What’s what in an orthotic report?

FOR THOSE of you who are involved in personal injury cases, you will no doubt have at some time seen a remark or recommendation that a client requires an orthotic opinion or orthotic report.

The first things, in my experience, that will cross a solicitor’s mind when coming across the word ‘orthotics’ for the first time are most probably listed below and in a similar order :

What are orthotics?
What is an orthotist?
Aren’t they just boot and shoe makers?
Don’t physiotherapists and orthopaedic surgeons deal with this?
Where do I find one?

So here’s an overview of what orthotics actually are, how they work, what they do and the role of the orthotist, Orthotics is a speciality of medicine in which external orthoses (braces/supports) are designed and fitted to an individual to provide one or more of the following:

Correction, prevention of a physical or structural deformity
Reduction of pain
Improvement in mobility or performance
Stabilisation of a joint or joints
Accommodation of existing deformities
Reduce the risk of injury.

It is a holistic practice that treats the whole body and every age group within the population. Individuals are assessed by a fully qualified State Registered Orthotist who will then prescribe, measure, design and fit an appropriate orthosis.

Following this, they will review its effectiveness and adjust the prescription accordingly.

The devices fitted will range from specialised footwear (orthopaedic footwear), foot orthoses (insoles, which you may be wearing when you run) or highly complex lower-limb and upper-limb devices.

All orthotics are designed to the individual’s requirements to provide biomechanical support and to correct dysfunctional biomechanics.

The orthotist is the professional who will have undergone extensive training in the following areas:
Anatomy – Structures, muscles and joints of the body
Physiology – How the body functions
Pathology – Nature and causes of human disease
Biomechanics – An understanding of the forces acting on the body from internal or external forces
Material science – Material performance and properties
Orthotic science – The design and application of orthotic devices
Footwear – The design, manufacture and clinical application of all types of footwear

The current academic course is a four-year honours degree course which contains a final year of clinical placement experience in a working clinic, usually working in some form or other within the NHS.

Any part of the human skeleton can, if damaged, possibly benefit from the fitting of an orthosis in some shape or other. The orthosis may be needed to reposition the body or to provide relief from discomfort.

The orthotist is trained to understand and respond to many conditions, and has an understanding of the practice of orthopaedics, the nature of trauma, rehabilitation, physiotherapy techniques, rheumatology and other conditions, such as diabetes. They are not able to practise in these areas or provide expert reports but they understand how these disciplines work and how orthotics can interact with them.

The essential part of the orthotist’s work is an assessment of the client’s specific problem. A prescription is formulated following detailed assessment of the client’s condition based on an interview, clinical history, physical assessment and in some cases more in-depth gait analysis (the study of walking).

All orthotic design in some way or another relies on Newton’s three laws of motion – and for those who have forgotten their school physics they are briefly as follows:

First Law: A physical body will remain at rest, or continue to move at a constant velocity, unless an external net force acts on it.

Second Law: The net force on a body is equal to its mass multiplied by its acceleration.

Third Law: For every action there is an equal and opposite reaction.

The detailed knowledge of these basic rules and human biomechanics, plus a greater understanding of more complex mechanics, allows the orthotist to fully understand the effect any orthosis may have and the implications for the client in the short and long terms.

They have access to technical information on a wide range of orthotic designs and also to commercially available orthoses that are not readily accessible to other professionals.

After full assessment, the orthotist is able to design an orthosis to suit the individual needs of the client. An understanding of the clinical problem must be matched with the knowledge of what is the most suitable device.

The measurement/casting, fitting and adjustment of the orthosis is the responsibility of an orthotist alone, and it is the orthotist who overviews the manufacture of the device. They will also educate the client on the use and fitting of their orthosis, which is vital to ensure correct function.

The orthotist has an understanding not only of the medical side of the client’s needs but should also be able to understand the financial implications.

In addition, they should be able to provide quantum reports based on their understanding of orthotic design, material science, and the biomechanics of the forces that are likely to occur on the orthosis during day-today activity.

Therefore, it is essential for the court to receive a complete, well-rounded expert report which provides a complete picture on the orthotic needs of a client.

There should be no reliance on recommendations from non-qualified professionals who may wish to stray outside their area of expertise. Simply seek a report from a fully-qualified registered orthotist.