Compensate or Rehabilitate? Don’t settle with just an orthosis brace, try therapy for a change in pace!
Definition of Orthotics
Orthotics are most commonly known for treating a variety of foot, ankle, knee, and hip conditions when the muscles are too weak to support themselves. Most of these conditions include impairments with mobility, due to either joint hypomobility or muscle weakness. Conditions which could require an orthotic to better improve an individual’s function are strokes, spinal cord injuries, neurological deficits that impair motor control, joint instability, or lack of proprioception. There are a wide variety of orthotics which can help improve mobility, walking, and overall function with daily activities. Some orthotics can be bought at a local pharmacy or sporting goods store if it is for a generic condition, other orthotics however, can be custom-made to fit an individual’s specific needs and impairments.
Types of Common Orthotics?
1. HKAFO (Hip Knee Ankle Foot Orthosis): this is one of the most restrictive, yet most stabilizing devices that help support the hip, knee, ankle, and foot joints. The device attaches around the pelvis and is seen most commonly in neurological conditions such as spinal cord injuries. If an orthotic is needed to support both legs, a Reciprocating Gait Orthosis is recommended to help improve gait mechanics in bilateral lower extremities.
2. KAFO (Knee Ankle Foot Orthosis): these devices provide knee, ankle, and foot stability for those individuals who lack strength in ankle musculature as well as lack quadricep and hamstring strength. This orthotic is more restrictive than an AFO in movements because it assists with helping move 3 joints (knee, ankle, foot), but is less restrictive than HKAFO because the hip joint is strong enough to support itself.
3. Solid AFO (Ankle Foot Orthosis): The reason this is called a “solid” orthotic is because it limits the mobility of the ankle into plantarflexion and dorsiflexion due to either weakness in the ankle muscles or because of a contracture in the joint. Devices like this keep the ankle joint in a stable position and limit any mobility that could impair function. This brace could, however, cause compensatory patterns with ambulation and stair negotiation due to the lack of ankle mobility. The solid AFO is less restrictive than the KAFO, allowing patient to use quadriceps and hamstring strength during standing activities.
4. Articulated AFO: The “articulating” orthosis allows for improved dorsiflexion which improves mobility with walking and negotiating stairs. The articulating AFO is less restrictive than the solid AFO and would be used if an individual is able to clear their toes with walking but is still limited in overall ankle stability and mobility.
5. Dynamic AFO: The “dynamic” orthosis allows for even more mobility than the articulating AFO. With the dynamic AFO, a person must have some strength within the dorsiflexor and plantar flexor muscles, but the AFO helps aid in “pushing off” on toes during ambulation. The brace also does not provide support laterally, so one must have moderate amounts of ankle strength to reduce risk for ankle sprains and improved stability.
6. Air cast: An Air cast is used when a person can clear their foot with walking but has more instability and higher probability of spraining their ankle. The air cast provides good lateral stability to reduce risk of “rolling” the ankle. The air cast is like a generic ankle brace found at the local pharmacy but can reduce risk for sprains/strains in the ankle joint.
7. Custom or Generic Foot Orthotics: Custom foot orthotics can be made by a pediatrist or generic foot orthotics can be bought at your local pharmacy. Typically, this orthotic are inserts for your shoe to help improve foot alignment and change arch to reduce pain and improve alignment of foot positioning.
How Physical Therapy Interventions Can Aid in Lower Extremity Impairments and Weakness
Knee, ankle, and foot orthotics are wonderful aids in assisting with muscle weakness and providing improved mobility and support that the muscle and joints otherwise could not provide. However, physical therapy is important in not just compensating for these deficits, but addressing the impairments to improve range of motion, strength, flexibility, and overall body mechanics with functional activities such as walking, stair negotiation, and transfers.
Physical Therapy Treatment Interventions
1. Manual Therapy: Therapists can provide passive assistance with range of motion as well as joint mobilizations to help improve joint mobility, flexibility, and reduce stiffness.
2. Exercise: Exercises provided by physical therapists help target weak muscles, improve active range of motion in joints that are limited with mobility, and increase motor control and coordination between the different muscle groups.
3. Wrapping: TheraBand wrapping can be applied by a therapist to help assist joints with mobility by providing proprioceptive feedback to hip flexors, quadriceps, hamstrings, ankle dorsiflexors, as well as ankle plantar flexors. The resistance of the TheraBand can help further progress the patient once strength begins to improve and less reliance is needed on external assistive device.
4. Tapping: Kinesio-tape can provide increased awareness to a specific joint by lifting the skin to increase blood flow and provide support to weakened muscles or joint pain. K-tape does not help improve joint mobility and is used on individuals who have enough strength to show normalized walking patterns but have either pain or instability in the joint. K-tape can help improve proprioception to a targeted area which can improve balance and stability too.
5. Aquatics: Aquacare Physical Therapy specializes in improving mobility and strength both with land therapy as well as aquatic therapy. The aquatic therapy can help off-load the weight of an individual to further reduce pain and improve walking abilities without increased pain or compensatory strategies. Aquatic exercises can help to further strengthen weakened joints and challenge balance to improve stability. Tapping and TheraBand wrapping strategies can be incorporated with aquatic therapy to provide patient with maximum therapeutic benefits while retraining weakened muscles!
6. Therapist’s Knowledge and Education: If a patient needs an orthotic. but isn’t sure exactly what they need to improve function, ask your therapist! We are a great resource to provide information about what the specific impairment is and provide education and interventions to further promote mobility.
If you have any questions regarding orthotics or how to improve your mobility and strength, visit our website to schedule a free consultation and see what Aquacare site works best for you!
Written by Carson Wigley DPT- Salisbury office- pursuing a neuro specialty.