O&P Guide - VGM OTS

Orthotics & Prosthetics Guide

Understand the options and processes when life’s challenges require orthotic or prosthetic solutions.

This guide offers orthotic and prosthetic (O&P) solutions that can make life easier for both patient and caregiver. We invite you to use this guide to increase your awareness of the processes, assistive devices, options, and services available.

Our trained and credentialed staff is available to help you make informed decisions and provide the right device, training, and service for your unique situation. We look forward to answering your questions and giving you the personal attention you and your loved ones deserve.

Did You Know…?

AS OF 2023, AROUND 2.1 MILLION PEOPLE IN THE U.S. LIVE WITH LIMB LOSS.

THERE ARE AROUND 185,000 AMPUTATIONS PERFORMED EACH YEAR.

APPROXIMATELY 1.7 MILLION PEOPLE IN THE U.S. UTILIZE PROSTHETIC DEVICES.

3D-PRINTING TECHNOLOGY HAS LED TO THE DEVELOPMENT OF MORE COSTEFFECTIVE O&P DEVICES.

Make an Informed Decision

Each situation that calls for O&P management is unique. Complications from diabetes, sports injuries, physical trauma, mobility limitations, children with disabilities, and other medical conditions present unique challenges for which solutions can be found in the world of O&P.

Choosing a Practitioner

The decision-making process begins with choosing a qualified provider/practitioner. It is important to consider several factors when choosing an orthotist and/or prosthetist. Chances are you will have a long-term association with your practitioner for a complicated life situation.

Here are some questions to consider:

1. Is the practitioner credentialed?

a. Ask about certification. (ABC- and BOC-certified practitioners ensure the highest standards.)

2. Is the practitioner experienced?

a. Ask questions and request recommendations from others.

3. Is there frequent and open communication?

a. You should feel comfortable communicating your needs.

4. Where are they located?

a. Locally owned O&P practices can provide personal attention and expertise not usually found in national chains.

Orthotists and prosthetists work closely with your primary physician. They closely evaluate a patient’s condition and take careful, precise measurements and impressions to create and properly fit the appropriate orthotic or prosthetic.

Certified O&P practitioners are recognized professionally as having completed rigorous education, training programs, and national board exams that satisfy industry standards.

Our trained and certified staff is here to answer your questions and find the best O&P solution to help you or your loved one return to daily living activities as soon as possible. We welcome your questions and concerns. We are here to assist in any way possible.

Diabetic Care Information

Those who suffer from diabetes are at greater risk of foot-related issues, including the need for amputation. However, studies have shown that comprehensive foot care programs can reduce and even prevent foot-related complications and can reduce amputation rates by as much as 85%! Insurance and Medicare will often cover diabetic shoes and inserts. Ask us, and we can help you determine coverage.

• Approximately 18.2 million people in the U.S. suffer from diabetes, and an estimated 16 million Americans have prediabetes.

• People with diabetes are at greater risk for foot problems that include blisters, calluses, ulcers, Charcot foot, deformities, infection, and amputation.

• Diabetes is the nation’s leading cause of non-traumatic lower limb loss – more than 82,000 amputations per year.

Helpful Diabetic Tips

Daily foot care for diabetics is crucial for lessening or preventing foot-related issues.

• Inspect your feet daily for blisters, cuts, and scratches. Always check between your toes.

• Wash your feet and dry them thoroughly.

• For dry and cracking feet, use a very thin layer of lubrication like baby oil. Apply after bathing and drying your feet. Do not use between your toes.

• Shoes should be fitted by a certified shoe care specialist and be comfortable at the time of purchase. Always wear socks.

• Don’t smoke or drink alcohol.

• Have your feet examined every visit to your physician.

• Don’t apply hot water bottles or heating pads to your feet.

Orthotic Braces and Solutions

The increase in demand for supportive devices that encourage healing while still allowing some level of active participation in daily living and sports has forced the orthotic profession to remain progressive. Braces can be very effective in preventing injury, supporting previously injured joints and muscles, and offering structural support and stability while healing from injuries.

Quick Checklist

Take a minute to consider and answer these questions. We are happy to help find the right solution to keep you active!

• Are you worried about the competence of a previously injured joint or ligament?

• Do you suffer from symptoms of overuse in your hands and wrists?

• Do you suffer from osteoarthritic knees?

• Do you participate in recreational fitness activities like riding a bike, jogging, tennis, etc.?

