Service Subtype: Paediatrics Orthotics

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Osteoarthritis of the Knee

Knee Osteoarthritis is a degenerative knee condition where the cartilage of your knee joint gradually wears away, exposing the underlying bone.

Early stages of knee Osteoarthritis (OA) is characterised by the onset of pain and mild inflammation around the knee. Usually pain is more severe in the morning and the knee may feel stiff and take a while to loosen up.

 

What is Knee Osteoarthritis (OA)?

Osteoarthritis (OA) is the most common form of arthritis and is characterised by the gradual breakdown of the articular cartilage in synovial joints, primarily of the knees, hands, and hips.

What causes Knee Osteoarthritis (OA)?

The body is complex and has processes in place to repair and maintain itself. OA is a result of this process being unable to occur correctly and causes an imbalance in enzymes which leads to the loss of collagen and proteoglycans, two proteins that are essential in the composition of the body’s connective tissue. It can occur spontaneously or be secondary to another condition.

Knee Osteoarthritis (OA)

What are the Risk Factors for Knee Osteoarthritis (OA)?

OA is often associated with joint wear and tear due to aging but can also stem from joint injuries, musculoskeletal abnormalities, genetics, and environmental factors. Obesity exacerbates OA by increasing joint stress and inflammation.

What are the Symptoms of Knee Osteoarthritis (OA)?

Symptoms include pain, swelling, stiffness, and reduced range of motion in the affected joint. Symptoms may worsen in cold weather, upon initiating activity, or after prolonged activity.

How is Knee Osteoarthritis (OA) Evaluated?

Practitioners diagnose OA using radiographic imaging. Key indicators of OA are narrowed joint spaces and bony spur formation which are indicative of cartilage breakdown.

Knee Osteoarthritis (OA) evaluation

What are the Treatment Options for Knee Osteoarthritis (OA)?

While there is no cure, treatment options aim to alleviate pain. Options include pharmaceuticals, physical therapy, bracing, and surgical intervention [1]. Treatment reccomendations will be tailored to the patietnt as well as the severity and location of the OA.

How Does Bracing Help Manage Knee Osteoarthritis (OA)?

Bracing aims to offload or stabilize the affected joint to reduce pain[2,3]. It is often used alongside medication and can be effective for mild to severe OA. Braces will apply three forces, in a ‘push’ or ‘pull’ mechanism, to open the joint space and is primarily beneficial for unilateral OA.

Osteoarthritis knee brace

 

BRACING OPTIONS

The amount of support provided by the brace is dictated by the severity of the OA and how active a person is. For example, an individual with very severe OA but is not very active, will not require as much support as someone with the same level of OA but is very active. This is because the person who is not as active will not be putting as much weight through the joint which can aggrevate their condition.

 

Mild support

Recommended for individuals with low OA severity and high activity level or vice-versa.

Action reliever

  • Anatomically shaped knitted fabric provides medical grade compression (~25mmHg)
  • Cross straps deliver an off-loading force that increases when the knee is straight and needs it the most
  • Clinically proven to decrease pain upon exertion and increase walking speed when compared to non-bracing[4].
Airshift

  • Contains an Airbladder system that can be adjusted to the level of unloading needed
  • Re-positionable condylar gel pads focuses the air bladder’s unloading force.
  • Alternating strap patters to prevent rotation of the brace

 

Moderate support

Ideal for individuals with a moderate to high activity level or OA severity.

UniReliever

  • BOA-dial system for adjustable and precise offloading
  • Cross straps delivers an off-loading force that increases the knee is straight and needs it the most
  • Quick-fit buttons for easy removal and wearing
Aspen OA brace

  • One step closure to for easy removal and wearing
  • Easily adjustable hinge above and below the knee for comfort
  • Comfortable non slip pads

 

High support

For those with severe OA or a high activity level

Rebel Reliever

  • Loadshifter Technology allows for adjustable corrective forces
  • Clinically found to reduce pain during motion to promote functional ability by decreasing the detrimental forces at the knee during stance[5][6].
  • Available in a range of fun colours

 

There are many knee brace options availble and finding the most appropriate one can be difficult. Many knee bracing options need to be fit by an expert such as an orthotist or physiotherapist.

See your local oapl orthotist to discuss the most appropriate options.

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Please contact orthotics@opchealth.com.au for more information.

