Conditions

A tendon is the soft tissue that attaches muscles to bones. Tendonitis is a painful condition, which occurs when there is inflammation of the tendon. It is caused from repetitive exercise, sudden sharp movements, running, jumping or throwing. It usually affects the elbow, wrist, finger, thigh and feet and can cause pain and stiffness when injured. It is treated with rest, ice, compression, elevation (RICE), painkillers, pain relieving gels and physiotherapy.
Depending on location, orthotics such as wrist splints, elbow supports or orthotic inserts can be used to help treat and manage tendinopathies.

Ligaments are the soft tissue that connects bone to bone to form joints and helps to protect them and function properly by holding them together like a tight rubber band does and they usually take their name from the location around the joint they protect.
Common ligaments in the body that are damage are found around the knee (and foot (e.g. ACL, ATFL).
The role of orthotics in the management of these injuries is adjunct and it greatly depends on the severity and location of the ligamentous injury.
For example a knee brace is an ideal orthosis to support the knee in instances of instability following an ACL injury and an ankle brace can help support the ankle following an acute ankle injury.

We prefer to refer to tendon disorders using an umbrella term such as tendinopathy as the old term of tendinosis may not always represent the condition at hand and the treatment may also change depending on presenting clinical picture. Common disorders of the Achilles are tendonitis and tendinosis.

Tendonitis is when there is inflammation of the tendon, which has a relatively short life span. If not resolved the tendon loses its form and structure and can cause tiny microscopic tears and eventually degeneration of the tendon also known as tendinosis.

A programme of physical therapy including strengthening exercises, massage, mobilisation, gait retraining and shockwave therapy have a high degree of success.

Orthotics and arch support along with night splints have a role to play in management and our expert team and trusted partner physical therapists can help you.

Achilles tendinopathies and the role of orthotics is a topic of particular interest at VIMA and we have dedicated a section on our blog post with more information to come (link to blogs).

Athletes with shin splints usually complain of pain along the shins when running and is common in sports in football players and marathon runners.
Generally these occur pre- season when there is an increased running capacity too quickly which can bring about shin splints and therefore a gentle weaning into running is usually recommended to athletes that have been relatively sedentary and return to sport.
Contributing factors is the presence of flat feet, tight calves, improper shoes and running on uneven terrain.
If you are unsure, whether or not you need orthotics into your shoes you can book your appointment with us for an evaluation.
Our orthotic evaluation will look into your foot and lower limb mechanics and how they function and the types of trainers you are using as well as the range of motion in your joints and power in your muscles.

Also known as hairline fractures, these tiny types of fractures can occur anywhere on the foot and are usually as a result of overtraining or overuse, using improper footwear and training techniques, foot deformities or having a diagnosis of osteoporosis. If left untreated they can lead to a complete fracture.

Rest and immobilisation are prescribed and sometimes an MRI or X-ray will be required to diagnose the location and extend of the injury.

We are experts with deep knowledge of the materials available and orthotics can help alleviate or lessen the loading of these structures with a well fitted and usually custom orthotic with dampening and supportive characteristics on the materials used.

There are 4 ligaments around the knee joint that help to hold it together.
Namely the ACL, PCL, which are within the knee joint and help support the knee joint front to back and the MCL and LCL that support the knee from side to side.
Usually these types of injuries cause knee instability and physical therapy and surgery are mostly indicated.
At times surgery can be delayed with the use of knee braces to support the knee.
Here at VIMA we can help our athletes return to sport using the best available functional knee braces in the market, either stock or custom made with artificial knee joints that can mimic the normal range of movement of the knee to support and protect it.

This is an umbrella term used to encompass any of several conditions around the kneecap such as patellofemoral malalignment, patellofemoral pain syndrome, chondromalacia patella and iliotibial band syndrome.
Physical therapy is the mainstay for all of these conditions, however orthotic supports can help alleviate some of the symptoms by maintaining proper patella alignment or the use of arch supports if indicated.
Our expert orthotist has a particular interest to managing sports injuries and we can guide you though the myriad of orthotic options to suit your needs.

Cerebral Palsy (CP) is an umbrella term used for problems caused to the brain before, during or soon after a birth. The original problem with the brain does not get worse over time but the condition as the child develops can put strain on the body.

The brain is the most complicated organ in the human body and is responsible for multiple tasks such as thinking and coordination, speech and walking as well as other involuntary actions such as breathing. The clinical picture of CP is a very complex one and varies significantly from patient to patient from some being rarely noticeable to the very disabled.

Symptoms of CP are not usually obvious soon after the baby is born and may take 2-3 years to become apparent. Some of these are delayed reach of developmental milestones, walking on tiptoes, swallowing difficulties, vision problems, and learning disabilities.

