So, if you have a disgruntled patient with a shopping bag of foot orthotics which have failed to properly resolve the patient’s complaints.
You have determined that no modifications to those foot orthotics will resolve the complaint and that the issue requires an AFO.
So how do you get the patient to commit to a lifestyle changing AFO? One which may require a change in footwear, activity level, weight loss, physical activity modification and therapy etc.? These are not reimbursement questions, but nevertheless, challenges that every orthotic practitioner will face.
The answers to all these questions are to be empathetic and truthful to your patient. Show them models or videos of other patients or anatomical presentations so that they can better understand the challenges they face. Many patients may only need the AFO for a few months along with physical therapy and then gradually over time successfully transfer back to a custom fabricated foot orthotic. Others such as patients with neurological issues or patients with traumatic injuries will no doubt require a permanent AFO. Promises of restoration of their ability to partially or fully resume their activities of daily living can be provided. However, one should be careful about overpromising patients pre-injury or pre-pathology restoration. Being creative with the AFO design to both adequately address their physical and psychosocial needs are equally important.
Surgical options often exist for many of these patients who fail custom foot orthotic therapy. Surgical alternatives have their own potential for success but also failure and complications. Patients deserve to hear all alternative treatment options.
Certainly, as part of the AFO selection process, patients need to be educated on what components are needed and why. This of course geared to their level of understanding. Furthermore, showing examples of the device(s) intended for them is a must.
If the problem is unilateral, the other limb must be leveled off to avoid iatrogenic limb length discrepancy. This can be done by adding a lift (heel or full length) to the contralateral limb’s foot orthotic.
Contacting KevinRoot Labs and speaking to the various staff Podiatric Consultants is always welcome in these difficult cases.