 

 

  1. DeRogatis, M., Anis, H. K., Sodhi, N., Ehiorobo, J. O., Chughtai, M., Bhave, A., & Mont, M. A. (2019). Non-operative treatment options for knee osteoarthritis. Annals of translational medicine, 7(Suppl 7), S245. https://doi.org/10.21037/atm.2019.06.68
  2. Cudejko T, van der Esch M, van den Noort JC, Rijnhart JJ, van der Leeden M, Roorda LD, Lems W, Waddington G, Harlaar J, Dekker J. Decreased pain and improved dynamic knee instability mediate the beneficial effect of wearing a soft knee brace on activity limitations in patients with knee osteoarthritis. Arthritis care & research. 2019 Aug;71(8):1036-43.
  3. Dries, T., VAN DER Windt, J. W., Akkerman, W., Kluijtmans, M., & Janssen, R. P. A. (2022). Effects of a semi-rigid knee brace on mobility and pain in people with knee Osteoarthritis. Journal of rehabilitation medicine. Clinical communications, 5, 2483. https://doi.org/10.2340/jrmcc.v5.2483
  4. Benning, R. Schneider-Nieskens. Superiority of a Knee Relief Orthosis in the Treatment of Knee Osteoarthritis: A Prospective Randomised Controlled Trial. ORTHOPÄDIE TECHNIK. 2017 Aug; 24-30.
  5. Lamberg EM, Streb R, Werner M, Kremenic I, Penna J. The 2-and 8-week effects of decompressive brace use in people with medial compartment knee osteoarthritis. Prosthetics and Orthotics International. 2016 Aug;40(4):447-53.
  6. Thoumie P, Marty M, Avouac B, Pallez A, Vaumousse A, Pipet LP, Monroche A, Graveleau N, Bonnin A, Amor CB, Coudeyre E. Effect of unloading brace treatment on pain and function in patients with symptomatic knee osteoarthritis: the ROTOR randomized clinical trial. Sci Rep. 2018; 8: 10519.

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3D Scanning for Plagiocephaly Helmet Therapy

oapl would like to introduce Liam, Senior Orthotist from our Sunshine Paediatric and Flemington clinics.

Liam has been treating children with Deformational Plagiocephaly for 8 years and has previously spent over 3 years at the Royal Children’s Hospital in Melbourne learning and developing treatment methods for paediatric patients. He has seen the development of new technologies such as 3D scanning systems and foam carving replace the old and dated plaster mould methods. Here is Liam describing the process of developing plagiocephaly helmets and the technology used in our oapl clinics…..

 

“Now In my fourth year treating across a range of oapl clinics, I am very excited to introduce the STARband® system from Orthomerica. This is a non-invasive and supremely accurate treatment method used to fabricate a cranial remodeling helmet. The process begins with an initial scan, which only takes minutes to complete and is done by taking a series of still photographs with a camera phone. There is no radiation or lasers and as such the process is pain-free and relatively stress-free for both the child and parent.

​

Once the scan is taken, a 3D image is generated and can be modified and viewed on a PC. The Measurement and Comparison Unit (MCU) is a state-of-the-art software package that an orthotist can use to provide concise and objective measurements of a child’s head shape. Whether treating conservatively, with a helmet or just monitoring for growth, the MCU will show comparative changes in growth and symmetry. Using the MCU software a pdf report can be generated to clearly illustrate changes over time which can be communicated with parents and other health professionals over the course of the child’s growth cycle.

 

The STARband® has been used to treat over 350,000 patients in the USA and is only available in Australia through oapl. We currently offer a wide range of cranial remolding orthosis designs, each created to effectively manage a variety of head shape deformities, levels of severity, and clinical indications. Treatment with a remodeling helmet usually begins at around 6 months of age and takes around 3-4 months depending on the child’s age and severity. Due to the precise nature of the scan, a custom fabricated helmet ensures accurate fitting and enables much more symmetrical growth than alternative fabrication methods.

We are continually finding more and more clinical evidence that supports the positive results of helmet therapy. In 2015 Steinberg et al in the Plastic and Reconstructive Surgery Journal showed that conservative and helmet therapy were both found to be effective in the correction of plagiocephaly. The usage of a helmet eliminated the factors that lead to failure in conservative management and may be more preferable from the outset. It was also highlighted that any delay in helmeting due to trialing conservative treatment does not ruin the chance of future correction as long as the helmet therapy is begun during growth stages at around 6-8 months of age.

 

Like to know more?

oapl orthotists specialise in the management of complex paediatric conditions like Plagiocephaly. We understand that the process can be daunting and that treating our little ones comes with that extra sense of anxiousness. We’re more than happy to answer any queries or concerns you may have before starting helmet therapy.

If you would like more information on the STARband® Plagiocephaly Helmet range or our range of orthotic services, please contact us. Alternatively, if you would like to book an appointment at your closest oapl clinic, you can use our clinic locator tool here.