A team of healthcare professionals from physiotherapists, occupational therapists, speech therapists and surgeons may be involved in the care of a child with CP and it is therefore important for co-operation to exist amongst them to improve outcomes.

When CP affects the limbs it can cause contractures and tightness to the muscles that drive the joints and bones in both the legs and the arms and therefore can affect tasks such as walking or other activities of daily living like holding onto objects and other fine finger tasks.

From the physical standpoint strength, muscle tone, reflexes, range of motion and balance are some of the things health care professionals will need to assess. A gait assessment is used to assess how someone walks and what the limitations are, in order to compose a treatment plan.

Gross Motor Function Classification System (GMFCS)

This scale is used to determine the level of mobility for a person with cerebral palsy and it is composed of five levels:

• Level one – someone who can walk with no limitations.
• Level two – a person can walk, but with some limitations.
• Level three – a person can walk, but has to use an assistive device like a walker or cane.
• Level four – a person may be mobile with a self-operated wheelchair
• Level five – mobility is only possible in a wheelchair operated by another person.

There are many types of CP such as spastic, ataxic, dyskinetic and mixed CP.

Terms such as hemiplegia, diplegia, triplegia and quadriplegia refer to the number of limbs affected.

Orthotic Aims

Orthotics plays a big role in the overall management of children with CP, from the mildest of forms to the more severely affected.

Preservation of range of motion and preventing contractures, maintaining upright posture, walking efficiency and fluidity and reducing pain from deformed joints are only a handful of reasons for a parent to visit an orthotist.

Plan your visit to VIMA

We have a range of orthotic options for children with CP that our orthotist can guide you through the best option for the mutual aims we set with the parents as well as the involved allied health professionals.

Strokes and Cerebro-Vascular Accidents (CVA) occur when the blood supply to the brain is interrupted either through a blockage in one of the arteries (clot) or a ruptured vessel and bleeding into the brain, which damages or kills brain cells. Having a stroke can affect how the body works and how one thinks and feels.

Causes

A stroke can happen to anyone, however there are some rick factors that increase the chance of suffering a stroke such as age, the presence of high blood pressure, obesity, smoking and diabetes.

Complications and problems

Sadly not everyone survives a stroke, however people that survive a stroke can recover at varying degrees. For some people it is more severe than others. The size and location of the original injury determines the effect of the stroke it has on someone.

A stroke survivor can present complex needs due to the detrimental effects on speech, walking and balance, cognitive ability, emotional disturbances and visual problems amongst other.

In the presence of severe spasticity and weakness then mobility and walking becomes more difficult, proprioception is poor as visual input and spatial neglect take place.

As orthotists we are mostly involved in lessening the impact on walking and balance as well as reducing joint pain from spasticity in the muscles through the use of Ankle Foot Orthoses, Contracture Correction Devices or other devices that may be suitable.

Orthotic consultation

During your first visit at VIMA we will assess the range of motion in your joints, joint stability, muscle powers and alignment, movement patterns in standing, walking and seating. On certain occasions we may be able to perform a house assessment, however it is best to contact us prior due to the effect this may have as a result of the Covid-19 pandemic.

Our products are almost exclusively custom made. In particular situations and milder effects of stroke some alternatives may be possible, which we could discuss at our initial consultation.

We are in the unique position to have access to a wide range of healthcare professionals such as neurologists, occupational therapists, clinical dieticians and physiotherapists that compliment and enhance the therapeutic outcome.

Resources –

www.stroke.org.cy

www.stroke.org.uk

Definition

Multiple Sclerosis (MS) is a lifelong autoimmune disease that affects the brain and nerves, whereby the body’s immune system attacks myelin. It is not clear why this happens. MS is the most common neurological condition, which affects young adults, it is more common in women than men and is characterised as progressive or remitting.

Myelin sheath is a membrane that covers and protects the nerves and with the multiple attacks on the nerves it leaves scarring (or sclerosis) of the myelin sheaths, which eventually affects the nerves and affect the body part the nerve serves.

Causes

This is an autoimmune disease and the cause is unknown but it may be from a combination of genetic and environmental factors.

Orthotics role

The role of orthotics is wide given the complex effects from MS on muscle spasticity, weakness and instability of joints. Depending on clinical presentation and symptomology we can guide you through your orthotic options, which can range from foot orthotics to more complex prescriptions such as lightweight carbon fibre AFOs and KAFOs.

Most of our products are bespoke or custom made unless we can identify an off the shelf option that suits your symptomology and presentation.

Links & Resources

https://www.mssociety.org.uk/

www.Mstrust.org.uk

The common peroneal nerve serves the lower limb by controlling various functions such as the muscles during walking or standing and sensation in the foot and toes.

