Presentations
- Foot orthoses
- Footwear
- Neurologincal lower limb orthoses
- Orthoses for burns care
- Orthoses for knee dysfunction
- Orthoses for spinal dysfunction
- Orthoses in the management of hand dysfunction
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Charcot neuroarthropathy
- High risk feet
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Biomechanical principles of joint motion control
- Biomechanics and phases of the gait cycle (to assist in differentiating normal from pathological patterns)
- Components of appropriate footwear
- Functional anatomy
- Identification of musculoskeletal and neuromuscular pathology, including contracture, joint deformity, joint instability, muscle weakness, and spasticity
- Normal limb and vertebral anatomy and neurophysiology
- Three rockers in stance phase
- Vertebral fracture classifications and relevant orthotic range of motion restriction requirements
Joint assessment
- Use of goniometer for lower and upper limb joint assessments
Lower limb
- Clinical gait assessment
- Footwear examination
- Role of gait laboratory assessments referral
- Targeted physical examination including:
- lower limb vascular examination
- musculoskeletal joint examinations
- neurological limb examination
- Understanding of gait analysis reports for the management of patients
- Wound (pressure area) assessment
Upper limb
- Musculoskeletal joint examinations
- Neurological limb examination
General principles
General principles
- Awareness of causes for poor compliance
- Awareness of footwear modification options to accommodate foot deformity/problems
- Awareness of orthotic use complications
- Indications and contraindications
- Multidisciplinary approach, especially working with occupational therapists, orthotists, podiatrists, and physiotherapists
- Orthoses for individuals with burns, musculoskeletal dysfunction, neurological impairments, and vertebral fractures
- Prescription of prefabricated versus custom-made orthoses
- Prescription of static versus dynamic orthoses
- Role of micro-processing orthoses, e.g. C-brace
- Role of robotic exoskeletal orthoses
- Utilisation of prefabricated, modified, or custom-made footwear
- Utilisation of various materials and components – semi-rigid, e.g. carbon fibre, ethylene vinyl acetates (EVA), joints, metal uprights, thermoplastic
- Wound healing, off-loading (including total contact casting), orthotic and footwear management in the high-risk foot
Biomechanical and functional advantages
Lower limbs
- Ankle-foot orthosis (AFO):
- alteration of knee biomechanics, e.g. GRAFO
- correct/prevent deformity
- improve efficiency of gait
- redistribution of weight bearing forces, e.g. PTB-AFO
- reduce need for compensation of ipsilateral and contralateral limbs and secondary pain
- stance phase stability
- swing phase clearance
- terminal swing foot prepositioning for stance
- Foot orthosis:
- anatomical support to prevent or correct deformity and reduce pain during weight bearing
- off-loading pressure relief
- Knee-ankle-foot orthosis (KAFO):
- facilitate swing phase clearance
- stability in stance
Spine
- Protect the spinal cord
- Stabilise spinal fractures reducing range of motion to facilitate healing
Types of orthotics
- Lower limb
- ankle-foot orthosis (AFO)
- foot orthosis
- hip-knee-ankle-foot-orthosis (HKAFO)
- knee-ankle-foot orthosis (KAFO)
- Prefabricated orthotics:
- single joint prefabricated orthoses (e.g. knee, ankle, wrist) for musculoskeletal conditions
- Spinal
- cervical orthosis
- cervicothoracic orthosis (CTO)
- lumbar orthosis
- thoracolumbar orthosis (TLO)
- thoracolumbosacral orthosis (TLSOs)
- Upper limb
- dynamic orthoses, including Lycra style, e.g. Second Skin
- elbow orthosis, e.g. dynamic for burns contractures
- finger/thumb orthoses
- shoulder orthosis, including for brachial plexus injuries
- spinal cord injury (SCI) orthoses (appropriate to level of injury) universal cuffs with functional attachments
- wrist-hand orthosis, e.g. resting orthoses and dynamic orthoses
Upper limbs
- Dynamic versus passive orthoses
- In the tetraplegic hand, consider positioning and functional orthoses at each cervical level of injury
- Maximising function in reach and grasp tasks
- Off-load an injured limb to allow healing
- Pain reduction
- Prevent or correct deformity
- Reduce need for compensation of ipsilateral and contralateral limbs and secondary pain
- Substitution of weak or absent muscle function
