Foot Orthoses

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem, Kim Jackson, Jess Bell, Naomi O'Reilly, Admin, Tarina van der Stockt, Lucinda hampton and Matthew Chin

Definition

In the Atlas of Orthoses and Assistive Devices: Foot orthoses (FO) are like the tires on an automobile: They provide a critical, biomechanical contact point for the human body, and they can be helpful to correct In the problems in the foot, knee, hip, and spine. Wittaker and Colleagues reviewed 19 clinical trials and reported moderate-quality evidence supporting the use of foot orthoses as an effective intervention at reducing pain in the medium term of plantar heel pain.

The correct term is orthotic devices and not orthotics.

Clinical Uses

The uses of orthoses vary from pain relief, comfort and enhancement of performance. They are widely used clinically in the treatment of different conditions:

Plantar Heel Pain: The use of foot orthoses is recommended by the The Journal of Orthopedic Sports and Physical Therapy to support the medial longitudinal arch and cushion the heel in individuals with heel pain/plantar fasciitis to reduce pain and improve function for short- (2 weeks) to long term (1 year) periods, especially in those individuals who respond positively to antipronation taping techniques.

A randomized clinical trial compared the use of orthoses to sham devices for three months in the treatment of plantar fasciitis found small short-term benefits in function and small reductions in pain but long-term beneficial effects compared with a sham device.

However, Rasenberg et al reviewed twenty studies investigating the effects of eight different types of foot orthoses on pain, function and self-reported recovery with Plantar heel pain compared with other conservative interventions. Their findings didn't support the Foot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP. Their findings suggested there isn't enough evidence to support the use of foot orthoses for plantar heel pain.

This adds to the controversy of the use of foot orthoses. The argument is that the use of orthoses in research is different from clinical practice. The applied assessment of foot mechanics in clinic, linking those findings to the presentation and applying corrections then testing their efficacy is what most clinicians would do to treat foot conditions. For example, shifting the forefoot load laterally can help reduce the plantar fascial load is a simple adaptation of mechanics in clinical practice. A study investigated the effect of wearing custom foot orthoses on first-step pain, average 24-h pain and plantar fascia thickness in people with unilateral plantar fasciopathy over 12 weeks found improve first-step pain and reduce plantar fascia thickness over a period of 12 weeks compared to new shoes alone or a sham intervention.

Rheumatoid Arthritis

Prescribing Foot Orthoses

Time-frame

Prefabricated vs Customized

There was no but several randomized controlled trials have shown prefabricated orthoses to have similar efficacy to customized orthoses in the management of plantar fasciitis

A study found prefabricated orthoses better in comparison with customized orthoses in the treatment of plantar fasciitis pain, another study found no difference between the two types of orthoses for the same condition.

Controversy Around Foot Orhtoses

In healthcare practice, some professionals might be against the use of orthoses for treatment of foot conditions. Their preservative opinion comes from the fact that orthoses might have been overused over time and the idea that they might contribute to weakening the muscles and the individual's relying on them. However, the argument is that if they're prescribed properly, tailored for the individual's needs and their condition they can be a useful tool combined with other interventions.

It is easy to fall in the sales pitch of orthoses as many of them might not deliver the benefit they claim to offer. A good clinical reasoning, detalied history taking, effective communication and assessment of the condition are needed to decide on the use of the right orthosis to avoid falling for the market industry and testing for the right orthoses .