I often get a request by a group of PTs to pre-articulate an AFO without
using metal upright/stirrup designs. They feel that metal is a
prehistoric method.. The patient is often a week or so post CVA with
trace or no ability to P/F or D/F at the ankle, the knee may or may not
be involved with extension weakness. The reason for the pre-articulated
AFO is a presumed non-coverage by the insurance for a solid AFO now and
a articulated later when strength returns. Frankly, I do not have
evidence one way or another to argue the point. My facility is not
researching the situation. So I blindly go about making a gummy bear
designed dorsi assist AFO without cutting the ankle through for
articulation. It can be cut later when articulation is warranted but
this rarely happens. I’m also not happy with the gummy bear joints as
they stretch allowing an unnecessary knee extension moment when the P/F
stop is contacted. Once in a while I’m requested to provide a strap
posteriorly to arrest D/F so they can have their cake and eat it too.
Cosmesis is no better for it as far as I can see. I don’t believe that
we can bill for this additional strap feature but we are billing for a
dorsi assist AFO. One might get their finger tip in the ringer by doing
so but in the final analysis the costs may all come out in the wash
anyway. I have wondered if some other ankle joint might give me the
same features without an unsightly strap or metal uprights necessary for
DAAJs that are used in other applications. Any thoughts on this
subject are appreciated.
Joe Harvey
