.  Over use injuries can also happen when the foot rolls out too much with over supination (under pronation) which can result in peroneus longus or peroneus brevis tendinitis (which cause pain on the outside of the ankle and into the foot).  There are many other problems that can be addressed with corrective foot orthoses that are not mentioned here.

Corrective foot orthoses are usually made to plaster casts of the feet while the feet are held in a corrected or neutral position.  The foot orthoses then maintain the corrected position of the foot when walking and running to prevent the position that causes the injury.  The foot orthoses are a little firmer than an accommodative foot orthosis, but they should always be comfortable.  You may need to get small adjustments after you have had a chance to wear them during your regular activity.  For more information on what to expect when getting foot orthoses click on Foot Orthoses - What To Expect.

Accommodative Foot Orthoses are designed to support and protect the feet by cushioning the feet and helping to remove pressure from certain points.  They are often used for people who have arthritis or diabetes mellitus.  In arthrits and diabetes, there may be boney deformities which tend to be more rigid and cannot be fully corrected.  We must then support the feet and cushion any of the boney areas.  People who have diabetes may get diabetic neuropathy where there is a loss of protective sensation in the feet which may result in callous build up and/or ulceration.  Since the person loses the ablity to feel the pressure on the foot, they will keep doing thier activitiy and not realize that the skin has had so much pressure that is becomes damaged to the point that is opens up and forms an ulcer.  For more information see Orthotic Management of the Diabetic Foot below.

Accommodative foot orthoses are made of softer materials to pad the feet and prevent pressure points from becoming painful or in the case of people with Diabetes, to prevent  pressure ulcers.  The orthoses are usually made from plaster casts of the feet which will reflect the areas of high pressure which require relief.  You may need to get small adjustments to the foot orthoses from time to time as the feet may change more often in someone who has arthritis or diabetes mellitus.  For more information on what to expect when getting foot orthoses, click on Foot Orthoses - What To Expect.

As this information is general and as everyone is unique, it is important to have a proper assessment by a physician to determine a correct diagnosis.  The Certified Orthotist will then assess the biomechanics and medical history to determine the appropriate treatment plan for each individual.

A Certified Orthotist C.O.(c) is a health care professional who specializes in the treatment of people with the use of externally applied devices (orthoses) which are used to support, align and protect parts of the body, prevent deformity and assist function for those individuals who may have neurological, muscular or orthopaedic conditions as the result of injury or disease.

The Canadian Board for Certification of Prosthetists and Orthotists (CBCPO) is the regulatory body for Certified Orthotists and is responsible for creating and maintaining standards for Certified Orthotists, Orthotic Residents, Accredited Educational Facilities, and Accredited Healthcare Facilites in Canada.  CBCPO is recognized world wide for the high standards set for the orthotic and prosthetic professions.

In order to be awarded certification by CBCPO an applicant must meet the following requirements:

• fluent in English or French
• Canadian citizen or legal landed immigrant
• must have graduated by a CBCPO accredited and officially recognized post-secondary clinical Prosthetic and Orthotic school
• must complete a minimum 3450 hours of Residency in Orthotics under the direct supervision of a Certified Orthotist in good standing with CBCPO
• apply and sit the national certification examinations
• must pass all sections of the three day national exam including written, practical and oral sections
• must be recommended to the CBCPO Board of Directors by the Examination Committee for the award of Certification
• must be accepted by the Board of Directors for the award of Certification for a five year term, subject to renewal

Once Certified, the C.O.(c) must complete Mandatory Continuing Education on a regular basis.

For more information on the specifics of Certification please go to www.cbcpo.ca/about

At Custom Orthotic Design Group Ltd., we have five Certified Orthotists and one Orthotic Resident who are responsible for caring for all of our patients.  if you have any questions or concerns, please do not hesitate to ask anyone of us for more information.

