ORTHOTICS SCIENCE

Dr. Uttara U. Deshmukh (P&O)

Principal, MGMIUDPO
Kamothe, Navi Mumbai
ORTHOSIS : is defined as an externally applied
device used to modify the structural & functional
characteristic of neuromuscular & skeletal systems .
ORTHOTICS : is defined as the science & art involved in
treating patient by the use of an orthosis. It refers to
the field of assessment &fabrication of orthosis .
ORTHOTIST : is defined as a person who have
completed an approved course of education & training
& is authorized to design , measure & fit the orthosis .
OBJECTIVES OF ORTHOTIC TREATMENT :
1. Relieve pain
2. Correct deformities
3. Prevent deformities
4. Increase or decrease range of joint motion
5. Compensate for segment length or shape
6. Manage abnormal neuromuscular function
7. Protect injured tissues
8. Promote healing
9. Provide psychological comfort
10. Realign the skeleton
COMMON GOALS OF ORTHOSIS :
1.Stabilize weak or paralyzed segment / joint
2.Support damaged or diseased segment
3.Limit or assist motion across joint
4.Control abnormal or spastic movements
5.Unload the distal segment
PRINCIPLES OF ORTHOTIC APPLICATION :
1. Adequate surface area : for comfortable pressure distribution .
2 . Joint Positioning : positioning the joint to correct anatomical
position is very important for efficient functioning of orthosis .
3 . Avoid localized compression of nerves .
4 . Accommodate the local lesions .
5 . Donning & doffing should be easy .
6 . Energy expenditure with brace should be less.
7 .Orthosis should be durable & cost effective .
8 . Maintenance & repairing of orthosis should be easy.
NOMENCLATURE OF ORTHOSIS :
It is decided by International Organization for Standardization
(ISO) terminology .
It describe the orthosis with reference to the body segment they
encompass .
1 . FO : Foot Orthosis
2 . AFO : Ankle Foot Orthosis
3 . KO : Knee Orthosis
4 . KAFO : Knee Ankle Foot Orthosis
5 . HO : Hip Orthosis
6 . HKO : Hip Knee Orthosis
7 . HKAFO : Hip Knee Ankle Foot Orthosis
8 . SIO : Sacroiliac Orthosis
9 . LSO : Lumbo Sacral Orthosis
10 . TLSO : Thoraco LumboSacral Orthosis
11 . CO : Cervical Orthosis
12 . CTO : Cervical Thoracic Orthosis
13 . CTLSO : CervicalThoracicLumboSacraOrthosis
MATERIALS USED IN FABRICATION OF ORTHOTIC
DEVICES :

•Metals & plastics are the basic materials used .

• Steels , alloy of aluminum (Duralium)
• Titanium & its alloy are also used .
• Minor use of copper , brass rivets .
• Nickel & chromium plating.
• Fabrics , Rubbers , Leathers .
• PVC (Poly Vinyl Chloride )
• HDPE (High Density Poly Ethylene )
• PP (Polypropylene )
• Orfit ( Low Temperature Thermoplastics )
• Velcro, webbing, press buttons ,D-rings for
fastening
Foot Orthotics
 FOOT ORTHOSIS :
Foot orthoses are specially designed shoe inserts that
help support the feet and improve foot posture.
 People who have chronic foot or leg problems that
interfere with the health and functioning of their feet may
be prescribed orthoses by their Orthotist.

Foot orthosis is a mechanical device used to

1 . Maintain the alignment of foot .
2 . Support the foot .
3 . Prevent , Correct or Accommodate the deformity
4 . Improve the function of foot .
FUNCTION OF FOOT ORTHOSIS :
1 . Evenly distribute the weight bearing stresses over the entire
plantar surface of the foot .
2 . Reduce the stress & strain on the ankle , knee , hip & spine
indirectly .
3 . Alleviate the pain from painful & sensitive areas of the sole of the
foot .
4 . Support the foot arches .
5 . Provide relief for tender areas i.e. corn , fissures
6. Decrease degree of foot movements which are beyond normal limits

7 . Improve foot alignment .

