A day in the life of – Blogs

My name is Tracy Crooks and I am an Orthotic assistant practitioner, I am currently employed by North Lincolnshire and Goole NHS Trust. I have been in this role for just over 3 years and prior to this I spent 6 years as a physiotherapy technical instructor.  I work very closely with our Orthotic provider which is TayCare.

As an assistant practitioner my role varies slightly from that of an orthotic assistant in that I can run my own clinics and I am  responsible for my own case load, but I also work with my line manager to keep track of budgets, Investigate, and manage complaints which are very few luckily, I chair team meetings regularly  and monitor waiting lists for our services across all three sites which are Grimsby, Goole and Scunthorpe.

It’s a role which I truly enjoy and a typical day for me looks like this:

I arrive at work at 07:45 and log on the system, look at emails and look at my day ahead. Today I am running my own clinic in Grimsby.

08:00-12:00 As it’s the school holiday I have children booked in all morning and it seems to fly by because it is so busy. This morning I’ve seen, five children for review of their footwear and all five need new boots, so I measure each one up and they choose their new boots for order with a little help from Mum or dad. Four reviews for insoles, three need new insoles so I take two FIB box impressions for some new custom-made insoles in EVA and I draw one draft for a set of thin board insoles. Four review helmets, three are fine but the last one needs a new custom-made helmet, so I need to take all the measurements which proves a little challenging because he thinks it’s a great game to keep moving about and starts to laugh each time he does it, so it takes a bit of time to get it done but we get there in the end and he decides he wants it to be made in red and yellow to match  his football team . When I finish the clinic, I catch up on notes from the morning.

13:00 -16:00 Afternoon clinic starts. Today I have two leg length discrepancy assessments which were straight forward with no complications. One was issued with an internal heel raise from stock but the other requires an adaptation of a through raise to the sole of the shoe as the difference is 28mm.

Three fit footwear appointments, two of which  went well with the footwear fitting nicely and no issues however the third I am unable to fit as the patient since being measured for the footwear is diabetic and while everything at the last appointment was fine, he has now developed an ulcer under the foot which at present has a dressing on and was bandaged by his nurse quite thickly this morning. I discuss this with the patient and advise them that it will be better to book them in again with the orthotist once the dressing has been removed.

I have a review with a patient for night splints that were issued 3 months ago. Patient is now able to reach Planter grade independently though there is still a bit of tightness there so we agree that he will continue with the calf stretch exercises and the splints for a while longer yet.

I have worked in health care in one form or another for over 35years but this is the role that I have been the happiest in. While a role of an assistant practitioner may not be the most glamorous and can sometimes be very difficult, it is a very rewarding job.

Many people think assistant practitioners because of the word assistant, are just there to fetch and carry or make up the numbers but we’re not!  Assistant practitioners have a bigger scope of practice and more autonomy than that. You can have an enormous impact on someone and their view of the NHS and this is especially true in Orthotics. The difference you can make to someone’s ability to function daily by reducing pain and discomfort not only influences how a person lives from day to day, but how they socialise and interact with others This in turn can also, and quite often, have an enormous effect on a person’s mental health.

For example, one of our orthotists recently saw a lady who had a very large abdominal hernia. The lady was very self-conscious and did not like going out in public because she was embarrassed. She stated that her relationship with her husband was strained because of it and that every time she had tried to tell people how she felt they seemed to brush it off and she cried in the appointment. This was obviously affecting her mental health and her relationships with others, and when she first came to us, she had resigned herself to the thought that this was her life from now on. She was unsure why she had been referred to orthotics. She did not know what we did or what we could provide, and her consultant had not explained either. Then the orthotist explained that we could look at a support, but she wasn’t convinced. He took the measurements and had it made. When she came back for fit and supply, she was still unconvinced. However, as soon as she put it on the difference was very significant to how she looked. The joy and amazement she had was contagious. She was so overwhelmed that she started to cry but this time from happiness. I have since seen her for a follow up review, and she has said that the difference this has made to her mental health has been huge. She now goes out again and she is happy to let people take her photo again.

