Prosthetists and orthotists assess, diagnose and treat people who need external medical devices to replace a missing limb or to aid their mobility, movement or function
Prosthetists work with people of all ages requiring artificial limb replacements. This includes those who have been born with a limb defect or missing limb (congenital absence), those who have lost a limb through trauma, or those who have had limb amputation due to infection or long-term health conditions.
Orthotists work with people who have a broad range of clinical conditions including spinal injury or deformity, neuro-muscular disorders, musculoskeletal concerns, traumatic injuries and congenital anomalies. Orthotists aim to relieve pain, correct and/or compensate impairments, whilst improving mobility and function. Common conditions treated include diabetes, arthritis, cerebral palsy, stroke, spina bifida and MS, as well as injuries and trauma.
You will see people of all ages and can work with them during their lifetime forming long-term professional relationships.
Whichever area you specialise in, the main purpose of your job is to:
- assess people in order to understand their problems and how a medical device can help improve their movement and quality of life
- create a treatment plan and agree goals going forward which may include a prosthesis (artificial limbs) or orthosis (brace)
- prescribe, engineer and design a prosthesis, orthosis and footwear to meet the needs identified
- fit prostheses/orthoses and modify for comfort and function and help people to adapt to using them.
Although training covers both orthotics and prosthetics, most clinicians go on to specialise in either one or the other area of work. However, a few centres in the UK have opportunities to work in both as a dual practitioner.
As a prosthetist/orthotist, you'll need to:
- assess movement and identify any biomechanical abnormalities (this is commonly called gait analysis)
- evaluate joint range of movements and muscle strengths
- listen to people to understand what they want their prosthesis or orthosis to achieve for them
- measure and design the required device
- shape capture using plaster or digital imaging and 3D scanning, CAD (computer-aided design) and CAM (computer-aided modelling) to make a model
- liaise with technicians who will manufacture the prosthesis/orthosis
- fit people with their prosthesis/orthosis
- modify prostheses/orthoses to perfect alignment and walking/function as required and monitor the impact of any changes
- review the impact of wearing a new prostheses/orthoses and help patients to adjust to using their new devices
- work as part of a multidisciplinary team with other healthcare professionals, including medics, nurses, physiotherapists, podiatrists, occupational therapists and technicians, to help manage patients' rehabilitation.
- Jobs in the NHS consist of nine pay bands and are usually covered by the NHS Agenda for Change (AfC) pay rates. Starting salaries for qualified prosthetists/orthotists range from £24,214 to £30,112 (Band 5).
- Senior and specialist prosthetists/orthotists can earn between £30,401 and £37,267 (Band 6), rising to £43,772 (Band 7).
- Salaries for consultant prosthetists and orthotists with management responsibilities can reach up to £50,819 (Band 8a).
Salaries for prosthetists and orthotists working for companies contracted by the NHS varies, but are often similar to NHS pay. Practitioners working for these companies may receive additional benefits including a company car.
Income figures are intended as a guide only.
Most prosthetists and orthotists in the NHS work between 37 and 40 hours a week, Monday to Friday. Working hours are usually between 8am and 6pm, although there may be some shift work involved, including nights and weekends. Part-time or flexible hours may also be available.
If you work in a private prosthetics/orthotics clinic or company, you may work evenings or weekends to suit your private clients.
What to expect
- Prosthetists are usually based within rehabilitation centres in NHS or private hospitals. Orthotists are often based in hospital outpatient clinics. As an orthotist, you may see people in ward settings or in their own homes, move around several hospitals and visit special needs centres.
- You'll work independently or as part of a multidisciplinary team that includes clinicians and technicians to aid patients' rehabilitation.
- The work is very rewarding and challenging as you combine theoretical engineering solutions and practical and manual skills with a significant level of people contact to improve lives.
- Jobs are available throughout the UK, but you may need to relocate to find work or to further your career. There are also opportunities to work abroad.
- You may need to travel during the day between different client sites or patient homes.
To work as a prosthetist/orthotist, you must be registered with the Health and Care Professions Council (HCPC). In order to register, you must successfully complete an HCPC-approved degree programme (BSc) or degree apprenticeship in prosthetics and orthotics.
Degree courses in the UK are offered by the University of Salford and the University of Strathclyde. Courses are full time and take three or four years to complete. Entry requirements vary but both universities accept a range of qualifications including A-levels, Scottish Highers and Irish Leaving Certificates.
