Borders Ref Help Toolkit (in development)
Who to refer:
- All patients who need to be assessed for suitability for provision of an Orthosis
- Patients who have been seen by the Orthotic service previouslybut haven’t had contact with our service for more than 3 years.* This group of patients need referral to ensure we have up to date medical information.
*Patient’s re-accessing the service
Patients can contact the Orthotics department directly for up to 3 years from date of last contact. If it has been more than 3 years and the patient has had no contact with Orthotics a new referral is required to ensure we have the most up to date medical information.
The list below gives a more detailed overview but is not exhaustive; if unsure please contact Orthotics to discuss.
Footwear: Patients who cannot fit comfortably and safely in high street footwear e.g. severe bunions, swelling, raised toes, severe foot deformity and wish to be assessed for accommodative Orthopaedic footwear. Diabetics at high risk of ulceration/reulceration who may benefit from seam free footwear or require footwear to accommodate deformity. For general wider fitting advice please see our NHS Borders guide to buying footwear.
Raises and Footwear Adaptations: Patients who require a raise to accommodate a leg length discrepancy or require a wedge or flare added to their shoe to influence their stability or foot position.
Insoles: Patients with foot pain who would benefit from custom insoles- often posterior tibial tendon dysfunction and other non resolving MSK foot conditions. Custom insoles could benefit patients with ulcers, foot pain, biomechanical instabilities, or those with plantar prominences which need off-loaded.
Ankle: Osteoarthritis patients who require support to reduce pain. Patients with heel ulcers that require offloading. Patients with frequent ankle inversion injuries not fully resolved with physio alone. Patients with foot drop who require a device to help lift their foot. Patients with Multiple sclerosis, Motor Neurone Disease, Cerebral palsy, stroke or other conditions where they have a poor foot or knee position when walking or on their wheelchair footplates.
Knee bracing: Osteoarthritis patients who require additional support to reduce pain or correct deformity. Patients with patellar subluxation who require a brace to help reduce frequency of subluxation and pain. Patients with knee hyperextension or quadriceps insufficiency who stand or walk. Knee ligament laxity where physio input has not sufficiently controlled symptoms.
Upper limb splinting: Recurrent subluxation/dislocation of the shoulder where a brace is required to help reduce frequency of dislocation and pain. Wrist hand splints to help prevent contracture, reduce pain or improve function.
Hernia Supports: Patients with symptomatic reducible abdominal hernias may benefit from an abdominal support. Patients with a symptomatic reducible scrotal or inguinal hernia where surgery is not planned may benefit from a truss.
Spinal Bracing: Patients who have been fitted with a collar or spinal brace and require a review or replacement pads. Patients with significant head drop, often those with Motor Neurone disease.
Children: As above but also for concerns with toe walking combined with tight calf muscles, late walkers with poor stability and frequent falls, children with cerebral palsy that impacts upon their walking or foot position. Severe over pronation with foot pain or falls.
Who not to refer:
The Orthotics Service provides a comprehensive range of Orthoses. Referrals for the following will not be accepted due to little or no clinical evidence of their benefit.
Foot/ankle:
These items can be purchased from high street pharmacies and online retailers
- Silicone heel cups/pads
- Toe spacers /toe protectors (for complex toe spacers patients can self refer to podiatry)
- Bunion protectors or pads
- Sorbothane/shock absorbing insoles
- Heated socks
- Forefoot cushioning pads e.g. silicone cushioning pads
Footwear:
Footwear advice only
Patients should be referred to the Orthotic Service to be considered for prescription footwear based on clinical need and when standard footwear is no longer appropriate, due to for example; swelling, rheumatoid disease, deformity, structural/biomechanical change.
The orthotic service does not supply footwear for feet which are simply unusual in size i.e. very slim, small or large feet. Please see NHS Borders guide to buying footwear for advice for patients seeking wider fittings.
Knee:
These items can be purchased from high street pharmacies and online retailer
- Elasticated knee supports
- Neoprene knee supports
Elbow:
These items can be purchased from high street pharmacies and online retailer
- Tennis elbow support/brace
- Elasticated elbow support bandage
Shoulder:
These items can be purchased from high street pharmacies and online retailer
- Arm sling
- Shoulder sling
Neck:
These items can be purchased from high street pharmacies and online retailer
- Soft collar
Head:
See document containing further advice on helmets and head protectors.
Spine:
These items can be purchased from high street pharmacies and online retailer
- Back protectors
- Waist supports
- Lifting belts
Maternity:
These items can be purchased from high street pharmacies and online retailer
- Maternity belts
- Maternity support belts
- Pelvic support belts
Orthoses for sport:
We will not provide an orthoses for the sole intention of participating in sport. In this instance we consider this part of the normal sport equipment and would expect patients to purchase these items themselves.
Most of the above items are easily commercially available either in pharmacies, high street stores or online.
Prosthetic Patients:
All prosthetic patients for artificial limbs should be referred to the Prosthetic service at SMART Centre. Contact 0131 537 9444.
Children with Flexible Flat Feet
Children with flexible flat feet that do not have pain and there are no concerns with stability or falls do not typically require treatment. Most children have flat feet and arches tend to develop naturally by age 7. CSP Leaflet on flat feet in young children.
Femoral Hernias:
Femoral hernias are not treated with trusses due to the higher risk of strangulation.
Wheelchairs or special seating:
Patients who require wheelchairs or special seating – Refer to OT/SMART centre Wheelchair and Special Seating Services.
Walking Aids:
Patients who need a walking aid such as a zimmer frame or walker – refer to physio.
How to refer:
Adults- We accept referrals from GP's via SCI Gateway. We also accept referrals by Clinic Letter or Referral Form Consultants and other healthcare professionals.
Children - We will now accept referrals on the new form from anyone with parental consent and from parents, carers and health care professionals. Request for assistance forms are available below and can be emailed to the orthotics inbox.
Patients can contact Orthotics directly for review of reassessment if they have been seen by our service within the previous three years.
Referral should include the following:
- Full demographics with contact telephone numbers.
- Nature of condition and duration.
- Relevant past medical history.
- Results of previous x-rays (or other investigations) together with a copy of the reports