CODG Blog

We are often asked which is better; custom made foot orthoses or ready made ones from the drug store?  Like anything in life, it is dependent on the proper use at the proper time.  In some cases a ready made insole is appropriate to help with foot and leg conditions; other times they are not and  custom made foot orthoses are necessary. 

Ready made insoles are made to fit everyone, usually in small, medium and large and fit according to shoe size.  They offer some support for the medial longitudinal arch (along the inside of the foot) and often provide cushion to the heel.  For people that have mild foot conditions and only need a little bit of support or cushion with regular shaped feet, the ready made insoles will work fine.  Often they are used as a first treatment option.   The advantage of the ready made insoles is that they are easily available and the cost is about $40.00 - $100.00.  They are not usually covered by insurance.

Custom made foot orthoses or orthotics are usually made from plaster impressions of the feet while held in a corrected position.  The casts are then used to make the orthoses with specific criteria for the individual foot.  The support, cushion, correction and/or accommodation is designed into the orthoses based on the particular condition of the person.  Each foot orthosis is unique.  The advantage of the custom made foot orthosis is that they are made according to the medical requirements and can address the exact need of the individual which provides for better fit and function.  They can also be adjusted if there are minor changes to the medical condition.  For more information on Custom Made Foot Orthoses, click here.

If you have questions, speak to your medical doctor or schedule an appointment and we can provide you with further information.  There is no charge for the initial assessment.

In December I had the opportunity to attend the Canadian Association of Wound Care (CAWC) Institute Levels 1-3 which works to support and educate health care professionals regarding wound prevention and management.  Some people ask, "Why wound a Certified Orthotist take a wound care course?"

My two thought processes involved in the answer are:

1. Certified Orthotists provide treatment to people with wounds on a regular basis.  We do not change dressings or apply medication, however we protect, support and offload the area of a wound to allow for better healing.  In a wound care team, the Certified Orthotist is one of the members who treat the cause of a wound and help prevent further damage.

One of the most common causes of wounds is due to peripheral neuropathy (loss of sensation) due to complications of diabetes mellitus and we see many patients on a daily basis who have diabetes.  Ideally we would treat a patient who has diabetes before complications arise to educate regarding proper foot care and proper foot wear.  If the person does have complications such as ulcers or a Charcot foot, the Certified Orthotist, offloads, or reduces pressure in the area to allow for healing.  Foot orthoses, orthopaedic shoes, ankle foot orthoses, removable cast walkers and CROW walkers are all different types of treatments that may be used based on the needs of the individual person.

2. The Canadian Association of Wound Care (CAWC) Institute is designed for the multidisciplinary team.  Doctors, nurses, occupational therapists, physiotherapists, dieticians and many other health care professionals take the course to learn about wound care and how we all fit together as a team to treat the whole patient.  As a Certified Orthotist, I play a very small part in the treatment of a wound, however as part of a team that includes all the disciplines, my small contribution helps to reduce the length of time a wound is present and treats the cause of the wound to prevent further damage.

The CAWC Institute was an excellent course where I learned more details about wound care and which also reinforced what I know and how I treat wounds. 

When you get a prescription from your doctor foot orthoses, orthotics or insoles (usually all the words mean the same thing) often people wonder what the next step would be.  Here is a check list of the steps of the process of obtaining the orthoses. 

1. Set up an appointment.  Sometimes your doctor will advise you on where to go or if not, talk to your friends and family.  Find a clinic that is convenient for you.  It is also important to make sure that the person that will be treating you is qualified.  In Ontario, there is no regulation on who can provide orthotics, so ask questions such as:

             - Is the person who will be treating me a Certified Orthotist C.O.(c) or Podiatrist or Chiropodist?

             - Are the orthoses made on site or sent away?

             - Can adjustments be made while I wait?

             - Does the cost of the orthoses include any follow-up and adjustments?

2. The first appointment provides an opportunity for the Certified Orthotist to assess your needs.  This session of gathering information will include a personal history (complaint/problem, age, activities, past medical history), a gait assessment (how you walk) and a physical examination (range of motion of joints, muscle strength, identification of deformities, abnormalities).  The Certified Orthotist will also discuss with you your goals and expectations.  You will then set up a plan together which may include foot orthoses and education regarding other factors such as footwear that you may need to take into consideration.  If orthoses are indicated and you choose to proceed, a cast impression of your feet is taken. The cast material is put on your feet (it feels nice and warm) and your feet are held into the appropriate position until the cast material sets (about 10 minutes).  A return appointment is then set up.

