AUDIT OF LOWER-LIMB ORTHOSES IN RHEUMATOLOGY PRACTICE

A questionnaire survey was conducted of the use made of lower limb orthoses by patients under the care of a Rheumatology Department. Orthoses included made to measure and ready made shoes, ankle-foot orthoses (AFOs) and adaptations to existing footwear. Referrals between August 1991 and July 1992 were included. The length of time taken to supply the orthoses and the cost was monitored. Made to measure shoes took twice as long to supply as ready made shoes. Of the total cost (26 243 pounds), 73.5% was for shoes, 18.5% for adaptations and 8% for AFOs. Overall 6% of orthoses had been discarded 1 month after supply and 7% after 6 months. Plastic AFOs were most frequently discarded. Discomfort was highest for plastic AFOs and internal adaptations. Made to measure shoes and calipers were worn more days per week and for longer periods than other orthoses. The dissatisfaction with plastic AFOs in terms of use and with internal adaptations in terms of comfort needs further investigation if inappropriate prescribing is to be avoided.