Orthotics is a specialty concerned with the provision of external devices/aids to any part of your body to prevent or correct deformity, promote or improve function of an affected area, or support pain reduction.
Orthotics involves the design, manufacture, fitting and application of these externally applied devices. It is so called as these devices are known as orthoses. They include braces, splints, footwear, insoles and supports that are used to guide and limit or immobilise joints that are injured, or to more evenly distribute weight bearing forces across joints and alleviate pain.
Our consultant orthotists work as part of a multi-disciplinary team of physiotherapists, podiatrists, consultant orthopaedic surgeons, consultant neurosurgeons and consultant rheumatologists to provide the best treatment options for your individual condition or injury.
What do orthoses do?
There are many different options and your orthotist will discuss the appropriate devices with you. Their main aim is to allow you to be more mobile and independent by making them as comfortable and functional as possible. They can:
- assist with joint motion – if you have muscle weakness
- resist joint motion – if joint movement causes you pain or instability
- relieve weight – to reduce pain in weight bearing areas of your body
- prevent deformities – by controlling your joints and relieving pain or discomfort, deformities from progressive conditions can be prevented or limited.
- improve body mechanics - orthoses can offer improved biomechanics when you stand, walk or take part in sport.
An initial assessment
An orthotist will initially perform a full clinical assessment. This usually involves a static and dynamic biomechanical assessment. They will then discuss appropriate and individualised orthoses for your treatment.
A static assessment is when you’re not moving and can be either weight bearing or non-weight bearing. Your consultant will see any unusual joint positions and check for muscle strength.
A dynamic assessment is a weight bearing assessment of your body whilst moving so that your consultant can see if there are any unusual joint positions or movements whilst moving.
Types of orthotics
Ankle foot orthoses (AFO)
There are many types of AFO such as rigid, hinged, dynamic, prefabricated and silicon. The decision will be based on the function you require of the device, your level of mobility and your health. AFOs aim to improve your mobility, support rehabilitation and your biomechanical goals. They are often used for conditions such as foot drop or reduced ankle stability.
Foot orthoses (FO)
Foot orthoses are devices that are worn in your shoes to change the way your foot works whilst walking and to provide cushioning or support. They can reduce pain, prevent or halt the development of a foot deformity, improve positioning, relieve pressure on a certain area of your foot and improve the biomechanical function of your foot, reduce lower limb and knee stress and improve pelvic alignment.
They are used for posture related pains, such as forefoot pain (metatarsalgia), heel pain (plantar fasciitis), heel spur, ankle pain (tibialis dysfunction, lateral impingement syndrome), knee pain (patellofemoral pain syndrome, patella tibial syndrome), shin pain (compartmental syndrome, shin splints), and hip and back pain.
Shoe inserts and insoles can be made of various materials and are selected on your weight, the reason for the inserts, and the type of footwear that the inserts are to be used with. You may be recommended shoe adaptations such as compensatory raises, rocker soles, wedges or flares.
Ankle foot orthoses (AFOs)
Ankle foot orthoses are designed to make standing and walking easier. They can control your foot and ankle position, accommodate a fixed joint position, compensate for muscle weakness, and reduce pain. AFOs are designed to be worn with footwear.
Knee ankle foot orthosis (KAFO))
These orthoses are used to compensate for muscle weakness, paralysis or skeletal problems which cause lower limb instability. They make standing and walking easier by: controlling knee and ankle joint instability, preventing excessive joint movement, improving your joint alignment and reducing pain. KAFOs can be metal or plastic. They are often used in the treatment of neurological conditions such as cerebral palsy, multiple sclerosis, spina bifida and traumatic brain injury.
Knee orthoses or braces are used for many problems affecting your knee joint such as knee ligament injuries, sports injuries, arthritis and patella dislocations. They help to reduce pain and stabilise your knee so that you can continue with normal everyday life and return to contact sports.
These orthoses are used to control the movement of your knee and ankle. They can be used for joint protection, pain reduction or support after surgery.
Spinal orthoses, also known as back supports or back braces, are used to correct, control, support and immobilise spinal deformities and injuries. They can control joint instability, prevent excessive joint movement, improve joint alignment and reduce joint pain.
These devices are designed for your individual needs and fall into three types: rigid devices with plastic or metal sections or supports, fabric devices and a combination of rigid and fabric sections.
Custom made and prefabricated orthoses
There are many prefabricated and custom-made orthoses. It’s important that they are fitted by a fully qualified orthotist or podiatrist.
Over the counter orthoses
These include insoles, foot supports and orthotic boots. They are often bought for mild pain and to help in rehabilitation.
It’s best to have your problem assessed first by a consultant orthotist or podiatrist as custom made orthoses may be a better option for you.
These can specifically suit and fit the shape of your foot. Assessments are carried out to determine the problem and casts can be made for a customised orthotic. Wearing custom made designs may take a little getting used to but they can take away any pain that is being caused by the problem immediately.
The fitting of your orthosis can take up to one or two hours, depending on its complexity. Sometimes, more than one fitting is required to adjust and fine tune your orthoses. Footwear and insoles may need to be worn in gradually.