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At least 19 recordsLinked to original sources
PubMed2001

The clash between theory and science on the kinematic effectiveness of foot orthoses.

Foot orthoses have been shown to be effective in the management of lower extremity pathologic conditions, but the mechanism by which orthoses achieve this effect is unclear. Kinematic studies that investigate changes in skeletal alignment from the use of foot orthoses have shown mixed results with generally small changes which may not be sufficient to account for the outcomes achieved with foot orthoses. A number of theoretic constructs have not been taken into account in the design and reporting of kinematic studies, and these omissions may account for mixed results. Kinematic studies need to report information about participants, (e.g., the subtalar joint axis position) so readers can judge the appropriateness of the orthoses prescriptions and the kinematic variable measured. The high prevalence of forefoot varus reported in some studies and the variability in orthoses prescriptions and in casting for these devices used in studies also needs to be addressed. In light of some of the theoretic explanations offered here, the recent suggestions that foot orthoses may work by methods other than aligning the skeleton may need to be re-evaluated.

Biomechanical Phenomena↗
PubMed2002

Health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders.

This exploratory study attempted to estimate the severity of health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders in the Netherlands. Information on the severity and the distribution of the complaints in these patients is important to acquire insight in the problems which these patients experience, and moreover is essential for further research, especially for evaluating effects of patients undergoing foot orthosis treatment. Patients with degenerative foot disorders aged 18 years and over were recruited from nine orthopaedic workshops over a period of three months in 2000. One hundred and twenty-two (122) patients were included in the study. Two approaches were used to obtain data. Firstly, shoe technicians and orthotists inspected patients' feet and legs and interviewed them at their initial visit. Data on gender, age, height, weight, existing and prescribed orthotic devices were recorded on a report form. Secondly, patients were asked to fill in a questionnaire assessing type, location, frequency, intensity and duration of health complaints, and disability. Data indicate that females with degenerative foot disorders and foot orthoses are twice as common as men. Patients supplied with foot orthoses are twice as often overweight compared to subjects in the general population. Besides frequent and protracted pain there are also fatigue complaints, particularly in the feet and lower leg. Duration and frequency of the complaints suggest that these patients suffer from a chronic pain syndrome. In addition, the results indicate that the functional level of these patients is below that of the general population, in particular regarding physical activities.

Adult↗
PubMed2001

The effect of foot orthoses on standing foot posture and gait of young children with Down syndrome.

The purpose of this study was to determine if foot orthoses (FOs) immediately affected gait of children with Down Syndrome (DS) and excessively pronated feet. Subjects were 3--6 years old; 16 with DS and 10 without disabilities. Gait of children with DS wearing sneakers was compared with and without FOs and compared to gait of children without disabilities. Ankle moment, walking speed during stance phase, sneaker prints, center of pressure, and transverse plane foot angles were collected and compared. In standing, heel eversion was reduced when the children wore FOs (p=0.000). During gait the transverse plane foot angle decreased indicating more internal rotation with FOs (p=0.000). Trial-to-trial variability of pronation-supination index (p=0.0001), foot length contact (p=0.0001), transverse plane foot angle (p=0.0003), and walking speed (p=0.0001) all decreased with FO use. Trial-to-trial variability of normalized peak ankle moment (p=0.0001), and of phase of peak ankle moment (p=0.0001) increased when the children wore FOs.

Child↗
PubMed2005

A critical review of foot orthoses in the rheumatoid arthritic foot.

