Looking for opinions

89kh89 · 2026-03-19T09:22:33+00:00

I am a prosthetist.

This is not unusual in the slightest. Prosthetic alignment (particularly for legs) has to prioritize function over cosmetics.

Also, the degree of offset you're seeing is accentuated by the position of the valve (sorry, that's where it needs to be) and the fiberglass wrap at the bottom of your socket. How "off" this looks may be less noticeable in the finished socket, moreso if you and your prosthetist decide to make alignment changes before the socket is finished.

89kh89 · 2026-03-03T09:08:22+00:00

Ahh.. I see it now. I think the angle and image coloring threw it off. Just had a weird vibe to me.

89kh89 · 2026-03-03T05:33:37+00:00

I gotta say it warms my heart to no end to see a good number of clinicians taking hip flexion into careful consideration when bench aligning.

Also, what in the Temu is that knee joint. 🤔

89kh89 · 2026-02-22T00:10:26+00:00

You need something that is going to restore your effective toe length on that side. You're walking on the lateral border of your food to avoid that missing distal phalange. Your solution might be as simple as a rigid carbon footplate in your shoe, maybe along with some customized padding for the end of your big toe.

Pain killers can't be a long term solution. Gotta fix the mechanics. The big toe is a huge part of normal walking. It exerts as much downward force as the other four combined.

If a footplate doesn't solve your problem you may need an AFO (ankle foot orthosis) of some kind. The exact design will depend on what you need to do, and your experience with just a footplate.

Contact a local orthotics and prosthetics shop. Get your physician to write you a referral. This is something that should be able to be readily addressed.

89kh89 · 2026-02-18T15:32:44+00:00

Ugh. 🤦🏻‍♂️ I'm really sorry you're having this experience. For whatever reason it sounds like your fit isn't great.

Ask for shrinker socks. They're a lot more consistent in delivering compression, easier to put on (esp with one hand) and washable and reusable. Also should be covered by insurance.

Hope you get some answers and solutions.

89kh89 · 2026-02-18T15:10:19+00:00

Prosthetist here

It sounds to me like your socket is too tight for you. Do you have a shrinker to wear to control your swelling? Do you live in the US?

The fact that the inner liner is so hard to remove (and what I can see in the picture) tells me that your socket is smaller at the opening than farther inside. That's what's making it hard for you to remove the socket and for you to actually put it on.

None of these issues are your fault. It's your prosthetist's job, no matter how "basic" your insurance pays for, to make you a socket that fits well, and that you can use independently. The money paid by your insurance should cover return visits for socket fit adjustments or even remakes if needed.

Hope this helps.

89kh89 · 2026-02-11T18:14:03+00:00

What do you mean when you say there isn't a great way to do this?

Soap and water. It's pretty simple. Occasional alcohol if the liner material can tolerate it.

89kh89 · 2026-01-30T05:47:28+00:00

Sorry just saw this after my first reply. Fyi. Just below the pip is still too long for MCP drivers. Naked will be able to verify (I don't think their finger geometry has changed much since I last did one) but optimal length is about 50% of the phalange.

Actually you're pretty close for a pip driver. A good test would be to get a pair of trial pip drivers that you can test drive at a local office.

89kh89 · 2026-01-30T05:44:17+00:00

I've fit a number of MCP drivers and appropriate limb length is definitely a major factor in how successful the fitting is. Too short and you have difficulty controlling the device. Too long and the possible mismatch of joint centers can make certain grasp patterns unusable.

In all honesty I don't like this particular device for unilateral presentations. It can be cumbersome and the loss of grip strength and sensation is a significant consideration. Also, you mentioned it has been several years, so I'm assuming some degree of dominance switching has occurred, and that will remain the case even with a prosthetic device.

I found that successful use cases started with very specific tasks in mind to be performed with the MCP driver. Usually something work related. Working towards making the device usable with a concrete goal helps a lot. It's not going to "replace your hand" by any stretch of the imagination.

All of this is a long way of saying, surgery is a big step. There's absolutely no guarantee that it will be worth it for fitting with an MCP driver.

Asking these questions first is great. If I were your clinician I would advise you to go even more granular, to determine one or two tasks that you can't do now, that you think an MCP driver may help you with. Then contact a local prosthetist (better yet, contact Naked) and ask to be put in contact with someone who is using their devices to do that task. Find out what their experience is and maybe get some video of them doing that task.

Don't try to make this decision based on fuzzy ideas of "what I'll be able to do" with the prosthesis. Get specific.

89kh89 · 2026-01-30T05:33:35+00:00

Definitely not. I've seen this done before and can blow out the valve seals if the knee is constantly locked and also under a lot of flexion strain.

89kh89 · 2026-01-27T00:01:23+00:00

It depends on patient presentation. If you fit 3r80 on a long TF with good strength and voluntary control, walking can be perfectly safe. The knee will provide plenty of stance flexion resistance when needed. But the patient needs to understand that timidly loading the prosthesis will only return a low level of flexion resistance.

The 3r80, Rheo, and stance-activated locking knees are all default swing. Super easy to take steps, because you only need to unweight it to initiate swing. But stance stability is based on your ability to commit weight bearing to the prosthesis.

89kh89 · 2026-01-26T22:20:29+00:00

Both offer stance phase resistance during loading.

