Reimbursement*
-
Reimbursement for the carbon fiber AFO:
Billing code L1932
Average reimbursement:
$800
Reimbursement for the Pair of Foot Orthotics:
Billing code L3000
Average reimbursement:
$400
Cash Charge for Heel Wedges:
$20 per set of wedges
$40 total Bilateral
Total Reimbursement for Achilles Offloading System:
$1240
*Note: Reimbursement varies among payors and region. No guarantees or assurances for reimbursement are implied with this document. Suppliers contact each payor to verify coverage and reimbursement amounts.
Immediate weight bearing with early mobilization of the ankle after surgical repair of the acutely ruptured Achilles tendon has now become standard protocol around the world. (1-7) More recently, a compelling body of evidence has validated equivalent outcomes with non-operative treatment of the acute Achilles tendon rupture compared to immediate surgical repair. ( 8-9) In the non-operative treatment of the acute Achilles rupture, immediate weight bearing with early immobilization has again produced the best results. (3,10)
Studies of early weight bearing after Achilles rupture have utilized various types of walking boots and casts to limit ankle joint motion and protect the injured tendon. There is no clear preference or standard for which type of immobilizing device or which position of ankle joint alignment is favored. (11) While standard practice has favored positioning the ankle in extreme equinus when weight bearing after an Achilles rupture, studies have shown favorable outcome when orthoses or braces are used which simply restrict ankle dorsiflexion to neutral (90 degrees).
Positioning the ankle in extreme ( 30 degrees) plantarflexion puts the Achilles in a slack position without the benefits of loading which is essential to proper tendon healing. Furthermore, decreased muscular activity in the calf while non-weight bearing in this position may account for long term deficits which patients suffer after Achilles tendon rupture including reduced calf circumference and reduced calf muscle strength. (6)
These studies have shown that there are no increased risks of re-rupture with weight bearing in an AFO regardless of whether the ankle was maintained in a plantarflexed position or allowed dorsiflexion to neutral. ( 12,13,14)
While intuitively we assume that less tension is placed on the Achilles when the ankle is held plantarflexed in a boot or AFO, we do not consider the compensatory muscle activity and tension which develops in the Achilles when the patient is required to walk in an extreme plantarflexed position at the ankle joint. A study of Achilles tension in human subjects showed that INCREASED tension in the Achilles resulted when the foot was positioned 20 degrees plantarflexed in a brace compared to a neutral ankle position. (15) Thus, a CAM type walking boot with the ankle set plantarflexed 20 degrees, causes the patient to walk on the forefoot only, which greatly increases Achilles tension to the same level as when they walked barefoot. (15) On the other hand, when patients ambulate in a walking boot, set at 90 degrees, two studies have shown that the reduction in contractile activity in the gastrocnemius and soleus is reduced to only 79% of normal walking ( 21% overall reduction). (16,17) However, when a 1 inch heel lift is applied inside the boot, reduces contractile activity to 57% of normal walking, while causing minimal plantarflexion of the ankle to 10 degrees. (16) Therefore, a 1 inch heel lift to a walking boot can be expected to reduce muscular activity of the ankle plantarflexors by 22% compared to walking in a boot in neutral position.
Walking boots with heel lifts will increase heel pressures while causing gait disturbances. (18) These negative changes include decreased time spent in terminal stance (propulsion) and pre-swing phase. (18) This accounts for the development of pain in the hips and knees reported by patients who must be immobilized in walking boots. A carbon fiber AFO with a one-inch heel raise will protect the Achilles by limiting ankle dorsiflexion, while restoring near-normal gait paramenters compared to a walking boot. The authors stated that this carbon fiber AFO could lead to an accelerated return to function and avoid the effects of disuse atrophy in the calf musculature. (18)
References
Richie AeroSpring
Achilles Tendon Offloading System
Clinical Indication:
Features:
Rationale for implementing this brace system in favor of the walking boot immobilization
Recent Research has Shown:
The Richie Achilles Off-Loading System provides these advantages compared to walking boots
Richie AeroSpring Achilles Tendon Offloading System
Clinical Indication:
Reimbursement*
Reimbursement for the carbon fiber AFO:
Billing code L1932
Average reimbursement:
$800
Reimbursement for the Pair of Foot Orthotics:
Billing code L3000
Average reimbursement:
$400
Cash Charge for Heel Wedges:
$20 per set of wedges
$40 total Bilateral
Total Reimbursement for Achilles Offloading System:
$1240
*Note: Reimbursement varies among payors and region. No guarantees or assurances for reimbursement are implied with this document. Suppliers contact each payor to verify coverage and reimbursement amounts.