Foot orthoses are commonly prescribed by health professionals as a form of intervention for the symptomatic foot in rheumatoid arthritis. However, there is a limited evidence base to support the use of foot orthoses in this patient group. This article provides a critical review of the use of foot orthoses in the management of rheumatoid arthritic foot pathologies. A search was conducted in the Cochrane Controlled Trials Register (current issue of the Cochrane Library), Physiotherapy evidence database (PEDro), Medline, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine (AMED) and from reference lists in journal articles. The language was restricted to English. Searching of the databases was undertaken between December 2004 and March 2005. The results indicated there is no consensus of opinion on the choice of foot orthoses used for the management of pathology in the rheumatoid foot, although there is strong evidence that foot orthoses do reduce pain and improve functional ability. The type of foot orthoses used ranged from simple cushioned insoles to custom-made rigid cast devices. Methodological issues raised included small sample size and poor use of valid and reliable outcome measures. There is limited evidence pertaining to cost-effectiveness. The results indicated a need for further investigation into the most clinically and cost-effective foot orthoses to prescribe in the management of the rheumatoid arthritic foot. This review highlights the need to identify the various types of foot orthoses that are most effective in the management of the established rheumatoid arthritic foot.

Arthritis, Rheumatoid↗
PubMed2005

Analysis of stiffness reduction in varying curvature ankle foot orthoses.

Ankle foot orthoses (AFO) are often used for patients who cannot generate a strong enough extension moment at the knee to allow functional gait. Orthotists often cut out portions of the AFO around the malleoli in order to improve comfort. There has been some question as to how this affects the stress distribution around the orthosis, the fatigue performance of the device, and the AFOs stiffness. To examine this, three orthoses were constructed with differing curvatures cut out of the malleolar regions. Photoelastic coatings were placed on the most stiff and least stiff orthoses, and the stress distributions while wearing the device were examined. A fixture was created to test the orthosis, and the stress distribution while loaded in the fixture closely matched the distribution with actual wear. These orthoses were then tested in fatigue for 500,000 cycles at 5 Hz in displacement control. Initial displacements were set to provide maximum loads of 45 lbs. The displacement settings for the stiffest orthosis were 0.4 to 0.6 inches of deflection; the load decreased from 44 lbs to 28 lbs after the final cycle. The least stiff displacement varied from 1.3 to 1.5 inches, and the load value changed from 46 lbs to 35 lbs. The data will be useful in guiding orthotists in building AFOs, particularly when shaving portions of the AFO for comfort. Excessive shaving may seriously degrade the performance of the device, especially after longer life cycles.

Ankle↗
PubMedDate not supplied

Static stance response to different types of foot orthoses.

Many different types of foot orthoses are used to treat biomechanical dysfunction of the foot. Little evidence is available to guide clinicians in the selection of foot orthoses. The aim of this project was to determine whether resistance of the foot to supination or the Foot Posture Index could predict the static stance response to different types of prefabricated foot orthoses. The Foot Posture Index score was determined and resistance to supination was measured in 18 subjects (36 feet). Changes in the frontal plane calcaneal angle and navicular height were then measured as the subjects stood on six different types of foot orthoses. All orthoses resulted in an increase in navicular height, but only three orthoses changed the calcaneal angle in the frontal plane. Resistance to supination did not predict the response to the different types of orthoses, but the Foot Posture Index score was associated with changes from using some of the orthoses.

Adult↗
PubMedDate not supplied

Effect of foot posture and inverted foot orthoses on hallux dorsiflexion.

A pronated foot posture is considered to be a factor in limitation of dorsiflexion at the first metatarsophalangeal joint during weightbearing. Customized foot orthoses are widely used to increase dorsiflexion at the first metatarsophalangeal joint in people with pronated feet. However, the effect of foot posture and customized foot orthoses on maximum first metatarsophalangeal joint dorsiflexion has not been widely investigated. This study sought to determine 1) the relationship between foot posture and static maximum first metatarsophalangeal joint dorsiflexion and 2) the effect of customized foot orthoses on static maximum first metatarsophalangeal joint dorsiflexion in people with pronated feet. Foot posture was assessed using the Foot Posture Index. Static maximum first metatarsophalangeal joint dorsiflexion of the right foot was determined using a goniometer while participants stood relaxed with and without Blake-style inverted (30 degrees) foot orthoses positioned under their feet. There was a significant negative correlation between Foot Posture Index and static maximum first metatarsophalangeal joint dorsiflexion (r = -0.587). Inverted (30 degrees) foot orthoses increased the magnitude of static maximum first metatarsophalangeal joint dorsiflexion from 83.4 degrees to 85.3 degrees in participants with an excessively pronated foot posture. However, this difference was not statistically significant. People with pronated feet are more likely to exhibit limitation of dorsiflexion at the first metatarsophalangeal joint during gait, and inverted foot orthoses are unlikely to be effective in increasing dorsiflexion at the first metatarsophalangeal joint in these people.

