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Orthotics definition

Discussion in 'Biomechanics, Sports and Foot orthoses' started by healthyfeet, May 25, 2010.

  1. healthyfeet

    healthyfeet Active Member

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    Dear Colleagues
    Does anyone have a good definition of an 'orthotic'?
  2. A device of any material, shape or contour that reduces force on a stressed tissue.

    Well thats mine.
  3. “A foot orthosis is an in-shoe medical device which is designed to alter the magnitudes and temporal patterns of the reaction forces acting on the plantar aspect of the foot in order to allow more normal foot and lower extremity function and to decrease pathologic loading forces on the structural components of the foot and lower extremity during weightbearing activities.”

    Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002, p. 8.
  4. Not mad on that as a definition. Bit limiting for me. What about a UCBL which alters the loading on the medial and lateral aspects of the foot (rather than the plantar)? What about the "spikeothotic" which is designed to alter function of the foot by altering plantar sensation to alter muscular activity? What If I want to make function LESS normal because normal is pathological?

    I'd keep it Broad.

    Orthotic - A device applied to the outside of the body designed to alter function.
  5. Griff

    Griff Moderator

    It is an Orthosis
    They are Orthoses
    They are Orthotic Devices
    They are not Orthotics

    Anthony, R. J. (1991). The manufacture and use of the functional foot orthosis. Karger; Basel, Switzerland.
  6. healthyfeet

    healthyfeet Active Member

    Thanks Guys.
    So by your definitions regarding altering function, Does an orthotic have to be an 'in-shoe' device, or can it be the footwear itself?
  7. An orthotic can be anywhere on the body. I once helped an orthotist cast somebodies entire trunk for a spinal jacket, that was an orthotic.

    So I suggest that surgical footwear meets the definition.
  8. Robert:

    Using your definition, a shoe would also be an "orthotic".

    Also, can't an orthosis also be used for pain relief, and not only for altering "function"?

    By the way, orthotic is an adjective, not a noun.
  9. In the broadest definition yes, although one might question whether the average shoe is DESIGNED to alter function. It may alter function but is that its primary purpose? Whereas an in shoe orthotic or a surgical boot is has this as its primary function.

    Good point on pain relief. I guess it depends on the definition (circular I know)

    Re orthotic vs orthotics vs orthoses and the noun / adjective it would appear to depend where you look. The concise oxford english dictionary has it as a noun:

    Webster has it as a noun

    AND as an adjective as part of the study of orthoticS

    So I guess orthotics is the plural of the adjective and orthoses is the plural of the noun?
  10. healthyfeet

    healthyfeet Active Member

    Thanks. That's interesting.
    I guess if i add forfoot or rearfoot postings to the existing footwear, it then as a whole becomes an orthosis! or at least has an 'orthotic' function.
  11. I'm afraid that the word which once only considered a modifier of a noun (orthotic device) is now, due to widespread incorrect usage, considered to be a noun also. Such is the evolution of the English language.

    My bet is that any dictionary printed before 1980 has "orthotic" listed only as an adjective. Anyone want to take a peak at some old dictionaries for us? This may be a very interesting example of the fluid nature of our language.

    Here is what my Dorland's Medical Dictionary, 25th edition, printed in 1974 says:

  12. Boots n all

    Boots n all Well-Known Member

    KK the only issue l have with your first statement
    "..order to allow more normal foot and lower.." What is normal?

    Even if you define what is normal some of the Othosis that we make dont create "Normal" plantar pressure, quite the opposite, as we off load the plantar aspect of a diabetics 1st MPJ for example, does this then mean it not an Orthosis?

    For the purpose of many private health funds a shoe is an Orthotic device.
  13. David:

    I first wrote that definition over 12 years ago on January 7, 1998 on JISC Podiatry Mailbase. I have since amended my orthosis definition slightly to the following:

  14. healthyfeet

    healthyfeet Active Member

    The definition of an orthosis though can be the shoe itself, rather than a just device that is in the shoe....
  15. healthyfeet

    healthyfeet Active Member

    So Will most health funds pay for 'orthotic footwear'? ie. footwear that has 'additions, posts or paddings' to alter or improve foot function....
  16. Boots n all

    Boots n all Well-Known Member

    l doubt for padding, but hey its all in the context l guess.

