Orthosis - reasons and shapes

Definition - what is an orthosis?

An orthosis is a medical aid that is used to support the functions of the musculoskeletal system, particularly joints. They are used after operations, accidents or in the case of congenital malpositions and are used to secure or restore postures.

There are orthoses, for example, for all larger joints such as the knee or wrist, but also for the back. An orthosis is usually a splint made of plastic and various straps that allow guidance and stabilization on the body part used.

What do you need an orthosis for?

The possible area of ​​application is very large, as these can be used for different reasons and on a large number of body parts. A common reason why you need an orthosis is injuries to joints or ligaments.

A common injury is a torn cruciate ligament on the knee, which can be sustained while skiing or playing football, among other things. A knee brace is often prescribed for a few weeks so that it keeps the knee joint stable from the outside and prevents further injuries.

In older people, signs of wear and tear of the joints (osteoarthritis) or bone loss (osteoporosis) are often the reason why the use of an orthosis is indicated. These can help stabilize body parts and thus maintain quality of life. People with dorsiflexor weakness, for example as a result of a herniated disc, can be supported when walking using a special orthosis.

In children, too, orthotics are an important part of therapy for many diseases. Congenital deformities of the hips or feet are most often the reason why orthotic treatment is necessary. Timely and consistent therapy can often correct a misalignment so that the child can learn to walk normally.

Even in the event that a misalignment can no longer or not completely be remedied, orthoses can often represent at least an aid for stabilization.

Finally, orthotics are sometimes used by healthy people in order to prevent injury or overload. Competitive athletes from the area of ​​running, for example, occasionally use orthoses for the legs to support and thus protect joints and ligaments.

How does an orthosis work?

Despite the diversity of the different orthoses and the differences in shape and size, orthoses are usually based on a common principle of action. It is the so-called three forces principle.

The effect of the orthosis is achieved in that there are three points of contact on the corresponding part of the body, two of which are used for stabilization and exert pressure.

In the case of so-called active orthoses, this effect is best demonstrated in movement, which means that the activity of the user is necessary.
Passive orthotics, on the other hand, fully support the joint even when at rest.

The most important prerequisite for a good effect of every orthosis is that it fits exactly and, if necessary, is adapted to the patient's dimensions. In addition, the individual requirements for the aid should also be taken into account.

It is also important that it is comfortable to wear and, for example, pressure points are recognized and compensated in good time. For the best possible effect, in addition to individual adjustment, for example by an orthopedic technician in the medical supply store, instruction on how to put the orthosis on correctly is important.

Which orthoses are there?

Orthoses can be classified according to different categories. A classification is made according to which part of the body they are used on. There are orthoses for arms and hands, legs and feet as well as for the torso, i.e. back or neck. In addition, a distinction is made between orthoses that only work actively and those that also provide passive support. In the case of orthoses, which are only actively effective, an effect only takes place when the wearer moves.

Another important classification is based on the purpose the orthosis is intended to serve. On the one hand, the goal can be to immobilize a joint, for example after an operation, so that the wounds can heal. Often these orthoses are also referred to as positioning splints. In the case of ligament injuries, on the other hand, orthotics are often used, which serve to stabilize the joint from the outside, such as after a cruciate ligament tear in the knee joint.So-called retention or reduction splints are used to compensate for or correct misalignments.

Another group are orthoses for length compensation, for example when one leg is longer than the other. In addition, the various orthoses differ based on the materials they are made of. In addition to different types of plastic, carbon (carbon fibers) can also be used.

Read more about the topic: Leg length difference

Knee brace

The knee joint is the largest joint in the human body and it has a complex structure with various ligaments that serve to stabilize while maintaining mobility. If ligament structures are damaged, for example through an accident, a knee-joint orthosis is often necessary.

From the outside, this forms a stable frame around the joint and thus replaces the stability that has been lost due to the injuries as far as possible. In addition, knee orthoses are usually equipped with axial joints. These can be fixed at different angles and thus limit the range of motion in the knee. Because the movement is released more and more over a period of several weeks, the damaged structures can recover and the knee joint becomes stable again even without an orthosis.

If an operation has been performed on the knee, however, a complete immobilization of the joint is usually required first. This ensures that the wound and internal structures can heal and that premature movements do not cause further damage. The orthoses used for this are so-called knee positioning splints. The knee is not stretched, but is usually fixed at a certain flexion angle, depending on the surgery and the structures that were injured. Since the tissue can swell after an operation, it is also important that the width of the knee orthosis can be adjusted.

Lower leg orthosis

A lower leg orthosis is prescribed, for example, if the Achilles tendon has torn or partially torn. The lower leg orthosis fixes the foot in an equinus foot position. This enables the tendon to grow back together and also prevents further injury from lowering the foot.

The angle between the lower leg and foot is achieved by using a wedge and is greatest at the beginning of the orthotic treatment, since this way the tendon ends are best against one another. Gradually, in the coming weeks, the angle will be reduced by changing to ever smaller wedges until the foot is back in its neutral position of 90 degrees. This prevents the tendon from shortening.

Other reasons why a lower leg orthosis is used are, for example, broken bones in the tibia or fibula. In addition, if the foot is twisted, ligaments can tear or become overstretched, so that here too it is necessary to wear an orthosis temporarily.

Ankle brace

Ankle injuries are among the most common injuries to the musculoskeletal system in humans. The mechanism of the accident is usually an inward or outward twist. This can lead to overstretching or a rupture of ligaments as well as a bone fracture on the inner or outer ankle.

