We routinely get questions from clients about how their device is made, starting from how a design is determined, to how their own brace is actually fabricated. It’s a complex process that begins with the expertise of your orthotist to determine what style is most appropriate, and then uses our technical team’s talent and skill to craft each device as uniquely as our clients.
Your orthotist will first conduct a thorough assessment that includes relevant medical history and a physical examination, and your orthosis design is based upon these findings and observations. We will factor in your activities of daily living, social situation, other relevant treatments, range of motion and strength testing, functional testing, and observational gait analysis. Any prior bracing will be considered, evaluated, and improved upon if possible. Following the assessment, your certified orthotist or resident orthotist will take a cast of your limb. This captures the three dimensional shape of your limb to work from. This is achieved by wrapping fiberglass casting tape or plaster bandage around your limb and held in a desired position until it sets. Once removed, the cast is sealed and filled with liquid plaster to create a three dimensional positive replica of the limb. A metal rod is inserted into the top of the cast which allows the positive to be held in a vice throughout the fabrication process.
The plaster cast then undergoes a modification process where additional plaster is added in areas to create pressure reliefs and shape of the device. This is a critical step in making an orthosis as this process will determine the function and fit of your brace, and this process draws heavily on the experience and knowledge of your orthotist. The cast is then smoothed to ensure there are no bumps or uneven spots as this would create a texture on the inside of the device. The cast is then left to dry, which usually takes about 24 hours.
Our highly skilled technical team at Boundless take the dried cast and move the process into fabrication. If any padding is being added, this will first be heated and shaped to the cast and edges thinned to avoid any ridges. To make the plastic shell of the device, a sheet of plastic is heated in an oven at about 400°F for approximately 20 minutes and until the plastic is clear. The pliable plastic sheet is draped over the cast and sealed under vacuum, which will pull the plastic tight to the shape of the cast. This is left to cool for about 24 hours before being removed.
The device shape is cut off the cast using a handheld oscillating saw and the edges are trimmed and rounded using a sanding machine that shapes and buffs the edges. Straps are measured, sewn, and riveted to the plastic device and pads are glued in. Any other additions are made in-house and then attached to the brace as the final step.
The device is now ready to be fit to the client. During the fitting appointment, your orthotist will check for initial fit and ensure snug areas are eased or padded as needed, and trim areas of unnecessary plastic. Once the static assessment is completed, we will fit the device into a shoe (if a lower extremity device) and perform a dynamic assessment to evaluate your gait pattern and function of the orthosis. Based on observations and client feedback, we will continue to tune the brace to ensure it has the desired fit and function.
Although this is a very simplified version of the process, it provides some insight into the various steps we take to provide orthotic management to each of our clients. We welcome any questions you have about your own process or general inquires, and hope this has provided some useful information on how an orthosis is made.
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