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Casting Confusion? What to Know Before

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3Current Pedorthics March|April 2012

Features

March/April 2012Volume 44, Issue 2Pedorthicscu

rren

t

Departments

10 | Overview of Casting Techniques By Kim Nicoll, BSc (Kin), C. Ped Tech (C)., C. Ped (C)

As pedorthists, we know that a cast’s quality determines how successful the foot orthosis will be in alleviating the client’s symptoms.

16 | Casting Confusion? What to Know Before the Dye is Cast

By Séamus Kennedy, C.Ped.One of the most frequent questions that I am asked during an in-service on foot orthotics is, “What kind of cast do you prefer?” I have given presentations to many different groups: pedorthists, orthotists and prosthetists, podiatrists, and physical therapists, and yet this same question always comes up.

22 | Medicare Advantage Plans: Information That You Need To Know

By Dean Mason, C.Ped., OST, BOCO, CO, BOC PedorthistIn addition to the traditional fee for service plans that we are all familiar with, Medicare offers what are known as Medicare Advantage (MA) plans, otherwise known as Medicare HMOs.

24 | Pedorthic Association of Canada’s Position Statement on Casting Techniques for Custom Foot Orthoses

Provided by Pedorthic Association of CanadaCustom Foot Orthoses (CFOs) are an essential element used by pedorthists to relieve foot pain related to biomechanical misalignment of the feet and lower limbs.

26 | Excitement Exceeds Evidence! Ready-Made vs. Custom Rockers

Reported By Shane Hayes, C.Ped.Cinderella bursts through your door, happy as a lark because her pain went away shortly after she purchased magic, glass “rocker” slippers from your facility.

34 | HHS Announces Intent to Delay ICD-10 Compliance Date

The U.S. Department of Health and Human Services (HHS) announced on February 17, 2011 that it will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

6 From the President

8 From the Executive Director

32 Industry News

34 Reimbursement & Coding News

38 Pedorthic Education

40 Marketplace

41 Products & Services

44 Advertiser Index

Cover Photo by Quayside Graphics

4 Pedorthic Footcare Association www.pedorthics.org

Executive CommitteePRESIDENT Kristi Hayes, C.Ped.

VICE PRESIDENT Liz Chiles, C.Ped.

TREASURER Jamie Dick, C.Ped., PT

SECRETARY Jay Zaffater, C.Ped., BOC Pedorthist

DIRECTORS Matt D. Almeida, C.Ped.; Christopher J. Costantini, C.Ped.; Tamara A. Daulton, C.Ped.; Jeremy A. Long, C.Ped.; Dean Mason, C.Ped., OST, BOCO, CO; Patricia A. Pande, C.Ped.; Stuart L. Pressman, C.Ped., CO; Rob Sobel, C.Ped.; and Michael D. Veder, C.Ped., CO, BOCO

VENDOR/MANUFACTURER LIAISON Andrew B. Simonds

MEDICAL ADVISOR James B. McGuire, DPM, C.Ped., PT

Editorial StaffVOLUNTEER EXECUTIVE EDITOR Kristi Hayes, C.Ped.

EDITOR Ali Sturman

ART DIRECTOR Teresa Gutsick

DESIGN/PRODUCTION Derek Heilmann; Susannah Letouze

PRINTER Balmar Inc.

Advertising & Sales StaffCURRENT PEDORTHICS Brian K. Lagana

MEMBERSHIP Brian K. Lagana

Headquarters StaffEXECUTIVE DIRECTOR Brian K. Lagana

MEMBERSHIP SERVICES Brian K. Lagana

EDUCATION COORDINATOR Brian K. Lagana

MEETINGS AND CONVENTIONS MANAGER Annette Suriani, CMP; Rebecca Fazarri, CMP

SPONSORSHIP AND ADVERTISING FULFILLMENT Brian K. Lagana

GOVERNMENT RELATIONS DIRECTOR William H. Applegate, Bryan Cave, LLC

LEGAL COUNSEL Allan J. Weiner, Kelley Drye & Warren, LLP

Marketing, Communications & Editorial CommitteeCHAIR Kristi Hayes, C.Ped.

CO-CHAIR Rob Sobel, C.Ped.

MEMBERS Faith Ballard, C.Ped., CO; Liz Chiles, C.Ped.; Tamara A. Daulton, C.Ped.; Jamie Dick, C.Ped., PT; Dean Mason, C.Ped., OST, BOCO, CO; Patricia A. Pande, C.Ped.; Stuart Pressman, C.Ped., CO; Jay Zafatter, C.Ped., BOC Pedorthist

Current Pedorthics (ISSN 1552-8111) is published bimonthly by the Pedorthic Footcare Association (PFA), 8400 Westpark Dr., 2nd Floor, McLean, VA 22102. Telephone: (703) 610-9035 or (800) 673-8447, Fax: (703) 995-4456, Website: www.pedorthics.org, Email: [email protected]. Copyright© 2012, PFA. All rights reserved. No part of this publication may be reproduced in any manner without written permis-sion. Letters to the Editor and other unsolicited material are assumed intended for publication and are subject to editing.

Articles in Current Pedorthics do not necessarily reflect the opinion of PFA, its board of directors or its employees. Authors are responsible for the validity of their content and credentials. Current Pedorthics’ use of trademarked names is done in an editorial fashion intended to benefit the trademark owner, with no intention of trademark infringement.

The annual subscription fee is included in PFA members’ dues. Subscriptions are available for $65 per year in the United States ($95 outside U.S.). Back copies, if available, may be purchased for $10 U.S. If you have any questions regarding display advertising or classified ads, please contact Ryan Abell at (202) 367-2332 or email [email protected]. Please send all product- and industry-related press releases to [email protected].

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ABOUT PFAThe Pedorthic Footcare

Association (PFA), founded in 1958, is the not-for-profit

professional association that represents the interests of the

certified and/or licensed pedorthist and supports the

pedorthic profession at large.

Through PFA’s efforts, pedorthics — the design,

manufacture, modification and fit of shoes and foot orthoses

to alleviate problems caused by disease, congenital condition, overuse or injury — is a well-

established allied health profession that makes an invaluable contribution to

public health.

MISSIONPFA’s mission is to enhance

the effectiveness and efficiency of the credentialed (certified and/or licensed) pedorthist

through education; increase the demand for the credentialed pedorthist’s services through

marketing; and defend the credentialed pedorthist’s right

to practice through government affairs activities.

Pedorthic Footcare Association8400 Westpark Drive

2nd FloorMcLean, VA 22102

phone (703) 610-9035 toll-free (800) 673-8447

fax (703) 995-4456 email [email protected]

website www.pedorthics.org

Scan the QR code with a smartphone to learn more about PFA.

F R O M T H E

PRESIDENT Kristi Hayes, C.Ped. PFA President [email protected]

“You can’t expect to meet the challenges of today with yesterday’s tools and expect to be in business tomorrow.”

— Unknown

Many people fear change, whether it is in personal or business matters, but changing nothing solves nothing. Never be afraid to make changes mid-stream; after all, you wouldn’t keep ordering footwear for your patients if it falls apart and you certainly wouldn’t make the same type of orthotic for every problem. So in day-to-day practice you are really employing

small changes all the time.

Sure, nobody likes big changes but they are necessary. Recently, PFA made a shift and hired a new management company. This enabled us to dramatically cut our costs in order to provide you with better benefits for your money without raising costs to you. In our new economy, we all need this kind of change to both sustain and grow.

Moving our files to a new office and training new staff isn’t an exciting or glamorous job, and is incredibly time consuming; however, the end result far outweighs the work involved to create the change. The adjustments you need to make in your business will not be any easier but it’s quite necessary.

Is your profit stagnant? Are your employees unhappy? Not getting return on your time investment where referrals are concerned? Then it’s time to evaluate your position overall and plan out some changes. Just because you have a problem here or a problem there, doesn’t mean you have to make as big of a change as we did; maybe all you need is a tweak. It’s vital to monitor your progress in every area so you can properly determine your next move.

The best advice I can give you is not to delay your full inspection of your own business. The sooner you can take a good, long look at it; the better off you will be because you can spring into action. “I’m too busy today, I’ll get to it tomorrow”…that can kill you. Too many wait until it’s almost too late, and I’ve even done it myself on an endeavor or two.

I had put off writing this President’s Message in the evenings to watch TV. I was watching a reality show about a gal who goes into your business, tells you quite bluntly what you are doing wrong, and in a week shows you how to do it right…I had to laugh because it reminded me of myself, and of course, I proceeded to tell myself to get off the couch and get my butt back to work! The only reason I share this personal tidbit is because shows like this are becoming more and more popular, and every time I see one, the business owner is in dire straits because they absolutely refused to change. This portrays a growing trend of people who don’t want to give up on their business, but will lose them because they just won’t do anything different.

Obviously the moral of this story is don’t be one of those people; get off the couch and talk to friends and colleagues, and find out what they do best and emulate that success wherever possible. Allow them to help inspire your changes, big or small. And as always, PFA is here to help. ■


I want to provide my patients with the best care possible.

I want to have the reputation in my community of maintaining the highest standards.

I want my practice to be a success.

That’s why I care. That’s why I chose ABC for my facilityaccreditation.

ABC—The gold standard. I don’t want anything less,why should you?

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PFA Adjusts to Meet Member Needs and Continue to Operate in the “New Normal” Economy

As Kristi Hayes, PFA President, alluded to in her adjacent President’s Message, the Pedorthic Footcare Association recently made the decision

to change management companies and settle in Northern Virginia (just a stone’s throw away from the Nation’s Capital) with Association Management Group. The move was primarily precipitated by the impact that the economic crisis has had on the association over the past four years and the need to further enhance our professional operations.

Even though PFA has moved offices, its mission and operation remain steadfast. Planning is well underway for the 2012 Symposium and Exhibition in Little Rock in November; production of Current Pedorthics is on schedule and will be in your mailboxes as usual; our lobbying efforts – as frustrating as they are at times – continue unabated with Bill Applegate and I spending considerable time meeting with Members of Congress and the Administration; our webinar program will be ramping up later this spring with four to six webinars planned through the end of 2012; the Council on Pedorthic Education (COPE) is working on a complete appraisal of the annual symposium and exhibition to improve and strengthen the event as well as reviewing PFA’s Bookstore offerings to ensure that existing titles remain relevant, or need to be removed and new titles added to meet member’s continuing needs; and PFA’s Board of Directors will be undertaking a significantly aggressive agenda to grow PFA and increase member benefits.

With that being said, it’s important for you to become acquainted with the oldest and newest members of the PFA Team:

Brian Lagana, Executive Director of PFA and Director of Government Affairs, a full-time dedicated staff leader.

Bill Applegate, PFA’s longtime lobbyist with

Brian LaganaPFA Executive [email protected] DIRECTOR

F R O M T H E

Bryan Cave, LLC continues his role fighting for pedorthists to be on an equal footing with other allied healthcare professions.

Annette Suriani, CMP and Rebecca Fazzari, CMP, PFA’s Meetings and Conventions Managers, will be responsible for Symposium and Exhibition planning and logistics, exhibitor and sponsorship sales, abstract and speaker management, webinar management, registration management (oversight of two registrars), etc. Annette has prior experience working with allied healthcare professions such as O & P, providing her with a leg up on the pedorthic profession. They can be reached at [email protected].

Teresa Gutsick, PFA’s Creative Services Manager, will be responsible for layout and production of Current Pedorthics magazine and all collateral material related to other PFA marketing and communications. Teresa has more than 14 years of experience in graphic design and has received many awards over the years, including two WebAwards for non-profit websites she designed, several Association Trends, All-Media Contest awards, and three New Jersey Press Association awards for her designs.

PFA is currently in the process of rounding out its team by filling the position of Marketing and Communications Manager, which will be finalized by the time this magazine goes to print. This full-time, dedicated staff member will be responsible for editing Current Pedorthics magazine, Current Pedorthics advertising sales and fulfillment, marketing and management efforts of corporate (non-Symposium) sponsorships, membership related programs as well as Symposium and Exhibition and continuing education programs. In the interim, Kristi Hayes, PFA President, can assist you with Current Pedorthics-related issues through [email protected], and I can help you with any other issues listed

above through [email protected].

Reaching PFA is easier than before. We have added a full-time receptionist to ensure that all calls are answered personally and directed to the correct individual. Of course, PFA’s website offers multiple, issue-specific response forms for you to communicate with individual committees, the board, executive committee and staff.

For your reference, please note PFA’s new address (physical and mailing), telephone number, toll-free number, fax number and e-mail:

Pedorthic Footcare Association 8400 Westpark Dr. 2nd Floor McLean, VA 22102 Telephone: (703) 610-9035 Fax number: (703) 995-4456

Please ensure that when sending payment and other correspondence to PFA, use the address above and not the old Washington, DC address.

