Orthotics are devices that attach to the body externally and are used to help improve function, restrict movement, correct alignment, reduce pain, or improve deformities.
Orthotics are special devices worn on the outside of the body that are used to correct problems with posture, gait, body alignment, or to improve problems related to deformities. The devices are most frequently used with athletes to reduce pain associated with certain kinds of movements such as jumping or running and to help heal injuries that occurred in the course of athletic activity. Orthotics are frequently prescribed when an individual goes in to see the doctor because of recurring pain. Orthotics are also used to restrict movement in cases where such restriction is required for proper healing, such as after surgery. In some cases, orthotics may be prescribed prophylactically, to help prevent a problem that is likely to occur later in life.
Orthotics can vary widely depending on the type of problem they are designed to correct. The three main types of orthotics are those designed for correcting the spine, those designed for correcting a lower limb, and those designed to correct an upper limb.
Orthotics are made out of a variety of different materials, including molded plastic and metal. The type of materials used depends on the type of orthotic device and to some extent the company that manufactures it. Orthotics are created by doctors who specialize in orthotics, many of whom also specialize in producing prostheses for individuals who are missing a body part.
Orthotics are specially shaped and molded to fit the individual who will be wearing them. They are adjusted to provide the correct alignment that the doctor feels will best improve the condition or alleviate the pain. Because orthotics are made to fit a specific individual, multiple trips to the doctor for consultations and fittings may be required.
Many insurance plans cover orthotics, although coverage varies depending on the type of plan and why the orthotic is required. Most insurance plans do not cover specially made shoe inserts unless rigid criteria are met.
Spinal orthotics are typically used for individuals who have severe back pain, to manage scoliosis, or to immobilize the back after spinal surgery or because of a fracture. The spinal orthotic is a hard device, usually made of plastic, that fits around the individual's torso from just above the tail bone to the middle of the chest. It has straps that allow the individual to adjust the orthotic and to remove it.
How long a spinal orthotic is required depends on the condition it is being used to treat. If it is being used to treat back pain, the device is only required until the individual can tolerate the amount of pain that occurs in the absence of the orthotic. If it is being used after spinal surgery, or to immobilize the spine so a fracture can heal, the device may be required for 6–12 weeks. When used to treat scoliosis, it may be required for even longer.
Upper limb orthotics are used to immobilize or restrict the motion of an upper limb or body part, commonly the hand, wrist, or shoulder. There are a variety of reasons that an upper limb orthotic may be indicated, most often trauma or injury to the body part. This is especially true for athletes who may require upper limb orthotics after injuring their hands and wrists during sports such as basketball or their shoulders pitching in baseball.
The materials out of which upper limb orthotics are made vary depending on the nature of the movement restriction necessary. Orthotics designed to hold the hand and wrist in place are typically made of hard plastic, molded to fit the lower arm, with straps to secure the hand or wrist in place. Orthotics designed for the shoulder are often made of a set of metal pins holding together straps that restrict the movement of the shoulder and provide additional support.
Lower limb orthotics are orthotics designed to correct position and provide support for the foot, ankle, and knee. The most familiar type of orthotic is the foot orthotic that inserts into the shoe. Shoe inserts are so common that some are sold in supermarkets, shoe stores, and other major retailers. Shoe insert orthotics work by adjusting the way that the foot is aligned when it hits the ground. Correctly aligning the foot can adjust the way that the ankles, hips, and even spine is aligned. Correct alignment can help reduce back, hip, ankle, knee, and foot pain. Many doctors who make specially molded shoe inserts warn against using mass-produced inserts sold in retail stores. These inserts have not been specially designed for the indivudal's specific foot issues, and can actually exacerbate problems with alignment, increasing pain rather than reducing it.
Sports orthotics typically refers to lower limb orthotics that are specially made for use during athletic activities. It can also refer to upper limb orthotics made for athletic use, although this is much less common. Individuals with a spinal orthotic device are typically not able to participate in athletic activities, and thus, sports orthotics does not usually encompass spinal orthotics.
