Yesterday morning a Podiatrist, Dr. Shuman (I love the name) came to our home to look at Ryan’s ankles and feet. I was going to do a complete write-up on what was covered in the visit, but realized I already did this in an email I sent to Sue. I thought it might be neat to share this. Not only does it thoroughly recap the visit, but it gives you a peek into how we coordinate to care for Ryan. In many ways, it’s not unlike a business servicing a customer. No doubt, we have become very efficient.
Here’s a copy of the actual email:
From: Ken Diviney
Date: July 2, 2012 5:26:54 PM EDT
To: Sue Diviney
Subject: Fwd: New Patient Forms
Here are some forms (attached) we still need to complete and fax over to Dr. Schuman.
Recap of home visit:
1. Extra Depth Shoe. We should go to www.safestep.net and select one. Dr. Schuman says the New Balance 812 is especially good. These would be used during therapies Once picked, we can asked her to write a script to submit to insurance.
2. Stiff Sandal. Brands she suggests are REI, TEVA, and Keen. I think I already own a pair of Keen. These can be worn during the day (non-therapy).
3. Bacitracin. She said this is the best. Continue to use it if there is skin breakdown.
4. Night AFOs. She loves the (blue) ones we use.
5. Day AFOs. Provided Ryan’s skin will not breakdown, she recommends AFOs during the day. She will write a script when we select style we want. She recommends a pair made of carbon fiber and 2 shin straps. See www.allardusa.com/frames/prodframes.html.
For your understanding, “AFO” is an acronym for “Ankle Foot Orthosis”. In layman’s terms, this is much like an ankle brace… on steroids. For Ryan, it has a dual purpose: 1) To support and hold the ankle joint in a neutral position laterally to prevent it from rolling in/out, and 2) To apply upward pressure on the sole of the feet to stabilize/reverse foot drop. Here is a picture of the style we use at night on Ryan:
I sometimes use this during the day as well, but it’s bulk prevents wear during therapies. There’s just no way that Ryan could have this on during cycling, for instance. The idea is to find one that can be worn during the day and can stay on (and actually help) me with his exercises. More precisely, it must fit within his footwear. For this, he will need a style similar to this photo:
Finally, the shoe he wears can go a long way in preventing skin breakdown from rubbing, especially during therapy. Ryan is particularly susceptible at the knuckles of his big toes (from curling them). He needs extra depth. The recommendation is the New Balance 812 (shown below).
In total, this will cost around $2,000 (not including the Podiatrist charges) to pull this off. As usual, we’ll get them and worry about paying later. We will send it to insurance, but it’s anyone’s guess if they will cover it. Our insurance has been wonderful to us from the beginning. They do as much as they can to help. Still, there’s always that argument that it doesn’t qualify as care or treatment for brain injury. Yes, in reality, traumatic brain injury to this extent touches every part of the body. Still, it’s easy to see how it could be a hard sell in the medical world that a person’s shoes are connected to the brain injury.