    Each health fund is different as is each level, but in short yes they do, also the TAC, the government road authority, as do the Hospital funding programs

    Most health funds will reimburse for custom footwear just like they would for custom orthosis.

    They will also reimburse for footwear modifications ie rocker soles, flares, build ups and likes.

    Most refer to them as "Orthotic devices" or "Orthotic modifications"

    l must admit when l first heard the term Orthotic device l was a little surprised, but as the lady from the insurance fund pointed out to me,"If it braces and supports the body, then its an orthotic device"
  17. Here in the States, if you called a shoe an orthotic, then everyone would think you didn't know what you are talking about. Maybe things are different in the UK.
  18. Boots n all

    Boots n all Well-Known Member

    Here in Oz a shoe is a shoe also, unless it is custom made with the aim of improving the gait of the client....."which is designed to alter the magnitudes and temporal patterns of the reaction forces acting on the plantar foot in order to optimize foot and lower extremity function and to decrease pathologic loading forces on the structural components of the foot and lower extremity during weightbearing activities.”

    Now dont confuse what l am saying here, an Orthosis can and does a whole lot more, its all part of the package, we are looking at a definition which is often also just an interpretation
  19. healthyfeet

    healthyfeet Active Member

    Thank you all for your input.
    One of our local health insurance companies was happy for us to prescribe shoes and sandals and asked us to label them as 'customised orthotics' as long as they were customised for that patient or there was a medical need.
    The shoes ans sandals have removable inlays that we post at the rearfoot and/or forefoot or replace with orthoses or use in conjunction with an orthosis and additions. They are particularly helpful in the summer when patients need some control or function in a sandal!
    They have however withdrawn recently this benefit to patients, and will only pay for shoes built from scratch which i think is a backward move!
  20. David Smith

    David Smith Well-Known Member


    At Strathclyde Uni, National Centre for Training & Education in Prosthetics & Orthotics, they define an orthosis as an aid to limb/joint function


    and a prosthetic as a replacement for the limb or joint.


    Cheers Dave
  21. healthyfeet

    healthyfeet Active Member

    So I guess the definition of what constitutes an 'orthotic' or orthoses depends on who who one asks!
    and how much 'function', control or support would customised footwear have to offer before its an orthosis?
  22. healthyfeet

    healthyfeet Active Member

    The footwear would have to be customised to alter function in order for the definition to applicable.....
  23. Jeff Root

    Jeff Root Well-Known Member

    PFOLA technical standards document at www.pfola.org:
    Foot Orthotic. An in shoe device that braces, supports, or protects the foot or part of the foot.
  24. Jeff, I think that is a really woeful definition.
  25. Jeff Root

    Jeff Root Well-Known Member

    Simon, it is intentionally broad and covers accommodative, functional and other types of devices. Some of these devices can be more clearly defined as subclasses of foot orthoses. It can include the definition of a prescription foot orthotic, an accommodative foot orthotic, a functional foot orthotic, etc. What is specifically wrong with this definition? If I were to go on a nationally televised show and were asked to tell the public what a foot orthotic is, what would I say? Can you imagine the reaction I would get with Kevin’s definition? If pfola can improve this definition, I would be interested to hear a better alternative that sufficiently inclusive.

    Dr. Scholl’s advertises “Custom Fit Orthotics” on national television (http://www.footmapping.com/). How would they define an orthotic for the public?
  26. Jeff, I guess if I was trying to put it into lay-mans terms, I'd say something like: A foot orthotic is a device which is placed between the foot and the inside of a shoe which is designed to alter the forces acting upon the foot and leg in such a way that it reduces symptoms in the foot or leg. Something along those lines...
  27. The problem with these is that the more you say, the more possibility there is for missing something out or getting it wrong, but the less you say the less helpful the definition is.
  28. Jeff:

    How about this definition for the lay public? Certainly I would be happy to help PFOLA with these terms in the future. All they need to do is ask.

