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.
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 include 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 increasingly sophisticated technology to provide its wide array of in-shoe foot orthoses as well as two models of ankle foot orthoses (AFOs).
In addition, it has converted to a CAD-CAM system, fully implemented workflow software that allows clients to upload patients’ foot scans, and has just begun a state-of-the-art renovation of its manufacturing plant. Despite these changes, Kramer said, the company still offers techniques and products that have been around for decades for its clients who prefer traditional methods.
The plant renovation, said Kramer, is an end-to-end redesign that will streamline processes and accommodate Levy & Rappel’s growing volume of work and burgeoning workforce.
“We’re also adding two CNC [computer numerically controlled] milling machines, for a total of three, to decrease turnaround times and improve service for our clients,” he said.
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 ethylene 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 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 makes all-leather orthoses. The company uses a tough flexible leather called Sole-Bends, which comes from the thick parts of the hide that run down the sides of a cow’s spine. The company’s line includes several three-quarter-length styles: one prescribed for arch support, one for rearfoot control, and a third 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 AFO lines 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.
For clients who are thinking of making the switch to digital orthotic prescription, Levy & Rappel provides loaner 3D foot scanners that allow these practitioners to access the faster flow and streamlined experience of up-to-the-minute technology.
With a scanner and the company’s workflow software, “They can 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 reduces both mistakes and turnaround times.
“We want to make it as easy as possible for customers to work with us,” he said.