Orthotics in Functional Rehabilitation of the Lower Limb.

Nawoczenski DA, Epler ME. Philadelphia, PA 19106, WB Saunders Co, 1997, hardcover, 280 pp, illus, $45.

This book is written for clinicians and students who recommend orthotic appliances to improve lower-limb function. The intended audience is practitioners in orthopedics, neurologic rehabilitation, sports medicine, and athletic training. The book provides information about orthotics in relation to the anatomy, biomechanics, and pathomechanics of the lower extremity. It also provides empirical data that support the effective use of orthoses. The authors designed the text as a clinical resource to be used in the selection of orthoses for management of lower-limb disorders.

Chapter 1 introduces the principles of orthotic design and explains the properties of the materials used to fabricate orthoses. This chapter includes other factors, such as cost and patient acceptance, that need to be considered when prescribing an orthosis. Chapters 2 through 6 discuss the orthotic management of common musculoskeletal disorders of the lower extremity. In separate chapters on the hip, knee, ankle, and foot, the authors review the anatomy, biomechanics, and pathomechanics of each region. They also cite current research to support or refute the use of specific orthoses.

With detailed illustrations, chapter 7 provides extensive coverage of adhesive strapping techniques. The authors suggest that therapeutic strapping could be a useful tool for evaluation or for prophylactic purposes. However, the amount of space the authors allot to strapping techniques seems excessive because there is limited information to support their effectiveness and because these techniques are time consuming and labor intensive.

In chapter 8, there is an exceptional analysis that compares the critical events in the normal gait cycle to the critical events in the gait cycle of people with neurological problems. This comparison is followed by a discussion on how different types of orthoses are used to effect change in the base of support, alignment, stability, and mobility during the gait cycle.

The final chapter focuses on orthopedic and neurologic problems unique to the pediatric population. It reviews the normal growth and development of bone and soft tissues, discusses the use of orthoses to prevent or correct deformities and improve function, and explains the inherent limitations of each orthosis.

Because the available research is based primarily on empirical data and subjective reports, the effectiveness of orthotic use is not clearly established. The authors repeatedly point out that studies are needed to produce quantifiable data about the effects that orthoses have on structural alignment and the functional outcomes for both short- and long-term use.

This easy-to-read text includes excellent illustrations of orthoses in each chapter. Some chapters include tables that summarize orthotic function and indicators for use. Overall, the book is a practical resource for physical therapists and other health care professionals who recommend orthoses.

Marylou Ingles, PT Sullivan County BOCES Liberty, NY

Ms Ingles is Director of Physical Therapy at the Sullivan County Board of Cooperative Educational Services, where she specializes in school-based therapy. She also provides physical therapy to infants at risk and to geriatric adults.