3. For second appointment it is important to bring in the shoes that you usually wear - even two or three pairs if you need to.  The Certified Orthotist fits the orthoses into the shoes and checks for proper alignment.  You will then try on the shoes with the orthoses.  The Certified Orthotist will check your standing position and have you walk to recheck your alignment and gait once more.  The orthoses will feel strange at first but should never be uncomfortable.  Sometimes based on your gait or how you feel, the orthoses will be adjusted.  You will be given instructions on wear times and care of the orthoses and sent on your way to try them.

4. The third appointment is arranged for a follow-up to check and see if everything is going well and that the goals that were set at the initial appointment are being met.  Often the symptoms are not completely gone by the second or third week of wearing the orthoses but there should be noticeable improvement.

5. At any time if there is any discomfort or if the orthoses are not helping, you should be encouraged to book an appointment for a recheck.  There should be no charge for the follow-up appointment.  If the orthoses are comfortable but not reducing the symptoms sufficiently, sometimes other interventions such as physiotherapy are required and your Certified Orthotist will suggest them to you and your doctor.

For more detailed information please check Foot Orthoses - What Should you Expect?

To arrange an appointment for a free assessment click here.

Plantar Fasciitis, also known as heel pain syndrome, can cause mild, moderate and even severe pain of the heel and/or the arch of the foot.  The plantar fascia is band of tissue that starts at the heel and blends into the tissues around the ball of the foot.  When there is excess tension around the plantar fascia, it may get inflamed and irritated.

Signs and Symptoms- Often with plantar fasciitis, there is a gradual increase in pain at the heel and sometimes into the inside arch of the foot.  The pain will be worse first thing in the morning when getting out of bed and then after resting during the day.  Sometimes the pain can continue all of the time.  It may be in one or both feet.  If an x-ray is taken, there may be a spur on the heel bone.  Plantar fasciitis can cause significant pain.

Treatment- Since plantar fasciitis can be caused by many factors all together, there are many things that should be done to treat it and since it often takes a long time to seek treatment, it may take sometime to cure.  See your doctor for a proper diagnosis and to rule out other possible underlying medical conditions.

• Proper footwear - A good supportive pair of running shoes or molded sandals should be worn at all times - NO BAREFOOT
• Biomechanical assessment to see if foot orthoses (or orthotics) are necessary
• Roll your foot over a frozen bottle of water to ice the area (make sure to protect the skin from frostbite and do not do this if you have loss of sensation in the feet)
• Daily exercises to stretch the calf muscle - must be gentle and slow - hold 30-60 seconds several times a day
• Sometimes your doctor will prescribe medication
• A night-splint  will hold the foot into a position to stretch out the Achilles tendon
• Physiotherapy may be necessary for ultrasound, proper stretching and other modalities

 Since plantar fasciitis is affected by so many factors and often develops over time, many factors and some time are involved in resolving it.  See your doctor and follow the instructions carefully!

We often have parents coming in for an appointment with their children wanting foot orthoses or insoles for "flat feet".  The big question is: Do children need foot orthoses? 

In everything that we do, we need to make sure that each situation and each person is assessed properly to determine if there is any treatment that should be provided.  Children are often hard to treat - they do not always act and perform the same as adults or even adolescents and it is difficult for them to verbalize their complaints (if they do at all).  The first line of treating a child with flat feet is to visit the physician for a good diagnosis and to rule out any possible underlying medical conditions.  The child can then be assessed by a Certified Orthotist where a complete history, a physical examination and a gait examination would be performed. 

In some cases, foot orthosesare beneficial and advised for young children and in some cases, we watch and monitor the child's growth and development.  It is important to remember that as a child grows and develops, they do go through a range of body alignments that are completely normal.  For example, very young children look like thay have completely flat feet due to the normal amount of fatty tissue in the feet - once the child grows a little, the feet thin out and do not look as flat. 

As a parent, the best thing to do is remain observant, listen to the children and educate yourself about the condition of your child.  Physicians, therapists and Certified Orthotists are all excellent resources for parents to use and learn from.  If you are concerned, have your child assessed and like any medical intervention, foot orthoses can and should be used but only when appropriate and only by qualified healthcare providers such as a Certified Orthotist in collaboration with a medical doctor.

The final answer: Sometimes!

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. 

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.

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.

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/

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.