Introduction and Types of Orthotics

Introductions of Orthotics

An externally applied used to the device modify the structural or functional characteristics of the neuromusculoskeletal system. Alternative Definition: An apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body.

During static stance and ambulation, the lower extremities are subjected to external forces and moments. During normal function, these troops and moments are resisted or controlled by internal structures of the body. These structures include skeletal segments, ligamentous connections, and muscle-tendon units.

When internal structures fail, orthoses can modify external forces and moments to allow the body to function in a “normal” manner.

An external device used to support or improve function of the foot and ankle can take many physical forms. This orthotic can be as simple as a felt pad placed under the metatarsals or as sophisticated as a composite brace controlling foot and ankle motions.

Orthotics prescribed for lower extremity pathologies include foot orthoses (Fos), ankle-foot orthoses (AFOs), knee orthosis, and knee-ankle-foot orthoses.

Types of Orthotics

Various types of orthoses commonly prescribed for foot and ankle pathologies. An overview of these orthoses provided in a show at Image 3.1

The primary subcategories are FOs prefabricated and custom. There are clear differences between the manufacture and design of orthoses in each category, yet advantages or benefit of one type of device over another has yet to prove.

Prefabricated devices have the distinct advantage of lower cost compared with custom-fabricated foot orthotics. In addition, prefabricated orthoses can be stocked in the clinic, pediatric facility, or retail setting for immediate dispensing to the patient.

3.1

The disadvantage of prefabricated orthotic devices is their difficulty in application to limb and foot shapes that fall outside the “average” range.

Custom molding and contouring of an orthotic device to a body segment may be the critical feature necessary for a successful treatment outcome. The mechanism by which foot orthotics achieve their treatment effects remains poorly understood, and thus claims of superiority of custom versus prefabricated device remain somewhat speculative.

Prefabricated FOs are available for a broad range of clinical application. In general, these methods are used to off-load specific areas of the foot, cushion the foot from impact, support the medical longitudinal arch, and provide mild biomechanical control of hindfoot movements.

Custom FOs fall into two basic categories: accommodative and functional. Functional orthoses are most often used with flexible feet, and work to alter how the foot meets the floor. Accommodative orthoses used with more rigid deformities. Rather than attempting to change foot alignment, accommodative orthoses work to relieve pressure under bony prominences (make the floor fit the foot better).

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