Richie AeroSpring Midfoot Offloading System 

 

Clinical Indication:

Treatment of sprain of the tarsometatarsal (TMT) joints.

Treatment of degenerative arthritis of the midfoot joints.

Features:

Carbon fiber ankle foot orthosis

 -  controls ankle joint dorsiflexion and load on the Achilles tendon

Custom functional foot orthosis (one pair)

 -  controls rearfoot pronation

 -  patented “Richie ArchLock”: offloads the medial-central band of the plantar fascia

Carbon fiber footplate with toe rocker

 - offloads dorsiflexion bending moments across the midfoot

Graduated Heel Wedges

 - 1cm heel lift via two 5 mm wedges B/L

 

Reimbursement

Reimbursement for the carbon fiber AFO:
Billed under code L1932
Average reimbursement: $800
Reimbursement for the Pair of Foot Orthotic:
Billing code L3000
Average reimbursement: $400
Cash Charge for Heel Wedges:
$20 per set of wedges, $40 total Bilateral
Total Reimbursement for Midfoot Offloading System: $1240

 

Note:  Reimbursement varies among payors and region.  No guarantees or assurances for reimbursement are implied with this document.  Suppliers must contact each payor to verify coverage and reimbursement amounts.


Mechanism

The Richie Aerospring LIsfranc Offloading System is designed to improve the protection of the midfoot joints provided by walking boots. While walking boots reduce load on the midfoot from the Achilles and provide a rigid rocker sole, there is no arch contour which is critical to support of the TMT joints. The new Aerospring Lisfranc Offloading System provides a brace to limit Achilles loading, a rigid carbon fiber footplate to reduce bending moment across the midfoot joints and a custom contoured foot orthosis to prevent sagittal plane collapse of the TMT joints. A graduated heel lift system further offloads the Achilles and the midfoot joints

 

SCIENTIFIC BACKGROUND

 

Lisfranc sprains or injuries to the TMT joints are often mis-diagnosed, are challenging to treat, and often lead to permanent disability. (1-3) Treatment of the sprain where the midfoot joints are stable, with no evidence of diastasis usually requires immobilization in a walking boot for a minimum of 8 weeks. (3,4) When open reduction and internal fixation is required, the post operative course requires up to 12 weeks of boot immobilization. (4,5)

Walking boots address several deforming forces on the TMT joints but do not provide proper arch support to prevent sagittal plane collapse across the midfoot joints. The bulk and limb length discrepancy imposed by walking boots discourages long tem use and leads to poor patient compliance with poor clinical outcomes. The Richie AeroSpring Lisfranc Offloading System offers a welcome alternative for patients facing long term immobiliazation after a midfoot sprain. The lightweight carbon fiber brace allows ease of ambulation while the thin composite footplate will not disrupt leg length. The brace can be quickly loosened at the proximal attachment to allow full mobility of the ankle while driving an automobile.


REFERENCES

1. Ardoin GT, Anderson RB. Subtle Lisfranc injury. Tech Foot Ankle Surg. 2010;9(3):100-106.
2. Calder JD, Whitehouse SL, Saxby TS. Results of isolated Lisfranc injuries and the effect of compensation claims. J Bone Joint Surg Br. 2004;86(4):27-30.
3. Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the ath- lete. Am J Sports Med. 2002;30(6):871-878.
4. Kuo RS, Tejwani NC, Digiovanni CW, et al. Outcome after open reduction internal fixation of Lisfranc joint injuries. J Bone Joint Surg Am. 2000;82-A(11):1609-1618.
5. Teng AL, Pinzur MS, Lomasney L, Mahoney L, Havey R. Functional outcome following anatomic restoration of the tarsal-metatarsal fracture dislocation. Foot Ankle Int. 2002;23(10):922-926.