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Orthotics

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Orthotics is the medical field concerned with the application and manufacture oforthoses, devices which support or correct the function of a limb or the torso. More

recently, the termcognitive 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 astroke, spinal cord injury, or a congenital abnormality such asspina bifida orcerebral

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 decreasepain, 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 afoot 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.
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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 withspecifications 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 apatient, 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 inproper 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 metaland 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 indelivering 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 thistreatise- "orthotics".

In addition to providing relief for painful foot problems or an injury, those who maybenefit 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 andstrength. 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 developedarthritis in their feet. Orthotics may also beprescribed 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 usualcircumstances may make one more vulnerable to injury with the extra stress of sportsactivity. 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 bealigned to give more propulsion, making walking, running and cycling more

mechanically efficient.
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[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 footdeformity and pain. There are three broad categories of orthotics: those that primarily

attempt to change foot function, those that are mainly protective or accommodative innature, and those that combine functional control and accommodation.

While orthotics can be made by several different processes, most podiatrists make aplaster 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" bypartially filling in the arch. This decreases the arch height of the orthotic and is done for

comfort reasons. Once a reproduction of the individuals foot is made, the technicians

then use the doctors prescription to custom-make a device to meet the patient's specificneeds. 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 andfunction, 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 flexslightly 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 designedto 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 offuncomfortable 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 properfunctions, 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 manufacturingtechnique 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
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comfortable functional control while maintaining the properties of an accommodative

device.

Proprioceptive stimulation orthotics are an alternative approach to relievingmusculoskeletal 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 feetand 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. BrianRothbart 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 bothsupinators (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 ofwork because of foot problems[citation needed]. The foot contains 26bones 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 peryear[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 andsports 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 CanHelp You Put Your Best Foot Forward"
http://en.wikipedia.org/w/index.php?title=Orthotics&action=edit&section=4http://en.wikipedia.org/wiki/American_Podiatric_Medical_Associationhttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/w/index.php?title=Orthotics&action=edit&section=5http://www.solesupports.com/Miscellaneous%20Downloads/FocusOnFunction_OrthtoicTheory&Methodology.pdfhttp://www.solesupports.com/Miscellaneous%20Downloads/FocusOnFunction_OrthtoicTheory&Methodology.pdfhttp://www.hss.edu/Conditions/Orthotics/Prescription-Foot-Orthoticshttp://www.hss.edu/Conditions/Orthotics/Prescription-Foot-Orthoticshttp://en.wikipedia.org/w/index.php?title=Orthotics&action=edit&section=4http://en.wikipedia.org/wiki/American_Podiatric_Medical_Associationhttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/w/index.php?title=Orthotics&action=edit&section=5http://www.solesupports.com/Miscellaneous%20Downloads/FocusOnFunction_OrthtoicTheory&Methodology.pdfhttp://www.solesupports.com/Miscellaneous%20Downloads/FocusOnFunction_OrthtoicTheory&Methodology.pdfhttp://www.hss.edu/Conditions/Orthotics/Prescription-Foot-Orthoticshttp://www.hss.edu/Conditions/Orthotics/Prescription-Foot-Orthotics


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[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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Categories: Articles with unsourced statements since February 2007 | All articles with

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