Dear Colleagues
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Does anyone have a good definition of an 'orthotic'?
thanks
M
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A device of any material, shape or contour that reduces force on a stressed tissue.
Well thats mine. -
Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002, p. 8. -
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. -
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. -
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?
M -
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. -
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. -
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:
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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.
Regards
M -
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:
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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. -
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:
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The definition of an orthosis though can be the shoe itself, rather than a just device that is in the shoe....
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So Will most health funds pay for 'orthotic footwear'? ie. footwear that has 'additions, posts or paddings' to alter or improve foot function.... -
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" -
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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 -
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!
Regards
Martyn -
Martyn
At Strathclyde Uni, National Centre for Training & Education in Prosthetics & Orthotics, they define an orthosis as an aid to limb/joint function
Example
and a prosthetic as a replacement for the limb or joint.
Example
Cheers Dave -
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?
Martyn -
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Foot Orthotic. An in shoe device that braces, supports, or protects the foot or part of the foot. -
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Dr. Scholl’s advertises “Custom Fit Orthotics” on national television (http://www.footmapping.com/). How would they define an orthotic for the public?
Regards,
Jeff -
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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.
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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.
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Define a sandal for me please?
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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!
Martyn -
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".
Respectfully,
Jeff -
Do health insurance schemes pay for MBT shoes?
Martyn
Podiatrist -
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 -
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. -
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 :) -
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. -
In dr. Kirby's definition replace the word "designed" with "believed by some"
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Ps do you have a cousin Podiatrist in New York ? -
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.
Regards
M
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