It makes more sense to me now, but there was a point when I was lost in the world of orthotic acronyms and what supports actually do. In its technical description, an orthotic (also known as a brace or orthosis) is anything that goes on a body part to improve or support its function. Therapists and specialists deal with orthosis on a regular basis so it all makes perfectly good sense to them. When a recommendation is made that your child might need orthotics, it could leave you grappling to figure out how necessary they are and what the outcome will be.
When it was time for Juliana to get her orthotics, I was really confused. Yes, it was explained to me and I wrote the information down, but it took some time for it to really make sense. It was very intimidating to put this little contraption on her foot. I was so nervous that if I got it wrong, I would ruin her feet. I didn’t realize it at the time, but I was very fortunate to be referred to CH Martin for her braces. A local leader in the orthotics industry, my experience with CH Martin has been very good. So much so that I asked Juliana’s Orthotist, Jackie McCutchen to allow me to pick her brain; hoping that it will help someone else who may be new to the world of orthotics.
What is your professional background and how did you end up doing what you do? After going to the Marine Corp, I returned to get a degree in Health Science. I completed an externship at CH Martin and I have been here ever since. I like the kids I work with and I am going into my 14th year as a trained, licensed and certified orthotist.
There is so much to learn about orthotics. Can you give me a summary of the most common orthotics that you fit? What is the purpose of each?
I’ll review those that are most common with children from the greatest to the least amount of support:
- Knee; Ankle; Foot Orthotic (KAFO): Goes all the way up the leg to support the knee joint
- Ankle Foot Orthotic (AFO): This is probably the most common orthotic that I fit. There are a lot of varieties of it. It fits just below the knee and encompasses the foot. Support is given to the ankle and foot with the AFO.
- Supramalleor Orthotics (SMO): With SMO’s, support is concentrated to the posture of the foot and side to side instability. There is more control for the ankle, heel and arch.
- University of California Berkeley Laboratory (UCBL): Similar to the SMO it sits just below the ankle bone. The UCBL (named by the lab that developed it) supports the arch to help with pronation (the condition that occurs when arches fall to the ground)
- Arch Support: Made out of cork, these low level supports go into the shoe to help support the arch.
When parents are new to the process, things can be so confusing. I know every company works differently, but can you walk me through what you do when you get a new client for a fitting?
The first appointment is the fitting of the mold that we use to make the brace. This could generally take 45 minutes to an hour. The parents may have to assist the orthotist in keeping the child still while measurements are taken. We make a plastered mold on the targeted area(s) that create what is similar to a cast. This is then sent to the manufacturer to make the orthotic. A follow-up appointment occurs in about three weeks when the brace is ready. The parent and child will return for a fitting and any adjustments are made at that time.
When parents return for the follow-up appointment it is a good idea to bring the shoes that the child will be wearing with the brace most often. The child will wear their new brace with their shoes and the orthotist will observe the child one last time to ensure proper fitting. This process may look different for another provider, but this is generally the way our appointments work.
I’ve spoken with you before about the irreversible effects when children do not get orthotics. Are there any signs that parents should look for to consider an evaluation for early intervention?
Parents should be as proactive as possible. I recommend that they always see a pediatrician and even better a pediatric orthopedist. It is helpful to see a specialist as orthopedists can monitor how a child is changing, their correct range of motion (the extent to which a joint or group of muscles can be extended) and alignment.
Whose call is it to make a decision about orthotics? The parent, doctor or therapist?
It’s a combination. The prescription has to be signed by the doctor. If the parent notices a problem, they can bring that to the therapist or doctor. Or it could be the other way around when the doctor or therapist notices a need or problem. There could be a difference of philosophy that varies. So ideally it is a joint effort. Again, I don’t think it is a bad idea to see an orthopedist for another professional opinion.
What can parents do to ensure that their child is having proper fitting and comfort if they are wearing orthotics?
It’s important to keep in mind that some companies don’t fit children, so the provider you choose is important. An orthosis has to be comfortable and functional. If they are doing that, they are still sufficient. Look for signs in things that change—such as red marks that don’t go away after 15-20 minutes, darkening areas or calluses. If your child is suddenly being stubborn about wearing the brace, it could be the sign of a problem.
In general do children outgrow orthotics or will there always be a need for the support?
Braces do a lot of things. They help children in walking, maintaining range of motion and not tripping over their own feet. The purpose is to keep the child aligned so that they are growing properly. As they grow, hopefully they will need less support. Some diagnoses will always need support but many kids are able to step down in the level of bracing support.