Orthotics

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Orthotics

 

There are various reasons that custom orthotics are recommended for children. Often, the purpose is to position the foot and ankle in alignment, stabilize a weak joint, prevent contractures, prevent gait deviations such as toe walking, or optimize gait pattern (heel-toe gait pattern). There are several types/styles of orthotics that each serves different purposes:

  • UCBL – shoe insert
  • Superomalleolar Orthosis (SMO) – custom molded to foot & ankle, inserts into shoe
  • Ankle-Foot-Orthosis (AFO) – custom molded to foot, ankle & lower leg (stops below the knee). The ankle support can be rigid or hinged, depending on the needs of the child.
  • Knee-Ankle-Foot Orthosis (KAFO) – is a leg brace designed to stabilize the knee, ankle and foot while supporting the leg. KAFO orthoses are generally used to assist mobility due to muscle weakness and/or partial or full leg paralysis.
  • Hip-Knee-Ankle-Foot Orthosis (HKAFO) or Reciprocating Gait Orthosis (RGO)- links two KAFOs together to assist with transferring movement from one leg to the other to assist with achieving a stepping pattern in children that do not have the neurological innervation to achieve a stepping pattern without assistance from the brace, typically due to paralysis.

 

Who Makes Orthotics?

There are many certified Orthotists in the K-W area that can make custom orthotics. However, in order to receive funding through the Assistive Devices Program (see below) the orthotics need to be made by a certified orthotist. It is also highly recommended when searching for a certified orthotist that they have experience working with casting children and youth. You will also want to consider when choosing the orthotist you would like to consult with, that you may need to go back for adjustments several times throughout the year to accommodate for growth of your child.

 

Below is a list of centres in the local area that are known to have certified orthotists in their clinics that deal with the pediatric population:


  • Hamilton Health Sciences - Prosthetic & Orthotic Department
    Chedoke Site, Holbrook Building, Hamilton
    905-521-2607

  • Orthopedic Bracing Solutions
    386 Gage St., Kitchener
    519-748-4848

  • Toronto Orthopedic Services
    2829 Dundas St. West, Toronto
    416-766-6800
    *offer monthly clinics at the Waterloo, Guelph & Cambridge KidsAbility sites

 

How Can I Get an Appointment? What Can I Expect When I Get There?

1.   Contact an orthotist directly (unless wanting to go use Toronto Orthopedics – ask your therapist to refer) and request an appointment time for a meet with the orthotist (consult) and to have casts/molds made for custom orthotics. Be prepared to provide the following information:

  • Health card number
  • ACSD number if applicable
  • Confirmation that a referral note or ADP form has been signed by a physician (see below)

2.   At the appointment, the orthotist will assess your child’s foot and gait pattern. A cast will be applied to the foot and ankle/leg to create a mold. The cast stays on for 2-3 minutes until the casting material is dry and well molded. When the cast is dry, it will be removed and you will be free to go after all the necessary paperwork is completed and payment is settled.

3.   A follow-up appointment will be scheduled for you to return a few weeks later to have your child fitted with the finished product. You will need to bring your child in for this appointment to ensure that the orthotic fits properly. You can expect to return sporadically throughout the year because your child will grow and his/her feet will change. Most orthotists will offer adjustments free of charge to accommodate growth changes in children. However, it is always a good question to ask.

 

How Much Do Orthotics Cost? Is There Funding Available?

Any customized device is expensive, and orthotics are no exception.

  • SMO: A basic pair of SMO’s can cost between $1,200$1,500.

 

  • AFO: Cost of one AFO will range from $780 for a rigid type to $965 for a hinged AFO. A pair of AFO’s will range from $1,554 (rigid) to $1,930 (hinged).

 

Government Funding

Fortunately in Ontario there is a government program, called the Assistive Devices Program, which will fund 75% of some orthotics (per year).

In order to qualify for this funding, a special ADP application form must be completed by an authorizing therapist and/or signed by a physician. 
The completed form must be provided to the orthotist on the day of you initial consult.


What about the remaining 25% balance?

The Family is responsible for paying the remaining 25% either out of pocket, or through extended health benefits or social assistance.

 

  • Extended Health Benefits: In most Extended Health Benefit Plans, custom orthotics are covered under the category of ‘Durable Medical Equipment, Braces, Artificial Limbs’ or under the section that covers prosthesis. Custom orthotics are more extensive that a basic orthotic that can be picked up off the shelf (which often are not covered). So be sure that the insurance provider knows that what has been prescribed is not a basic orthotic; they need to understand that this is different from a regular shoe orthotic or insert.

  • Social Assistance: If you qualify, ACSD will fund the remaining 25% that ADP does not cover. You will need to bring your most recent ACSD stub (the monthly receipt that gets mailed to you) to your orthotics appointment so that billing can be arranged.

  

Wearing the Orthotic

Information about wear and care of the orthotics will be provided. Orthotics are to be inserted in a shoe; children should not stand in an orthotic without a shoe on! Orthotics add bulk to the foot, and the initial pair will be slightly longer than the foot to accommodate room for a year’s growth, therefore your child will need a pair of shoes that are a size bigger than he/she would typically wear. It is often good to wait to buy a shoe until after you have received the orthotics.

  

Summary of What I need to Take to the Orthotics Appointment:

  • ADP form – completed and signed
  • Health card
  • ACSD number if you receive social assistance (the orthotist might ask to photocopy the last stub that you received in the mail so that they can send a bill and receive payment from ACSD) or 
  • Self Paying out of pocket – check if they accept cash, cheque or credit card to pay the 25% balance not covered by ADP