Name of the Procedure:

Heel, Thomas with Wedge (HCPCS Code: L3465)

Summary

The Heel, Thomas with Wedge procedure involves fitting a specialized orthotic device to the patient's shoe. This device is designed to alleviate discomfort and improve mobility by providing proper alignment and support to the heel.

Purpose

• Medical Conditions/Problems it Addresses: This procedure is often used to treat conditions like plantar fasciitis, Achilles tendonitis, and certain types of heel or arch pain.
• Goals/Expected Outcomes: The primary goals are to reduce pain, improve foot function, and enhance overall mobility.

Indications

• Specific Symptoms/Conditions: Chronic heel pain, arch pain, Achilles tendonitis, plantar fasciitis.
• Patient Criteria: Patients with persistent heel pain unresponsive to conservative treatments like rest, ice, or over-the-counter orthotics.

Preparation

• Pre-procedure Instructions: No fasting or specific medication adjustments are generally required.
• Diagnostic Tests/Assessments: A thorough physical exam and possibly imaging studies like X-rays or MRIs to determine the underlying cause of heel pain.

Procedure Description

1. Fitting the Device: The healthcare provider measures and molds the orthotic device to fit the patient's shoe.
2. Adjustment and Customization: Adjustments are made to ensure the wedge provides the proper heel lift and support.
3. Final Fitting: The device is fitted into the shoe, and any necessary adjustments for comfort and effectiveness are made.

• Tools/Equipment: Custom orthotic device, measuring and molding equipment.
• Anesthesia/Sedation: Not applicable as this is a non-invasive procedure.

Duration

The fitting process typically takes around 30 minutes to an hour.

Setting

The procedure is usually performed in an outpatient clinic or orthopedic specialist's office.

Personnel

• Orthopedic specialist or podiatrist
• Medical assistant or orthotic technician

Risks and Complications

• Common Risks: Initial discomfort, need for adjustments.
• Rare Risks: Allergic reactions to materials, worsening of symptoms.
• Management of Complications: Follow-up appointments for adjustments or alternative treatments if necessary.

Benefits

• Expected Benefits: Reduction in heel pain, improved walking comfort, better foot alignment.
• Realization Time: Benefits can often be noticed within a few days to a week of regular use.

Recovery

• Post-procedure Care: Patients are advised to gradually increase wear time to allow their feet to adjust.
• Expected Recovery Time: Most patients fully adapt within 1-2 weeks.
• Restrictions/Follow-up Appointments: Follow-up visits for adjustments may be necessary.

Alternatives

• Other Treatment Options: Physical therapy, over-the-counter orthotics, anti-inflammatory medications, and in more severe cases, surgery.
• Pros/Cons of Alternatives: Non-custom solutions may be less effective but are cheaper; surgery is more invasive with a longer recovery but may be necessary for severe cases.

Patient Experience

• During the Procedure: Minimal discomfort during the fitting process.
• After the Procedure: Patients may initially feel some discomfort as they adjust, but pain relief should follow. Pain management is generally not required beyond over-the-counter pain relievers if needed. Regular follow-ups ensure optimal comfort and effectiveness.