This is just one example of why Orthotics is so important and so worthwhile as a whole service.

When we have busy clinics, and we are rushing because the next patient is waiting, it’s all too easy to forget what some of our patients are feeling or experiencing in their private lives. Or that for some of these patients, especially the elderly ones who live alone, that we may be the only person they have seen all week. We need to be more aware of our own clinical practice, which is one of the main pillars of care that we all strive to work to. Its vitally important we think about the person that is behind the patient in front of us. We need to see them as a whole and not just the condition to which they have been referred to us. We need to let them have a voice and make them feel that they have been listened to. By letting them have their own voice they then become more empowered which leads to better outcomes like the lady above. Once she had been listened to and had things explained her rather than been spoken at or to, the outcome was dramatically different.

One of my favourite quotes is by Dr Jane Goodall

“What you do makes a difference, and you have to decide what kind of difference you want to make.”

For care to improve it takes someone to take the first step. That first step could be by anyone, and it could lead anywhere.

By Tracy Crooks

 

We walked around to the clinic room and the assessment commenced. The patient was having noises coming from his leg, and the socket was rubbing on his knee. I checked the residual limb and identified the area causing the rub, then took the prosthesis to workshop for the technician to check the limb over and repair anything that may be causing the noise. I adjusted the socket to reduce the pressure and then returned the prosthesis to the patient to trial. The team had done their job – the prosthesis was no longer making noises as the patient walked, and the socket was much more comfortable – a 10/10 from the patient.

Next in was a patient for casting – a new socket was needed for their arm as they had lost some weight and therefore the socket was no longer fitting well. A cast using plaster of Paris was taken to replicate their residual limb and measurements of their arm were also taken so the team can make their arm the correct shape and length. Some cleaning was needed at the end of the appointment, as plaster of Paris can be quite messy!

A brief interlude to start writing up some clinical notes and orders came next and a chance to have quick drink of water. A tap at the office door paused this as a physiotherapy colleague needed some assistance and as all AHPs aim to do, I went to help. My colleague filled me in as we walked to the gym – the patient had recently got their first limb, and having developed their walking, was beginning to struggle a little with the prosthesis set up – they were catching their toes when walking. We assessed all possible causes – was the socket too big, or too small, was the prosthesis too long, was the foot angled correctly and had the patient changed shoes? Once lots of questions had been asked and assessments completed, we found that the patient had decreased in volume of their stump, which is common in primary/new amputees. We checked the fit using stump socks and after adjustments, the patient was walking much better again, and no longer catching their toes.

Another colleague and I stopped for lunch at the same time today, and decided to sit outside for some fresh air and a chat whilst we ate. Its always helpful to be able to take a few minutes to chat through some situations, get some sun and generally check up on others to make sure they are ok through the day.

The afternoon started with a department meeting. We had some product/component demonstrations and discussions over challenging cases. Working closely with the MDT and other prosthetists helps spread learning and ensure a holistic view of cases are taken and all clinical staff are aware of any plans.

Once the meeting finished it was back to the computer to finish notes, orders and arranging some appointments whilst I waited for the last patient of the day. Unfortunately, they did not attend the appointment, and they didn’t call to let us know. The team rebooked the patient for a few weeks’ time and a letter will be sent in the post to confirm this appointment in the hope they will attend.

I find completing my admin and tying up loose ends before moving on to my plaster work allows me to focus better on the rectification needed. Following the admin, I went to the rectification room to work on the cast I took in the morning. The cast was filled with plaster and the outer shell removed so I had a copy of the residual limb that I could adjust and smooth to ensure a good fit. Details for manufacture were documented on the cast and passed through to the workshop for manufacture.

I finished my day by cleaning down my work bench and rectification area, then replying to a couple of emails before logging off and heading home.