Adult↗
PubMed2003

The role of foot orthoses as an intervention for patellofemoral pain.

Foot orthoses often are prescribed for patients with patellofemoral pain. The purpose of this clinical commentary is to review the theoretical and research basis that might support this intervention and to provide our own clinical experience in providing foot orthoses for these patients. Literature is reviewed regarding (1) the effects of foot orthoses on pain and function, (2) the relationship between foot and lower-extremity/patellofemoral joint mechanics, (3) the effects of foot orthoses on lower-extremity mechanics, and (4) the effects of foot orthoses on patellofemoral joint position. The literature and our own clinical experience suggest that patients with patellofemoral pain may benefit from foot orthoses if they also demonstrate signs of excessive foot pronation and/or a lower-extremity alignment profile that includes excessive lower-extremity internal rotation during weight bearing and increased Q angle. The mechanism for foot orthoses having a positive effect on pain and function for these patients may include (1) a reduction in internal rotation of the lower extremity; (2) a reduction in Q angle; (3) reduced laterally-directed soft tissue forces from the patellar tendon, the quadriceps tendon, and the iliotibial band; and (4) reduced patellofemoral contact pressures and altered patellofemoral contact pressure mapping. Foot orthoses may be a valuable adjunct to other intervention strategies for patients who present with the previously stated structural alignment profile.

Biomechanical Phenomena↗
PubMed2005

The effect of foot orthoses in rheumatoid arthritis.

OBJECTIVE: To evaluate the effectiveness of foot orthoses using the foot function index (FFI) in a group of patients with rheumatoid arthritis (RA) during a period of 6 months. METHODS: Thirty-six rheumatoid subjects with foot pain were examined and appropriate foot orthoses were prescribed according to each patient's needs. All the patients were evaluated 30, 90 and 180 days after the baseline visit. FFI values, daily time of wearing the orthoses and adverse effects were noted at each appointment. The Stanford Health Assessment Questionnaire (HAQ) was used at the initial visit to evaluate the influence of physical condition on FFI response. RESULTS: With the use of foot orthoses, FFI values decreased in all subscales (pain, disability and activity limitation). This reduction was noted in the first month and was maintained throughout the trial. Those using EVA (ethyl-vinyl acetate; n = 28) orthoses presented results similar to those for the total group. Patients wearing made-to-measure orthoses (n = 8) exhibited higher initial FFI values and worse evolution during the trial, significant for pain and disability but not for activity limitation. Minor adverse reactions were noted; none required interruption of treatment. There was no relation between HAQ and FFI evolution. CONCLUSIONS: Foot orthoses were effective as an adjuvant in the management of rheumatoid foot. They significantly reduced pain, disability and activity limitation, as measured by the FFI, with minor adverse effects.

Activities of Daily Living↗
PubMedDate not supplied

Casting methods and plantar pressure: effects of custom-made foot orthoses on dynamic plantar pressure distribution.