The term "orthopaedic shoes, orthotic shoes, custom made shoes, comfort shoes and diabetic shoes"  are terms that are often used interchangeably and incorrectly by many people including patients, physicians, insurance company representatives and other health care professionals.  I hope to explain the terms here to clarify the terminology for those people who are investigating the options.

Custom Made Orthopaedic Shoe

The first and most easy to define is the "custom made orthopaedic shoe".  This type of shoe is made specifically for one person by using measurements and a cast impression of the persons foot.  The cast and measurements are used to make a last or model of the  foot around which the shoe is constructed from raw materials such as leather, foams and soling. 

Advantages 

• excellent fit for hard to fit or severely deformed feet
• choice of materials

Disadvantages

• price - usually very expensive ($800.00 - 2,500.00)
• hard to find a provider
• takes time to make and adjust
• styles are not usually current

Stock Orthopaedic Shoe

Stock orthopaedic shoes are ready made shoes that are usually purchased through a speciality shoe store.  This type of shoe is made in different widths and with extra depth in the toe area to accommodate toe and toe deformities.  They often have extended heel counters to give additional support and control to the heel area.  Most stock orthopaedic shoes are made of soft pliable materials to prevent any excess pressure areas.  They have removable insoles to allow for use of foot orthoses or brace (AFO). The sole of the stock orthopaedic shoes is often wider and more stable than regular shoes and may have a rockered sole (think the bottom of a rocking chair) to promote a stable heel to toe motion.  May be available with hook and loop closure (Velcro®). Common stock orthopaedic shoes include P.W.Minor, Finn Comfort, Mephisto, Naot and Drew.

Advantages

• fit most hard to fit feet
• accommodate for foot orthoses and braces (AFO)
• less expensive than custom made shoes ($150.00 - $500.00)
• excellent control and stability
• protect sensitive feet
• they can be modified

Disadvantages

• more expensive than regular shoes
• not always in current style

Comfort Shoes

Comfort shoes are widely available in many speciality stores and commercial or chain shoe stores.  They sometimes have different widths available and have more current styles than traditional stock orthopaedic shoes.  Many comfort shoes are made of soft pliable materials and have a cushion type sole.  Common comfort shoes include Ecco, Birkenstock, Dansko, Wolky and MBT.

Advantages

• less expensive
• fit most regular shaped feet
• commonly available
• stylish

Disadvantages

• may not accommodate foot orthoses or braces (AFO)
• may not provide adequate support

Diabetic Shoes

Diabetic shoes are are not usually classified on their own.  They are often shoes that are either custom made orthopaedic shoes or stock orthopaedic shoes depending on the shape, size and condition of the individuals' feet.  A person with Diabetes may have a condition known as Diabetic Neuropathy where there is loss of sensation to the feet which occurs very slowly and necessitates very special care for the feet.  Since many people who have Diabetes do not realize that they have neuropathy, it is critical to fit appropriate shoes to protect the feet from trauma both within and without of the shoes.  It is essential that the shoes fit properly (see Buying and Fitting Shoes).

Some insurance companies will provide coverage for shoes.  The best way to ensure that you know what your coverage is prior to getting the shoes is to send a predetermination or estimate to the insurance company.  You most likely will also require a prescription with a diagnosis and treatment (orthopaedic shoes) from your physician.

This is a story that came to me by e-mail - I am not sure of the original author so I cannot give credit, but I am sure it is meant to share.  I have left the entire email intact and not edited anything.  Remember that we are all here to make a difference!

What  would you do?....you make the choice. Don't look for a punch line, there isn't one. Read it anyway. My question is: Would  you have made the same choice?

At a fundraising dinner for a school that serves children with learning disabilities, the father of one of the students delivered a speech that would never be forgotten by all who attended.  After extolling the school and its dedicated staff, he offered a question: 'When not interfered with by outside influences, everything nature does, is done with perfection. Yet my son, Shay, cannot learn things as other children do. He cannot understand things as other children do. Where is the natural order of things in my  son?'