Change for the sake of change can be problematic. However, when it is as thoughtfully and carefully conceived as this plan by the Board was, it can bring about big differences to everyone. And this brings me to a final thought – rumors! It seems this profession is rife with them, and that people thrive on spreading false rumors about PFA, Medicare, the pedorthic profession and what have you. Instead of getting caught up in the frenzy of the rumor of the moment, sit back for a minute and ask yourself, “Why would they do that?” If you still need a solid answer, call us! We can put those rumors to rest and your mind at ease all with a simple phone call or e-mail. PFA is here to help you…so, help us to help you. ■

Toll-free number: (800) 673-8447 Email: [email protected]

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Overview of Casting Techniques

BY KIM NICOLL, BSC (KIN), C. PED TECH (C)., C. PED (C)

s pedorthists, we know that a cast’s quality determines how successful the foot orthosis will be in alleviating the client’s symptoms. It has been determined that intra-caster reliabilities (using two different casting techniques) are better than

inter-caster reliabilities.1 This means it is easier for a trained clinician to reproduce the same cast, while two clinicians are hard-pressed to achieve the same final product. Studies such as McPoil and Hunt2 have also indicated that finding subtalar neutral is less important than what we had originally anticipated.

A

10

Photo by Pepsiline


From the research, we can summarize that it is the clinician’s job to master a few casting techniques to provide the desired level of care for their clients, whether that be in subtalar neutral or not, using full-weight bearing, semi-weight bearing, or a non-weight bearing casting method. The type of weight-bearing casting method (full, semi, non) is in large part easier to break down the casting techniques as opposed to what medium is being used. The different mediums being direct mould, foam box, wax and sand, computer-generated contact digitizer, plaster casting, plaster sock and computer-generated laser foot scan.

In this article, I review the different methods and the mediums of foot orthoses casting. Each has pros and cons. It is up to the clinician to decide which of these techniques best suit their clientele and to master them.

Full-weight bearing and semi-weight bearing castingFull-weight bearing casting is achieved in a standing position with the client using their own body weight to produce the cast. This method produces a fully compensated, closed kinetic chain cast impression in which the foot is not in subtalar neutral. It is used when cushioning is the goal and motion control is not of much concern. Examples of when this method could be chosen are a client with diabetes who has a Charcot Joint or a client with severe rheumatoid arthritis.

Semi-weight bearing casting is achieved in a seated position with the hip, knee, and ankle all at 90° angles. This is still a closed kinetic chain, semi-compensated position. The most common method is to cast the foot in subtalar neutral. This is achieved by the clinician holding subtalar neutral by using one hand to landmark while the other hand externally rotates the client’s tibia. Semi-weight bearing casting allows the clinician more control in the foot positioning, which allows for an orthosis with more components of motion control. Semi-weight bearing

casting has been used for clientele where the amount of correction has to do more with foot position, shell material selection and posting principles.

To capture both a full- and semi-weight bearing cast, a direct mould, foam box, wax and sand or computer-generated contact digitizer can be used; which medium a clinician uses depends on the criteria.

Direct mould castingIn the direct mould process, the heat-mouldable material used to cast the foot becomes the shell of the orthosis. The weight-bearing client may wear an insulated sock to protect the foot from the heat.

The material is heated and placed on a foam block or in some sort of footwear. The client holds the foot in the same position until the material has cooled. For semi-weight bearing direct moulding, the big difference is that the clinician compresses the cast/shell material into the desired shape. This is more labour intensive and has a greater margin of error for optimal foot positioning.

Options of making a more controlling shell are very limited due to the nature of the heat-mouldable materials that can be heated directly against the skin. Higher durometer materials need to be heated at too high of a temperature to allow direct molding against the foot. Moreover, common posting materials would also be too high of a durometer to be used in conjunction with the materials used to make a direct mould cast/shell. This technique is used extensively in the retail industry, such as in ski shops.

Advantages of direct mould:

•Quick method of orthotic manufacturing.

•Good technique if a flexible device is required.

•Very clean cast; not as messy as plaster.•Fewer supplies are required.•Can still work with the shell when it

comes off the foot.• Inexpensive.

Disadvantages of direct mould:

•Plantar pressure of the foam tends to supinate the foot around the longitudinal mid-tarsal joint axis, levating the first and exaggerating a forefoot varus.

•First and fifth rays can both “float” if the casting foam is too rigid.

•Difficult to get the material tight to the foot, allowing too much tissue expansion.

•Difficult to know if the mid-foot is locked and subtalar neutral has been obtained.

•Must be aware of the temperature of the material before placing against foot.

Foam box castingThe foam box is one of the most common casting mediums in pedorthic clinics. When the clinician uses foam box in a full-weight bearing cast, the client places a foot lightly on top of the foam and slowly applies weight as the foot sinks into the foam. The clinician attempts to hold subtalar neutral in this process; however, this is difficult to achieve due to lack of strength to hold the desired position while the client is applying pressure. The full-weight bearing foam box method works great for rigid foot structures.

Semi-weight bearing foam box is the more common of the two weight bearing techniques. Even though it takes the strength of the clinician to push the foot into the foam, they can use different techniques to achieve their desired cast results. One of these techniques is the gait referenced casting, which was developed by Edward Glaser, DPM.3

For both weight-bearing methods, it is common to use “foam art” to modify the cast. For example, the clinician uses a finger to take away foam from an area of a bony prominence to increase offloading.


OVERVIEW OF CASTING TECHNIQUES

Advantages of foam box casting:

•Fast and clean.•Easily transportable.•Adequate soft tissue displacement.•Good pressure from the foam helps

load the lateral column.•Allows soft tissue expansion to occur.•Client can remain in chair for casting

and does not have to get on a plinth.

Disadvantages of foam box casting:

•Any positioning is usually lost with even partial weight bearing.

•Force of foam can distort hyper-mobile forefoot alignment.

•Poor visual confirmation of the foot position.

•Too much help from the patient can distort the impression.

Sand and wax castingThe wax and sand medium is used in some pedorthic clinics. A thin sheet of wax is heated in water and placed on a metal tray that holds levelled sand. The client then stands or sits in front of the casting box and places the foot in the box until the wax has cooled. Once the wax hardens and becomes brittle, the cast is removed from the sand box and the client’s foot.4 This is a form of direct moulding.

Advantages of sand and wax casting:

•Allows soft tissue expansion to occur.•Yields a positive that is extremely

clean.•No clean-up on the patient.

Disadvantages of wax and sand casting:

•Can be time-consuming.•Requires storage of the sand box and

materials.•Clean-up is needed for any spilt sand.

•Any positioning is usually lost with partial weight bearing.

•Poor visual confirmation of the foot position.

Contact digitizer castingThe computer-generated contact digitizer is the technologically advanced casting method for full- and semi-weight bearing. This technique uses CAD/CAM software to obtain the three-dimensional cast. With the contact digitizer, the client stands on or sits in front of the unit and the digitizer elevates numerous pistons that contact the foot’s plantar surface. The 3-D image is then transferred electronically and viewed on a computer, where the image can be modified on the screen. This system is commonly used in pedorthic clinics.

Advantages of contact digitizer casting:

•Accurate plantar contour measurement.

•On-screen cast modifications with software.

•No distortion by operator or materials between scan and fabrication of orthosis device.

•Quick and clean scanning and manufacturing.

•Cast storage and duplicate orthoses greatly simplified using available software.

•Positive perception by client of the procedure.

Disadvantages of contact digitzer casting:

•What you cast is what is manufactured; a poor cast is a poor orthosis.

•Systems are quite heavy, making mobility difficult.

•Expensive, especially if equipment fails.

Misconceptions:

•Office scanners provide diagnostic information.

•Result is more exact because it’s done with computers.

•Technology replaces the skill of the practitioner.

•CAD/CAM technology is only for large institutions due to cost.

Non-weight bearing castingNon-weight bearing casting is achieved with the client lying prone, supine or in a seated position. Whatever position is used, the most common method is to cast in a subtalar neutral position. This is an open kinetic chain, in an uncompensated position. To achieve subtalar neutral, the clinician places their thumb between the sustentaculum tali and the medial malleolus with the index finger in the sinus tarsi cavity on the lateral portion of the talus. The thumb of the other hand locks the calcaneocuboid joint by applying a dorsiflexion force to the fourth and fifth metatarsal heads until resistance is felt in the ankle joint. When the client lies in a prone position, the clinician is best able to see the forefoot and rear foot position. However, prone position is harder for the client to manoeuvre into.

The other method of casting in non-weight bearing is the hang technique,5 which is not used very often. With this method, the client lies supine or prone and the cast is taken with no loading of the forefoot, and subtalar neutral positioning does not occur. All types of orthoses can be produced from non-weight bearing casts. This method of casting is most used when motion control is the primary objective.

Plaster castingAlong with foam box casting, plaster casting is the other most common casting medium in pedorthic clinics and the medium used in the pedorthic certification exam. It requires the most skill in how to apply and position the

Plaster casting allows a lot of control and flexibility in making the negative cast.


foot in the desired alignment. Plaster casting allows a lot of control and flexibility in making the negative cast.

Advanced casting techniques are commonly used that mimic what occurs with intrinsic posting. An example of this is pressing the medial calcaneus with the fleshy part of the palm while the plaster is drying, thus mimicking the Kirby Skive technique in rear foot intrinsic posting. Clinicians will commonly add pressure to the forefoot to obtain a tripod with the first, fifth and heel when the client has a flexible forefoot varus.

Plaster casts are either a full-length slipper cast that covers the toes and will hold plaster to do a manual positive cast or a three-quarter slipper cast that is not as deep and does not include the toes. The three-quarter slipper cast is often done when a cast laser scanner is

going to be used to make a computer-generated positive cast or shell. To achieve good and workable casts, training and time for the clinician are required.

Advantages of plaster casting:

•Easy to manipulate the subtalar joint into a neutral position.

•Can load the lateral column and neutralize longitudinal axis to provide good mid-foot and forefoot stability.

•Good visual confirmation of foot position.

Disadvantages of plaster casting:

•Need to modify positive model of cast to compensate for soft tissue expansion during weight bearing.

•Requires water and creates a mess.•Can be time consuming.

Common errors:

•Poor positioning of the subtalar joint: either too much pronation or too much supination.

• Insufficient or excessive loading of the lateral column.

•Allowing the metatarsal heads to elevate (and the toes to sag), which distorts the position of the first ray.

Plaster sock castingThe plaster sock medium is very similar in pros and cons to plaster casting. The plaster sock is one unit where the clinician matches the client’s foot size to the sock size. During the drying process, the plaster sock heats up and requires a plastic bag to act as a barrier between the foot and the cast. A plastic tube is inserted in the dorsal aspect of the foot and acts as a vacuum, taking away any air pockets.

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Once the cast dries, the clinician cuts the cast, usually where the channel tube was inserted, which allows the cast to come off easily. The socks come in many different heights. The most common used for orthosis being the slipper sock, which ends below the malleoli and covers the toes. Casting with the sock requires less manipulation of the wet plaster than with the strips, which allows for a tidy end.

Once the clinician becomes familiar with the medium, this technique is very fast. Like plaster casting, the clinician can use advanced casting techniques and use a laser cast scanner after the negative is off the foot.

Advantages of plaster sock casting:

•Easy to manipulate the subtalar joint into a neutral position.

•Can load the lateral column and neutralize longitudinal axis to provide good mid-foot and forefoot stability.

•Good visual confirmation of foot position.

•Cast is one unit, less manipulation of wet plaster.

Disadvantages of plaster sock casting:

•Need to modify positive model of cast to compensate for soft tissue expansion during weight bearing.

•Requires water and creates a mess.•Storage required for casting materials

due to different cast foot sizes.

Common errors:

•Poor positioning of the subtalar joint: either too much pronation or too much supination.

• Insufficient or excessive loading of the lateral column.

•Allowing the metatarsal heads to elevate (and the toes to sag), which distorts the position of the first ray.

Laser foot scanner castingComputer-generated laser foot scanner is the technologically advanced medium for casting in non-weight bearing. This

technique also uses CAD/CAM software to obtain the 3-D cast. With any laser scanner, the clinician produces a digital image of the foot/cast using laser or white light.

The laser foot scanner is not used regularly in pedorthic clinics. The pedorthist must either give up a hand to hold the device or work around a bulky piece of equipment to hold the foot in position. Most commonly, a cast laser scanner is used in lieu of the laser foot scanner.

Advantages of laser foot scanner casting:

•Accurate plantar contour measurement.

