Hi Doctor Pelto here. I am going to share now talking about DME or durable medical equipment stuff and this is going to be the the custom stuff stuff that we that has made custom. So a few things to realize, custom things that can't be returned. So once they're made they're stuck with the patient we try to modify them. It's usually covered by most insurances under DME Blue Cross Blue Shield.
Currently anyway when I'm recording this needs to be sent out, usually saying it tended to hangar. You have to check Same or similar for Medicare to make sure they haven't had one in five years. May go to the deductible they have to fill out the forms needs to last at least five years unless it's lost foot changes or like a dog ate it or something else like that. You have to be careful for hotspots from the brace rubbing and for shoes you might have to go up a half to a full size.
Yeah, there's a couple of ortho, ortho feet or different types of shoes. We do many different types. I'm going to go over the most common ones, Arrow, Spring, Arizona Crow, Lateral Blaze, Meso, Medial blaze, Dorsey Assist and more. Balance brace and then the Ritchie Blaze. Some of these are kind of interchangeable and I'll explain that in a little bit. Let's start here with the arrow spring Arrow spring is a brace, it's called a carbon fiber brace.
So it has this carbon fiber on the front goes around to this carbon fiber plate on the bottom. So what happens is when when the when the when the tibia or the front of the leg goes forward, it it, it kind of causes a spring loaded thing as it goes backward and that takes stress off the middle of the foot, off the Achilles and off the plantar
fascia. This is made for people that may have been wearing a walking boot for a long time or for chronic issues of Achilles tendonitis, mid foot arthritis or plantar fasciitis or even drop foot. It. It uses the body movement to spring the foot forward. It's applied to the front of the leg. It's hard for patients that have a really big front of leg. So just be aware of that. There's a lot of girth there.
It's going to be hard. It's good for patients that are wearing a walking boot for a long period of time and there's some kind of more information about it right there. Here is the prescription for it. There are the main areas. They come for our Achilles mid foot arthritis, drop foot, plantar fascia and then just the brace only. Usually you put an orthotic on top of it. So if have a patient has an orthotic, usually an orthotic can be made or should be made a pair of orthotics Achilles.
They tend to add these heel wedges to it to reduce pulling. The Achilles mid foot as well has a heel wedge. Sometimes those can be hard to fit in shoes. I want to be clear. OK so sometimes that can be a challenge. Arizona AFO this is a common AFO brace. Basically it's a leather. It's almost like a leather glove that has laces. There's laces or speed laces as well. It can be articulated, which means it can move at the ankle or not. This one's not moving.
It reduces abnormal movement and and basically it's a way of fusing the joints, the painful joints without fusing them. It's a test fusion. It's good for ankle and rifid arthritis. It's good for severe tendon injuries like peroneal tendon, posterior tibial tendon tendon stuff. That's really bad, really big feet. It's made custom. It's it takes a little bit more space in the shoe. But for patients for example, if they get out of a crow boot, will go over a crow boot in a second.
That's for a charcoal foot. It can help maintain the foot stability afterwards. So it's a very good brace. It's custom once again needs to be modified occasionally, and if their foot changes, you may have to change it. Here's the different types. There's a standard Arizona, which we do. There's a tall one if you want more protection up top. There's a one with Velcro, A hinge and a foot. This is kind of like the meso brace, along with a higher up one.
This is good if you have a if you your ankle is not arthritic. This one even goes up higher if they have kind of a really unstable foot. Here's a sport one, which is a little bit lower profile and only restricts the ankle. And this is kind of a slim one, depending on the foot type. And this is a breeze which looks very similar to the balance brace, but it's just a kind of a breathable material. It's a lighter material. It's not as rigid as these
leather ones. So those are the different types that we do here in the office. When you fill it out, you're going to have to put in what foot and then kind of any other additional things that you're going to want for these braces. This is another company that does similar braces. So there are Ritchie braces which are similar, but they have a stirrup on the outside and they help prevent inward and outward kind of like that other velocity brace that I talked
about. And they also have the the Achilles offloading system with this arrow spring and it talks about different modifications. You have to be aware of cup, heel, cup depth and stuff like that. So there's different other things that you can add orthotic modifications or or or brace modifications as well. So there's different types of braces that can be made. These are kind of similar to the Arizona, but they are, they're
more like athletic. They're for a younger type of a patient that they're easier to get on and off and things like that. OK. A crow boot is a charcoal restraint restraining orthotic Walker. It's for charcoal, for like a collapsing foot and it's used if it's in this chronic state which are the acute state, which is we really swollen and red. And so you'd put them in this. I had one patient that had both of these and you put in there till it calms down.
