Name of the Procedure:

Clubfoot Wedge Application (HCPCS L3380)

Common Names:

• Clubfoot Wedge
• Orthopedic Shoe Insert for Clubfoot

Technical/Medical Terms:

• Clubfoot Orthotic Device
• Pediatric Orthopedic Orthosis

Summary

A clubfoot wedge is a custom orthopedic shoe insert designed for children with clubfoot. It helps to correct the foot's position by gradually realigning it into a more normal stance. This non-surgical approach is a part of a comprehensive treatment plan often used alongside physical therapy.

Purpose

Medical Conditions Addressed:

• Congenital talipes equinovarus (clubfoot)

Goals/Expected Outcomes:

• To correct foot deformity
• To improve foot functionality and achieve a normal gait
• To reduce the need for invasive surgeries

Indications

Symptoms/Conditions:

• Apparent inward turning of the foot in infants and children
• Difficulty with foot placement and balance

Patient Criteria:

• Infants and young children diagnosed with clubfoot
• Non-responsive or partially responsive to initial treatments like casting

Preparation

Pre-Procedure Instructions:

• No fasting required
• Continuing current medication unless advised otherwise by a doctor

Diagnostic Tests/Assessments:

• Physical examination by a pediatric orthopedic specialist
• Possible imaging studies like X-rays to assess foot deformity

Procedure Description

1. The child's foot will be measured precisely to create a custom-fit wedge.
2. The orthopedic wedge is fabricated based on the measurements.
3. The child will be fitted with special shoes that hold the wedge in place.

Tools/Equipment:

• Measuring tools
• Custom orthopedic wedge
• Specially designed orthopedic shoes

Anesthesia/Sedation:

• None required

Duration

• Initial fitting and adjustment take about 30-45 minutes.
• Follow-up appointments may be shorter, around 15-20 minutes.

Setting

• Outpatient clinic or pediatric orthopedic specialist's office

Personnel

• Pediatric orthopedic specialist
• Orthotist (specialist in orthopedic devices)
• Pediatric nurse

Risks and Complications

Common Risks:

• Mild discomfort or irritation
• Increased pressure points leading to minor blisters

Rare Risks:

• Developing an allergy to the materials used
• Inadequate correction of the deformity, requiring further intervention

Benefits

Expected Benefits:

• Improved foot alignment
• Reduced need for surgical intervention
• Enhanced mobility and corrected gait
• Benefits are typically noticeable within a few months, with ongoing improvements over time.

Recovery

Post-Procedure Care:

• Continuous wearing of the orthopedic wedge as directed
• Regular follow-up visits for adjustments

Expected Recovery Time:

• Gradual improvement over months to a few years
• Possible restrictions on activities that could hinder correction

Follow-up Appointments:

• Scheduled regularly to monitor progress and make necessary adjustments

Alternatives

Other Treatment Options:

• Serial casting (Ponseti method)
• Surgical correction

Pros and Cons:

• Serial casting is effective but can be time-intensive.
• Surgery is more invasive, with longer recovery times and higher risk, but can be definitive for severe cases.

Patient Experience

During the Procedure:

• The patient should feel minimal to no pain.
• Fittings can be mildly uncomfortable but are generally well-tolerated.

After the Procedure:

• Initial period of adaptation may include mild discomfort.
• Effective pain management includes over-the-counter pain relievers and comfortable, supportive footwear.
• Regular check-ins to ensure the patient is adjusting well and to make necessary corrections.