Orthotics Treatments and Glossary of Terms, Injuries, Diseases and Chronic Conditions
Orthoses are named according to what bones, joints, portion or the body they encompass:
• CO = Cervical orthosis or neck brace
• LSO = Lumbo-sacral orthosis = back support
• TLSO = Thoraco-lumbo-sacral orthosis = back support/body brace
• AFO = Ankle foot orthosis
• FO = Foot orthosis = foot insert or foot orthotic
• HKAFO = Hip knee ankle foot orthosis
• KO = Knee orthosis or knee brace
• KFO = Knee ankle foot orthosis
• HO = Humeral orthosis
• EO = Elbow orthosis
• WO = Wrist orthosis
• WHO = Wrist hand orthosis
• SEWHO = Shoulder elbow wrist hand orthosis
Diseases and Chronic Conditions
Ankylosing Spondylitis: Ankylosing spondylitis involves inflammation surrounding of one or more or the vertebrae. It is a chronic inflammatory disease that affects the joints between the vertebrae eventually causing them to fuse or grow together. These patients exhibit a “stooped” posture and have a very rigid spinal column. Surgery if indicated can be very dangerous, due to the rigidity of the spine and the repositioning there can be significant nerve damage.
Cerebral Palsy (CP): is a term used to describe a group of disorders that affect movement control. It can be caused by injury to the brain before, during, or after birth. Cerebral palsy may be acquired after birth secondary to an accident, head injury or infections such as bacterial meningitis or viral encephalitis. Symptoms vary with each case.
Degenerative Joint Disease (DJD): DJD is also referred to as osteoarthritis (OA) It may affect over 80% of people over the age of 60. Arthritis is a general term used for many conditions that result from the degenerative changes of the joint and its structures. DJD describes a slow and progressive loss of the cartilage structures that function as a shock absorber between two bones. Cartilage helps to provide a barrier and helps keep the joints flexible. Once the cartilage is thinned or lost, the constant grinding of bones against each other causes pain and stiffness around the joint. Abnormal and excess bone formations called spurs grow from the damaged bone, causing further pain and stiffness.
Diabetes: Diabetes is a metabolic disorder in which the body does not produce or properly utilize the hormone “insulin”. Our bodies digest food for growth and energy in the form of glucose (sugar in the blood). Glucose is the main source of fuel for the body. After digestion the glucose passes into the bloodstream where it is used by the cells for growth and energy; transportation is accomplished by insulin a hormone produced in the pancreas. The amount of insulin produced by our body is regulated by what we eat. Patients that suffer from diabetes produce too little insulin and therefore cannot process the glucose properly. When this occurs, glucose overflows into urine and is passed out of the body. This translates into a decrease of fuel to the body.
This disease is catergorizd as Type I or Type II and has a significant effect on other systems and can lead to cerebrovascular and coronary artery complications, peripheral vascular impairment; visual impairment; and peripheral and autonomic nervous system impairments. To prevent ulcerations, skin breakdown and abrasions, patients are observed carefully for signs and symptoms of diabetic neuropathy, such as numbness or pain in the hands and feet,
decreased vibratory sense, foot drop, and neurogenic bladder.
Multiple Sclerosis: MS is an autoimmune disease of the central nervous system (CNS), which presents with destruction of myelin (outer sheath of the nerve cells) and nerve axons within several regions of the brain and spinal cord at different times. This destruction results in temporary, repetitive, or sustained disruptions in nerve impulse conduction causing symptoms such as muscular weakness, numbness, visual disturbances, or loss of control of bowel, bladder, and sexual functions. MS is a relatively common disorder: 250,000 + Americans are affected multiple sclerosis. Women are twice as likely to be diagnosed as men.
Muscular Dystrophy Syndrome: Muscular dystrophy (MD) is a genetic syndrome that causes muscular weakness and wasting. MD is a progressive disorder that affects the lower extremities and gradually moves more proximal. As it moves proximal it may affect cardiac and respiratory systems. This condition is found more in males than females.
