Re: Changed subject cuz Kori doesn't want to be right all the time...

[Guest guest]

Got my feedback from Dr. Dobbs. Here's what he wrote:

Hi :

I think if the Markell shoes are working that is great. I think the

new brace (AFO style) is for those patients who have trouble in the

Markell shoes which is typically those patients with atypcial clubfeet

and many babies. I see problems with the Markell shoes in my younger

patients where the feet don't seem to fit well in these shoes. Once

the child grows some the feet tend to fit better in the shoes.

Therefore, once they fit well in the shoes that is perfecly o.k. to use.

To answer your other question I don't think the AFO style will have

any effect on calf strength development. The kids wear the brace

mostly at nightime and are free during the day.

With regards to the other comments.

1. We have not run into any problems with insurance not covering the

AFO's. In fact it has been better for most patients because it has

been 100% covered. On the contrary many insurance companies will not

cover the Markell shoes. New sizes are not needed more frequently

than shoes. Usually every 6 months for the moldable insert and 9

months to a year for the AFO.

2. We have been improving the Velcro straps.

3. The ankle/calf development will not be hindered since the brace is

worn at night for the majority of the time. We have modified the bar

now also so kids can stand in the brace, but again by the time kids

are doing much of that activity they are in mostly for sleeping hours.

4. I have no answer for sweaty feet at the moment.

5. The problem with regular tennis shoe is the soft bottom. In

principal the answer is yes but we have to find a way to solidly fit a

soft bottom onto the bar.

6. Cutting hole in the AFO will weaken it and it would break. Since

there is no laces I think it is easier to get the foot down with

straps then to try to hold the heel down as you tie laces.

7. I am working on making this brace more widely available. A company

has expressed interest in making 200 for general availability as a trial.

Thanks for the feedback--it helps me to hear any concerns that are out

there. I think the brace will prove valuable for those cases that

fail the traditional treatment but I also don't think every child

needs the brace.

Thanks

Dobbs

> > >

> > > Kori,

> > > I just had to tell you how right you were about using the Markell's

> > > properly! You are the queen of all things shoe/brace related, I

> >will

> > > bow to your instructions in the future!! : )

> > > Sammy's daycare broke the strap on one of his AFO's yesterday so I

> >had

> > > to pull out the Markell's and I put them on our Dobb's brace. He

> > > couldn't be happier in them -- I drilled holes in the heels and took

> > > out that dumb plastizode and we are happy campers. And I don't know

> > > if this is just a coincidence or what, but he has been stubbornly

> > > refusing to roll from his tummy to his back in the brace but

> >suddenly

> > > this morning w/ the Markell's on instead of the AFO's he starts

> > > rolling over like crazy! I really am wondering if it has something

> >to

> > > do with the not being able to move his ankles thing.

> > > I just know I was not getting the heels down when he got his sores,

> > > and I am glad Dr. Dobbs gave us the AFO's as another alternative,

> >but

> > > I'm starting to think that maybe we will stick w/ the Markell's

> >now...

> > > We'll have to see if the shoes bother him at all today. I think my

> > > issues with the shoes both before and after the sores was that I was

> > > having a hard time because of 1) tenderness after just getting out

> >of

> > > the cast, 2) just general baby foot floppiness, 3) plastizode was

> > > doing more harm than good -- it was just in the way of getting the

> > > heel down, not really helping cushion at all!, 4) my own

> >stubbornness

> > > at wanting to blame the shoes and not myself. I just felt so

> > > prepared for the shoes after reading the tips sheet a million times

> > > but then when he got the sores after 1 day in the shoes I just

> >freaked

> > > out (even though it was my own fault for not cutting out the

> >heels)!

> > > But now that I'm a cut out heel convert, and his foot has been out

> >of

> > > casts for a while and isn't so tiny and floppy I think the shoes may

> > > be just fine!

> > > Oh and I also should add that I think another drawback on the AFO's

> >is

> > > the strap breaking thing, this is our second one to break. Luckily

> >I

> > > work very close to the orthotics shop but this could definitely be

> >an

> > > issue for parents who have to travel at all to get their shoes and

> >braces.