Today was a good balance of both patient facing and MDT working. Some days can be more patient facing, others could be more meetings and courses, but every day is a learning experience and provides many opportunities to help others needing our expertise.

Every day I make a difference to those who come for appointments, be that stopping their limb making a noise so they can walk along the corridor without people looking at them curiously, reducing discomfort to make walking more comfortable or solving problems to make life and every day living easier for the patients in our care.

I get the chance to solve problems, work alongside a great team, get messy and creative with hands on skills, see new and innovative products and above all, have a positive impact on peoples lives.

I find completing my admin and tying up loose ends before moving on to my plaster work allows me to focus better on the rectification needed. Following the admin, I went to the rectification room to work on the cast I took in the morning. The cast was filled with plaster and the outer shell removed so I had a copy of the residual limb that I could adjust and smooth to ensure a good fit. Details for manufacture were documented on the cast and passed through to the workshop for manufacture.

I finished my day by cleaning down my work bench and rectification area, then replying to a couple of emails before logging off and heading home.

Today was a good balance of both patient facing and MDT working. Some days can be more patient facing, others could be more meetings and courses, but every day is a learning experience and provides many opportunities to help others needing our expertise.

Every day I make a difference to those who come for appointments, be that stopping their limb making a noise so they can walk along the corridor without people looking at them curiously, reducing discomfort to make walking more comfortable or solving problems to make life and every day living easier for the patients in our care.

I get the chance to solve problems, work alongside a great team, get messy and creative with hands on skills, see new and innovative products and above all, have a positive impact on peoples lives

 

 

My commitment to this field has been driven by a genuine desire to enhance rehabilitative services for individuals grappling with various impairments, deformities, and mobility challenges.

After graduating with my bachelor’s degree in 2018, my professional journey has taken me on a diverse and exciting path. This journey has encompassed roles in the commercial sector, exploration of cutting-edge technologies, dedicated research pursuits, leadership roles, and invaluable clinical experiences, all within prosthetics and orthotics. Over the past five years, I’ve crafted my unique career trajectory to show how many things one can do in the profession.

As a newly qualified orthotist in the UK, I am currently in a graduate orthotist role. A big part of this experience has been the rare opportunity to shadow different orthotists.

So what does a day in my life look like?

Morning Commute and Clinic Preparation

My day kicks off with a brisk bike ride from my residence to James Cook University Hospital, where I begin my duties as an orthotist. This is my primary place of assignment, where I work with the wonderful TayCare team.

 💡 Some of my colleagues are responsible for clinics in different towns within the same trust. Orthotists often find themselves frequently traveling to cover various regions, as it’s a common aspect of our profession.

The clock strikes 8:30 AM, marking the start of our morning clinics. In an average clinic session, my team and I see around 10 to 12 patients, and we usually run one to two clinics per day led by different orthotists. Additionally, we have specialised clinics dedicated to paediatric and diabetic patients.

💡 Orthotists have various employers. Some are employed directly by the NHS, others work for private companies that provide services to NHS trusts, and some orthotists work in the private sector, serving patients outside the NHS system.

Orthotist’s Role and Patient Interaction

The most rewarding aspect of being an orthotist is the opportunity to be integral to individuals’ journeys toward improved well-being. Many mistakenly confuse us with cobblers or podiatrists initially, but when patients comprehend the scope of our expertise and how we can positively impact their lives, their faces light up with hope and gratitude

I genuinely enjoy engaging with our patients and learning about their life stories. My mentor, Kristina, is exceptionally skilled in this regard. Her profound understanding of our patients’ backgrounds creates a warm and welcoming atmosphere in her clinics.

Orthotics is an intricate discipline that demands analytical thinking and rapid problem-solving abilities. Patient-centred care is at the core of our practice because an orthotic device serves no purpose if the patient does not embrace it. The profession is undeniably hands-on, and orthotists often acquire do-it-yourself skills to meet patients’ unique needs.

