Custom Orthotics

Orthotics (Greek: ortho, "to straighten" or "align") is a specialty within the medical field concerned with the design, manufacture and application of orthoses. An orthosis (plural: orthoses) is a single, rigid or semi-rigid device that is worn to support a weak or deformed body member, or restrict or eliminate motion in a diseased or injured part of the body. They include foot pads, shoe inserts and ankle bxraces/ankle foot orthoses.

  • Foot pads are placed on the sole of the shoe. They are used to treat conditions that include metatarsal (a group of five long bones in the foot, located between the tarsal bones of the hind- and mid-foot and the phalanges of the toes) and sesamoid (a bone embedded within a tendon) pain.
  • Shoe inserts are also placed in the shoe. These devices are used to treat a wide variety of problems that include foot arthritis and flat feet.
  • Ankle braces are devices the patient must put on before fitting into a shoe. They are used to treat a variety of injuries and diseases like recently uncasted ankle fractures, sprains, ankle arthritis and tendinitis. Depending on the type, severity and location of the condition, some braces need to be custom made for the patient. An ankle foot orthosis (AFO) braces the ankle and footer. It is normally used for foot drop due to stroke, MS (Multiple Sclerosis), CP (Cerebral Palsy), nerve damage, spinal cord injuries, traumatic brain injury (TBI) and general weakness. AFOs may or may not need to be custom fit for the individual patient.

An orthosis may be used to:

  • Control, guide, limit and/or immobilize an extremity, joint or body segment for a particular reason
  • To restrict movement in a given direction
  • To assist movement generally
  • To reduce weight bearing forces for a particular purpose
  • To aid rehabilitation from fractures after the removal of a cast
  • To otherwise correct the shape and/or function of the body, to provide easier movement capability or reduce pain

Orthoses are sometimes used prophylactically or to optimise performance in sport.

Custom Fabricated vs. Custom Fitted and Prefabricated

According to American Society of Hand Therapists (ASHT), a custom fabricated orthosis is created for one specific patient. It may be fabricated based on clinically derived and rectified castings, tracings, measurement and/or images such as x-rays of a given body part.

Custom fitted orthoses are prefabricated without a specific patient in mind, but requires the expertise of a therapist to customize the orthosis to fit a specific patient. This may include trimming, molding or bending, with or without heat.

Prefabricated orthoses, sometimes termed "off-the-shelf," require minimal self adjustments. These types of orthoses may or may not require a therapist's expertise to trim, bend, mold, assemble or customize to fit initially.

What is the difference between an orthosis and a brace?

An orthosis is an orthopedic appliance or apparatus used to support, align, prevent or correct deformities or to improve function of movable parts of the body. It is both a clinical service and a product. However, the clinical portion comes first and must be of sound biomechanical correction for the orthosis to work.

Some examples of orthoses include:

  • Ankle-foot orthoses (AFOs), also known as foot drop brace, are any orthotic device for the lower limb that enclose the ankle and foot and do not extend above the knee. These are intended to prevent footdrop by stabilizing the foot and ankle.
  • Knee-ankle-foot orthoses (KAFO) are orthotics that also accommodate for knee stabilization problems and stem from above the knee to the foot. Knee-ankle-foot orthoses are used when muscle weakening and wasting has spread to the thigh muscles and exacerbate knee-stabilization problems during gait and causing sudden knee bending.
  • Hip-knee-ankle-foot orthosis (HKAFO) is basically a KAFO with the addition of a hip joint and pelvic section to provide control to selected hip motions. HKAFOs are used on patients requiring more stability of the hip and lower torso, due to paralysis and weakness, in addition to the lower extremity involvement.

Bracing is a type of orthosis. A brace is an orthotic device that is used to support and hold any part of the body in the correct position to allow function and healing, such as a leg brace that permits walking and standing.