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What is orthotics? The role of an orthotist in injury management

Orthotics is the field of medicine concerned with the design and manufacture of artificial devices called orthoses. An orthosis is placed on the body to modify or correct functional and structural characteristics of the neuromuscular system and the skeletal system. Orthotists are medical clinicians who prescribe, manufacture and manage the application of orthoses.

Orthoses may be used to support the limbs of patients suffering disease or injury through controlling, guiding, limiting or immobilising a joint, limb or body segment. They may be used to restrict movement, to enable movement (mechanical), as a rehabilitation device after the removal of a cast, to reduce weight bearing pressure, to correct the shape or function of part of the body, or to ease pain.

Prophylactic braces can be used by athletes participating in contact sports or in dangerous activities. Functional braces have been designed for individuals with weak joints due to a previous injury or, for example, for people suffering from arthritic pain. Rehabilitation braces are used to restrain movement, usually after surgery, to immobilise a joint.

What is the discipline?

As an orthotist, your aim is to aid bodily movement, correct deformities, relieve pain and prevent orthopaedic deformities from progressing. This is done by fitting an orthosis to an existing body part, for example, by using a brace, calipers, neck collar or splint. These devices are commonly made from various types of materials including thermoplastics, carbon fibre, elastic, metals, EVA and fabric. With serious or long-term conditions, orthoses are custom made specifically for an individual patient, but for less serious injuries such as a sprained ankle, pre-manufactured braces that are available in a range of sizes may be purchased over the counter. These simply slide on (or wrap around) to cover the injured area and are held tight by Velcro. Your input as an orthotist can make a huge difference to your patient’s quality of life either over a period of rehabilitation or perhaps even the rest of their lives. Due to the long-term use of orthoses, it is imperative that they fit correctly and do not have pressure points or areas of irritation for the patient.

Pedorthics is a branch of orthotics that deals specifically with the feet and lower limbs. A pedorthist is trained in the assessment of lower limb anatomy and biomechanics. They can identify dysfunction and create either insoles, complete shoes or shoe modifications designed to correct issues associated with a patient’s gait or foot pain due to disease, trauma or the prolonged wearing of ill-fitting shoes.

What does it involve?

Initially an orthotist examines and assesses a patient’s needs during a consultation. The patient’s requirements are discussed and in association with other professionals such as physiotherapists, a decision on the best plan of action for treating the injury will be made. Traditionally, orthoses were made by creating a tracing of the affected extremity together with the taking of measurements in order to assemble a snug-fitting device. Now, however, computer modelling programs such as CAD (computer aided design) and CAM (computer-aided manufacturing) may be used, firstly to take measurements of the affected area and then to feed this information to a 3D printer for creation of the initial unit. During the next manufacturing step, the orthotist works together with an orthotic technician to produce the final product. The device will be fitted during a further consultation and the patient is fully informed and educated in its use, fitting and removal. During follow-up appointments the orthotist will ensure that the patient is coping well with their orthosis and that the device is functioning properly and is comfortable. Adjustments or repairs will be carried out if or when needed, throughout the period of rehabilitation.

What qualifications do you need?

To practice as an orthotist in the UK, registration with the Health and Care Professions Council (HCPC) is essential, but before this you need to hold an approved Bachelor of Science degree in Prosthetics and Orthotics. Prosthetics is the area of medicine that involves working with patients who have lost limbs and the creation of new artificial replacement devices for them that match the missing limb as closely as possible. The two disciplines of prosthetics and orthotics are closely linked and therefore studied together. There are two UK universities that offer these courses (University of Salford and University of Strathclyde). The degrees take three and four years, respectively, to complete. Once you have graduated, you can specialise in one area or practice both prosthetics and orthotics. Some professionals then choose to specialise in one area of care such as paediatrics, geriatrics or sports medicine. To be accepted for the degree, you will usually need at least 5 GCSEs and three A levels, which include maths and two of the science subjects, physics, biology or chemistry. Once registered with the HCPC, you will need to remain on the HCPC register throughout your working career, while ensuring your knowledge and skills are kept up to date through continuing professional development and paying an annual fee.

What training is required?

During your degree course, you will combine academic studies with clinical placements where you will work with patients in institutions or private clinics. The range of subjects studied will include anatomy, physiology, pathology, biomechanics and engineering, materials and design. On completing your degree, further training can be undertaken by attending short courses made available through the British Association of Prosthetists and Orthotists (BAPO). On their website, there is a downloadable manual of BAPO Standards for Best Practice that outlines the duties and expected standards for the work completed by prosthetists and orthotists. BAPO is the only UK body that represents the interests of prosthetic and orthotic professionals and it was established to encourage high standards of practice. It is committed to continued professional development and education to enhance the standards of prosthetic and orthotic care.

What experience do you need?

To become an orthotist, you need to have an interest in how the human body moves and works, good technical and practical skills, good problem solving skills and creativity to design and produce the required devices. Interpersonal skills are needed as you interact with patients and other colleagues. These include good communication, sensitivity and understanding the needs of patients, as well as the ability to use your initiative and work well in a team. Strong IT skills are becoming more important in this role, as computer technology is becoming an increasingly significant part of the production process.

Many people enter the profession because they have a family member or friend with a prosthesis or orthosis. Others may make a lateral move from areas such as engineering, bioengineering or kinesiology. A common motivation in all orthotics professionals is that they would like to help people and have a greater personal impact on the world.

Where do the professionals work?

Depending on whether you specialise in orthotics or prosthetics or want to cover both, you can work in a variety of environments. Most orthotists usually work in hospitals, health centres or private clinics. In addition, they may, for example, visit patients at their own homes, work in retail outlets, fabrication laboratories, rehabilitation facilities, pharmacies or cancer care centres.

Many orthotists are employed by private companies and then contracted by the NHS.

In this role, you will work alongside clinicians, nurses, chiropodists, physiotherapists, occupational therapists and technicians and be an integral part of the team.