Chapter 30: Orthotics

LEARNING OBJECTIVES

1. Relate the major parts of the shoe to the requirements of individuals fitted with lower-limb orthoses.

2. Compare the characteristics, advantages, and disadvantages of plastics, metals, and other materials used in orthoses.

3. Describe the components of contemporary foot, ankle–foot, knee–ankle–foot, hip–knee–ankle–foot, trunk–hip–knee–ankle–foot, and trunk orthoses.

4. Explain the orthotic options available for patients with paraplegia.

5. Identify the features of lower-limb and trunk orthoses that are considered during the examination process.

6. Outline the physical therapist’s role in management of patients fitted with lower-limb and trunk orthoses.

7. Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.

INTRODUCTION

An orthosis is a device worn to restrict or assist motion or to transfer stress from one area of the body to another. An alternate term is brace. A splint is a temporary orthosis. An orthotist is a health care professional who designs, fabricates, and fits orthoses for the limbs and trunk, while a pedorthist is a health care professional who designs, fabricates, and fits shoes and foot orthoses. The term orthotic is an adjective. Archaeological evidence confirms that orthoses have been used for at least four thousand years.¹ The term orthosis originated in the mid-twentieth century.

This chapter presents the most frequently prescribed orthoses for the lower limb and the trunk, as well as new developments in the field. Essentials for teaching patients to use orthoses are considered. Focus is on orthotic designs and materials, biomechanical rationale, and criteria for evaluating orthotic fit, function, and construction. While every attempt is made to use evidence-based research to guide clinical practice, paucity of research and heterogeneity within the population of orthotic users and within orthotic designs confound this effort.²

TERMINOLOGY AND TYPES OF ORTHOSES

Orthoses are named by the joints they encompass and motions controlled. Foot orthoses (FOs) are applied to the foot and placed inside or outside a shoe. Ankle–foot orthoses (AFOs) encompass a shoe and terminate below the knee. The knee–ankle–foot orthosis (KAFO) extends from the shoe to the thigh. A hip–knee–ankle–foot orthosis (HKAFO) is a KAFO with a pelvic band that surrounds the lower torso. A trunk–hip–knee–ankle–foot orthosis (THKAFO) covers part of the torso and the lower limbs. Knee orthosis (KO) and hip orthosis (HO) cover their respective joints. Cervical orthoses encircle the neck. Most trunk orthoses are named by the motions controlled, although orthoses that manage scoliosis usually are named for the city where they were designed.

LOWER-LIMB ORTHOSES

Lower-limb orthoses (LLOs) range from shoes used for clinical purposes to THKAFOs. Characteristics and functions of the principal FOs, AFOs, KAFOs, HKAFOs, and THKAFOs, and trunk and cervical orthoses will be described. Although physical therapists occasionally encounter KOs, HOs, and orthoses for special purposes, such as management of Legg Calve Perthes’ disease, ...