• Are you experiencing chronic pain or discomfort from a sports or fitness-related injury?

• Would you like to continue to participate in competitive sports while recovering from an injury?

Orthotic Braces and Solutions

Prefabricated Braces

Wrist Braces: Cost-effective and lightweight. Wrist braces offer alleviation to discomfort and instability caused by carpal tunnel syndrome or other wrist/hand injury.

Elbow Braces: Utilized to assist in arm movement due to elbow injury (e.g., tennis elbow) but are also utilized in serious conditions such as cerebral palsy, stroke, and multiple sclerosis.

Shoulder Immobilizers: Offers stability toward effective post-operative shoulder injury. May also include clavicle or rib supports if needed.

Back Braces: These braces vary depending on the type of back/spinal injury such as disc herniation, surgical recovery, or scoliosis. Some also include heating or cooling relief to facilitate faster recovery.

Knee Braces: Various types available dependent on specific injury. Certain braces, such as unloader braces, can assist with early stages of osteoarthritis (the most common type of knee arthritis). These are not recommended for high-impact sports.

Walker Boots: Used to stabilize and promote healing to soft tissue injuries, sprains, and stable fractures after surgery, injury, or during rehab.

Ankle Braces: Several types available. Includes a simple wrap-around application, and most can be worn with shoes. These can often be modified depending on the injury severity.

Night Splints: A functional brace meant to be worn during the evening to keep tendons stretched in a prone position to allow healing. Often used for plantar fasciitis, Achilles tendonitis, and drop foot.

Orthotic Braces and Solutions

Custom Orthotic Bracing

Broken bones, arthritic joints, knee hyperextension, muscular weakness, and paralysis are a few conditions that can be positively influenced by the application and use of these orthoses. In some cases, custom orthotics may be fabricated. The orthotist will custom-fit an off-the-shelf device to a patient’s dimensions, often incorporating additional components for desired results.

Ankle-Foot Orthoses (AFOs): These are an effective solution to weakened bones or muscles in the foot and/or ankle. Constructive materials are chosen for strength, flexibility, and patient comfort. While fitting AFOs, patients should wear clothing that can be rolled to expose the lower leg. Using knee-high socks is advised to lessen rubbing. Frequently worn shoes should be taken to the fitting to ensure user comfortability.

Knee-Ankle-Foot Orthoses (KAFOs): While similar to AFOs, KAFOs cover the knee joint. It’s important to note that it may take some time to adjust to movement; KAFOs often utilize more user energy for movement, but some KAFOs offer solutions to lessen this challenge.

Hip-Knee-Ankle-Foot Orthoses (HKAFOs): Much like AFOs and KAFOs, HKAFOs extend to the pelvis and hip joint. Hip joints can be locked, partially locked, or free depending on the condition or injury sustained. Ankle and knee joints can also be locked or free depending on the range of motion or diagnosis of the patient.

Wrist-Hand Orthoses (WHO): Used for limitation or mobilization of wrist motion. Fingers can still be moved when utilizing a WHO. Often worn during wrist injury recovery.

Limb Loss: Assessing Your Prosthetic Needs

There are many different situations, events, and health reasons that lead to limb loss. The beginning of a rehabilitative process after limb loss can be very overwhelming, but know that you are not alone in this journey. Our caring and credentialed staff is here to ease the process and answer your questions. The forming and fitting of a prosthetic limb is a precise science, and we are here to help you through the process.

We offer the following expertise:

• Emotional adjustments

• Shaping/exercise of residual limb

• The making of your prosthesis

• Socks, liners, and shoes

• Skin challenges

• Physical therapy education

• And more!

What is Your Functional K Level?

A K Level is a scale used to rate rehabilitation level and utilized by Medicare, with many other insurances modeling the Medicare use and coverage for prosthetics. Based on a 0-4 scale, your K level may change over time and is determined by your pre- and post-amputation capabilities to visualize your functional abilities and limitations faced day to day.

K-Level 0

There is no potential to walk or transfer safely with or without assistance, and a prosthetic will not enhance quality of life or mobility.

K-Level 1 (Low Impact)

There is potential for transfer or ambulation on level surfaces at set walking rates, allowing daily living and simple tasks to be completed in the home with minimal foot impact.

K-Level 2 (Moderate Impact)

Determined if there are lower impact tasks desired outside the home and on slightly uneven terrain levels (such as grass, curbs, and stairs).