Features:
Rationale for implementing this brace system in favor of the walking boot immobilization
Recent Research has Shown:
The Richie Achilles Off-Loading System provides these advantages compared to walking boots
Immediate weight bearing with early mobilization of the ankle after surgical repair of the acutely ruptured Achilles tendon has now become standard protocol around the world. (1-7) More recently, a compelling body of evidence has validated equivalent outcomes with non-operative treatment of the acute Achilles tendon rupture compared to immediate surgical repair. ( 8-9) In the non-operative treatment of the acute Achilles rupture, immediate weight bearing with early immobilization has again produced the best results. (3,10)
Studies of early weight bearing after Achilles rupture have utilized various types of walking boots and casts to limit ankle joint motion and protect the injured tendon. There is no clear preference or standard for which type of immobilizing device or which position of ankle joint alignment is favored. (11) While standard practice has favored positioning the ankle in extreme equinus when weight bearing after an Achilles rupture, studies have shown favorable outcome when orthoses or braces are used which simply restrict ankle dorsiflexion to neutral (90 degrees).
Positioning the ankle in extreme ( 30 degrees) plantarflexion puts the Achilles in a slack position without the benefits of loading which is essential to proper tendon healing. Furthermore, decreased muscular activity in the calf while non-weight bearing in this position may account for long term deficits which patients suffer after Achilles tendon rupture including reduced calf circumference and reduced calf muscle strength. (6)
These studies have shown that there are no increased risks of re-rupture with weight bearing in an AFO regardless of whether the ankle was maintained in a plantarflexed position or allowed dorsiflexion to neutral. ( 12,13,14)
While intuitively we assume that less tension is placed on the Achilles when the ankle is held plantarflexed in a boot or AFO, we do not consider the compensatory muscle activity and tension which develops in the Achilles when the patient is required to walk in an extreme plantarflexed position at the ankle joint. A study of Achilles tension in human subjects showed that INCREASED tension in the Achilles resulted when the foot was positioned 20 degrees plantarflexed in a brace compared to a neutral ankle position. (15) Thus, a CAM type walking boot with the ankle set plantarflexed 20 degrees, causes the patient to walk on the forefoot only, which greatly increases Achilles tension to the same level as when they walked barefoot. (15) On the other hand, when patients ambulate in a walking boot, set at 90 degrees, two studies have shown that the reduction in contractile activity in the gastrocnemius and soleus is reduced to only 79% of normal walking ( 21% overall reduction). (16,17) However, when a 1 inch heel lift is applied inside the boot, reduces contractile activity to 57% of normal walking, while causing minimal plantarflexion of the ankle to 10 degrees. (16) Therefore, a 1 inch heel lift to a walking boot can be expected to reduce muscular activity of the ankle plantarflexors by 22% compared to walking in a boot in neutral position.
Walking boots with heel lifts will increase heel pressures while causing gait disturbances. (18) These negative changes include decreased time spent in terminal stance (propulsion) and pre-swing phase. (18) This accounts for the development of pain in the hips and knees reported by patients who must be immobilized in walking boots. A carbon fiber AFO with a one-inch heel raise will protect the Achilles by limiting ankle dorsiflexion, while restoring near-normal gait paramenters compared to a walking boot. The authors stated that this carbon fiber AFO could lead to an accelerated return to function and avoid the effects of disuse atrophy in the calf musculature. (18)
References
AeroSpring Achilles Tendon Offloading System
Clinical Indication:
Reimbursement*
Reimbursement for the carbon fiber AFO:
Billing code L1932
Average reimbursement:
$800
Reimbursement for the Pair of Foot Orthotics:
Billing code L3000
Average reimbursement:
$400
Cash Charge for Heel Wedges:
$20 per set of wedges
$40 total Bilateral
Total Reimbursement for Achilles Offloading System:
$1240
*Note: Reimbursement varies among payors and region. No guarantees or assurances for reimbursement are implied with this document. Suppliers contact each payor to verify coverage and reimbursement amounts.
Features:
Rationale for implementing this brace system in favor of the walking boot immobilization
Recent Research has Shown:
The Richie Achilles Off-Loading System provides these advantages compared to walking boots
Immediate weight bearing with early mobilization of the ankle after surgical repair of the acutely ruptured Achilles tendon has now become standard protocol around the world. (1-7) More recently, a compelling body of evidence has validated equivalent outcomes with non-operative treatment of the acute Achilles tendon rupture compared to immediate surgical repair. ( 8-9) In the non-operative treatment of the acute Achilles rupture, immediate weight bearing with early immobilization has again produced the best results. (3,10)
Studies of early weight bearing after Achilles rupture have utilized various types of walking boots and casts to limit ankle joint motion and protect the injured tendon. There is no clear preference or standard for which type of immobilizing device or which position of ankle joint alignment is favored. (11) While standard practice has favored positioning the ankle in extreme equinus when weight bearing after an Achilles rupture, studies have shown favorable outcome when orthoses or braces are used which simply restrict ankle dorsiflexion to neutral (90 degrees).
Positioning the ankle in extreme ( 30 degrees) plantarflexion puts the Achilles in a slack position without the benefits of loading which is essential to proper tendon healing. Furthermore, decreased muscular activity in the calf while non-weight bearing in this position may account for long term deficits which patients suffer after Achilles tendon rupture including reduced calf circumference and reduced calf muscle strength. (6)
These studies have shown that there are no increased risks of re-rupture with weight bearing in an AFO regardless of whether the ankle was maintained in a plantarflexed position or allowed dorsiflexion to neutral. ( 12,13,14)
While intuitively we assume that less tension is placed on the Achilles when the ankle is held plantarflexed in a boot or AFO, we do not consider the compensatory muscle activity and tension which develops in the Achilles when the patient is required to walk in an extreme plantarflexed position at the ankle joint. A study of Achilles tension in human subjects showed that INCREASED tension in the Achilles resulted when the foot was positioned 20 degrees plantarflexed in a brace compared to a neutral ankle position. (15) Thus, a CAM type walking boot with the ankle set plantarflexed 20 degrees, causes the patient to walk on the forefoot only, which greatly increases Achilles tension to the same level as when they walked barefoot. (15) On the other hand, when patients ambulate in a walking boot, set at 90 degrees, two studies have shown that the reduction in contractile activity in the gastrocnemius and soleus is reduced to only 79% of normal walking ( 21% overall reduction). (16,17) However, when a 1 inch heel lift is applied inside the boot, reduces contractile activity to 57% of normal walking, while causing minimal plantarflexion of the ankle to 10 degrees. (16) Therefore, a 1 inch heel lift to a walking boot can be expected to reduce muscular activity of the ankle plantarflexors by 22% compared to walking in a boot in neutral position.
Walking boots with heel lifts will increase heel pressures while causing gait disturbances. (18) These negative changes include decreased time spent in terminal stance (propulsion) and pre-swing phase. (18) This accounts for the development of pain in the hips and knees reported by patients who must be immobilized in walking boots. A carbon fiber AFO with a one-inch heel raise will protect the Achilles by limiting ankle dorsiflexion, while restoring near-normal gait paramenters compared to a walking boot. The authors stated that this carbon fiber AFO could lead to an accelerated return to function and avoid the effects of disuse atrophy in the calf musculature. (18)
References