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Services

Orthotic Services
at InStride

Since 1932, InStride Prosthetics & Orthotics has provided comprehensive orthotic care to Southwestern Pennsylvania.

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New patients: Call 412-748-0252 to schedule your evaluation.

Our Orthotic Services

  • Lower Extremity Orthotics

  • Spinal Orthotics

  • Upper Extremity Orthotics

  • Pediatric Orthotics

  • Pedorthic Services

Lower Extremity Orthotics

Lower extremity orthotics provide essential support and stability for the foot, ankle, knee, and hip. These custom-designed devices help improve gait patterns, reduce pain and discomfort, correct biomechanical alignment issues, prevent further injury, and restore functional independence. Whether recovering from injury, managing a chronic condition, or addressing developmental concerns, our lower extremity orthoses are precisely crafted to meet your individual needs.

Ankle-Foot Orthosis (AFO)

An AFO is a brace that encompasses the ankle and foot, extending from just below the knee to the toes. AFOs are one of the most commonly prescribed orthotic devices and serve multiple functions: controlling unwanted motion, providing stability during walking, preventing foot drop, maintaining proper joint alignment, and supporting weak muscles. The design of each AFO is customized based on your specific diagnosis, level of weakness or spasticity, walking environment, and footwear preferences.


How AFOs Work:
AFOs work by controlling motion at the ankle joint while providing support throughout the gait cycle. Depending on the design, they can prevent unwanted plantarflexion (foot dropping down), limit dorsiflexion (toe lifting), control inversion and eversion (side-to-side motion), or allow controlled movement in specific directions. The brace maintains the foot and ankle in optimal alignment, reducing stress on joints and muscles while improving walking efficiency and safety.

Common Conditions Treated: 

  • Foot drop (inability to lift front of foot) from nerve damage or muscle weakness

  • Cerebral palsy affecting lower limb muscle tone and control

  • Multiple sclerosis causing progressive muscle weakness

  • Stroke recovery with resulting hemiplegia or hemiparesis

  • Charcot-Marie-Tooth disease and other peripheral neuropathies

  • Achilles tendonitis requiring immobilization and controlled motion

  • Post-surgical immobilization following foot or ankle surgery

  • Chronic ankle instability from repeated sprains

  • Spinal cord injuries affecting lower limb function

  • Muscular dystrophy with progressive weakness

Types of AFOs We Provide:

Solid Ankle AFO: Provides maximum stability with no ankle motion. The ankle is held in a fixed position, typically at 90 degrees. This design is ideal for patients with severe spasticity, significant weakness, or those requiring maximum support during weight-bearing. Solid ankle AFOs offer the most control but limit natural ankle motion during walking.


Articulated (Hinged) AFO: Features a mechanical joint at the ankle that allows controlled dorsiflexion (toe lifting) while preventing plantarflexion (foot drop). This design permits a more natural gait pattern while still providing necessary support. The hinge can be adjusted to allow or block specific ranges of motion based on your needs.


Posterior Leaf Spring AFO: A flexible, lightweight design specifically for foot drop. The thin, spring-like posterior strut stores energy during heel strike and releases it at toe-off, assisting with foot clearance during swing phase. This design allows some natural ankle motion while preventing the foot from dropping.


Carbon Fiber AFO: Utilizes advanced carbon fiber materials for maximum strength with minimum weight. These AFOs are exceptionally thin and can fit into most regular shoes. The carbon fiber provides dynamic response, storing and returning energy during walking. Ideal for active patients who need support without bulk.


Ground Reaction AFO (GRAFO): Extends further up the leg with an anterior tibial shell. This design uses ground reaction forces to control knee stability, often eliminating the need for a KAFO. Excellent for patients with knee hyperextension or crouch gait patterns.


Dynamic Response AFO: Designed for higher activity levels, these AFOs use flexible materials to store and return energy with each step. They provide a more natural, efficient gait pattern while maintaining necessary support.

Supramalleolar Orthosis (SMO)

SMOs are specialized pediatric orthoses designed for very young children and toddlers who need stabilization around the ankle but not the full support of an AFO. The trim lines of an SMO extend just above the malleoli (ankle bones), providing support to the subtalar joint while allowing some ankle motion. SMOs are particularly effective for young children who are just beginning to walk or have mild to moderate foot and ankle instability.


How SMOs Work:
SMOs capture the heel in a deep heel cup and provide medial and lateral stability to control excessive pronation or supination. By stabilizing the hindfoot, SMOs create a stable base of support that allows the muscles and ligaments of the foot to function more efficiently. This helps children develop proper walking patterns and prevents compensatory movement problems.

Conditions Treated: 

  • Hyperpronation (excessive rolling in of the feet)

  • Hypotonia (low muscle tone) affecting foot stability

  • Developmental delays in walking

  • Down syndrome with associated hypotonia

  • Early signs of cerebral palsy

  • Flexible flatfoot that requires more support than an arch support

 

Benefits:

  • Supports proper foot and ankle development during critical early years

  • Controls excessive pronation without restricting all ankle motion

  • Improves balance and stability for more confident walking

  • Helps children walk with better alignment and less fatigue

  • Prevents development of secondary problems from abnormal mechanics

  • Fits easily into regular children's shoes

Knee-Ankle-Foot Orthosis (KAFO)

A KAFO is a comprehensive lower limb orthosis that extends from the upper thigh to the foot, encompassing and supporting the knee, ankle, and foot joints. KAFOs are prescribed for patients with significant lower limb weakness, paralysis, or severe instability who require control of both the knee and ankle during standing and walking. These devices are custom-fabricated using lightweight materials to provide maximum support with minimum weight.


How KAFOs Work:
KAFOs use a combination of mechanical knee joints, metal or carbon fiber uprights, and custom-molded plastic components to provide support from the thigh to the foot. The knee joints can be configured to lock for stability during standing and weight-bearing, or they can incorporate sophisticated stance-control mechanisms that lock during weight-bearing and unlock during swing phase for a more natural gait. The ankle portion functions like an AFO, controlling foot and ankle position. KAFOs redistribute forces and provide stability that weak muscles cannot, enabling patients to stand and walk who might otherwise require a wheelchair.

