Orthoses provide protected motion within a controlled range, prevent or reduce severity of injury, prevent or relieve contracture, allow lax ligaments and joint capsules to shorten, and provide functional stability for an unstable limb segment. These devices should not be seen as a replacement for surgery, but complementary or adjunctive. They can be designed to restrict, block, enable, or guide range of motion. They can absorb, store, and return energy. They may provide progressive, controlled dynamic return to motion. They can block one plane of motion while allowing another to persist. They may compensate for limb length discrepancy. Importantly, these devices do not create dependency or atrophy unless intended or is an unavoidable consequence of severe injury.
There are many conditions amenable to prescription orthoses. Orthoses can be used as preoperative, postoperative, or “no-operative” solutions. In cases where surgery must be delayed, they can provide interim support, protect the limb, allow more comfortable and mechanically appropriate ambulation, and minimize disuse atrophy. In a postoperative situation, orthoses can provide a safe, effective, and dynamic alternative to traditional casting. Orthoses are also used when surgery is not possible. This might include patients who are poor anesthetic candidates, patients with comorbidities precluding surgery, the aged, injuries for which there is no surgical correction, and families with financial limitations, among others. These “no-operative” patients represent a large and heretofore underserved population.