Name of the Procedure:

Common Name: Partial Foot Prosthesis
Technical/Medical Term: Partial Foot, Molded Socket, Tibial Tubercle Height, with Toe Filler (HCPCS Code: L5020)

Summary

This procedure involves creating a custom-molded prosthetic socket that extends up to the tibial tubercle (just below the knee) to assist patients with a partial foot amputation. The prosthesis includes a toe filler to mimic natural foot shape and function, helping patients regain mobility.

Purpose

The procedure addresses the loss of the forefoot due to amputation resulting from conditions such as diabetes, severe injury, or vascular disease. The primary goal is to restore the ability to walk and perform daily activities, improve balance, and enhance the cosmetic appearance of the foot.

Indications

• Partial foot amputation (transmetatarsal, Lisfranc, Chopart level)
• Inability to weight-bear or walk properly due to the missing forefoot
• Pain or discomfort using standard shoe modifications or lesser prosthetic options
• Desire for improved cosmetic and functional outcomes

Preparation

• Pre-procedural fitting session with a prosthetist to take precise measurements
• Potential imaging studies (e.g., X-rays) to assess the residual limb
• Ensuring the surgical site of amputation is fully healed
• Possibly adjusting medications, particularly anticoagulants, based on physician instructions

Procedure Description

1. Initial Consultation: Detailed evaluation and measurement of the residual limb.
2. Casting or Digital Scanning: A cast or digital scan of the limb is taken to create a custom mold.
3. Prosthesis Fabrication: A custom-molded socket is created using durable, lightweight materials. The prosthesis includes a toe filler to maintain the foot's shape and improve functionality.
4. Fitting and Adjustment: The prosthesis is fitted to the patient, with adjustments made to ensure comfort and effectiveness.
5. Training: The patient is trained to walk and perform activities using the new prosthesis.

Tools and equipment include casting or scanning tools, materials for molding (e.g., thermoplastics, silicone), and alignment devices for fitting. No anesthesia is typically required as this is a non-surgical procedure.

Duration

The entire process, from initial consultation to receiving the final prosthesis, can take several weeks. Each fitting and adjustment session may last about 1-2 hours.

Setting

The procedure is performed in a prosthetics and orthotics clinic or a specialized outpatient setting.

Personnel

• Certified Prosthetist
• Orthotist
• Prosthetic Technicians
• Physical Therapist (for post-fitting training)

Risks and Complications

• Skin irritation or pressure sores at the site of contact
• Initial discomfort or pain while getting used to the prosthesis
• Need for frequent adjustments or replacements due to wear and tear or changes in residual limb size

Benefits

• Improved mobility and ability to perform daily activities
• Enhanced balance and stability
• Better cosmetic appearance compared to standard shoe fillers
• Potential for pain reduction in the residual limb

Recovery

• Gradual increase in usage time as the patient adapts to the prosthesis
• Regular follow-up appointments for adjustments and monitoring of limb health
• Maintenance of prosthesis as recommended by the practitioner

Alternatives

• Customized shoe inserts or modifications
• Other types of lower-limb prosthetics, such as ankle-foot orthoses (AFO)
• Each alternative has varying degrees of function, comfort, and cosmetic appeal, which should be discussed with a medical professional to determine the best option for the patient.

Patient Experience

Patients may initially feel discomfort or awkwardness while adapting to the prosthesis. Physical therapy and ongoing support from healthcare providers help manage pain and improve comfort. Most patients experience a significant improvement in mobility and daily function within a few weeks to months of consistent use and adaptation.