Foot orthoses are widely used to treat various foot problems. A literature search revealed no publications on differences in plantar pressure distribution resulting from casting methods for foot orthoses. Four casting methods were used for construction of orthoses. Two foam box techniques were used: accommodative full weightbearing method (A) and functional semiweightbearing method (B). Also, two suspension plaster casting techniques were used: accommodative casting (C) and functional subtalar joint neutral position (Root) method (D). Their effects on contact area, plantar pressure, and walking convenience were evaluated. All orthoses increased the total contact area (mean, 17.4%) compared with shoes without orthoses. Differences in contact areas between orthoses for total plantar surface were statistically significant. Peak pressures for the total plantar surface were lower with orthoses than without orthoses (mean, 22.8%). Among orthoses, only the difference between orthoses A and B was statistically significant. Differences between orthoses for the forefoot were small and not statistically significant. The gait lines of the shoe without an insole and of the accommodative orthoses are more medially located than those of functional orthoses. Walking convenience in the shoe was better rated than that with orthoses. There were no differences in perception of walking convenience between orthoses A, B, and C. Orthosis D had the lowest convenience rating. The four casting methods resulted in differences between orthoses with respect to contact areas and walking convenience but only slight differences in peak pressures.

Adult↗
PubMed1993

[A comparison of ankle fixation between two kinds of low-temperature plastic anterior ankle foot orthoses].

The low-temperature ankle foot orthosis (AFO) was designed in the anterior leaf type, called anterior AFO, to meet the need of indoor barefoot walking. It could be easily molded and remolded to fit the foot, as well as to adjust the position of the foot and ankle. Two kinds of low-temperature plastic anterior ankle foot orthoses, anterior encased and anterior direct molding ankle foot orthoses, were compared to analyze the effectiveness of ankle fixation in plantar flexion and inversion. Force was applied to each of the anterior AFOs at the anterior-middle and anterior-lateral sides to simulate the movement of ankle plantar flexion and inversion. At the same time, the deformation in plantar flexion and inversion of both anterior AFOs were recorded to analyze the relationship between force and the deformed angle. The results showed that plantar flexion deformed angles of the anterior direct molding AFO were 2.6 times more flexible than anterior encased AFO. The ankle inversion deformed angles of the anterior direct molding AFO were 3 times more flexible than the anterior encased AFO in inversion. These results support our belief that anterior encased AFO is more effective in controlling ankle plantar flexion and inversion than anterior direct molding AFO, especially for severe spastic hemiplegia in gait correction.

Ankle Joint↗
PubMed1996

Measurement of dynamic pressures at the shoe-foot interface during normal walking with various foot orthoses using the FSCAN system.

Foot orthoses are routinely used in clinical practice to redistribute pressure at the shoe-foot interface, although there is very little scientific evidence to support the efficacy of their use. In this study, the FSCAN sensor (an ultrathin in-shoe transducer) was used to determine the efficacy of pressure redistribution with a Plastizote, Spenco, cork, and a plastic foot orthosis as compared with control (no orthosis). Measurement variations of up to 18% occurred between sensors, and changes in stance time of up to 5% occurred between the orthoses and the control conditions. In spite of these potentially confounding variables, statistically significant differences in peak pressure between the orthotic types and the control condition (range, 9-146%) were noted. We conclude that Plastizote, cork, and plastic foot orthoses can be beneficial in relieving pressure in certain regions of the shoe-foot interface, but that they may do so at the cost of increasing pressure in other areas of the plantar surface.

Adult↗
PubMed2004

Foot orthoses in rehabilitation--what's new.

Foot orthoses have been effective in the treatment of a variety of sport-related foot conditions. Although their use is well-established in clinical practice, many of the orthoses have not been evaluated in experimental conditions. Of the clinical studies that have examined the biomechanical changes associated with their use, many do not have predictable results. The failure of some studies to find trends for a particular variable does not preclude this variable being affected by the orthoses in an individual patient; rather, it may speak to the highly subject-specific responses with orthotic use. It is important to recognize that foot orthoses cannot be considered independent of a rehabilitation protocol that includes stretching and strengthening-specific therapies, as well as a consideration of training surfaces and training regimes. Additionally, foot orthoses must be considered in concert with the foot-wear recommendation.

Biomechanical Phenomena↗
PubMed2000

Efficacy of foot orthoses. What does the literature tell us?