K-Level 3 (High Impact)

Determined if there is potential to walk various speeds, navigate uneven surface levels, and demand beyond standard walking, such as exercise. The need for a prosthetic is beyond simple to/from tasks.

K-Level 4 (Sports/Extreme Impact)

Usually children and highly active adults or athletes fall into this level, especially if day-to-day tasks require high impact, high energy levels.

Prosthetic Q&A

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How can I prepare for wearing a prosthesis?

It is important to address any initial feelings or emotions you are experiencing and decide how to work through them for after-amputation life. If needed, seek out a counselor or therapist to work through these emotions. It is also important to exercise to build muscle for needed balance—learn your body positioning and stretch to become adjusted. Along with exercise, gradually desensitizing your residual limb is an important step in preparing for your prosthesis.

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When will I get my prosthesis?

This will all depend on how quickly your residual limb recovers after surgery. Sometimes a temporary prosthetic is provided, but your fitting for your actual prosthesis can be anywhere from two to six months post-surgery based on recovery rate.

How long before I’m back to normal?

It will all depend on your amputation, recovery time, and how quickly you get adjusted to your prosthesis. For the first few months, it will take some time to get adjusted to your new normal. Often, there will be some readjustment to your prosthesis due to your residual limb changing shape and building muscle during the healing process.

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How long will my prosthesis last?

Prostheses can last between a few months to several years depending on your age, activity levels, and residual limb adjustments. The first few months and years may require some occasional changes until your comfort level is met. After, it should only require maintenance as needed.

When will I have my “definitive” prosthesis?

As soon as your residual limb is healed and the size and shape have stabilized, you are ready for a more complex “definitive” prosthesis. It is very important that you maintain a consistent weight, as even a 10-pound weight gain or loss could affect the prosthetic fitting, which would require adjustments or a new prosthesis.

How should I maintain/clean my prosthesis?

Your prosthesis can be wiped down daily with a damp cloth or anti-bacterial soap. Your prosthetist will thoroughly explain the care and maintenance of each component of your prosthesis.

Common Questions for Your Prosthetist

There are ongoing challenges with the use of any orthosis or prosthesis. Consider asking some of these questions below and discussing with your prosthetists.

• What is the process of obtaining a prosthesis?

• How will I wear the prosthesis?

• What activities can I participate in with my prosthesis?

• Are you able to connect me with a patient that has had a similar experience?

• Is my insurance accepted and does it cover necessary costs?

• Are there warranties for my prosthesis?

• How often are replacements needed?

• How can I handle prosthesis adjustments if I’m not in the area?

• Are there any resources for emotional or physical support?

These are just a few questions to raise. Feel free to make your own list of any other questions or concerns you may have to address with your prosthetist.

What to Expect After Surgery

Everyone’s recovery time to limb-loss surgery is different. However, those first few months of recovery can be challenging, both physically and mentally. Your certified prosthetist (CPO) and medical team will be there to guide you through your recovery process. Below is what you can expect during these first few months. But remember, everyone is unique, and your road to recovery will differ from others depending on the specific amputation and prosthetic.

Pain Management

This is the first step the medical team will take. Unmanaged pain will hinder your recovery. If any pain is experienced post-surgery, it can be due to the surgery, damaged nerves, or musculoskeletal issues. Your medical team will take proper precautions and steps for treatment recommendation for pain management.

Healing

Making sure the amputation site is healing properly is important. Your medical team will keep a close eye on it, and this is done usually in the first two to four weeks post-surgery. The amputation site is cleaned and bandages are changed regularly to facilitate proper healing and prevent infection. Around week three, sutures and staples will be removed from the site.

In this same time frame, it is common for swelling to occur in your limb after surgery. A “shrinker” is a compression garment typically placed on your limb by your CPO to help alleviate swelling, pushing out excessive fluid from around the surgery site. A shrinker should be comfortable to wear. If there is any discomfort, consult your doctor immediately.

Prosthetic Fitting

After swelling has subsided, your CPO will take measurements to be used to construct your prosthesis. This is achieved by the usual casting method, or, with technological advancements, by a 3D-modeling program to provide a rendering of the limb. These renderings are sent to a lab to begin the construction of your proper prosthesis.

Using Your Prosthesis

Once your prosthesis is constructed, your CPO will begin the fitting process to ensure comfortability. Once comfortable, physical and occupational therapy can begin to regain strength and balance, as well as proper use of your prosthesis.