The  audience was stilled by the query. The father continued. 'I believe that when a child like Shay, who was  mentally and physically disabled comes into the world, an opportunity to realize true human nature presents itself,  and it comes in the way other people treat that child.'

Then he told the following story: Shay and I had walked past a park where some boys Shay knew were playing baseball. Shay asked, "Do you think they'll let me play?" I knew that most of the  boys would not want someone like Shay on their team, but as  a father I also understood that if my son were allowed to play, it  would give him a much-needed sense of belonging and some confidence to be accepted by others in spite of his handicaps. I approached one of the boys on the field and asked (not expecting much) if Shay could play.  The boy looked around for guidance and said, "We're losing  by six runs and the game is in the eighth inning. I guess he can be on our team and we'll try to put him in to bat in the ninth inning." Shay struggled over to the team's bench and, with a broad smile, put on a team shirt. I watched with a small tear in my eye and warmth in my heart.  The boys saw my joy at my son being accepted.

In the bottom of the eighth inning, Shay's team scored a few runs but was still behind by three. In the top of the ninth inning, Shay put on a glove and played in the right field. Even though no hits came his way, he was obviously ecstatic just to be in the game and on the field, grinning from ear to ear as I waved to him from the stands. In the bottom of the ninth inning, Shay's team scored again. Now, with two outs and the bases loaded, the potential winning run was on base and Shay was scheduled to be next at bat. At this juncture, do they let Shay bat and give away their chance to win the  game?

Surprisingly, Shay was given the bat. Everyone knew that a hit was all but impossible because Shay didn't even know how to hold the bat properly, much less connect with the ball. However, as Shay stepped up to the plate, the pitcher, recognizing that the other team was putting winning aside for this moment in Shay's life, moved in a few steps to lob the ball in softly so Shay could at least make contact. The first pitch came and Shay  swung clumsily and missed. The pitcher again took a  few steps forward to toss the ball softly towards Shay. As the pitch came in, Shay swung at the ball and hit a slow ground ball right back to the  pitcher. The game would now be over.

The pitcher picked up the soft grounder and could have easily thrown the ball to the first baseman. Shay would have been out and that would have been the end of the  game. Instead, the pitcher threw the ball right over the first baseman's head, out of reach of all team mates. Everyone from the stands and both teams started yelling, "Shay, run to first! Run to first!" Never in his life had Shay ever run that far,  but he made it to first base. He scampered down the baseline, wide-eyed and startled. Everyone  yelled, "Run to second, run to second!" Catching his breath, Shay awkwardly ran towards second, gleaming and struggling to make it to the base.

By the time Shay rounded towards second base,  the right fielder had the ball, the smallest guy on their team who now had his first chance to be the hero for his team. He could  have thrown the ball to the second-baseman for the tag, but he understood the pitcher's intentions so he, too,  intentionally threw the ball high and far over the third-baseman's head. Shay ran toward third base deliriously as the runners ahead of him circled the bases  toward home. All were screaming, "Shay, Shay,  Shay, all the Way Shay" Shay reached third base because the opposing shortstop ran to help him by  turning him in the direction of third base, and shouted,  "Run to third! Shay, run to third!" As  Shay rounded third, the boys from both teams, and the  spectators, were on their feet screaming, "Shay, run home! Run home!" Shay ran to home, stepped on the plate,  and was cheered as the hero who hit the grand slam and won the game for his team.

"That day", said the  father softly with tears now rolling down his face, "the  boys from both teams helped bring a piece of true love and humanity into this world." Shay didn't make it to another summer. He died that winter, having never forgotten being the hero and making me so happy, and coming home and seeing his Mother tearfully embrace her little hero of the day!

