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When injury or illness affects your feet, ankles, knees, hips, or lower back, it can lead to a chain reaction of changes that alter how you walk, sit, stand, and move in general. Every adjustment your body makes to avoid pain or compensate for a dysfunctional limb or joint has the potential to make the problem worse or cause new problems. At The Woodlands Sports Medicine Centre in The Woodlands, Texas, our team of orthopedic surgeons, neurosurgeons, and sports medicine specialists know that two of the most powerful treatments for problems that affect your joints, motor function, gait, and balance are bracing and orthotics. Here are some of the advantages of these drug-free, non-invasive treatments. Increase stabilityBraces are external devices that maintain proper alignment in your joints and prevent unwanted movements. Braces can be worn inside your shoes or boots, on your wrist, or over your knee to keep you stable. Bracing can also help you lift, swing, and plant your foot if you suffer from dropfoot. If you have scoliosis, an external body brace can help correct your curved spine. Pain reductionInstability in the joints often leads to inflammation, such as tendonitis or bursitis. Osteoarthritis and rheumatoid arthritis also cause painful swelling in the joints. Bracing supports the joints so they move more smoothly. Whether you have pain in your ankles, knees, or hips, braces can:
By shifting the weight away from your painful joints and offering compression to tamp down swelling, braces can be one of the most effective tools in your arthritis arsenal. Shock absorptionOrthotics that slip into your shoes can absorb the shock of each step you take. It may not seem like much, but every heel strike has the power to cause pain all the way up your legs. If you have weak or fallen arches, or your arches are too high, you can feel the consequences in your ankles, knees, hips, and back. We can prescribe custom-designed insoles that compensate for any abnormalities and handle the shock so your feet — and the rest of your body — don't have to. Lower risk of injurySome athletes wear braces or orthotics to prevent injury. For example, volleyball players are known to use braces to avoid rolling an ankle. If you have a joint or limb weakened by a past injury, bracing can add extra strength and support to prevent a recurrence. Prevent progression of diseaseCertain medical conditions can worsen without the assistance of bracing. Scoliosis, degenerative disc disease, osteoarthritis, and rheumatoid arthritis are a few of the conditions that require external aid to slow or stop their progression. Immobilize a fracturePerhaps the most familiar type of orthotic is a cast or splint used to immobilize a broken bone. Fractures need to remain still and stable in order to heal correctly, so a rigid splint or full fiberglass cast can support and accelerate healing. Accommodate deformitiesIf you have foot deformities, you know how difficult it is to find shoes that fit and feel comfortable. Our custom orthotics are molded to fit your feet perfectly and accommodate hammertoes, bunions, heel spurs, or any other shape or protrusion that causes you problems. Which type of brace or orthotic is right for you?At The Woodlands Sports Medicine Centre, we offer several different types of orthotics and braces that address virtually every type of injury or disease that affects your limbs and back. Some are designed to focus on one particular body part, while others address more than one joint at the same time. Our experienced physicians evaluate your symptoms and recommend the best course of treatment. To find out if orthotics or bracing can be an integral part of your overall treatment plan, schedule a consultation with us today. Call us at 281-410-2882 or book an appointment online. Commonly Used Types of Orthotics[edit | edit source]1. Ankle Foot Orthoses[1][edit | edit source]The main function of an Ankle Foot Orthosis (AFO) is to maintain the foot in a plantigrade position. This provides a stable base of support that facilitates the function and can also reduce tone in the stance phase of the gait. The AFO supports the foot and prevents foot drop during swing phase. When worn at night, a rigid AFO may prevent contracture[2]. AFOs provide a more energy efficient gait. The brace should be simple, light but strong. It should be easy to use. Most importantly it should provide and increase functional independence. For more information on this, please see Introduction to Ankle Foot Orthoses. 2. Functional Foot Orthosis[3][edit | edit source]A Functional Foot Orthosis (FFO) is designed to realign the joints and bones in the foot in order to decrease stress within the knee, ankle or foot. Patients may require a single FFO or a pair of FFOs. Various techniques are used when designing an FFO. One commonly used technique is to create a Heel Skive. This is an intrinsic (i.e. within the heel cup) flat spot that creates an angled floor under the foot. This angled floor can be put anywhere within the heel cup.