8 . Accommodate congenital or developmental foot anomalies .
9 . Equalize the foot length discrepancy & compensate for leg length
discrepancy .
10. Serve as an addition to AFO , KAFO & HKAFO
 INDICATIONS

• Plantar Fasciitis.
• Heel Spurs.
• Degenerative Joint Disease.
• Pes Planus (flat feet)
•Posterior Tibial Tendonitis.
• Metatarsalgia (inflammation of the ball of the foot)
• Neuroma (growth of nerve tissue)
•Peripheral Neuropathy (damage to the nerves)
 TYPES OF FOOT ORTHOSIS
• 1 .MEDIAL LONGITUDINAL ARCH SUPPORT :
• 2 .LATERAL LONGITUDINAL ARCH SUPPORT :
• 3 .METATARSAL BARS & PADS :
• 4 .WEDGES
• THOMAS HEEL OR CROOED & ELONGATED
HEEL :
• 5 . HALLUX VALGUS SPLINT :
 TYPES OF FOOT ORTHOSIS :

INSOLES WITH MEDIAL ARCH. MOLDED INSOLES

LATERAL & MEDIAL SCOOPED HEEL
WEGDE
HALLUX VALGUS SPLINT UCBL ORTHOSIS
DIFFERENCE BETWEEN CUSTOM MADE FO & MARKETED FO
CUSTOM MADE FO MARKETED FO
• Gives anatomical fit & • Does not give good fitting
comfort & comfort
• Unlimited sizes • Limited sizes
• Easy to modify • Not easy to modify
• More effective • Less effective
• High patient acceptance • Acceptance poor
• High cost • Low cost
• Time consuming process • Prefabricated so less time
• Limited supply • Abundant supply
 SUPRAMALLEOLAR ORTHOSIS
• Low profile design that crosses the ankle .
• Less invasive trim lines than a standard AFO .
SMO supports the foot just above the ankle bone or
malleolus.
 SMOs are prescribed for patients who have soft, flexible,
flat feet (pes planovalgus).
 The SMO is designed to maintain a vertical, or neutral, heel
while also supporting the arches of the foot.

INDICATIONS :
•Ankle instability.
•Pes planus (adult)
•Pes planovalugus.
Supra Malleolar Orthosis (SMO ) :
SUPRAMALLEOLAR ORTHOSIS SUPRAMALLEOLAR ORTHOSIS
WITH AFO.
 ANKLE FOOT ORTHOSIS :
 When orthosis extends above ankle joint but below knee joint then it is called as
AFO .
 AFO can be designed with sufficient mechanical lever arm to effectively control
ankle complex & to influence knee joint indirectly .
 AFO can also be used for foot problems where only foot orthosis are not effective

INDICATIONS :
 Drop Foot
 CVA/Stroke
 Arthritis
 Posterior Tibial Tendon Dysfunction
 Ankle Instability
 Paralysis
 Ankle Fusion
 Multiple Sclerosis
Ankle-Foot Orthoses
 ANKLE FOOT ORTHOSIS :
• When orthosis extends above ankle joint but below knee
joint then it is called as AFO .
• AFO can be designed with sufficient mechanical lever arm to
effectively control ankle complex & to influence knee joint
indirectly .
• AFO can also be used for foot problems where only foot
orthosis are not effective .

Basic function of AFO is

1 . To provide mediolateral stability at ankle joint during
stance phase &
2 . Toe pick up during swing phase .
In short to give gait closer to normal gait with less energy
consumption .
INDICATIONS :
 Drop Foot
 CVA/Stroke
 Arthritis
 Posterior Tibial Tendon Dysfunction
 Ankle Instability
 Paralysis
 Ankle Fusion
 Multiple Sclerosis
 METAL AFO WITH SHOES :
Indications :
1 . Wide fluctuation of edema
2 . High risk foot i.e. Foot having absent

or diminished sensation , visual impairment

Uprights :
Aluminum : for light weight
Stainless steel : for durability
Main components of conventional
orthosis are :
1 . Stirrup
2 . Spur
3 . Ankle joints
4 . Uprights
 CLASSIFICATION OF AFO :
NON – ARTICULATED AFO
ARTICULATED AFO OR
OR STATIC AFO
Dynamic AFO