The peroneal nerve can get damaged following a fracture of the fibula bone, during knee surgery or after prolonged pressure onto the nerve from positions during sleep or coma.

Damage to the peroneal nerve can cause a flaccid foot drop and difficulty or inability to control the muscles that lift the foot, atrophy of the muscles and loss of sensation to the foot.

Orthotist role

From an orthotist point of view we will look to combat the effects of gravity, to assist function and motion and we are in a pride position to guide you through your best options either bespoke or off the shelf options.

Charcot Marie Tooth (CMT) is an inherited progressive disease that affects the peripheral nerves. It’s also known as Hereditary Motor and Sensory Neuropathy (HMSN) or Peroneal Muscular Atrophy (PMA). There is no cure for CMT. The name derived from the three physicians who described it in 1886. It is not life threatening as it rarely affects the muscles that are involved in breathing and people with CMT are expected to have normal life expectancy.  Progressive muscle weakness becomes apparent usually in adolescence or early adulthood but symptoms can present at any age.

Treatment remedies focus on aiding mobility, increasing independence of daily tasks and quality of life as well psychological and coping mechanisms.

A common problem amongst people with CMT is the presence of foot drop, which can cause mobility and balance difficulties.

Each person has different needs therefore not every person with CMT will be a candidate for the same assistive device such as an AFO as they happen to be plenty of options. At VIMA we offer bespoke and off the shelf solutions for people with foot drop.

Links & Resources

https://www.cmt.org.uk/

https://www.ninds.nih.gov/

Spinal stenosis is a narrowing of the space between the vertebrae, which are the bones that make up the spinal column. This narrowing causes pressure on the nerve exits and is most common in the lower back and cervical spine. The narrowing may be from a herniated disc, trauma, tumours or overgrowths of bone from arthritis in the intervertebral joints. For some people the stenosis may not cause any real problems but others may experience tingling, burning, numbness and muscle weakness on the periphery of the lower and upper limbs. Symptoms may get worse over time and may need surgery.

In severe cases of canal stenosis of the lumbar region there may be muscle weakness in the foot and ankle that causes flaccid foot drop, which causes walking and balance issues.

Our different levels of stock and bespoke solutions to help you manage your foot drop with guidance from our expert orthotist can help you improve your walking and lessen the chance of tripping and falling and as close return to normality as possible.

Myelopathy

Myelopathy is an injury to the spinal cord caused by severe compression that may arise from spinal stenosis, disc degeneration, disc herniation, autoimmune disorders such as rheumatoid Arthritis or trauma.

When this occurs it causes nerve dysfunction with pain, numbness, loss of balance and coordination. It can occur at any level in the spinal cord.

The cauda equine is the bundles of nerves at the low end of the spinal cord in the lumbosacral region and the nerves at this region send nerve signals to the legs, feet and pelvic organs.

Cauda Equina Syndrome (CES) is a rare disorder that is usually a medical emergency and requires surgical intervention whereby ‘something’ severely compresses all of the nerves in the lumbosacral region. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage.

If immediate treatment to relieve the pressure is not pursued, it can result in permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation, and other problems. Even with immediate treatment, some patient may not recover complete function.

In no particular order herniated disks, tumours, infection, fracture, or severe spinal canal stenosis may cause CES.

Red flag signs/ symptoms are:

• Severe Low back pain
• Bladder and or bowel dysfunction
• Immediate and progressive loss of sensation and function in the lower limbs

After surgery there is going to be a period of intensive physiotherapy and prognosis varies. Our therapeutic goals and orthotic intervention may differ from person to person depending on clinical presentation and extend of functional deficit.

Spina bifida is when a baby’s spine and spinal cord does not develop in the womb, which causes a gap in the spinal cord.  It is unknown what causes spina bifida to develp in babies however lack of folic acid before and early on during pregnancy is a risk factor.

There are different types of spina bifida:

• Myelomengocele – The spinal canal remains open along multiple vertebrae in the back, the spinal cord and membranes push out and form a sack in the baby’s back.
• Meningocele – This occurs when the meninges, which are the protective membranes around the spinal cord, push out and form a sac. Surgery can be used to remove the membranes as the spinal cord usually forms.
• Spina Bifida occulta – This is the mildest type of spina bifida where usually one of the vertebrae do not form properly, resulting in a small gap and dimple in the back with tuft hair patch. Most people may be unaware they have it.

Most people with the more severe forms of spina bifida require surgery soon after birth to close the sac that is formed. Accompanied is damage to the nervous system, which can present itself as weakness or paralysis in the lower limbs, bowel incontinence, urinary incontinence and loss of skin sensation. Brain function is retained and people with spina bifida are expected to live well through adulthood.

