Again, Thanks to all who took the time to respond.
Jacob
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Freedom Fabrication makes a SAFO-like AFO, but maybe out of a different material. I am
not actually sure what the material is, but it feels like a silicone, and may be, and
it at least has very similar properties. They can be made with varying degrees of
flexibility, like the SAFO and others made in Europe.
Regarding indications, I frankly have had a hard time defining that, except in one
situation. There is no question that they can be more comfortable, and somewhat more
forgiving of shape issues. However, if there is a meaningful malalignment (i.e. the
most common would be a significant, non-correctable pes planus or pronation deformity
secondary to PTTD), motion is usually the enemy, so the increased flexibility,
compared to an Arizona, is usually not helpful. If there is ligament dysfunction,
resulting in functional instability, but no malalignment, then the support provided
by a SAFO or Arizona is usually overkill, and there is a nearly endless selection of
OTS ligamentous ankle supports to choose from.
The only situation for which a SAFO or equivalent is clearly indicated vs. an Arizona,
IMHO, is the very active, significantly unstable, fully correctable ankle/midfoot for
whom a hard endpoint of functional pronation would cause problems higher up the
kinetic chain, and whose size/activity level tends to overpower OTS ankle supports.
I don’t know the exact cause of the endpoint problem, but I have assumed that since
a pronation moment is a normal motion, and also a part of the shock absorbing mechanism
of ambulation, for some people they need a “soft” endpoint that a more flexible
device can provide vs. a nearly rigid endpoint that an Arizona or equivalent provides.
One difficulty with this scenario is that I have never figured out a way to determine
ahead of time who needs a soft endpoint and who does not, and changing device types is
an expensive mistake. I have had a few patients that were coming for one of these
devices when their rigid Rohadur FOs were no longer sufficient. I assumed that if
they could tolerate the rigid endpoint of that kind of FO, they could tolerate the
rigid endpoint of an Arizona, but that was not always the case. It maybe should not
have been surprising, given how much more of the leg is affected by an Arizona vs.
FO, but so few patients tolerate the rigid FOs that I assumed that if they could
tolerate those, they would be OK with an Arizona.
I know a few practitioners that go with the SAFOs and their brethren simply because
they are lazy regarding accurate shaping issues, and the very flexibility of the
device will make shape mismatches less of an issue, as mentioned above.
I personally think that is a jackass reason to do anything, and I rarely have fitting
problems with Arizona AFOs. But I am very careful about my casting technique, and
mark carefully, and strictly according to Arizona’s protocol. At previous facility I
worked at we made these devices in-house, both flexible (SAFO) and nearly-rigid
(Arizona), and the same was true there, as it is most anywhere: garbage in, garbage
out.
The only contraindication (?) I am aware of is one mentioned above, that of the
malaligned patient that cannot be corrected and for whom motion will result in
continued pain, usually the same that brought them to us in the first place. If there
is significant arthritis in play, I would never use a flexible one, because motion
at the joints usually aggravates that as well. I use a question mark with
contraindication because it isn’t the best use of the word. More accurate would
be to say that the best benefit for those folks would probably be obtained with a
less flexible device.
Having said all of that, the functional difference between the two is not large,
except perhaps in very obese patients, where there is a limit as to how thick you
can make the SAFOs without introducing donning difficulty. The wrap-around nature
of the devices provides some cylindrical stiffening, and there is also some
stiffening synergy between the device and the limb. It would be unlikely, in
either direction, that one device would produce outcome magic and the other
functional disaster.
Regarding reimbursement, I have never figured out a way to improve it, and there is
the PDAC issue to consider. Thinking only of Medicare for the moment, even if you
felt that additional codes were justified from an expense perspective, from a
functional justification perspective you would have to document why the medically
necessary outcome could not have been accomplished with the less expensive device.
Personally, I think that is a tough argument to make, precisely because the
difference between the devices is not large, and you would only have known that the
less expensive one (Arizona) did not work by trying it.
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I made some from the uk company for pt. They don’t really work. They are about as
strong as the foot up. If a foot up is enough than the silicone will work. Misc code
is only way to charge. Pt pays cash up front.
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Reach out to Mike Angelico at Advanced in Chicago.
708-878-2241
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Orthomerica just came by. It’s not silicone but is a tough material close sort of to
pelite that won’t tear. Don’t know what your patient wants it for. U can custom make
one like a custom BK liner by creating a bivalve socket over a pelite inner & inject
it w silicone after the pelite is removed
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Contact Dorset and get yourself designated as one of their US
distributors for this product. It takes a while with international
shipping but it is an effective and well tolerated device.
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Tony Wickman at Freedom Fabrication in Havana, FL does a nice one.
1-800-304-3733
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I am not a provider but a patient with an SAFO. The fabricator and provider
was Dorset Orthopedics in the UK.
I actually traveled to the UK for the molding and fitting. The following US
O&P firm works with Dorset and will assist US clients:
Next Step Bionics & Prosthetics Inc
Contact:Arthur Graham
Email:[email protected]
Address:
Next Step Bionics & Prosthetics
57 Chapel Street – Suite 101
Newton MA 02458 USA
Website:www.nextstepoandp.com
Telephone:+1 (0) 617 581 6750
My understanding is spasticity is a problem with the SAFO. I have drop foot
from a spinal cord injury. I believe these AFO are very suitable for CMT
since they are custom molded and somewhat pliable for deformities.
BUT, I am a patient not a professional. Happy to answer any questions you
might have regarding my experience..if it would be of help.
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Orthomerica in Orlando central fans silicone AFOs. 800.446.6770.
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