Myelomeningocele and Spina bifida: Myelomeningocele and spina bifida patients present with a portion of the spinal cord and membranes protruding from their back. These patients experience paralysis at the level of spinal cord destruction. Depending upon the level of disruption, patients can require limited orthotic intervention or it can be as involved as reciprocating gait orthoses and wheel chairs.
Neurofibromatosis: Neurofibromatosis is disorder characterized by the formation of neurofibromas or tumors that involve nerve tissue in the skin, subcutaneous tissue, cranial nerves and spinal nerve roots. It presents with visible skin tumors, café au lait spots and pain surrounding the nerves involved.
Peroneal Palsy: This is a condition is caused by an injury or damage to the peroneal nerve. Patients often present with drop foot, weakened dorsi flexors and evertors (those muscles innervated by the peroneal nerve).
Rheumatoid Arthritis: This is characterized as a chronic inflammatory disease that primarily affects the joints and surrounding tissues. This is often associated with severe joint swelling, pain and fatigue.
Spastic Hemiplegia: Increased muscular tone occurring in half of the body. It results from an upper motor neuron lesion, such as a stroke, central nervous system trauma, or tumor.
Lymphedema: An abnormal accumulation of tissue or lymph fluid in the interstitial spaces.
Pitting Edema: A local or generalized condition in which the body tissues contain an excessive amount of tissue fluid. If you apply slight pressure to the area of edema and then remove the pressure you will see a resultant indentation. The indentation will then resolve after the pressure has been removed and the fluid migrates back to its original state.
Burst Fractures: A burst fracture is the disruption in the integrity of the vertebral body and is characterized by the inability of the vertebral body to resist axial loading. These fractures are mechanically unstable and if bony fragments are retro-pulsed (moved backwards) into the spinal canal they can be neurologically unstable.
Closed Fracture: A broken bone without an open wound.
Communated Fracture: a bone that is broken in multiple pieces.
Displaced Fracture: A broken bone with the parts of the bone mal-aligned.
Fracture Dislocation: This injury is a combination of a dislocation of the joint and a fracture (usually located very close to the joint).
Mal-Union: Healing of the bone in an unsatisfactory position.
Non-Union: Failure of the bone to heal together (pseudo-joint).
Immobilization of Injured Area: It is also imperative the fracture site be immobilized while the bones are allowed to heal together in proper alignment. If motion is allowed at the onset of the rehabilitation process there is a high incidence of mal-union and/or poor reduction/alignment.
Reduction: This refers back to immobilization.The objective of a fracture orthosis is to maintain compression of the limb to in effect maintain alignment of the fracture.
Fractures of the Spine
Anterior Compression Fracture: This is characterized by a reduction in height of the anterior portion of the body of the vertebrae. Typically there is no neurological damage associated with this injury however, if left untreated it can lead to increased deformity and neurological deficits (weakness and or paralysis).
Spinous/Transverse Process Fractures: These are fractures of the spinous and transverse processes of the spine. They are unlikely associated with any neurological deficit however can cause pain and stiffness while healing.
Brown-Sequard Syndrome: This syndrome is a rare neurological condition characterized by a lesion on the spinal cord that results in weakness and or paralysis on one side of the body and loss of sensation on the contra lateral side. This syndrome is associated with degenerative diseases, tumors on the spinal cord, multiple sclerosis, and infectious and inflammatory diseases.
Central Cord Syndrome: Central Cord syndrome is an acute spinal cord injury that presents with greater impairment in the upper extremities than the lower and sacral sparing. The brain's ability to send and receive signals to and from parts of the body below the site of trauma is affected but not entirely blocked.
