What do you do with a golfer and the need for foot orthotics? Golf involves a lot of walking, so they need a reasonably firm or rigid pair of foot orthotics to control the foot during that activity (assuming that foot orthotics are indicated). The crucial part of the golf game is the swing. The swing stance involves a reasonable amount of inversion and eversion of teh foot to be done efficiently. How much does a rigid orthotic with a rearfoot post interfere with that motion and affect that efficient golf swing? Foot orthotics for golf are going to have to be a compromise. It is surprising how often this issue comes up on some golfing forums for discussion.
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Showing posts with label foot orthotics. Show all posts
Showing posts with label foot orthotics. Show all posts
Tuesday, August 31, 2010
Thursday, August 26, 2010
The Cluffy Wedge
The Cluffy Wedge has been getting a bit of attention lately. It was original trademarked by Dr James Clough as a mean to dorsiflex the hallux to help functional hallux limitus. It was first written about in JAPMA. The concept is based on preloading the hallux to get it to load earlier in the stance phase. The biggest effect of this is to bring the windlass mechanism on sooner as it hold the hallux in a slightly dorsiflexed position. While the Cluffy Wedge can be purchased as an orthotic add-on or shoe insert, many people just fabricate their own. The Cluffy Wedge is being marketed through a number of different channels. Podiatry TV has a number of videos on the Cluffy Wedge.
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Tuesday, August 24, 2010
Foot Orthotics and Cycling
Cycling represents interesting challenges for podiatric management of problems. First the cycling bike needs to be set up properly to ensure efficient biomechanics and power generation for cycling fast. Any mechanical problem that needs foot orthotics are going to be difficult as there is not a lot of room in the shoe for cycling foot orthotics. Also there is no “swing phase” in the cycling “gait” as there is when walking and running. This can result in a type of plantar forefoot neuropathy due to the constant weight bearing (this is also seen in gyms on equipment like the cross trainers in which there is a constant stance phase). A lot of these issues is discussed amongst cyclists on cycling forums and Podiatry Arena has had a few discussions on cycling.
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Sunday, August 08, 2010
Foot orthoses or gait retraining for patellofemoral pain?
Its long been held that excessive foot pronation causes the tibia to rotate excessively internally causing a misalignment of the patella and results in patellofemoral pain syndrome or anterior knee pain in runners. Therefore, based on this you use foot orthotics to correct the foot pronation to treat the problem. Two reasonably well conducted RCT’s shows that foot orthotics are successful at that.
However:
1. Almost the cross sectional and prospective evidence shows that foot pronation is not associated with patellofemoral pain (despite the fact that foot orthotics been shown to help).
2. Even though the foot and tibia are coupled, the research as to which is the driving force, shows that it is tibial internal and external rotation that drive foot pronation and supination. It is not foot motion that drives leg motion, it is the other way around (see this discussion). This is so counter-intuitive to what podiatrists, in general, have believed.
3. More and more physiotherapists are using proximal control exercises and gait retraining to treat patellofemoral pain without the use of foot orthotics, and the evidence shows that this is just as effective as foot orthotics in treating this problem.
What is going on? Is it proximal or distal that the problem is coming from? Should we really be using foot orthotics is the problem is proximal? Should physiotherapists be using proximal control exercises if the problem is distal?
I have been in a couple of conference debates with physiotherapists at both a physiotherapy and a podiatry conference. I have learnt a lot through that and I genuinely do believe that the solution to patellofemoral pain syndrome is proximal control exercises. However, I also believe that this proximal control will not work if the ankle inversion moment (or supination resistance) is above a certain threshold (which will probably vary from individual to individual). For example, if the ankle inversion moment is low (i.e. supination resistance is low), then the proximal control exercise should work easy to help and they may not even need foot orthotics. However, if the ankle inversion moment is high (i.e. supination resistance is high), then it does not matter what you do proximally, it’s not going to work as the foot won’t move. So, therefore the role of foot orthotic in patellofemoral pain could be to reduce the ankle inversion moment to below a certain threshold, so the proximal control can work. This theory makes sense to me and is consistent with the most recent evidence.
