Name of the Procedure:

Full Sole and Heel Wedge, Between Sole
Common names: Shoe wedge insert, heel lift insert
Technical/medical term: Full sole and heel wedge (HCPCS code: L3420)

Summary

A full sole and heel wedge is a custom-made shoe insert designed to adjust the alignment of the foot, offering additional support and correction for specific conditions. It is inserted between the sole and the insole of the shoe.

Purpose

This procedure aims to address conditions like uneven leg length, plantar fasciitis, heel spurs, and certain gait abnormalities. The goal is to redistribute weight more evenly across the foot, alleviate pain, and improve walking efficiency.

Indications

• Uneven leg length causing hip, knee, or lower back pain
• Plantar fasciitis or heel spurs
• Abnormal walking patterns or gait abnormalities
• Conditions requiring offloading pressure from specific foot areas

Preparation

• No fasting or specific medication adjustments are typically needed.
• A comprehensive foot examination and gait analysis may be conducted.

Procedure Description

1. A foot doctor (podiatrist) evaluates the patient's needs.
2. Measurements of the foot and leg are taken.
3. A custom wedge insert is fabricated, typically using materials like EVA (ethylene vinyl acetate) or cork.
4. The wedge is placed between the sole and insole of the patient’s shoe.
5. The patient tries the shoe to verify comfort and effectiveness, and adjustments are made if necessary.

Duration

The fitting and measurement process usually takes about 30-60 minutes. Custom fabrication can take a few days to a week.

Setting

The initial consultation and fitting are typically done in a podiatrist’s office or outpatient clinic.

Personnel

The procedure generally involves a podiatrist or an orthotic specialist, and may include a medical assistant.

Risks and Complications

• Initial discomfort as the patient adjusts to the wedge
• Rarely, skin irritation or sores
• Potential for inadequate correction if the wedge is not properly fitted; requires follow-up for adjustments

Benefits

• Relief from foot, leg, and back pain
• Improved gait and walking efficiency
• Prevention of further musculoskeletal issues Benefits can often be noticed within days to weeks.

Recovery

• Gradual adjustment over a few days to a week.
• Patients advised to wear the adjusted shoes for progressively longer periods each day.
• Follow-up appointments may be necessary to make adjustments.

Alternatives

• Over-the-counter shoe inserts (less customized, may not provide adequate correction)
• Physical therapy for gait training
• Surgical options for severe cases Compared to alternatives, custom wedges offer more precise correction and comfort, though they may cost more and require specialist intervention.

Patient Experience

• Mild discomfort is common initially, as the foot adjusts to the new alignment.
• Patients often report feeling more supported within days.
• Pain management may include over-the-counter pain relievers if necessary.
• Regular activities typically continue unabated, with gradual integration of the wedge into daily life.