As this is a congenital condition a range of therapists are involved from an early age to treat and support secondary issues that may arise from spina bifida and make the day-to-day life easier and maintain independence.

When there is loss of function in the lower limbs with the additional consideration of loss of sensation prescription can be tricky and at VIMA we are best suited to guide and advise you through your options and considerations in the design process and selection of an appropriate orthosis carefully.

Links & Resources

https://www.shinecharity.org.uk/

https://www.spinabifidaassociation.org/

Polio is a serious viral infection that due to the widespread use of vaccines it is almost irradicated with very few cases recorded each year around the globe.

There is no cure for polio, which makes the use of vaccines ever so important.

In some cases, the poliovirus attacks the nerves in the spine and base of the brain. This can cause paralysis, usually in the legs, that develops over hours or days after the virus is contracted.

Post Polio Syndrome

There is a chance that someone who’s had polio in the past will develop similar symptoms again, or worsening of their existing symptoms, many decades later. This is known as post-polio syndrome.

The damage to the nerves is a long-lasting effect of polio and some people will be left with some degree of permanent paralysis in the leg muscles and require long term input of orthotic intervention to support the limb for mobility.

MND describes a group of conditions that affect the brain and nerves (motor nerves), which causes weakness in the muscles and gets progressively worse. It affects people over 50 but can also affect adults of all ages. MND is life-threatening and there is no cure.

MND can affect how you walk, talk, eat, drink and breathe. Treatments focus on reducing the impact it has on a person’s life. Orthotics has a limited role for a short period in order to maintain the level of mobility and independence to the extend the disease process allows for.

*MND and ALS are different descriptions of the same disease. In the UK we use the term motor neurone disease (MND) and in the USA they use amyotrophic lateral sclerosis (ALS). There are several forms of MND. ALS is the most common type. MND is an umbrella term for all forms of the disease. In the USA, ALS is used as the umbrella term.

Links & Resources

https://www.mndassociation.org/

Amyotrophic Lateral Sclerosis is a rare progressive disease that causes the death of neurons that control voluntary movements. Motor neurons are nerve cells that extend from the brain to the spinal cord and to muscles throughout the body. There is no known treatment to halt, reverse or treat this disease. Most people with ALS die from respiratory failure, usually within 3 to 5 years from when the symptoms first appear.

One of the symptoms of ALS is progressive muscle weakness. From an orthotics point of view we want to make some aspects of the lives of those suffering from ALS as easier as possible up, until the point that is possible given the natural disease process and it may include orthoses for the hand and arm or foot and ankle.

* MND and ALS are different descriptions of the same disease. In the UK we use the term motor neurone disease (MND) and in the USA they use amyotrophic lateral sclerosis (ALS). There are several forms of MND. ALS is the most common type. MND is an umbrella term for all forms of the disease. In the USA, ALS is used as the umbrella term.

Links & Resources

https://www.mndassociation.org/

What is scoliosis?

In simple terms, scoliosis is a sideways curvature of the spine.

There are many types of scoliosis but the most common type is adolescent idiopathic scoliosis.

How is it measured?

It is measured and regularly reviewed with X-rays using the Cobb angles and the Risser sign to determine the amount of growth left. Spinal bracing is more often the mainstay of treatment to correct or reduce the rate of curvature progression and to reduce or eliminate the need of surgery.

Typically scoliosis is classed as mild from 10-20 degrees, moderate from 20-45 degrees and severe with Cobb angles of 45-50 degrees and over.

Adolescent Idiopathic Scoliosis (AIS)

What is it?

As the name suggests, it is idiopathic, which means there is no, one causation for developing scoliosis. It may be hereditary and tends to affect more girls than boys between the ages of 9 to 15. It is diagnosed through physical exam and X-Rays and it is managed either through observation, bracing or surgery.

What other types of scoliosis exist?

Besides the most common type of AIS, there are other types of scoliosis such as:

• Congenital scoliosis – This is observed immediately after birth when the vertebrae develop incorrectly in utero and may be caused if one or more of the vertebrae did not form properly, are absent or two or more vertebrae are fused.
• Infantile or Early onset scoliosis – This is used to described scoliosis for children under the age of 3 and it is usually associated with other problems and not present at birth.
• Juvenile Idiopathic Scoliosis – This type develops in children between 3 to 10 years old.
• Structural scoliosis – This type of scoliosis develops as a result of hemi vertebra, which usually requires an aggressive bracing approach, as a skeletal deformation is the driving force for the deformity.
• Neuromuscular scoliosis is secondary due to the presence of a more significant diagnosis such as cerebral palsy, muscular dystrophy or Marfan syndrome that makes the muscles in and around the trunk and spine weaker, resulting in muscle imbalances and a C-Shape deformity that typically requires an aggressive approach towards management.
• Functional scoliosis – This is usually as a result of a leg length difference and is treated without a brace by addressing the leg length difference.

