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FREQUENTLY ASKED QUESTIONS

What is orthotics?

Orthotics is a specialty within the medical field concerned with the design, manufacture and application of orthoses.

An orthoses can take the form of a brace, splint, orthotic insoles and orthotic shoes.

Cervical Collar Brace

Arm (Elbow) Brace

Lumbar Brace

Finger Splint

Kneecap Brace

Kneecap Brace

Ankle Brace

TLM Orthotic Insoles and shoes distributes pressure evenly across your feet.

TLM Orthotic Men's Shoe

TLM Orthotic Children's Shoe

TLM Orthotic Student's Shoe

What does TLM orthotist do?

The Ministry of Health defines an orthotist as a specialist from a multidisplinary healthcare team who cares for those who require mechanical devices to support or supplement abnormal joints. He/she is the primary medical clinician responsible for the prescription, design, manufacture and management of orthoses to relieve pain and discomfort in a patient's body.  An orthotist requires combined knowledge of anatomy and physiology, pathophysiology, biomechanics and engineering, and should be able to analyse medical X-ray images. 

 

Conditions that can be treated by an orthotist include:

  • Pain and strain in the musculoskeletal system, such as foot pain, knee pain, back pain, shoulder pain, arm pain and hand pain.

  • Support or correct musculoskeletal deformities, such as flat foot, high arch, bunion, bow legs, knock knees and scoliosis etc.

  • Protect and support an injury, such as sports injury and post-surgery protection.

  • Assist in rehabilitation and recovery of injury.

Fig 1. A order form for the manufacture of an orthosis traditionally received by the orthotist. In this order, the orthotist has been instructed to make a scoliosis brace with an additional ring flange.

Traditionally, an orthotist receives instructions from an orthopedist for the design and manufacture of orthoses. For example, they may receive the following order for a scoliosis brace, including any modifications to the basic model.

However, following the development of the field, an orthotist receive more comprehensive training in relevant fields of medicine including:

 

1) Sports Medicine

2) Rehabilitation Medicine

3) Physiotherapy

4) Neurology

5) Neurosurgery

6) Orthopaedic Surgery

7) Hand Surgery

8 ) Pain Management

9) Family Medicine and Continuing Care

As such, many orthotists are qualified to set up their own practice to practice independently and to exercise their discretion in the design of orthoses. They may also introduce improvement to the design of orthoses based on their clinical experience.

What is orthosis (plural: orthoses)?

An orthosis is an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal systems. An orthosis is designed and fitted to the body to achieve one or more of the following goals:

  • Support or correct musculoskeletal deformities

  • Support weakened joints

  • Control biomechanical alignment

  • Enhance or maintain mobility

  • Protect and support an injury

  • Assist rehabilitation

 

By achieving the above goals, pain or discomfort in the body will be relieved.

Orthosis, Braces, Splints, Prosthesis, what's their difference?

A medical brace is an externally applied device used to restrict movement of the joint it is fitted to by holding it in place. This may be done to allow an injured joint to heal. They are unable to modify the structural and functional characteristics of the musculoskeletal system like an orthosis.

A medical brace is classified according to the joints to which it is applied as well as the degree of movement it allows the joint.

Soft Lumbar brace

 

An adjustable medical brace can be adjusted according to recovery to allow increasing degree of movement to the joint which it is applied to. It is usually prescribed when injury is not as serious (e.g. torn ligament) and certain movements will not aggravate the condition. Such braces usually allows for adjustable degrees of flexion (0-90 degrees) and extension (0-135 degrees) (forward and backward movement of the joint)

A splint is prescribed to protect and support an injury.

Rigid Ankle brace with adjustable hinge

Knee Brace w adjustable hinge

 

A soft medical brace allows considerable movement to the joint which it is applied to. It is usually prescribed to tighten muscles surrounding the joints to support movement and reduce pain while moving. It usually allows movement of the joint in all directions.

A rigid medical brace allows very limited movement to the joint which it is applied to. It is usually prescribed to aid recovery after trauma (e.g. fracture) and thus severely limit movement of the joint. It usually allows only flexion and extension (forward and backward movement of the joint).

Finger Splint

In general, braces and splints are non-corrective orthoses; they are prescribed to assist in rehabilitation. Corrective orthoses on the other hand are prescribed to modify the biomechanical alignment of the body and they serve as treatment.

If we take the example of a spinal condition, a brace is prescribed if the vertebrae are not misaligned, as shown in picture 1. The brace serves to lock the spine in place while the surrounding tissues heal.

However, an orthosis is prescribed if any of the vertebra has shifted out of alignment, as shown in picture 2. This is because an external force has to be applied in order to push the misaligned section back into its original position.

A prosthesis is an externally applied device used to replace wholly or partly an absent or deficient limb segment. It is also classified as a brace.

Image Courtesy: Orthomerica

Is it normal for someone to feel pain or discomfort when wearing orthosis?

Orthoses, such as orthotic insoles and scoliosis or spine braces, are non-invasive devices, causing no harm to the human body. When orthosis is uncomfortable to wear, patient will stop wearing it, thus stopping the treatment. This also delays the treatment. However, orthosis designed and manufactured by a good orthotist is very comfortable to wear, without causing any pain, discomfort or irritation. It is akin to putting on a pair of spectacles; a pair of correctly prescribed spectacles will enhance your vision once you put it on. Good results will be shown between half an hour to two hours after wearing TLM's orthoses. This is TLM Foot-Knee-Back-Arm Orthotics Centre's guarantee to our patients.

These are two pairs of foot casts taken from patients before and after their orthotics treatment.

 

Several deformities of both patients' foot, most notably the inner slant, has been significantly corrected following treatment.