Spinal Cord Injury: This is characterized by injury to the spinal cord resulting in muscular, sensory, neurological deficits. These injuries can be incomplete or complete. Incomplete injuries are ill defined and exhibit some weakness in one area while the contra lateral side may be weaker or stronger. Complete injuries are defined as a total neurological deficit below the inured site. Complete injuries that affect the lower extremities are defined as paraplegia while complete injuries that affect the upper and lower extremities are defined as quadriplegia. Patients that survive complete spinal cord injuries that affect the upper cervical spine, above C3, are pentiplegics.
Lower Extremity Injuries, Syndromes, and Diseases or Chronic Conditions
Achilles Tendonitis: Achilles Tendonitis causes inflammation and degeneration of the achilles tendon.
Ankle Instability: Ligamentous instabilities of the ankle are often a result of ligamentous laxity, acute or chronic ankle injuries including sprains and or strains.
Bunion: A bunion is a thickening of the fist metatarsal joint of the great toe. This is usually associated with enlargement and lateral displacement of the toe. Heredity, degenerative bone or joint diseases such as arthritis may cause bunions; however ill fitting shoes are the primary causes of this condition. High heels force the toes together and displace weight onto the forefoot.
Cavus Foot Deformities: Cavus Foot Deformities: This is characterized by an abnormally high longitudinal arch or concavity of the sole of the foot. This condition causes excessive pressure on the calcaneus (heel) and the metatarsal head (forefoot). Orthotics often helps to redistribute pressure and help prevent skin breakdown and abrasions.
Charcot Marie Tooth: Charcot-Marie-Tooth disease (CMT) is a disorder of nerve conduction causing weakness and mild loss of sensation in the limbs. These patients often present with rigid cavus deformities of their foot and ankle.
Club Foot (talipes equino varus): This term is derived from Latin, talipes = anklebone, pes = foot, equino = horse. The term "clubfoot" refers to a foot that points downward; the toes turn inward, and the bottom of the foot faces inward. If this condition occurs when a baby is born it is called "congenital clubfoot." If left untreated the condition can worsen causing the patient to walk on the dorsum of their foot. Serial casting, corrective surgical procedures, and orthosis are often used to treat this condition.
Flat Foot (Pes Planus): Abnormal flatness of the sole and the arch of the foot. Many times this condition is asymptomatic and will not interfere with the normal functioning of the foot. The inner longitudinal and anterior transverse metatarsal arches may be depressed causing pain and discomfort. This condition may be acute, sub-acute, or chronic and patients may benefit from orthotic intervention.
Forefoot Adduction/Abduction: Metatarsus Adductus: Metarsus adductus is a condition in which there is medial displacement of the metatarsals. The forefoot is therefore adducted at the tarsal metatarsal joint.
Hallux Varus/Valgus: This is displacement of the big toe away/towards the other.
Hammer Toes: This is a deformity of the foot marked by an excessively high longitudinal arch, usually accompanied by dorsal contracture of the toes.
Metatarsalgia: Metatarsalgia is a condition characterized by pain emanating from the metatarsal heads that increases with weight bearing and pressure. Shoes with higher heels that place the majority weight on the forefoot and metatarsals often worsen this condition.
Plantar Fasciitis: This condition is an inflammation of the plantar fascia (fibrous connective tissue that runs along the bottom (plantar surface) of the foot from the heel to the metatarsal region. This commonly occurs in athletes and caused by a strain/over stretching of the fascia. This causes pain, inflammation, and often a bone spur at the attachment site on the calcaneus.
Mobilization of the Patient
Bone Remodeling: Bone is dynamic and is continuously remodeling in response to mechanical forces and metabolic demands. Stress, pressure, weight bearing, and physical activity increase help control the remodeling process.
Range of Motion: It is important to mobilize the effected area after the initial healing process has begun. This helps to prevent contractures, maintain muscle strength, and helps to promote bone growth.
Muscle Strain vs. Sprain
Sprain: This refers to trauma to a ligament that causes pain and at times disability depending upon the severity of the injury to the structure.