Orthotic aims

The main aim of spinal bracing for sideways curvatures of the spine is to support and reduce the rate of progression of the curvature until the person stops growing and reaches skeletal maturity. If the curve is between 20-40 degrees and there is still growth then bracing is indicated as well as physiotherapy to stretch and strengthen the muscles around of the trunk. Importantly once skeletal maturity is reached then bracing in not indicated.

What is it?

Unlike scoliosis, which is a sideways curve of the spine, kyphosis is obvious when observed from the side in the thoracic spine usually, which looks like rounding of the upper back or similar to the letter ‘C’. It can occur at any age, but it is most common in teenage years. Though the thoracic spine is supposed to be curved, if the curve in a person’s thoracic spine is more than 40 to 45 degrees, it is considered abnormal – or a spinal deformity.

What causes kyphosis?

Similar to scoliosis it can be as a result of multiple reasons, either structural or due to an underlying condition.

Types of kyphosis

• Postural kyphosis is easy to correct with posture correction exercises and education.
• Congenital kyphosis – means that there is a problem at birth, which causes kyphosis. This kyphosis is also the most common non-traumatic, non-infectious cause of paraplegia (paralysis of the lower part of the body).
• Osteoporotic Kyphosis – this is a very common type of kyphosis, that is usually affecting the older population, whereby the bones that make up the spine called the vertebrae due to thinning of the bones collapse due to gravity, causing a “roundback” or “hunchback”. You can read more information in the dedicated section below (see osteoporosis).
• Scheuermann’s Kyphosis – With this type of kyphosis there is vertebral wedging of more than 5 degrees or three or more vertebrae that are next to each other, which have a triangular appearance, so they wedge together and limit the space between the vertebrae. The thoracic curve is usually 45 and 75 degrees.

Role of orthotics

Orthotics and back braces have a role to play when it comes to conservative management of kyphosis outside of surgery. Bracing can be successful in patients with kyphosis between 55 – 80 degrees if the diagnosis is made before skeletal maturity. Once skeletal maturity is reached, bracing is ineffective.

At VIMA we use both 3D scanning and conventional casting methods to obtain a mould of the patient’s trunk to manufacture a fully customised brace.

You can read more on our dedicated blog posts on spinal deformities.

What is AS?

Ankylosing Spondylitis (AS) is a long – term condition where the spine becomes inflamed and over time causes some of the bones in the spine to fuse. The fusion, also known as ankylosis, makes the spine less flexible and creates a hunched posture. It affects mostly the lower back and cervical spine. There is no cure for AS but treatments can help lessen the effect from AS.

Men are slightly more likely to develop AS than women and can be diagnosed at any age but it is usually diagnosed from a multiple of factors below the age of 40. Although the exact cause is unknown, genetics seem to play a role and research is focused on identifying genetic markers and triggering factors.

Keeping active and maintaining a good posture are key to either avoid AS or lessen the effects as it would keep the spine flexible and helps to live a normal life. Over the counter painkillers, more advanced Disease Modifying Anti-Rheumatic Drugs (DMARD’s) and biological therapies may also be prescribed to lessen the impact from AS.

At VIMA we choose a cautious approach to treating AS with back braces and tends to be the last cog on the wheel as the evidence suggests keeping active and pharmacological approach may be a better alternative to bracing.

If other alternatives fail to help then a suitable back brace may be required to help support the lower back and provide some temporary relief.

Links & Resources

https://www.versusarthritis.org/

https://spondylitis.org/

What is it?

With age, we lose strength in our bones, which become thinner and more brittle and susceptible to fractures, also known as osteoporosis. Fractures in the spine are very common with people with osteoporosis and are almost twice as common from other osteoporotic fractures in the hips or wrists.

As we age our vertebrae weaken and become flatter, which makes them more susceptible to breaking. They may be as a result of a fall but for people with osteoporosis it can occur from activities of daily living such as sneezing, twisting or coughing. Due to the effects of gravity and natural curves in the spine, osteoporotic fractures tend to lessen the height of the individual.

Most people who suffer a vertebral compression fracture get better within 3 months and it does not require any special treatment to repair the fracture. It presents with back pain in the area affected and gets worse with activity and motion. It is alleviated with rest and lying down along with limited use of pain medications and often sufficient to make an impact.

