Foot Orthoses: Difference between revisions

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[https://physio-pedia.com/Patellofemoral_Pain_Syndrome '''Patellofemoral Pain Syndrome:'''] The Journal of Orthopaedic & Sports Physical Therapy 2019 guidelines recommended clinicians to prescribe prefabricated foot orthoses for patients with greater than normal pronation to reduce pain, but only in the short term (up to 6 weeks). The use of foot orthoses should be combined with other interventions<ref name=":1">Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, Lynch AD, Snyder-Mackler L, McDonough CM, Altman R, Beattie P. Patellofemoral pain: Clinical practice guidelines linked to the international classification of functioning, disability and health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2019 Sep;49(9):CPG1-95.</ref>.  
[https://physio-pedia.com/Patellofemoral_Pain_Syndrome '''Patellofemoral Pain Syndrome:'''] The Journal of Orthopaedic & Sports Physical Therapy 2019 guidelines recommended clinicians to prescribe prefabricated foot orthoses for patients with greater than normal pronation to reduce pain, but only in the short term (up to 6 weeks). The use of foot orthoses should be combined with other interventions<ref name=":1">Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, Lynch AD, Snyder-Mackler L, McDonough CM, Altman R, Beattie P. Patellofemoral pain: Clinical practice guidelines linked to the international classification of functioning, disability and health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2019 Sep;49(9):CPG1-95.</ref>.  
The applied use of foot orthoses on PFPS as suggested clinically and in literature is the use of single leg squat or double leg squat. If reproduced PFP then the clinician might test a foot orthosis and ask the patient to repoerform the test. If the pain reduces then it's an indication of the likelihood benefit of orthosis with this patient<ref>Vicenzino B, Collins N, Crossley K, Beller E, Darnell R, McPoil T. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: a randomised clinical trial. BMC musculoskeletal disorders. 2008 Dec;9(1):27.</ref>. Another test that was developed to identify patients with Patellofemoral Pain who are likely to benefit from foot orthoses by measuring the width of the patient's foot from a non weight bearing position, and  compare it to standing mid-foot width. if there was a great increase in mid foot width, that foot orthoses would help<ref>Vicenzino B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. British journal of sports medicine. 2010 Sep 1;44(12):862-6.</ref>. However, in a following study Matthews and Colleagues reported that the test is not reliable<ref>Matthews M, Rathleff MS, Claus A, McPoil T, Nee R, Crossley KM, Kasza J, Vicenzino BT. Does foot mobility affect the outcome in the management of patellofemoral pain with foot orthoses versus hip exercises? A randomised clinical trial. British Journal of Sports Medicine. 2020 Mar 25.</ref>


Rheumatoid Arthritis  
Rheumatoid Arthritis  

Revision as of 20:00, 28 May 2020

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[edit | edit source]

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[1]. 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[2].

The correct term is orthotic devices and not orthotics.

Clinical Uses[edit | edit source]

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[3].

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[4].

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[5].

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[6]. 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[7].

Patellofemoral Pain Syndrome: The Journal of Orthopaedic & Sports Physical Therapy 2019 guidelines recommended clinicians to prescribe prefabricated foot orthoses for patients with greater than normal pronation to reduce pain, but only in the short term (up to 6 weeks). The use of foot orthoses should be combined with other interventions[8].

The applied use of foot orthoses on PFPS as suggested clinically and in literature is the use of single leg squat or double leg squat. If reproduced PFP then the clinician might test a foot orthosis and ask the patient to repoerform the test. If the pain reduces then it's an indication of the likelihood benefit of orthosis with this patient[9]. Another test that was developed to identify patients with Patellofemoral Pain who are likely to benefit from foot orthoses by measuring the width of the patient's foot from a non weight bearing position, and compare it to standing mid-foot width. if there was a great increase in mid foot width, that foot orthoses would help[10]. However, in a following study Matthews and Colleagues reported that the test is not reliable[11]

Rheumatoid Arthritis

Prescribing Foot Orthoses[edit | edit source]

Time-frame

Prefabricated vs Customized[edit | edit source]

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[12], another study found no difference between the two types of orthoses for the same condition[4].

The PFPS 2019 guidelines There is insufficient evidence to recommend custom foot orthoses over prefabricated foot orthoses[8].

Controversy Around Foot Orhtoses[edit | edit source]

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 [13].

References[edit | edit source]

  1. ↑ Fox JR, Lovegreen W. Lower Limb Orthoses. InAtlas of Orthoses and Assistive Devices 2019 Jan 1 (pp. 239-246). Content Repository Only!.
  2. ↑ Whittaker GA, Munteanu SE, Menz HB, Tan JM, Rabusin CL, Landorf KB. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med. 2018 Mar 1;52(5):322-8.
  3. ↑ Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, McDonough CM, Altman RD, Beattie P, Cornwall M, Davis I. Heel pain—plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy. 2014 Nov;44(11):A1-33.
  4. ↑ 4.0 4.1 Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Archives of internal medicine. 2006 Jun 26;166(12):1305-10.
  5. ↑ Rasenberg N, Riel H, Rathleff MS, Bierma-Zeinstra SM, van Middelkoop M. Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis. British journal of sports medicine. 2018 Aug 1;52(16):1040-6.
  6. ↑ Kogler GF, Solomonidis SE, Paul JP. In vitro method for quantifying the effectiveness of the longitudinal arch support mechanism of a foot orthosis. Clinical Biomechanics. 1995 Jul 1;10(5):245-52.
  7. ↑ Bishop C, Thewlis D, Hillier S. Custom foot orthoses improve first-step pain in individuals with unilateral plantar fasciopathy: a pragmatic randomised controlled trial. BMC musculoskeletal disorders. 2018 Dec 1;19(1):222.
  8. ↑ 8.0 8.1 Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, Lynch AD, Snyder-Mackler L, McDonough CM, Altman R, Beattie P. Patellofemoral pain: Clinical practice guidelines linked to the international classification of functioning, disability and health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2019 Sep;49(9):CPG1-95.
  9. ↑ Vicenzino B, Collins N, Crossley K, Beller E, Darnell R, McPoil T. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: a randomised clinical trial. BMC musculoskeletal disorders. 2008 Dec;9(1):27.
  10. ↑ Vicenzino B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. British journal of sports medicine. 2010 Sep 1;44(12):862-6.
  11. ↑ Matthews M, Rathleff MS, Claus A, McPoil T, Nee R, Crossley KM, Kasza J, Vicenzino BT. Does foot mobility affect the outcome in the management of patellofemoral pain with foot orthoses versus hip exercises? A randomised clinical trial. British Journal of Sports Medicine. 2020 Mar 25.
  12. ↑ Pfeffer G, Bacchetti P, Deland J, Lewis AI, Anderson R, Davis W, Alvarez R, Brodsky J, Cooper P, Frey C, Herhck R. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot & Ankle International. 1999 Apr;20(4):214-21.
  13. ↑ Ingraham P. Pain Science. Are Orthotics Worth It? A consumer’s guide to the science and controversies of orthotics, special shoes, and other allegedly corrective foot devices. Available from: https://www.painscience.com/articles/orthotics.php
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