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Background: Several works have shown the benefits of foot orthosis intervention on postural stability in healthy individuals and patients with foot malalignment. However, the effects of foot orthoses on the daily ambulatory activities explored by the Six-Minute Walk Test (6MWT) were never examined. We hypothesized that foot orthoses could increase the gait distance and attenuate the post-6MWT posture alterations already reported in healthy individuals. Methods: In ten normal-weight (NW) and ten obese patients with foot malalignment and/or abnormal foot arch, we examined the benefits of 4 weeks of custom-molded orthosis intervention (D30) on 6MWT gait distance, fatigue sensation scores, ankle plantarflexion force, and post-6MWT sway of the center of pressure (COP) measured by a pedobarographic platform. Data were compared with those measured in two control-matched groups of ten NW and ten obese individuals, explored at study inclusion and at D30. Results: At study inclusion, the post-6MWT changes in COP surface and the medial and lateral COP deviations were significantly higher in obese participants who needed to wear the foot orthoses compared with obese control subjects. The foot orthosis intervention significantly improved the ambulatory performances of NW and obese individuals during the 6MWT, attenuated the bodily fatigue sensation after the 6MWT, and reduced the post-6MWT COP deviations, with the benefits of insoles being significantly accentuated in obese participants. Conclusions: Four weeks of foot orthosis intervention significantly increases gait distance and is an effective means to reduce postural sway after walking.

Background:A talus control foot orthosis (TCFO) combines an inverted rigid foot orthosis (RFO) with a broad upright portion that rises well above the navicular to cover and protect the talonavicular joint. We sought to identify the therapeutic effect of TCFOs in children with flexible flatfoot.Methods:Flexible flatfoot was diagnosed in 40 children when either of the feet had greater than 4° valgus of resting calcaneal stance position (RCSP) angle and one of the radiographic indicators was greater than 30° in anteroposterior talocalcaneal angles, 45° in lateral talocalcaneal angles, and 4° in lateral talometatarsal angles and less than 10° of calcaneal pitch in barefoot radiographs. Of 40 children with flexible flatfoot, 20 were fitted with a pair of RFOs and 20 with TCFOs, randomly. Follow-up clinical and radiographic measurements were completed 12 months later.Results:All of the radiographic indicators changed toward the corrective direction in both groups. There were significant improvements in calcaneal pitch and RCSP in both groups (P < .05). In the TCFO group, the anteroposterior talocalcaneal angle and the RCSP showed statistically significant improvement compared with the RFO group.Conclusions:In this study, the TCFO was more effective than the RFO at treating children with flexible flatfoot.

Foot orthoses are believed to exert their therapeutic effect on the human locomotor apparatus by altering the location, magnitude, and temporal patterns of ground reaction forces acting on the plantar foot during weightbearing activities. In-shoe pressure-measurement systems are increasingly being used by clinicians and researchers to assess kinetic changes at the foot-orthosis interface to better understand the function of foot orthoses and to derive more efficacious treatments for many painful foot and lower-extremity abnormalities. This article explores how the inherent three-dimensional surface topography and load-deformation characteristics of foot orthoses may challenge the validity, reliability, and clinical usefulness of the data obtained from in-shoe pressure-measurement systems in the context of foot orthotic therapy and research. The inability of in-shoe pressure-measurement systems to measure shearing forces beneath the foot, the required bending of the flat two-dimensional sensor insole to fit the pressure insole to the three-dimensional curves of the orthosis, the subsequent unbending of the sensor insole to display it on a computer monitor, and variations in the load-deformation characteristics of orthoses are all sources of potential error in examination of the kinetic effects of foot orthoses. Consequently, caution is required when interpreting the results of orthotic research that has used in-shoe pressure insole technology. The limitations of the technology should also be given due respect when in-shoe pressure measurement is used to make clinical decisions and prescribe custom foot orthoses for patients. (J Am Podiatr Med Assoc 100(6): 518–529, 2010)

Osteoarthritis of the knee is a common condition that can cause considerable pain and disability. Various forms of lateral wedging may be effective in the treatment of medial compartment osteoarthritis, but it is not known whether incorporating a lateral wedge into a custom-molded foot orthosis will achieve similar results. Therefore, 30 subjects (21 men and 9 women) aged 29 to 77 years (mean ± SD, 58.1 ± 11.6 years) with radiographically confirmed medial compartment knee osteoarthritis were issued custom-molded foot orthoses with a 5° lateral heel wedge. Pain levels were recorded using a 100-mm visual analog pain scale on the date of issue of the orthoses (baseline) and again 3 and 6 weeks later. Mean ± SD pain levels were significantly reduced at 3 weeks (34 ± 22 mm) and 6 weeks (23 ± 22 mm) versus baseline (69 ± 19 mm) (F2 = 39.57). The degree of pain reduction was greater in patients with less severe osteoarthritis. At 6 weeks, all subjects had achieved at least some reduction in pain, and 28 reported that their orthoses were comfortable. This preliminary study indicates that laterally wedged foot orthoses may be beneficial in the treatment of mild-to-moderate osteoarthritis of the medial compartment of the knee. Further investigations using a larger sample, longer follow-up, and a no-treatment control group seem warranted. (J Am Podiatr Med Assoc 95(4): 347–352, 2005)