– Surgery

If the pain is severe and you are a candidate that can have surgery then there are two procedures that can take place, which involve a needle inserted into the damaged vertebra.

Kyphoplasty – The procedure involves the insertion of a needle into the affected vertebrae, in which a balloon tamp is funnelled through that is pumped and creates a void, which is then filled with a special putty or cement. It restores vertebral high with good outcomes overall.

Vertebroplasty – In contrast to kyphoplasty, no void is created but cement is injected to the damaged vertebra.

– Role of orthotics

There may be cases where patients are instructed to wear a brace to restrict movement and allow the vertebral compression fracture to heal and this is when VIMA can help. We have a variety of different types of braces to help you from soft fabric braces to super lightweight carbon fibre spinal braces that provide pressure systems to support your back.

A spinal tumor is an abnormal mass of tissue in the spine, either within or surrounding the spinal column or canal. They grow and multiply uncontrollably. They can be benign (non-cancerous) or malignant (cancerous) and are either primary meaning they originate in the spine or spinal cord OR metastatic from cancer spreading from another part of the body to the spine.

The dura is the covering of the spinal cord and spinal tumours are classed from their location to the dura and whether they are within the cord material (medulla) and from the level of the spine.

Intradural/ Extramedullary – The tumour is located inside the dura but outside the actual spinal cord.

Intramedullary – The tumour is within the spinal cord.

Extradural – These tumours occur outside the dura.

When these tumours set within the spinal column and cord can cause pain, loss of sensation, muscle weakness in the arms, legs and chest, stiffness, loss of bowel or bladder function.

Surgery

Indications for surgery vary depending on the type of tumor and are associated with a major risk for complications. This is best discussed with the expert surgeons involved in your care.

Non- Surgical Treatments

Chemotherapy and radiation therapy are some options to try and shrink the tumour.

The role of spinal bracing

With these tumours the spinal column may be compromised, similar to a tree trunk that needs support. Your surgeon and radiologist will need to examine your back and decide if it needs additional support from further structural compromise. From an orthotist’s point of view is to provide the appropriate amount of support using pressures to stabilise the spine. We offer both bespoke and off the shelf solutions, which we can discuss with you and your surgeon to offer you the best possible outcome.

Spinal fractures come in many different forms and severity. The spinal cord and/or nerves may also be injured, depending on the severity of the fracture.

Causes

Fractures from high-energy trauma such as road traffic accidents can be so severe that result in complete paralysis whereas others are from low energy trauma such as with patients with osteoporosis. Most common areas affected are the lumbar and thoracic regions of the spine.

Treatment

Treatment depends on the type and nature of the fracture, which may or may-not include surgery. Once treatment plan has been set with your spinal and orthopaedic surgeon a brace is likely to be required.

Role of orthotics

The aim of the brace is to limit movement in the spine either in flexion, extension or rotation and the most important aspect that is needed before bracing is whether the spinal fracture is stable or unstable. Unstable fractures tend to require surgery, whereas stable fractures can be adequately managed with an orthosis. We can liaise with your surgeon to discuss and choose an appropriate type of brace. Bracing usually lasts anywhere between 6 to 12 weeks.

Forefoot and toe amputations encompasses, isolated toe amputations, trans-metatarsal amputations as well as metatarsophalangeal disarticulations.

The management of these types of amputations are based on the desired outcome of the patient as well the underlying cause for the amputation.

For example the management of an amputation of the diabetic insensate foot versus a traumatic amputation varies significantly in terms of orthotic and prosthetic options.

For cosmetic silicone options we work with one of the best silicone prosthetic supplier in the Middle East.

Orthotic solutions such as orthopaedic insoles, toe fillers and AFOs may be utilised for this type of clientele depending on the condition, presentation and desired outcome and aim of treatment.

The Lisfranc joint is the part of the midfoot where the metatarsal bones meet up with the tarsal bones. The name originates from the Lisfanc ligament in the midfoot.

Propulsion during the third rocker are impaired. This is a type of amputation can be managed orthotically with an AFO rather than with a prosthetic.

Fortunately, high end orthotic devices are available now in Cyprus that can help you deal with this type of amputation at our clinic VIMA, without the need for unnecessary trips outside of the country. Book your appointment now.

Francis Chopart (French orthopaedic surgeon) first described disarticulation thru the midtarsal joint in the 1700s. Chopart amputation removes the forefoot and midfoot, saving talus and calcaneus (ankle joint). This type of amputation is fitted with prosthesis or a hybrid orthosis. One of the major advantages is the preservation of plantar weight bearing surface but one of the major drawbacks is that it may lead to a gradual equinus deformity of the ankle, which can hinder prosthetic input.