Often an ankle brace has to be worn for some time after the injury. This can be the real deal for minor injuries. A so-called stabilization splint prevents the foot from twisting again while maintaining mobility in the ankle. In cases with a major injury, an operation may have to be performed first. An orthosis is then often required to immobilize the ankle area so that the wounds and injured structures can heal.

Read more on the topic: Ankle brace

Wrist brace

A wrist orthosis usually consists of a splint that runs from the palm of the hand over the wrist to the forearm and is fixed with straps or straps. This fixes the joint in a neutral position. This ensures optimal blood flow and makes immobilization as pleasant as possible.

A wrist brace to immobilize the joint is required, for example, after a broken bone or surgery. A wrist orthosis can also be used as an aid after severe sprains in the wrist or irritation in the area of ​​the thumb or forearm. In the case of wear and tear, a wrist orthosis can also help stabilize and maintain functionality.

Elbow brace

An elbow orthosis is used to immobilize the arm in a bent position. This is necessary after a broken bone in the area of ​​the elbow, for example, so that healing is not hindered by movements in the joint.

In addition, in some cases the elbow joint is affected by wear and tear (osteoarthritis) or inflammation. Again, immobilization with an elbow brace can help relieve pain and allow the joint to recover.

Thumb brace

A thumb orthosis is usually prescribed in the event of wear disease of the thumb saddle joint between the wrist and the first metacarpal bone. This disease, known as rhizarthrosis, mainly affects older people. Due to a loss of articular cartilage, the bone surfaces rub directly against each other in an advanced stage and the affected thumb is painfully restricted.

A thumb orthosis serves to stabilize the joint by fixing it in its functional position. The mobility of adjacent joints is hardly affected. As a result, the ability to grip the hand can often be retained and there is significantly less pain. In most cases, permanent use of a thumb orthosis is indicated in such a case.

Read more about the topic here: Diagnosing saddle joint arthrosis

Back brace

Trunk or back orthoses are usually also referred to as corsets. A distinction can be made between active and passive corsets. The passive support orthoses primarily serve to relieve and support people who suffer from spinal instability due to an illness, which can be accompanied by severe pain.

Examples of this are cancers that have radiated into the bones or severe bone loss, which can particularly affect older women. The corset is intended to relieve pain and stabilize the back in order to prevent broken bones and paraplegia.

The active back orthoses, on the other hand, are used to treat diseases in which the spine is statically incorrect and should be corrected as far as possible. The treatment of children and adolescents is particularly important and promising, since incorrect posture can best be corrected at this age or their development can at least be positively influenced.

The most common example in which treatment with an active back brace is necessary is scoliosis. Seen from behind, the spine is crooked and gives way to the left or right. In addition, vertebral bodies are twisted against each other. The active back orthosis can only develop its effect if it is worn during physical activity. However, it must also be worn at night. As a rule, this must be done 23 hours a day in order to achieve the best possible treatment result.

Read more about the topic: Brace treatment for scoliosis

Another disease that back orthoses are used to treat is Scheuermann's disease. This leads to an increasing stiffening of the spine through bony attachments and hardening of ligament structures. Mostly young men are affected and timely and consistent treatment with a back orthosis is important to counteract the stiffening of the spine.

Immobilization splints for the cervical spine are a special form of back orthosis with a completely different area of ​​application. These are put on after a traffic accident, for example, to prevent consequential damage caused by transport in the event of a possible injury to the cervical spine.

What are orthotic shoes?

Orthotic shoes are shoes that can be put on when an orthosis has to be worn on the foot or lower leg that does not allow normal shoes to be put on. They are wider than normal shoes and offer various adjustment options, thus enabling individual adaptation to the foot and the orthosis.

It is important to be as comfortable as possible to ensure that there are no pressure points and that there is no pressure on ducts. Orthotic shoes are used in particular for children who receive long-term treatment with orthotics due to the treatment of misaligned feet.

However, there are also a large number of orthotic shoes for adults that are particularly necessary if the orthosis has to be worn for a long time. Another type of auxiliary means, which are sometimes also referred to as orthotic shoes, are special shoes that are used to compensate for a difference in leg length. Strictly speaking, however, this is not an orthosis.

Also read the article: The orthotic shoes.

Should I also wear an orthosis at night?

Orthoses should always be worn as agreed with the doctor. Due to the large number of different orthotics, no general statement can be made as to whether they should be worn at night. In many cases, it is appropriate or even necessary to wear the orthosis at night, for example, to prevent further damage from turning while sleeping in the case of an injured joint.

In some cases, however, it is not necessary to wear the orthosis at night or it should even be avoided. In general, some orthoses should first get used to the aid. In addition, it sometimes makes sense to wear them only for a short time at the beginning to prevent sores or relieving postures. Over time, these sections are increased until the orthosis is left on the body if necessary. It should therefore always be discussed with the prescribing doctor when and for how long the orthosis should be worn.

Can I drive a car with an orthosis?

In principle, you can drive a car with an orthosis. However, you should refrain from doing this if you are restricted in operating the vehicle due to the orthosis or the underlying injury.

In some cases, special modifications to the car may be necessary to enable the orthosis wearer to drive the car. In this regard, you can get advice from the medical supply store, for example. A simple option can often be to switch to a conventional car with an automatic transmission.