research : The Effectiveness of Foot Orthotics
greater progressive condition called adult acquired flatfoot ( AAF ), which can ultimately result in significant changes in multiple foot ligaments . Contributing factors include obesity , diabetes and age . Often , these patients are poor surgical candidates , so any and all conservative measures should be fully explored . Alvarez et al . 13 conducted a study ( n = 47 ) to identify strength deficits with early-stage PTTD and to assess the efficacy of a focused nonoperative treatment protocol . The rehabilitation protocol included the use of a short , articulated AFO or foot orthosis , high-repetition exercises , aggressive plantarflexion activities and an aggressive high-repetition home exercise program that included gastrocsoleus tendon stretching . This study indicated that many patients with stage I and II PTTD can be effectively treated nonoperatively with an orthosis and structured exercises . painful cavus foot ( n = 154 ). They concluded that custom foot orthoses were more effective than a control for the treatment of cavus foot pain and its associated functional limitations .
Slattery et al . 18 tested subjects ( n = 16 ) with hemophilia A and stages one through five of ankle joint damage . Throughout a six-week period , researchers evaluated the efficacy of functional foot orthoses . Their findings supported the use of functional foot orthoses to treat patients with hemophilia A , as significant reductions in pain levels appear to greatly improve the lives of the patients .
Likewise , studies on patients with forefoot
19 , 20
pathologies such as metatarsalgia and functional hallux limitus 21 found successful conservative treatment to be viable alternatives to surgeries .
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 .
In a long-term follow-up study ( n = 32 ), Lin et al . 14 noted treatment of stage II PTTD with a double-upright AFO was shown to be a viable alternative to surgery . There was a high likelihood of adequate function , avoidance of surgery and being brace-free at the seven- to 10-year follow-up . This represents a significant cost savings for health care providers and a much-improved quality of life for patients .
( 17 – 22 )
The Painful Foot
There are many other studies that validate the use of custom foot orthoses for a variety of painful foot conditions . Burns et al . 17 examined the effect of orthotic therapy for the
( 23 – 25 )
Diabetes
The medical costs and complications from the progression of diabetes mellitus are well understood . Protection of the neuropathic foot and offloading pre-ulcerative calluses are critical in the efforts to preventing ulcerations and eventual amputations . The use of properly designed total-contact foot orthoses in conjunction with orthopedic shoes , AFOs , cam walkers , etc ., is essential . In addition to having a better quality of life , patients who continue to walk and stay active remain healthier and delay the onset of the more pernicious aspects of the disease .
These studies are only a sampling of the available literature . They clearly demonstrate the benefits of foot orthoses in treating various painful and debilitating conditions of the lower limb . In many cases , it is accepted that orthotics are not a stand-alone cure but , taken as part of an overall program of rehabilitation , they considerably improve function and quality of life for many patients . Certainly , more work needs to be done to refine our understanding and develop predictive models for treating specific patient groups and designing therapeutic devices . Notwithstanding , I feel that it is important that we champion the effectiveness of foot orthotics . ■
References
Plantar Fasciitis
1 . Lynch DM , Goforth WP , Martin JE , Odom RD , Preece CK , Kotter MW . Conservative treatment of plantar fasciitis . A prospective study . J Am Podiatr Med Assoc . 1998 ; 88 ( 8 ): 375 – 380 . www . ncbi . nlm . nih . gov / pubmed / 9735623
2 . Gross MT , Byers JM , Krafft JL , Lackey EJ , Melton KM . The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis . J Orthop Sports Phys Ther . 2002 ; 32 ( 4 ): 149 – 157 . www . ncbi . nlm . nih . gov / pubmed / 11949663
3 . Hume P , Hopkins W , Rome K , Maulder P , Coyle G , Nigg B . Effectiveness of foot orthoses for treatment and prevention of lower limb injuries : a review . Sports Med . 2008 ; 38 ( 9 ): 759 – 779 . www . ncbi . nlm . nih . gov / pubmed / 18712943
4 . Lee SY , McKeon P , Hertel J . Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis ? A meta-analysis [ published online ahead of print November 20 , 2008 ]. Phys Ther Sport . 2009 ; 10 ( 1 ): 12 – 18 . www . ncbi . nlm . nih . gov / pubmed / 19218074
5 . Roos E , Engström M , Söderberg B . Foot orthoses for the treatment of plantar fasciitis . Foot Ankle Int . 2006 ; 27 ( 8 ): 606 – 611 . http :// www . ncbi . nlm . nih . gov / pubmed / 16919213
6 . Scherer PR . Heel spur syndrome . Pathomechanics and nonsurgical treatment . Biomechanics Graduate Research Group for 1988 . J Am Podiatr Med Assoc . 1991 ; 81 ( 2 ): 68 – 72 . www . ncbi . nlm . nih . gov / pubmed / 1999801
Rheumatoid Arthritis
7 . Budiman-Mak E , Conrad KJ , Roach KE , et al . Can Foot Orthoses Prevent Hallux Valgus Deformity in Rheumatoid Arthritis ? A Randomized Clinical Trial . J Clin Rheumatol . 1995 ; 1 ( 6 ): 313 – 322 . www . ncbi . nlm . nih . gov / pubmed / 19078008
32 Pedorthic Footcare Association www . pedorthics . org