If you suffered an amputation and would like to discuss your prosthetic or orthotic needs, we at VIMA are happy to see you and detail your options. Book your appointment now.

Syme’s amputation is also the name for an ankle disarticulation. It involves removing the ankle joint and resection of the tips of the malleoli and re-placing the heel pad for weightbearing. A prosthetic socket and a low built foot type are usually needed. Selection of prosthetic feet may be limited due to the long residual limb and limited space for components. It does however, give a weight-bearing surface for patients to walk on without a prosthetic albeit short distances and this function is often very much needed for some patients.

Book your appointment now to discuss your options.

This is the most common type of amputation in the lower limb, a below knee amputation (BKA). Approximately 1 in 5 of major limb amputations is a BKA and most people that undergo a BKA are over the age of 65.

Main causes for a BKA are:

• Peripheral Vascular disease
• Diabetes
• Infection
• Foot ulcers
• Trauma
• Tumours

Selective BKA

BKA is a serious undertaking and it is aimed to address serious issues in the foot or other areas below the knee. Any decision to amputate involves multiple factors and should include many discussions between the patient and their team of doctors. Although it is a life changing event it is important to note that the scope for a BKA is to return to a normal quality of life for someone that may have a non-viable limb.

After a BKA the patient needs to relearn how to walk again with their prosthesis. The prosthesis is composed of three sections:

• The socket
• The pylon
• The componentry

Prosthetic process

We take a holistic approach at your initial consultation at VIMA.

We will ask you many questions to see what kind of lifestyle you have, what hobbies you may have and what you do for a living and your level of activity, what you would like to do and go through your different options and componentry.

Your prosthetist will go through with you the type of socket that is most suitable to your needs, the type of suspension, materials and lastly componentry such as prosthetic feet or other adaptors that may be suitable.

A cast is then taken of the residual limb and the process to manufacture your 100% custom made prosthetic limb follows.

We have a dedicated section that unwraps the various different stages of the process of making a custom made device. Book your appointment now.

This type of articulation is common in children. It has advantages and disadvantages, all of which must be carefully weighted.

The main drawbacks are that a knee disarticulation does not retain the natural knee joint and therefore is less energy efficient with walking, there tend to be cosmetic considerations due to the bulbous residual limb end as well as limitations to componentry.

However, it is superior functionally when compared to an above knee amputation due to the increased length of the residual limb giving better prosthesis control and the distal end of the femur gives better weight bearing capability.

If you would like to know what we could do to help you, book you appointment at VIMA now.

This is another very common amputation and is considered a high level amputation. It is common that patients with an AKA require considerably more energy during walking and their gait is often sub-optimal.

There are tend to be more considerations when it comes to prosthetic input for the patient group to the way the prosthesis is aligned in relation to the artificial knee and ankle as it affects balance, walking efficiency and stability. Weight of components, socket comfort, suspension and stance stability become key deciding factors in the manufacture of the custom prosthetic limb.

In the past options were limited when it came to componentry selection. Fortunately, the advent of new technologies and the development of a plethora of microprocessor knees (MPK) have upgraded to the good the lives of many people over the last decade and they continue to improve in terms of weight and functional characteristics, with return to the most optimised and close to physiological gait as possible.

At VIMA we are certified to fit and supply the German Ottobock Genium and C-Leg MPKs, which are considered by many best in class.

This procedure is mostly used for pelvic tumours and is major amputation involving partial or complete resection of the pelvis and hip, and results in significant mobility difficulties. The most common type of prosthetic socket used is the rigid “Canadian style” socket but slowly over the last few years the newer “bikini style” sockets have taken over as they tend to be more comfortable, lighter and therefore more functional.

The end user will spend some time for certain tasks using their prosthesis, whereas some activities may be best performed without the prosthesis due to the weight of the prosthetic limb, which is absolutely normal.

If you would like to know what we could do to help you, book you appointment at VIMA now.

This umbrella term encompasses a whole range of absences of a limb or part of a limb from birth. The exact cause of a congenital limb defect is often not known. Certain things may increase the chances of a child being born with such a defect.

The way CLDs are managed is not indifferent with the traditional sockets and componentry used and the considerations in manufacture, which are similar.

The main goal is to provide your child with a limb that has proper function and appearance.  For upper limb absences the aim is to help child’s play and help the child develop fine motor skills and to help them through their life to have normal and meaningful lives with the use of any specialist equipment hybrid orthosis or prosthesis that may need.  Task specific prosthesis are also essential in achieving the child’s goals with that regard.

If you would like to know what we could do to help you, book you appointment at VIMA now.

