What is Orthotics: Symptoms, Causes, Diagnosis, and Treatment

Definition & Overview

Orthotics refers to the branch of medicine that deals with the designing and manufacturing of shoe devices used to aid people suffering from a wide range of foot problems. Orthotic shoe devices, such as insoles and braces, are molded using rubber, metal, plastic, leather, and other synthetic materials such as carbon fiber, EVA, thermoplastics, or a combination of any of these materials. Their main purpose is to keep the foot in a neutral position. In addition, they also provide cushioning to protect the foot from overuse. In some cases, they also help reduce foot pain.

Different foot problems call for different orthotic devices, which are prescribed by orthotists, doctors who have received specialization in this specific field. For the more common orthotic devices, patients can choose between generic non-prescription orthotics, which are available in drugstores and sporting goods stores, and custom-made ones, which are more expensive. For less common orthotics that have very specific functions, an orthotist custom designs the devices based on the patient’s unique circumstances.

Cause of Condition

Orthotics has several functions depending on the needs of the patients. These include:

• To control and guide a joint or body segment
• To limit or immobilize an extremity
• To support weak limbs
• To restrict movement
• To assist movement
• To reduce weight bearing
• To speed up rehabilitation after cast removal in the case of fractures
• To correct pronation problems
• To improve athletic performance
• To reduce pain
• To protect from injury

People may need orthotics for several possible reasons. Some of the most common are:

• Underlying condition such as cerebral palsy or spina bifida
• Past injury in the spinal cord
• History of stroke
• Plantar fasciitis and other soft issue inflammatory problems
• Spine deformities
• Arthritis
• Fracture injury
• Paralysis
• Sciatic nerve
• Interdigital neuroma
• Impaired muscles

Key Symptoms

To determine whether an orthosis may be necessary for your condition, here are some symptoms to watch out for:

• Foot pain while standing
• Foot pain while walking
• Muscle tightness
• Recurrent muscle tears and strains
• Knee pain
• Back pain
• Neck pain
• Hip pain
• Heel pain
• Calluses and corns
• Bunions
• Achilles tendonitis
• Morton’s Neuroma
• Shin splints
• Patella femoral syndrome
• When shoes wear out unevenly
• When shoes wear out unusually quickly

If you experience any of these symptoms, the biomechanics of your feet should be assessed by an orthotist. Such assessments are, as of present, conducted using the TOG Gaitscan, an advanced computerized technology.

If you suffer from an immobilizing, limiting, or paralyzing injury, your attending physician will refer you to an orthotist if you will need an orthosis during the recovery period.

Who to see & types of treatments available

If you think an orthosis may benefit you, look for an orthotist in your area or you may also approach an orthopedist, who can oversee the entire treatment plan while working closely with an orthotist.

It is now easy to have a special orthotic device made especially for the purpose that you require, thanks to the advances in the manufacturing process. Today, an orthosis is manufactured using a plaster of Paris molding of the body part that requires assistance. The actual design of the device is then rendered using CAD/CAM and CNC machines. The 3D printing technology has also greatly improved the accuracy and efficiency of orthotics manufacturing.

Orthoses are classified based on the body region that they are used for. Here are the different types of orthotic devices:

1. Upper-limb orthoses

• Clavicular and shoulder orthoses
• Elbow orthoses
• Arm orthoses
• Upper-extremity orthoses
• Hand orthoses
• Forearm-wrist orthoses
• Forearm-wrist-thumb orthoses
• Forearm-wrist-hand-orthoses

2. Lower-limb orthoses

• Foot orthoses – These refer to custom-made inserts or foot beds that are fitted into a shoe. Foot orthoses are available in many different types, such a general sports insoles, running insoles, and insoles for fashion and dress shoes. There are also foot orthoses specifically designed for children, elderly patients, and arthritis sufferers.

• Ankle-foot orthosis (AFO) – These are braces that cover the entire ankle to foot area; they are also known as foot-drop braces. These are the most common of all orthotic devices, making up around 26% of all orthoses in use in the United States. Due to their widespread use, they now come in different types, namely flexible, anti-talus, rigid, and tamarack flexure joint AFOs, to address different problems.

• Knee-ankle-foot orthosis (KAFO) – These are longer orthotic devices that cover the knee all the way down to the foot. These are most useful for paralyzed patients.

• Knee orthosis (KO) – Also known as a knee brace, this orthotic device supports and align the knees. It is most useful in cases where flexion and stability of the knees are compromised, such as in neurological conditions and muscular impairment. Knee braces are also helpful for arthritis and osteoarthritis sufferers as they can realign the knee’s joint into the varus or valgus.

• Prophylactic braces – These are beneficial for athletes who do contact sports such as football as these help prevent ligament tears.

• Functional braces – These are meant for patients suffering from a knee injury. Their design helps them prevent hyperextension of the knee. In the long run, these can improve the strength and agility of the knee.

• Rehabilitation braces – The main purpose of rehabilitation braces is to limit movement while waiting for complete healing. These are commonly used after ACL reconstruction, the rehabilitation stage that athletes undergo after suffering from an ACL injury.

