Orthoses for HSP

From an expert in the field


Orthoses* for people with Hereditary Spastic Paraplegia (HSP)

Christina Tsikos
Christina Tsikos


Christina Tsikos is a successful departmental head within one of Australia’s largest hospitals, Austin Health¹.

With over 15 years of clinical expertise, she has honed her skills in identifying and developing repeatable solutions, prescriptions and has delivered effective outcomes and patient centred care.

Christina has refined these skills within private and public sectors, and has developed a keen interest in enhancing people’s lives via innovation. Orthotic management of neuromuscular conditions and the application of sound biomechanical principles are areas of specialty for her.

Her team of Orthotists / Prosthetists have over 100 years of combined experience, and work in the spirit of collaboration to deliver exceptional patient outcomes.


 What are Orthotists and what do they do

Orthotists are tertiary qualified Allied Health Professionals who assess and treat the physical and functional limitations of people resulting from illness or disability. Orthotic management involves the assessment / fitting of ‘orthoses’ – which are externally applied devices used to modify forces on the body.

Orthotic devices for people with HSP

Orthotic devices may be used for the purpose of improving mobility, reducing pain, managing musculoskeletal weakness, malalignment, pressure injuries, contractures and spasticity. Orthoses may be individually custom-made, customised or fitted as prefabricated devices.

For people with HSP, there may be many indications that make an orthosis worth considering. These may include various muscle weaknesses, most of which usually occur in the hips, knees, and ankles. Unaided, this might result in toes catching on the ground when walking – commonly known as ‘foot drop’. Spasticity or tight muscles can also result in decreased balance, and over time this may cause extra stresses on other joints. Numbness in the feet and lower legs (known as Peripheral Neuropathy) may also be a symptom of HSP. This can result in decreased standing balance, clawing of the toes, and bony areas under the feet. Any of these symptoms could cause increased pressure under the foot when walking, which over time might potentially develop into wounds.

How orthotic devices can help

The use of an Orthotic device can provide numerous benefits to someone with HSP. The main advantages may include:

  • improving a person’s overall function
  • conserving energy and increasing endurance when walking
  • helping correct or maintain alignment of the legs
  • improve stability of weak or paralysed muscles, thereby improving balance
  • allowing anyone affected by HSP to be able to stand or walk for longer periods of the day
  • assisting with providing a smoother walking pattern
  • decreasing muscular / joint pain in the feet, ankles and knees
  • making it safer to walk in the community with a reduced chance of tripping
  • increasing a person’s confidence when going out of the house
  • reducing the risk of wounds or skin breakdown, commonly caused by increased pressure.

Often, there are a range of options available, and an Orthotist can help navigate the way through a range of custom made and customised devices. The types of Orthotic products available to people with HSP may include any of the following:

Custom made, full length foot orthoses
Orth-PW flarelr
Appropriate footwear & footwear modifications – flare
Orth-NB whitelr
Appropriate footwear & footwear modifications – raise
Orth-Black GRAFOlr
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Orth-Dynamic AFOlr
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Orth-GRAFO on pt lr
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Custom Ankle Foot Orthoses (AFO, GRAFO) and dynamic carbon fibre orthoses


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Orth-Lions KAFO2
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Custom made Knee Ankle Foot Orthoses (KAFO)


Electronic Stance control KAFO: enhanced knee & ankle stability
Electronic Stance control KAFO – for enhanced knee & ankle stability
Orth-FES snapshot
Functional Electrical Stimulation (FES) – for neurological conditions with ‘footdrop’.



Where and how you can get help

If you, a family member or a friend would like further information about orthotic assistive devices, or if you would like to have an assessment to see if any orthotic options may be suitable for you, Orthotics departments can be found to be associated within many public hospitals. There are also many Orthotists working in private clinic environments. Ask your Neurologist or General Practitioner to make a referral for an assessment.


* Definition of Terms

Orthotics and Prosthetics – a clinical allied health discipline that deals with supportive devices for people with musculoskeletal weakness or neurological disorders (orthoses), and artificial limbs for people with amputations (prostheses).

Orthotic device / Orthosis (orthoses pl.) – a brace, splint, or other artificial external device serving to support the limbs or spine, or to prevent or assist relative movement.

Orthotist – the primary Allied Health clinician responsible for the prescription, manufacture and management of orthoses.

Musculoskeletal – relating to or denoting the musculature and skeleton together.


Written by Paul Ranalli and Christina Tsikos

¹ More information about the Orthotic and Prosthetic Department at Royal Talbot Rehabilitation Centre, located in Kew Victoria, can be found at http://www.austin.org.au/page/701







1 comment

  1. I have solid AFO’s.
    But I find them too stiff and rigid, which gives me no flexibility at all.
    Would a slightly hinged afo be any better for HSP?

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