•On-screen cast modifications with software.

•No distortion by operator or materials between scan and fabrication of orthosis device.

•Quick and clean scanning and manufacturing.

•Cast storage and duplicate orthoses greatly simplified using available software.

•Positive perception by client of the procedure.

Disadvantages of laser foot scanner casting:

•What you cast is what is manufactured; a poor cast is a poor orthosis.

•Expensive, especially if equipment fails.

Misconceptions:

•Office scanners provide diagnostic information.

•Result is more exact because it’s done with computers.

•Technology replaces the skill of the practitioner.

•CAD/CAM technology is only for large institutions due to cost.

As you can see, there are many different options of casting. Most pedorthists become great at casting either a semi-weight bearing or a non-weight bearing cast. Then they become good at the other weight-bearing methods. This way,

the clinician can achieve any result they and their client like. Research indicates that introducing an orthosis will not necessarily change foot alignment to the degree we had originally thought, and that the use of an orthoses is mainly to provide comfort to the client.6 So it is the client’s comfort level, which they associate with alleviation of pain that determines if a pedorthist is doing his or her job well. The first step in orthosis fabrication is a great cast! ■

References1Trotter LC, Pierrynowski MR: “Ability of foot care professionals to cast feet using the non-weight bearing plaster and the gait-referenced foam casting techniques.” JAPMA 98: 1, 2008. 2McPoil TG, Hunt GC: “Evaluation and management of foot and ankle disorders: present problems and future directions.” JOSPT 21: 6, 1995. 3Decker W, Albert S (2002) Contemporary Pedorthics. Seattle, Washington: Elton-Wolf Publishing. 4Michaud, T.C. (1993) Foot Orthoses and Other Forms of Conservative Foot Care. Baltimore, Maryland: Williams & Wilkins. 5Nigg BM: “Impact forces and movement control - Two new paradigms.” PAC Conference April 15–17, 2005. 6Nicoll KD: PEDS 6012 Advanced Orthosis Systems. University of Western Ontario, 2010.

*This is a periodical of the Pedorthic Association of Canada. Originally printed in Pedorthics Quarterly, Fall 2010. Printed by Kendrick Printing, ISSN 1922-9429.

Kim Nicoll has been a Certified Pedorthist since 2003. She has helped develop and taught the Advanced Orthosis Systems course at the University of Western

Ontario since the onset of the pedorthic diploma program. Kim is now turning a new leaf and going back to school to increase her practical knowledge in Traditional Chinese Medicine.

OVERVIEW OF CASTING TECHNIQUES


Casting Confusion?What to Know Before the Dye is CastBY SÉAMUS KENNEDY, C.PED.

One of the most frequent questions that I am asked during an in-service on foot orthotics is, “What kind of cast do you prefer?” I have given

presentations to many different groups: pedorthists, orthotists and prosthetists, podiatrists, and physical therapists, and yet this same question always comes up.

replaced cork, leather and metal. All this new science required better ways to replicate foot shape. Plaster casting is the optimum method for capturing the foot in sub-talar joint neutral. It is done non-weight bearing with the patient lying either supine or prone, while the thumb and index finger load and control the fourth and fifth met heads holding the midtarsal joint at the end of its range of motion. A good cast cannot be rushed, and the inside surface should reveal some of the lines of the skin. Specific anatomical points or areas in need of relief can be indicated in pencil. Marking calcaneal bisection is also helpful when intrinsic balancing or posting is required. There is also an STS synthetic slipper “sock” available that mimics plaster without the delay or mess. The slipper cast is particularly useful when you are designing functional foot orthotics. Their aim is to improve the biomechanical function of the foot. It is beneficial in applications

such as sports orthotics, where precision is required in order to obtain maximum benefits. It is also good for flexible foot types, where weight-bearing casts may only capture a fully pronated foot structure. However, after more than a decade of owning a custom foot orthotics lab, I have witnessed some pretty unusual things come through the door that are supposed to represent the shape of a foot. Thus, I give you my first rule of plaster casting: make sure that the final cast is a true image of the patient’s foot. Being honest, rather than academic, will be more helpful to all involved. If you lack time, plaster splints or good technique, then it may be best to avoid the plaster slipper cast.

Impression Foam Impression foam casting has the obvious advantages of being both quicker and cleaner. It offers a good method of creating a negative of the patient’s foot. Approximately 75 percent of all casts that we receive are taken with impression foam. I usually recommend that practitioners take a semi-weightbearing cast when using foam. The patient should be seated in a chair with both feet plantargrade. It is important that the cast be taken slowly with the practitioner in control and guiding the descent of

Caught among the theory of plaster slipper casts; the practicality of impression foams; and the new choices with digital scanners, most practitioners are more than a little confused. I know there are strong viewpoints on this topic, so I will humbly offer some observations of my own. (Please don’t write to the editor and complain. But feel free to share your thoughts through Current Pedorthics, e-mail [email protected].)

Plaster Cast The plaster slipper cast is the gold standard of casting methods. It was popularized in the 1960s as Root et al. were developing the field of lower-extremity biomechanics. At that time there was an improved understanding of foot function and orthotics. The emphasis shifted from general arch support to sub-talar joint control. There were also significant changes in orthotic fabricating materials: thermoplastics


the foot. It is best not to take impressions on tiled floors as the box may slide halfway through the process. A good, controlled cast will not crack or split the foam around the perimeter.

Impression foam is the method of choice when you are making accommodative foot moulds. These orthotics are often designed to alleviate pain in a specific area of the foot. A semi-weight-bearing, or even a weight-bearing cast, may often capture better the location of a bony prominence, callous or fibrous-tissue mass. Many practitioners use impression foam exclusively when dealing with restless patients (e.g., young children or people with certain disabilities).

Shipping Once the cast is complete, it is important to take a little time and care with the shipping. Plaster casts should be left out to cure and dry for 24 hours before being sent off. Otherwise, they will tend to flatten, and even dampen and potentially damage the shipping box. Although some impression foam is sold in cartons that are ready-to-ship, we recommend that you send them inside another box for better protection. On occasion, if the carrier service is having a rough day, all that may arrive at the lab is a forensic jigsaw puzzle!

Scanners One of the more obvious changes in the broader field of orthotics and prosthetics is the adoption of scanners. The recent proliferation of systems indicates a clear shift toward digital casting. Although available for some time, scanners are now becoming more widespread, possibly due to a combination of lower cost and increased practitioner trust.

There are several advantages to using scanners:

• a reduction in the time, cost and mess associated with traditional casting;

Plaster Casting

Impression Foam Scanning

Can be a little messy Clean Clean

Takes approximately 15 minutes

Takes approximately 1 minute

Takes less than 1 minute

Material cost $1.50 - $2.50/pair

Material cost $4 - $6/pair

Costs can be payper-click; up-front equipment purchase; or some combination

Best method for capturing STJ neutral

Good method for accommodative devices

Neutral position image for functional and accommodative

Taken non-weight bearing

Taken semi- and full-weight bearing

Non-weight bearing

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• elimination of shipping costs and a faster turnaround time with electronic data transmission;

• long-term storage of cast data without significant cost; and

• improved accuracy and consistency of shape capture across practitioners, resulting in fewer errors.

The introduction of surface-touch wands and laser scanners allows practitioners to capture the topography of feet and limbs. Once captured in 3-D, the software allows the operator to shave and shape the model to his or her specification.

There are some restrictions to widespread adoption of this technology:

• a high initial cost; • a learning curve to master the

software; and • a reluctance, or inertia, to change from

traditional methods of fabrication.

However, according to Moore’s Law (regarding the exponential increase in integrated circuit capacity and computational processing speed) it is inevitable that costs will continue to fall. In addition, software upgrades will make CAD/CAM and digital-scan systems very user friendly.

Scanners are just one aspect of changing technology that will reshape the orthotic industry. Digital files are seamlessly transferred into CAD/CAM software that can modify casts and then direct carve the final device. I believe this technology, and other yet-to-be developed breakthroughs, will make our industry more productive, efficient and effective.

Conclusion Using a results-oriented philosophy, evaluate the outcomes of your casts and the resulting orthotics. Then, modify

your approach accordingly. Regardless of the method employed, the goal is to deliver the best possible custom orthotics for your patients’ foot conditions. Satisfied clients generate referrals and repeat business – and that is always valuable feedback worth working for. ■

*This article was originally printed in Current Pedorthics, Volume 42, Issue 1.

Séamus Kennedy has been a Certified Pedorthist since 1996. He studied Mechanical Engineering at University College Dublin and worked in industry for seven years. He and his

brother bought Hersco Ortho Labs in 1995. They have developed it into a central fabrication company that makes custom foot orthotics, custom molded shoes, AFOs and ankle gauntlets.


On the evolutionary chart, when chimpanzees became bi-pedal, they decided that a foot impression in dried mud might be a reproducible technique for making foot orthoses. Thus, began the age old argument between the apes and the chimps on whether it needed to be volcanic mud or if any mud puddle would do. It wasn’t until Charlton Heston fell out of the sky to the “Planet of the Apes” and a computer was introduced into the equation that the argument of casting modalities progressed. The new argument became Simian or Simulation?

That’s a whimsical look at the evolution of orthotic casting but reasonably accurate. As time progressed, the “Root” of a theory emerged as the gold standard in the late ‘60s to early ‘70s. By 1989, an article in The Journal of Current Podiatric Medicine1 stated:

The problem for podiatry is that the current research has shown that STJ Neutral is not a reliable location and Root’s theories are not reinforced by physics and engineering studies performed by The International Biomechanics Community. At present, there are no true standards to the science of biomechanics. Today, the same patient, examined by ten different practitioners, would get ten different diagnoses and ten different orthotics.

The first CAD/CAM systems were introduced in the late 80’s to early 90’s to a lukewarm reception. When comparing

the cost of plaster to the new technology, most opted for the least expensive option. That calculation omitted the manual hours spent working the plaster. A CAD/CAM system would pay for itself in the first year of use on the manual hours saved alone. If the tax write offs are included, then a computerized system wins the price war. Since, the new technologies were not being presented in the medical classroom, the earlier casting modalities prevailed.

The revolution of evolution continued thru 2002 as evidenced in these two studies: Evolution of the foot orthotics –part 1: coherent theory or coherent practice? The use of foot orthoses is well documented for the treatment of many maladies, yet clinical successes have been achieved both inside and outside of the classic Root paradigm. Clearly, a more complete theoretical understanding of the mechanisms of foot orthotics awaits discovery.

Evolution of foot orthotics--part 2: research reshapes long-standing theory. Considerable evidence supports the exploration of new theories and paradigms of orthotics use. Investigations of flexible orthotic designs, proprioceptive influences and the three-dimensional effects of subtalar joint motion on the entire kinetic chain are areas of research that show great promise.

Today, the argument/discussion of the best casting technique continues as

evidenced by the numerous articles in this magazine. Practitioners naturally start with the techniques taught in the medical classroom. As they progress with their career, many will vary those techniques or switch to a different one based upon clinical experience and continuing education. The classic example of this was an article a few years ago when podiatrists were randomly selected from various parts of the country and queried about their casting technique – no two of them agreed 100%. Pedorthists are riding high in that same boat! ■

1 Dennis Shavelson, D.P.M. June 1989 Biomechanics issue of The Journal of Current Podiatric Medicine edited by Justin Wernick, D.P.M. The Future of BIOMECHANICS2 J Manipulative Physiol Ther. 2002 Feb;25(2):116-24, J Manipulative Physiol Ther. 2002 Feb;25(2):125-34Ball KA, Afheldt MJ. Biomechanics/Gait Research Laboratory, Foot Levelers Gait Research Program, New York Chiropractic College, Seneca Falls, NY 14450, USA. [email protected]

Shane Hayes, C.Ped., a Seymour Lefton award winner, is a Certified Pedorthist and orthotic fitter based in Seattle, Wash. His work has been published in the

Journal of American Medical Association and, he is a former president of PFA.

CAD/CAM or Heinz 57 Casting?BY SHANE HAYES, C.PED.

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Medicare Advantage Plans: Information That You Need To KnowDEAN MASON, C.PED., OST, BOCO, CO, BOC PEDORTHIST

In addition to the traditional fee for service plans that we are all familiar with, Medicare offers what are known as Medicare Advantage (MA) plans, otherwise known as Medicare HMOs. These are plans that are operated under contract from CMS by independent health insurance companies to Medicare eligible beneficiaries. These plans offer several options that may include: prescription drugs, health and

wellness coaching, nurse call-in services, and other benefits. There are quite a few plans available, and the beneficiary selects the plan that best suits their needs.