This paper reviews the literature relating to foot orthoses, in particular foot orthoses that attempt to alter biomechanical function. Whilst few well-controlled studies have been performed, the findings from the available literature are generally positive. The authors provide an overview of this literature and then summarise the findings. The literature is categorised into six research outcome areas: (i) patient satisfaction, (ii) pain and deformity, (iii) plantar pressures, (iv) position and motion, (v) muscle activity, and (vi) oxygen consumption. In addition, the difficulties associated with researching foot orthoses are discussed.

Biomechanical Phenomena↗
PubMed2000

Effects of foot orthoses on skeletal motion during running.

OBJECTIVE: To quantify the effects of medial foot orthoses on skeletal movements of the calcaneus and tibia during the stance phase in running. DESIGN: Kinematic effects of medial foot orthoses (anterior, posterior, no support) were tested using skeletal (and shoe) markers at the calcaneus and tibia. BACKGROUND: Previous studies using shoe and skin markers concluded that medially placed orthoses control/reduce foot eversion and tibial rotation. However, it is currently unknown if such orthoses also affect skeletal motion at the lower extremities. METHODS: Intracortical Hofman pins with reflective marker triads were inserted under standard local anesthetic into the calcaneus and tibia of five healthy male subjects. The three-dimensional tibiocalcaneal rotations were determined using a joint coordinate system approach. Eversion (skeletal and shoe) and tibial rotation were calculated to study the foot orthoses effects. RESULTS: Orthotic effects on eversion and tibial rotations were found to be small and unsystematic over all subjects. Differences between the subjects were significantly larger (p<0.01; up to 10 degrees ) than between the orthotic conditions (1-4 degrees ). Significant orthotic effects across subjects were found only for total internal tibial rotation; p<0.05). CONCLUSIONS: This in vivo study showed that medially placed foot orthoses did not change tibiocalcaneal movement patterns substantially during the stance phase of running. RELEVANCE: Orthoses may have only small kinematic effects on the calcaneus and tibia (measured with bone pins) as well as on the shoes (measured with shoe markers) during running of normal subjects. Present results showed that orthotic effects were subject specific and unsystematic across conditions. It is speculated that orthotic effects during the stance phase of running may be mechanical as well as proprioceptive.

Adult↗
PubMed1994

The center of pressure index in the evaluation of foot orthoses in shoes.

The objective and quantitative measurement of the effect of orthoses on the foot is important in evaluating orthosis design, negative casting techniques, orthosis materials, and relative clinical outcomes. The center of pressure pattern is the centroid of the pressure distribution at a series of moments in time as ground reaction is applied over the plantar surface of the foot. This article describes methods to obtain this index and how to apply this information to the evaluation of foot orthoses.

Foot↗
PubMed1993

A system for the continuous measurement of ankle joint moment in hemiplegic patients wearing ankle-foot orthoses.

Plastic ankle-foot orthoses (PAFOs) are now commonly used in clinical practice to supplement the gait disabilities of hemiplegic patients. However, few biomechanical investigation have been performed to analyze the corrective functions of PAFOs. In this paper, a measuring system was developed to assess the effect of dorsi/plantar flexibility of a PAFO on patient's gait. First, a mathematical model of gait with a PAFO was established so that the overall ankle joint moment can be separated into the muscle moment and the corrective moment generated by a PAFO. An experimental AFO, which simulates PAFOs, was specially designed and fabricated to continuously measure the corrective moment of the experimental AFO during gait. A device was also developed to continuously measure the overall ankle joint moment, so that the muscle moment can be estimated from the data obtained by the two devices. The measurement accuracy of the device was evaluated using gait data of eight healthy subjects who simulated hemiplegic gait. The range of the mean +/- 1 SD of the errors, calculated for the eight subjects, fell within +/- 5 Nm, which well compares with the error of commonly used comprehensive gait analysis systems.

Adult↗