You'll usually need two or three A-levels, including maths, physics, biology or engineering, along with five GCSEs or equivalent at grade 4/C or above including English language, maths and science, to get a place. Contact the course providers for full details on entry requirements.
Courses combine theoretical learning with clinical work placements, which can take place in prosthetic or orthotic centres anywhere in the UK. This means you'll need to be flexible around geographic location as you may have to relocate temporarily during placements.
The other main route into the profession is through a degree apprenticeship (Level 6) in prosthetics and orthotics. You'll need to apply for an apprentice position with a healthcare provider and will typically need a Level 3 qualification or above, as well as a genuine interest in the profession. Search for apprenticeship vacancies at NHS Jobs and Find an apprenticeship.
You'll have to pass an enhanced criminal record check to get a place on a course. Before taking any placements, you may also have to pass a health assessment.
Once you've successfully completed the degree or degree apprenticeship, you're eligible to apply for registration with the HCPC and can then choose to specialise in either prosthetics or orthotics. You can also become a member of the British Association of Prosthetists and Orthotists (BAPO), the UK professional body for prosthetists and orthotists.
You'll need to have:
- listening skills, in order to understand patients' needs
- excellent verbal communication skills to explain treatment solutions to technicians and patients
- patience and the ability to stay calm in challenging situations
- sensitivity and understanding towards patients and their families
- good manual skills including coordination and dexterity
- knowledge of manufacturing production and processes
- confidence in using software packages
- scientific understanding, particularly human biology and physics
- creativity and problem-solving skills
- strong IT skills and a willingness to embrace new and emerging technologies
- strong attention to detail
- the ability to work as part of a larger team alongside other medical practitioners
- determination and an ability to motivate people.
You'll need a driving licence for many orthotist positions as you'll be travelling during the day to visit patients at home and in hospitals.
Getting work experience specifically in the area of prosthetics and orthotics can be difficult. Try contacting your local NHS centre to see if you can arrange a visit, some work shadowing or work experience. The Limbless Association provides a list of local NHS Disabled Services Centres (DSCs) and private prosthetics clinics. It's also worth contacting BAPO or the universities of Salford and Strathclyde for details of your local centre.
If you apply for a prosthetics and orthotics degree programme, you may have to attend a prosthetic and/or orthotic clinic and provide a summary of your experience as part of the application process.
Paid or voluntary work experience in other health and care disciplines is also useful, especially in areas that bring you into contact with patients.
Prosthetists and orthotists are usually employed by hospitals, clinics and health centres, as well as by commercial prosthetics and orthotics companies contracted by the NHS.
Opportunities to work in the field can also sometimes be found in:
- manufacturing and servicing companies
- overseas healthcare providers
- voluntary organisations such as the British Red Cross who work in regions affected by war.
Look for job vacancies at:
- BAPO (requires a membership log in)
- Health Jobs UK
- NHS Jobs
- NHS Scotland Recruitment
- websites of individual NHS trusts and organisations.
There are also opportunities to set up in private practice and run your own clinics.
Training in your first year after registration with the HCPC usually involves being mentored by an experienced prosthetist or orthotist to help consolidate your skills and knowledge. You may choose to specialise in either prosthetics or orthotics, or practise in both.
You'll need to undertake continued professional development (CPD) throughout your career to retain your registration with the HCPC and to keep your skills and knowledge up to date. CPD activities include attending conferences, workshops and seminars organised by BAPO. Membership of BAPO also provides the opportunity to network with other prosthetists and orthotists.
The universities of Salford and Strathclyde both offer opportunities to undertake research degrees (MPhil, PhD) in prosthetics and orthotics. These qualifications are particularly useful if you want to move into research and teaching.
As there is currently a shortage of prosthetists and orthotists, both in the UK and internationally, career prospects are generally good. The profession is relatively small, however, and in order to progress your career, you may need to relocate to where the jobs are.
You'll begin in a junior position and can progress into a more senior clinician role with experience. There are opportunities to specialise in a specific clinical area such as sports injuries, neurology or diabetes, or with a particular client group, such as children.
With further experience, there are some opportunities to move into supervisory and management posts, with responsibility for managing staff and budgets within an orthotics or prosthetics service.
With additional qualifications, you could also progress into a teaching or research and development role.
Some practitioners also go on to set up their own clinics, either independently or with other prosthetists and orthotists.
Find out how Becky became a prosthetist at BBC Bitesize.