Orthotics

Orthotics can be constructed to be soft, rigid, semi-rigid, or sports-specific. Orthotics can aid in providing stability when foot issues and deformities are present.

Watch-out: Fitting and adjusting a prosthesis or orthosis is outside the PTA’s scope of practice. Your role is to monitor how the device performs during functional activities - gait pattern, skin condition at contact points, and reports of pain - and report findings to the supervising PT rather than modify the device or plan of care yourself.

A precaution means extra care is needed (for example, checking a socket or orthotic interface frequently for redness that doesn’t fade within 20 minutes); a contraindication means the action should not be done at all (for example, never lift or reposition a patient using the rods of a halo vest, since this can dislodge the pins and destabilize the cervical spine). Stop the activity and report immediately if you see new skin breakdown, unusual pin-site drainage, or a sudden change in fit.

• Soft orthotics
  • Also called accommodative orthotics, these are made of flexible materials that mold to the shape of your foot. They can help with conditions like plantar fasciitis and diabetes-related foot ulcers
• Rigid orthotics
  • Also called functional orthotics, these are made of firm materials like plastic or carbon fiber. They can help with foot deformities and repetitive stress injuries
• Semi-rigid orthotics
  • These combine soft and rigid materials to provide both cushioning and stability. They are often used for flat feet.
• Sports-specific orthotics
  • These are designed for athletes to improve alignment and reduce the risk of injury

Lower limb orthotics

Foot orthoses (FO)

• Definition:
  • Foot orthoses are inserts placed inside shoes to support, align, or improve foot function. They help with conditions such as flat feet, plantar fasciitis, and overpronation
• Components:
  • Shell: The main body of the orthotic, made from rigid, semi-rigid, or soft materials
  • Posting: Adjustments to correct alignment (e.g., medial wedge for overpronation)
  • Top cover: Soft padding for comfort and shock absorption
  • Heel cup: Helps control heel motion and provides stability
  • Arch support: Maintains the natural arch to prevent excessive collapse
• Types:
  • Rigid FO: Controls foot motion and alignment, typically made of plastic or carbon fiber.
  • Semi-rigid FO: Provides balance between control and flexibility, often used in sports
  • Soft FO: Offers cushioning for diabetic patients or those with sensitive feet

Ankle-foot orthoses (AFO)

• Definition:
  • Ankle-foot orthoses (AFOs) extend from the foot to just below the knee and are used for conditions affecting foot and ankle stability, such as drop foot, stroke, cerebral palsy, and peripheral neuropathy
• Components:
  • Footplate: Extends under the foot to control foot movement
  • Ankle joint: Can be fixed, hinged, or adjustable to allow varying degrees of movement
  • Straps: Secure the orthosis to the leg for stability
  • Calf support: Provides additional control over ankle motion
  • Material: Typically made from thermoplastics, carbon fiber, or metal uprights for different levels of support
• Types:
  • Solid AFO: Provides complete immobilization of the ankle joint
  • Hinged AFO: Allows controlled ankle motion while still providing support
  • Carbon fiber AFO: Lightweight and energy-efficient for active users
• Specific types of AFO
  • Other types:
    • Posterior leaf spring AFO: A flexible AFO that helps with foot clearance during walking by providing a spring-like effect
    • AFO with a posterior stop: A physical block on the back of the brace that prevents excessive ankle plantar flexion for controlling an unstable knee
    • Dynamic ankle foot orthosis (DAFO): Designed for individuals with neurological conditions, often shorter, and with a neurological footplate design
    • Ground reaction force ankle foot orthosis (GRAFO): Designed to reduce instability at the knee joint as well as the foot and ankle
    • Hybrid AFO: A combination of different AFO types, offering a balance of support and flexibility

Knee-ankle-foot orthoses (KAFO)