For more see:
Foot Orthoses for Knee Pain
Foot orthoses and patellofemoral pain syndrome
Foot pronation and knee pain
Does the tibia drive the foot or does the foot drive the tibia?
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However:
1. Almost the cross sectional and prospective evidence shows that foot pronation is not associated with patellofemoral pain (despite the fact that foot orthotics been shown to help).
2. Even though the foot and tibia are coupled, the research as to which is the driving force, shows that it is tibial internal and external rotation that drive foot pronation and supination. It is not foot motion that drives leg motion, it is the other way around (see this discussion). This is so counter-intuitive to what podiatrists, in general, have believed.
3. More and more physiotherapists are using proximal control exercises and gait retraining to treat patellofemoral pain without the use of foot orthotics, and the evidence shows that this is just as effective as foot orthotics in treating this problem.
What is going on? Is it proximal or distal that the problem is coming from? Should we really be using foot orthotics is the problem is proximal? Should physiotherapists be using proximal control exercises if the problem is distal?
I have been in a couple of conference debates with physiotherapists at both a physiotherapy and a podiatry conference. I have learnt a lot through that and I genuinely do believe that the solution to patellofemoral pain syndrome is proximal control exercises. However, I also believe that this proximal control will not work if the ankle inversion moment (or supination resistance) is above a certain threshold (which will probably vary from individual to individual). For example, if the ankle inversion moment is low (i.e. supination resistance is low), then the proximal control exercise should work easy to help and they may not even need foot orthotics. However, if the ankle inversion moment is high (i.e. supination resistance is high), then it does not matter what you do proximally, it’s not going to work as the foot won’t move. So, therefore the role of foot orthotic in patellofemoral pain could be to reduce the ankle inversion moment to below a certain threshold, so the proximal control can work. This theory makes sense to me and is consistent with the most recent evidence.
For more see:
Foot Orthoses for Knee Pain
Foot orthoses and patellofemoral pain syndrome
Foot pronation and knee pain
Does the tibia drive the foot or does the foot drive the tibia?
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Thursday, December 10, 2009
Negative Model Production
I much prefer the terminology of Negative Model Production than casting or negative casting. In order to make a foot orthotic, then some sort of volumetric model is needed of the foot. There are so many legitimate ways to do this these days as opposed to in the past when we mostly just had the traditional plaster cast. Some of these other methods are old, but are gaining in popularity (eg foam box casting) and some have come about with advances in technology (eg digital scanning). I also like to include the term 'eye balling' as a method of negative model production, as this is the modelling that we do before using a prefabricated foot orthotic.
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Saturday, August 08, 2009
MASS Foot Position Theory for Foot Orthotics
MASS foot orthotic position theory has been proposed by Ed Glaser, DPM from Sole Supports Inc. MASS stands for Maximum Arch Subtalar Supination. It is a position of the foot that is much more supinated than the traditional subtalar joint neutral position, but also maintains the forefoot on the ground (no varus or valgus captured). Ed advocates the use of semi-weightbearing foam box as opposed to plaster (though it is not difficult to reproduce the position non-weightbearing with plaster bandage). The position results in a very different foot orthotic shape that is what is traditionally used. For more see comments on the Boot Camp site: MASS Foot Position Theory and the threads on Podiatry Arena tagged with MASS position theory (they do get a little heated).
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Saturday, July 25, 2009
The MOSI Foot Orthotics
If the foot is abnormally pronating and causing problems, there is only one way it can be stopped. It has to be stopped by the use of a force on the medial side of the assumed subtalar joint axis. While this makes intuitive sense, the problem arises as the position of the axis varies substantially. There are clinical tests that can tell us where the axis is, so we can work out where the force from a foot orthoses has to be applied.
When the axis is located more medially located, the problem comes that there is very little room on the plantar surface medial to the joint axis for that force to be applied. To apply the force various orthotic design parameters have been developed. There is the DC Wedge, Kirby medial skive, the the Blake Inverted foot orthotic.
Recently a unique design, the MOSI foot orthotic has been proposed by Paul Harradine, and Simon Collins., Chris Webb , Lawrence Bevan. The MOSI orthotic stands for medial oblique shell inclination. The aim of this design is to incline upwards the shell of the orthotic on the medial side of the subtalar joint axis. It is an interesting innovative design that makes good theoretical sense.