 

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Smart Orthotic Technology S.O.T.

Resting Hand Orthosis

S.O.T is a resting splint for the spastic and paretic hand, when the goal is to maintain or increase the mobility of the hand.

The orthosis is smooth and lightweight. The S.O.T has an aluminium core which allows adjustment to the desired position. The aluminium core is embedded into polyethylene foam, which is covered with fabric. The brace is delivered in a resting position. A resting position can offer pain relief, relaxation to the hand and it also provides a good biomechanical position that may reduce the risk of flexor shortening of the wrist and fingers.
​

The orthosis anatomic configuration supports the important thenar muscle, the CMC- and MCP joint, which is particularly important for the intended patient groups, when the thumb tends to adduct in the CMC joint and hyperextend in the MCP joint. S.O.T Resting splint increases the conditions for an effective grip.

Recommended application:
Stroke, CP, rheumatoid arthritis, radialis paresis, muscular dystrophy, edema or plexus injury.

 

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Foot Drop Causes & Solutions

Have you ever been out and about and noticed someone dragging their foot? As orthotists, it is a condition we regularly treat in our clinics as there are so many different causes. Luckily, there are many treatment options available.

Foot drop describes the inability to raise the foot due to weakness caused by varying conditions which we’ll explain in this article. For individuals with this weakness in the foot, visually you may see the foot drag and unfortunately this can lead to trips and falls.

On a positive note, there are so many solutions for foot drop that no one should have to struggle! With these in mind, everyone should be able to take each step with confidence and without the risk of tripping over.

Causes

Foot drop can affect either one or both feet depending on the underlying problem and can be either temporary or permanent based on the condition causing the foot drop.

Neurological conditions such as Multiple Sclerosis, Stroke, Cerebral Palsy, Polio and motor neuron disorders often result in muscular weakness affecting the strength in the lower limbs.

Injury to the spinal cord from trauma or spinal degeneration can also result in foot drop as the nerve that sends the message to pick the foot up may have been damaged and can no longer perform the action. If significant trauma has occurred this foot drop may be permanent. Sometimes following lower back surgery some individuals may experience some weakness in their legs resulting in foot drop, luckily our bodies can often heal those potentially damaged nerves and over the period of a few months, the foot drop has the potential to resolve.

A not so commonly known cause but an extremely important one is Diabetes, formally know as Diabetic Neuropathy. Nerve damage can arise from poorly managed diabetes and chronically high levels of blood sugar. Over time, Diabetic Neuropathy causes damage to the nerves including those that pick the feet up, again resulting in drop foot. Unfortunately, damage caused by Diabetic Neuropathy can not be reversed.

Treatment and Orthotic Intervention

Foot Drop AFO
Foot Drop AFO

 

Ankle Foot Orthoses (AFO)

A device commonly prescribed for individuals with foot drop is called an Ankle Foot Orthosis (AFO). These can be either custom made or off the shelf and can be made of different materials depending of the function required. (Click here for our AFO-Patients Guide)

As technology has improved over time, so too has the materials that AFOs are made of. Some individuals may still use traditional plastic AFOs to manage their foot drop. Some more commonly used AFOs nowadays include AFOs that are made from carbon fibre. These types of AFOs (like the ToeOff) are extremely lightweight but also have some flexibility in them as opposed to being fixed or rigid. This flexibility allows the AFO to move and store energy, like a spring that is compressed when the pressure is released or as the weight is taken off the foot, the AFO actually helps to push the individual forward to take a step. There is still enough strength in the AFO to prevent the foot from dropping – individuals frequently note how natural their gait feels when using this type of device!

WalkAide FES DrWalkAide Foot Drop FES Device

Functional Electrical Stimulation (FES) Devices

For some individuals who have foot drop caused by an upper motor neuron lesion such as Multiple Sclerosis, Cerebral Palsy, Stroke, or ABI, there are devices that use Functional Electrical Stimulation (FES) to stimulate the nerve when walking.

This stim will pick the foot up at the exact point whilst walking to prevent foot drop, amazing right! These devices require the user to only wear a cuff that sits just above the calf muscle rather than wearing a brace and a shoe. This gives the individual freedom to wear different shoes or walk barefoot, even allowing you to put your toes in the sand and walk in the water as they can be splash resistant.

There are so many more styles of AFOs and it is always best to have an assessment with a qualified orthotist so that the right brace can be prescribed for each individual.

 

At oapl we can help you navigate different funding options including the NDIS, SWEP, DVA, TAC or any other third-party funders. For more information, call us on 1300 866 275.

Photo by Andrea Piacquadio from Pexels

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