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what is an orthotist

What is an Orthotist?

 

 

 

Pediatric physical therapists and physicians often rely on the help of orthotists and prosthetists to help with patients’ mobility needs. Sometimes, children come to physical therapists with gait and postural deviations (toe-walking, in-toeing, scoliosis, etc) and other conditions where exercises and muscle retraining simply are not enough. In those cases, we often ask for the help of an orthotics and prosthetics (O&P) specialist. Braces and artificial limbs are important to facilitate movement and promote independence.

When we refer children to an orthotist, it means we think that some aspect of their movement and growth could be helped out by an external medical device. An orthotist is a critical part of the rehabilitation and therapy process. Orthotics help correct alignment and improve function of childrens’ neuromuscular or musculoskeletal system. Orthotists evaluate what a child’s functional needs are and will design and construct the orthotic devices as needed. An orthotist is a certified healthcare professional who is knowledgeable in human anatomy and physiology, biomechanics, and engineering. As movement specialists, physical therapist rely heavily on the help of orthotists to achieve the mobility goals for our clients.

Some conditions that may require help of an orthotist:

Not sure if your child will have orthotic needs? Come see a physical therapist and we can point you to the right medical professional depending on your needs.

Click here to read our run-down of the best over the counter foot orthotics.

night splints

The Quick Guide to Night Splints for Children

 

 

 

For many children who are idiopathic toe-walkers, physical therapists often take the conservative approach. We have many things in our arsenal to help children improve without undergoing costly and painful surgery. Outside of stretching and strengthening exercises, we might recommend ankle foot orthoses (AFOs) for day time and/or night time wear. Depending on the child’s range of motion measurements, walking mechanics, and underlying pathology, different types of orthotics might be recommended. We often work closely with orthotists (professionals who design medical supportive devices such as braces) to make sure each child receives the individualized care and equipment he needs to gain full function and optimal alignment.

Here are reasons why your physical therapist might have recommended night splints for your child:

  1. The main goals of physical therapy interventions for toe-walkers are to increase ankle dorsiflexion range of motion and to decrease possible contractures that are associated with the condition. Physical therapy exercise programs include stretching the calf muscles, strengthening the trunk muscles, manual therapy, treadmill training, balance training, and ankle mobility training. Sometimes, in stubborn cases of toe-walking, orthotics are needed to maintain the range of motion gained throughout daily exercise sessions.
  2.  If you’ve ever tried to stretch your pre-schooler’s muscles, you know that children can be active and fidgety. They don’t tolerate passive stretches as well as adults and might complain of boredom, pain, or ticklishness. The most effective stretches are those held for a prolonged period of time at a joint’s end range. Night splints allow for increased stretch time at the ankle joint, because the child is sleeping or resting when they are in place.
  3. The best time to gain range is when a child is relaxed. Since children relax more during sleep, even more range can be gained through passive stretching using a night time AFO.
  4. This is where the night-time splint comes in. While the daytime AFO is a rigid orthosis that keeps your child’s ankles from plantarflexing (pointing down) past neutral while he walks, the night time AFO is a much more dynamic system. Night splints can be adjusted as the ankles gain more range into dorsiflexion. They provide a low-load, prolonged-duration stretch that helps with contracture reduction and counters high tone.
  5. In the literature, night splints have been found to be effective for contractures at a variety of joints, and can be useful in brachial plexus injuries, cerebral palsy, and muscular dystrophy.

As pediatric physical therapists, we rarely recommend over-the-counter orthotics for your child’s orthopedic needs. By consulting with an orthotist, we make sure each child is fitted to the most comfortable and developmentally appropriate custom foot wear for his condition. Usually, children who adhere to a strict physical therapy program and who receive the right orthoses can see a complete change to their posture and gait mechanics in as short as 6 months’ time.

Click here to view our gross motor milestones infographic!

References:
Cincinnati Children’s Hospital Medical Center. Evidence-based care guideline for management of idiopathic toe walking in children and young adults ages 2 through 21 years. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2011 Feb 15. 17 p. [49 references]

What are the Best Over the Counter Foot Orthotics?

Although most children with feet problems should be treated with a custom orthotic prescribed by a podiatrist, over-the-counter orthotics are an option for some children, teens and young adults.  Could your teen or young adult child benefit from an over-the-counter orthotic?  Read on for several great options.

What are Over the Counter Orthotics?pediatric orthotics

In general, over the counter (OTC) orthotics look like shoe inserts and are placed inside your shoe to add extra support and to help with arch problems. They’re geared toward people suffering from foot, knee, or back pain that can arise from having flat feet, wearing uncomfortable shoes, or simply walking or running incorrectly. Unlike custom orthotics, they are available without a doctor’s prescription.

What to Look for in an Over the Counter Orthotic:

It is best to find an over the counter orthotic that has a plastic polymer or a hard plastic that is a little more rigid than just the typical shoe insole. While the average lifespan of custom orthotics is 3 years, the average life span of over-the-counter orthotics is 6 months.  Read more