Sunday, September 24, 2006
This study has generated a lot of good discussion:
Effectiveness of Foot Orthoses to Treat Plantar Fasciitis A Randomized Trial
Karl B. Landorf, PhD; Anne-Maree Keenan, MAppSc; Robert D. Herbert, PhD
Archives of Internal Medicine 2006;166(12), June 26:1305-1310.
"Background Plantar fasciitis is one of the most common foot complaints. It is often treated with foot orthoses; however, studies of the effects of orthoses are generally of poor quality, and to our knowledge, no trials have investigated long-term effectiveness. The aim of this trial was to evaluate the short- and long-term effectiveness of foot orthoses in the treatment of plantar fasciitis. Methods A pragmatic, participant-blinded, randomized trial was conducted from April 1999 to July 2001. The duration of follow-up for each participant was 12 months. One hundred and thirty-five participants with plantar fasciitis from the local community were recruited to a university-based clinic and were randomly allocated to receive a sham orthosis (soft, thin foam), a prefabricated orthosis (firm foam), or a customized orthosis (semirigid plastic). Results After 3 months of treatment, estimates of effects on pain and function favored the prefabricated and customized orthoses over the sham orthoses, although only the effects on function were statistically significant. Compared with sham orthoses, the mean pain score (scale, 0-100) was 8.7 points better for the prefabricated orthoses (95% confidence interval, –0.1 to 17.6; P = .05) and 7.4 points better for the customized orthoses (95% confidence interval, –1.4 to 16.2; P = .10). Compared with sham orthoses, the mean function score (scale, 0-100) was 8.4 points better for the prefabricated orthoses (95% confidence interval, 1.0-15.8; P = .03) and 7.5 points better for the customized orthoses (95% confidence interval, 0.3-14.7; P = .04). There were no significant effects on primary outcomes at the 12-month review. Conclusions Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device. The customized and prefabricated orthoses used in this trial have similar effectiveness in the treatment of plantar fasciitis."
Discussion here.
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Effectiveness of Foot Orthoses to Treat Plantar Fasciitis A Randomized Trial
Karl B. Landorf, PhD; Anne-Maree Keenan, MAppSc; Robert D. Herbert, PhD
Archives of Internal Medicine 2006;166(12), June 26:1305-1310.
"Background Plantar fasciitis is one of the most common foot complaints. It is often treated with foot orthoses; however, studies of the effects of orthoses are generally of poor quality, and to our knowledge, no trials have investigated long-term effectiveness. The aim of this trial was to evaluate the short- and long-term effectiveness of foot orthoses in the treatment of plantar fasciitis. Methods A pragmatic, participant-blinded, randomized trial was conducted from April 1999 to July 2001. The duration of follow-up for each participant was 12 months. One hundred and thirty-five participants with plantar fasciitis from the local community were recruited to a university-based clinic and were randomly allocated to receive a sham orthosis (soft, thin foam), a prefabricated orthosis (firm foam), or a customized orthosis (semirigid plastic). Results After 3 months of treatment, estimates of effects on pain and function favored the prefabricated and customized orthoses over the sham orthoses, although only the effects on function were statistically significant. Compared with sham orthoses, the mean pain score (scale, 0-100) was 8.7 points better for the prefabricated orthoses (95% confidence interval, –0.1 to 17.6; P = .05) and 7.4 points better for the customized orthoses (95% confidence interval, –1.4 to 16.2; P = .10). Compared with sham orthoses, the mean function score (scale, 0-100) was 8.4 points better for the prefabricated orthoses (95% confidence interval, 1.0-15.8; P = .03) and 7.5 points better for the customized orthoses (95% confidence interval, 0.3-14.7; P = .04). There were no significant effects on primary outcomes at the 12-month review. Conclusions Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device. The customized and prefabricated orthoses used in this trial have similar effectiveness in the treatment of plantar fasciitis."
Discussion here.
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Thursday, December 22, 2005
Comparison of foot orthoses made by podiatrists, pedorthists and orthotists
"Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p< .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and orthotists." More information and comments.
