How are foot orthotics made?
Foot orthotic (arch support, footbeds) are made in a variety of ways usually depending on the experience, skill level, and facility set up where the health practitioner works. The Certified Orthotists at Nipissing Orthopaedic Lab Inc use the plaster of Paris slipper cast impression technique. We feel that this technique is the gold standard for foot impression because it allows the practitioner to maintain the foot in an optimal alignment and off-load problematic pressure areas of the foot during the process. Everyone’s optimal alignment varies as much as individual fingerprints do. There are other techniques such as foam box imprint, wax mould imprint, and pressure computer “dimpling” – but we rarely use these other techniques for impression taking.
These Plaster of Paris slipper casts then become the basis on which your orthotic is vacuum moulded. We laminate various layers of materials to create your device. The materials range from very soft foam laminates for rigid feet to very firm plastics and rubber base materials for hypermobile feet, where more control is needed.
The foot orthotic industry was exclusively in the realm of the Orthotist until approximately 25 years ago. Today, with the advent of computerized foot pressure digitizing and access to central fabrication services, all allied health professionals have the ability to fit foot orthotics. However, the best service will be provided by those who actually fabricate the foot orthoses they deliver. Certified Orthotists have been hand-crafting all appliances they deliver since the profession was created after World War II and the polio epidemic in the late 1940s and early 1950s.
Are foot orthotics for everybody?
This is a complex question because there are many variables to consider. Essentially, if you have foot alignment issues, family pre-disposition leading to foot deformity and pain or chronic leg, back or foot pain, then the answer is yes. If you have normal foot alignment, flexibility, and still have foot pain, then structured orthopaedic footwear and stretching or strengthening exercises are indicated for you. We routinely refer clients to physiotherapists for assessment of the feet when chronic or acute foot pain is expressed and normal foot mechanics are evident.
How do I go about getting started with a brace fitting at Nipissing Orthopaedic Laboratory Inc?
The decision regarding the need of an orthopaedic appliance often starts with a discussion with your Doctor or other health professional. This referral becomes the basis from which an individualized orthotic treatment protocol will be prepared by our clinical staff. This protocol involves careful history taking and performing a variety of physical assessments by the Orthotist clinician. From there a decision regarding the need for a prefabricated or custom made appliance is made.
Are devices prefabricated or customized at Nipissing Orthopaedic Laboratory Inc?
Prefabricated or off-the-shelf appliances can be in stock or specially ordered. These devices are ordered from a large number of American and European manufacturers. Our clinicians are always on the look out for new concepts and approaches for the treatment of acute or chronic physical ailments with off-the-shelf devices. Prefabricated appliances however are a very small part of our business. The majority of appliances that we dispense are custom made, in house, by our specialized orthotic technicians.
What types of devices are available?
Custom made appliances can range from the smallest (but very effective) custom toe separators to full spinal immobilization body jackets. The most commonly braced body parts in order are the feet, the ankles, the knees, the low back and spine, the wrists, and the elbows. The hips and shoulders are only braced in rare instances.
What is involved to create a custom device or appliance?
This custom brace manufacturing and dispensing specialization is what we do best. We prefer to make our own devices which usually involves impression taking the involved body segment or segments with plaster of Paris or fiberglass casting materials. We often also take limb tracing and measuring using calipers and measuring tapes.
The body segment cast is then filled with plaster of Paris slurry, allowed to harden and prepared for modification. Positive cast modification is a complex procedure which allows the clinician to safety load and off-load areas that are being braced, in order for the appliance to correctly function as needed. This is the art part of our profession and a major part of what we learn at our clinical prosthetic and orthotic schools.
The modified positive cast is then brought to a different section of the lab where our technicians oversee the manufacturing which often consists of vacuum molding plastics, foam and other materials. The cooled molded components of the brace are then cut away from the positive cast and reassembled, trimmed, polished and riveted together. Various straps, joints and uprights and other function mechanisms are then added prior to the appliance being ready for dispensing.
What is involved in the manufacturing of a prosthetic device?
Prosthetic appliances are an amalgam of three distinct parts. The socket in which the residuum (stump) is housed, the components that replace lost limb segments, and the suspension method that retains the prosthesis in place on the body. All three aspects of a prosthesis are uniquely designed and adapted for each amputee.
What is a prosthetic socket?
The socket for the prosthesis is made from casting the amputee’s residuum using plaster of Paris in order to produce a mold of the involved segment. This process is very similar to the way that a body segment is casted for an orthopaedic appliance.This positive mold is modified to offload certain body parts and to load others. This way, a prosthetic socket can safely allow an amputee to stand without damaging underlying tissue of the residuum. The art of offloading an amputated limb is constantly evolving, but generally you have total surface bearing sockets or area specific loading sockets.
The prosthetic technician will take this modified positive cast and initiate the manufacturing of a prosthetic socket.
New amputees will undergo rapid limb atrophy after amputation very much in the same way that your arm will atrophy when wearing a cast, while healing from a bone fracture. This will necessitate more frequent socket changes initially in the first 3 to 5 years after amputation.
