A familiar orthoses from the past: Leather and metal polio-brace

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Orthoses are external supports attached to a limb or a body part. Today such devices are made of lighter materials, and are used to support knee, ankle, elbow or hand. We use more elaborate ones to straighten or support our spines. Till a few decades ago, heavier Leather and steel lower limb orthoses were common. These elaborate supports were used to improve function of legs, that were left paralysed by poliomyelitis. Over the years, poliomyelitis has become a disease of the past. Moreover, orthoses have also become lighter and smarter. However, heavy metal orthoses were a common place, and postage stamps are a testimony to this past.

A Beginning for Orthotics

We attribute earliest orthotics to ancient Egyptians. These were wooden splints, and were often used to splint injured limbs. These splints were made from a rough, slender wood strip, and wrapped up with the linen bandage before being fixed to the limb. Around 460 BC until 370 BC, Hippocrates had used splints made of leather and wood to fix a fractured tibia. We attribute further progress, beyond splints and plasters to a French Surgeon in the 15th century Ambroise Paré. He introduced adjustable harness, knee lock control, and other engineering features in the orthotic devices.

Other than prosthetics, Ambroise Pare also invented a perforated steel orthosis or better known as the metal corset which could help in correcting the spinal column structure or scoliosis. The corset was made from either iron or steel with a leather lining at its edge. The orthosis was designed with several holes on it to reduce the weight of orthosis. He also designed splints and orthoses for club foot, a common congenital foot defect in children.

In 19th century Antonius Mathijsen, Dutch surgeon of Army, invented the plaster cast and, as an innovator, used it to immobilise the fractured bones. Later this plaster cast was improved and hardened. Later in 1876, Hugh Owen Thomas an English Surgeon invented Thomas splint which is used to treat the deformities at the lower limb. He also created other innovations such as ‘Thomas collar’ and Thomas test to diagnose the hip joints deformities.

Splints and Braces

We had our first orthoses and orthopaedic splints in the beggining of 20th century. These devices were first used for injured soldiers in the two world wars. One of the earliest patents for such braces is from 1912 by Weaver. After the wars such braces were adapted for children, who had survived Polio.

Ronald Huckstep was an Australian Orthopaedic surgeon. In 1950s, he worked in Uganda where he treated patients with polio. He operated to improve quality of life of people with severe innate deformations. His ingenuity allows to invent a lot of orthopaedic splints and other useful devices. These orthotic devices that included steel rods and leather straps were used across the world for many decades.

Orthotic devices become lighter and simpler

While metal orthotic supports were sturdy, and their leather buckled were secure – these had their own drawbacks. These were heavy, especially for small children. Further, these were to be worn for life. In the 1960’s, first ideas emerged about replacing metal orthosis with the thermoformed plastics. plastics are light, hygienic, form-fitting, and noise-free. Unlike metal orthoses, plastic orthoses are thin enough to be worn within the user’s clothes, thus increasing the cosmetic value. Later the plastics gave way to carbon composites.

Today leather straps has been changed into Velcro straps, steel splints or braces has been changed into a lighter material such as aluminium or carbon fiber. Finally, heavy and bulky shoes as the foot support now have lighter material such as polypropylene, and spring loaded hinges.

After this material leap, orthotics of today took another leap of biomechanics. Further developments incorporate the user experience, rehabilitation needs and individualisation, rather than one size fits all concept. Foot sensors and 3D printing is the next big step in individualised orthoses.

Epilogue

Advances in materials, and biomechanics have also led to development of prostheses, a sister branch of orthoses. On one hand orthoses support from outside, and prostheses are a replacement for the lost limbs. Together these two fields have transformed support and mobility for humans in need.