> > >

> > > Thanks for all your support and words of wisdom!

> > >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

My questions after reading this are:

1 - It sounds like he says the only long bracing time is the 23/7 for 3

mo. Then they only wear it to sleep. Which would lead me to think he's

reducing to 12hr/d after the initial 3 mo. If not, you have to realize

that 18hr/d means the child wears it during many waking hours. If you do

one long stretch like we did that's 8pm till 2pm the next day. Lots of

waking hours in that schedule. Even if you do naps, and take it off a

couple of hours early that mean noon the next day. Still, quite a few

waking hours while the child kicks legs and plays and rolls around on the

floor and learns to crawl and whatever else.

2- What about the shoes instead of the AFO's? I didn't see this

addressed at all. This sounds like the perfect choice to me.

3- Exactly how much is insurance covering on the AFO's anyway? My

experience with durable medical equipment is that it's covered at 80%

typically. So compare not covering a pair of Markell's which are $60-$90

from what I hear to having to pay 20% of $1,500 (this is what Shriners told

me AFO's cost, actually they said $2,000). Where is the benefit?

I'm sure there's more but I can't think of it right off hand. I'm catching

up after being gone all day yesterday.

Kori

At 07:56 AM 2/23/2005, you wrote:

>Got my feedback from Dr. Dobbs. Here's what he wrote:

>

>Hi :

>

>I think if the Markell shoes are working that is great. I think the

>new brace (AFO style) is for those patients who have trouble in the

>Markell shoes which is typically those patients with atypcial clubfeet

>and many babies. I see problems with the Markell shoes in my younger

>patients where the feet don't seem to fit well in these shoes. Once

>the child grows some the feet tend to fit better in the shoes.

>Therefore, once they fit well in the shoes that is perfecly o.k. to use.

>

>To answer your other question I don't think the AFO style will have

>any effect on calf strength development. The kids wear the brace

>mostly at nightime and are free during the day.

>

>With regards to the other comments.

>

>1. We have not run into any problems with insurance not covering the

>AFO's. In fact it has been better for most patients because it has

>been 100% covered. On the contrary many insurance companies will not

>cover the Markell shoes. New sizes are not needed more frequently

>than shoes. Usually every 6 months for the moldable insert and 9

>months to a year for the AFO.

>2. We have been improving the Velcro straps.

>3. The ankle/calf development will not be hindered since the brace is

>worn at night for the majority of the time. We have modified the bar

>now also so kids can stand in the brace, but again by the time kids

>are doing much of that activity they are in mostly for sleeping hours.

>4. I have no answer for sweaty feet at the moment.

>5. The problem with regular tennis shoe is the soft bottom. In

>principal the answer is yes but we have to find a way to solidly fit a

>soft bottom onto the bar.

>6. Cutting hole in the AFO will weaken it and it would break. Since

>there is no laces I think it is easier to get the foot down with

>straps then to try to hold the heel down as you tie laces.

>7. I am working on making this brace more widely available. A company

>has expressed interest in making 200 for general availability as a trial.

>

>Thanks for the feedback--it helps me to hear any concerns that are out

>there. I think the brace will prove valuable for those cases that

>fail the traditional treatment but I also don't think every child

>needs the brace.

>

>Thanks

>

> Dobbs

>

>

> > > >

> > > > Kori,

> > > > I just had to tell you how right you were about using the Markell's

> > > > properly! You are the queen of all things shoe/brace related, I

> > >will

> > > > bow to your instructions in the future!! : )

> > > > Sammy's daycare broke the strap on one of his AFO's yesterday so I

> > >had

> > > > to pull out the Markell's and I put them on our Dobb's brace. He

> > > > couldn't be happier in them -- I drilled holes in the heels and took

> > > > out that dumb plastizode and we are happy campers. And I don't know

> > > > if this is just a coincidence or what, but he has been stubbornly

> > > > refusing to roll from his tummy to his back in the brace but

> > >suddenly

> > > > this morning w/ the Markell's on instead of the AFO's he starts

> > > > rolling over like crazy! I really am wondering if it has something

> > >to

> > > > do with the not being able to move his ankles thing.

