Orthotic braces, or orthoses, are used to provide support to a weakened body part or joint. While many times they are worn for a short period of time, usually after an injury or surgery, some braces are used to address long-term or chronic conditions. An example of some common conditions for which long-term use of an orthoses may be prescribed by your physician includes osteoarthritis, scoliosis, back pain, and drop foot.
Some orthotic braces are used passively, meaning they simply support the injured or weakened body part. A common example of this type of device is an ankle-foot orthoses (AFO) that is used to address drop foot, a common symptom after a stroke that results in the loss of the ability to control the ankle joint. The use of an AFO in this situation maintains the correct position of the foot and ankle, allowing the patient to walk without stumbling and potentially falling.
Other orthotic braces offer a more active role in that they not only support the weakened body part, but also provide a counterforce that achieves the desired outcome. A common example of this type of device is a knee orthosis that treats osteoarthritis, a common disease that causes pain as a result of bone surfaces contacting each other.
Osteoarthritis orthoses are used to separate the bones and reduce pain and inflammation as a result.
Types of conditions for which therapy often Includes “off the shelf” bracing. Off the shelf orthoses are a subset or orthotic treatment that are typically used to treat short term or minor injuries where there is no need for customization in order for the orthosis to meet the needs of the user. These orthoses are typically dispensed by your provider with minimal instruction regarding the care, use, and wearing of the orthosis.
Off the shelf, orthoses are commonly used to treat conditions such as foot and ankle sprains, minor shoulder injuries and to provide back support. While often effective, more significant or chronic conditions usually require the customization of a primarily prefabricated orthosis or custom fabrication of an orthosis designed to meet the extended medical needs of the patient.
The provision of custom-fit or fabricated orthoses is usually done by individuals with proper training, education, and expertise, such as a certified orthotist.
Ankle, Foot, and Knee Bracing
Orthoses that are used to treat conditions of the ankle, foot, and/or knee come in many varieties and range from basic, off-the-shelf, orthoses that are typically made of plastic and not designed for use by a specific patient, to complex orthoses that are custom fabricated from a model of the patient’s limb and used to treat significant injuries or chronic conditions.
Orthoses used to treat both the ankle and the foot are correctly named ankle-foot orthoses, or AFOs. These orthoses are constructed of either plastic or leather and metal and provide support to the foot through the use of a molded or non-molded footplate or orthopedic shoe with an additional segment that extends upwards onto the lower leg. AFOs are often used to provide support to a weakened ankle and foot to allow the patient to walk without a significant limp or abnormal gait pattern.
Knee orthoses can be made of plastic, metal, or composite materials and are primarily used to provide support to or immobilize the knee joint. Knee orthoses are often used to completely immobilize the knee joint immediately following surgery. This immobilization facilitates healing and maintains the proper position of the knee in order to prevent further injury. Knee orthoses may also be used to address chronic conditions such as osteoarthritis and hyperextension.
Shoe Orthoses
Orthopedic shoes are used to accommodate and address specific deformities of the feet. While orthopedic shoes by themselves are not a covered benefit under the Medicare program, they are eligible for Medicare coverage if they are used as an integral part of an ankle-foot orthosis. This type of design is usually constructed of one or more metal bars that attach to an orthopedic shoe using a caliper or stirrup
attachment. The orthosis is unable to function without the shoe, therefore the shoe is considered part of the orthosis and therefore eligible for Medicare coverage.
Medicare will also cover therapeutic shoes that are used as part of the course of treatment for diabetic patients. These shoes must be constructed of specific materials and in a certain way in order to be eligible for coverage.
Health Insurance
Most insurance plans, whether private or public, provide coverage for orthoses. Traditional Medicare covers orthoses with a 20% patient coinsurance. For patients who have Medicare and a Medicare supplement policy, their orthosis may be covered with little or no out of pocket cost.
A current area of focus on the delivery of healthcare in the United States is the use of cost-effective delivery models that reduce the overall cost of healthcare to both patients and insurers. Recent studies on the cost-effectiveness of orthoses have shown promising results. Studies show that the use of an orthosis actually reduces the overall cost of healthcare as a result of increased patient mobility and a reduction in related health issues.
Additional studies are currently underway to further quantify actual cost savings in healthcare expenses for patients who receive an orthosis as opposed to those who do not.