This research project investigated the orthotic prescription habits of podiatric physicians in Australia and New Zealand. A 23-item questionnaire was distributed to all members of the Australian Podiatry Association and the New Zealand Society of Podiatrists. When asked what type of foot orthoses they prescribe most often, 72% of respondents reported functional foot orthoses; the next most common response was prefabricated orthoses (12%). A typical prescription for functional foot orthoses consisted of a modified Root style orthosis, balanced to the neutral calcaneal stance position, with the shell made from polypropylene and an ethyl vinyl acetate (EVA) rearfoot post applied. The majority of podiatric physicians surveyed used a commercial orthotic laboratory to fabricate their orthoses. However, New Zealand respondents were three times more likely to prescribe prefabricated foot orthoses, and males were twice as likely as females to manufacture the orthoses themselves rather than use a commercial orthotic laboratory. (J Am Podiatr Med Assoc 91(4): 174-183, 2001)

The proficiency of clinicians to place a rearfoot at the subtalar neutral position is important for the treatment of patients with lower extremity dysfunctions, and especially for foot orthosis prescription, fabrication, and management. However, the ability of experienced foot care specialists to perform this task has not been statistically compared with an average capacity. In this study, eight experienced chiropodists and eight untrained physiotherapy students placed six rearfeet at the subtalar neutral position five times. Statistically, the foot care specialists were able to find the subtalar neutral position better than the students (mean 0.00 versus 0.99 degrees, SD 1.84 versus 2.97 degrees, range -5.27 degrees to 4.33 degrees versus -6.25 degrees to 9.27 degrees). This can be interpreted as stating that foot care specialists and untrained students place a rearfoot within +/- 1 degree of the subtalar neutral position 41.3% and 25.0% of the time, respectively. Corresponding values within +/- 2 degrees of the subtalar neutral position are 72.3 degrees and 47.6 degrees, respectively. Alternatively, it can be stated that experienced foot care specialists are within +/- 3.0 degrees of the subtalar neutral position 90% of the time. A corresponding value for the students is +/- 4.9 degrees. These results suggest that although experienced foot care specialists position a rearfoot at the subtalar neutral position better than untrained physiotherapy students, there is room for improvement.

Current orthotic theory is limited by fabrication design techniques based upon vacuum pressing a single thickness sheet of material. This produces a uniformed contoured shell with limited dynamic response. This research presents a new concept of using computer design and milling to make orthotics more rigid by increasing the thickness across the arch. Such a device could be tailored to an individual’s biomechanics and symptoms.

The purpose of this study was to assess the effectiveness of a semirigid foot orthosis with a varus wedge on forefoot vertical forces in a 24-year-old female with a compensated rearfoot varus deformity. The results of this study indicate that the use of total contact semirigid foot orthoses reduces the forefoot force-time integral during walking, whether a rearfoot varus wedge was or was not used. The authors recommend that total contact construction of the foot orthoses be considered when a reduction of the forces acting on the forefoot is the goal of treatment.

A new method of foot orthosis modification that enhances the pronation controlling ability of foot orthoses is presented. The medial heel skive technique involves selectively removing small amounts of the medial portion of the plantar heel of the positive cast of the foot to create a unique varus wedging effect within the heel cup of the foot orthosis. The resulting increase in supination moment across the subtalar joint axis of the foot clinically produces significantly improved pronation control on pediatric flexible flat feet, posterior tibial dysfunction, and other types of excessively pronated feet.

Background: Diverse theories of orthoses application have evolved with the continual development of podiatric biomechanics and orthotic management. This theoretical disparity can lead to confusion in clinical, educational, and research situations. However, although approaches are varied, the common consensus is that foot orthoses outcomes are generally positive. Methods: Three main podiatric theories exist: the foot morphology theory, the sagittal plane facilitation theory, and tissue stress theory. By researching the available literature, the perspectives of all three theories are summarized, emphasizing areas of conflict and agreement. Results: Through a unified theory, we introduce a premise by which the similar orthotic outcomes obtained from the three main podiatric theories may be explained. Conclusions: It remains up to the individual podiatric physician to decide which method to use to prescribe a foot orthosis. It may be of benefit to encompass all approaches rather than be dogmatic or exclusive. (J Am Podiatr Med Assoc 99(4): 317–325, 2009)

The control of excessively pronating feet in athletes can be a prolonged and frustrating experience for both the doctor and the patient. The inverted orthotic technique has previously been described for making a device that has two basic applications: to control excessive subtalar joint pronation, especially where a Root or modified Root device cannot, and to invert the entire lower limb for such problems as medial knee pain. The authors present two case histories that highlight the indications of this orthotic device for the athletic population.

A variety of plantar pressure and force measures were explored in 22 healthy individuals with excessive pronation. The measures were obtained while the subjects wore a thin-soled athletic shoe alone, a modified Root foot orthosis made from a neutral cast, and a flat noncast insole with a 6 degrees varus rearfoot post. The data obtained from subjects wearing the noncast insole differed only minimally from those obtained while they were wearing the shoe only. In contrast, the modified Root orthosis had a profound effect on foot function. Heel forces and pressures were reduced, and the rearfoot contact area was increased. Measures of force in the midfoot demonstrated substantial increases in load in this region, but the increase in area associated with the contoured device resulted in no increase in midfoot pressure measurements. Forefoot pressures were reduced both medially and laterally with the cast device in place.

The ability of foot care specialists to place a rearfoot at the subtalar neutral position is important for the care of patients who require foot orthosis prescription, fabrication, and management. Although some clinicians perform this procedure with the patient in the prone position, others prefer a seated or standing approach. This study examined whether patient position and preferred patient position influence the ability of clinicians to place a subject's rearfoot at the subtalar neutral position. The results suggest the following: a clinician's ability to find the subtalar neutral position is better with a seated subject; clinicians do not necessarily perform better assessments on a subject in a position corresponding to their patient position preference; and clinicians who prefer their patients prone generally have more flexible and reproducible observations. In addition, the findings suggest that the nature and relative importance of the tactile and visual cues used by clinicians to place a rearfoot at the subtalar neutral position warrant further exploration.