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Common Conditions Treated: 

  • Polio or post-polio syndrome causing permanent muscle weakness

  • Severe knee instability from ligament damage or muscle weakness

  • Spinal cord injury with paralysis or significant weakness

  • Muscular dystrophy with progressive muscle deterioration

  • Peripheral nerve damage affecting multiple lower limb muscles

  • Post-surgical stabilization following complex knee procedures

  • Cerebral palsy with involvement of knee and ankle

  • Spina bifida affecting lower limb function

  • Guillain-Barré syndrome recovery

KAFO Features and Options:

Knee Joint Options: Drop locks (manual locking), bail locks (spring-loaded locking), free motion joints, stance-control joints (automatically lock during weight-bearing), or offset joints for specific alignment needs. Joint selection depends on your strength, balance, and functional goals.

 

Stance Control Technology: Advanced microprocessor or mechanical stance-control knee joints detect when weight is on the leg and automatically provide stability, then unlock when the leg swings forward. This technology allows for a more natural, efficient gait pattern compared to locked knees.


Lightweight Construction: Modern KAFOs use carbon fiber uprights and advanced thermoplastics to minimize weight while maximizing strength. This reduces energy expenditure during walking and improves comfort.


Custom Molded Components: All plastic components are custom-molded to your exact leg shape, ensuring optimal fit, comfort, and pressure distribution.

Knee Orthosis (KO)

Knee orthoses provide targeted support, protection, and stability specifically for the knee joint. These devices range from soft, neoprene sleeves to rigid, hinged braces depending on the severity of the condition and the level of support required. KOs are commonly prescribed following knee injuries, during post-surgical recovery, or for chronic knee conditions that require ongoing support.


How Knee Orthoses Work:
Knee orthoses work through several mechanisms: providing compression to reduce swelling, stabilizing the patella (kneecap) for proper tracking, protecting and supporting injured ligaments, unloading specific compartments of the knee affected by arthritis, controlling the range of motion during healing, and providing proprioceptive feedback to improve joint position awareness. The specific design is tailored to address your particular knee problem.

Common Uses and Conditions:

ACL/PCL Injuries: Anterior or posterior cruciate ligament tears require bracing for stability. Post-surgical ACL reconstruction braces protect the healing graft and allow controlled rehabilitation. Functional ACL braces support the knee during return to activities.


Meniscus Tears: Bracing after meniscus repair or for degenerative tears helps reduce pain and provides stability. Post-operative braces control range of motion to protect the healing meniscus.


Osteoarthritis Unloading: Specialized unloader braces apply forces that shift weight away from the affected compartment of the knee (medial or lateral), reducing pain and potentially slowing disease progression. These are particularly effective for unicompartmental arthritis.
Post-Operative Stabilization: Following knee surgery, hinged braces with adjustable range-of-motion controls protect healing tissues while allowing progressive rehabilitation. Locking mechanisms can prevent harmful movements.


Patellofemoral Pain Syndrome: Braces with patellar buttresses or J-shaped pads help center the kneecap and improve tracking, reducing anterior knee pain.


Ligament Instability: Multi-ligament injuries or chronic instability require custom-fitted braces with polycentric hinges that match the knee's natural motion while providing medial-lateral and rotational control.


MCL/LCL Sprains: Medial or lateral collateral ligament injuries benefit from hinged braces that provide valgus or varus support while allowing flexion and extension.

Spinal Orthotics

Spinal orthotics support and stabilize the spine, restrict movement to promote healing, reduce pain, prevent progression of deformities, and maintain proper spinal alignment. We provide custom-fitted spinal orthoses for all regions of the spine, from the neck (cervical) through the lower back (lumbar) and sacral regions. Each spinal orthosis is carefully designed based on your specific diagnosis, spinal level involved, degree of support needed, and treatment goals.

Spinal orthoses work by limiting motion in specific planes (flexion, extension, lateral bending, rotation), increasing intra-abdominal or intra-cavitary pressure to reduce load on the spine, applying corrective forces to address deformities, providing proprioceptive feedback about posture, and offering psychological reassurance during healing. The level of motion restriction varies from minimal support with soft braces to complete immobilization with rigid devices.

Cervical Orthosis (CO)

Cervical orthoses support the neck and limit motion of the cervical spine (C1-C7). They range in design from soft foam collars that provide minimal support and serve primarily as reminders to limit motion, to rigid multi-post devices that significantly restrict neck movement. The choice of cervical orthosis depends on the stability of your condition, the vertebral levels involved, and whether you need support during healing or long-term management.


Types of Cervical Orthoses:
Soft Cervical Collar: Made of foam rubber covered with stockinette. Provides minimal motion restriction but offers warmth, comfort, and serves as a kinesthetic reminder to limit neck motion. Used for minor strains, muscle spasms, or as a comfort measure.


Rigid Cervical Collar: Two-piece plastic collar that encircles the neck, providing support under the chin and occiput. Significantly restricts flexion and extension but allows some rotation. Used for stable cervical injuries or post-operative immobilization.


Cervical-Thoracic Orthosis (CTO): Extends from the head and neck down to the mid-thoracic spine, providing greater motion restriction than a cervical collar alone. May include chest and back plates for enhanced stability.

Common Conditions Treated:

  • Cervical fractures requiring external immobilization

  • Whiplash injuries causing neck pain and muscle spasm

  • Post-surgical stabilization following cervical fusion or discectomy

  • Cervical strain or sprain from trauma or overuse

  • Degenerative disc disease causing neck pain

  • Cervical radiculopathy (pinched nerve) requiring rest and immobilization

  • Rheumatoid arthritis affecting the cervical spine

Thoracic-Lumbar-Sacral Orthosis (TLSO)

A TLSO is a body jacket or brace that supports the thoracic (mid-back), lumbar (lower back), and sacral regions of the spine. TLSOs extend from just below the shoulder blades down to the pelvis, providing comprehensive trunk support. These orthoses are commonly used for treating scoliosis, stabilizing spinal fractures, and providing post-operative support following spinal surgery.


