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By Larry Huppin, DPM on 6/24/2013 3:54 PM
A question from a client today:

QUESTION:

In patients with a pediatric flat foot or a young adult with flat foot deformity .....with the STJ in neutral upon standing and the first ray doesn't touch the ground, do you add a forefoot extension, first ray cut out or to get the forefoot on the ground? 
By Larry Huppin, DPM on 6/10/2013 2:54 PM
 I had a ProLab client called me today stating that she wanted to make a soft orthotic for a patient who had a significant pes planus foot type and was suffering from plantar fasciitis. She wanted to make a soft device because she said the patient had “hard orthotics” in the past and did not tolerate them.

The first thing that we need to think about when deciding on an orthotic prescription is to determine the goal of therapy. Since this patient’s primary complaint is arch pain due to plantar fasciitis, our goal with the orthotic device should be to reduce tension on the plantar fascia. To accomplish this we need a device that is going to decrease arch collapse in order to decrease lengthening of the arch and increased tension on the plantar fascia. 
By Larry Huppin, DPM on 6/10/2013 2:54 PM
 I had a ProLab client called me today stating that she wanted to make a soft orthotic for a patient who had a significant pes planus foot type and was suffering from plantar fasciitis. She wanted to make a soft device because she said the patient had “hard orthotics” in the past and did not tolerate them.

The first thing that we need to think about when deciding on an orthotic prescription is to determine the goal of therapy. Since this patient’s primary complaint is arch pain due to plantar fasciitis, our goal with the orthotic device should be to reduce tension on the plantar fascia. To accomplish this we need a device that is going to decrease arch collapse in order to decrease lengthening of the arch and increased tension on the plantar fascia. 
By Larry Huppin, DPM on 6/6/2013 2:45 PM
 A common question I get regarding billing for orthotic devices is how to charge for the casting component. This is becoming more complicated lately because many ProLab clients are now using the ProLab foot scanner rather than plaster casting to capture an image of the foot.

In my own clinic, we have never billed separately for casting of orthotic devices. We have always considered casting an integral part of the orthotic have simply billed for the L3000 code for the right and left orthotics and then an EM code for the evaluation and management portion of the orthotic visit, which includes the evaluation of the patient and decision making regarding the orthotic prescription that is best going to treat the problem of each specific patient.
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