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Orthotics

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Orthotics is the medical field concerned with the application and manufacture of
orthoses, devices which support or correct the function of a limb or the torso. More
recently, the term cognitive orthotics has been applied to assistive technology to correct
cognitive functions.

The term is derived from the Greek "ortho", to straighten. Sciences such as materials
engineering, gait analysis, anatomy and physiology, and psychology contribute to the
work done by orthotists, the professionals engaged in the field or orthotics. Individuals
who benefit from a complex orthosis may have sustained a physical impairment such as a
stroke, spinal cord injury, or a congenital abnormality such as spina bifida or cerebral
palsy.

Simpler foot orthotics allow the muscles, tendons and bones of the feet and lower legs to
function at their highest potential. When appropriately prescribed, orthotics can decrease
pain, not only in the foot, but in other parts of the body such as the knee, hip and lower
back. They can also increase stability in an unstable joint, prevent a deformed foot from
developing additional problems, and improve quality of life overall.

Contents
[hide]

• 1 Custom / Prefabricated
• 2 Benefits
• 3 Structure and Function
• 4 Foot Orthotics
• 5 Reference
• 6 External links

• 7 Commercial Manufacturers of Foot Orthotics

[edit] Custom / Prefabricated


Some professionals choose to use the adjective orthotic as a noun, usually describing a
foot supporting device or insole. Orthosis (plural: orthoses) is the base word for orthotic
and is grammatically more apt to describe the items or devices that provide direct contact
with a portion of the external body surface, rendering resistance to unwanted movement.
All orthoses are fabricated prior to or concurrent with being delivered or fitted to the
person using them, even casts- as they are created on the patient and become effective for
use prior to being used by hardening. Some of the devices are made or fabricated with
specifications that derive directly from considerations of a single person end user. Some
orthoses are made to fit by sizing; e.g. small, medium, large

Orthoses that directly support the knee, back, hip, and even the upper extremity exist;
manufactured by specialized technicians and fitted to the end user, often referred to as a
patient, are delivered by orthotists. The orthotist generally works by prescription, as a
pharmacist would. In fact, some prefabricated orthoses can be found in a pharmacy. Some
prefabricated orthoses, or supports, are soft and can be purchased as a retail item. Care in
proper fit of any device that applies force to the body must be taken to ensure good
results and to prevent unwanted problems from an orthosis that is too tight or otherwise
uncomfortable.

Sophisticated custom orthoses to more rigidly support compromised joints, weak


muscles, and other medical conditions are often provided by orthotists. Plastic vs metal
and leather fitting, complex mechanical hinges, and fasteners to keep the orthosis affixed
well to the portion of the body that the orthosis supports are a part of the process in
delivering orthotic support.

[edit] Benefits
The following information, as with the third paragraph of the opening section of this
entry, has to do most directly with foot orthoses, shoe inserts, or as referred to in this
treatise- "orthotics".

In addition to providing relief for painful foot problems or an injury, those who may
benefit from orthotics include people who must walk or stand excessively on the job. For
those who are active in sports, orthotics will often increase endurance, performance and
strength. For overweight individuals, orthotics can help to counteract the extra stress on
the feet, as minor problems are often magnified due to the increased weight.

Orthotics are particularly effective in relieving foot fatigue and discomfort experienced
by older adults, who may have developed arthritis in their feet. Orthotics may also be
prescribed for children who have a foot deformity.

In athletic individuals, sports activities result in a great deal of movement and pressure on
the foot. Slight imbalances in the foot that are not harmful or even detectable under usual
circumstances may make one more vulnerable to injury with the extra stress of sports
activity. By eliminating the need for one's muscles to compensate for imperceptible
imbalances, orthotics can reduce fatigue and promote efficient muscle function to
enhance performance. With enough functional correction, the foot structure can be
aligned to give more propulsion, making walking, running and cycling more
mechanically efficient.
[edit] Structure and Function
Orthotics take various forms and are constructed of various materials. All have the goal
of improving foot function and minimizing stress forces that could ultimately cause foot
deformity and pain. There are three broad categories of orthotics: those that primarily
attempt to change foot function, those that are mainly protective or accommodative in
nature, and those that combine functional control and accommodation.

While orthotics can be made by several different processes, most podiatrists make a
plaster mold of the patient's foot and send it to a laboratory with a prescription. At the lab,
technicians pour plaster into the mold, and when it hardens; it exactly reproduces the
bottom of the individual's foot, although it is common for labs to "cast correct" by
partially filling in the arch. This decreases the arch height of the orthotic and is done for
comfort reasons. Once a reproduction of the individual’s foot is made, the technician’s
then use the doctor’s prescription to custom-make a device to meet the patient's specific
needs. The above process was first advocated by Root et al in the late 1970's and remains
the preeminent standard. It is based on the neutral position model of correction.

