Name of the Procedure:

Orthopedic shoe, oxford with supinator or pronator, infant (HCPCS Code: L3201)

Summary

This procedure involves fitting an infant with an orthopedic oxford shoe designed to correct abnormal foot positioning. The shoe can feature either a supinator or pronator insert to help align the child's foot correctly for better posture and movement.

Purpose

The orthopedic shoe is used to correct various foot abnormalities in infants, such as overpronation (foot rolls inward) or supination (foot rolls outward). The goal is to promote proper foot development, improve balance, and prevent future complications.

Indications

• Flat feet
• Inward or outward rolling of the foot
• Gait abnormalities observed in early walking stages
• Need for postural correction due to congenital or developmental conditions

Patient criteria:

• Infants showing signs of abnormal foot positioning
• Recommendation from a pediatric orthopedist or podiatrist

Preparation

• No specific preparation such as fasting or medication adjustment is required.
• A thorough physical examination by a pediatric orthopedist or podiatrist.
• Foot measurements to ensure the correct shoe fit.

Procedure Description

1. Assessment: A healthcare professional evaluates the child’s foot structure and gait to determine the need for a supinator or pronator insert.
2. Measurement: Accurate measurements of the infant’s feet are taken to ensure a proper fit.
3. Fitting: The orthopedic oxford shoe is fitted with the appropriate insert (supinator or pronator) and placed on the child's foot.
4. Adjustment: The shoe may be adjusted for optimal comfort and correction.

Tools and Equipment:

• Orthopedic oxford shoe
• Supinator or pronator insert
• Measurement tools (e.g., Brannock Device)

Anesthesia or Sedation:

• Not applicable

Duration

The fitting and adjustment process typically takes about 30 minutes to 1 hour, depending on the child’s cooperation and the complexity of the foot issue.

Setting

The procedure is usually performed in an outpatient clinic specializing in pediatric orthopedics or podiatry.

Personnel

• Pediatric orthopedic surgeon or podiatrist
• Orthopedic technician or nurse

Risks and Complications

Common Risks:

• Initial discomfort as the child adjusts to the shoe
• Minor skin irritation or blistering

Rare Risks:

• Allergic reaction to materials used in the shoe

Management:

• Monitoring and adjusting the shoe as needed to ensure proper fit and comfort
• Application of padding or bandages to prevent skin irritation

Benefits

• Corrects abnormal foot positioning
• Promotes proper foot development and balance
• Improves gait and posture
• Reduces the risk of future foot and posture problems

Improvements are typically seen within a few weeks to months of consistent use.

Recovery

• Regular use of the orthopedic shoes as prescribed.
• Periodic follow-up appointments to assess progress and make any necessary adjustments.
• No specific recovery time; the child can continue regular activities with the shoes.

Alternatives

• Physical therapy exercises to correct foot positioning
• Custom-made orthotic inserts for everyday shoes
• Non-orthopedic supportive footwear

Pros and Cons:

• Physical therapy may be less invasive but may require longer to see results.
• Custom orthotics offer a tailored fit but can be more expensive.
• Non-orthopedic supportive footwear provides general support but may not address specific abnormalities.

Patient Experience

The child may initially experience some discomfort as they adjust to wearing the orthopedic shoes. Most infants quickly acclimate and experience improved comfort and movement. Pain management and comfort measures include regular monitoring and ensuring a proper fit to prevent irritation.