Orthotics at Guildford Hospital

What is orthotics?

Orthotics is the area of healthcare concerned with designing, fitting and providing orthoses, external devices also known as braces, splints or supports, that help a part of the body work better or feel less pain. These range from simple shoe inserts to devices supporting an arm, leg or the spine.

What conditions does orthotics treat?

Orthoses can help with conditions affecting many different parts of the body, including:

• foot and ankle problems such as bunions, flat feet, high arches, plantar fasciitis and sprained ankles
• musculoskeletal and neuromuscular conditions, including cerebral palsy and scoliosis
• diabetes-related foot problems
• rheumatoid arthritis and other joint conditions
• sports injuries and trauma

Signs that an orthosis might help include foot pain or swelling after everyday activities, a sharp heel ache on waking, balance problems linked to collapsed arches, or a change in the way you walk after a leg injury.

What are the benefits of orthotics?

Orthoses can align and support the part of the body they're made for, ease pain, and sometimes delay or prevent the need for more invasive treatment such as surgery.

Evidence for some specific uses, such as treating flat feet in adults, remains limited. Even so, research suggests that wearing inserts doesn't cause harm, so many people still find them worth trying.

Are there different types of orthoses?

• foot orthoses, ranging from cushioned pads and heel liners to arch supports and full shoe insoles
• ankle foot orthoses, sometimes called drop foot splints, supporting the ankle and lower leg
• orthopaedic or adapted footwear, including shoe raises and other adaptations
• braces and splints for the knee, wrist or hand
• spinal braces, used for conditions such as scoliosis
• hernia supports and made-to-measure compression garments

Custom devices are shaped specifically for you, using a plaster mould, a foam impression, or a digital scan of the body part involved. Firmer, semi-rigid materials are often used where the goal is controlling movement, while softer, more flexible materials that mould to the body suit conditions such as diabetes-related foot problems.

What happens before an orthotics appointment?

You'll usually need a referral before being seen, typically from your GP if you're an adult. Children with a long-term neurological or developmental condition are usually referred by their physiotherapist instead.

For footwear-related appointments, it helps to wear or bring suitable shoes, trainers or lace-up styles work better than slip-ons, and heels higher than 3cm are generally unsuitable for fitting an orthosis alongside.

What happens during your orthotics appointment?

1. Your orthotist examines the affected part of your body and asks about your symptoms and daily activities.
2. Measurements are taken, sometimes using a plaster mould, a foam box impression, or a digital scan.
3. For custom devices, your orthosis is shaped to match your body and how you move.
4. Your orthotist fits the finished device, checking it works well with your footwear or clothing, and makes any adjustments needed.

Fitting appointments are usually arranged around 4 to 6 weeks after your initial assessment. Footwear may need two separate fitting visits, meaning around 8 to 12 weeks in total before it's ready.

What does recovery look like?

Getting used to a new orthosis takes time, typically a month or so for your body to adjust, so some initial discomfort or strangeness is normal.

Orthoses manage symptoms rather than cure the condition behind them, so if one is working well for you, you'll likely be advised to keep wearing it long-term. Stopping can mean your symptoms return or get worse.

How long a device lasts depends on the material it's made from, your activity levels, any changes in your weight, and how well you care for it. Prescription orthoses can last for years when looked after properly.

In children, some orthoses, such as supportive boots used while learning to stand and walk, are only needed for a limited time and aren't prescribed as standard.

What are the practical considerations and limitations?

• an adjustment period of up to a month while your body gets used to the change
• limited evidence for some specific uses, such as treating flat feet in adults, though this doesn't appear to cause harm
• symptoms potentially returning or worsening if you stop wearing an orthosis that was working for you
• needing to change your usual footwear style in some cases for an orthosis to fit and work properly