How TLSOs Work:
TLSOs work by applying three-point pressure systems to reduce spinal deformities, limiting trunk flexion, extension, lateral bending, and rotation, increasing intra-abdominal pressure to reduce load on the spine, and maintaining the spine in a corrected or protected position during healing or growth. For scoliosis, TLSOs apply corrective forces designed to prevent curve progression.

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Common Conditions Treated:

Scoliosis (Adolescent and Adult): Scoliosis bracing is the primary non-surgical treatment for spinal curves. For adolescents with curves between 25-40 degrees who still have significant growth remaining, bracing can halt progression and potentially prevent the need for surgery. Adult scoliosis bracing focuses on pain relief and preventing further progression.


Compression Fractures from Osteoporosis: Vertebral compression fractures are common in osteoporosis. TLSOs limit motion to reduce pain and allow healing while preventing further collapse of the vertebrae.

 

Kyphosis (Scheuermann's Disease): Excessive forward curvature of the thoracic spine in adolescents can be treated with extension-style TLSOs that help reduce the curve and prevent progression.


Spinal Fractures from Trauma: Stable thoracic or lumbar fractures that do not require surgery can be immobilized with TLSOs, allowing the bone to heal while the patient remains mobile.


Post-Surgical Spinal Stabilization: Following spinal fusion, laminectomy, or other spinal procedures, TLSOs provide external support while internal healing occurs.


Herniated Discs: Severe disc herniations may benefit from TLSO immobilization to reduce painful motion and allow the disc to heal.

Scoliosis Bracing - A Specialized Focus:

We specialize in custom scoliosis braces designed to halt curve progression in growing children and adolescents. Scoliosis bracing is most effective when started early, when the curve is between 25-40 degrees and significant growth remains (typically Risser 0-2). The brace applies corrective pressure to the spine while allowing room for growth, with the goal of preventing the curve from progressing to the point where surgery becomes necessary.

Our Ccoliosis Braces Include:
Boston Brace: The most common underarm TLSO design. Custom-molded to the patient with strategically placed pads that apply corrective forces to the spine. Typically worn 16-23 hours per day. Fits under most clothing.


Custom-Molded TLSOs: Fabricated from precise measurements and molds of the patient's trunk. Each brace is uniquely designed based on the specific curve pattern, apex location, and rotational component of the scoliosis.


Providence Nighttime Brace: An over-correcting brace designed to be worn only at night (8-10 hours). Provides maximum corrective forces while sleeping. Allows brace-free daytime activities for select curve patterns.


Charleston Bending Brace: Another nighttime-only option that holds the patient in a side-bent position to over-correct single lumbar or thoracolumbar curves.

For optimal results, scoliosis bracing requires excellent compliance (wearing the brace as prescribed), regular follow-ups every 3-6 months for adjustments and growth, continued wear until skeletal maturity (typically age 14-16 for girls, 16-18 for boys), and close monitoring with periodic X-rays. We work closely with your orthopedic surgeon or spine specialist to ensure the brace design and wearing schedule are optimal for your individual curve pattern.

Lumbar-Sacral Orthosis (LSO)

LSOs provide support specifically for the lower back (lumbar) and sacral regions of the spine. These braces range from simple elastic supports to rigid custom-molded devices, depending on the condition being treated and the level of support required. LSOs are among the most commonly prescribed spinal orthoses due to the high prevalence of low back pain and lumbar spine disorders.


How LSOs Work:
LSOs work primarily by increasing intra-abdominal pressure, which reduces compressive loads on the lumbar spine, limiting trunk flexion, extension, and lateral bending, providing proprioceptive feedback to encourage proper posture and body mechanics, offering localized warmth to reduce muscle spasm, and restricting painful movements while allowing healing. The degree of motion restriction varies with brace rigidity.

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Types of LSOs:

Soft Corset or Belt: Elastic or neoprene wrap-around supports with hook-and-loop closures. Provides compression, warmth, and serves as a reminder for proper body mechanics. Minimal motion restriction but can be helpful for muscle strains and mild pain.


Rigid LSO with Panels: Features rigid plastic or metal stays (panels) in the back and sides within a fabric shell. Provides moderate to significant motion restriction. Panels can be removed or added to adjust support level.


Custom-Molded LSO: Fabricated from a mold of the patient's torso for maximum contact and optimal fit. Provides the highest level of motion restriction and load transfer. Used for severe conditions or post-surgical stabilization.


Williams Flexion LSO: Designed to prevent excessive lordosis (arching) of the lower back while allowing flexion. Uses rigid posterior supports and an elastic anterior panel. Beneficial for conditions aggravated by extension such as spinal stenosis.

Common Conditions Treated:

  • Low back pain from muscle strain, ligament sprain, or mechanical causes

  • Degenerative disc disease causing chronic pain and instability

  • Spinal stenosis causing neurogenic claudication and back pain

  • Spondylolisthesis (forward slippage of vertebra) requiring stabilization

  • Post-surgical support following lumbar procedures

  • Compression fractures of lumbar vertebrae

  • Sacroiliac joint dysfunction causing lower back and hip pain

  • Muscle strain or spasm requiring rest and support

  • Disc herniations in the lumbar spine

Upper Extremity Orthotics

Upper extremity orthotics support and stabilize the shoulder, elbow, wrist, hand, and fingers. These devices serve multiple functions: protecting injured structures during healing, maintaining joints in optimal positions, preventing contractures and deformities, assisting with weak muscles, reducing pain from overuse or arthritis, and facilitating rehabilitation following injury or surgery. Upper extremity orthoses range from simple resting splints to complex dynamic devices that assist with movement.

Wrist-Hand Orthosis (WHO)

A WHO supports the wrist and hand while typically leaving the fingers free for functional use. The orthosis extends from the forearm across the wrist, with variations in how much hand coverage is provided. WHOs can be fabricated as rigid immobilization splints or as more flexible supports that allow some wrist motion. The specific design depends on whether complete immobilization is needed or if protected motion is desired.