1. AFO WITH 1. SOLID ANKLE

TAMARACK AFO
JOINT 2. POSTERIOR LEAF
2. AFO WITH SPRING AFO
OKLAHOMA 3. SPIRAL AFO
JOINT 4. HEMISPIRAL
3. AFO WITH AFO
OVERLAPPING
4. CAMBER AXIS
AFO
AFO are differentiated depending on the component :

1 . Molded supramalleolar orthosis

2 . Single upright orthosis with shoes
3 . Double upright orthosis with shoes
4 . Plastic rigid AFO
5 . Plastic articulated AFO
6 . Molded spiral orthosis
7 . Plastic AP shell orthosis
8 . PTB AP shell orthosis
9 . CROW orthosis

Orthosis with shoe are called as Conventional Orthosis .

 TYPES OF ARTICULATED AFO :

AFO WITH TAMARACK AFO WITH OKLAHOMA AFO WITH

JOINT JOINT OVERLAPPING
 TYPES OF NON ARTICULATED AFO :

SOLID ANKLE AFO POSTERIOR LEAF SPIRAL & HEMISPIRAL AFO

SPRING AFO
SOLID AFO REINFORCEMENT ARTICULATED AFO
Posterior Leaf Spring
CUSTOM MOLDED BIVALVED A-P SHELL ORTHOSIS :
Functions :
1. Provides total contact support of the foot & ankle joint
which can stabilize fracture part .
2. Immobilize the joint & aid in wound healing through
compression .
3. Distribute pressure equally over entire surface of the foot ,
ankle , lower leg thus avoiding concentrated areas of
pressure
 KNEE ANKLE FOOT ORTHOSIS :
A KAFO is a long-leg orthosis that spans the knee, the
ankle, and the foot in an effort to stabilize the joints and
assist the muscles of the leg.

INDICATIONS:-
MUSCLE WEAKNESS
LOWER MOTOR NEURON LESSIONS
SNINAL CORD INJURY
PARAPLEGIA
POLIO (PPRP)
 KNEE-ANKLE-FOOT ORTHOSIS
(KAFO)
Consists of
• a shoe attachment,
• ankle control,
• uprights,
• knee control, and
• bands or shells for the calf and thigh
 K.A.F.O.

Conventional KAFO Modular KAFO Modular KAFO with Joints

 TYPES OF KNEE ANKLE FOOT ORTHOSIS :

KNIGHT SPLINT

KAFO WITH TAMMRAC

ANKLE JOINT- DROP LOCK
KNEE JOINT- TUBER BAND
 KNEE ORHTHOSIS :

Knee orthosis is designed to support, protect and prevent deformity of the

knee joint.

INDICATIONS :
 Osteoarthritis
 Knee Instability
 ACL/PCL Tear or Repair
 Varus (Inward Angle) or Valgus (Outward Angle) Deformities
 MCL/LCL Insufficiencies
 Post Operative
 Patella Dislocation
 Multiple Sclerosis
 TYPES OF KNEE ORTHOSIS :

PUSH KNEE SPLINT KNEE CAGE ORTHOSIS

SINGLE BAR ORTHOSIS
VARIOUS TYPES OF KNEE ORTHOSIS : KO are designed
1 . To support or control movement of knee
2 . To transfer load while allowing normal knee motion
Effectiveness of KO depends on the length of the brace .
Longer brace provides greater amount of leverage .
Three types of KO can be defined :
1 . Prophylactic Knee Orthosis :
These are usually designed with the unilateral , single hinge
system .
Used to limit the strains on medial or lateral collateral
ligaments .
2 . Functional Knee Orthosis :
These are used for post operative care or for A-P stability .
3 . Rehabilitative Knee Orthosis :
It prevents excessive load on injured part & allow early
return to activity .
PLUMBO ORTHOSIS ( PATTELAR CAP ) :
It consist of elastic sleeve with patella cutout & two straps
which apply dynamic tension on the patella .
It is given to prevent lateral subluxation or dislocation of
patella .

