Point-Counterpoint: Do AFOs Have A Role In Fall Prevention?

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Author(s): 
Jeffrey C. Christensen, DPM, FACFAS, and Douglas Richie Jr., DPM, FACFAS

   Dr. Richie is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is a Fellow of the American College of Foot and Ankle Surgeons. He is in private practice in Seal Beach, Calif. Dr. Richie writes a monthly blog for Podiatry Today. One can access his blog at www.podiatrytoday.com/blogs/301 .

References

1. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub3.
2. Moore Balance Brace. www.fallpreventionbrace.com . Accessed August 26, 2013.
3. Rubin G, Cohen E. Prostheses and orthoses for the foot and ankle. Clin Podiatr Med Surg. 1988; 5(3):695-719.
4. Richie D. New research warns of negative effects of AFOs on balance. Podiatry Today. Available at http://www.podiatrytoday.com/blogged/new-research-warns-negative-effects... . Published April 23, 2013. Accessed Aug. 26, 2013.
5. Panwalkar N, Aruin AS. Role of ankle foot orthoses in the outcome of clinical tests of balance. Disabil Rehabil Assist Technol. 2012; 8(4):314-20.
6. Hadadi M, Mazaheri M, Mousavi ME, Maroufi N, Bahramizadeh M, Fardipour S. Effects of soft and semi-rigid ankle orthoses on postural sway in people with and without functional ankle instability. J Sci Med Sport. 2011; 14(5):370-5.
7. Ramstrand N, Ramstrand S. The effect of ankle-foot orthoses on balance-a systematic review. Official Findings of the State–of-the-Science Conference. J Prosthet Orthot. 2010; 22(10):4-23.
8. Richie D. The truth about AFOs and Fall prevention. Podiatry Today. Available at http://www.podiatrytoday.com/blogged/truth-about-afos-and-fall-prevention . Published Feb. 24, 2012. Accessed Aug. 26, 2013.
9. Spink MJ, Menz HB, Fotoohabadi MRF, Wee E, Landorf KB, Hill KD, Lord SR. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomized controlled trial. BMJ 2011;342:d3411 doi:10.1136/bmj.d3411
10. Richie D. Preventing falls in the elderly: where DPMs can have an impact. Podiatry Today. 2012; 25(9):38-51.

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Timothy K. CPO, FAAOPsays: October 3, 2013 at 4:51 pm

Dr. Christensen,

I am confused. You state that practitioners should "never prescribe custom braces in a prophylactic manner to prevent falls." Yet your entire article is advocating this practice?

Furthermore, are you saying that when a patient fails the Timed Up and Go test, they qualify for a custom AFO according to Medicare guidelines? I have read the Medicare guidelines for medical necessity and there is nothing about balance disorders, peripheral neuropathy or arthropathy which you state are valid diagnoses for AFO reimbursement from Medicare.

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Douglas Richie DPM FACFASsays: October 30, 2013 at 11:52 pm

Jeff,
I have waited patiently for your reply to this valid challenge to your position in prescribing and billing Medicare for "Falls Prevention AFOs". Can you provide your insight and experience with billing Medicare for these devices when the medical necessity of this treatment is not justified, according to current Medicare guidelines?

Thanks,
Doug

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