How are orthoses manufactured and why do their prices vary so much?

The price of an orthosis will vary depending on its function, including intended length of use, as well as its manufacturing process, which determines cost.

Pre-fabricated braces are usually priced below a thousand dollars because they can be produced cheaply in bulk at factories.

A soft brace is usually priced at less than $200 because it is intended to be used for a short duration of time. A rigid or semi-rigid brace is usually priced between $200 to $600 depending on the materials used as well as functionality (e.g. hinges for adjustable degrees of movement). 

Custom-made corrective orthoses made by an experienced orthotist on the other hand are priced between $1,000 to $10,000 because they require a very time consuming and messy process. A mould of the patient's feet has to be taken and made into a cast to serve as a model for biomechanical realignment. There is a significant amount of hands-on skill required of the orthotics technician who makes the devices. Therefore, a lower volume of orthotics can be manufactured by this method.

Is it possible to cure foot pain, knee pain or back pain using TLM orthoses?

1) Orthotist prescribe treatments/orthoses to cure foot pain, knee pain or back pain that arise from musculoskeletal system conditions. As can be observed from the following X-rays of a scoliosis patient, the spine of the patient was significantly straightened after receiving orthotic treatment with TLM.

2) Occasionally, foot pain, knee pain or back pain requires a comprehensive treatment plan involving other specialists. For example, diseases involving synovial membranes or causing degeneration of cartilage may cause arthritis, which is characterized by swelling, warmth, redness of the overlying skin, pain and restriction of motion. When a patient has symptoms of arthritis, orthopaedic specialist will be involved to develop a comprehensive treatment plan for the patient.  

After 14 months

 

Before treatment

 

After 4 months

 

After 8 months

 

What is the clinical characteristics of foot pain?

1) For foot dyplasia, when one foot is bigger than the other foot, the body’s center of gravity will move to the bigger foot and cause foot pain.

2) Everyone’s feet are not the same, just like an unstable building foundation. When a person is tired, there will be foot pain. Some people will feel pain or discomfort in the forefoot and some will feel pain or discomfort in the rear. With age, knee and lower back pain will appear. Problems in the microcirculation system will arise too, such as the appearance of varicose veins.

 

How does TLM Foot-Knee-Back-Arm Orthotics Center treats foot pain?

1) For children, we will align the bone structure of the foot to its correct position using orthosis to ensure healthy growth of foot. 

2) For adult, we will do a full body musculoskeletal examination to determine if there is a strong relationship between your foot biomechanical issue and the symptoms you are experiencing. After which, we will adjust the bone stucture of the foot using orthosis, followed by adjustment of the body's bone structure if necessary. Treatment process lasts for approximately 6 months to three year depending on the severity of your condition.

What do TLM orthotic insoles feel like when you wear them?

Initially, you may feel like you are walking on clouds in the sky. After 10-20 minutes of wearing insoles, the bottom of your feet will feel more comfortable. Foot size will change after wearing insoles, thus it is the orthotist's responsibility to match a suitable pair of shoes for the customer.

 

Do I need to change TLM orthotic insoles often?

 

For Children

1) For children who are strong and healthy, 1-2 pairs of insoles are needed as foot size changes when they grow taller. For children who are weaker, 2-3 pairs of insoles are needed.

2) During the initial phase of treatment, the size of the child's feet will become smaller as deformities are corrected. This will cancel out the growing of their feet. Therefore we will not see significant changes in the size of their feet.

3) Teenagers who are undergoing their growth spurts between (approximately 12-15) however will see rapid changes in their shoe size.

For adults

For adults, 1 pair of insoles can be worn for a long period of time. Wearing insoles is like wearing spectacles, if there is no further changes to the biomechanical alignment of the feet as a person ages, a pair of insoles can be worn for more than 10 years.

What's the difference between TLM Customised Shoes and TLM Orthotic Shoes?

TLM Customised shoes are shoes made according to a customer's feet to ensure comfort and fit. They are intended to prevent the development of musculoskeletal conditions if worn routinely.

TLM Orthotic Shoes and Insoles are prescribed as part of an orthotic treatment process for patients with musculoskeletal conditions. They are corrective orthoses prescribed to remedy biomechanical misalignment.

When you order a customised shoe with us, we will make a cast of your feet to determine if a customised shoe is suitable for you. We will proceed to make a pair of customised shoe for you if suitable. Otherwise, we recommend that you come down to our center for an examination so we can make you a pair of orthotic shoes and insoles that can remedy your condition.

For example, you will need a pair of orthotic shoes and insoles if your foot has a visible deformity like the one on the left. A pair of customised shoes will suffice if your foot does not have a visible deformity like the one on the right.

Why should I bother with custom-made shoes?

A pair of shoes that fits you is crucial to good health. According to Dr. David B. Agus, author of bestselling book, A Short Guide to a Long Life:

"inflammation has been linked to some of our most troubling degenerative diseases today, including heart disease, Alzheimer’s disease, cancer, autoimmune diseases, diabetes, and accelerated aging.

When you’re walking around barefoot or wearing uncomfortable shoes, you’re causing some unnecessary inflammation in your feet that can have an impact on your entire system. If the goal is to reduce your overall inflammation and take the load off your joints and lower back to further reduce inflammation, then I know no better, easier way to do this than to simply wear a pair of supportive and comfortable shoes daily."
 

This is something we have observed in our practice; our patients report that their chronic conditions improved after wearing our orthotic shoes and insoles. 

A pair of shoes that truly fits you has to be made according to the unique shape of your feet in order to ensure fit and comfort. This is something that you cannot get from mass manufactured shoes. Therefore, you should definitely invest in a pair of custom-made shoes designed according to sound biomechanical principles to safeguard your health.