Documentation and Administrative Duties

Another significant aspect of our day involves meticulous documentation of patient care. We spend considerable time writing detailed patient notes and placing orders for various orthotic devices. This attention to documentation ensures the continuity and quality of patient care.

The Learning Curve and Preceptorship

In my relatively short time as a newly qualified orthotist (less than a year), I have shadowed 10 experienced orthotists as part of my preceptorship program. While not everyone may have access to such valuable support, I am immensely grateful for the opportunity to learn from experts in diverse areas of orthotics.

Participation in Multidisciplinary Team Meetings

One of the highlights of working as an orthotist at James Cook University Hospital is my involvement in Multidisciplinary Team (MDT) meetings. I’ve had the privilege of sitting in on the paediatric MDT clinic, which includes an orthopaedic consultant, a physiotherapist, and an orthotist. On another occasion, my mentor took me to a diabetic MDT meeting featuring consultants, podiatrists, radiologists, and various other specialists. These gatherings offer a comprehensive view of the patient care pathway and underscore the significance of orthotic interventions in the overall success of a patient’s rehabilitative journey.

In conclusion, the day-to-day life of a newly qualified orthotist is a diverse and rewarding experience. We bridge continents, cultures, and individual stories in our quest to improve the lives of those who rely on our expertise and care.

 As we celebrate P&O Day this year, I want to take this opportunity to applaud all newly qualified prosthetists and orthotists for their hard work and dedication. I also want to express gratitude to the seasoned practitioners who have dedicated decades of their lives to this noble profession. Your commitment has paved the way for us to follow, and for that, we say thank you.

Once again, I cannot emphasize enough how deeply proud I am to be an orthotist.

HAPPY P&O DAY

My name is Jourja Pattrik, I am a Junior Orthotist at the Royal Berks in Reading. I graduated in 2022 and have been in the job a year this month.

Every morning starts the same; I get into the office for 7am and have a brief meeting (and a cup of tea) before our first patients at 7:30. Our department provides NHS Orthotic services to patients within the Reading and wider Berkshire area. An Orthotic patient could be seeing us from a child growing into an adult or for a brief time such as an inpatient on a ward. Below is an example of what my day entails as a graduate Orthotist.

7:30– I start my first appointment, today it was a new FFO for a lady with metatarsalgia. She tells me today she has had ongoing issues with her feet for the last 10 years and feels she is always walking on pebbles. She was able to explain her symptoms in detail and her referral included all the relevant information to help me in the appointment.
We discussed her footwear and agreed to trial a modular FFO with a met dome to allow for some offloading to her metatarsals and reducing the pain. She was able to trial these today in our appointment, found immediate relief, and was very happy. We agreed to review in a few months and ensure still getting on with them.

8:00– I then have a review of an AFO for a lovely girl who was an inpatient on one of the wards. She has complex neurological conditions and due to being in a wheelchair all day is at risk of contractures. Her mum tells me today she is back home and doing well. The AFOs are still fitting well and we checked them over today. Mum tells me they are having trouble keeping her feet inside the AFO as she does not wear shoes in her wheelchair and so is able to wriggle her toes over the edges. We trialled today adding a toe strap which is able to keep the toes in place whilst she was wearing and mum was very happy. We gave a few extra straps just in case they were lost and agreed to review her with growth. 

8:30– My next patient was a new FFO for a little boy with pain in his feet. He tells me is has pain in the bottom of his feet along the middle. He was able to tell me he has pain when he first walks up and sometimes after football. He tells me he also plays basketball outside of school for fun but sometimes this hurts. I was able to complete a full assessment and explain to him and his dad the presentation of his feet. We agreed to trial a pair of stock FFOs with the aim of reducing the stress/ strain on his soft tissues. I advised dad having feet that roll in a little is normal but pain and instability are not. Dad was aware and happy with this and we agreed to review with growth.

