Stroke Orthotics in London
A stroke can change how you stand, walk and use your arm, usually on one side of the body. Orthotic treatment does not act on the stroke itself. What it can do is support muscles that have been weakened, help hold a limb in a better position and make walking feel safer and less effortful.
Our consultant orthotists assess adults after stroke at four London clinics and work alongside the physiotherapists, consultants and rehabilitation teams already involved in your care.
How a Stroke Affects Movement
Damage to one side of the brain typically affects the opposite side of the body. Several of the consequences have a direct bearing on orthotic care:
- Weakness or paralysis, most often down one side, affecting an arm and a leg together
- Raised muscle tone and spasticity, which over time can draw a limb towards a fixed position
- Foot drop, where the ankle cannot lift the foot clear of the floor as the leg swings through
- Reduced control at the knee, so the leg can feel as though it might give way under load
- Altered sensation, meaning you may not reliably feel where your foot has landed
- Tiredness, which makes an inefficient walking pattern much harder to keep up across a day
None of this stays still. Change tends to be quickest in the early months following a stroke, but limb position and walking pattern can keep shifting for years afterwards. That is why orthotic care after stroke is rarely a single appointment and a single device.
What Happens at Your Assessment
We start with what you are actually finding difficult, whether that is stairs, uneven pavements, getting tired by the afternoon or catching your toes and stumbling. From there the assessment covers how you walk, the range of movement available at your hip, knee and ankle, muscle tone, skin condition, sensation and the footwear you wear day to day.
Where it adds something useful, gait analysis is used to look at the walking pattern in more detail than the eye can pick up. We then talk through what an orthosis could realistically change, and equally what it will not, so that any decision is made with a clear picture.
Orthoses Commonly Used After Stroke
There is no single device that suits everyone after a stroke. The prescription follows from the assessment, and often from a period of trialling more than one option.
- Ankle foot orthoses, the most frequently prescribed device after stroke. Rigid designs give maximum control where instability is significant, hinged designs allow controlled ankle movement, posterior leaf spring designs suit milder foot drop, and carbon fibre designs offer a lighter, more dynamic response
- Ground reaction ankle foot orthoses, used where control at the knee is reduced and a more stable base is needed through stance
- Knee ankle foot orthoses, where weakness extends above the ankle and the knee itself needs support
- Wrist and hand orthoses, used to position the hand, protect skin integrity and in some cases assist with grip and daily tasks
- Custom insoles and footwear adaptations, which are used to manage altered foot posture or pain, address pressure and deal with any difference in leg length
Timing, and Why Devices Get Reviewed
Orthotic input can begin during early rehabilitation, and it can also begin years later. Neither is unusual. What matters more is that the device continues to match the leg it is fitted to, is comfortable and meets your goals. Tone can rise or settle, strength can improve, footwear changes, and treatments such as botulinum toxin injections or a period of serial casting can alter the picture considerably.
For that reason we build review into the plan rather than treating provision as a finished job. A device that suited you in the first year after a stroke may not be the right one in the fifth.
Working With Your Wider Team
Orthotics works best as one part of a rehabilitation plan rather than something running alongside it. We are used to being part of a multidisciplinary team and will liaise with your physiotherapist, consultant or rehabilitation coordinator where you would like us to.
We also see a considerable number of clients through case managers and solicitors, and can provide the detailed written assessments and recommendations that this work requires.
Common Questions
Will an orthosis mean I can walk normally again?
An orthosis is designed to compensate for what the leg is currently able to do, not to restore what the stroke affected. Many people find walking becomes steadier, less tiring or less prone to trips. What that looks like in practice varies a great deal, and we would rather set out a realistic expectation at assessment than promise a particular result.
Is it too late if my stroke was several years ago?
No. A good proportion of the people we see are well beyond the early rehabilitation period, and are looking to address a walking problem that has settled into a long-term pattern.
Will an ankle foot orthosis make my muscles weaker?
This is a common worry. An orthosis is prescribed to support function where muscle activity is not currently sufficient, and it is used alongside physiotherapy rather than instead of it. It is a point worth raising directly at your assessment so it can be discussed against your own circumstances.
Will it fit into ordinary shoes?
Most designs are made to be worn inside footwear, and shoe choice forms part of the conversation at fitting. Where standard shoes will not accommodate a device, modular and custom footwear options are available.
Do I need a referral?
We accept self-referrals as well as referrals from consultants, physiotherapists and case managers.