PATELLOFEMORAL ORTHOSIS :
It consist of foam padded strap that encircle the knee
immediately below the patella .
It helps to control movements of patella during flexion &
extension of knee & should be worn only during activities .
Elastic Knee Orthosis :
KNEE IMMOBILIZER :
 HIP KNEE ANKLE FOOT ORTHOSIS :

The HKAFO is a custom-molded plastic shell with contoured

metal uprights and a pelvic band that provides support and
correction to the hip, knee, ankle and foot.
An HKAFO improves body alignment and posture, increases
bone and muscle strength, and enhances independence and
self-esteem.

INDICATIONS:-
ASSIST GAIT
CONTROL MOVEMENT
MINIMIZE PROGRESSION OF MOVEMENT
 HIP-KNEE-ANKLE-FOOT ORTHOSES
(HKAFO)
• The HKAFO is a custom-molded plastic shell with contoured
metal uprights and a pelvic band that provides support and
correction to the hip, knee, ankle and foot.
• An HKAFO improves body alignment and posture, increases
bone and muscle strength, and enhances independence and self-
esteem.

Contain
• A hip joint
• Pelvic band added to a KAFO
 H.K.A.F.O.

Unilateral Bilateral Modular

 HIP ORTHOSIS:-
It is designed to support, protect and prevent deformity of the
hip joint, this orthosis is used to prevent excessive hip flexion
or extension and to limit hip abduction (the legs moving
together).
INDICATIONS :
Hip Fracture
Hip Dislocation
Post-operative
Osteoarthritis
Developmental/Congenital Dysplasia of the Hip
Coxa Valgum/ varum
 TYPES OF HIP ORTHOSIS :

SWASH ORTHOSIS
HIP STABILIZING ( Standing , Walking & FRAJEKA PILLOW
ORTHOSIS Sitting Hip Orthosis )
 SPINAL (TRUNK) ORTHOSES:
COMPONENTS/TERMINOLOGY
 FUNCTIONS & GOAL OF SPINAL ORTHOSIS
• FUNCTION OF SPINAL • GOAL / OBJECTIVE OF
ORTHOSIS : SPINAL ORTHOSIS :
1. Correct the Deformity 1. SUPPORT
2. Limit Motion 2. PROTECT
3. Stabilize the Spinal 3. PREVENT
Segment 4. CORRECT
4. Deload the spine 5. REST / IMMOBILIZE
5. Miscellaneous Effects
e.g. Massage ,Heat etc
 INDICATIONS OF SPINAL ORTHOSIS
A. PAIN :
1 . NONSENSITIVE TISSUES
a . Disc
b . Ligamentum flavum
c . Interspinous Ligaments
2 . SENSITIVE TISSUES
a . Longitudinal Ligaments
b . Muscles
C . Posterior Nerve Root
B . MALALIGNMENT – CONGENITAL / ACQUIRED :

1 .Torticollis ( Wryneck )
2 . Scoliosis
3 . Khyposis
4 . Lordosis
5 . Spondylolisthesis
C . TRAUMA :
1 . Fractures & Dislocations
2 . Herniation (ruptured ,slipped or bulging disc) D .
D . INFLAMMATION :
1 . Osteomyelitis
2 . Tuberculosis ( Pott’s Disease)
E . METABOLIC & DEGENERATIVE DISORDERS :
1 . Osteoporosis
2 . Rickets
3 . Osteogenesis Imperfecta ( Osteosclerosis)
4 . Juvenile Khyposis (Scheuermann’s disease)
5 . Spondylosis ( Osteoarthritis)
6 . Rheumatoid Arthritis
F . CONGENITAL DISORDERS :
1 . Spina Bifida
2 . Spondylolysis ( bony defect )
G . NEOPLASMS : (TUMORS)
H . ORTHOSIS FOR POST OPERATIVE CARE :
 CLASSIFICATION OF SPINAL ORTHOSES :
• According to the material used for fabrication of
orthosis they are classified as
1 . FLEXIBLE SPINAL ORTHOSIS :
Use of soft material like canvas , foam etc.
2 . SEMIRIGID SPINAL ORTHOSIS :
Combination of flexible & rigid material like M.S.
Patti covered with leather or plastics covered with
soft material .
3 . RIGID SPINAL ORTHOSIS :
Molded in H.D.P.E. or ORFIT , AP shell type
 TYPES OF SPINAL ORTHOSES :

