An orthotic is a support, brace, or splint used to support, align, prevent, or correct the function of movable parts of the body. As such their purpose is to:
- Create awareness or enhance proprioception
- Support a joint
- Facilitate with repair of injuries to tendons or ligaments
- Prevent further complications during treatment
- Act as a rehabilitative aid
Braces are available as soft braces (off-the-shelf) and rigid, custom-made braces (usually fibreglass). There is an intermediate option which is an off-the-shelf brace with a thermoplastic insert. This insert is moulded to fit the dog. The shaping must be done by a physical rehabilitation professional or a veterinarian so as to avoid the development of pressure sores. The prices vary based on the materials used, and the professional expertise required in the manufacture of the brace.
When using a brace be aware that your companion will require an adjustment period. The animals are not accustomed to having something on their joint or leg. Making allowances for their discomfort is important in the successful use of a brace. Begin with short periods a number of times a day (a few minutes 3 - 4x per day). During this time encourage the dog to walk with the brace on. Gradually increase the time the brace stays on the dog. The brace is most often required for times of exercise or increased impact. Once your dog is wearing the brace for a period of time, be certain to check for areas of pressure. Neoprene braces can easily be removed allowing areas like the interdigital spaces to breathe. The braces can also be washed.
It is important to bring the brace with to rehabilitation sessions. The rehab professional will check for proper fit and support. Adjustments can be made during the consultation. The brace will also be used during the session whether in the water or during land-based exercises.
PiP and her Brace
PiP was a pure bred Bouvier des Flandres. At the age of 7 she was diagnosed with arthritis which was most severe in her front legs, especially the carpal joints. When she started showing signs of discomfort at training and a reluctance to participate in fly ball I took her to Dr Tim Hepplestone at Blue Hills Vet for an evaluation to see if she was a candidate for Stem Cell therapy. She was and so the procedure was done with great success.
It was at this point that I started taking her to Tanya Grantham at Animal Health and Hydro where she started swimming (not her favourite pastime) and then using the newly installed underwater treadmill which she took to readily.
After two years she started limping badly and it was easy to put it down to her arthritis and the expected longevity of the stem cells but when it impacted severely on her comfort and mobility I took her back to Blue Hills to see if the procedure should be repeated. In an inspired move Tim decided to x-ray her shoulder and not just the lower leg as we had been doing previously and to my utter devastation he saw a lesion at the top of the humerus which turned out to be an osteosarcoma. I was given options for her treatment and after some discussion and soul searching settled on amputation of her right front leg followed by 5 bouts of chemotherapy which I was advised could buy us an extra 9-12 months.
The surgery was done and her rehabilitation started. Suffice to say that she proved that dogs live in the moment as when I fetched her 3 days after her operation she happily attempted to jump into the car to go home and once home, got out of the car with little assistance and went inside and jumped onto the couch!
With her remaining front leg compromised with her arthritis and bearing in mind that dogs carry the vast proportion of their weight on their front legs, it was suggested that I get a brace for her and she was fitted with a soft wrap-around brace to support her left carpal joint. This afforded her more stable movement and it seemed that she was not sinking down as far on the joint. She just appeared more comfortable when moving about. She was still going to school and was keen to join in whatever the other dogs were doing – she negotiated the weaving poles, went over small jumps and was even able to go through the tunnels even though she had to crouch somewhat. She wore the brace most of the day but it was removed at night.
With the passage of time the soft brace lost its integrity and softened at strategic points which meant that the support which it had offered was no longer sufficient and after about 6 months Tanya suggested that we look at a more rigid, custom made brace and so I took PiP through to Antoi Ferreira, an orthotist with a special interest in animal orthotics. There she was measured and a fibreglass prosthetic was made to measure.
This brace was a back slab with a flexible joint at the carpus and front straps which held it in place. It afforded much greater support. It required a little getting used to although with the resilience of the patient this was achieved with little effort. She did not wear the brace all day but it was put on her when we went to the park for our walks, when she went to school or therapy and any other time when she was to be more active. As she was an older dog and Bouviers are notorious couch potatoes, it was not deemed necessary for her to wear it at home. Also the rigidity of the piece
could have caused some discomfort although this did not seem to be an issue on the
odd occasions when I forgot to take it off!
This brace was used for about 18 months (with only the “hinges” having to be replaced after about a year) when she suffered a pathological fracture of her right back leg and I was forced to say goodbye to my strong-minded, brave girl. I had had an extra 24 months almost to the day with my heart on three legs.
I learnt a lot while guardian to this special girl.
In the beginning it was very hard to resist rushing to help her each time she stumbled. I quickly saw that she wanted to do things on her own, just picking herself up and carrying on. Both braces were beneficial in her being able to do this with relative ease. Momentum was very important to her ease of getting about. The faster she was able to run, the better she coped. Walking slowly was far more difficult to handle with or without either of the braces. Slippery floors were difficult and I resorted to putting carpet tiles down, giving her paths which she instinctively followed when moving about the house. Another thing which was evident was that as a front limb amputee she was not able to negotiate ramps even with the added support of a brace. Steps presented little or no problem. This was something that was of interest to the vets at Blue Hills who had been advising people to install ramps for tripod animals. (I am not sure how back leg amputees cope) I know that her regular attendance at AHAH was a major factor in her quality of life and well-being and believe that cannabis oil also played its part especially in preventing the spread of the cancer to her lungs for which she was x-rayed every 3 months.