Hanger Clinic/ExoSym

The ExoSym (formerly the IDEO) device became available to civilians (it was designed for and used by wounded warriors prior) in 2013. There is only one place in the United States to get these devices, the Hanger Clinic in Gig Harbor, Washington. A lot of club foot sufferers have received these devices and reported tremendous success in getting their quality of life back. I’ve linked to a few of their blogs in my Resources & Links page.


AS of 2016, the ExoSym costs $9,000 per device, and this includes casting, fitting, and up to eight physical therapy appointments to learn to use it. Insurance covers it in some cases (depends on your coverage, location, etc.). The folks at the Hanger Clinic are good about helping you get together what you need to request coverage from your insurance company. They’ll work closely with your doctor as well to help increase your odds. It took a little work, but in the end my Premera Blue Cross insurance assured me they covered the devices minus my deductible (that story is here). Be ready to pay out your full deductible to the Hangar Clinic as the clinic requires that before you take delivery of the devices.

For me, I’m getting two, so the total number of visits for me is 10, a casting appointment, a test device appointment and eight PT appointments to adjust the device and train my body. It’s less if you only have one device or your body assimilates quickly to the devices. Folks from out of town often decide to fly in and get the device in one or two several-day visits. In this area I was really, really lucky. I live 45 minutes away in Seattle so drive down for my appointments. Many people who have come from out of town have saved money by going with an airbnb. The Hanger Clinic folks send you valuable info on where to stay in town if you do need to stay once you’ve set up an appointment. Why not make it a vacation? This is such a gorgeous part of the world!


Below is information directly from the Hanger Clinic’s ExoSym Website as of July 2016. There is a lot of info there so it’s worth a look:

If you have experienced a severe lower limb injury, perhaps even limb salvage surgery, you may be wondering if you will ever get your life back. You may have tried traditional ankle-foot orthoses (AFOs) but still experienced limited movement or pain.

You’re not alone. Some people in similar situations have even chosen amputation as a way to move on, since it is now possible to live an active life with prostheses.

However, the decision to amputate is irreversible. If you are determined to get back to work and to an active lifestyle, Hanger Clinic has another solution to offer: the ExoSym™ kinetic orthosis.

Background of the ExoSym (formerly IDEO)

Prosthetist Ryan Blanck designed the Intrepid Dynamic Exoskeletal Orthosis (IDEO*) at the Center for the Intrepid, Brooke Army Medical Center in 2009. His goals were to reduce pain and restore mobility to active-duty and retired service members with limb salvage conditions as a way to avoid amputation.

The IDEO provided increased dynamics and energy return to give patients more agility and enable high impact activities like running, jumping, skydiving and redeployment, sometimes carrying up to a 120‐pound ruck sack. Of the 500+ service members who received custom IDEO devices, many have returned to active duty and deployment.

Hanger Clinic continues to support the military in these goals, while bringing this Department of Defense-proven technology to civilians. Ryan joined Hanger Clinic in 2013 and now provides the highest possible level care with the ExoSym program to restore high‐level activity and function to patients with severe lower-extremity conditions or injuries.

Candidates for the ExoSym Kinetic Orthosis

The ExoSym device has helped patients across the United States, Canada and abroad with limb salvage injuries as well as ankle fusions, partial-foot amputations, fractures, tarsal coalitions and other lower extremity dysfunctions.

Device Design

The ExoSym device is an evolution of the IDEO that is lighter, thinner and stronger than the original version. It is more like a hybrid prosthetic‐orthotic design than a conventional orthosis. The upper section incorporates many socket design concepts used in prosthetic limbs. Each patient is evaluated for the right degree of alignment and off‐loading for the specific injury and dysfunction. The ExoSym incorporates a specialized dynamic energy‐storing strut system often used in prosthetic running limbs for amputees. This adaptation provides injury‐specific deflection, energy storage and power, all while maintaining control and minimizing pain.

Alignment and positioning is critical to success. Even with similar injuries, each case must be carefully evaluated to determine the exact characteristics of strut resistance, ankle positioning and triplanar control. Each patient is evaluated utilizing a variety of tests and measures to make sure he or she is a good candidate. This allows the ExoSym to be custom-made for each individual’s needs with optimal alignment, positioning, off‐loading and control.


For more info on the devices, check out the ExoSym website.