AND NOW A LITTLE FOOT NOTE TO  THIS STORY: We all send thousands of jokes through the e-mail without a second thought, but when it comes to  sending messages about life choices, people hesitate. The crude, vulgar, and often obscene pass  freely through cyberspace, but public discussion about  decency is too often suppressed in our schools and  workplaces. If  you're thinking about forwarding this message, chances are  that you're probably sorting out the people in your address  book who aren't the "appropriate" ones to receive this type of message. Well, the person who sent you this believes that we all can make a difference. We all have thousands of opportunities every single day to help realize the "natural order of things." So many  seemingly trivial interactions between two people present us with a choice: Do we pass along a little spark of  love and humanity or do we pass up those opportunities and leave the world a little bit colder in the  process?

A wise man once said every society is judged by how it treats it's least fortunate amongst them. You now have two choices: 1.  Delete or 2. Forward.

May your day, be a Shay  Day.  

Diabetes Mellitus affects more than two million people in Canada and many of them have complications that affect the feet.  The level of complications vary widely, and therefore the treatment options are highly variable as well.  The one thing that all people with Diabetes Mellitus must remember is: "Check your Feet Everyday!"  What do you check for? Red marks, pressure areas, blisters, cuts - anything that is not normal.  See your health care provider if you are not sure.

The reason that checking your feet is so important is that diabetes can lead to Diabetic Neuropathy where the sensation in the feet is altered and eventually a person with diabetes can lose all sensation.  The loss of sensation along with other complications of diabetes can allow what normally would be a small callous become a life threatening ulcer.  Prevention is the most important tool we have to protect your feet and here are some of the things that may be used to help you.

Foot Orthoses - custom made insoles made from plaster impressions of your feet to distribute pressure more evenly to help reduce callouses

Orthopaedic or comfort shoes - Shoes must fit properly and accommodate all foot deformities in length, width and depth (see Buying and Fitting Shoes Guidelines).  The shoes offer protection for the feet from outside dangers as well as providing a stable base of support for the feet and help redistribute pressure.

Offloading Boot - For those people who have diabetic ulcers, it is essential to offload or remove pressure from the area.  Several different types of boots are available, such as an AirCast, to help redistribute pressure and change the gait to allow the ulcer to heal.

Charcot Restraint Orthotic Walker (CROW) or custom ankle foot orthosis (AFO) - many different types of braces are designed and used to further offload pressure from the ulcerated area or the Charcot ankle.  The CROW is a boot like brace that reduces pressure in the foot area and stabilizes the ankle.

For more information and pictures, please check:

http://www.slideshare.net/CODG/orthotic-management-of-the-diabetic-foot-v21

For more information from the Canadian Diabtes Association please check:

http://www.diabetes.ca/about-diabetes/living/complications/foot-care/

Our staff found out today that one of our long term patients passed away suddenly last week.  We are all saddened by her passing and our thoughts are with her family and friends. 

Although we only play a very small part in our patients life, each one touches us in a different way and makes us remember that even though we may only interact with someone a small amount, they leave a part of themselves with us.   This lady, with all her many health concerns and frustrations with all of her complications, has always treated all of us with kindness and respect.  Through her difficulties she was patient and grateful for the little that we could do for her.  She has reminded all of us that even when life is hard to treat others as you would like to be treated and that is how you will be remembered and leave your mark. 

It has been our pleasure to have known this lady.

As Certified Orthotists, we are only a small part of the healthcare team that looks after the people who have had a stroke.  Although not all people who have a stroke require a brace, one of the most common reasons that I see people in my office for a consultation regarding an ankle foot orthosis (AFO or leg brace) is due to a stroke.   In fact, according to the Heart and Stroke Foundation of Ontario, more than 50,000 people in Canada have a stroke each year.  Since I do see so many people who have had strokes, I am always interested in new technology (ways to make a better AFO) and new knowledge to help my patients (so I can do a better job).  I recently came across a book that I highly recommend to all healthcare professionals as well as family and caregivers of people who have had a stroke. 

