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FITTING

 

Patient Foot Assessment

 

Prior to fitting and taking a patient’s measurements, a comprehensive foot assessment should be completed. Please note that a foot assessment made by a non-Podiatrist is not meant to function as a diagnosis. Only qualified physicians make diagnoses. The purpose of a fitter’s foot assessment is to add notes and observations to a patient’s file, to be used later for the appropriate selection of diabetic footwear and inserts.

 

The information gathered through a foot assessment should be used and placed in the patient’s file, either as an assessment form or as part of the S.O.A.P. notes. For additional and more in-depth information on foot assessment technique, we encourage you to consider courses for certification as either a CPed or a CFts.

 

The foot assessment should be conducted in an exam room with the fitter wearing gloves, both for the protection of the patient and the fitter.

 

Diabetic Shoes (A5500)

 

Properly fitting Anodyne shoes and inserts assures that your shoes have total contact and avoid shearing. Fitting a patient should be done with your Anodyne Foot Measuring Device. Measurements should be taken with the patient wearing socks that they will wear with their new shoes. For full instructions on how to use your Anodyne Foot Measuring Device, click here.

 

In some cases, it’s possible that a patient will have a significant variation in the length of their two feet. If there is a size discrepancy of greater than one and a half sizes, getting a split pair will likely be needed. However, if the discrepancy is less than one and a half sizes, we would not recommend getting a split pair. Please note that all split pair orders will incur a non-refundable, 50% up-charge on the order.

 

It is important to have your patients try on shoes with Anodyne inserts in them. Trying on shoes without an insert will not give an accurate representation of the shoe’s fit (diabetic shoes are intentionally made with an extra depth to accommodate insert placement).

 

Note: In many cases, the use of our supplementary grey insert “fillers” can provide the accommodation necessary for a foot size discrepancy (i.e. by placing underneath the insert of the smaller foot).

 

Tri Lam Heat Moldable Inserts (A5512)

 

Qualifying patients are eligible for three pairs of heat moldable (prefabricated) inserts to come with their diabetic, extra depth shoes. Medicare requires that, when dispensed, the inserts be heat-molded using a heat source of 230 degrees (or higher) and make total contact with the patient’s arch. Please note, when inserts are dispensed to the patient, all three pairs must be heat molded to qualify for Medicare billing.

 

Heating the inserts generally takes 1-3 minutes and can be done using either:

 

*A heat gun set to a minimum of 230 degrees Fahrenheit

*A convection oven set at 230 degrees Fahrenheit. When heating the inserts, make sure that both the top and bottom layers are heated, with focus on the arch.

 

Note: When heating the inserts, a microwave should not be used and you must be extremely careful to not overheat the inserts, which could put the patient at risk.

 

Once the inserts have been heated, place them (one at a time) on a foam block. Have the patient wear a sock (or other protective material) and position his/her foot on top of the heated insert. With the insert and foot stable, use your hands to press up on the bottom of the insert to mold the arch with the patient’s foot. Do this with all three sets of inserts. When you’ve completed the molding process, place the insert on the floor (or suitable flat surface) and double check to ensure total contact has been established on all parts of the patient’s feet.

 

Custom Accommodative Inserts (A5514) and Partial Foot Toe Fillers (L5000)

 

Custom inserts and toe fillers require a foam impression, slipper cast or scan/photo of the patient’s foot. Impression foams can be purchased directly through us online, over the phone, or by fax. Scans can be sent directly through our Anodyne iPad scanner app.

 

Special Accommodations: Custom inserts are often required because a patient may need very specific accommodations made to their inserts. These include, but are not limited to, off-loading of certain areas, heel cups, added metatarsal pads, etc. If these accommodations are requested and specified on the Custom Insert Order Form, our lab will make sure that they are taken care of, at no additional charge.

 

Taking a Scan of the Foot: If you choose to take and send a scan using the Anodyne iPad scanner app, review the following to ensure your scans are sent correctly. For visual instructions, check out our Scanner App Instructions.

 

*Open the scanner app and click to enter a “New Patient.”

*Enter the necessary information on the shoe order form for both the inserts and associated shoes.

*Make sure patient’s foot is subtalar neutral by having them lay face down on a table or place their knee on a chair.

*Click the right foot icon on the top right of the screen and the scanning screen will appear.

*Click the scan button on the right side of the screen to begin scanning once the foot is focused within the scanning box.

*Once the scan has rendered complete, click the scan button to stop.

*Click the “save” icon on the top right of the screen, and then the “back” icon on the top left corner of the screen.

*Repeat steps 9 through 10 for the right foot.

*Click the email icon to send the scan and associated order form. You will see a notification on the screen confirming that everything was sent.

 

Taking a Foam Impression of the Foot: If you choose to take a foam impression of the patient’s foot instead of using our scanner app, please carefully review the following steps to ensure you don’t damage the foam.

 

*Sitting in a chair with thigh and knee at a 90-degree angle, place the foam box next to the patient’s left foot (non-weight bearing).

*Place the foot over the center of the foam (heel about 1” from back of foam box).

*Gently grasp below the patient’s anklebone. Using your other hand, apply some pressure at the metatarsals and heel. Push down on his/her knee until resistance is met.

*Once patient’s metatarsals and heel are all at the same depth (you may use a pen to check the depth), remove the patient’s foot from the foam.

*Repeat the process for the right foot.

*Special accommodations may be marked in the foam, gently using a permanent marker.

 

When you have completed this process, make sure to complete the Custom Insert Order Form and place it in the foam box. Although impression foam is being used, a measurement should still be taken of the patient’s feet to ensure proper fit.

 

If, upon receipt, you find that the custom inserts are in any way incorrect or do not achieve total contact as expected, please Contact Us immediately and we will coordinate to have them sent back and corrected, at no additional cost to you.

 

Shoe Modifications

 

Our lab offers shoe modifications for those patients that the Prescriber (or other qualifying physician) has determined need accommodations for their gait (or other complications). We encourage you to have the patient try on the shoes without modification prior to placing the order with our lab. If you have any questions regarding shoe modifications, please don’t hesitate to Contact Us.