How WHOs Work:
WHOs work by maintaining the wrist in a functional position (typically slight extension), immobilizing the wrist joint to allow healing of injured structures, reducing stress on tendons passing through the carpal tunnel, preventing painful or harmful wrist motions, and providing support to weak wrist extensors or flexors. The orthosis can be worn full-time during acute phases or only during activities or sleep for chronic conditions.

Common Conditions Treated:

  • Carpal tunnel syndrome - immobilizes wrist in neutral to reduce pressure on median nerve

  • Wrist fractures (Colles, scaphoid, etc.) requiring immobilization during healing

  • Wrist tendonitis (De Quervain's, flexor/extensor tendonitis)

  • Arthritis of the wrist joint causing pain and instability

  • Post-surgical immobilization following wrist procedures

  • Nerve injuries affecting wrist control

  • Wrist sprains requiring protected healing

  • Repetitive strain injuries from work or sports

 

WHO Design Options:

  • Volar (palm-side) design for dorsiflexion support

  • Dorsal (back-side) design for flexion support

  • Circumferential design for maximum immobilization

  • Thumb spica inclusion when thumb CMC joint needs support

  • Removable vs. non-removable depending on compliance needs

Wrist-Hand-Finger Orthosis (WHFO)

WHFOs provide comprehensive support for the wrist, hand, and fingers. These orthoses can be static (holding joints in fixed positions) or dynamic (using springs, elastic bands, or other mechanisms to assist or resist movement). WHFOs are highly customized devices used for complex hand conditions that require precise positioning or controlled mobilization of multiple joints.


Static vs. Dynamic WHFOs:
Static WHFOs: Hold joints in fixed positions to protect healing structures, prevent contractures, reduce pain, or maintain functional alignment. Examples include resting hand splints, anti-spasticity splints, and post-surgical immobilization devices.


Dynamic WHFOs: Use mechanical components (springs, elastic bands, pulleys) to apply gentle forces that assist weak muscles, increase range of motion, or provide resistance for strengthening. Examples include tendon repair protocols with controlled motion and contracture reduction devices.

Uses and Conditions:

  • Tendon repairs - controlled mobilization protocols prevent adhesions while protecting repair

  • Nerve damage rehabilitation - positioning to prevent contractures and assist weak muscles

  • Hand contracture management - serial static or dynamic splinting to increase range of motion

  • Arthritis management - rest splints to reduce inflammation and pain

  • Cerebral palsy - positioning splints to prevent contractures and improve function

  • Stroke recovery - splints to prevent flexion contractures and facilitate recovery

  • Burns - pressure garments and positioning to prevent scar contractures

  • Complex hand fractures - precise positioning of multiple bones during healing

Shoulder Orthosis (SO)

Shoulder orthoses provide stability, support, and controlled motion for the shoulder joint and surrounding structures. The shoulder is the most mobile joint in the body, making it susceptible to injuries and difficult to immobilize effectively. Shoulder orthoses must balance the need for protection and immobilization with the requirement to prevent stiffness and maintain function.


Types of Shoulder Orthoses:

Sling and Swathe: Simple immobilization holding the arm against the body. Used for minor injuries, fractures, or initial post-operative immobilization.


Abduction Orthosis: Positions the arm away from the body at various angles (typically 15-90 degrees). Used after rotator cuff repairs to reduce tension on healing tendons. Includes a waist belt, arm support, and adjustable positioning.


Airplane Splint: Rigid device that holds the arm elevated in abduction and external rotation. Used for specific surgical protocols or brachial plexus injuries.


Glenohumeral Stabilization Orthosis: Designed to prevent specific movements that cause shoulder instability or dislocation while allowing controlled motion in safe directions.

Common Uses:

  • Rotator cuff repairs - positioning to protect healing tendons

  • Shoulder dislocations - immobilization in stable position to allow healing

  • Post-surgical immobilization following shoulder arthroplasty or repair

  • Proximal humerus fractures requiring specific positioning

  • Acromioclavicular (AC) joint separations

  • Brachial plexus injuries requiring arm elevation

Pediatric Orthotics

Children have unique orthotic needs that differ significantly from adults. Growing bones and developing motor patterns require specialized approaches to orthotic management. At InStride, we understand that pediatric orthotics must not only address current problems but also support proper development and prevent future complications. We specialize in providing age-appropriate orthotic solutions that accommodate growth, support development, improve function, and build confidence in young patients.

Our pediatric approach recognizes that children are not simply small adults. Their bones are still developing, their growth plates are active, their neuromuscular systems are maturing, and their compliance depends heavily on comfort and family support. We create orthoses that fit properly on small frames, incorporate designs that children will actually wear, allow for rapid growth adjustments, use materials that withstand active play, and can be transferred between multiple pairs of shoes.

Our pediatric services include comprehensive evaluation with developmental assessment, custom fabrication using pediatric-specific designs and materials, regular follow-ups to monitor growth and development, adjustments and modifications as children grow, education and training for parents and caregivers, and collaboration with pediatricians, physical therapists, and occupational therapists.

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Pediatric Orthotic Devices We Provide:
Supramalleolar Orthoses (SMOs): Specifically designed for very young children (typically under age 5) who need more than a simple foot orthotic but less than a full AFO. Provides ankle stability while allowing some motion.


Pediatric AFOs: Available in many designs from solid ankle for maximum support to hinged versions allowing controlled motion. Can be decorated with colors and designs to increase acceptance.


Pediatric KAFOs: For children with weakness or paralysis affecting both knee and ankle. Designed to be as lightweight as possible while providing necessary support.


Scoliosis Braces: Custom TLSOs designed specifically for growing spines. Requires excellent compliance and regular adjustments for growth.


Clubfoot Braces (Boots and Bar): Denis-Browne bar connecting specially designed shoes, maintaining feet in corrected position following casting.

 

Upper Extremity Splints: Hand, wrist, and elbow orthoses for children with cerebral palsy, brachial plexus injuries, or other conditions affecting arm function.


