Name of the Procedure:

Common Name: Addition to Lower Limb Support

Technical Term: Lower Extremity, Dorsiflexion and Plantar Flexion Assist/Resist, Each Joint (L2220)

Summary

This procedure involves adding a device to the lower extremity that assists or resists movements related to dorsiflexion (upward foot movement) and plantar flexion (downward foot movement) at each joint. It aims to enhance mobility and stability for individuals with lower leg weaknesses or disabilities.

Purpose

The procedure primarily addresses conditions that impair muscles' ability to move the foot upward and downward effectively. The expected outcomes include improved balance, enhanced gait stability, and increased mobility.

Indications

• Patients with muscular dystrophy
• Individuals suffering from stroke-related lower limb weaknesses
• Conditions like cerebral palsy that affect foot movement
• Those recovering from lower extremity injuries or surgeries

Patient criteria may include:

• Documented difficulty with dorsiflexion or plantar flexion
• Physical assessment confirming the need for additional support

Preparation

• No specific fasting or medication adjustments required.
• A thorough physical exam focusing on lower limb function.
• Imaging tests like X-rays or MRIs might be recommended to assess joint condition.

Procedure Description

1. Assessment: The healthcare provider performs a detailed assessment of the patient's lower limb function.
2. Customization: A device is custom-fitted based on the patient's specific needs and physical measurements.
3. Application: The assistive device is securely attached to the patient's lower extremity, targeting the joints requiring support.
4. Adjustment: The device's tension and support levels are adjusted to ensure it assists or resists the targeted movements effectively.
5. Monitoring: During the initial period, the patient is monitored to ensure the device is functioning correctly and adjust if necessary.

Equipment Used:

• Custom orthotic device
• Adjustable tension straps or mechanical components

Anesthesia or Sedation:

• Not required

Duration

Fitting and adjustment of the device usually takes about 1 to 2 hours.

Setting

• Outpatient clinic
• Orthopedic or prosthetic fitting center

Personnel

• Orthotist
• Physical therapist
• Physician (for overseeing the fitting and ensuring appropriateness)

Risks and Complications

• Skin irritation or pressure sores
• Discomfort due to improper fitting
• Device malfunction or breakage

Management involves re-evaluation, adjustments to the device, or, if necessary, discontinuing use.

Benefits

• Improved foot mobility and function
• Enhanced gait and balance
• Increased independence in daily activities Benefits are often realized immediately after fitting but may take a few weeks for full adaptation.

Recovery

• Minimal recovery time; most individuals resume normal activities immediately.
• Regular follow-up appointments to adjust the device and monitor progress.
• Instructions on using and caring for the device.

Alternatives

• Physical therapy focusing on strengthening muscles.
• Surgical interventions in severe cases.
• Use of alternative orthotic devices.

Pros and Cons:

PT:

• Non-invasive
• May require long-term commitment

Surgery:

• Potentially permanent solution
• Higher risk and longer recovery time

Patient Experience

• Initial fitting might be uncomfortable but typically improves with adjustments.
• Pain management generally unnecessary, as this is a non-invasive procedure.
• Most patients adapt within a few days to weeks.