• Corset
• Provides abdominal compression, increases intraabdominal
pressure; assists in respiration in individuals with SCI; relieves
pain in low back disorders; sacroiliac support
• Lumbosacral orthoses (LSO): control or limit lumbosacral
motions
• Lumbosacral flexion, extension, lateral control orthes (LS FEL)
(Knight Spinal): includes pelvic and thoracic bands to anchor
the orthosis with two posterior uprights, two lateral uprights and
an anterior corset
• Plastic lumbosacral jacket: provides maximum support by
spreading the forces over a larger areal more cosmetic but
hotter
 LUMBO SACRAL ORTHOSIS
• The lumbosacral corset provides anterior and lateral trunk
containment and assists in elevating intraabdominal pressure.
• Restriction of flexion and extension can be achieved with the
addition of steel straps posterior.

Abdominal Corset Lumbo-Sacral Orthosis

TRUNK ORTHOSIS
Knight Brace Taylor Brace
Jewett Brace ASH Brace
Trunk Orthosis
Milwaukee Boston
Cervical Orthosis
Soft Collar Four Poster
Cervical Orthosis
Halo Minerva
 Upper Extremity Orthoses
• Categories of orthoses

• Finger orthosis (FO)

• Hand orthosis (HdO)
• Wrist–hand orthosis (WHO)
• Wrist–hand–finger orthosis (WHFO)
• Elbow orthosis (EO)
• Elbow–wrist–hand orthosis (EWHO)
• Shoulder orthosis (SO)
• Shoulder–elbow orthosis (SEO)
• Shoulder–elbow–wrist–hand orthosis (SEWHO)
 Clinical objectives of orthotic treatment
 To relieve pain

 To manage deformities

 To prevent an excessive range of joint motion

 To increase the range of joint motion

 To compensate for abnormalities of segment length or shape

 To manage abnormal neuromuscular function (e.g., weakness

or hyperactivity)

 To protect tissues

 To promote healing

 To provide other effects (e.g., placebo, warmth, postural

 Type of functional hand splinting
• Short opponence splint
• Long opponence splint
• C-bar
• THUMB POST
 C-bar
 C- bar is a curved piece of stainless steel or aluminum, riveted to the
palmar arch of either the short or long opponens hand splint in such a
position that hold the M.P. joint of the thumb in abduction but without
extending beyond the I.P. joint .

 Attachment:- Either the short or

long opponens hand splint.

 Indication:-
1. When thumb abductors =Zero to poor
2. Thumb adductor= fair to normal.
(the thumb web soon becomes tight)

 Material :- Curved piece of 0.037 inch

stainless steel or aluminum.
 THUMB POST
 Indication: - Used where active opposition
and thumb flexion are not sufficient for
prehension.

 Attachment:- Either the short or long

opponens hand splint.

 Indication:-
1. When thumb abductors =Zero to poor
2. Thumb adductor= fair to normal.
(the thumb web soon becomes tight)

 Material :- Curved piece of 0.037(10mm)

inch stainless steel or aluminum.
 FINGER SPLINTS
Finger splint for immobilization of fingers after injury or surgery in order
to prevent contractures in the finger joints

INDICATION
• Fracture of Phalanges
• Ligament Laxity
• Post-operative
• Rheumatoid arthritis
• Swan Neck Deformity
• boutonnière deformity
• Tendonitis
• Carpal Tunnel Syndrome
• Dupuytren syndrome
 TYPES OF FINGER SPLINTS

Dupuytren syndrome Swan Neck Murphy Ring

Deformity
 HAND AND FINGER ORTHOSIS
3. PIP extension stop 4. PIP flexion stop
 FINGER ORTHOSIS
Static:
 Boutonniere orthosis- A static splint corrects
hyperflexion at PIP joint by 3-point pressure
principle.
 HAND ORTHOSIS :

to support weak or damaged parts of the forearm, wrist

and hand, while it also serves to correct orthopedic
maladjustments with both mobile and immobile functionality.