Gait Trainers and Positioning Devices: Supportive devices that allow children with significant disabilities to achieve upright positioning and practice walking patterns.

Common pediatric conditions we treat:
Cerebral Palsy: The most common motor disability in childhood, requiring orthoses to prevent contractures, improve gait, support weak muscles, and maintain functional positions. Orthoses must be carefully designed to avoid increasing spasticity while providing needed support.

 

Clubfoot (Talipes Equinovarus): Following Ponseti casting treatment, children require boots-and-bar orthoses to maintain correction and prevent recurrence. Full-time wear initially, transitioning to nighttime wear, typically until age 4-5.


Flat Feet (Pes Planus): Flexible flatfoot is common in young children. Most cases resolve naturally, but symptomatic or rigid flat feet may benefit from arch supports or custom orthotics to improve alignment and reduce discomfort.


High Arches (Pes Cavus): Abnormally high arches can cause pain, instability, and abnormal weight distribution. Custom orthotics redistribute pressure and improve stability.


Scoliosis: Bracing is the primary non-surgical treatment for progressive idiopathic scoliosis curves between 25-40 degrees in growing children. Early detection and compliance with brace wear are critical for success.


Developmental Delays Affecting Mobility: Children with delayed motor milestones often benefit from orthoses that provide stability and support to facilitate development of walking and other motor skills.


Congenital Limb Differences: Children born with limb length discrepancies, missing bones, or deformities require specialized orthoses to equalize leg lengths and improve function.


Spina Bifida: Depending on the level of involvement, children with spina bifida may need foot orthotics, AFOs, KAFOs, or hip-knee-ankle-foot orthoses to achieve mobility and prevent deformities.


Muscular Dystrophy: Progressive muscle weakness requires evolving orthotic management to prolong ambulation, prevent contractures, and maintain function as long as possible.


Down Syndrome: Joint hypermobility and low muscle tone often require supportive foot orthoses or AFOs to improve stability and alignment.

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Growth Management:
Children grow rapidly, and orthoses must be adjusted or replaced regularly. We schedule follow-ups based on your child's age and growth rate, typically every 3-6 months for young children and every 6-12 months for older children. We also educate families on signs that an orthosis is becoming too small, including skin redness or breakdown, difficulty donning the device, complaints of discomfort, and visible gaps in fit.

Frequently Asked Questions About Orthotics

Do I need a prescription for orthotic services?
Yes, most insurance companies require a prescription from your physician for orthotic devices. The prescription should specify your diagnosis and the type of orthosis needed. However, you can schedule an initial evaluation with us to discuss your needs, and we can work with your physician to obtain the necessary prescription for insurance billing. If you're paying out-of-pocket, some simpler orthotic devices may not require a prescription, but we always recommend physician involvement in your care.

How long does it take to receive my custom orthotic device?
The timeframe varies depending on the complexity of the device:

  • Simple AFOs or foot orthotics: 1-2 weeks

  • Complex devices (KAFOs, custom TLSOs): 2-3 weeks

  • Scoliosis braces: 2-4 weeks

  • Pediatric devices requiring special materials: 2-3 weeks


Our on-site fabrication facility allows us to complete most devices faster than facilities that send work to outside labs. We will provide you with a specific timeframe at your evaluation appointment and will contact you as soon as your device is ready for fitting.

Will my orthotic device be uncomfortable?
When properly fitted, orthotic devices should not cause pain. However, there is typically an adjustment period as your body adapts to the new support and alignment. During the first 1-2 weeks, you may experience:

  • Mild skin sensitivity as your skin adjusts to contact with the device

  • Muscle soreness as your muscles work differently with the orthosis

  • Awareness of the device, which will decrease as you become accustomed to it

  • Slight fatigue as your body adapts to improved alignment


We recommend gradually increasing wear time during the first week. If you experience persistent pain, skin breakdown, or significant discomfort beyond the initial adjustment period, contact us immediately. We can make adjustments to ensure your orthosis is comfortable and functioning properly. Most patients find that after the break-in period, the orthosis becomes comfortable and provides significant relief.

Does insurance cover orthotic devices?
Most health insurance plans provide coverage for medically necessary orthotic devices when prescribed by a physician. Orthotic devices are typically covered under Durable Medical Equipment (DME) benefits. Coverage varies significantly by insurance provider and specific plan.

InStride accepts the following insurance:

  • UPMC (all plans) - full orthotic services

  • Highmark (all plans) - full orthotic services

  • United Healthcare - full orthotic services

  • PA Health & Wellness - full orthotic services

  • Workers Compensation - full orthotic services

  • Aetna - prosthetics only (not orthotics)

  • Cigna - prosthetics only (not orthotics)

  • Humana - prosthetics only (not orthotics)


Our staff will verify your insurance benefits before fabrication begins and provide you with an estimate of your out-of-pocket costs, including any deductibles, copayments, or coinsurance. We recommend contacting your insurance company to understand your specific DME coverage, including any authorization requirements, coverage limits, and approved providers.

How long will my orthotic device last?
The lifespan of an orthotic device depends on several factors:

  • Type of device: Rigid devices typically last longer than flexible ones

  • Materials used: Carbon fiber and rigid plastics last longer than soft materials

  • Your activity level: Active individuals may wear out devices faster

  • Body weight and biomechanical forces: Higher forces cause more wear

  • Proper care and maintenance: Well-maintained devices last longer


General lifespan expectations:

  • Foot orthotics: 3-5 years

  • AFOs and KAFOs: 3-5 years

  • Spinal orthoses (TLSO, LSO): 2-3 years or until treatment is complete

  • Soft tissue supports (knee braces, wrist splints): 1-2 years

  • Pediatric devices: 6-12 months due to rapid growth


Many insurance plans allow for orthotic replacement every 3-5 years. Signs that your orthosis needs replacement include visible wear or cracks in the plastic, loose or broken straps or closures, the device no longer fits properly, loss of structural support, or changes in your condition requiring different support. We recommend annual check-ups to assess the condition of your device.

