I was happy with the summary , but the remainder of the article generally took a skeptical look at orthotics . The writer ’ s specific question to me had been , “ What kind of rigorous scientific evidence ( like randomized , controlled clinical trials ) supports the notion that orthotics — custom made or over-the-counter — can speed healing of injuries or prevent them ?”
Before responding , I researched many journals and periodicals to substantiate any statements I might make . I found the whole experience quite illuminating for several reasons .
First , there are plenty of papers and studies that clearly validate the use of orthotics to treat injuries and pain of the lower limb . However , not all of the studies are stand-alone positive . Some of them were conducted in conjunction with physical therapy , while others used only prefabricated orthotics and many were inconclusive .
Second , given that the evidence is not 100-percent positive , personal opinion becomes a factor in interpretation . Although we can define a problem scientifically , we often find it difficult to reconcile conflicting outcomes . This does not mean that the science is flawed ; rather , it means that the subject is more nuanced than a single cause and effect .
Finally , I realized that , as a profession , we need to do a better job of presenting the obvious benefits and results that our orthotics and prosthetics provide . We compete with many health care providers and budgets for scarce reimbursement dollars . We owe it to our patients and our profession to be crystal clear about the effectiveness and direct benefits of the devices that we dispense .
Plantar Fasciitis ( 1 – 6 )
Plantar fasciitis ( PF ) is one of the more common foot injuries treated by foot and ankle physicians . It is a debilitating condition characterized by subcalcaneal pain and is thought to develop due to a number of factors , including abnormal foot mechanics and overuse . There are several excellent studies that show the benefits of orthotic therapy . One randomized prospective study by Lynch et al . 1 evaluated 103 subjects ( n = 103 ) to compare the individual effectiveness of three types of conservative therapy : anti-inflammatory , accommodative or mechanical . A statistically significant difference was noted among the groups : mechanical treatment with taping and orthoses proved to be more effective ( 70 percent reported improvement ) than either anti-inflammatory ( 30 percent reported improvement ) or accommodative ( 33 percent reported improvement ) modalities .
Gross et al . 2 investigated the impact of custom , semi-rigid foot orthotics on pain and disability for individuals with PF ( n = 15 ). They concluded that custom , semi-rigid foot orthotics may significantly reduce pain experienced during walking and may reduce more global measures of pain and disability for patients with chronic PF . Hume et al . 3 conducted a literature review to determine the effectiveness of foot orthoses for the treatment and prevention of lowerlimb injuries . One conclusion was that customized , semi-rigid foot orthoses have moderate to large beneficial effects in treating and preventing PF and posterior tibial stress fractures . They also noted that further research with randomized controlled trials is needed to establish the clinical utility of a variety of foot orthoses for the treatment and prevention of various lower-limb injuries .
Rheumatoid Arthritis ( 7 – 12 )
Rheumatoid arthritis ( RA ) is a painful systemic disease that attacks all of the body ’ s joints , resulting in inflammation and swelling , cartilage and bone breakdown , and joint dislocation . This sequence leads to skeletal loss of shape and alignment , pain and loss of movement . The majority of patients suffering with RA will develop foot pathology , and in more than one-third of the cases , the foot will be the initial site of involvement . Typically , patients present with various combinations of metatarsalgia , rearfoot valgus , arch collapse and first metatarsal phalangeal joint ( MPJ ) changes .
Hallux valgus deformity is the most commonly observed forefoot deformity in patients with RA . Budiman-Mak et al . 7 conducted a five-year , doubleblind , randomized clinical treatment trial comparing custom orthoses with placebos for the prevention of hallux valgus deformity in the rheumatoid arthritic foot ( n = 102 ). In a logistic regression analysis , the treatment group was 73 percent less likely to develop hallux valgus deformity compared with the control group .
Chalmers et al . 8 compared the effects of custom semi-rigid and soft orthoses worn in supportive shoes and supportive shoes worn alone on MPJ pain ( n = 24 ). They concluded that custom semi-rigid orthoses worn in supportive shoes were an effective treatment for metatarsalgia . Supportive shoes worn alone or worn with soft orthoses did not provide pain relief for metatarsalgia .
In another randomized controlled trial of RA patients Woodburn et al . 9 prescribed custom foot orthoses to 50 patients ( n = 98 ). They found that the custom-designed foot orthoses used continuously throughout a 30-month treatment period resulted in a reduction in foot pain by 19.1 percent , foot disability by 30.8 percent and functional limitation by 13.5 percent .
Powell et al . 10 looked at the efficacy of custom foot orthoses in children with juvenile idiopathic arthritis ( JIA ) ( n = 40 ). Their results showed that children with JIA wearing custom-made , semi-rigid foot orthoses with shock-absorbing posts had significantly decreased levels of pain and increased speed of ambulation , selfrated activity and functional ability levels compared with prefabricated , off-theshelf shoe inserts or supportive athletic shoes worn alone .
Posterior Tibial Tendon
( 13 – 16 )
Dysfunction
Posterior tibial tendon dysfunction ( PTTD ) is now considered part of a
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