The padding might have to be adjusted based on the swelling as it goes down. They wear it for six months and then you transfer them into an Arizona brace. Usually we send these braces out due to the frequent adjustments that are needed for these. That's called a crow boot. Here's the crow boot prescription. These are some of the more advanced ones, so these are like thermoplastic AF OS. These could be used for drop foot as well. Here is a similar to like an
errors, a Ritchie brace. And this is the crow boot. So you have to put in what side. You have to put little markers on these when you do these as well. So just be aware of that. This is a lateral blaze. So there's medial blaze, lateral blaze and a drop foot brace by this company. It's used for lateral ankle instability, high arches, ankle sprains, things like that. So it protects it from going on the outside.
So here's the media one on the inside that protects it from flattening in cuboid lock is the one that protects it from the outside and the drop foot one. So there's different different ones from this company going back. This is the meso brace. So basically it's just a portion of the Arizona brace that's just in the middle of foot. So it's good for mid foot arthritis for patients. It looks right here. Meso brace, it's used to restrict mid foot movement. It can also be used.
Another option would be the the arrow spring brace, which doesn't restrict the movement as much as it just takes the movement and and and uses the the brace to to move the middle of the foot as it takes strain off of it. It's a little bit difficult fitting in shoes. Similar to the other Arizona braces, you have to go up a half size. It's used in conjunction many times with a cortisone injection into the joint or shockwave or something else like that to reduce some of the swelling in
that area. Here's that medial blaze. This is when we do a lot for collapsing flat foot patients. You use it when an orthotic isn't enough.
So a lot of our patients they're going to get an orthotic and this brace and so they'll wear this if they're doing a lot of standing and walking and then if there's everyday they might use their orthotic and it's excellent for a prominent medial malleolus on the inside of the ankle, if it's very prominent or if they're collapsing really, really badly, it won't irritate this, unlike a Ritchie brace that many times will be
irritated. Here kind of an example and here's the link to their to their websites. Here's a Dorsi assist brace. This is for someone that has a drop foot. It's a little bit lower profile than than some of the other ones. That's why our patients like it. It has like this leaf spring. It has these little little things in here like Jelly things that go in there that lift it up.
So when you bend it back, when you bend it down it it, it it tightens these and then it as you take away it lifts it up the foot, it kind of assists the foot and going up, this is a more balance brace or a balance brace. It's used to help produce postural sway and walking. It's used for patients with neuropathy and balance issues, those that have lack of feeling. It works well and they come as a pair for patients and they just leave them in their shoes and
they and they fit them in there. So here's some example of some of the the balance brace information as well. You have to choose if you want most people do the Velcro in black. Here is another example very similar to the There's an Optima brace by one company, which is the Arizona, and then there's the Ritchie brace, which is this. Now the medial Blaze one allows a lot more flattening out. This one doesn't allow it because it hits the inside here and it hurts them.
That's why there's that medial Blaze AFO. But it's similar thing used for kind of ankle sprains, tendonitis, flat foot, not too too bad like the other one, it's articulated so it keeps the ankle joint moving, good for posterior tibial tendon dysfunction. They may have orthotics as well, similarly that they can wear orthotics for certain activities, but wearing this for
long periods of activity. So those are the custom DME items that we have to scan that we either scan the patient or do a custom, it's called Asts sock where we put this like kind of this casting around there and then we make different marks on where it goes, OK. So hope that was helpful.