Martin Senior Prosthetist and Orthotist “I work in a centre in a hospital, but also with children in a local special school. I practise both as an orthotist and a prosthetist.”

Martin works in a hospital Disablement Services Centre. Dividing his time between prosthetics and orthotics gives him a varied work schedule. Sometimes he has to deal with some unusual and intriguing requests.

You split your time between orthotics and prosthetics?

Yes. We all train in both areas, some people specialise in one or the other. I spend about 30% of my time on orthotics, the rest on prosthetics.

I'd like to concentrate mainly on your orthotics work. What would you say you do?

An orthotist needs to understand and respond to the wide variety of conditions that lead to pain in joints or physical deformity. So I might work, for instance, with children with cerebral palsy, or I might work with adults helping with spinal bracing or insoles.

Spinal bracing?

Supposing a patient comes to me with degenerative scoliosis – that's the shifting of alignment of the vertebrae in the spine. I might supply them with a device to actively correct the deformity or to minimise its progression.

Among adults I see people with advanced diabetes. Most are elderly people, but some are in their 30s. As an orthotist I would manage only serious cases, where people's feet are really distorted, where the foot is no longer foot-shaped. This means the foot will no longer provide motion and needs very careful support.

I've just been dealing with two very complex cases, one of them is a patient with a diabetic foot. The patient had developed a rub with the device we'd made. Watching him walk up and down allowed me to assess his biomechanical gait. Eventually I decided to realign the forces because his foot's no longer foot-shaped. Mobility is essential.

Is orthotics always about helping people walk?

Not necessarily. I see children, for instance, with poor hand function – say with hands that are curved in, or they can't control their hand function. I'll provide a device that straightens out their hands or stops the contraction continuing. Or it might be putting the patient's hand in a position where it can function.

I might have children in wheelchairs. Here I might give them devices to assist with stability when they're in their chairs, but it's not good to be in a chair all day. So they may need special devices to help them stand or walk – an orthotist will supply those, though I don't do that myself. It's a different specialism.

Do you work a lot with children?

Yes. One special school I work with in North Bristol has 77 very problematic cases. A lot of these are patients with cerebral palsy. Cerebral palsy is the name for a trauma at or around the time of birth. But it's a very general term, more like a label, almost not a medical term. Patients with cerebral palsy can range from those where you'd hardly notice it right through their life to those who can't feed themselves.

When I have paediatric patients I advise parents on the help we can give; I answer their questions. This is when the strength of multi-disciplinary teamwork comes to the fore as well. We might have to work out if the young patient is unable to walk or unwilling to walk. If the child is showing slight developmental delay we have to assess whether we wait to take action and how long we wait. I'll work with team members like physiotherapists.

Another decision we might have to make is should we provide a device that gives passive stretching to a limb during the night or one that works dynamically during the day.

What was the other complex case you've been dealing with?

It's a young woman who wanted graphic art on her prosthetic leg. She'd had an artist prepare the designs and brought them in on a CD. I worked with the technicians so we could transfer them in a very specific way to a high standard. I give a lot of my own time to things like this because I enjoy it. Her leg was brilliant, I enjoyed doing it; it was very cool.

Any bad bits to the job?

When you have a patient and there's nothing you can do to help. You have the feeling that you've been through your armoury of various tools and have nothing left to try. You build up a relationship with your patient, they're depending on you and you feel you've let them down. You haven't, of course, but we're all human.

And best bits?

When you see your patient take off and sprint round the car park jumping over bushes and pavements. What I say is, "If you can't catch your patient neither you nor your patient has anything to worry about."