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Pediatric Orthotics

What Is an Orthosis?

An orthosis (singular), or orthoses (plural), are external devices with controlling forces to improve body alignment, improve function, immobilize an injured area, prevent or improve a deformity, protect a joint or limb, limit or reduce pain, and/or provide feedback. Orthoses are named for the part of the body they cover. Orthoses can be custom or non-custom fabricated. A custom-molded or custom-fit orthosis requires a prescription signed by a physician.

Who Designs and Provides Orthoses?
⁃ Certified orthotists have formal education in biomechanics and material sciences required in designing custom devices. Pediatric orthotists evaluate the child, cast the child (for a mold), modify the mold, fabricate the orthosis, and custom fit the orthosis to the child.
⁃ Physical therapists are trained in the function of orthoses and will frequently fit and measure orthoses. If the child is measured by the physical therapist, the orthoses are usually fabricated through a company, then delivered to the family or therapist. Following delivery of the orthosis, physical therapists provide education and functional training to the child and family.
⁃ Physicians, orthotists, and physical therapists often provide simple, off-the-shelf devices for acute situations. The sizing of these devices is determined by measurement and does not require custom fitting.
⁃ Families can purchase supports and braces at pharmacies and sport stores.

Common Types of Orthoses:
⁃ Foot orthosis: oftentimes referred to as a shoe insert, and assists with arch alignment.
⁃ UCBL: stabilizes foot/ankle complex.
⁃ Supra Malleolar Orthosis (SMO): for severe and excessive movement of foot/ankle joint due to low tone and/or ligament laxity. Provides support and stabilization to foot/ankle.
⁃ Articulating Ankle Foot Orthosis (AFO): assists with keeping toes/ankle up, to avoid foot drop, and foot slap. Comes up over the ankle and lower leg, to provide support to foot/ankle and also helps with knee control. Can also be used for toe walking. Allows for movement of the ankle in the sagittal plane.
⁃ Solid Ankle Foot Orthosis (SAFO): does not allow movement at the ankle joint. Can be used for severe hypertonia (high tone), or severe rheumatoid arthritis of the foot and ankle, to protect the ankle.

Are Orthoses covered by Insurance?
Oftentimes, custom-molded Orthoses are covered by insurance companies, at least in partial amounts. Non-custom orthoses are less costly, and families can sometimes receive reimbursement.

Communication between the physician, physical therapist, orthotist, and family is important to determine the most appropriate orthosis.

Your physical therapist will discuss options for your child, and if they require a custom-molded orthosis, or if they would benefit from a non-custom orthosis.

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