The most important thing about the lower leg orthosis

What is a lower leg orthosis?

An orthosis is the term used for orthopedic aids that are attached to the affected parts of the body from the outside.

A lower leg orthosis is a kind of support for the lower leg. Mostly it is needed when the muscles of the leg are insufficient to support the body weight. In such cases, a lower leg orthosis can take over the weight of the body.

Pure lower leg orthoses are usually attached below the knee and reach over the ankle. In this way they support the ankle, but the knee is not affected by the orthosis.

At this point the question arises as to why the muscles of the lower leg could be restricted in their function. You can get an overview of this question at:

• Muscle weakness

What is the indication for a lower leg orthosis?

Indications for a lower leg orthosis can be various diseases.

Usually they are accompanied by muscle weakness of the lower leg. These can be pure injuries to the muscles or the nerves that control the muscles. Causes for this are, for example, accidents, but infections or various types of cancer can also damage the structures. Due to the lack of innervation (nerve supply) or the injury to the muscles, paralysis occurs, and the leg can no longer support the body weight of the person concerned. Lifting your foot while running can also be a problem. A lower leg orthosis supports these functions.

Other possible diseases can be in the spinal cord area. If nerves that are responsible for the lower leg and foot muscles are injured there, muscle weaknesses can also occur. Possible causes are incomplete paraplegia, pinching of the nerves or herniated discs.

There can also be diseases in the brain that are an indication for lower leg orthoses. Children are often affected, but adults can also suffer brain damage from cerebral haemorrhage or a reduced oxygen supply, which means that the lower legs need additional support in the form of orthotics.

Nerve diseases such as multiple sclerosis or infectious diseases such as polio (polio) can also be indications for lower leg orthoses.

You can read about other important reasons for using an orthresis at: Muscle weakness in the legs

How does an orthosis work?

An orthosis is attached to the outside of the leg and is made of solid material. It supports the lower leg in its holding function.

With a built-in joint at the level of the ankle joint or a particularly elastic material, the ankle joint is supported with every step on the one hand, and mobility is made possible on the other hand by the orthosis. This keeps the gait pattern dynamic.

Rigid orthoses can also be used to correct misalignments. These fix the lower leg and foot in a certain position. The aim is to compensate for the misalignment so that the affected person is ideally able to walk.

Many lower leg orthoses are also worn by people with dorsiflexor weakness. The sole of the foot is placed on the orthosis, the sole portion is connected to the attachment on the lower leg. Due to the solid sole, the foot cannot tip over while running, but a fairly normal gait is possible with the orthosis.

To learn more about dorsiflexion weakness, also read: Dorsiflexion weakness

What should you watch out for when wearing an orthosis?

When wearing a lower leg orthosis, it is important that the orthosis fits well. For example, if it causes pressure points or if the leg has too much leeway in the orthosis, long-term injuries to the skin and the underlying tissue will occur. This can result in open wounds, or even the muscles, vessels or nerves are impaired even more.

Correct application of the orthosis is also important so that it can fulfill its function. There are orthoses that can simply be worn on the bare skin, while others provide for a stocking to be worn underneath. The instructions of doctors, physiotherapists and orthopedic technicians should be followed.

The situations in which the orthosis is to be worn and the daily duration must also be taken into account. Depending on the indication, this can range from a few hours to the entire day. Sensible support or correction of incorrect posture is only guaranteed if the orthosis is also worn for the prescribed time.

Furthermore, the lower leg orthoses with joint can be fixed in different positions, alternatively only certain movements are permitted in the joint or the joint can be moved freely. As a rule, these requirements change depending on the progress of the therapy. In order to guarantee a reliable treatment and to prevent excessive and insufficient demands on the lower leg and foot muscles, the release of the joint must be checked regularly.

Finally, you should also pay attention to the shoes in which the orthosis can be worn.

What types of lower leg orthoses are there?

Different lower leg orthoses can be used depending on the indication. A distinction is made between dynamic and fixed lower leg orthoses.

The dynamic orthotics usually have a joint that sits at the level of the ankle. This enables them to move in the ankle. They are therefore suitable for people whose muscles are sufficient to control the ankle, but where the strength is insufficient to adequately stabilize the lower leg.

However, most lower leg orthoses do not contain a joint. Instead, they bridge the ankle, as those affected, for example with a weak foot, can no longer lift their foot independently. Without the orthosis, you would often trip. With these fixed orthoses there are some that are suitable for flaccid paralysis and some that are used for spastic paralysis.

With flaccid paralysis, the muscles can no longer be controlled, so the foot and lower leg need support. Spastic paralysis is caused by increased muscle tension, which also restricts mobility and makes it difficult to control the lower leg.

In the case of the lower leg orthoses used, a distinction can also be made between particularly light material such as carbon and somewhat heavier orthoses made of hard plastic.

Dynamic lower leg orthosis

Dynamic lower leg orthoses can have a joint that sits at the level of the ankle joint, enables its mobility and at the same time stabilizes the foot and lower leg.

But an orthosis made of particularly elastic material can also be described as dynamic. The foot and lower leg are firmly embedded in the orthosis, the connection between the two parts is made of supportive but somewhat flexible material, so that a certain mobility is maintained in the ankle.

Depending on the weakness of the person concerned, the strength of the dynamic orthosis can be adjusted.

Lower leg orthosis with joint

Articulated lower leg orthoses have their joint at the level of the ankle.In this way, the independent movements of the affected person in the ankle can be stabilized without restricting mobility.

Such a joint can be left free, but it is also possible to only allow a certain range of motion. For example, if the foot lifter muscles are paralyzed, the lowering of the foot can be prevented with every step, but pushing off at the end of the step is possible.

Malpositions in the ankle can also be corrected and held in this way. This includes an ankle that is tilted inwards or outwards or an equinus foot.

The overview of the foot misalignments is also interesting at this point: An overview of foot malpositions

Lower leg orthosis with equinus foot position

People with an equinus cannot put their heel on the floor because the ankle is fixed in a straight position. Affected people would have to walk on tiptoe without an orthosis.

This equinus foot position can be gradually corrected with the help of orthotics with a joint. So the foot is stabilized with every step, the angle of the joint is adjusted slightly smaller week after week until the equinus has become a foot that can be angled up to 90 ° in the ankle.

Stiff orthoses can also be used for equinus feet, but their angle must be adjusted depending on the progress of the therapy.

The following article is also interesting at this point: Orthosis for the foot

Should an orthosis also be worn at night?

Whether an orthosis has to be worn at night depends on the indication.

Anyone who wears an orthosis to correct misalignments in the lower leg, ankle or foot usually needs the lower leg orthosis at night. This is the only way to continuously improve the malposition.

People with weak muscles who need the orthosis to support them when walking can usually do without the orthosis at night. Usually the strength is sufficient to move the lower legs and feet without the orthosis, but when walking over longer distances, support in the form of an orthosis is required.

Is it possible to drive with an orthosis?

In principle, driving a car with an orthosis is not prohibited. However, it depends on how severely affected individuals are.

For example, if you only wear an orthosis on your left lower leg, you can easily drive an automatic car in which only your healthy right leg is required for the brakes and accelerator. If both legs or the right leg are affected, it depends on the functionality of the leg.

Anyone who only needs the orthosis for stabilization and has enough force, especially to step on the brakes, can drive a car safely.

For those who find it difficult to reliably control their legs even with orthoses, for their own safety they should refrain from driving themselves.