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These plans are supposed to offer all the services that traditional Medicare offers. As a provider, you may or may not be able to participate with these plans. Technically, all Medicare providers are eligible to bill the advantage plans. However, each plan has their own rules and procedures, including their providers list. Some plans will allow any provider to bill for services, and most do not, unless you are contracted with that insuror.

In addition to somewhat limited participation, the fee schedule does not have to match that of traditional Medicare, and oftentimes it does not. Many of these plans pay significantly less than traditional Medicare, so you must make a decision if you want to work with these patients.

Medicare has several parts. Part A covers hospital expenses, part B covers physician and ancillary services (O and P is considered an ancillary service), part C are the Advantage plans, and Part D is the prescription drug benefit. The part C plans are alphabet soup: HMO (health maintenance organizations) PPO (preferred provider organization) PFFS (private fee for service), SNP (special needs plans) and MSA (medical savings accounts) comprise this soup. PPOs generally have a specific panel of providers under contract to the insuror. PFFS works like traditional Medicare in that any provider may send in claims, and SNPs are designed for the chronically ill, nursing home patients, and those with a Medicare/Medicaid in-house plan. Now, isn’t that clear as mud?

MA (Medicare Advantage) plans may have co-pays, and traditional Medicare does not cover them. The MA is their Medicare. Enrollment follows the standard established schedule and you know when that is when the television commercials start playing. A patient can change from a MA to a traditional plan after January 1 until February 14 each year. They may not change from MA to MA. Exceptions are made for moves out of a service area or to a Nursing Home

(institutions). Assisted Living and group homes are not considered institutions.

One very important caveat, persons on an MA plan get a standard Medicare card with their claim number on it. They also have a card from the MA. It is important to get information from both sources; however, billings go to the MA plan. Some patients will hand you their traditional Medicare card stating that they have Medicare. You bill and the claim is denied because they have an MA plan. Make sure to ask. You can verify their coverage either through the IVR or through one of the DME MAC on-line verification services. (Jurisdiction B: Connex).

Claims are processed by the MA and may not be paid out of network. Claims are paid according to the contract that the MA has with CMS. It is advisable to contact the MA regarding correct coding for the services you are providing.

Appeals are handled differently from traditional Medicare. It is your responsibility to correctly submit claims to the proper address. Appeals are handled according to the plan manual. If there is a discrepancy, the first level of appeal is through the MA plan. After a second denial, the appeal is handled by MAXIMUS, a federal service provider [www.medicareappeals.com or (585) 485-4210]. Non contracted suppliers are required to have a signed statement waiving liability on the part of the beneficiary holding them harmless. There is a 180 day limit from the initial notice of payment to file this appeal. The next level is to contact C2C Solutions, a company contracted to provide resolution services.

Important Considerations With MA Plans1. The Advance Beneficiary Notice

cannot be used with a MA plan. These are usable only with traditional Medicare; thus the necessity of the hold harmless agreement (above).

2. The DME MAC has no contract

with the MA plan; contracts are between CMS and the MA plan. The regulations and procedures of the MA plan are primary.

3. The MA plan is under no obligation to follow the standard fee schedule. Ask before you get a big surprise.

4. The O A-24 denial code does not apply here, only under traditional Medicare.

Always consult your local DME MAC or CMS’s website for information about MA plans. The website of the plan is helpful to consult as well.

Some patients will be\benefit from these plans as they tend to cover more than traditional Medicare. Rarely is there an advantage for the provider. In many cases, the reimbursement will be less (in some plans, the A5501 payment is less than what it costs to procure the custom shoes). Some plans pay half of the standard reimbursement to contracted providers. Be aware of these situations. Each practice will have to make a business decision on whether to accept the reimbursement from a MA plan and for what services. ■

Dean Mason, C.Ped., OST, BOCO, CO, BOC Pedorthist, owns North Shore Pedorthics, LLC, in Lorain, Ohio, and is a member of PFA’s Board of Directors as co-chair

of PFA’s Government Affairs Committee and a member of the Marketing, Communications and Editorial Committee.


Pedorthic Association of Canada’s Position Statement on Casting

Techniques for Custom Foot Orthoses

PROVIDED BY PEDORTHIC ASSOCIATION OF CANADA

Photo by Quinet


It is widely accepted in both the research and clinical literature that a three-dimensional model of the foot is required to fabricate a truly custom made device.

Debate continues as to which three-dimensional casting technique is most effective. More specifically, each technique has its own merits and the casting technique chosen by a trained and certified clinician is but one component in a comprehensive treatment protocol.

To choose one specific casting technique as the “standard” is to ignore the expertise of the clinician and the needs of the patient. It is the opinion of the Pedorthic Association of Canada that it should be the judgment of the clinician as to when to use a specific three-dimensional casting technique.

Casting TechniquesSlipper Casting (Plaster of Paris, Foot Impression Wax, and STS Casting Sock)

The use of a slipper cast has been employed for many years in the provision of CFOs. Maintaining a “subtalar neutral” or Neutral Calcaneal Stance Position (NCSP) during the casting technique, the clinician is able to reproduce the position typically used to assess foot alignment. A negative cast is taken with plaster, wax, or a polyurethane embedded sock. This is then used to yield a positive mould for further correction or modification before fabrication. This method works well in capturing the plantar contour of the foot, as well as the forefoot-to-rearfoot

relationship. It does require a great deal of skill, and requires considerable training and practice to obtain reliable results from patient to patient.

Semi-Weight Bearing Foam Box CastingThe use of a semi-weight bearing casting technique which employs a low density foam block for capturing the three-dimensional contour of the foot is widely utilized by many foot care practitioners.

It also employs the subtalar neutral position or NCSP during the capture of the foot contour. This technique requires less cast dressing prior to manufacture of the foot orthosis, and is also useful when the patient requires an accommodative device, or is unable to maintain a prone or supine position due to injury or medical condition. Foam box casting requires a great deal of skill to be performed successfully and reliably and it is necessary for a trained clinician to be involved for casting and manufacture of an appropriate device.

Contact DigitizingThe use of contact digitizing employs the mechanical placement of many small pins to capture the plantar contour of the patient’s foot. When done correctly, the subtalar neutral position or NCSP is maintained while the client’s foot is scanned into the software program where all modifications to the image of the foot are executed. This technique uses a milling machine to carve a foot orthosis from the corrected image. As with plaster casting and foam

box casting, reliability is improved with education and practice.

Laser ScanningRecent innovations in the use of optical laser scanning techniques have shown great promise. Combining the techniques employed in Plaster of Paris slipper casting with the functionality of computer modeling is designed to eliminate the reliance on messy plaster as well as speed turnaround times by removing the need to modify models by hand prior to orthosis fabrication. At this time the accuracy of laser scanning has been shown to be equal to the other techniques, and can be prone to human errors if not completed by a properly trained clinician.

Our PositionWhile some organizations may be attempting to limit the type of casting techniques used by clinicians and manufacturers of these custom made medical devices, doing so would put a limit on the skills and treatment palette available to the health care provider.

It is the position of the Pedorthic Association of Canada that the limiting of accepted providers to those groups that exclusively dispense orthotic devices in conjunction with a referring practitioner would be a far more effective means of ensuring quality care and in controlling the provision of these devices.

This would ensure the treatment of patients by professionals who retain a formal education in foot mechanics, pathology and treatment, and would eliminate the conflict of interest that can arise when the individual prescribing the device is also the individual providing the device. ■

*This is a periodical of the Pedorthic Association of Canada. Originally printed in Pedorthics Quarterly, Fall 2010. Printed by Kendrick Printing, ISSN 1922-9429.

ustom Foot Orthoses (CFOs) are an essential element used by pedorthists to relieve foot pain related to biomechanical misalignment of the feet and lower limbs. Orthoses can also accommodate foot deformities and redistribute

forces applied to the foot. The aim of this position statement is to help clarify some of the rationale that may be used in choosing one casting technique over another.


Excitement Exceeds Evidence!Ready-Made vs. Custom Rockers

REPORTED BY SHANE HAYES, C.PED.

Photo by vseb

Excitement Exceeds Evidence!Ready-Made vs. Custom Rockers

Prince Charming, who manufacturers the magic rockers also decides to repeat the “new evidence” in his ads and not surprisingly, the talking heads in the media blow it totally out of proportion. “Cinderella is not only cured, she’s so toned that Victoria’s Secret is close to an endorsement deal. This blonde bombshell is reportedly dating a ‘Charming’ fellow! Apparently, all you need is a pair of glass rocker shoes to live happily ever after!”

Eventually because of the hype of ready-made rocker shoes, some doctors have even begun to make recommendations and now even some pedorthists have started to believe these “magic” shoes are the greatest thing since sliced bread. Then, some party-pooper comes along to state that the science doesn’t support the excitement!

Recently, a panel of pedorthic experts heard arguments on both sides of the controversy and presented evidence at the North American Pedorthic Congress in Orlando, FL. One member of the panel, Bob Schwartz, C.Ped., reminded everyone that many footwear styles, including most athletic shoes, have extra

toe spring which equals variations of a toe rocker. Another panelist, Arnie Davis, C.Ped., illuminated the attendees about the intricacies of custom rockers and their use for specific pathologies. Biomechanical considerations and questions of the audience were contributed by Dr. Justin Wernick,

DPM, while Shane Hayes, C.Ped., in addition to offering comments on the above subjects shared these two outside opinions:

Based on recent research findings, which have not been published just yet, Dr. Joseph Hamill, a leading world expert on lower extremity biomechanics had this to say on the topic: “The medial lateral instability shoes have less of an effect on muscle activation than if an individual

did a stair workout in normal shoes.” This comment directly conflicts with earlier claims from manufacturers and other individuals that ready-made or off the shelf rocker shoes act as “exercise footwear”. Dr. Hamill went on to say that “The biggest benefit of these shoes is that it’s causing them to walk and doing any exercise is helping people. However, if they could motivate themselves to walk in any shoe they would see similar results.”

Newsweek’s, John Tucker penned an article titled, Sole Technology, an excerpt borrowed from that article stated the following:

“The shoe market has recently been glutted with a new wave of “toner” sneakers promising a better body

simply by walking. At first blush, these new kicks seem like the most magical footwear since Dorothy’s ruby slippers. But consumers are right to ask whether the shoes are based on sound science or marketing gimmickry. With price tags ranging from $100 to $245, are they designed to firm up bottoms or bottom lines?”

“Recently, researchers from the American Council on Exercise decided to put the toners to the test. They recruited subjects; laced them up in EasyTones, Shape-ups, and MBTs; and put them on treadmills. Then they used electromyography to measure the muscle activation in their calves, quads, hamstrings, buttocks, back, and abs. The researchers found no significant increase in muscle activity when comparing toners to normal sneakers. “There is simply no evidence to support the claims that these shoes will help

Cinderella bursts through your door, happy as a lark because her pain went away shortly after she purchased magic, glass “rocker” slippers from your facility. Logically, you share Cinderella’s success story with others to

justify their potential purchase and a non-scientific claim is born, also known as anecdotal evidence. Depending on one’s penchant for hyperbole, the claims may get somewhat embellished with each new patient. “It’s pedorthIc magIc!”

Current Pedorthics March|April 2012 27

“The medial lateral instability shoes have less of an effect on muscle activation than if an individual did a stair workout in normal shoes.”

At first blush, these new kicks seem like the most magical footwear since Dorothy’s ruby slippers. But consumers are right to ask whether the shoes are based on sound science or marketing gimmickry.


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EXCITEMENT EXCEEDS EVIDENCE!

wearers exercise more intensely, burn more calories, or improve muscle strength and tone,” the report found.”i (scientific evidence).

The Pedorthic Congress panelists concluded that rockers really fall into two major categories: Custom Rockers and Ready-Made Rockers. For the general public to use ready-made rockers as a

motivation to exercise more is just fine; after all self-help or following a retailer’s advice in an attempt to relieve a specific pathology is indeed their privilege. Similarly, thousands of pre-made inserts are purchased everyday in an attempt to self-medicate, surrounded by a lot of unsubstantiated medical claims.

In the end though, the best proven way

to relieve a specific pathology is with custom rockers that have indeed had a fair amount of scientific testing, making them a viable pedorthic modality to use. ■

ihttp://www.newsweek.com/2010/10/14/will-toning-footwear-get-you-in-shape/shaper-sneakers.html

Shane Hayes, C.Ped., a Seymour Lefton award winner, is a Certified Pedorthist and orthotic fitter based in Seattle, Wash. His work has been published in the Journal

of American Medical Association and, he is a former president of PFA.