• Definition:
  • Knee-ankle-foot orthoses (KAFOs) extend from the foot to the thigh, providing support for patients with quadriceps weakness, spinal cord injuries, or post-stroke conditions.
• Components:
  • Footplate: Provides support to the foot like an AFO
  • Ankle joint: Can be rigid, hinged, or free-motion
  • Knee joints: May include locking mechanisms (drop lock, bail lock) or free-motion for controlled knee flexion
  • Thigh cuff: Provides proximal stability to the femur
  • Straps & padding: Ensure proper fit and comfort
  • Materials: Metal (for strong support) or plastic (for lighter weight)
• Types:
  • Locked KAFO: Prevents knee flexion for complete knee support.
  • Stance control KAFO: Allows free knee flexion during the swing phase but locks during the stance
  • Offset joint KAFO: Reduces knee buckling by shifting the mechanical knee joint posteriorly

Hip-knee-ankle-foot orthoses (HKAFO)

• Definition:

  • A hip-knee-ankle-foot orthosis (HKAFO) is a full-leg brace that supports and stabilizes the hip, knee, ankle, and foot. HKAFOs are often prescribed for individuals with significant muscle weakness or paralysis in the lower limbs and hips.

• Components:

  • HKAFO components include the same footplate, ankle joint, knee joints, thigh cuff, straps/padding, and materials as a KAFO, plus:
  • Hip joint and pelvic band: Controls hip motion and connects the orthosis to the pelvis, sometimes using a pelvic girdle for maximum stability

• Types:

  • Conventional HKAFOs: offer basic support with different joint options: single-axis, two-position lock, or double-axis hip joints.
  • Reciprocating gait orthosis (RGO) is a specialized type of HKAFO. It uses a cable or bar system to couple the hip flexion of one leg with the hip extension of the opposite leg.
  • Microprocessor-controlled HKAFOs (MPKAFOs): use microprocessors to regulate swing and stance control, offering stability, stumble recovery, and controlled knee flexion.

Spinal orthoses

Lumbar-sacral orthoses (LSO)

• Definition:
  • LSOs provide support and stability to the lumbar and sacral spine, commonly used for low back pain, post-surgical stabilization, herniated discs, and fractures
• Components:
  • Rigid or semi-rigid frame: Provides stability and restricts motion
  • Abdominal panel: Offers compression to reduce lumbar lordosis
  • Straps or Velcro closures: Ensure a snug fit.
  • Pelvic section: Stabilizes the sacrum and lower lumbar spine
• Types:
  • Rigid LSO
    • Restricts lumbar flexion and extension.
    • Commonly used post-surgery or for fractures.
  • Corset-style LSO
    • Provides mild to moderate support.
    • Often used for chronic back pain and muscle strain
  • Jewett brace (a thoracolumbar hyperextension orthosis - classified as a TLSO, not an LSO)
    • Hyperextension orthoses are designed to limit spinal flexion
    • Used for anterior compression fractures

Thoracolumbar-sacral orthoses (TLSO)

• Definition:
  • TLSOs provide support to the thoracic, lumbar, and sacral spine, commonly used for post-surgical recovery, scoliosis, and compression fractures
• Components:
  • Rigid or semi-rigid frame: Limits spinal movement
  • Anterior and posterior panels: Provide structural support
  • Straps for compression: Adjust tightness for stabilization
  • Shoulder straps (for some models): Helps maintain posture
• Types:
  • Rigid TLSO
    • Used for scoliosis and spinal fractures.
    • Limits motion in all planes.
  • Hyperextension TLSO
    • Limits spinal flexion but allows extension.
    • Common for compression fractures.
  • Soft TLSO
    • Provides mild support and posture correction.
    • Used for mild osteoporosis or muscle strain

Cervical orthoses (CO)

• Definition:
  • Cervical orthoses are designed to support and immobilize the cervical spine, commonly used for whiplash, post-surgical recovery, and cervical fractures
• Components:
  • Collar or shell: Provides cervical stabilization.
  • Anterior and posterior panels (for rigid braces): Limit flexion, extension, and rotation
  • Chin and occipital support: Maintains head position
• Types:
  • Soft cervical collar
    • Provides minimal support and is used for mild strains or whiplash
  • Rigid cervical brace (e.g., Philadelphia Collar, Miami J, Aspen Collar)
    • Provides moderate to firm immobilization.
    • Common for post-operative care and cervical fractures
  • Halo vest orthosis
    • Provides maximum cervical immobilization
    • Used for unstable cervical fractures or post-surgical fusion
  • Sterno-occipital mandibular immobilizer
    • Limits flexion and extension, often used for C1-C3 fractures