> > > > I just know I was not getting the heels down when he got his sores,

> > > > and I am glad Dr. Dobbs gave us the AFO's as another alternative,

> > >but

> > > > I'm starting to think that maybe we will stick w/ the Markell's

> > >now...

> > > > We'll have to see if the shoes bother him at all today. I think my

> > > > issues with the shoes both before and after the sores was that I was

> > > > having a hard time because of 1) tenderness after just getting out

> > >of

> > > > the cast, 2) just general baby foot floppiness, 3) plastizode was

> > > > doing more harm than good -- it was just in the way of getting the

> > > > heel down, not really helping cushion at all!, 4) my own

> > >stubbornness

> > > > at wanting to blame the shoes and not myself. I just felt so

> > > > prepared for the shoes after reading the tips sheet a million times

> > > > but then when he got the sores after 1 day in the shoes I just

> > >freaked

> > > > out (even though it was my own fault for not cutting out the

> > >heels)!

> > > > But now that I'm a cut out heel convert, and his foot has been out

> > >of

> > > > casts for a while and isn't so tiny and floppy I think the shoes may

> > > > be just fine!

> > > > Oh and I also should add that I think another drawback on the AFO's

> > >is

> > > > the strap breaking thing, this is our second one to break. Luckily

> > >I

> > > > work very close to the orthotics shop but this could definitely be

> > >an

> > > > issue for parents who have to travel at all to get their shoes and

> > >braces.

> > > >

> > > > Thanks for all your support and words of wisdom!

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

See my thoughts below:

>

> 1 - It sounds like he says the only long bracing time is the 23/7

> for 3 mo. Then they only wear it to sleep. Which would lead me to

> think he's reducing to 12hr/d after the initial 3 mo. If not, you

> have to realize that 18hr/d means the child wears it during many

> waking hours. If you do one long stretch like we did that's 8pm

> till 2pm the next day. Lots of waking hours in that schedule. Even

> if you do naps, and take it off a couple of hours early that mean

> noon the next day. Still, quite a few waking hours while the child

> kicks legs and plays and rolls around on the floor and learns to

> crawl and whatever else.

>

I don't think he is reducing to 12 hr right after the initial 3 mo.

but you are right, 16-18 in the brace is still a lot of waking hours

-- I guess he is thinking that it is still not that long of a time

period before they start walking and get reduced hours??? I'm still

not convinced on this one but since we are not using the AFO's anymore

I guess I will never know if they would have affected his calf muscles.

> 2- What about the shoes instead of the AFO's? I didn't see

> this addressed at all. This sounds like the perfect choice to me.

> 3- Exactly how much is insurance covering on the AFO's anyway? My

> experience with durable medical equipment is that it's covered at

> 80% typically. So compare not covering a pair of Markell's which

> are $60-$90 from what I hear to having to pay 20% of $1,500 (this is

> what Shriners told me AFO's cost, actually they said $2,000). Where

> is the benefit?

From what he said, I think he is just trying to come up w/

alternatives that work for when people have trouble w/ the Markells.

He's not trying to do away w/ them. I think they are still working on

getting the articulating bar on the sandals. The AFO's might

be a good alternate if insurance pays for them when they won't pay for

's at all. Our insurance paid 100% of the Markell's and gold

bar as well as the articulating bar and the AFO's. It seems a lot of

people in St. Louis have United Healthcare which covers 100% of

durable medical equipment so that could be why his experience is good

w/ getting everything covered.

Thanks for the feedback,

>

> At 07:56 AM 2/23/2005, you wrote:

>

>

> >Got my feedback from Dr. Dobbs. Here's what he wrote:

> >

> >Hi :

> >

> >I think if the Markell shoes are working that is great. I think the

> >new brace (AFO style) is for those patients who have trouble in the

> >Markell shoes which is typically those patients with atypcial clubfeet

> >and many babies. I see problems with the Markell shoes in my younger

> >patients where the feet don't seem to fit well in these shoes. Once

> >the child grows some the feet tend to fit better in the shoes.

> >Therefore, once they fit well in the shoes that is perfecly o.k. to

use.