3. Spinal orthoses

Spinal orthotic devices are used to treat abnormal curvature of the spine, which is the defining factor in most spinal conditions, such as scoliosis. They can also be used as part of rehabilitation therapy following a spinal fracture. Spinal orthoses come in different kinds, namely:

• Milwaukee brace
• Boston brace
• Charleston bending brace
• Jewett brace – This brace speeds up healing and rehabilitation following an anterior wedge fracture.
• Halo brace – This is a cervical thoracic brace that limits the movement of the cervical spine to allow healing after injury or fracture.

When fitting a new orthotic device, make sure to remember the basic rules in orthotics use:

• The device must be comfortable
• The orthoses must relieve the symptoms previously felt
• The orthoses must have a warranty from the manufacturer

Take note, however, that orthotics cannot completely treat an injury or disease. Instead, it is used as part of a treatment plan together with medication, surgery, and physical therapy.

Resources:

• American Academy of Orthotists and Prosthetists
• The American College of Foot and Ankle Orthopedics Medicine: “Prescription Custom Foot Orthoses Practice Guidelines”
• Afzal B, Bashir MS, Noor R. (2014). “Role of foot orthosis in management of planter fasciitis.” Rawal Medical Journal.

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## Understanding Orthotics: Alleviating Foot,‍ Ankle, and Gait Issues



### What is Orthotics?



Orthotics are medical devices designed to align, support,​ and/or immobilize the foot or lower leg.‌ They can be customized to address various foot, ankle, and lower‌ limb issues, such as:

“Flatfoot,” Plantar Fasciitis, Differing Leg Length, and other conditions affecting balance, stability, or a natural⁣ walking stride.



### Orthotics Types

Orthotics generally fall into one​ of ⁣three classes:



1. **Rigid:** These offer maximum support and restriction of ⁣motion.



2. **Semi-Rigid:** These provide moderate foot support ⁤and some degree of flexible movement.



3. **Soft:** ⁣These are ⁣often used for shock absorption and cushioning.



#### 1. Prescription vs. Over-the-Counter (OTC) Orthosis

Prescription orthotics are custom-designed and created based on an extensive evaluation of a patient’s biomechanics and condition. ⁢OTC orthotics are pre-fabricated and come in standard‍ sizes.



#### 2. Custom vs. Off-the-Shelf Insoles

Custom orthotics are made specifically to fit a particular person’s foot, while off-the-shelf insoles are pre-made to fit a wider⁢ range of feet.



## Symptoms and Conditions which Orthotics Address



Orthotics are commonly‍ used to treat a range‌ of‍ symptoms and conditions, including:



* **Biomechanics:**⁢ Variations in musculoskeletal systems that ​influence standing, walking, and movement



* **Foot** Measurement, Proportion, and Posture Gait analysis determines the interplay between orthotics, shoes,⁣ and the ⁤lower kinetic chain



* ‌**Impaired Balance or⁢ Stability:** Abnormal ankle/foot stability caused by ‍foot and ankle instability, weakness, or injury



* **Pain ⁣and Discomfort:** Heel pain, arch pain, metatarsalgia, heel ⁤spurs, plantar‌ fasciitis



*⁢ **Developmental Conditions:** ​Flexible flatfoot or foot deformity correction, abnormal joint alignment ⁣or position



* **Other Conditions:**‍ Lower limb length discrepancies, diabetes, nerve‍ damage, arthritis



### Diagnosis and Examination for Orthotics



A comprehensive evaluation and diagnosis are‌ essential for determining the best orthotic solution.

An assessment typically involves:



* **Physical Examination:** A healthcare provider ⁣will​ assess stance, posture, alignment, range of motion, and observe walking ⁢patterns.

* **Observational Gait Analysis:** A clinician will observe a patient’s walking pattern, checking for foot placement, step ⁤length, and heel strike.

* **Biomechanics:** A podiatrist/orthopedic specialist will analyze lower limb biomechanics with sensors, motion cameras,‍ and computer algorithms, capturing data like pressure distribution and foot angles.



### Treatment with ⁢Orthotics



Orthotics work to improve foot and lower limb biomechanics, thereby alleviating pain, strain, and abnormal walking patterns. They can also enhance balance, stability, and mobility.



#### Effectiveness of Orthotics



The effectiveness ⁣of Orthotics varies based on the condition being treated‍ and​ the individual’s circumstances. Studies have suggested that orthotics may:



1. Reduce Pain and Improve Balance: ⁣Custom OTC arch supports⁣ eased pain in diabetic foot ‌ulcer patients.

2. Improve Mobility in Arthritis Patients: Custom OTC orthotics enhanced ⁢mobility in mild knee osteoarthritis patients.

3. Alleviate Plantar Fasciitis Symptoms: Inflammation, pain, and stiffness reduction with OTC arch supports in plantar fasciitis cases.



#### Adaptations​ & ‌Maintenance of Orthotics

For optimal results, patients should observe their Orthotics’ adjustment ‌period for adaptation and may experience discomfort for a period before adaptation is complete. Orthotics ⁢generally last between 12‌ and 18 months, and patients⁣ are advised to consult with ⁤their healthcare provider about proper ⁣maintenance and potential re-evaluation needs.