“There is simply no evidence to support the claims that these shoes will help wearers exercise more intensely, burn more calories, or improve muscle strength and tone”

What does Rowan Billing Services have to offer? • Pedorthic Billing Specialists with a trained pedorthist and Certified Medical Reimbursement Specialist (CMRS) on staff • Our commission is charged on the amount collected rather than the amount billed, so we don’t get paid unless you get paid • Proven industry experience with a track record of getting paid for DME suppliers nationwide • Consistent performance using the newest technology and software • There are no set up fees and no minimum monthly charges • Claims are always filed in a timely manner — usually the same day received • Our specialty is extensive follow up on all primary, secondary, & tertiary claims • Two different types of accounts receivable reports are worked each month in order to follow up on all outstanding claims • We handle all redetermination requests to Medicare at no additional charge

Why should you use Rowan Billing Services instead of billing yourself? • Avoid the upfront costs of servers, workstations and expensive software including upgrades and maintenance costs • Avoid expensive training, as well as a learning curve that will result in claim denials • Stop spending time and money training employees – only to watch them leave • Avoid additional payroll, insurance and personnel costs • Prevent the constant costs of continued education for medical billing

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“You run your business - we’ll run your claims”

Dear Physician, As the Zone 5 Zone Program Integrity Contractor (ZPIC), AdvanceMed Corporation, LLC performs benefit integrity activities aimed to reduce fraud, waste, and abuse in the Medicare (Part A, B, DME, Home Health and Hospice) Program. Provider/supplier education is part of the ZPIC activities. Zone 5 will use this letter to highlight the responsibilities of the referring/ordering physician. (This a companion document to Dr. Hoover’s Jurisdiction C DME MAC’s “Dear Physician” letter that reviews the general documentation requirements for referring/ordering physicians. Dr. Hoover’s letter reiterates that referring/ordering physicians cannot charge the billing provider/supplier or the beneficiary for the required documentation. Dr. Hoover’s letter is found here: http://www.cgsmedicare.com/jc/forms/pdf/JC_Physician_Documentation_Request_Letter.pdf

Referring-Ordering “Dear Physician” Letter



the Medicare program. (f) Maintaining and providing access to documentation. (1) A provider or a supplier who furnishes covered ordered DMEPOS or referred home health, laboratory, imaging, or specialist services is required to maintain documentation for 7 years from the date of service and, upon the request of CMS or a Medicare contractor, to provide access to that documentation. The documentation includes written and electronic documents (including the NPI of the physician who ordered the home health services and the NPI of the physician or the eligible professional who ordered or referred the DMEPOS, laboratory, imaging, or specialist services) relating to written orders and requests for payments for items of DMEPOS and home health, laboratory, imaging, and specialist services.

(2) A physician who ordered home health services and a physician and an eligible professional who ordered or referred items of DMEPOS or laboratory, imaging, and specialist services is required to maintain documentation for 7 years from the date of the order, certification, or referral and, upon request of CMS or a Medicare contractor, to provide access to that documentation. The documentation includes written and electronic documents (including the NPI of the physician who ordered the home health services and the NPI of the physician or the eligible professional who ordered or referred the DMEPOS, laboratory, imaging, or specialist services) relating to written orders or requests for payments for items of DMEPOS and home health, laboratory, imaging, and specialist services.

Also, the Office of the Inspector General (OIG) U.S. Department of Health and Human Services provides physician educational resources on physician

relationships with payers and vendors. These resources are found here: http://oig.hhs.gov/compliance/physician-education/index.asp. The educational information discusses maintaining and providing documentation as well as the importance of legitimate prescriptions for patients. As a referring/ordering physician you may not ask and/or require providers/suppliers or beneficiaries to pay for or refuse to provide documentation when requested.

As a referring/ordering physician, if you are asked to sign or write prescriptions for Medicare beneficiaries by a provider/supplier for unnecessary services/items or for patients you do not know, please report the incident.

To report potential Medicare fraud and abuse please review the OIG or Stop Medicare Fraud websites for multiple ways to report:

http://oig.hhs.gov/fraud/report-fraud/index.asp

http://www.stopmedicarefraud.gov/ index.html

You can also call the OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477).

Working with the DMEPOS supplier increases the level of care your patient(s) receive as well as ensures only services and/or items that are legitimately prescribed by you are provided to your patient(s).

Sincerely,

Zone 5 ZPIC ■

1The definition of physician is found at http://www.socialsecurity.gov/OP_Home/ssact/title18/1861.htm#act-1861-r.

Title XVIII §1833(q) of the Social Security Act requires the referring/ordering physician information be submitted on a Medicare claim when the billing provider/supplier has received a referral or order for the referred/ordered service(s) or item. Section 1842 (p)(4) of the Act requires the referring/ordering physician provide documentation to the billing provider/supplier based on a referral/order:

In the case of an item or service defined in paragraph (3), (6), (8), or (9) of subsection 1861(s) ordered by a physician or a practitioner specified in subsection (b)(18)(C), but furnished by another entity, if the Secretary (or fiscal agent of the Secretary) requires the entity furnishing the item or service to provide diagnostic or other medical information in order for payment to be made to the entity, the physician or practitioner shall provide that information to the entity at the time that the item or service is ordered by the physician or practitioner.

Pursuant to 42 Code of Federal Regulations (CFR) § 424.535, a referring/ordering physician’s failure to provide the above required documentation may result in the revocation of enrollment and billing privileges in the Medicare program:

(a) Reasons for revocation. CMS may revoke a currently enrolled provider or supplier’s Medicare billing privileges and any corresponding provider agreement or supplier agreement for the following reasons:

(10) Failure to document or provide CMS access to documentation. (i) The provider or supplier (as described in section 1866(j) of the Act) did not comply with the documentation or CMS access requirements specified in §424.516(f) of this subpart.

Regulation 42 CFR § 424.516 sets forth the types of documentation that are required to be provided by impacted provider/suppliers:

Additional provider and supplier requirements for enrolling and maintaining active enrollment status in

Working with the DMEPOS supplier increases the level of care your patient(s) receive as well as ensures only services and/or items that are legitimately prescribed by you are provided to your patient(s).


INDUSTRYNEWS

ABC 2011 Annual Report Now Available

The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc. (ABC) 2011 Annual Report is now available on the ABC website.

The report summarizes the organization’s successes and provides data on the total number of certified individuals and accredited facilities.

In the 2011 Annual Report, each of ABC’s five core departments provide statistical analysis and highlight the accomplishments that have helped to strengthen and improve ABC’s contribution to the profession. Again in 2011, ABC enjoyed significant growth in its credentialing and facility accreditation programs, a testament to the high standards and quality services that ABC offers.

Included in the report is a message from

John M. Kenney, CPO, FAAOP, ABC’s 2011 President. Kenney provides an overview of the organization’s year long strategic successes.

Successes in 2011 include:

•ABC exceeded last year’s record for the number of accredited facilities choosing ABC – a total of 8,418 facilities applied or renewed their existing accreditation.

•A total of 1,078 newly certified individuals were added to the ABC family in 2010 – bringing the total number of ABC certified professionals to 13,638.

•The Certified Technician Exam was given for the first time as a computer based exam and will be given four times a year here out.

•The second phase of the Certified Assistant credential was in place and a total of 604 individuals meet the requirements and were granted certification

The 2011 Annual Report is available on the ABC website, under the Resources and Links section.

ABC Names New Outreach Development Manager The American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc. (ABC) is pleased to announce that Jim Lawson has been hired as Outreach Development Manager.

Jim will be continuing ABC’s efforts in reaching out to universities, colleges, and O&P education programs nationwide. In addition, he will be representing ABC at state, regional, and national meetings to provide information on accreditation, certification, and other ABC programs.

Catherine Carter, Executive Director remarked, “I am excited at the opportunity to add another great professional to the team who will help us further ABC’s mission.”

Jim has over 13 years experience in partnership building, public outreach, and business development, and brings to ABC the exact set of skills needed for this position.

In addition, Jim has experience consulting with local, state, and federal agencies on a wide range of public policy issues. His association experience includes membership recruitment and retention, trade show and corporate sponsorship sales, and customer service programs.

“Jim’s skills, expertise, and proven track record of outreach development, in addition to his public presentation skills will be a tremendous asset to ABC as we move forward with our plans for reaching out to individuals and business owners looking for a credentialing home,” said Debbie Ayres, Director of Marketing & Public Relations.

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REIMBURSEMENT&CODINGNEWS

HHS Announces Intent to Delay ICD-10 Compliance DateThe U.S. Department of Health and Human Services (HHS) announced on February 17, 2011 that it will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce

a new compliance date moving forward.

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under

the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

Additional Documentation Request Submission - 60 day Time-frame Effective January 2012Beginning January 2012, suppliers have 45 calendar days to reply to NAS Additional Documentation Request (ADR) letters for prepayment and post-payment review.

The letters created by NAS DME MAC



for Jurisdiction D include modified language that notifies suppliers they have 45 calendar days from the date of the ADR request to submit their documentation. This is a change from the prior 30 day response time-frame previously utilized per CMS requirements. NAS staff will deny claims for which the requested documentation was not received by day 60. During the transition to the new time-frame, suppliers are encouraged to review ADR letters to verify timeliness requirements for each claim.

The ADR letters generated by NAS contain specific fax numbers based on the department that needs the requested documentation. The NAS fax numbers for ADR receipts are similar and if the incorrect fax number is used for the documentation submission, this will delay claim processing. It is important that suppliers verify the fax number used matches the fax number on the ADR letter.

Referring-Ordering Education ArticleAs the Zone 5 Zone Program Integrity Contractor (ZPIC), AdvanceMed Corporation, LLC performs benefit integrity activities aimed to reduce fraud, waste, and abuse in the Medicare (Part A, B, DME, Home Health and Hospice) Program. Provider/supplier education is part of the ZPIC activities. In this educational article Zone 5 will highlight the responsibilities of the referring/ordering physician.

Title XVIII §1833(q) of the Social Security Act requires the referring/ordering physician information be submitted on a Medicare claim when the billing provider/supplier has received a referral or order for the referred/ordered service(s) or item. Section 1842 (p)(4) of the Act requires the referring/ordering physician provide documentation to the billing provider/supplier based on a referral/order:

In the case of an item or service defined in paragraph (3), (6), (8), or (9) of subsection 1861(s) ordered by a physician or a practitioner specified in subsection (b)(18)(C), but furnished by another entity, if the Secretary (or fiscal agent of the Secretary) requires the entity furnishing the item or service to provide diagnostic or other medical information in order for payment to be made to the entity, the physician or practitioner shall provide that information to the entity at the time that the item or service is ordered by the physician or practitioner.

Pursuant to 42 Code of Federal Regulations (CFR) § 424.535, a referring/ordering physician’s failure to provide the above required documentation that referring/ordering physician’s Medicare number may result in revocation. The revocation of enrollment and billing privileges in the Medicare program:

(a) Reasons for revocation. CMS may revoke a currently enrolled provider or

supplier’s Medicare billing privileges and any corresponding provider agreement or supplier agreement for the following reasons:

(10) Failure to document or provide CMS access to documentation. (i) The provider or supplier (as described in section 1866(j) of the Act) did not comply with the documentation or CMS access requirements specified in §424.516(f) of this subpart.

Regulation 42 CFR § 424.516 sets forth the types of documentation that are required to be provided by impacted provider/suppliers:

Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program. (f) Maintaining and providing access to documentation. (1) A provider or a supplier who furnishes covered ordered DMEPOS or referred home health, laboratory, imaging, or specialist services is required to maintain

Standard Documentation Language for Local Coverage DeterminationsMany errors reported in DME MAC MR Reviews and CERT Audits arise from problems associated with submitted documentation. Discussions about documentation issues commonly focus on inadequate medical record information not created by the billing supplier. However, in addition to medical record information related errors, numerous errors are identified due to noncompliance with non-medical record documents. These errors can often be avoided by the supplier. LCDs are being revised to include more detailed information about documentation requirements.

An expanded and standardized Documentation Requirements section has been developed. It is written in a modular format to allow each policy to contain information relevant to that policy while not including material that does not apply. This revised section includes considerable detailed information about existing Medicare requirements that has historically been found in the DME MAC Supplier Manual or in CMS interpretive manuals. Suppliers are strongly encouraged to review this material and use it to ensure that the records created will meet the standards required to justify payment for the DMEPOS item(s) provided.

If you would like to read the entire article, please visit www.pedorthics.org.



documentation for 7 years from the date of service and, upon the request of CMS or a Medicare contractor, to provide access to that documentation. The documentation includes written and electronic documents (including the NPI of the physician who ordered

the home health services and the NPI of the physician or the eligible professional who ordered or referred the DMEPOS, laboratory, imaging, or specialist services) relating to written orders and requests for payments for items of DMEPOS and home health, laboratory, imaging, and

specialist services.