Sports orthotics are usually shoe inserts made of more durable materials than typical shoe inserts. They may also be made of materials designed to better absorb the impact created by jumping or running. In many cases, sports orthotics are thicker than normal orthotics, and fit better in shoes designed for running or other athletic activities than daily-wear shoes.
If an individual has sports orthotics made, they may be of a slightly different shape than his or her daily-wear orthotics because the foot can fall differently while running or jumping than while walking. It is generally advisable for professional and serious athletes to have sports orthotics made and not use their daily-wear orthotics while participating in athletic activities.
Orthotics should be created and fitted specifically for each individual by a doctor, usually a podiatrist, who specializes in orthotics. Using orthotics designed for someone else can lead to misalignment, possibly causing serious consequences. Some orthotics, usually foot orthotics, are available in supermarkets, shoe stores, and general merchandise stores. Although these orthotics can sometimes offer relief, consumers should be wary. Each individual's foot is different, and orthotics should be specially molded to provide the best support possible. Using mass-produced orthotics can lead to misalignment. Misalignment can cause serious pain in the shins, ankles, calves, thighs, and lower back. It can put strain on the arches, knees, ankles, and hips that can lead to joint pain and inflammation. Poorly fitted foot orthotics can also increase the risk of ankle sprain, as the foot may not land evenly when moving. Landing at the wrong angle can cause the ankle to twist or sprain.
Prior to having an orthotic made, the patient must be examined by a medical professional, specifically one specializing in orthotics. The medical professional will evaluate the correction necessary to relive a specific type of pain or to provide stabilization of a certain area. Multiple visits or consultations may be necessary to ensure proper form and fit of the orthotic.
Athletes should talk to their doctor about what sports and fitness activities can be done while wearing the orthotic. In some cases it may require a scaling back of training to learn correct movements with the orthotic in place. While this can be frustrating, it is important to prevent the strains and sprains that can occur when muscles are used to make new movements too quickly.
No aftercare is typically required for orthotics. For common orthotics such as shoe inserts no special training or practice is usually necessary to make full use of the orthotic correctly. For more specialized and complex orthotics such as spinal braces, practice may be required to learn to move effectively with the new device.
Complications from orthotics are typically caused by the realignment of body parts straining muscles or putting additional pressure on joints. This can cause pain, soreness, and discomfort. These complications typically resolve within a few weeks of beginning to wear the orthotic. If they do not resolve or there is significant pain the individual should consult the doctor who prescribed the orthotics or the clinic that created and fitted the device.
To reduce the chance of pain associated with wearing a new orthotic, it is recommended that the orthotic be introduced gradually. The individual begins by wearing the orthotic for a short time, often as little as one hour a day, and slowly increases the wearing time over a few weeks until the orthotic is worn all the time, or as often as prescribed.
Many athletes find that a good pair of sports orthotics can improve foot, ankle, and even back comfort while running. In some cases, athletes may even find their performance enhanced due to the increased comfort and correct alignment of the spine and foot.
See also Foot health .
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American Academy of Orthotists and Prosthetists, 1331 H St. NW, Ste. 501, Washington, DC, 20005, (202) 380-3663, Fax: (202) 380-3447, http://www.oandp.org .
American Medical Society for Sports Medicine, 4000 W. 114th St., Ste. 100, Leawood, KS, 66211, (913) 327-1415, Fax: (913) 327-1491, http://www.amssm.org .
American Orthotic and Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA, 22314, (571) 431-0876, Fax: (571) 431-0899, email@example.com, http://www.aopanet.org .
American Orthopaedic Society for Sports Medicine, 9400 W. Higgins Rd., Ste. 300, Rosemont, IL, 60018, (847) 292-4900, Fax: (847) 292-4905, http://www.sportsmed.org .
Tish Davidson, AM