What can the patient expect?
A thorough assessment - Patient Hx
Identification of the problem
weight-bearing exam for lower extremity cases
non weight-bearing exam
Observational gait assessment for lower extremity cases
Skin condition, circulation, tone, etc
Follow-up to verify the outcome
A complete assessment is the foundation of proper orthotic intervention. In cases where the patient has issues such as insufficient ROM, excessive oedema, etc which would limit an optimal result then the patient is referred to the appropriate health professional to address these issues in order to obtain proper orthotic therapy.
In cases where an orthosis would not be appropriate, then no orthosis will be provided and the patient will be referred to the appropriate health care provider. Some cases may be resolved by appropriate orthopedic footwear or modifications to footwear, etc.
Are assessments required for all cases?
No. Certain problems such as Carpal tunnel syndrome or epicondylitis simply require a fitting although under the supervision of the orthotist where we will also verify the person’s occupation and the way it will be used to dispense the appropriate type. Other problems such as an ankle sprain, or patella problem may require a brief assessment.
Does the patient require a prescription for a consultation?
No. Anyone can set an appointment with the orthotist however in order to receive an orthosis, then a recommendation will be written to the Doctor or N.P.
Insurance companies and third party payers require prescriptions to obtain funding.
How do we know if an orthosis will be beneficial?
By performing a complete assessment, basing the orthosis on sound biomechanical design principles in accordance with the patient’s objectives and the treatment objectives, it is very rare to obtain less than satisfactory results.
As in all health care, we cannot guarantee the outcome, there are always uncontrollable variables. Patient compliance, other healthcare issues or undiagnosed conditions or compromises in orthotic design to satisfy patient preferences, can all contribute to less than stellar results. But in the vast majority of cases, if all elements of the assessment correlate with the objectives, then a satisfactory result will be achieved. In foot orthosis cases, we have been recording follow-up results and only 10-20% require an adjustment. Of those that require an initial adjustment, only 10% need a second adjustment. Those who require a third adjustment will typically get re-assessed and get their orthosis redone free of charge. In the last ten years, less than five cases have had to have their orthoses re-done. In most of these cases, there typically was an undiagnosed condition that prevented an optimal result.
What is the difference between an orthotist, Certified Orthotist, Pedorthotists, podiatrist etc?
There is no legislation governing the dispensing of orthoses in New Brunswick so anyone can call themselves an orthotist however a Certified Orthotist is a registered title that is reserved for those who have graduated from a recognized, accredited orthotic-prosthetic program, done their residency under a Certified Orthotist and passed the three day board exams consisting of 1 day written exams, 1 day oral exams and one day practical exams.
Many others provide orthoses but only the title of C.O.(c) guarantees that the person has formal training in this field. However, there is a tremendous shortage of C.O.’s so other providers have a role to play. The important thing is that the patient receives an orthosis that fits and functions well no matter who provides it.
Podiatrists typically deal with foot care such as treating callouses, trimming nails and other foot conditions. In the course of their treatment, they will also dispense foot orthoses.
Pedorthotists are foot-ankle specialists dealing with orthoses and orthopedic footwear. Some have kinesiology degrees, some have taken correspondence courses in foot orthoses, there are varied levels of education among different pedorthotists.
It is important that the patient be assured of receiving a thorough assessment, only receive an orthosis if it will help their condition and appropriate follow-up to verify the results obtained. If the patient assessment-casting is over in 5 minutes, there may have been some elements missed in the process.