Name of the Procedure:

All lower extremity prosthesis, solid ankle cushion heel (SACH) foot, replacement only (HCPCS L5971)

Summary

The SACH foot replacement is a procedure to fit a new solid ankle cushion heel prosthetic foot for individuals who have previously had an amputation of the lower extremity. This type of prosthesis is designed to provide stability and cushioning to allow for more natural walking.

Purpose

The purpose of replacing a lower extremity SACH foot prosthesis is to:

• Improve mobility and walking ability
• Restore balance and stability
• Enhance comfort and functionality of the prosthetic limb
• Address wear and tear or unsuitability of the old prosthesis

Indications

• Wear and tear or damage to the existing SACH foot prosthesis
• Discomfort or pain with the current prosthetic foot
• Changes in the residual limb shape or volume that affect the fit
• Specific complications from the use of the old prosthesis, such as skin irritation or sores

Preparation

• No specific fasting or medication adjustments are typically required.
• A fitting assessment may be conducted to ensure the new prosthetic foot is appropriate.
• The patient may undergo a physical examination to check the condition of the residual limb.

Procedure Description

1. The prosthetist removes the old SACH foot prosthesis.
2. The residual limb is examined for any issues that need addressing before fitting the new prosthesis.
3. The new SACH foot prosthesis is fitted to the residual limb.
4. Adjustments are made to ensure proper alignment and comfort.
5. The patient takes test walks to ensure the prosthesis fits well and functions properly.

Tools and Equipment:

• Prosthetic fitting tools
• SACH foot prosthetic component

Anesthesia or Sedation:

• None required for the replacement procedure.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a prosthetics clinic or an outpatient setting specialized in prosthetic fittings.

Personnel

• Certified prosthetist
• Prosthetics technician (optional)
• Physical therapist (may assist with gait training post-fitting)

Risks and Complications

• Initial discomfort or soreness as the new prosthesis is adjusted
• Potential for skin irritation or blistering
• Alignment issues that may require follow-up adjustments
• Rarely, the prosthetic foot may be incompatible, necessitating a different model or design

Benefits

• Immediate improvement in stability and walking ability
• Enhanced comfort and reduced pain
• Better overall balance and mobility
• Increased functionality and daily activity levels

Recovery

• Minimal recovery time; patients can usually walk immediately post-fitting
• Instruction on care and maintenance of the new prosthetic foot
• Follow-up appointments to ensure proper fit and function
• Activity restrictions are generally minimal, but heavy physical activities may require additional guidance

Alternatives

• Continued use and potential repair of the current prosthetic foot
• Different types of prosthetic feet, such as energy-storing feet or multi-axis feet, depending on patient needs
• Non-surgical management options for certain conditions (e.g., specialized footwear or orthotics)

Pros and Cons Compared to Alternatives:

• SACH feet are generally less complex, cost-effective, and durable but may lack the energy return features of more advanced prosthetics.
• Other prosthetic options may offer more dynamic movement but can be more expensive and require longer adjustment periods.

Patient Experience

• The patient may experience some initial discomfort as they adapt to the new prosthetic foot.
• Pain management is typically not necessary, but over-the-counter pain relievers can be used if needed.
• Supportive care is provided to ensure the patient adjusts well to the new prosthetic, with attention to optimizing comfort and function.