INDICATIONS :
Fracture of radius and ulna
Radial nerve Palsy/ Wrist Drop
Dislocation
Ligament Laxity
Post-operative
Osteoarthritis
Radial and or Ulnar Fracture
Tendonitis
Carpal Tunnel Syndrome
Cerebral Vascular Accident (CVA)/Stroke
 TYPES OF HAND ORTHOSIS :

FUNCTIONAL HAND
SPLINT DYNAMIC HAND
SPLINT

RESTING HAND
SPLINT / PAN
 WRIST HAND ORTHOSIS
These orthotics encompass the forearm and the palm.
They are primarily used to support weak muscles and/or
immobilize or limit the motion of the wrist while
allowing the fingers to move.

INDICATIONS :
Fracture of Carpal and Metacarpal bones
Ligament Laxity
Post-operative
Rheumatoid arthritis
Tendonitis
Carpal Tunnel Syndrome
 TYPES OF WRIST HAND ORTHOSIS :

SHORT OPPONENCE SPLINT THUMB SPICA

 Dynamic orthosis

 Dynamic motion blocking:

Utilizes passive elastic pull in
one direction and active
movement in other direction.
WRIST DROP
This allows to maintain the
functioning of the unaffected
group of muscles.

For example, dynamic cock

up splint, active flexion and
DYNAMIC COCKUP
passive extension is allowed.
SPLINT
 HAND AND FINGER ORTHOSIS

1. Metacarpophalangeal flexion orthosis to

prevent the metacarpophalangeal extension.
 HAND AND FINGER ORTHOSIS

2. Metacarpophalangeal extension orthosis for

finger drop
ELBOW ORTHOSIS :
It is designed for immobilization of elbow joint after
injury or surgery in order to prevent contractures.

INDICATIONS :
Humeral Fracture
Elbow Dislocation
Ligament Laxity
Post-operative
Osteoarthritis
Radial and or Ulnar Fracture
Tendonitis
Lateral Epicondylitis (Tennis Elbow)
Medial Epicondylitis (Golfer’s Elbow)
 TYPES OF ELBOW ORTHOSIS :

PEDIWRAP
SPLINT/ STATIC
ELBOW
ORTHOSIS
ELBOW ORTHOSIS WITH
TENNIS ELBOW
LIMITATION ADJUSTMENT
SPLINT
JOINT RANGE OF MOTION
 Elbow orthosis

1. Functional dynamic elbow flexion orthosis:

2. Functional dynamic elbow extension orthosis

 SHOULDER ELBOW WRIST HAND ORTHOSIS
(SEWHO)
INDICATIONS :
•Distal humeral fractures
•Immobilization after surgery
•Unconscious movement during sleep
•Olecranon and Epicondyles Fractures
•Ligament injuries in the elbow joint
•Instabilities or hyperextension
•Injuries requiring limited range of motion at the elbow
•Elbow Arthroplasty
•Postoperative conditions
•Postoperative cast
 TYPES OF SHOULDER ELBOW WRIST HAND
ORTHOSIS (SEWHO):

HUMERUS BRACE WITH UNILATERAL ELBOW

GUNSLINGER ORTHOSIS JOINT IMMBOLIZER AND FOREARM
SUPPORT.
 Static Arm Orthosis
1. Shoulder and arm
Orthosis
 Aeroplane splint: it keeps
the arm in 90 degree
abduction and allows no
movement in the
glenohumeral joint.
 it is made of plastic or
metal and it is held to the
AEROPLANE SPLINT chest wall by straps or
elastic bandage. Indicated
in Erb’s palsy and burns in
the axilla.
Thank you !