David Kramer, CPed, didn’t start out to build a career in custom foot orthotics; the tendency just ran in the family. Kramer’s uncle owned Levy & Rappel, the venerable orthotics company in Saddle Brook, NJ, then sold it to Kramer’s father, Bob, in 1993. Bob Kramer, DDS, a retired dentist and dedicated bass fisherman, died in 2010, so David, who was already serving as company president, took the reins.
“I just came to work here after college because I needed to make some money,” David acknowledged with a laugh. “It turned out I never left.”
Levy & Rappel has a long and storied history. Founded in 1930, the company made its mark by developing and marketing a soft supportive custom foot orthosis. Past clients included a couple of US presidents and many of the GIs serving in World War II.
The company has expanded since those days and now offers a wide array of in-shoe foot orthoses as well as two new models of ankle foot orthoses (AFOs). It has converted to a CAD-CAM system and has other innovations in the works, but it still offers techniques and products that have been around for decades.
The company’s orthosis line includes the Pro-Walker, which comes in two models, both of which combine polyethylene thermoplastic with a cushioning top layer. “These are hybrids of a fully functional and an accommodative device,” Kramer said.
Levy & Rappel also offers three-quarter length functional orthoses made of either ortholen (a dense polyethylene) or graphite, which can be made in a range of rigidities and designs.
The company’s Bio-Sport line features full-length orthoses, also available in ortholen or graphite. “The Bio-Sport line is for more athletic active people,” Kramer explained. “It’s for common foot ailments in these patients—anything from nonspecific pain to plantar fasciitis to pes planus.”
The carbon version is thinner, lighter, and rigid, whereas the ortholen model is semirigid. Both offer top covers designed to minimize friction and shear forces.
Levy & Rappel also makes accommodative orthoses from various combinations of ethyl vinyl acetate (EVA), leather, Plastazote, and cork. There is, in addition, a line of low-cost, multidensity, diabetic-specific orthoses, machine milled using the company’s CAD-CAM system. This new Levy Diabetic line of orthoses meets Medicare guidelines. For those patients with forefoot amputations who require toe fillers, Levy & Rappel offers a full line of partial foot prostheses.
Levy & Rappel is one of the few companies that still make all-leather orthoses. They use a tough flexible leather called Sole-Bends, which comes from the thick parts of the hide that run down the sides of the cow’s spine. The company’s line includes several three-quarter length styles: one prescribed for arch support, one for rearfoot control, and one for fashion footwear.
“You cut the pattern out of this big piece of cowhide, skive it to uniform thickness, and soak it in water until it’s malleable,” Kramer explained. “Then you strap it onto the mold and let it dry overnight, and it will hold its shape.”
The insoles can keep that form almost indefinitely, as long as they don’t get soaking wet, he added. “I’ve gotten them back in the shop after twenty years for a new top and bottom cover.”
Levy & Rappel’s AFO products include a molded gauntlet with a posterior heel window and either lacing or Velcro closures, and an articulated model. The new lines of AFOs include the Levy Dynamic and the Levy AFO to meet a variety of indications and patient requirements. The bulk of the company’s business is still in-shoe orthoses, however, and in that realm Kramer is doing his best to strike a balance between tradition and innovation.
“Until about four years ago, we would pour every mold in plaster and hand modify them,” he said. “It was all done by hand, from scratch, and we still do many things the traditional way. But we also now have a CAD-CAM 3D foot imaging system in-house, so we can make a 3D image of the negative cast, and build the positive from that instead of pouring plaster. We mill the positive molds, and everything is scanned and digitized; we don’t have a big room storing positive casts any more.”
The company is also implementing new workflow software that will allow clients with foot scanners to log in and upload those scans.
“They’ll be able to scan a foot in their office, log in to their account, and enter their orders, along with whatever adjustments they want, such as raising the arch,” Kramer said, noting that this approach should reduce both mistakes and turnaround times. “We want to make it as easy as possible for customers to work with us.”
Cary Groner is a freelance writer in the San Francisco Bay Area.