What materials are prosthetic sockets made from?
Years ago you would have received an open ended, carved wood socket or possibly even a hand hammered aluminum socket. Today’s laminated sockets are made of a mix fiberglass, Kevlar, nylon and carbon fiber, as well as thermoplastics and blends using silicone and polyethylene.
Socket/residuum inter phase materials have also evolved dramatically with antibacterial and anti odour silver particles imbedded into thermoplastics and as thread lining in stump socks. Also, a wide variety of silicone and urethane gel liners have made prosthetic device wearing much more comfortable thereby allowing activities that were formally very difficult to do such as running with your prosthesis.
What are components?
Prosthetic components replace the lost joint segment below the residuum. Components consist of prosthetic joints, prosthetic feet, upper extremity terminal devices which includes hands and hooks, pylons and adapters that connect all the components together. Components are manufactured by a number of European, American and Asian manufacturers. Function, cost, and complexity vary enormously and depend on numerous functional, physical and economical variables.
How does a prosthetic stay in place?
Prosthetic suspension is quite variable and is often dependent on body shape, functional abilities and amputation type. They consist of belts, straps, cuffs, bony anatomy wedges, suction valves, ratcheting pins, lanyards and sleeves. The prosthetist will decide on which suspension type is best suited to an amputees needs, taking into consideration the amputee’s residuum type and shape, patient abilities and desired functional outcomes. Then again there is a newer technique that you can look up online consisting of direct bone attachment called osteointegration. This is mostly done in Scandinavia but gaining momentum in North America.
How common is amputation?
There are two main groups of amputees, acquired amputations or amputations that are congenital in origin. Congenital amputations are self-explanatory while acquired amputations can be divided into 2 groups, trauma and through the disease process. In Canada, the vast majority of amputation occur as a result of vascular compromise as a result of large or small blood vessel diseases such as Diabetes Mellitis, Peripheral Vascular Disease and from smoking. The average age for an amputation in Canada is around 70 and most amputations are of the lower extremities.
Why do I need foot orthoses (or foot orthotics)?
Although there are a huge number of physical ailments that are treated by Certified Orthotists, a number of generalizations can be made in regards to how orthopedic footwear and orthotics help the human body.
Mankind has seen tremendous changes in lifestyle since the advent of the industrial age about 200 years ago. These changes have necessitated greater amounts of time standing on increasingly harder surfaces. Prior to the start of the industrial age, people were intensely colloquial, meaning that they lived their entire lives generally within a small radius of where they were born. Most time was spent on softer ground surfaces and on irregular ground surfaces. The softer ground surfaces tended to minimized the impact of walking and standing on the lower extremities. Today, modern people spend most of their time on much harder surfaces such as concrete, ceramic tile, and hardwood floors. This, coupled with a recent trend towards softer and flatter shoes to accommodate these harder surfaces, an aging demographic, and increasingly sedentary lifestyles, has led to a situation where a good percentage of the population suffers from back, leg, and foot ailments.
Would better shoes help me?
The ground reaction forces imparted through hard ground surfaces while standing and walking are transmitted up the legs and into the back are not being reduced by the softer-soled footwear that we have adopted of late. Also, people with biomechanical misalignment of the feet and lower extremities are especially prone to the development of connective tissue strains and pain and degenerative joint changes throughout the lower extremities and back, as a result of wearing unsupportive softer soled footwear over long periods of time. Repetitive work activities, poor posture and weak abdominal core strength are other major factors that lead to lower extremity ailments and back strain and pain.
Orthopaedic footwear maintain the feet in optimal alignment and reduce strain in the lower extremities and spine. As a result, most active adults will benefit from wearing orthopaedic footwear.
Do I only wear orthopaedic footware outdoors?
Orthopedic footwear with or without a foot orthotic, provide the body with structure where it is needed most, at the bottom of the kinetic chain, at the feet and ankles. This structured footwear stabilizes and aligns the body in a proper way, thereby reducing strain higher up the body. The thing to remember with structured orthopedic footwear and/or foot orthotics is that wearing them indoors is just as important as on the job and away from home. We spend around 8 hours sleeping, 8 hours at work and approximately 8 hours of time doing leisure activities per day. Older or retired persons spend even more time indoors, especially in winter. Not wearing structured footwear indoors allows undesirable forces to act unabated on the body and I always urge my clients to wear structured footwear indoors as well as out of doors.
Functional foot orthotics reduce strain and pain and can counter deforming forces caused by faulty foot alignment issues. This is very important because these alignment issues lead towards premature joint degeneration within the foot or up into the knees, hips, and back, with age. Functional foot orthotics are quite complex in their own right and require the skilled knowledge of a Certified Orthotist to properly assess, prescribe and dispense these biomedical devices. Not everybody will need to wear custom made functional foot orthotics, but most people will benefit from wearing orthopedic footwear indoors and outdoors on a daily basis.