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Saturday, August 13, 2005
The placebo effect of foot orthoses
We all know about the possible placebo effect of our treatments etc etc, but tend not to pay a great deal of attention to it...We have a plantar fasciitis RCT in press at the moment - subjects randomised to one of 3 "inserts" (all of which can be purchased from a retail pharmacy) - these are devices that I would never consider using clinically (they are that bad) ..... to our dismay all but 3 of the subjects got better - the world did not end then....Now just finished the number crunching on a second plantar fasciitis RCT. One group got the comfort model of Formthotics (not the regular one most use) and the other group got the same, but they were modified depending on the presence of risk factors for plantar fasciitis according to a strict protocol (ie tight calf muscles (lunge <38> heel raise; high force to establish windlass --> lateral column elevation; etc) --- we would have thought that this time we would find some differences .... but no - there was no difference between the two groups and everyone showed some symptomatic improvement ..... now you can see why I am in a "mood".At the end of the day, I just now think that when it comes to clinical trials with foot orthoses, that the placebo effect and Hawthorne effects are so powerful, everyone seems to get better .... this is forcing me to have a major rethink about how we really should be designing our foot orthoses clinical trials.
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Sunday, May 08, 2005
Custom vs prefabricated fot orthoses
This debate has been going on for years and will continue. All research to date has shown no differences in outcomes between the two. The exception is this recent publication on foot pain in those with juvenile chronic athritis:
Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and ILONA S. SZER
Objective. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
(J Rheumatol 2005;32:943-50)
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Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and ILONA S. SZER
Objective. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
(J Rheumatol 2005;32:943-50)
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Custom vs prefabricated fot orthoses
This debate has been going on for years and will continue. All research to date has shown no differences in outcomes between the two. The exception is this recent publication on foot pain in those with juvenile chronic athritis:
Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and ILONA S. SZER
Objective. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
(J Rheumatol 2005;32:943-50)
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Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and ILONA S. SZER
Objective. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
(J Rheumatol 2005;32:943-50)
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Sunday, February 06, 2005
RCT on Foot orthoses and low back pain
A Controlled Randomized Study of the Effect of Training With Orthoses on the Incidence of Weight Bearing Induced Back Pain Among Infantry Recruits. Spine. 2005 Feb 1;30(3):272-275.Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A.
Quote:
STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
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Quote:
STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
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RCT on Foot orthoses and low back pain
A Controlled Randomized Study of the Effect of Training With Orthoses on the Incidence of Weight Bearing Induced Back Pain Among Infantry Recruits. Spine. 2005 Feb 1;30(3):272-275.Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A.
Quote:
STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
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Quote:
STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
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Saturday, December 11, 2004
Foot orthoses outcomes and kinematic changes
To get some debate going, I just posted this at Podiatry Arena:
"Foot orthoses outcomes and kinematic changes
1. We use various types of foot orthoses in clinical practice in an attempt to alter the pattern of rearfoot motion to "improve" biomechanics and make patients better.
2. Numerous outcomes studies, patient satisfaction surveys (many with methodological flaws) and RCT's show patient do get better with foot orthoses that attempt to alter the pattern of rearfoot motion.
3. The numerous kinematic studies (many with methodological flaws) are about evenly divided as to if foot orthoses do alter the pattern of rearfoot motion or not. Half show no differences in rearfoot kinematics and the other half show such small (but statistically significant) differences that the biological significance of those differences need to be questioned.
Does anyone see the paradox here? What we do clinically works, but not by trying to do what we think we are doing
In an attempt to resolve this paradox, one of our projects this year measured patient symptoms (FHSQ) at issue of foot orthoses and at 4 weeks follow up. At issue of foot orthoses, rearfoot kinematics was also measured with and without the use of the foot orthoses. Guess what we found? ---- there was no correlation between changes in the pattern of rearfoot motion and symptom reduction
This is troubling as I have spent most of my professional life trying to alter patient's pattern of rearfoot motion .... they get better, but not because of the changes in rearfoot motion
What say you? "
I don't think many people are grasping the significance of all the most recent reseach on foot orthoses, their effectiveness and how they work..... especially those with vested financial interests ;-)
Back to home
"Foot orthoses outcomes and kinematic changes
1. We use various types of foot orthoses in clinical practice in an attempt to alter the pattern of rearfoot motion to "improve" biomechanics and make patients better.
