Techniques for Fitting Custom ToeOFF and BlueRocker AFOs: A Comprehensive Guide

1. Custom ToeOFF & BlueRocker Achieving Success! After viewing this presentation you should be made fully aware of the proper techniques required to fit a Custom ToeOFF or BlueRocker.

2. Agenda This presentation will cover • Indications • Applications • Process and procedures • Model acquisition • Reimbursement

3. Indications Some of the indications that have been successfully fit with both Standard and Custom ToeOFF products are: • CVA • MS • CMT • ALS • TBI • GB • SCI • Neuropathy • Post-Polio • Soft-tissue Injuries

4. The primary reasons you would use a Custom over a standard product are for the following conditions: • Applications • Atrophy • Obesity • Deformity • Modified ToeOFF or Blue Rocker properties

5. Some additional applications include: • Change support level • AP (crouch gait) • ML (Trunk sway) • Change heel rise • Incorporate relief • Tibial crest • Cavus foot

6. A Custom ToeOFF NOT an application for:  • Delamination Refer to the ToeOFF Customization guide to resolve delamination issues.

7. Process & Procedures • Evaluate patient • Assess in standard ToeOFF or BlueRockerwhenever possible • Establishes baseline for required dynamic response

8. Process & Procedures • Evaluate patient • Complete forms

9. Process & Procedures • Evaluate patient • Complete forms • Important to fill out informationon size used forevaluation purposes.

10. Process & Procedures • Evaluate patient • Complete forms • Page 4 allows changes to bemade to the dynamic properties. • Fill out all grey boxes.

11. Process & Procedures • Evaluate patient • Complete forms • Measure the heel height of thepatient’s shoe tomake sure the Custom ToeOFF is aligned properly.

12. Process & Procedures • Evaluate patient • Complete forms • Page 5 is only to be used when orderingby measurements. • Photo must accompanythe forms. • Don’t forget to attach pages 3 & 4.

13. Process & Procedures • Evaluate patient • Complete forms • Select footwear • Shoe selection • Shank & counter • Rocker sole • Facilitate 3rd rocker • Measure Heel Rise

14. Process & Procedures • Evaluate patient • Complete forms • Select footwear • Determine heel rise Inside heel = 5/8” Inside ball = 1/8” Needed rise = 1/2”

15. Process & Procedures • Evaluate patient • Complete forms • Select footwear • Determine heel rise • Manage the footbiomechanics. • Foot orthotic shell • At a minimum • Custom if necessary • Capture if casting or scanning

16. Process & Procedures • Evaluate patient • Complete forms • Select footwear • Determine heel rise • Manage the foot • What is possible

17. What is possible? Modify the properties of a Standard ToeOFF!

18. Process & Procedures • What is possible? • Extra small • No height restrictions on the low end. • Smallest footplate is 190mm or 7 ½”

19. Process & Procedures • What is possible? • Extra small • Extra tall • Up to ¾” taller than an XL • Max. Footplate length 310mm or 12¼”

20. Process & Procedures • What is possible? • Extra small • Extra tall • Increase or decrease stiffness by up to 2 times a standard product. • AP • ML

21. Model Acquisition • Cast-requirements • Fiberglass only • Posterior-medial opening • Neutral in sagittal plane • Or to proper heel height • Anterior & Lateral plumb lines

22. Model Acquisition • Cast • Note: If there are any uncorrectable deformities in the frontal plane, they should be represented by standing the patient and then marking the plumb lines.

23. Model Acquisition • Cast • Measurement • All forms must be completely filled out • 4”(exactly) Piece of tape, placed vertically on calf • Photo must accompany the forms

24. Model Acquisition • Cast • Measurement • Scan • Must have extension “.cxpxp” or export as a STL File

25. Warranty • Two replacements within one year • If on using the left side of form • Heel height from ¼” to 1” • Standard lateral strut • Greater than 1”, covered 6 months under GMP (Good Manufacturing Practices)

26. Turnaround Time • Casts shipped to Allard USA, then to Sweden • 3 – 4 week turnaround • Scans or measurements emailed to Sweden • 2 – 3 week turnaround

27. Solid Ankle Reimbursement • Cost • Materials $ 60 • Labor $ 150 • Total $ 210 • Allowable Ceiling Floor • L1960 $ 625 $ 469 • L2270 $ 61$ 45 • Total $ 686 $ 514

28. Hinged AFO Reimbursement • Cost • Materials $ 100 • Labor $ 150 • Total $ 250 • Allowable Ceiling Floor • L1970 $ 802 $ 602 • L2220x2 $ 92 $ 69 • L2270 $ 61$ 45 • Total $ 955 $ 716

29. Custom ToeOFF Reimbursement • Cost • Base $ 695 • SoftKit $ 36 • Total $ 731 • Allowable Ceiling Floor • L1945 $1,044 $ 738 • L2232 $ 105 $ 79 • L2755x2 $ 282 $ 212 • L2820 $ 98 $ 73 • Total $1,529 $1,147

30. Additional Information • Contact Scott Hennessy, CO National Product Manager Office 888-678-6548 Fax 800-289-0809 Cell 210-874-1599 scott.hennessy@allardusa.com www.allardusa.com