Why Orthotic Standards Are Falling: The Urgent Need for Structured Training, Fabrication Skills, and Licensing in Pakistan

Why Orthotic Standards Are Falling: The Urgent Need for Structured Training, Fabrication Skills, and Licensing in Pakistan

The profession of orthotics sits at the intersection of medical science, biomechanics, and craftsmanship. It requires not only clinical knowledge and patient assessment skills, but also deep understanding of materials and the ability to fabricate functional, comfortable, and durable devices. Unfortunately, in Pakistan, the competency level of many practicing orthotists is alarmingly low—largely due to the absence of a rigorous and structured training program aligned with international standards.

This decline is further exacerbated by the lack of licensing and accountability, leading to a system where underqualified practitioners routinely dispense life-altering medical devices without the skills required to ensure safety and efficacy.

The Fabrication Gap: The Heart of the Crisis

One of the most damaging aspects of current orthotic training programs in Pakistan is the severe lack of practical fabrication experience. Orthotists today are often graduating without ever having designed and built an orthosis with their own hands—from concept to completion.

Orthotic practice is not theoretical. The ability to fabricate a device is a critical skill, not a luxury. If an orthotist cannot convert a mental design into a tangible, properly crafted device, they are not just professionally handicapped—they become dependent on technicians to interpret their clinical goals, often without the clarity or specificity required for precise outcomes.

This disconnect between design and execution results in poorly fitted, non-functional, or even harmful appliances. Worse, when the orthotist cannot instruct or guide the technician properly—due to unfamiliarity with material behavior, reinforcement techniques, or trimline decisions—the outcome is inevitably compromised.

Material Selection and Handling: The Forgotten Curriculum

Material knowledge is foundational in orthotics. The choice between polypropylene, polyethylene, carbon fiber composites, silicone, or thermoplastic elastomers is not cosmetic—it directly affects weight, durability, flexibility, and patient compliance. Orthotists must know which material is best suited for specific pathologies and patient lifestyles.

Sadly, many training programs provide minimal exposure to material science or practical handling. Students may recognize materials by name, but rarely understand their characteristics in depth—how they react under vacuum forming, how they behave when riveted, how to modify them without compromising structure. This results in clinical designs that are theoretically sound but practically flawed.

Why Licensing and Accountability Matter

In developed nations, the role of the orthotist is clearly defined, regulated, and monitored. Professional boards ensure that no one can practice unless they have passed structured, competency-based evaluations that include material handling, appliance fabrication, patient fitting, and clinical justification.

In Pakistan, however, there is no such oversight. Anyone with a diploma can open a practice—even if they’ve never fabricated a single orthosis independently. There is no licensing body, no minimum standards of competence, and no consequence for malpractice.

This lack of accountability is one of the main reasons why the overall standard of orthotics in Pakistan is declining with every passing year. We are producing “qualified” practitioners who are unable to meet even the basic functional expectations of the profession.

The Consequences: Real Harm to Real People

Orthotic devices are not optional—they are often prescribed to correct deformities, prevent deterioration, offload ulcers, support paralysed limbs, or facilitate walking after stroke or spinal injury. A poorly made or incorrectly selected orthosis can lead to pain, tissue damage, pressure sores, deformity progression, or complete rejection of treatment by the patient.

This is not merely an academic issue—it is a public health crisis in the making. When patients lose trust in orthotic care due to repeated failures, the damage is irreversible.

The Way Forward: Reform and Responsibility

To reverse this disturbing trend, Pakistan must prioritize the following:

1. Comprehensive Curriculum Overhaul
   Training programs must emphasize fabrication, material handling, and practical application just as much as theory. Students should be able to design, fabricate, and fit multiple appliances before they graduate.
2. Apprenticeship and Clinical Mentorship
   Mandatory supervised clinical rotations in real settings, under licensed professionals, must be integrated into every orthotics curriculum.
3. National Licensing Body
   Establish a regulatory body to certify practitioners based on standardized assessments—both clinical and technical.
4. Ongoing Competency Evaluation
   Introduce continuing education, skills upgrades, and recertification requirements to keep practitioners updated and competent.
5. Technician-Orthotist Integration
   Promote teamwork and mutual understanding between orthotists and technicians to ensure that design intentions are translated into precise, patient-centered appliances.

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Conclusion

An orthotist who cannot fabricate an orthosis, select appropriate materials, or instruct a technician effectively is incomplete—and potentially dangerous. Without structured training and licensing, we are failing our future professionals and, more importantly, our patients. It is time to raise the bar and realign orthotics education in Pakistan with global best practices—for the safety, mobility, and dignity of those we serve.

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Written by Mr. Kamran Saleem Awan, UK-registered Prosthetist & Orthotist, certified by Ottobock Germany in Myoelectric, Silicone, and KAFO technologies. Founder of Arthromax Orthopedics and Podiatry, Mr. Awan is dedicated to bringing international standards of care, training, and accountability to Pakistan’s orthotic and prosthetic landscape