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Can I wear my orthotic device with regular shoes?
This depends on the type of orthotic device:
Foot Orthotics: Can typically be transferred between shoes with removable insoles. Shoes should have adequate depth and width to accommodate the orthotic without crowding.


AFOs and KAFOs: Require shoes that are one size larger than normal to accommodate the foot plate of the brace. Shoes should have wide openings, removable insoles, and good support. Athletic shoes and Oxford-style shoes work best. Slip-on shoes and high heels typically do not work with AFOs.


Spinal Orthoses: Are worn over a thin t-shirt and under regular clothing. Most modern TLSOs and LSOs are designed to be low-profile and fit comfortably under clothing.

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Upper Extremity Orthoses: May require clothing with looser sleeves or short sleeves, depending on the device size.At your fitting appointment, we will discuss appropriate footwear and clothing options for your specific orthosis. We can also recommend shoes that work well with braces.

How do I clean and care for my orthotic device?
Proper care extends the life of your orthosis and prevents skin problems. Care instructions vary by device type:
Plastic Orthoses (AFOs, KAFOs, TLSOs):

  • Wipe down daily with a damp cloth and mild soap

  • Dry thoroughly before wearing

  • Do not submerge in water or put in washing machines

  • Avoid extreme heat (car trunks, heaters) which can warp plastic

  • Check daily for cracks, loose parts, or excessive wear


Padded or Fabric Orthoses:

  • Spot clean with mild detergent

  • Air dry completely

  • Some devices may be hand-washed if instructed

  • Replace worn padding when it becomes compressed

 

Straps and Closures:

  • Clean regularly as they absorb perspiration

  • Check for wear and replace when they lose grip

  • Keep Velcro free of lint and debris


Skin Care:

  • Always wear a thin sock or t-shirt under the orthosis

  • Check your skin daily for redness, blisters, or breakdown

  • Do not apply lotions or creams before wearing the device

  • Contact us immediately if you develop persistent skin problems


What if my orthosis doesn't fit properly or causes problems?
Proper fit is essential for orthotic effectiveness and comfort. If you experience any of the following, contact us immediately:

  • Persistent pain that doesn't improve after the break-in period

  • Skin redness that doesn't fade within 20 minutes of removing the device

  • Blisters, sores, or skin breakdown

  • The device feels too loose or too tight

  • New areas of pain or discomfort develop

  • The orthosis interferes with your ability to walk or function


We provide follow-up adjustments as part of your care. Most minor fit issues can be resolved quickly with modifications. Do not attempt to modify the device yourself, as this may damage it or create new problems. We want you to be completely satisfied with your orthosis, so please don't hesitate to contact us with any concerns.

Can my child participate in sports and activities with an orthosis?
In most cases, yes! We encourage children to remain as active as possible while wearing their orthoses. Physical activity is important for overall health, strength, and social development. However, some considerations apply:

  • Contact sports may require protective padding over the orthosis

  • Water activities require removing most orthoses (they are not waterproof)

  • Some activities may require a specific sports orthosis in addition to the daily-wear device

  • Scoliosis braces may be removed for 1-2 hours for sports participation if approved by your physician

  • Close-fitting gear (shin guards, cleats) may need sizing adjustments


We work with families to find solutions that allow children to participate in activities they enjoy while maintaining the therapeutic benefits of the orthosis. Many of our young patients successfully participate in soccer, basketball, swimming, gymnastics, and other sports.

Will I need to wear my orthosis forever?
This depends entirely on your condition and treatment goals:
Temporary/Short-term Use: Post-surgical orthoses, fracture bracing, and orthoses for healing injuries are worn only during recovery, typically 6-12 weeks.


Time-limited Treatment: Scoliosis bracing is worn until skeletal maturity (typically 2-4 years), then discontinued. Some pediatric orthoses are discontinued once proper development is achieved.


Long-term/Permanent Use: Orthoses for chronic conditions (cerebral palsy, arthritis, permanent weakness) may be needed indefinitely. However, the style or level of support may change over time.
Activity-specific use: Some patients wear orthoses only during certain activities (sports braces, work-related supports) rather than full-time.

Your physician and orthotist will work together to determine the appropriate wearing schedule and duration for your specific situation. Some patients can gradually reduce wear time or transition to less supportive devices as their condition improves, while others may require continued support. Regular follow-ups help us assess whether changes in your orthotic management are appropriate.

Pedorthic Services
Foot Orthotics

Foot orthotics (also called insoles, inserts, or arch supports) are devices placed inside shoes to correct biomechanical problems, redistribute pressure, support arches, and alleviate pain. They range from simple over-the-counter arch supports to sophisticated custom-molded devices prescribed for complex conditions.

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How Custom Foot Orthotics are Created:
Plaster casting: The traditional gold standard method. The foot is wrapped in plaster bandages while held in a corrected position, creating a mold that captures optimal foot alignment.


Foam Impression: The patient steps into a foam box, leaving an impression. The foam captures the contours of the foot for fabrication of the orthotic


Digital Scanning: 3D scanning technology captures precise measurements and contours. The digital file is used with CAD/CAM technology to design and mill the orthotic.

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Two Main Categories:
Functional Orthotics: Rigid or semi-rigid devices made from materials like plastic, carbon fiber, or fiberglass. Designed to control abnormal motion, correct biomechanical dysfunction, and improve alignment. Used for conditions requiring motion control such as excessive pronation, plantar fasciitis, posterior tibial tendonitis, and structural abnormalities.


Accommodative Orthotics: Soft, cushioning devices made from materials like EVA foam, cork, or gel. Designed to accommodate fixed deformities, provide shock absorption, redistribute pressure away from painful areas, and increase comfort. Used for diabetic feet, arthritis, metatarsalgia, and conditions requiring cushioning rather than correction.

