Name of the Procedure:

Foot, Abduction Rotation Bar, Including Shoes (HCPCS Code: L3140)

Summary

This procedure involves fitting a child with a special orthopedic device known as a foot abduction rotation bar, which includes attached shoes. The device is used to correct foot positioning by maintaining the feet in an abducted and rotated position.

Purpose

The foot abduction rotation bar is primarily used to treat congenital foot deformities, such as clubfoot. The goal of using this device is to correct the foot's alignment and to maintain the correction achieved through initial treatment methods, ultimately promoting proper foot development and function.

Indications

• Clubfoot (Talipes Equinovarus)
• Metatarsus Adductus
• Other congenital foot deformities

Suitable for pediatric patients who have undergone initial corrective treatment, such as casting or surgery, and require maintenance of foot positioning to ensure long-term correction.

Preparation

• No specific fasting or medication adjustments are generally required.
• Prior assessment through imaging studies, such as X-rays, may be needed to evaluate the extent of the deformity and monitor progress.

Procedure Description

1. The orthopedic specialist will measure the child's feet to determine the correct size and fit of the abduction rotation bar and shoes.
2. The bar, which has adjustable settings, is set to hold the feet at a specific angle to ensure proper abduction and rotation.
3. The shoes attached to the bar are carefully fitted to the child's feet and secured.
4. Parents are instructed on how to properly use and maintain the device, including when and how often it should be worn.

Equipment used includes the foot abduction rotation bar and specialized orthopedic shoes. This procedure does not typically involve anesthesia or sedation.

Duration

Fitting and adjusting the device usually takes about 30 minutes. The device is typically worn full-time initially, then gradually reduced as the child grows and the condition improves.

Setting

This procedure is performed in an outpatient orthopedic clinic.

Personnel

• Orthopedic specialist or pediatric orthopedist
• Supporting nursing staff

Risks and Complications

• Skin irritation or sores from the device
• Discomfort or pain if improperly fitted
• Potential for recurrence of the deformity if the device is not used as directed

Benefits

The primary benefit is the correction and maintenance of proper foot alignment, ensuring normal foot development and function. Improvements can often be seen within a few months, although long-term use may be necessary.

Recovery

• Parents should monitor the child's skin for any signs of irritation and ensure the device is worn as prescribed.
• Regular follow-up appointments with the orthopedic specialist to monitor progress.
• Adjustments to the device may be needed as the child grows.

Alternatives

• Serial casting
• Surgical intervention
• Orthotic devices or custom-made footwear

Alternatives vary in invasiveness and effectiveness. Serial casting and surgery may offer more immediate correction but come with higher risks and longer recovery times compared to using the foot abduction rotation bar.

Patient Experience

During the fitting, the child may feel minimal discomfort as the device is adjusted. Ongoing use of the device might cause mild discomfort initially, but this generally subsides as the child adapts. Pain management includes ensuring the device is correctly fitted and making necessary adjustments to alleviate pressure points.

Comfort measures include regular inspection for skin issues and providing the child with periods of rest from the device as recommended by the physician.