Strain: This refers to trauma to a muscle or the musculotendinous unit by way of a violent contraction or excessive forcible stretch.
Spinal Injuries and Conditions
Facet Syndrome: Facet syndrome is usually difficult to diagnose. It presents with localized low back pain usually on one side and near/around the joint capsule. In some cases there may be degenerative changes on the facet surfaces causing further irritation.
Herniated Disc: A disc herniation refers a derangement of the intervertebral disc. In this instance the nucleus pulposus is pushed out through the outer annulus fibrosus applying pressure to the spinal column. Pain can result from inflamed tissue and from nerve compression. Most disc herniations are posterior (out the back) and to the side. In some severe cases there can be nerve root compression causing radicular pain and lower extremity weakness.
Low Back Pain: The term “non-specific low back pain” refers to a condition where there is localized pain in the back but no specified origin found. Pain is often referred to as a dull, continuous pain with tenderness near the muscular attachment sites of the lower lumbar, lumbosacral, and sacroiliac vertebral segments.
Scoliosis: Scoliosis is defined as an abnormal bending of the spine. It is often thought of as a lateral bending however there is rotational, flexion, and extension abnormalities also exhibited. Often times we associate scoliosis with juveniles however if left untreated adult and geriatric patients can have severe secondary complications such as spinal nerve root compression, pain, and pulmonary complications.
Trauma: Trauma to the spine can involve a fracture, spinal cord injury, nerve compression, and syndromes such as central cord syndrome and Brown-Sequard syndrome.
Upper Extremity Injuries, Syndromes, and Diseases or Chronic Conditions
Brachial Plexus Injury, also called Erb’s Palsy or “Waiter’s tip” is an injury to the brachial plexus resulting in weakness or paralysis of the upper extremity. The patient often has an arm that hangs limp and is internally rotated at the shoulder. The elbow is extended but flexion of the wrist and fingers are preserved with the palm potentially facing up. This injury is common with difficult births (2-3 per 1000 births) symptoms will sometimes resolve with immobilization however, if no improvement is seen surgery is indicated.
Carpal Tunnel Syndrome characterized by pain, numbness, or tingling in the wrist is typically associated with repetitive motions of the hand. The repetitive motions cause swelling and compression of the median nerve and tendons that pass through a tunnel of fibers at the base of the hand causing the symptoms listed above.
Fracture Management and Orthotic Intervention
Protection of the injured area: Once the fracture has been reduced (realigned) it is imperative that it is protected from further detrimental forces.
Epicondylitis is an inflammation or damage to the area of an epicondyle of bone. An epocondyle is an projection of bone above condyle (a rounded prominence at the end of a bone usually where the bone connects to another bone) where ligament and tendons are attached.
Golfer’s Elbow, also called Medial Epicondylitis is indicated by increased pain over the inner or medial side of the elbow. It is often a result of small tears in the flexor tendons that attach at the elbow.
Common symptoms include: pain over the inside of the elbow, pain when lifting, or pain when flexing and supinating (turning your palm upward)
Stenosis: This refers to a narrowing of the intervertebral foramen from which the spinal nerves exit. This occurs due to degenerative changes that cause a bony overgrowth in the canals. Symptoms resulting from nerve impingement include associated back pain and radiating pain down both legs. Patients report some relief when sitting or when the spine is flexed creating a wider opening for the nerves to pass through. Surgery is sometimes indicated to “open up the canals” creating a larger passage or foramen decreasing nerve root compression.
Tennis Elbow, also called Lateral Epicondylitis is usually indicated by increased pain over the lateral portion of the elbow. It is often a result of small tears in the extensor tendons that attach at the elbow.
Common symptoms include: pain over the outside of the elbow, pain when lifting something, pain when extending and pronating (turning your palm downward).
Ulnar is the larger of the two large bones in the forearm and is located on the same side of the arm as the little finger.