My Stroke of Insight by Jill Bolte Taylor, Ph.D. relates her experience of having a stroke.  Her unique perspective as a "brain scientist" helps us all understand the physical side (damage the stroke causes) and how she as a patient, lived through the chain of events following the stroke.  She gives insight to the people who are on the outside, helping, treating, caring for the person who has had a stroke that helps us to understand what is or could be happening on the inside of the brain that has had a stroke.  This insight will help us be more compassionate, patient and thoughtful which in turn will help us care better for the person who sometimes does not have the voice to speak for themself.

Once it is determined that you need to purchase foot orthoses (insoles or orthotics) the cost of the devices may be an issue for some.  In Ontario, our government insurance (OHIP) does not provide coverage for foot orthoses and we often look to our group insurance or third party coverage.  When investigating the coverage it is very important to find out all of the specifics of your individual policy.  Policies between companies are often quite different from each other and often policies with the same insurance company are different between different employers.  Before committing to purchasing the foot orthoses make sure that you check your policy to find out exactly what you have coverage for as well what needs to be submitted to the insurance company. 

Important things to check:

•  Do you need and have a prescription from a medical doctor?  Most insurance companies require a prescription with a diagnosis and prescribed item (foot orthoses) from a medical doctor.  This insures that the doctor has checked for possible underlying medical conditions and also provides a professional impartial third opinion of the requirement for the orthoses.
• Is the provider you have chosen accepted by the insurance company?  Many insurance companies recommend preferred providers.  In Ontario there is no regulations with respect to who can provide orthoses so the insurance companies have investigated to determine who is the best qualified to assess and provide the devices.  For example, Certified Orthotists are preferred providers with many insurance providers.
• How is the assessment done?  The person doing the assessment should ask about your medical history, perform a gait and biomechanical analysis and discuss your shoes, activities and expectations.  Many insurance companies require copies of this information.
• How are the foot orthoses made? Custom made foot orthoses are usually made from a plaster impression (cast) of the feet held in a neutral position.  The cast is then filled with liquid plaster which hardens to form a model of your feet.  The materials used for the foot orthoses are then heated and molded under vacuum to form to the contour of your feet.  The foot orthoses are then shaved or ground down to the proper angle.  Some insurance companies require a plaster cast method for manufacturing.
• Can the provider bill the insurance company directly?  Some insurance companies allow the provider to bill directly.  If no direct billing is allowed, the client would pay for the foot orthoses first and submit a claim to be reimbursed.

When purchasing anything, the consumer is ultimately responsible for the cost of the item so it is important to understand exactly the costs involved prior to committing to anything.  Once you understand all of the requirements of the insurance company and arrange the paperwork ahead of time, you can go confidently and comfortably into your new foot orthoses!

This week, my colleague Jim Amesbury B.Sc.C.O.(c) and I had the opportunity to attend an advanced programming seminar on the WalkAide® System.  Custom Orthotic Design Group Ltd. has been providers of the WalkAide® Function Electrical Stimulation (FES) System for the past year with great success. 

The WalkAide® uses a gentle electrical stimulation to simulate the normal nerve signal to the muscles to create a "lift" of the foot for people who have "foot drop" due to certain diseases such as Multiple Sclerosis or impairments such as stroke or spinal cord injury.  The nerve stimulation works in a cycle that is programmed for each individual to replicate the normal function during gait with variables such as speed, length of time of stimulation and amount of stimulation. 

The extra training was an excellent opportunity for us to learn more about the updated software and to trouble shoot timing issues with the use of the WalkAide®.  Although most of the programming that we have done already has made an improvement for our current patients' gait, there have been little changes that we would have liked to make, but until now we were unable.  Now we can adjust many of the parameters to the fraction of a second.  The new software along with the advanced techniques that we learned this week will allow is to fine tune the cycle even better for each individual to help create a smoother, safer gait.

If you are interested in further information regarding the WalkAide® System please check out the page WalkAide: Living With Foot Drop or our slide show on Slideshare at http://www.slideshare.net/CODG/walkaide-breakthrough-treatment-for-foot-drop.