Name of the Procedure:

Common Name: Custom Orthotic Insert (for the Foot) Technical Term: Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell (HCPCS Code: L3000)

Summary

A custom orthotic insert is a specially designed shoe insert that is molded to match the unique shape of an individual's foot. Known as a 'ucb' type or Berkeley shell, this insert aims to provide support, correct alignment, and relieve discomfort.

Purpose

Medical Conditions Addressed:

• Foot pain (e.g., plantar fasciitis)
• Flat feet or high arches
• Overpronation or supination
• Conditions affecting gait and posture

Goals:

• Alleviate pain and discomfort
• Improve foot alignment
• Enhance walking and standing comfort
• Prevent further foot and lower limb complications

Indications

• Persistent foot pain not relieved by over-the-counter insoles
• Gait abnormalities or imbalances
• Diagnosed conditions such as plantar fasciitis, flat feet, or high arches
• History of foot-related issues affecting daily activities

Preparation

Pre-Procedure Instructions:

• Wear or bring a pair of your frequently used shoes.
• Review any current medications with your healthcare provider.
• Follow specific instructions given by the podiatrist or orthopedic specialist.

Diagnostic Tests:

• Foot imprint molding or 3D scanning
• Gait analysis (walking on a specialized treadmill)
• X-rays or other imaging tests, if necessary

Procedure Description

1. Consultation and Evaluation:
   • Initial evaluation of foot condition and walking pattern.
   • Discuss symptoms and footwear habits.
2. Foot Molding:
   • Taking an imprint of your foot using a foam box or plaster mold.
   • Alternatively, using a 3D scanner to create a digital model.
3. Model Creation and Adjustment:
   • Custom orthotic is crafted based on the foot model.
   • Adjustments made for optimal fit and comfort.
4. Fitting:
   • Fitted into your shoe and tested for comfort.
   • Additional minor adjustments, if needed.

Tools Used:

• Foam box, plaster mold, or 3D scanner
• Specialized orthotic fabrication materials

Anesthesia:

• Not required

Duration

Initial consultation and foot molding take about 30 minutes to 1 hour. The creation of the insert may take several days to weeks. The final fitting session lasts about 30 minutes.

Setting

Typically performed in a podiatrist's or orthopedic specialist's office.

Personnel

• Podiatrist or orthopedic specialist
• Trained orthotic technician

Risks and Complications

Common Risks:

• Initial discomfort or need for adjustments
• Skin irritation or pressure sores if improperly fitted

Rare Complications:

• Allergic reactions to materials
• Gait alterations if misaligned

Management involves regular follow-up visits to ensure proper fit and comfort.

Benefits

• Improved comfort and reduced pain during walking and standing
• Better foot alignment and overall balance
• Potential for fewer foot-related complications in the long term

Recovery

Post-Procedure Care:

• Gradually increase wear time to allow your feet to adjust.
• Follow specific instructions on usage and care.
• Schedule follow-up appointments for adjustments.

Recovery Time:

• Immediate but incremental comfort improvements.
• Several weeks to fully adapt.

Alternatives

Options:

• Over-the-counter shoe inserts
• Physical therapy and exercises
• Anti-inflammatory medications
• Custom footwear

Pros and Cons:

• Over-the-counter inserts are less expensive but may not offer the same level of support.
• Physical therapy can address underlying issues but doesn't provide immediate support.
• Custom footwear can be a more comprehensive solution but is more costly.

Patient Experience

During the Procedure:

• Mild pressure when making the mold or scan
• Minimal to no discomfort

After the Procedure:

• Gradual improvement in comfort
• Possible initial adjustment period with mild discomfort
• Pain management strategies, such as using prescribed medications or over-the-counter pain relievers, if needed.

Always maintain regular follow-ups to ensure the orthotic is functioning correctly and to make necessary adjustments.