(2) A physician who ordered home health services and a physician and an eligible professional who ordered or referred items of DMEPOS or laboratory, imaging, and specialist services is required to maintain documentation for 7 years from the date of the order, certification, or referral and, upon request of CMS or a Medicare contractor, to provide access to that documentation. The documentation includes written and electronic documents (including the NPI of the physician who ordered the home health services and the NPI of the physician or the eligible professional who ordered or referred the DMEPOS, laboratory, imaging, or specialist services) relating to written orders or requests for payments for items of DMEPOS and home health, laboratory, imaging, and specialist services.

Jurisdiction C DME MAC’s Medical Director, Robert D. Hoover, published a “Dear Physician” letter that reviews the general documentation requirements for referring/ordering physicians. Dr. Hoover’s letter reiterates the above information as well as reminds referring/ordering physicians that they cannot charge the billing provider/supplier or the beneficiary for the required documentation. Dr. Hoover’s letter is found here: http://www.cgsmedicare.com/jc/forms/pdf/JC_Physician_D ocumentation_Request_Letter.pdf

Also, the Office of the Inspector General (OIG) U.S. Department of Health and Human Services provides physician educational resources on physician relationships with payers and vendors. These resources are found here: http://oig.hhs.gov/compliance/physician-education/index.asp. The educational information discusses maintaining and providing documentation as well as the importance of legitimate prescriptions for patients.

As a billing provider/supplier, if you are asked and/or required to pay for or

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refused documentation by a referring/ordering physician, please report the incident as potential fraud and/or abuse. As a referring/ordering physician, if you are asked to sign or write prescriptions for Medicare beneficiaries by a provider/supplier for unnecessary services/items or for patients you do not know, please report the incident.

To report potential Medicare fraud and abuse please review the OIG or Stop Medicare Fraud websites for multiple ways to report:

http://oig.hhs.gov/fraud/report-fraud/index.asp

http://www.stopmedicarefraud.gov/index.html

You can also call the OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477).

1The definition of physician is found at http://www.socialsecurity.gov/OP_Home/ssact/title18/1861.htm#act-1861-r.

Only One Electronic Remittance Advice Recipient Per NPI / Legacy ID Starting April 1, 2012Prior to the implementation of the Healthcare Integrated General Ledger Accounting System (HIGLAS), Medicare’s Multi-Carrier System (MCS) created just one check per sender, National Provider Identifier (NPI), or legacy ID. Each sender / NPI / legacy ID was able to have multiple receivers of the electronic remittance; MCS would use the sender ID submitting each claim to aid in determining to whom the remit should be sent. For each check that was created, MCS also created an electronic remittance advice (ERA), which accurately reported the payment amount for that ERA.

When a MAC transitions to HIGLAS,

only one check can be produced per NPI/legacy ID. The old MCS system logic, which took the sender information into account when generating the remit, was not changed when MACs began their transition to HIGLAS; in some instances, the result was a remittance advice that did not contain all of the claims processed in a given cycle or a remittance advice containing payments that did not total to the EFT/check amount.

In order to accurately produce electronic remittance advices to match the EFT/

check amount, MCS will be changing their logic effective Sun Apr 1, 2012 – and will no longer consider the sender information when creating the ERA files. MACs will allow only one receiver of an electronic remittance per NPI/legacy ID regardless of whether the provider submits their inbound files under different sender IDs. Your respective MAC will be contacting you if you are set up on their files for multiple receivers of the ERA, in which case you will need to select one receiver for your electronic remittance.

Therapeutic Shoes – 4th Quarter 2011 Prepayment Review UpdateNational Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Review department continues to conduct a prepayment targeted medical review for therapeutic shoes. This is a selection of multiple supplier submitted claims based on a targeted service(s) that are reviewed for medical necessity.

As of 12/31/11, a total of fifty-four (54) claims were captured for review and developed for additional documentation. All of these claims have been reviewed and processed. Of these, 50 claims were denied (92.60% claim error rate). Below continue to be the top two (2) reasons for denial.

The top issues causing these denials are:

•Not responding to request for documentation letter in the required timeframe

•No or insufficient medical records submitted from the certifying physician to substantiate qualifying foot condition

It is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the Therapeutic Shoes Local Coverage Determination (LCD) (L27040) and Policy Article (A47129). Ensure when submitting additional documentation, that all medical necessity documentation is current for the date of service. Supplier responses should also be submitted timely. Suppliers can review the Therapeutic Shoes LCD for all DME MAC jurisdictions on the PFA website at www.pedorthics.org, and clicking to the Information for DMEPOS Suppliers Section. Suppliers may also find useful information and articles on the National Government Services Web site under Education and Training – Clinical Education.

Reasons % of claims completedNo documentation received 48%

Denied as non covered 34%


PEDORTHICEDUCATION

UPON REQUESTEneslow Pedorthic Institute470 Park Avenue South @ 32nd Street, New York, N.Y.

One-on-One Training and Tutoring Program, Individual and Small Group Program. Contact Sarah Goldberg at (212) 477-2300, ext. 211, [email protected] or visit www.eneslow.com/epi.

COURSESRobert M. Palmer M.D., Institute of Biomechanics1601 Main St., Elwood, Ind.

Courses providing pedorthic education for the retail, clinical or biomechanical knowledge seeking pedorthist.Also offering traveling courses to your area. Course dates for Levels 1-3 in a variety of locations in the United States, Hong Kong,Mainland China and Koreaare available. Contact Pam Haig, (765) 557-7216; [email protected]; www.pedorthicbiomechanics.org

Scholl College at Rosalind Franklin UniversityPedorthic pre-certification course. Contact Ellie Wydeven, Special Programs Office, (847) 578-8410, [email protected] or visit www.rosalindfranklin.edu/scpm/ce.

MONTHLYRiecken’s Orthotic Labs5115 Oak Grove Rd., Evansville, Ind.

SAFIO Class and Wax and Sand Casting Class, held on an as-needed basis. Contact Charlesat 800-331-8040, extension 102.

APRIL 2012

April 20 - 21Pedorthic Association of Canada2012 Annual SymposiumWestin Resort & Spa, Whistler, British Columbia

For more information, contact PAC at (888) 268-4404 or visit www.pedorthic.ca.

April 27 - 29Hands-on Custom Foot Orthosis Fabrication CourseNational Pedorthic Services, Milwaukee, Wis.

Contact Nora Holborow at (414) 438-6662, email [email protected] or visit www.npsfoot.com.

MAY 2012

May 11One-Day C.Ped. Pre-Exam Review SessionFoot Solutions Pedorthic Training Facility, Marietta, Ga.

Contact Tracy Strickland at (866) 338-2597, ext. 206, or email [email protected]; Betty Hubauer at (866) 338-2597, ext. 201, or email [email protected]; or, Dr. William Faddock at (866) 338-2597, ext. 209, or email [email protected].

May 14 - 25Foot Solutions Pedorthic Training Facility, Marietta, GAPedorthic Pre-certification Course

Contact Tracy Strickland, (866) 338-2597, ext. 206, [email protected]; Betty Hubauer, (866) 338-2597, ext. 201, [email protected]; or, Dr. William Faddock, (866) 338-2597, ext. 209, [email protected]

May 18 - 20A Hands-on Approach to Footwear ModificationsNational Pedorthic Services, Milwaukee, Wis.

Contact Nora Holborow at (414) 438-6662 or visit www.npsfoot.com.

AUGUST 2012

August 3One-Day C.Ped. Pre-Exam Review SessionFoot Solutions Pedorthic Training Facility, Marietta, Ga.


August 6 – 17Pedorthic Pre-certification CourseFoot Solutions Pedorthic Training Facility, Marietta, Ga.


Editor’s note: The listings provided in the Pedorthic Education Calendar are provided as an informational service. Inclusion of a course in this listing does not imply endorsement or support by the Pedorthic Footcare Association. Students and others considering courses are alone responsible to conduct due diligence when selecting their education provider.

Mark Your CalendarsIVO Congress 2012

March 29-31, 2012Sydney, Australia


PEDORTHICEDUCATION

August 24 - 26A Hands-On Approach to Footwear ModificationsNational Pedorthic Services, Milwaukee, Wis.

Contact Nora Holborow at (414) 438-6662 or visit www.npsfoot.com.

SEPTEMBER 2012

September 21 - 23Hands-on Custom Foot Orthosis Fabrication CourseNational Pedorthic Services, Milwaukee, Wis.

Contact: Nora Holborow at (414) 438-6662, e-mail: [email protected], or visit www.npsfoot.com

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NOVEMBER 2012

November 1 - 3Pedorthic Footcare Association53rd Annual Symposium & ExhibitionStatehouse Convention Center, Little Rock, Ark.

Contact: (703) 610-9035; [email protected]; http://www.pedorthics.org/; http://www.pfa2012symposium.org

November 5 - 16Pedorthic Pre-certification CourseFoot Solutions Pedorthic Training Facility, Marietta, Ga.


November 91-Day C. Ped. Pre-Exam Review SessionFoot Solutions Pedorthic Training Facility, Marietta, Ga.



MARKETPLACE

Certified Pedorthist/Orthotic Fabricator WantedExperienced Pedorthist or orthotic fabricator needed for an expanding orthotic lab in New Jersey. Great opportunity and potential to buy in. E-mail resume to:[email protected]

Pedorthist WantedA local pharmacy group is expanding its services to a premier Pedorthics Company providing diabetic footwear, meters/strips, and mail order Rx in daily dose packaging at the patient’s home. Patients and paperwork for shoes are generated at the home office and the schedule is coordinated for the pedorthist. The compensation is a specific fitting fee with additional earnings through the pharmacy and other ancillary services sales. Company offers health insurance, holiday pay and vacation pay. We plan to be a long time in the industry, so, if you are ethical and looking for a good home, Diabeticshoesusa is for you!! Currently hiring for Beaumont and Houston. Please e-mail your resume to [email protected].

C. Peds. Wanted NationwideJoin the Arch Fitters team of C. Ped. Work in your own region. We provide you our free 3-D process Scanner to get you started. E-mail Dr. Kim Christensen for a complete description of this job opportunity - [email protected]

Certified Pedorthist WantedSeeking an experienced, dynamic, patient oriented Certified Pedorthist.

Excellent opportunity to run and develop existing pedorthic department within a successful Podiatric practice in beautiful San Luis Obispo, California. The practitioner will provide patient care in two locations and be responsible for onsite fabrication. The candidate should have three years of clinical pedorthic experience. Undergraduate or graduate degree is a plus. The right practitioner has great opportunity for career and financial growth. Excellent compensation, benefits and relocation allowance provided.

Forward resume to: [email protected]: please include letter of interest. Highlight clinical experience and provide references.

www.sanluispodiatrygroup.com

San Luis Podiatry Group-San Luis Obispo, California

TEXAS Pedorthists Needed!!A Pharmacy group is expanding its services to a premier Pedorthics Company providing Diabetic Footwear, Meters/Strips and Mail Order Rx in daily dose packaging to patient’s at home. Patients and paperwork for shoes are generated at the home office and the schedule is coordinated to the Pedorthist. The compensation is a specific fitting fee with additional earnings through the Pharmacy and other ancillary services sales. Company offers health insurance, holiday pay and vacation pay. We plan to be a long time in the industry, so, if you are ethical and looking for a home, Diabeticshoesusa is for you!! Currently hiring for Amarillo,Austin,Beaumont,Corpus Christi,Houston, El Paso, Lubbock and San Antonio. Please email your resume to: [email protected]

HELPWANTED

CLASSIFIED RATES

Words Member Non-Member

50 or fewer words $25 $45

51-75 words $45 $65

76-150 words $65 $125

The following rates are calculated by counting complete words. (A telephone number is counted as a complete word.)

To place a classified ad, email [email protected], send a fax to (202) 367-2145, or mail to Pedorthic Footcare Association, ATTN: Current Pedorthics, 2025 M St., NW, Suite 800, Washington, DC 20036.

YOUR AD HERE

DO YOU HAVE SOME NEWS? Send your industry news to the CURRENT PEDORTHICS editor at [email protected].

Pedorthic/Shoe Repair Facility in South FloridaIn the same location for 20 years. Owner has been a certified pedorthist since 1974. Please call between 9 AM and 5 PM, Tuesday thru Friday, (561) 994-0792

Business Software Specifically Designed for Orthopedic BillingCurtis Research Inc has developed a quick, simple and easy to use software program that can create Pedorthic and other DME claims in seconds! This Program is perfect and Affordable for small companies yet powerful! Electronic Claims Submission, Medicare Eligibility, Accounts Receivable reporting and tracking and much, much more! For a Demo or more Information Contact us @ (800) 648-2377 or email @ [email protected] or visit us on the web @ www.curtissoft.com.

