Justification for Echelon Foot: Descriptor; Self Aligning Feature, with Adjustable Hydraulic Plantar & Dorsi Flexion Control Patient Name: Above Knee: Below Knee: Prosthetist: Facility: Date: Dear Medical Professional/Insurance Adjuster As no particular code exists for the specific function of the Echelon Foot, a code ofL-5999 with the above descriptor must be used. Please read the information which describes the major benefit of the Echelon Foot for an amputee. The Echelon Foot provides dorsi flexion and plantar flexion including a feature of automatic alignment to terrain. It is designed to facilitate walking on level or uneven ground, up and down inclines, ascending or descending stairs and sitting down at ease. The Echelon's continuous adjustment to terrain helps give the amputee better distribution of forces at the interface from the prosthesis to the body. Through increasing knee stability and safety for the amputee the risk of falls is significantly reduced and confidence is increased as a result. The Echelon and it's unique ability to self align distinguish it from all other conventional ankle-foot systems. When the user walks on level terrain the Echelon Foot remains in a dorsi flexed position after "toe off'. This enables the user a greater ground clearance during swing phase, minimizing the risk of catching the toe and potentially falling. At heel strike the foot moves into plantar flexion to initiate a stable safe base for loading of the prosthesis. When the amputee walks up or down inclines the hydraulic fluid adjusts the foot to match to the gradient. In stair ascent Echelon moves up to 9 degrees (seefig J) during the first step. Similarly when descending stairs the hydraulic ankle allows dorsi flexion during the first step which permits the user to place the entire prosthetic foot on the subsequent downward step further enhancing safety and comfort. I, j~.§~ r\,_~.1 '3' JJ.J t= ~i Ij ! I '~! \I Hydraulic Ankle I" <;) \1, ~ __I?) 0 Fig L Echelon model of the self-aligning with plantar/dorsi flexion motion How this is achieved: Apart from prosthetic socket fit, the alignment of prosthesis (e.g. the geometrical positioning of the prosthesis relative to the body) has a profound effect on the function that the prosthesis provides and the long-term rehabilitation outcomes for amputees. The main drawback with current prostheses is that all the prosthetic foot designs are based upon an ankle-foot mechanism that continually force the ankle-foot towards a fixed position established by the prosthetist during fitting in a clinic on level terrain. This means the alignment of the foot relative to the body