Effective Orthotic Therapy for the Painful Cavus Foot

Abstract

Joshua Burns*, Jack Crosbie**, Robert Ouvrier*, Adrienne Hunt**

*Faculty of Medicine, University of Sydney, and **School of Physiotherapy, University of Sydney, Sydney, Australia

Citation: Burns J, Crosbie J, Ouvrier R, Hunt A. Effective Orthotic Therapy for the Painful Cavus Foot: A Randomized Controlled Trial. Journal of the American Podiatric Medical Association 96(3): 205-211, 2006

Abstract: Patients with a cavus or high-arched foot frequently experience foot pain, which can lead to significant limitation in function. Custom foot orthoses are widely prescribed to treat cavus foot pain. However, no clear guidelines for their construction exist, and there is limited evidence of their efficacy.

Methods: In a randomized, single-blind, sham-controlled trial, the effect of custom foot orthoses on foot pain, function, quality of life and plantar pressure loading in people with a cavus foot type was investigated.

One hundred fifty-four participants (n=154) with chronic musculoskeletal foot pain and bilateral cavus feet were randomly assigned to a treatment group receiving custom foot orthoses (n=75) or to a control group receiving simple sham insoles (n=79).

Results: At 3 months, 99% of the participants provided follow up data using a Foot Health Status Questionnaire. Foot pain scores were improved with custom foot orthoses (difference, 8.3 points; 95% confidence interval (CI), 1.2 to 15.3 points; p = 0.022). Function scores also improved more with custom foot orthoses than with the control (difference, 9.5 points; 95% CI, 2.9 to 16.1 points; p= 0.005). Quality of life data favored custom foot orthoses, although differences reached statistical significance only for physical functioning (difference, 7.0 points; 95% CI, 1.9 to 12.1 points; p=0.008). Plantar pressure improved considerably more with custom foot orthoses than with the control for all regions of the foot (difference, -3.0 N.s/cm²; 95% CI, -3.7 to –2.4 N.s/cm²_; p<0.001).

Conclusion: In conclusion, custom foot orthoses are more effective than a control for the treatment of cavus foot pain and its associated limitations in function.

____________________________________________

Influence of a Custom Foot Orthotic Intervention on Lower Extremity Dynamics in Healthy Runners

Abstract

Christopher MacLean*, Irene McClay Davis**, Joseph Hamill*

*Department of Kinesiology, University of Massachusetts Amherst, and **University of Delaware

Citation:  MacLean CL, McClay Davis I, Hamill J. Influence of a Custom Foot Orthotic Intervention on Lower Extremity Dynamics in Healthy Runners. Clinical Biomechanics 21: 623-630, 2006

Objective:  To investigate the influence of a custom foot intervention on the lower extremity dynamics in healthy runners.

Design:  Three-dimensional kinematics and kinetics were collected on 15 female runners (>10 miles per week) while each performed the over-ground running trials.  Kinematic and kinetic variables were analyzed using Paired Sample t-tests.

Background:  Custom foot orthoses (CFO) are frequently prescribed treatment modality for the management of overuse running injuries. Although it is generally accepted that CFO intervention produces positive clinical outcomes, it remains unclear what influence this therapeutic modality has on the dynamics of the lower extremity

Methods:  Each subject performed 5 acceptable over-ground running trials (3.6 m.s^-1 (+/- 5%)) with and without the CFO intervention in a running shoe. Selected maximum ankle and knee joint angles and moments were measured during the stance phase.

Results:  While wearing the CFO device, subjects exhibited significantly decreased maximum values in rearfoot eversion angle, rearfoot eversion velocity and internal ankle inversion moment. 

Conclusions:   In this sample of healthy female runners, the CFO intervention led to significant decreases in maximum values for ankle dynamics in the frontal plane while no significant changes were exhibited at the knee joint.

Relevance:  It remains unclear how CFO intervention influences lower extremity dynamics to produce positive clinical outcomes. Furthering our understanding of the dynamical influence will not only inform improved prescription and manufacturing practices but may provide insight into the mechanisms that cause overuse injuries. 

___________________________________________________

Posting versus Custom-molding of Foot Orthoses:

Effects on Biomechanical Variables and Comfort

Abstract

Anne Mündermann

Ph.D. Thesis, Department of Medical Science, University of Calgary, Canada