Introduction to Orthotics

Introduction[edit | edit source]

The aim of orthotics are to increase the efficiency of function during acute or long-term injury. This includes soft-tissue and boney injury, as well as changes as a result of neurological changes. They can be an effective adjunct alongside physiotherapy techniques such as muscle strengthening and stretches, gait and balance retraining and reach and grasp strategies.

A number of considerations need to be made before deciding on the type of orthotic needed:

  • What are the patient’s goals?
  • What are the specific impairments impacting on their function (thinking of head-to-toe and gait analysis).
  • Are impairments the result of soft-tissue changes? Can they be changed with therapy input?
  • Is a walking aid needed?
  • Does the injury need to be protected from particular movements?
  • Can an orthotic improve the efficiency of an activity?
  • Can the patient cope with any adjuncts given?

Orthotics can be pre-made or customised, depending on the patient's needs.

What is an Orthosis?[edit | edit source]

An orthosis is generally an individually designed or customised device, which is applied to the external part of the body to provide support and protection for that particular area of the body. It uses integrates biomechanical principles to realign joints and reduce pain. The design, materials and function of the orthosis is based on a patient assessment, including their medical history, biomechanical principles and the individual needs of the user.

"Off the shelf" Orthotics[edit | edit source]

Many patient's can utilise ready made orthotics, which can often be adjusted to fit their size. These may come in small, medium and large sizes and can often be sized to the patient, e.g. with velcro straps. These are often lighter materials. They can also be good for an assessment, to confirm or deny a theory before a custom orthotic is made.

Custom Orthotics[edit | edit source]

Some individuals have more complex injuries / changes to one of multiple joint structures, and therefore require a customised orthosis. This may be particularly true in neurological conditions, such as Cerebral Palsy (CP), Parkinson's Disease (PD) or after brain injury, such as traumatic brain jury (TBI) or stroke. In these cases, spasticity of muscles may have an impact on the patient's function. Orthotics can be used both in resting and during mobility to improve affects of spasticity or reduce risk of contractures. In which case the orthotic will be specifically measured to the individual, and likely to be redone as the individual grows (in paediatrics) or as changes are made to joint structures.

Why is an Orthosis used?[edit | edit source]

An orthosis provides support and protection for joints or parts of the body. It can optimally align a joint into a better functional position, whether it be the position of a hand or an elbow or a knee or a foot.[1] It is often used to reduce pain. A good orthosis can also maintain a functional position with the joint and we can use an orthosis either dynamically or statically to achieve this functional position.

Where can an Orthosis be used?[edit | edit source]

An orthoses can be fitted to any part of the body from the head, such as helmets to the feet and toes with insoles and footwear.[2]

3 Steps to Create an Orthosis[edit | edit source]

The position, structure, design and fitting of the orthosis is based on the assessment of the patient and clear goals of what the therapist and patient want to achieve.[3] This can be a complex process and a problem-solving exercise. [4]All orthotists need to be good at problem solving.[5]

The three main steps to follow are assessment, design and manufacture, and fitting and evaluation.

1. Assessment[edit | edit source]

  • Medical/Physical
  • Biomechanical[6]
  • ROM/Muscle Power
  • Proprioception
  • Sensation

2. Design/manufacture[edit | edit source]

  • Materials
  • Construction
  • Suspension/strapping
  • Cosmesis

3. Fitting and evaluation[edit | edit source]

  • Good anatomical fit
  • Good biomechanical function
  • Easy to don/doff
  • Comfortable to wear

Advantages[edit | edit source]

Lower limb: Influence both swing and stance phase of gait[7].

  • Prevent or correct deformity and reduce pain during weight bearing
  • Improve efficiency of gait and maintain balance
  • Improve base of support / lateral support
  • Reduce need for compensation of ipsilateral and contralateral limbs and secondary pain
  • To facilitate training in skills

Upper limbs: Can be used after an injury to prevent further injury, or reduced pain by supporting an injured limb.

  • Prevent or correct deformity reducing pain and maximising function in reach and grasp tasks.
  • In prove efficiency of reach and grasp tasks
  • Off load an injured limb to allow healing
  • Reduce need for compensation of ipsilateral and contralateral limbs and secondary pain
  • Improve role of upper limb in maintaining balance

Spine: Stabalise spinal fractures to allow the patient to return to some normal activies (although they may be restricted) and protect the spinal cord.

Possible Complications[edit | edit source]

  • Loss of sensation (check skin regularly- risk of pressure areas)
  • Compensations in ipsilateral or contralateral limbs.
  • Impact on spasticity (is the patient utilising spasticity to allow some function in absence of muscle strength?)
  • Complications of casting at incorrect angle: Foot deformities[8], increased knee flexion in stance[9], muscle contractors[9]
  • Loss of sensory feedback and proprioception loss
  • Ristricted range of motion
  • Loss of natural shock absorption and long term joint damage
  • Spinal orthotics must be put on and taken off within the guidelines of a spinal professional. Patients may be able to moblise within set restrictions, depending on the severity of their injury. Non-adherence to guidance may result in spinal cord injury.

Consider:[edit | edit source]

  • Cosmesis
  • Footwear
  • Weight/rigidity
  • Ability to Don Doff
  • Compensations preferred
  • Compensations required

References[edit | edit source]

  1. Webster JB, Murphy DP, editors. Atlas of orthoses and assistive devices. Amsterdam, The Netherlands:: Elsevier; 2019.
  2. Jarvis HL, Nester CJ, Bowden PD, Jones RK. Challenging the foundations of the clinical model of foot function: further evidence that the root model assessments fail to appropriately classify foot function. Journal of foot and ankle research. 2017 Dec;10(1):1-1.
  3. Chui KC, Jorge M, Yen SC, Lusardi MM. Orthotics and Prosthetics in Rehabilitation E-Book. Elsevier Health Sciences; 2019 Jul 6.
  4. Mangai S, Ranganathan R, Pugalendhi A, Gokul Raj N, Deepan Raju S, Dharani T, Durga R. Design And Development Of Ankle Foot Orthosis Using Additive Manufacturing Technique.
  5. Menz HB, Allan JJ, Bonanno DR, Landorf KB, Murley GS. Custom-made foot orthoses: an analysis of prescription characteristics from an Australian commercial orthotic laboratory. Journal of foot and ankle research. 2017 Dec;10(1):1-9.
  6. Nester CJ, Jarvis HL, Jones RK, Bowden PD, Liu A. Movement of the human foot in 100 pain free individuals aged 18–45: implications for understanding normal foot function. Journal of foot and ankle research. 2014 Dec;7(1):1-0.
  7. Condie & Meadows Report of a consensus conference on the lower limb orthotic management of cerebral palsyInternational Society for Prosthetics and Orthotics(1995) ISBN 9788789809021
  8. Karakas & Hoy (2002)
  9. 9.0 9.1 Owen E. The Effects of Tuning an Ankle-Foot Orthosis Footwear Combination on Kinematics and Kinetics of the Knee Joint of an Adult with Hemiplegia Prosthetics and Orthotics (2014) 34(3): 270-6