PFFD is a dysplastic phenomenon with a spectrum of femoral involvement in the upper two thirds. It is an extremely rare congenital anomaly with an incidence of 1.1–2.0 in 100,000 live births. It is often associated with hip instability, rotation of the hip, and insufficient musculature, leg length discrepancy, along with instability at the knee joint. Most cases of PFFD are unilateral (85–90%); PFFD is rarely bilateral, when unilateral, the right femur is the most frequently affected hip.

Treatment pathways differ per case. PFFD poses a significant challenge to effective treatment and it demands a multidisciplinary approach of prosthetists, paediatric orthopaedic surgeons, and the physical therapists involved in the care of the patient.

The first step in most treatments of a child with PFFD coincides with the time when the child is ready to stand and the child will be fitted with prosthesis to facilitate standing and equalise leg length difference and this is done irrespective of any future interventions such as surgery as treatment needs to follow normal developmental milestones.

Surgical management is more complex and is broadly divided into multistage limb lengthening or limb modification surgical journeys taking place until the child reaches high school.

These types of amputations are usually as a result of trauma and they are one of the more common types of upper limb amputations in Cyprus during Easter and the irrational tradition of firecrackers use.

Single or several fingers are severed, which affects function and fine motor skills and finger use.

Prosthetic options are either passive or active and range from cosmetic silicone gloves to more functional and active partial hand and smaller finger prostheses either body powered or electrically powered prostheses. Task specific prostheses are also used with a particular occupation or action in mind.

In selected cases, Osseo integrated finger prosthesis may be a viable alternative. A crucial aspect of finger amputation and partial hand amputation rehabilitation is the presence or absence of thumb opposition.

If you would like to discuss your various different options, please do not hesitate to contact us.

This is another common amputation, usually post-traumatic, in which the hand is severed from the forearm.

Prosthetic options range from passive to active options. There is certainly not one single options that works equally as well for all individuals.

Cosmetic silicone gloves are common but they tend to restore only the cosmetic aspect and very small proportion of the functional scope of hand use.

More active hand prosthesis, usually electronically driven prosthesis are commonplace. Task specific prosthesis is also very common and close co-operation is required with your prosthetist to design a hand prosthesis that will work for you.

If you would like to discuss your various different options, please do not hesitate to contact us.

Commonly known, as below elbow prostheses is the most common upper limb amputation. Traumatic injuries and tumours are the most frequent pathologies to necessitate amputation.

The main goal is to restore function, which may be for a specific task or assist activities of daily living that require bilateral use of the hands or to improve the cosmetic appearance of the upper limb. Socket types vary depending on the length of the residuum and componentry.

A common type of prosthesis despite general public perception is body-powered prosthesis, which uses a harness that is worn around the opposite arm and across the back. A hook is most often used for a terminal device. Patients use the muscles of the shoulders and arms and the harness pulls on a cable, which either opens or closes the terminal device (depending on the type of terminal device). By relaxing the muscles, the terminal device then performs the opposite operation.

Myoelectric control is on the rise over the last few years with many companies are investing in myoelectric controlled prosthetic terminal devices. Control is achieved through the use of electrodes or touch pads. They are usually self-suspending meaning the prosthesis does not require a harness to be held onto the residuum. The prosthesis is held gripping above the bones of the elbow.

Myoelectric arms are functional as well as cosmetically appealing. However, they are heavier, more expensive, and less functional than the traditional hook and require more maintenance.

Targeted muscle re-innervation (TMR) has been used to enhance a patient’s experience using a myoelectric prosthetic device. TMR is an invasive procedure intended to make prosthetic use more intuitive. It entails coapting nerves that would otherwise be amputated with the motor nerves of muscles remaining at the stump site, it also increases the signal to operate the terminal device and by coapting the nerves into muscles that are destined to certain tasks then the overall control becomes a lot more intuitive and normalised.

If you would like to discuss your various different options, please do not hesitate to contact us.

An above elbow amputation is usually as a result from trauma, infections or malignancies. We include trans humeral and shoulder or hindquarter amputations in this category, as there are common principles to the prosthetic aspects and considerations of managing these high level amputations.

The major requirement in the case of high-level upper limb amputees is that of a light and cosmetic prosthesis. A functional limb is only occasionally prescribed despite the huge loss of function associated with this level of amputation.

Cosmetic or passive prostheses are used in many cases but provide little to no function.

Functional prosthesis requires a harness type of socket that is needed in order to share the weight and load of a usually heavy prosthesis. Componentry options are limited, however over the last decade there have been strides towards providing better and more options to this patient group.

A type of functional prosthesis is task orientated and tends to yield great outcomes and fulfilment for the people that use it, for example prosthesis for cycling, archery or musical instrument play such as the violin.

If you would like to discuss your various different options, please do not hesitate to contact us.