9:00– I had a new knee brace today for a man with medial osteoarthritis affecting his right knee who has been seen by orthopaedics but is not suitable for surgery. This is due to his age. He reports he is still quite young and active and so hoping to reduce his pain and stay active at the gym. He tells me he has a lot of pain in his R knee, especially at the end of the day or after the gym. We did a full assessment today and checked his ROM and laxity levels. I took some measures today and will order 2 different knee braces for his fitting appointment to ensure he finds a brace which is not only helpful and reduces pain but which he will be compliant in wearing.

9:30– I had another new FFO for a lady with previous Tibialis Posterior surgery 15+ years ago and arthritis in her L knee. She tells me today she has a lot of pain in her L medial side of her knee and pain in her medial side of the foot. She tells me in the last 6 months she has had to be less active due to the pain. Her daughter tells me she is also complaining of pain more in her feet and the knee even when just doing jobs around the house. Today she was wearing very flexible flat shoes with no fastenings, which she tells me she wears all the time or her slippers at home. I did a full assessment today of her foot and ankle and she presented with a pes planus foot type on the L with rearfoot valgus and difficulty on single leg heel rise on L. She was painful on inversion when checking ankle ROM and tender along tib post tendon tracking. We discussed today her presentation and agreed to trial a pair of insoles but also advised her on her footwear. I advised the footwear is very unsupportive and therefore an FFO needs to be in a supportive shoe and provided a footwear leaflet with the information on shoes and shoe companies who make good supportive shoes. We agreed to look at these shoes in the fitting to ensure she was happy with them and could still get them on and off herself.

10:00-My final patient of the morning was a review of a shoulder brace/new AFO. This patient I have seen before but he is now having some more intense therapy and he is able to stand now with some assistance and take a few steps forward. He is a complex patient due to his brain haemorrhage leaving him with severe weakness. After taking a full assessment of his lower limbs, I advised the patients I would like to speak to one of my colleagues before making a full decision. The patient was happy with this and so I popped out to see if one of my colleagues was free. Lucking, the clinical lead and consultant orthotist had a few moments. I was able to fully describe the patient and my proposed plan, he was then able to pop into the room and see the patient and confirm the proposed plan may be possible but we would make a few changes. We discussed with the patient who was happy with this approach and so we took a cast for his left leg and wrote a prescription for the AFO together. I will then fit this when it is back in.

11:00-I then had 4 fits of FFOs, these were for different custom orthotics which needed to be fitted and the patients were advised on breaking in and next steps. I was able to see them in quick succession that made my final appointments run very smoothly.

Then I had my lunch with my colleagues and looked at the inbox for any ward referrals. There were 2 new wards which needed to be seen urgent. My colleague saw a gentleman on the stroke ward for foot drop and due to his presentation prescribed a PLS AFO to trial and review once an outpatient. I saw a lady on the Orthopaedic ward for a complex spinal injury. She had multiple rib fractures, stable fractures to her spine but also an unstable T11 fracture. With the help of the team, she was able to be log rolled for me to but a TLSO brace in situ. She found this to be manageable to her spinal injuries and I agreed I would pop back up at the end of the week to check she was still getting on.

1:30-My first afternoon patient was another 2 fittings of FFOs from previous appointments. I was again able to fit them to the patient’s shoes and advice on breaking in and the next steps. We were also able to provide or guidelines for FFOs leaflet with the information in writing.

2:00-Finally, I saw my last patient of the day which was a new helmet. He was a 14 month old with a history of seizures, he was seen with his mum. This was my first helmet appointment without shadowing but I was able to take a full assessment and we agreed to trial a stock helmet first to see if he could tolerate this. I took measures for this and we agreed to book a fitting and a review to see how getting on after the fitting. Mum was very happy with this plan.

Wrapping up

After seeing all my patients I then have some time to catch up on my admin tasks. Finally, I gave the workshop and plaster room a quick tidy before heading home.