Common Conditions Treated with Foot Orthotics:

  • Plantar fasciitis - heel and arch pain from inflammation of plantar fascia tissue

  • Arthritis - reduces joint stress and redistributes forces

  • Morton's neuroma - reduces pressure on interdigital nerve

  • Excessive pronation (flat feet, overpronation)

  • Excessive supination (high arches, underpronation)

  • Heel pain and heel spurs

  • Metatarsalgia (ball of foot pain)

  • Achilles tendinitis

  • Posterior tibial tendon dysfunction

  • Leg length discrepancy

  • Bunions and hammertoes

  • Knee, hip, or back pain related to foot dysfunction


Lifespan and Care:

Custom foot orthotics typically last 3-5 years with proper care. They should be worn in appropriate footwear (athletic shoes or shoes with removable insoles work best), cleaned regularly with mild soap and water, and checked periodically for signs of wear. Many insurance plans cover replacement every 3-5 years.

Shoe Modifications

Shoe modifications are adaptations made to existing footwear to improve function, reduce pain, correct gait abnormalities, or accommodate deformities. These modifications can significantly improve walking efficiency and comfort while avoiding the need for more complex orthotic devices.

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Common Modifications:

Rocker Soles: An external modification that creates a curved bottom on the shoe, resembling a rocking chair runner. This reduces forefoot pressure, facilitates toe-off, and creates a smoother gait pattern.

  • Types of rocker soles include forefoot rockers (curve starts just behind the metatarsal heads), heel-to-toe rockers (entire sole is curved), negative heel rockers (forefoot is higher than heel), and mild rockers (slight curve for comfort). Beneficial for arthritis affecting forefoot, metatarsalgia, hallux rigidus (stiff big toe), diabetic foot ulcer prevention, and reducing extension of the toes during walking.


Shoe Lifts: External or internal elevations added to compensate for leg length discrepancy or equinus deformity (inability to bring foot to 90 degrees).

  • Internal lifts (inside the shoe) can accommodate up to 1/2 inch difference. External lifts (added to the sole) are used for larger discrepancies, typically starting at 3/8 inch. Full sole lifts distribute the elevation across the entire foot. Heel-only lifts provide elevation just at the heel. Creates pelvic symmetry, reduces compensatory movements, and decreases stress on spine, hips, and knees.


Flares or Offset Heels: Extensions added to the medial (inside) or lateral (outside) edge of the heel to control pronation or supination.

  • Medial flares control excessive pronation (inward rolling). Lateral flares control excessive supination (outward rolling). Improves stability during heel strike, corrects alignment, and reduces stress on ankle and knee joints.

Common Modifications continued:

SACH Heel (Solid Ankle Cushioned Heel): A modification where the heel is cut horizontally and a wedge of soft, compressible material is inserted.

  • Cushions impact at heel strike, reduces shock through the lower extremity, smooths the transition from heel strike to midstance, and reduces stress on heel pain conditions. Particularly beneficial for heel pain, arthritis, and patients with prosthetic legs.


Metatarsal Bars: A ridge of material added to the sole across the ball of the foot, just proximal to the metatarsal heads.

  • Relieves pressure on metatarsal heads by shifting weight to the metatarsal shafts, reduces extension of toes during push-off, and helps with metatarsalgia, Morton's neuroma, and arthritic joints in the forefoot.


Wedges: Angled inserts or external modifications that change the angle of the foot.

  • Medial heel wedges tilt the foot outward to control pronation. Lateral heel wedges tilt the foot inward to control supination. Forefoot wedges can accommodate or correct forefoot deformities. Can be placed inside or outside the shoe depending on the amount of correction needed.

Frequently Asked Questions About Pedorthic Services

What conditions can pedorthic services help?
Pedorthic interventions can help a wide range of foot and ankle conditions:

  • Plantar fasciitis and heel pain

  • Arthritis affecting the feet and ankles

  • Bunions, hammertoes, and other deformities

  • Flat feet (overpronation) or high arches (supination)

  • Metatarsalgia (ball of foot pain)

  • Morton's neuroma

  • Leg length discrepancies

  • Achilles tendonitis

  • Knee, hip, or back pain related to foot problems


What is the difference between over-the-counter insoles and custom orthotics?
Over-the-Counter (OTC) Insoles:

  • Mass-produced in standard sizes and shapes

  • Available immediately at pharmacies and retail stores

  • Less expensive 

  • May provide general arch support and cushioning

  • Work well for mild discomfort or general foot fatigue

  • Do not address specific biomechanical problems

  • Not custom-fitted to your unique foot structure


Custom Orthotics:

  • Fabricated from casts or scans of your specific feet

  • Designed to address your particular diagnosis and biomechanics

  • Prescription devices requiring professional evaluation

  • More expensive but typically covered by insurance

  • Provide precise correction and support tailored to you

  • Made from higher-quality, more durable materials

  • Last 3-5 years with proper care

  • Can be adjusted and modified as needed


For mild, general foot discomfort, OTC insoles may be sufficient. For specific conditions, significant pain, or biomechanical problems, custom orthotics are more appropriate and effective.

How long does it take to get custom foot orthotics?
The process typically takes 2-4 weeks from your initial evaluation to receiving your finished orthotics:

  • Week 1: Initial evaluation, examination, and casting or scanning of your feet.

  • Week 2-3: Fabrication in our on-site lab.

  • Week 3-4: Fitting appointment where we ensure proper fit and function.


Our on-site fabrication facility allows us to complete orthotics faster than facilities that send work to outside labs. In urgent cases, we can sometimes expedite the process.

Can I use my custom orthotics in different pairs of shoes?
Yes, custom foot orthotics can typically be transferred between multiple pairs of shoes, provided the shoes are appropriate:
Best shoes for custom orthotics:

  • Athletic shoes with removable insoles

  • Walking shoes and running shoes

  • Oxford-style dress shoes with laces

  • Boots with adequate room

  • Casual shoes with removable insoles


Shoes that typically don't work:

  • High heels

  • Slip-on shoes (loafers, mules)

  • Sandals and flip-flops

  • Very narrow dress shoes

  • Shoes without removable insoles


If you need orthotics for different types of footwear (dress shoes, work boots, athletic shoes), we can fabricate multiple pairs designed for each shoe type. Many patients have a primary pair for everyday use and a secondary pair for work or sports.