2. Numerous outcomes studies, patient satisfaction surveys (many with methodological flaws) and RCT's show patient do get better with foot orthoses that attempt to alter the pattern of rearfoot motion.
3. The numerous kinematic studies (many with methodological flaws) are about evenly divided as to if foot orthoses do alter the pattern of rearfoot motion or not. Half show no differences in rearfoot kinematics and the other half show such small (but statistically significant) differences that the biological significance of those differences need to be questioned.
Does anyone see the paradox here? What we do clinically works, but not by trying to do what we think we are doing
In an attempt to resolve this paradox, one of our projects this year measured patient symptoms (FHSQ) at issue of foot orthoses and at 4 weeks follow up. At issue of foot orthoses, rearfoot kinematics was also measured with and without the use of the foot orthoses. Guess what we found? ---- there was no correlation between changes in the pattern of rearfoot motion and symptom reduction
This is troubling as I have spent most of my professional life trying to alter patient's pattern of rearfoot motion .... they get better, but not because of the changes in rearfoot motion
What say you? "
I don't think many people are grasping the significance of all the most recent reseach on foot orthoses, their effectiveness and how they work..... especially those with vested financial interests ;-)
Back to home
Foot orthoses outcomes and kinematic changes
To get some debate going, I just posted this at Podiatry Arena:
"Foot orthoses outcomes and kinematic changes
1. We use various types of foot orthoses in clinical practice in an attempt to alter the pattern of rearfoot motion to "improve" biomechanics and make patients better.
2. Numerous outcomes studies, patient satisfaction surveys (many with methodological flaws) and RCT's show patient do get better with foot orthoses that attempt to alter the pattern of rearfoot motion.
3. The numerous kinematic studies (many with methodological flaws) are about evenly divided as to if foot orthoses do alter the pattern of rearfoot motion or not. Half show no differences in rearfoot kinematics and the other half show such small (but statistically significant) differences that the biological significance of those differences need to be questioned.
Does anyone see the paradox here? What we do clinically works, but not by trying to do what we think we are doing
In an attempt to resolve this paradox, one of our projects this year measured patient symptoms (FHSQ) at issue of foot orthoses and at 4 weeks follow up. At issue of foot orthoses, rearfoot kinematics was also measured with and without the use of the foot orthoses. Guess what we found? ---- there was no correlation between changes in the pattern of rearfoot motion and symptom reduction
This is troubling as I have spent most of my professional life trying to alter patient's pattern of rearfoot motion .... they get better, but not because of the changes in rearfoot motion
What say you? "
I don't think many people are grasping the significance of all the most recent reseach on foot orthoses, their effectiveness and how they work..... especially those with vested financial interests ;-)
Back to home
"Foot orthoses outcomes and kinematic changes
1. We use various types of foot orthoses in clinical practice in an attempt to alter the pattern of rearfoot motion to "improve" biomechanics and make patients better.
2. Numerous outcomes studies, patient satisfaction surveys (many with methodological flaws) and RCT's show patient do get better with foot orthoses that attempt to alter the pattern of rearfoot motion.
3. The numerous kinematic studies (many with methodological flaws) are about evenly divided as to if foot orthoses do alter the pattern of rearfoot motion or not. Half show no differences in rearfoot kinematics and the other half show such small (but statistically significant) differences that the biological significance of those differences need to be questioned.
Does anyone see the paradox here? What we do clinically works, but not by trying to do what we think we are doing
In an attempt to resolve this paradox, one of our projects this year measured patient symptoms (FHSQ) at issue of foot orthoses and at 4 weeks follow up. At issue of foot orthoses, rearfoot kinematics was also measured with and without the use of the foot orthoses. Guess what we found? ---- there was no correlation between changes in the pattern of rearfoot motion and symptom reduction
This is troubling as I have spent most of my professional life trying to alter patient's pattern of rearfoot motion .... they get better, but not because of the changes in rearfoot motion
What say you? "
I don't think many people are grasping the significance of all the most recent reseach on foot orthoses, their effectiveness and how they work..... especially those with vested financial interests ;-)
Back to home
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