The Department of Orthotics provides clinical services to inpatients and outpatients.  The Department of Orthotics compromises 3 Orthotists and 3  administrative staff.  The Orthotists assess for and provide a range of orthoses.  Orthoses are braces and splints to help support, align and protect different parts of the body.  We see people with a wide range of problems, which includes:

  • People with spinal injuries requiring protective bracing whilst the injury heals
  • People with difficulty walking due to neurological conditions
  • People with a history of ulceration who may require protective footwear

For more information about disabled access for this service, please click here.

Access to service

At Sandwell Hospital the referral to the service is via a hospital Consultant.  At City Hospital the referral to the service is via a hospital Consultant and some referrals will be accepted from the local GPs.

Once you have been referred to us you will be offered an appointment to be assessed by one of the Orthotists.  This could be at either Sandwell Hospital or City Hospital.

Access Critera

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The ‘Access Criteria’ for referrals to the Orthotic Department have been examined in light of ‘length of wait’ for appointments and ‘number of referrals’.  Simply put there is an increasing length of time that patients are waiting to be seen to be assessed and provided with orthoses, also there seems to be an increasing number of referrals to the Orthotic Department further applying pressure on the waiting times.  As a Department during Clinical Governance meetings we have been reviewing our access criteria for referrals.  We hope that this will help manage the waiting times for the patient groups that we NEED to see in a Hospital setting.  It is important to note that this approach is supported by the policy of ‘Right Care Right Here’ helping to ensure that patients are seen in appropriate settings near to their home and to reduce waiting time.

We, as a Department, are aware that there are other routes for provision of some orthoses:  Some Occupational Therapists and Physiotherapists will provide some ’upper limb splints and orthoses’; Some Podiatrists will provide some ‘insoles’; Some nurses will provide ‘upper limb splints’ and ‘compression stockings’.  Thus patients would still have access to assessment and provision, simply not from the Orthotic Department   This process of reviewing access criteria has happened previously with the provision of ‘compression stockings’ which we no longer provide.

As a Department we have discussed the possible impact of this change in access criteria. One effect would be spend on each orthosis, the average cost of an orthosis is likely to increase as the patients who would continue to be seen in the department would be those that tend to need more expensive orthoses. This would likely increase the ‘costs per case’ of orthotic interventions for the Department.


  1. We first considered our ‘patient population’ and ‘classified’ them uneasily with a mixture of diagnosis and referral source. This is far from ideal but it gave a working structure.
  2. Each of the groups we tried to stratify into three, this represents the complexity of diagnosis, presentation or provision, again an uneasy classification.
  3. The range of interventions that are only carried out by Orthotists? Thus the patient group that we NEED to see.

The access criteria have been presented in a table form, one table for paediatrics and one table for adults.  These are not exhaustive guides, details may be missing and may well need clarification but this does offer a working structure (some abbreviations have been used).  It is anticipated that these guidelines will evolve and gain further clarity as and when required.


Classification of Paediatrics Green, who we need to see Red, who we will not see
Paediatrics with a neurological diagnosis:

  • CP

  • KAFOs
  • AFOs
  • Lycra, CCDs

  • Supporting boots

  • Insoles
Paediatrics with Muscular Skeletal  conditions: Issues/Provision:

  • KAFOs for Blount’s



  • Raise for Leg length differences, quite rare

  • Insoles for flat feet, or knee pain due to over pronation of feet


Points to note:

  • Paediatric referrals for insoles should be directed to the Community Foot Health Departments
  • The Paediatric referrals from Hospital Consultants for insoles will also not be accepted by the Department, in line with ‘Right Care Right Here’ approach


Classification of Adults Green, who we need to see Red, who we will not see
Adults with a neurological diagnosis:

  • CVA
  • MS
  • TBI
  • Others

  • KAFOs
  • AFOs
  • Lycra, footwear

  • Shoulder supports
Muscular Skeletal conditions:

  • OA
  • Polio

  • Significant weakness (polio)
  • Significant alignment issues (for example, knees or feet/bunions
  • Orthoses, various designs
  • Footwear, various designs

  • Leg length differences, for a raise to shoes
  • Alignment issues requiring more than insoles

  • Insoles
  • Over pronation of feet
  • Plantar Fasciitis
  • Mortons Neuroma
  • General foot pain
Diabetics Issues/Provision:

  • Increased risk of ulceration
  • Current ulceration
  • Amputations
  • Charcot joints

  • At risk

  • Low risk
Rheumatoid Arthritis Issues/Provision:

  • Significant foot deformities
  • Bespoke footwear

  • Foot deformities
  • Modular footwear

  • Over pronation of feet
Vascular Issues/Provision:

  • Ulceration
  • Significant risk
  • Footwear
Issues/Provision: Issues/Provision:
Staff, referred from Occupational Health Issues/Provision:

  • Over pronation of feet
  • Plantar Fasciitis
Issues/Provision: Issues/Provision:
Hand Splinting Issues/Provision: Issues/Provision: Issues/Provision:


Points to note:

  • Adult referrals for insoles should be directed to the Community Foot Health Departments
  • Staff referred by Occupational Health at the Trust will not be accepted if they are referred for insoles, in line with other Muscular Skeletal conditions


Contact details

Department of Orthotics at City Hospital:             0121 507 4358

Email address: swb-tr.SWBH-GM-Orthotics@nhs.net

We are open from Monday to Friday:

8.00 am -12.30pm

1pm – 3.30 pm.