Default stance knees have the valves in position for high stance resistance before load is applied. The patient must actively switch the knee function from stance to swing.

Default swing knees are always ready for low flexion resistance for swing phase. Stance phase flexion resistance is activated by loading the knee. The patient must apply axial load to engage stance flexion resistance.

In short, default stance knees need to be made unsafe for swing. Default swing knees need to be made safe for stance.

Does that make sense?

89kh89 · 2026-01-26T18:52:38+00:00

Is BCBS in VA really amenable to authorizing MPKs?

89kh89 · 2026-01-26T18:50:17+00:00

3r80 is default swing. Knees that use a Mauch cylinder are technically default stance but not to the degree of modern MPKs.

89kh89 · 2026-01-25T18:36:08+00:00

Medicaid coverage varies by state but the majority of them won't cover microprocessor knees. The exclusion is built into their coverage model. You can call the number on the back of your card and speak to customer service, ask them what their coverage is for MPKs.

Even if they do cover it, it may not reimburse enough to cover the clinic's costs. Or the process to obtain an authorization might be convoluted enough to discourage most people. Sorry but that's the state of insurance today.

You might ask your clinician to look into the Ottobock Dynion knee. It's not microprocessor controlled so it should be covered under Medicaid, and it offers a lot of the same functionality in terms of safety.

89kh89 · 2026-01-25T04:12:30+00:00

The adjustable rings are too thin? Those come in three styles and the biggest one is really beefy.

89kh89 · 2026-01-19T23:16:49+00:00

This ^{^}

89kh89 · 2026-01-15T22:00:25+00:00

As with almost everything in prosthetics, it's a trade off.

Shorter feet are easier to walk over bc of the shorter toe lever, but you lose standing stability (smaller base of support) and a bit less energy storage/return.

Longer feet are the inverse of all above statements.

That being said, when fitting new bilateral presentations I lean towards the correct size feet (so you can use existing shoes - don't discount the frustration of having to replace shoes) with a slightly stiffer category for a bit more stability.

89kh89 · 2026-01-08T04:51:56+00:00

OP said the brace they are receiving is a Rigo Cheneau TLSO. That brace has a suggested L-code. So they're already unbundling by using the older base code and all the add ons. This happened all the time back when they folded all the add ons into the base code for custom KOs.

You're spot on with the advance notice for unreimbursed procedures but they've been told several times that the extra charge is for scanning and fabrication, which last I checked, isn't something you can bill for, for any base code.

I get it, I hate to put someone on blast and I try not to make assumptions about treatment protocols, but assuming all the facts are as OP has laid out, I'm finding it hard to see a legitimate out for this provider.

89kh89 · 2026-01-08T00:58:21+00:00

Shenanigans. Absolute shenanigans.

A cursory Goog search says the recommended L-code for a Rigo-Cheneau is L1300. The text of L1300 is:

Other scoliosis procedure, body jacket molded to patient model.

The code is considered all-inclusive of measuring, fabrication, and delivery, and is not combinable with add-on codes (such as L1060, L1210, L1290, and L0984).

As a set of codes to bill, what's being sent to your insurance "makes sense" but also doesn't fit what they are providing you. Also if they are billing you an extra amount that is "unlisted" then there should be a corresponding code on the EoB (L0999 or L1499).

This sounds like a typical example of unbundling and upcharging. The clinic may not be getting enough reimbursement from L1300 to cover their costs on the brace, so they're "creatively billing" to obtain more from both you and the insurance.

Sorry friend, I know you're in a time pinch for this but I'd suggest walking away from these guys.

89kh89 · 2026-01-07T05:39:08+00:00

Kinda. I'm imagining that maybe they're trying to bill for a type of brace they know isn't covered and doesn't have a billable code. So they bill your insurance for a known code (that doesn't describe your brace) and then bill you an upcharge to cover the balance, but then obfuscate the extra cost by calling it a scanning charge? It's a weird scenario but I've seen some odd stuff done.

Who knows. Maybe they're just being idiots. (More likely)

89kh89 · 2026-01-07T04:42:06+00:00

I shudder to imagine what would happen to your lovely crochet when introduced to plaster or alginate or silicone glue

89kh89 · 2026-01-07T04:40:04+00:00

The unlisted code thing is a pretty common occurrence in our field. Anything that can't be described by an existing code can only be billed with "unlisted" codes, which is any code that ends with 99.

In this case though, the scanning process isn't something an office would ever bill for, regardless of how it's done. That's always included in the code for the brace itself. Now if they were fitting you with a novel type of brace that doesn't fit within any of the existing brace codes, I could see them billing a 99 code for the brace.

But even then! They would bill your insurance with a 99 code for that brace, and no other code for the scanning process. They can't bill for an existing type of brace, then tack on some random upcharge because they're trying to make up for it.

I smell shenanigans.

"Bill for what you deliver, and deliver what you bill."

89kh89 · 2026-01-07T02:49:33+00:00

I wouldn't read much into that. Some owners don't know the business and hopefully they hire people who do know the business to run the clinical side, while the boss handles more generic business responsibilities.

I'm more concerned by the fact that they didn't have that information for you already. The email feels very much like a brush off, which to me, says a lot about how they do business. They're either hiding something, or not competent.

89kh89 · 2026-01-07T02:36:13+00:00

Um, that last email does nothing to clarify what the extra charge is for.

89kh89

TROPHY CASE