> >

> >To answer your other question I don't think the AFO style will have

> >any effect on calf strength development. The kids wear the brace

> >mostly at nightime and are free during the day.

> >

> >With regards to the other comments.

> >

> >1. We have not run into any problems with insurance not covering the

> >AFO's. In fact it has been better for most patients because it has

> >been 100% covered. On the contrary many insurance companies will not

> >cover the Markell shoes. New sizes are not needed more frequently

> >than shoes. Usually every 6 months for the moldable insert and 9

> >months to a year for the AFO.

> >2. We have been improving the Velcro straps.

> >3. The ankle/calf development will not be hindered since the brace is

> >worn at night for the majority of the time. We have modified the bar

> >now also so kids can stand in the brace, but again by the time kids

> >are doing much of that activity they are in mostly for sleeping hours.

> >4. I have no answer for sweaty feet at the moment.

> >5. The problem with regular tennis shoe is the soft bottom. In

> >principal the answer is yes but we have to find a way to solidly fit a

> >soft bottom onto the bar.

> >6. Cutting hole in the AFO will weaken it and it would break. Since

> >there is no laces I think it is easier to get the foot down with

> >straps then to try to hold the heel down as you tie laces.

> >7. I am working on making this brace more widely available. A company

> >has expressed interest in making 200 for general availability as a

trial.

> >

> >Thanks for the feedback--it helps me to hear any concerns that are out

> >there. I think the brace will prove valuable for those cases that

> >fail the traditional treatment but I also don't think every child

> >needs the brace.

> >

> >Thanks

> >

> > Dobbs

> >

> >

> > > > >

> > > > > Kori,

> > > > > I just had to tell you how right you were about using the

Markell's

> > > > > properly! You are the queen of all things shoe/brace related, I

> > > >will

> > > > > bow to your instructions in the future!! : )

> > > > > Sammy's daycare broke the strap on one of his AFO's

yesterday so I

> > > >had

> > > > > to pull out the Markell's and I put them on our Dobb's

brace. He

> > > > > couldn't be happier in them -- I drilled holes in the heels

and took

> > > > > out that dumb plastizode and we are happy campers. And I

don't know

> > > > > if this is just a coincidence or what, but he has been

stubbornly

> > > > > refusing to roll from his tummy to his back in the brace but

> > > >suddenly

> > > > > this morning w/ the Markell's on instead of the AFO's he starts

> > > > > rolling over like crazy! I really am wondering if it has

something

> > > >to

> > > > > do with the not being able to move his ankles thing.

> > > > > I just know I was not getting the heels down when he got his

sores,

> > > > > and I am glad Dr. Dobbs gave us the AFO's as another

alternative,

> > > >but

> > > > > I'm starting to think that maybe we will stick w/ the Markell's

> > > >now...

> > > > > We'll have to see if the shoes bother him at all today. I

think my

> > > > > issues with the shoes both before and after the sores was

that I was

> > > > > having a hard time because of 1) tenderness after just

getting out

> > > >of

> > > > > the cast, 2) just general baby foot floppiness, 3)

plastizode was

> > > > > doing more harm than good -- it was just in the way of

getting the

> > > > > heel down, not really helping cushion at all!, 4) my own

> > > >stubbornness

> > > > > at wanting to blame the shoes and not myself. I just felt so

> > > > > prepared for the shoes after reading the tips sheet a

million times

> > > > > but then when he got the sores after 1 day in the shoes I just

> > > >freaked

> > > > > out (even though it was my own fault for not cutting out the

> > > >heels)!

> > > > > But now that I'm a cut out heel convert, and his foot has

been out

> > > >of

> > > > > casts for a while and isn't so tiny and floppy I think the

shoes may

> > > > > be just fine!

> > > > > Oh and I also should add that I think another drawback on

the AFO's

> > > >is

> > > > > the strap breaking thing, this is our second one to break.

Luckily

> > > >I

> > > > > work very close to the orthotics shop but this could

definitely be

> > > >an

> > > > > issue for parents who have to travel at all to get their

shoes and

> > > >braces.

> > > > >

> > > > > Thanks for all your support and words of wisdom!

> > > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >