Quality Foot Care Without Overlooking the Obvious
November 2017 Issue
Maintaining or increasing mobility is a common goal of O&P interventions and the quality foot care pedorthists provide is one way of supporting this goal. Providing therapeutic footwear, custom foot orthotics, diabetic inserts, and even general advice to steer people toward appropriate footwear for their specific needs all help to keep clients more active and prevent further complications. In this issue we highlight topics related to the delivery of pedorthic care and how the details can be taken for granted.
"Keeping Your Shoes On: Does the Closure Matter?" focuses on an often-overlooked area of shoe selection—the closure mechanism. While much time and thought is put into selecting the proper shoe width, depth, and heel drop to meet clients' needs, it is all for naught if their shoes do not remain snugly in place. Remember old-fashioned shoelaces? They remain a popular choice for their versatility and ability to provide good closure economically, but options abound to ensure pedorthists can match the closure choice to the client as carefully as they choose other aspects of their intervention.
"Let Me Be Direct: A-5513 Coding Clarification and the Future of CAD/CAM Direct-milled Inserts" tackles the recent Centers for Medicare & Medicaid Services (CMS) coding clarification and how it may impact central fabrication businesses that provide direct-milled custom diabetic inserts. While the ruling has little effect on practices that fabricate in-house, some pedorthists who can offer this service to their clients at current reimbursement rates by using outsourced direct-milled inserts may have to discontinue it if the ruling remains unchanged. And, as experts we spoke with attest, that sort of shift would most impact patients who benefit from reduction in diabetic ulcers and fewer amputations as a result of using diabetic inserts. The author also examines whether a simple word choice based on available technology at the time of the original rule may be behind the stricter interpretation of the coding requirement.
The final feature in this issue, "What Sweeps Them Off Their Feet? An Analysis of Pain and Fatigue in Adults With Cerebral Palsy", explores the potential for helping an underserved population in the area of pedorthics. While many symptoms of cerebral palsy (CP) first affect children, it can be easy to forget that once patients with CP age out of pediatric healthcare, the symptoms continue and can worsen. Nearly one-half of adults with CP report foot and ankle pain, leading the article's author to review potential pedorthic treatments to help reduce pain that could open up an avenue of practice and support increased mobility for patients whose needs may be overlooked.
On that note, I hope these articles help you to remember that the solution is often in the details.