FORSALE

PFA OnLine is PFA’s members-only, monthly e-newsletter. The publication covers high-level industry (pedorthic and general heath care) news, government affairs updates and association news. If you do not currently receive PFA OnLine, email [email protected].

PFA’s E-newsletter Covers the Pedorthic Community

mailto:[email protected]


http://www.sanluispodiatrygroup.com



PRODUCTS&SERVICES

Acor (1979)Custom and comfort footwear, inserts and materials. Originator of Tri-Lam and P-Cell.

Cleveland, OHPhone: (800) 237-2267Fax: (216) 662-4547Email: [email protected]: www.acor.com

Aetrex Worldwide, Inc. (1973)Aetrex Worldwide has been a supplier of footcare products for 60 years. Aetrex’s brands include Aetrex® and Apex Footwear, Lynco® Orthotics, iStep® and raw materials.

Teaneck, NJPhone: (800) 526-2739Fax: (201) 833-1485Email: [email protected]: www.aetrex.com

Affinity Insurance Services, Inc. (1998)Affinity Insurance Services administers the PFA product and malpractice liability insurance program. Designed for pedorthists, insurance protection can be customized for each-PFA member.

Chicago, IL Phone: (800) 544-2672Fax: (312) 922-9321

AGS Footwear Group (1995)Shoe store supplies, fabricating materials, prefabricated orthotics, heel cups and forefoot supports.

Ashland, VAPhone: (800) 446-3820Fax: (800) 822-0180Email: [email protected]: www.agsfootweargroup.com

Akaishi Co., Ltd. (2011)Shizuoka-City, JapanPhone: +81-54-256-5551Fax: +81-54-256-5550Email: [email protected]: www.akaishinet.com

AliMed, Inc. (2004)Orthopedic products including orthoses and orthotic materials, orthopedic supports, walkers and shoes, therapeutic modalities, diabetic footwear and more.

Dedham, MAPhone: (800) 225-2610Fax: (800) 437-2966Email: [email protected]: www.alimed.com

Amfit Inc. (1996)Footfax-SL 3D Contact Digitizer, Footprinter Foam Casting System, precision CAD/CAM Carving Mill, accommodative and functional custom foot orthoses and orthotic sandals.

Vancouver, WAPhone: (800) 356-3668Fax: (360) 566-1380Email: [email protected]: www.amfit.com

Apis Footwear Company (2000)Women’s footwear, 103 sizes; men’s footwear, 98 sizes. Open stock for immediate delivery.

S. El Monte, CAPhone: (888) 937-2747Fax: (626) 448-8783Email: [email protected]: www.bignwideshoes.com

Arizona AFO, Inc. (2003)Arizona AFO manufacturers a line of medical ankle braces for the treatment of foot disorders. The Arizona AFO line is used by physicians and practitioners as a way to increase mobility, avoid pain, avoid surgery and provide a better quality of life.

Mesa, AZPhone: (480) 222-1580Fax: (480) 461-5187Email: [email protected]: www.arizonaafo.com

Atlas International (1994)For pedorthic needs. Complete range of materials, prefabs, tools and machinery.

Rancho Cordova, CAPhone: (800) 545-6287 Phone (outside United States): (916) 858-3322Fax: (916) 858-3320Email: [email protected]: www.atlasortho.com

Bestsole, Inc. (2010)Boynton Beach, FLPhone: (561)547-4681Fax: (561) 547-4684Email: [email protected]

Bintz Company, Inc. (1991)Distributor of pre-molded orthotics, comfort foot products, fitting aids and sheet goods. Products from Birkenstock, Birko Orthopadie, Pedag, Powerstep, Spenco, Pedifix, Knit-Rite, Hapad, Rieckens PQ and more.

Wheaton, ILPhone: (800) 235-8458Fax: (630) 653-5077Email: [email protected]: www.bintzco.com

Birkenstock USA, LP (1990)U.S. distributor of Birkenstock sandals, shoes, clogs and arch supports, and also representing Footprints shoes and Birko Orthopadie arch supports.

Novato, CAPhone: (800) 949-7301Fax: (415) 884-3250Email: [email protected]: www.birkenstockusa.com

Brooks Sports, Inc. (2001)Walking/athletic shoes in women’s and men’s styles. Delivery includes special orders.

Bothell, WAPhone: (800) 2-BROOKSFax: (425) 483-8181Email: [email protected]: www.brooksrunning.com

C.N. Waterhouse Leather Co., Inc. (1998)Manufacturer and distributor of fine leathers, woolskins, suede pig-skins, sheet goods and adhesives for use in the pedorthic footwear and orthopedic industries.

Bedford, MAPhone: (800) 322-1177Fax: (781) 271-0499Email: [email protected]

The Compliance Team (2010)Spring House, PAPhone: (215) 654-9110Fax: (215) 654-9068Email: [email protected]

Curtis Research, Inc. (2009)Curtis Research, Inc. is unique in the industry due to it’s dual role. We are both a software development company and billing service bureau specializing in O & P and DME claims serving hundreds of clients nationwide for over 25 years. Our software package provides electronic O & P and DME claims, on-line Medicare Patient eligibility, accounts receivable tracking and much, much more and is cost effective and suitable for company’s big and small depending on your needs and budget. Our professional service bureau (Claimcare) has over 25 years experience processing O & P and DME claims electronically for Medicare, Medicaid and various other Commercial insurance companies.

Akron, OHPhone: (800) 648-2377Fax: (330) 376-9812Email: [email protected]: www.curtis.lek.net

This reference guide is intended solely to make it easier for individuals, facilities and companies to locate pedorthic products. Companies listed in the guide are PFA vendor/manufacturer members. Companies may produce additional products beyond those listed, and most companies are pleased to provide additional information on request. As a courtesy to our readers, Current Pedorthics has noted the year the company joined PFA in parentheses after the company’s name. Inclusion in this list does not suggest or imply PFA endorsement of companies or products. Vendor/Manufacturer members are encouraged to keep their listing up-to-date. To arrange changes in your company’s listing, email [email protected].


PRODUCTS&SERVICES

DAVMAR Comfort Shoes (2004)Comfortable on the inside, stylish on the outside, our quality crafted shoes and socks are specially made to provide relief for problem feet. If you have diabetes, sensitive feet, circulatory problems, or swollen or wide feet, we invite you to step into our world and make yourself comfortable.

Glendale, WIPhone: (855) 284-3544 Fax: (855) 284-3444Email: [email protected] Website: www.davmarshoes.com

Doctor Specified (2008)The Doctor Specified line has been specially developed for the discerning consumer or those among us with foot or general health issues. The line includes Diabetic and Medical Grade categories, which feature socks that are specific in need and technically advanced.

By incorporating features such as hand-linked seamless toes, extra-deep heel wells, and our proprietary Med Dry® moisture management system, we have produced a product line unique to the U.S. market.

Hickory, NCPhone: (828) 485-3316Fax: (828) 485-0049Email: [email protected]: www.doctorspecified.com

Dr. Comfort (2004)Dr. Comfort manufactures, warehouses and distributes the finest quality extra-depth shoes for diabetics or patients who need quality comfort shoes.

Mequon, WIPhone: (262) 242-5300Fax: (262) 242-9300Email: [email protected]: www.drcomfortdpm.com

Dr. Jeff Wisecare, Ltd. (2011)Wanchai, New Territories, Hong Kong Phone: +(852) 21-59-5060Fax: +(852) 28-02-0331Email: [email protected]: www. dr.jeff-wisecare.com

Dr. Kong Footcare Limited (2005)Manufacturer of children’s, men’s and women’s healthy shoes insoles, footcare accessories and computerized assessment software. 33 chain shoe shops in Hong Kong. Provides check and fit services and healthy products for everybody.

Kwai Chung, N.T., Hong KongPhone: (852) 2744-2638Fax: (852) 2744-8845Email: [email protected]: www.dr-kong.footcare.com.hk

Drew Shoe Corporation (1968)Men’s and women’s depth and comfort footwear in over 150 sizes.

Lancaster, OHPhone: (800) 837-3739Fax: 740-654-4979Email: [email protected]: www.drewshoe.com

Euro International, Inc. (1997)Preformed insoles, diabetic shoes and materials in different hardnesses, especially for diabetics.

Tampa, FLPhone: (800) 378-2480Fax: (813) 246-5998Email: [email protected]: www.eurointl.com

Ever-Flex, Inc. (2008)Ever-Flex is a well-respected manufacturer of fine medical foot orthotics. Specialized laboratory technicians in both the US and UK precisely form and finish custom Rx and pre-fabricated orthotics which are dispensed by health care professionals worldwide. We offer a complete line of orthotics which have proven successful in the treatment of neuromas, heel spurs, plantar fasciitis, poor posture, and other medical problems relating to the foot, ankle, knee and back.

Taylor, MIPhone: (734) 947-2060 Fax: (734) 947-9372Email: [email protected]: www.ever-flex.com

Finn Comfort (1993)Luxury comfort footwear. Men’s and women’s walking shoes, sandals and boots featuring removable/modifiable orthopedic footbeds. Hand-crafted in Germany.

Thousand Oaks, CAPhone: (805) 375-0038Fax: (805) 375-0848Email: [email protected]: www.finncomfort.de

Frankford Leather Company, Inc. (1997)Frankford Leather Co., Inc., is your single source supplier for your pedorthic shoe repair and shoe store supply needs. In stock, more than 8,000 products are available for immediate shipment. Representing major brands and lines like Vibram, Soletech, Spenco, Powerstep, Pedifix, Pedors, Orthofeet, Kiwi; shoe care, adhesives, leather and more. Free catalog available.

Bensalem, PAPhone: (800) 245-5555Fax: (215) 244-4411Email: [email protected]: www.frankfordleather.com

Gadean Footwear (2010) Gadean Footwear is the largest orthopaedic shoemaker in Australia. Gadean Footwear provides retailers with washable slippers, motion shoes, fashion shoes, depth shoes, removable insole sandals and many more products.

Mount Hawthorn, Western Australia, AustraliaPhone: 08-9208 1000Fax: 08-9443 9915Email: [email protected] Website: www.gadeanfootwear.com.au

Guard Industries, Inc. (1996)Components for shoe care, foot comfort, orthotics and prosthetics. Complete listing of available products will be sent upon request.

St. Louis, MOPhone: (800) 535-3508Fax: (314) 534-0035Email: [email protected]: www.guardmfg.com

Haflinger/Highlander (Gerda Hoehm) (1999)Boiled wool slippers, latex arch support, felt and leather clogs, cork molded footbed. Highlander is Gerda Hoehm’s new high-quality comfort line with a removable footbed. Both Haflinger and Highlander are made in Germany.

New York, NYPhone: (212) 949-6767Fax: (212) 949-8833Email: [email protected]

Hapad, Inc. (1988)Hapad is a leading manufacturer of 100% natural wool felt foot products and sports replacement insoles used for conservative management of common, painful foot complaints. Correctly sized, comfortably skived and adhesive backed for quick and effective adjustments in the shoe.

Bethel Park, PAPhone: (800) 544-2723Fax: (800) 232-9427Email: [email protected]: www.hapad.com

J.H. Cook & Sons, Inc. (2004)Shoe modification components, foot comfort products and shoe repair supplies. Products from Aetrex, Spenco, Vibram and Soletech.

Granite Quarry, NCPhone: (704) 279-5568Fax: (704) 279-5261Email: [email protected]

Jerry Miller I.D. Shoes, Inc. (1977)Jerry Miller Shoes extensive custom-molded shoemaking experience has also been applied to a new family of custom AFOs - Buffalo Brace. Both shoes and braces feature state-of-the-art CAD technology, high quality glove leather, various color options and a choice of closure methods. Jerry Miller Shoes and Buffalo Brace. For all walks of life!

Buffalo, NY Phone: (800) 435-0065Fax: (716) 881-0349Websites: www.jerrymillershoes.com and www.buffalobrace.net

JMS Plastics Supply (1992)JMS Plastics Supply, Inc. is your one source for materials and equipment for fabricating Orthotics. We have in stock TL-2100/ XTX/ mortons toe extension plates, J-turf in pre cuts and full sheets. Our new products include the KLENZ multi-purpose Sanitizer machine, kills up to 99.7 percent of bacteria. Great for a diabetic patients footwear. The Orthofeet line of shoes, insoles and socks with Bamboo. Posting strips with adhesive on one side, Gel Knee sleeves and Masterflex, A polyethylene plastic sheet that is great for knee bracing. Call (800) 342-2602 for your free catalog and sample ring or view our website at www.jmsplastics.com.