  29. healthyfeet

    healthyfeet Active Member

    A customised shoe or sandal will do the same re. altering or enhancing function, so the orthosis doesn't need to be an 'in-shoe' device. What alternatives are there otherwise for sandal use in the 5-6 months of the summer?
  30. Boots n all

    Boots n all Well-Known Member

  31. healthyfeet

    healthyfeet Active Member

    What do you guys think of the orthaheel 'orthotic sandals' with the 'built-in 4 degree medial posting?
    I recommend them for patients that have symtoms caused/exacerbated by excessive pronation for occasions where they can't/wont wear a shoe and orthotic, ie. around house and garden and inplace of soft house slippers. Remember we can walk 5km/day even if we don't leave the house!
  32. Jeff Root

    Jeff Root Well-Known Member

    If the foot bed is removable from the sandal and it meets the definition of an orthosis, then it's an orthosis in a sandal. My lab sells Sandal-thotics™ which are sandals with removable footbeds that have an orthosis placed in them in place of the stock footbed.

    If you modify or customize a sandal or shoe, its a modified or customized shoe! Insurance companies that cover orthoses will pay for the orthosis but not for the sandal itself. We itemize this on the invoice otherwise we could be a party to fraud if we billed the practitioner for both under the category of "orthotic".

  33. healthyfeet

    healthyfeet Active Member

    Do health insurance schemes pay for MBT shoes?
  34. Boots n all

    Boots n all Well-Known Member

    l cant answer the MBT question out right, but l can tell you that there was/is a review by private health funds that will prevent a lot of off the shelf products been reimbursed for, not sure how far a long it is at this stage.

    Sandals are on the market that will take an Orthosis, some better then others, it is going to come down to what you define as a sandal and how much support your client needs

  35. Shoes and foot orthoses are different, not the same. A shoe can't be worn in a foot orthosis, now can it? I have never heard of an "orthosis shoe", or "orthotic shoe" for that matter. However, I have heard of a custom molded shoe with a custom insole or orthosis inside the shoe.

    Healthyfeet, where are you from and where do you practice? I really would like to know if your country is using the term "orthosis" to describe a custom shoe, or if these odd remarks of yours are just your opinion.
  36. TedJed

    TedJed Active Member

    But no one has mentioned the origin of the word 'orthotic' (adj.)

    Anyone who has studied 'My Big Fat Greek Wedding' will know the word's origin must be Greek and so it is:

    Orthotic adj to make straight.

    Ted :)
  37. BAMBLE1976

    BAMBLE1976 Active Member

    Orthosis - an external device–eg, a cast, brace, or splint used to stabilize, reinforce or immobilize an extremity, ↓ sensory input to an extremity, prevent stretch weakness, ↓ contractures, functionally assist weak muscles, protect a limb with pressure sores, provide a mechanical block to prevent undesired movement
    McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

    In the uk under the current nhs contracts, footwear is included in the list of orthoses as they are fitted by orthotists. I think that footwear can be loosely termaed orthoses as they can be altered to help alter the GRF and in the case of diabetes act as an accomodative device in reducing shear forces on the dorsum of the foot by means of upper design and lining material.

    I also agree with the term orthosis - singular, orthoses - plural.
  38. robert bijak

    robert bijak Banned

    In dr. Kirby's definition replace the word "designed" with "believed by some"
  39. Ok we get that you think Biomechancis understanding has no role in treatment of patients by the use of orthosis, but this biomechanics and orthotics forum. So go and play in the Surg forum and hope that you don´t float off into space or fall on your face today ;)

    Ps do you have a cousin Podiatrist in New York ?
  40. healthyfeet

    healthyfeet Active Member

    Thank you.
    I understand the points you are making. However, we prescribe a range of 'shank dependant' shoes and sandals, where the 'functional, customisable' inlays constitute part of the structure of the footwear. In other words they can't function without each other!
    So in this case the footwear (including the orthoses componant) is indeed 'orthotic footwear' or an orthosis in its own right according to many podiatrists and orthotists definitions!
    Our range of footwear can change function or offer specific support or pressure redistribution and/or shock absorption.

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