If you required a lower-limb amputation, your team will focus on your gait during therapy, ensuring you are standing and walking naturally. Your prosthesis can be adjusted for a more natural alignment if it feels off during use.

Limb and Prosthesis Care

Prevention of skin damage or further limb/body injury is of the utmost importance when using a prosthesis. It is not uncommon to notice limb shrinkage after a few weeks, and while this is normal, it should be addressed as soon as possible so that proper adjustments can be made to your prosthesis, or even have a new socket made.

If an amputation happens on one side of the body, the opposite-sided limb, or the “sound limb,” becomes incredibly important. Your medical team will walk you through how to prevent further limb loss.

We are happy to discuss with you in further detail what to expect after limb surgery. Please keep in mind, your CPO and medical staff will guide you through the healing process post-surgery. If surgery has already occurred, please consult your CPO or medical team as they will be able to provide the appropriate guidance for your unique situation.

Prosthetic Solutions

When considering a prosthetic, it’s important to be aware of certain factors and the options available to you.

Upper extremity: Options include cosmetic restoration, body-powered, electrically powered, hybrid solutions, or activity-specific.

Lower extremity: Options are based largely around the individual’s activity level. It’s important to note that once fitted with a long-term lower-extremity prosthesis, changes in weight, activity, and personal goals could result in needing an entirely new prosthesis.

No two prosthetics are alike. We will make sure to provide you with all available options. We are here to help fit you with the best components to enhance your quality of life and achieve your current and future goals.

The Impact of O&P

Local O&P providers are vital to patient recovery.

Easton Monteith is a sophomore in high school. He has participated in a variety of sports and relies on a local provider to modify his sports equipment due to an upper limb difference. Easton was born with brachysyndactyly of his left hand-notably, he was born without a thumb and his other digits were shortened and fused together. His relationship with the local provider began as a young child with dreams of playing hockey, baseball, and golf. Adaptations were made to his equipment to allow for maximum function of his left hand. Sometimes the goal was for better grip, while other modifications were made to allow Easton to be more independent when getting equipment on and off without assistance.

Working with my local provider gave me the confidence to perform at my very best. And after a win in the net as our high school varsity soccer goalie, there was no better feeling than giving a high-five to my opponents with my limb-different hand. This proves that no matter what challenges we are faced with physically, we can overcome it with the right attitude.

~ Easton Monteith

Insurance & Medicare Guide

Medicare and private insurances provide a variety of coverage for orthotic and prosthetic devices. We can help you determine the coverage that fits your unique situation.

Therapeutic Shoe Bill

Congress passed this bill specifying coverage for proper footwear and inserts for people with diabetes.

What is Covered?

Coverage is limited to one of the following within a calendar year:

• One pair of off-the-shelf depth shoes and up to three additional pairs of multi-density inserts.

• One pair of off-the-shelf depth shoes including modification and up to two additional pairs of multi-density inserts.

• One pair of custom-molded shoes and up to two additional pairs of multi-density inserts. Coverage is limited to shoes and inserts meeting certain requirements for patients with specific clinical conditions.

Prosthetics

Prosthetic coverage is based on Medicare’s K-Level system. Please see page 11 for more information.

As always, we are here to help and answer any questions you may have regarding O&P coverage.

Record Keeping

Orthotic and prosthetic devices and their components do break down and function less effectively over time. Keep track of your equipment maintenance and replacement below. Medicare and insurances sometimes cover replacement parts or new devices. Ask us. We are here to help.

Replacement Information

Inserts

Orthotics

Prosthetic Liners

Prosthesis

Once a year

Every fourth months (no more than three in a year)

Every five years or as deemed necessary by a change in status

Every six months

Every five years or as deemed necessary by a change in status

Be sure to schedule a follow-up visit with your physician by / / (date). It is also very important to schedule a follow-up visit with us in six months. / / (date)

Other Helpful Contact Information

O&P Guide

A guide to understanding options and processes when life challenges require orthotic or prosthetic solutions.

• Did You Know…?

• Make an Informed Decision

• Diabetic Care Information

• Orthotic Braces and Solutions

• Limb Loss: Assessing Your Prosthetic Needs

• What is Your Functional K Level?

• Prosthetic Q&A

• Common Questions for Your Prosthetist

• What to Expect After Surgery

• Prosthetic Solutions

• Impact of O&P

• Insurance & Medicare Guide

• Record Keeping

When you or a loved one is injured and needing an O&P device, we’re here to help you through the process. Feel free to reach out to us, and one of our kind staff will assist.