Neptune, NJPhone: (800) 342-2602 Fax: (732) 918-1131Email: [email protected]: www.jmsplastics.com

Justin Blair & Company (2001)Manufacturer of Ralyn Shoe Care and Backroom Supplies and NightCare Foot Care. Distributor for Aetrex, Acor, Darco, Herbal Concepts, Pedifix, Swede-O, Silipos and Therafirm.

Chicago, ILPhone: (800) 566-0664Fax: (773) 523-3639Email: [email protected]: www.justinblairco.com

KLM Laboratories (2006)An industry leader in the manufacture of foot orthotics and insoles, specializing in custom orthotics, pre-fabricated orthotics, orthotic insoles and orthotic materials.

Valencia, CAPhone: (800) 556-3668Fax: (800) 556-3338Email: [email protected]: www.klmlabs.com


PRODUCTS&SERVICES

Klogs-USA (2007)Sullivan, MOPhone: (573) 468-5564Fax: (573) 468-5560Email: [email protected]

Kumfs Shoes N.Z., Ltd. (1998)Quality, thoughtfully designed shoes and sandals. Orthotics friendly with specialist designed removable contoured footbeds.

El Dorado Hills, CAPhone: (530) 676-9960Fax: (530) 676-9965Email: [email protected]: www.kumfs.com

Landesman Bros., Inc. (2003)Distributors of foot comfort products, pedorthic, orthopedic and wound care supplies. Same day shipping.

Island Park, NYPhone: (800) 852-8855Fax: (516) 889-1253Email: [email protected]: www.landesmanbros.com

Lord Custom Molded Shoes, Inc. (1994)Fashionable custom-molded shoes for men, women, and children. Guaranteed fit and service.

Bohemia, NYPhone: (800) SHOES11Fax: (516) 471-3090

MacPherson Leather Co. (2005) MacPherson Leather Company has provided a tradition of caring service since the early 1900s. As a generational family business, we are committed to providing excellent service and expertise for all of our customers’ needs.

As a wholesale and retail company, we offer quality products for saddle and tack, shoe findings, and leather craft trades. We hope you find what you are looking for on our site and please contact us with any questions you may have.

Seattle, WAPhone: (206) 328-0855Fax: (206) 328-0859Email: [email protected]: www.macphersonleather.com

Miami Leather Company (2001)Wholesaler to the orthopedic, prosthetic, retail shoe and shoe repair trades. Wide variety of products.

Miami, FLPhone: (305) 266-8328Fax: (305) 266-8728Email: [email protected]: www.miamileather.com

M. J. Markell Shoe Company, Inc. (1973)Men’s, women’s and children’s comfort and orthopedic footwear.

Yonkers, NYPhone: (914) 963-2258Fax: (914) 963-9293Email: [email protected]: www.markellshoe.com

MMAR Medical Group, Inc. (2003)Distributor of multiple diabetic shoe brands at manufacturer-direct wholesale pricing. Other products include AFO’s, ankle braces and cam walkers.

Houston, TXPhone: (800) 662-7633Fax: (713) 465-2818Email: [email protected]: www.mmarmedical.com

Mobils by Mephisto (1998)Extra-depth footwear with a removable footbed and natural orthopedic support.

Franklin, TNPhone: (800) 775-7852Fax: (615) 771-5935Email: [email protected]: www.mephisto.com

New Balance/Aravon (1990)New Balance is a leading manufacturer of technologically innovative athletic products.

Boston, MA Phone: (617) 783-4000Fax: (617) 783-7050Website: www.newbalance.com

Oasis Footwear, LLC (2009)Oasis Footwear was founded on the principle of prevention, wellness, and style through our diabetic shoes and inserts. We strive to offer the diabetic patients a shoe they will want to wear. Oasis Footwear is “Diabetic Footwear Redefined.” To learn more, visit our website today at www.oasisfeet.com.

Erie, PAPhone: (814) 384-7579Fax: (814) 217-1354Email: [email protected]: www.oasisfeet.com

Orthofeet, Inc. (1999)Manufacturer and distributor of high quality depth-shoes and orthotics.

Northvale, NJPhone: (800) 524-2845Fax: (201) 767-6748Email: [email protected]: www.orthofeet.com

PAL Health Technologies (2003)PAL Health Technologies has been a market leader in orthotic quality and customer satisfaction for more than 34 years. PAL is one of the nation’s leading domestic suppliers of prescription foot and ankle orthoses, offering a full line of custom foot orthotics.

Pekin, ILPhone: (309) 347-8785Website: www.palhealth.com

PartnerShip (2000)PartnerShip, in cooperation with PFA, offers members-only discounts and savings on small package shipping with FedEx Ground, and on large freight shipments with Yellow Freight.

Cleveland, OH Phone: (800) 599-2902Fax: (800) 439-8913

PediFix, Inc. (2001)Foot specialists since 1885, PediFix is the only fourth generation, family-owned business in the pedorthic industry. Choose from more than 150 quality foot treatment products, including a unique OTC line guaranteed to generate cash sales, keystone profits and doctor referrals, an assortment of both traditional and exclusive Visco-GEL foot pads and cushions, new dermatology products, GelStep silicone insoles and orthotics, Diabetic Solutions Socks, PediPlast and more. 15 new products are being introduced this year.

Contact PediFix today for a free color catalog.

Brewster, NYPhone: (800) 424-5561Fax: (845) 277-2851Email: [email protected]: www.pedifix.com

Pedors Shoes (1999)Pedors Shoes manufacturers stretch orthopedic shoes that are heat moldable to provide an affordable customizable solution to accommodate even the most demanding pathology. Our pre-fabricated inserts are available up to a Men’s size 20.

Marietta, GAPhone: (800) 750-6729Fax: (800) 446-3101Email: [email protected]: www.pedors.com

PEL Supply Company (1995)Wholesale distributor stocks broad selection of finished foot and arch products, materials and tools for fabricating foot orthotics.

Cleveland, OHPhone: (800) 321-1264Fax: (800) 222-6176Email: [email protected]: www.pelsupply.com

Pilgrim Shoe Factory (2003)Pilgrim Shoes, a U.S.-based shoe manufacturer, headquartered in Baltimore, Md., brings a new comfort and sophisticated design to the footwear industry. Since 1997, Pilgrim Shoes have been devotedly delivering fashionable footwear with all necessary pedorthic features to American customers to make their walk lighter and life easier.

Baltimore, MDPhone: (410) 277-8855Fax: (410) 277-9988Email: [email protected]: www.pilgrimshoes.com

Propet USA, Inc. (2000)Leading manufacturer in men’s and women’s comfort walking shoes. Available in up to 5 widths, sizes 5-13 in women’s, 7-17 in men’s. Propet features a vast selection of Medicare A5500 coded footwear with removable orthotics, secure closure and maximum customization.

Kent, WAPhone: (800) 877-6738Fax: (800) 597-8668Email: [email protected]: www.propetusa.com

P.W. Minor, Inc. (1968)Footwear products for foothealth.

Batavia, NYPhone: (585) 343-1500Fax: (585) 343-1514Website: www.pwminor.com

Remington Products (2000)Insoles and sheet packages, rigid arch supports, viscoelastic heel cups, 3/4 and full insoles.

Wadsworth, OHPhone: (330) 335-1571Fax: (330) 336-9462Email: [email protected]: www.remprod.com

Renia GmbH (2001)Specially designed adhesives and components for the shoe industry, shoe repair trade, and O & P industry.

Cologne, GermanyPhone: 49-221-6307990Fax: 49-221-63079950Email: [email protected]: www.renia.com

Ruby Leather & Orthopedic Company Inc. (1998)Milwaukee, WIPhone: (414) 778-2288Fax: (414) 778-2047


PRODUCTS&SERVICES

SAS Shoemakers (1992)Comfort walking shoes for women and men in a wide range of widths and sizes.

San Antonio, TXPhone: (210) 924-6561Fax: (210) 921-7460Email: [email protected]: www.SASshoes.com

STS Company (1997)Resin-impregnated tubular and fitted socks made to take foot and ankle impressions for custom shoes and foot/ankle orthotic devices.

Mill Valley, CAPhone: (800) 787-9097Fax: (415) 381-4610Email: [email protected]: www.stssox.com

SafeStep (1994)SafeStep makes it easy to utilize the Medicare Therapeutic Shoe Program by streamlining shoe ordering, document procurement and Medicare billing.

Milford, CTPhone: (866) 712-7837Fax: (208) 728-0091Email: [email protected]: www.safestep.net

Sequoia/Comfort Rite (1998)Quality comfort footwear in a variety of sizes and widths.

New Holstein, WIPhone: (800) 898-5556Fax: (920) 898-4605

Shoe Systems Plus, Inc. (2003)Complete line of orthotic and prosthetic equipment including finishers/grinders, vacuum pans, pumps, presses, industrial sewing machines, fume busters and more.

Goshen, NYPhone: (800) 354-6278Fax: (845) 291-7097Email: [email protected]: www.shoesystemsplus.com

SoleTech, Inc. (1994)Orthopedic footwear, cushioning and rubber materials, and adhesives.Salem, MAPhone: (800) 225-2192Fax: (978) 741-2091Email: [email protected]: www.soletech.com

Southern Leather Company (1996)7 locations nationwide. The most extensive pedorthic and shoe care/repair inventory in the industry. Inventory includes Apex, Soletech, Eva, Vibram and Acor.

Memphis, TNPhone: (800) 844-6767Fax: (901) 946-1059Email: [email protected]

Spira (2004)El Paso, TXPhone: (866) 838-8640Fax: (915) 838-8641

Sroufe Healthcare Products LLC (2006)Custom diabetic inlays, casting foam boxes, pre-fabricated orthotics and orthopedic softgoods.

Ligonier, INPhone: (260) 894-4171Fax: (260) 894-4092Email: [email protected]: www.sroufe.com

Superfeet Worldwide LLP (2003)Ferndale, WAPhone: (360) 384-1820Fax: (360) 384-2724Email: [email protected]

TechMed 3D (2011) TechMed 3D is an easy to use, accurate, and portable solution for the digital acquisition of images and measurements of human body parts, giving orthotists, prosthetists and pedorthists access to very reliable and consistent measurements.

Levis, Quebec, Canada Phone: (418) 836-8100Fax: (418) 836-1589 Email: [email protected] Website: http://www.techmed3d.com

Therafirm (A Division of Knit-Rite, Inc.) (1999)Quality medical-grade compression hosiery and diabetic socks.

Ellerbe, NCPhone: (800) 562-2701Fax: (910) 652-2438Website: www.therafirm.com

Tekscan, Inc. (1994)Broad range of pressure assessment and clinical/research evaluation tools for use in orthotics, brace evaluations, joint biomechanics, and gait analysis.

Boston, MAPhone: (617) 464-4500Fax: (617) 464-4266Email: [email protected]: www.tekscan.com

Thor-Lo, Inc. (2001)Statesville, NCPhone: (704) 872-6522Fax: (704) 838-6323

Tru-Mold Shoes, Inc. (1980)Tru-Mold Shoes offers a complete line of contemporary, fully accommodating custom-molded shoes, including the Thera-Medic Shoe package – the most flexible, highest value shoe package for Medicare-eligible patients with diabetes.

Buffalo, NYPhone: (800) 843-6653Fax: (716) 881-0406Email: [email protected]: www.trumold.com

Advertiser Page Website

American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc. Page 7 www.abcop.org

Acor Orthopaedic, Inc. Page 33 www.acor.com

Aetrex Worldwide, Inc. Pages 9, 36, BC www.aetrex.com

Amfit Page 19 www.amfit.com

Apis Footwear Co. Page 39 www.apisfootwear.com

Cascasde Dafo, Inc. Page 13 www.dafo.com

Dr. Comfort Page 5 www.drcomfortdpm.com

KLM Laboratories, Inc. Page 28 www.klmlabs.com

New Balance Athletic Shoes, Inc. Page 2 www.newbalance.com

New Step Orthotic Lab, Inc. IBC www.newsteporthotics.com

Orthofeet Page 15 www.orthofeet.com

Orthoheel IFC, Page 1 www.orthaheelusa.com

Pedorthic Footcare Association Page 32 www.pedorthics.org

PEL Supply Company Page 21 www.pelsupply.com

Riecken’s Orthotic Laboratories IFC www.footcomfortworld.net

Rowan Billing Services Page 29 www.rowanbillingservices.com

Verne Bintz Company Pages 18, 34 www.bintzco.com

The advertiser index is published for the readers’ convenience. If you have any questions about advertising, please contact advertising sales representative Brian K. Lagana at (703) 610-9035 or email [email protected]

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