A completely different model and orthotic making process has been advocated by Edward
Glaser, DPM since 1992. In this model, the goal is to restore optimal arch height and
function, since it is loss of arch that is the most common factor behind foot pain and
deformity. In order to capture the optimal amount of arch for any given foot, casting is
done against the ground in foam. The orthotic is then made to match the exact shape of
the foot with the rigidity calibrated to be able to hold the arch up with activity and flex
slightly for comfort.

Rigid orthotic devices are designed to control foot function, and may be made from a
firm material such as plastic or carbon fiber. These types of orthotics are mainly designed
to control motion in two major foot joints, which lie directly below the ankle joint. This
type of orthotic is often used to improve or eliminate pain in the legs, thighs and lower
back due to abnormal function of the foot.

Soft orthotic devices help to absorb shock, improve balance and take pressure off
uncomfortable or sore spots. They are usually made of soft, compressible materials. This
type of orthotic is effective for arthritis or deformities where there is a loss of protective
fatty tissue on the side of the foot. They are also helpful for people with diabetes.

Semirigid orthotic devices are often used to treat athletes. It allows for dynmaic balance
of the foot while running or participating in sports. By guiding the foot through proper
functions, it allows the muscles and tendons to perform more efficiently. It is constructed
of layers of soft materials, reinforced with more rigid materials.

Calibrated orthotic devices are those based on the correction model and manufacturing
technique advocated by Glaser. It factors in the individual's body weight, foot flexibility
and activity level to deliver a custom calibrated level of support that delivers firm but
comfortable functional control while maintaining the properties of an accommodative
device.

Proprioceptive stimulation orthotics are an alternative approach to relieving


musculoskeletal pain in the feet, legs and back by changing how the feet perceive the
ground. Proprioceptive stimulation orthotics are based on 1] muscular control of the feet
and 2] that the foot and body responds to subtle pressure to the sole of foot. Dr. William
Rossi DPM suggests that shoes disrupt true feedback from the ground, and Dr. Brian
Rothbart DPM suggests that true feedback can be disrupted by the foot structure itself.
Proprioceptive stimulation alters feedback to the feet by strategically locating thin
dimensions on a flat flexible insole. Proprioceptive stimulation insoles work for both
supinators (weak ankles) and hyperpronators.

[edit] Foot Orthotics


Since feet are the major weight-bearing part of the body, foot pain is common; half of the
Americans polled by the American Podiatric Medical Association had missed a day of
work because of foot problems[citation needed]. The foot contains 26 bones and many small
structures which support and balance the weight of the entire body. Walking puts up to
1.5 times one's body weight on the foot, and humans walk an average of 1,000 miles per
year[citation needed].

Foot pain is not normal and should not be ignored; problems can affect the functioning of
other parts of the body, including the hips, knees, and back. These are foot-related
problems that may be related to biomechanical issues. Podiatrists, physical therapists and
sports medicine practitioners will often prescribe custom foot orthoses as part of a
treatment regimen.

They are prescribed to:

• Reduce the symptoms associated with many foot related pathologies.


• Provide support
• Accommodate foot deformity
• Provide better positioning
• Relieve pressure on a certain area of the foot
• Improve the overall biomechanical function of the foot and lower extremity

[edit] Reference
• Glaser, Edward, DPM et al "Focus On Function: Orthotic Theory &
Methodology"
• Positano, Dr. Rock DPM, MSc, MPH Director of the Non-Surgical Foot and
Ankle Service 2006, Hospital For Special Surgery, "Prescription Orthotics Can
Help You Put Your Best Foot Forward"
[edit] External links
• Theory and Practice Combine for Custom Orthotics
• PedAlign Digital Casting Systems
• Prescription Foot Orthotic Laboratory Association
• Foot Pain Explained
• National Commission on Orthotic and Prosthetic Education
• American Orthotic & Prosthetic Association
• American Academy of Orthotists & Prosthetists
• O&P Care.org
• American Board for Certification in Orthotics & Prosthetics
• http://www.hss.edu/Conditions/Orthotics/Prescription-Foot-Orthotics
• http://www.hss.edu/Conditions/Foot-Injuries-and-Conditions/Cosmetic-Foot-
Surgery
• http://www.hss.edu/Departments/Specialties/Physiatry/Affiliated-Centers-and-
Services/Non-operative-Foot-and-Ankle-Service/
• http://www.hss.edu/newsroom/avoiding-problematic-orthotics
• Board for Certification in Pedorthics
• Pedorthic Footwear Association
• National Orthotics and Prosthetics Company

[edit] Commercial Manufacturers of Foot Orthotics


• Sole Supports, Inc.: True Custom Calibrated Orthotics
• PAL Health Technologies

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