Does Medicare or insurance cover diabetic shoes and foot orthotics?
Diabetic Footwear: Medicare Part B covers diabetic shoes for patients who meet specific criteria:

  • Documented diagnosis of diabetes

  • Evidence of diabetic peripheral neuropathy with loss of protective sensation

  • Certification by a physician (MD or DO) that the patient has one or more of the following:

    • History of partial or complete foot amputation

    • History of previous foot ulceration

    • History of pre-ulcerative callus

    • Peripheral neuropathy with evidence of callus formation

    • Foot deformity

    • Poor circulation


Medicare Coverage: One pair of therapeutic diabetic shoes AND three pairs of custom inserts per calendar year. Or one pair of custom-molded shoes (if foot deformity cannot be accommodated in depth shoes) AND two pairs of inserts.

Custom Foot Orthotics: Most private insurance plans cover custom orthotics when prescribed by a physician for a medical condition. Coverage typically falls under Durable Medical Equipment (DME) benefits.

Our billing staff will verify your specific insurance benefits and provide cost estimates before fabrication. We accept UPMC, Highmark, United Healthcare, PA Health & Wellness, and Workers Compensation for full pedorthic services.

Will custom orthotics cure my foot problems?
Custom orthotics are a treatment tool, not necessarily a cure. The goals of orthotic therapy depend on your specific condition:
Orthotics can:

  • Significantly reduce or eliminate pain

  • Improve biomechanical function and alignment

  • Prevent progression of deformities

  • Protect feet from ulceration (especially in diabetes)

  • Improve walking efficiency and reduce fatigue

  • Avoid or delay the need for surgery

  • Support healing of injured tissues


For some acute conditions (like plantar fasciitis), orthotics combined with other treatments may lead to complete resolution, and you may not need them indefinitely. For chronic conditions (like arthritis or structural deformities), orthotics provide ongoing symptom management and function improvement but may be needed long-term. Your pedorthist and physician will discuss realistic expectations for your specific condition.

Do I need to break in my new orthotics?
Yes, there is typically a break-in period for custom orthotics as your feet, muscles, and body adjust to the new support and alignment.

Recommended break-in schedule:

  • Days 1-3: Wear 1-2 hours per day in appropriate shoes

  • Days 4-7: Increase to 3-4 hours per day

  • Week 2: Increase to 6-8 hours per day

  • Week 3: Full-time wear as recommended


During the break-in period, you may experience mild arch discomfort, awareness of the orthotic, muscle soreness in feet, legs, or hips, or slight fatigue. These symptoms should gradually decrease. If you experience significant pain, blisters, or persistent problems, contact us for adjustments.

Why Choose InStride for Your Orthotic Care?

At InStride Prosthetics & Orthotics, we combine nearly a century of experience with modern technology and a patient-first philosophy. We understand that orthotic care is personal, and we take the time to understand your unique needs, goals, and lifestyle.

On-Site Fabrication Facility: Unlike facilities that send work to outside labs, we fabricate most devices right here in our Pittsburgh facility. This means faster turnaround times, better quality control, and the ability to make same-day adjustments when needed.


Advanced Technology: We utilize 3D scanning and printing, CAD/CAM design software, and state-of-the-art fabrication equipment to create precise, high-quality orthotic devices.


Board-Certified Practitioners: Our team includes Anna Cordell, CPO (Certified Prosthetist-Orthotist) and Mike Rees, BOCO (Board-Certified Orthotist). They bring decades of combined experience and specialized training to your care.


Continuity of Care: You will work with the same practitioner from your initial evaluation through final fitting and follow-up care. This continuity ensures consistency and allows us to build a relationship with you.

Nearly a Century of Experience: Serving Southwestern Pennsylvania since 1932, we have deep roots in our community and an unmatched legacy of quality care.


Mobile Services: We understand that transportation can be challenging. We offer mobile services to South Hills and Beaver County areas by appointment.


Family-Owned Values: As a family-owned practice, we prioritize people over profits. We take the time each patient deserves and never rush appointments to meet quotas.


Comprehensive Services: From simple foot orthotics to complex KAFOs, pediatric bracing to diabetic footwear, we provide the full spectrum of orthotic and pedorthic services under one roof.

What to Expect at Your Orthotic Appointment

Understanding the process helps reduce anxiety and ensures you're prepared for your visit.

Initial Evaluation
Your first appointment is a comprehensive evaluation, typically lasting 45-60 minutes:

  • Review of your medical history, diagnosis, and symptoms

  • Discussion of your functional goals and lifestyle needs

  • Physical examination including strength, range of motion, and alignment

  • Gait analysis (observing how you walk)

  • Measurement and assessment of the affected area

  • Discussion of orthotic options and recommendations

  • Insurance verification and cost estimate


Casting or Measurement
Once you decide to proceed, we take precise measurements:

  • Plaster casting, foam impression, or 3D scanning

  • Multiple measurements of circumferences, lengths, and angles

  • Tracings or photographs as needed

  • Selection of materials and components


This process typically takes 30-45 minutes. Most patients find it comfortable and non-invasive.

Fabrication
Your device is custom-fabricated in our on-site lab. The timeframe depends on complexity:

  • Simple devices: 1-2 weeks

  • Complex devices: 2-4 weeks


We will contact you as soon as your device is ready for fitting.

Fitting and Adjustment
Your fitting appointment typically lasts 30-45 minutes:

  • Try on the orthotic device and assess initial fit

  • Make immediate adjustments as needed

  • Observe you standing and walking with the device

  • Fine-tune alignment and strapping

  • Provide wearing schedule and care instructions

  • Discuss what to expect during the break-in period

  • Schedule follow-up appointment


Follow-Up Care
We schedule a follow-up appointment 2-4 weeks after your fitting to:

  • Assess how the device is working

  • Make any necessary adjustments

  • Address any concerns or discomfort

  • Evaluate progress toward your goals


Additional follow-ups are scheduled as needed. We recommend annual check-ups to assess device condition and function. Our care doesn't end when you leave with your orthosis - we're here for ongoing support.

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