3. Total Contact Insoles (TCI)[5][edit | edit source]A Total Contact Insole (TCI) is a custom-designed foot orthotic which aims to redistribute a person’s weight evenly over their foot. It is specifically designed for each individual, based on a model of an individual's foot,[5] and after extensive examination. It offers support through the shape and density of materials. A TCI has better shock absorption due to the materials used in the design than an FFO. A TCI is custom-made, usually made from Ethyl Vinyl Acetate (EVA). It can be a high, medium or low density material. They are designed from a cast, foam box or scan and manufactured in a workshop or lab. While they can be bulky, they are designed to support, correct and accommodate a foot with good shock absorption. 4. Off the Shelf Insoles (OTS)[edit | edit source]An Off the Shelf (OTS) insole is generally in a neutral position with a standard arch support. The insole is made of a material, which has different densities. It is low profile and has good shock absorption. These insoles offer minimal correction with no accommodation of deformity. But they are often a good starting point. Non-Pathological Foot[edit | edit source]
Congenital Paediatric Problems[edit | edit source]
Flexible Pes Planus[edit | edit source]Pes planus, also known as flat foot, is the loss of the medial longitudinal arch of the foot, heel valgus deformity, and medial talar prominence.[6] In lay terms, it is a fallen arch of the foot that causes the whole foot to make contact with the ground surface. The deformity is usually asymptomatic and tends to resolves spontaneously in the first decade of life. However, occasionally it progresses into a painful rigid form, which causes significant disability. All children have flat feet at birth and noticeable foot arches are not usually seen until approximately 3 years of age.[8] There are generally two forms of pes planus; flexible flat foot and rigid flat foot. Flexible flat foot is when the arch of the foot is intact on heel elevation and non-weight bearing, but disappears when standing on the foot. Rigid flat foot is when the arch is not present in either heel elevation or weight bearing.[9] Treatment: Off the Shelf (OTS) insoles Tests: Jack's Test[10] Common Problems in the Adult Non-Pathological Foot[edit | edit source]
Posterior Tibial Tendon Dysfunction[edit | edit source]Posterior tibial tendon dysfunction (PTTD) occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot. PTTD is characterised by the degeneration of this tendon and it is progressive if not treated. It can also be associated with a tear or stretching of the spring ligament. The spring ligament functions as a static restraint of the medial longitudinal arch. It supports the head of the talus from planter and medial subluxation against the body weight during standing.[12] Posterior tibial tendon dysfunction is typically a slow onset condition mainly affecting women older than 40 years of age.
Posterior Tibial Tendon Orthotic Prescription[13]
Hallux Limitus[edit | edit source]
Non-Pathological Foot - Injury /Trauma[13][edit | edit source]
Common Pathological Foot Conditions[edit | edit source]Pathological foot conditions are commonly broken up into three categories: neurological, motor and sensory. A pathological condition is often more complex to treat as all joints or muscles are affected. On assessment, you should look at hip and knee position as well. Feet and ankles will adapt to the ground to support structures higher up and compensate for bony abnormalities.[13] 1. Neurological[edit | edit source]
2. Motor[edit | edit source]
3. Sensory/ Neuropathy[13][edit | edit source]
When dealing with pathological foot conditions there are four common deformities encountered when creating on orthosis:
Valgus Deformity[13][edit | edit source]
Varus Deformity (Cavus)[13][edit | edit source]
Forefoot versus Hindfoot Deformity[edit | edit source]
Summary[edit | edit source]
Physiopedia Pages to Further Your Knowledge[edit | edit source]Orthotics in Cerebral Palsy Biomechanics for Cerebral Palsy Orthotics References[edit | edit source]
What type of orthotics support weakened body parts correct deformities and prevent joint movement?A static orthosis is rigid and is used to support the weakened or paralyzed body parts in a particular position. A dynamic orthosis is used to facilitate body motion to allow optimal function. In all orthotic devices, 3 points of pressure are needed for proper control of a joint.
Is a type of orthotic used to support weakened body parts?An orthosis is used to describe a single, rigid or semi-rigid device that supports a weak/deformed body part or restricts/eliminates motion in a diseased/injured body part. These devices were commonly called splints, braces, wraps, or supports previously.
What type of exercises strengthens the cardiopulmonary system?Examples: Brisk walking, running, swimming, cycling, playing tennis and jumping rope. Heart-pumping aerobic exercise is the kind that doctors have in mind when they recommend at least 150 minutes per week of moderate activity.
Are made of plaster plastic or fiberglass and are used to hold a bone in place after reduction of a fracture?Casts & Splints. Casts and splints are orthopedic devices that are used to protect and support fractured or injured bones and joints. They help to immobilize the injured limb to keep the bone in place until it fully heals. Casts are often made from fiberglass or plaster.
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