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Introduction: Observation is the treatment of choice for idiopathic scoliosis with Cobb angles between 15 degrees - 20 degrees in growing children. This passive approach does not address the anxiety of the patient and the stress of the parents. In this paper, we attempt to identify skeletally immature patients with mild scoliosis curvatures that are more at risk of progression and propose possible intervention for this group of subjects. Methods: The literature was searched in Pubmed, and additional references were searched manually in the literature. Results: Many studies have shown that low serum 25[OH]D level, bone mineral density (BMD), and body mass index (BMI) are related to the curve severity or progression of the curve. We suggest that skeletally immature patients (< Risser 2) with mild curves be divided into two groups, viz. Group O (observation) with a lower risk of progression, and Group I (intervention) with a higher risk of curvature progression. We propose early intervention for the latter group. It is suggested that pre-menarcheal, skeletally immature patients with mild idiopathic scoliosis, and low vitamin D, BMD, and BMI should be treated. Also, asymmetric foot biomechanics should be addressed, although nutrition and foot orthoses are regarded to have no role in the management of idiopathic scoliosis. The outcome of early intervention may be utterly different from late treatment when the curvature becomes more structural, and the patient more skeletally mature. Conclusion: Research is required to prove if the intervention is clinically indicated.

Some studies have found that patients with asthma have bilateral foot dorsal flexion limitations, contributing to impaired quality of life. The authors hypothesised that foot misalignments could also occur in patients with chronic obstructive pulmonary disease (COPD), and that foot orthoses could increase the motor benefits of their pulmonary rehabilitation (PR). Presented herein are the results from a nonrandomised controlled study in 40 patients with COPD. Twenty patients had foot misalignment (Group 1) and wore foot orthoses for a 1-month PR period. Their data were compared to those obtained in 20 other patients with COPD who had no foot misalignment and did not wear foot orthoses (Group 2). Bodily fatigue, 6-minute walk test (6MWT) distance, peak plantar flexion force (PFF), and oscillations of the centre of pressure (CoP) were measured. Measurements were performed prior to and following completion of PR (Groups 1 and 2), immediately after wearing the foot orthosis (Group 1), and after completion of PR plus foot orthoses (Group 1). In Group 2, PR increased the 6MWT distance, but did not increase PFF nor reduce CoP oscillations and fatigue scale. Wearing the foot orthosis for the first time significantly increased the 6MWT distance (+98+12 m). Following PR with foot orthoses (Group 1), a further increase in 6MWT distance occurred (+120+13 m), bodily fatigue was reduced, PFF increased, and CoP oscillations decreased. In patients with COPD and foot misalignment, foot orthoses enhanced the functional capacity and improved the postural control.

Objective Soldiers’ lower limbs and feet are frequently affected by overload- and overuse-related injuries. In order to prevent or limit the incidence of these injuries, the use of foot orthoses is often recommended. The aim of this study is to assess the effects of shock-absorbing insoles on in-shoe plantar pressure magnitude and distribution in a group of professional infantry soldiers wearing military boots during standard indoor military training. Methods Twenty male professional soldiers of the Italian Army (age 35.1 ± 6.1 years; BMI 25.2 ± 2.3 kg/m2) were recruited for this study. Each subject underwent clinical examination to assess possible overuse-related diseases of the lower limb and trunk. Subjects with altered foot morphology according to the Foot Posture Index (FPI) were excluded from this study. Twelve subjects were considered eligible and therefore underwent an indoor training routine comprised of marching, running, jumping inside parallel bars and jumping from different heights. Soldiers repeated the training session twice wearing standard military boots along with two types of insoles: the standard prefabricated insole within the boots (STI), and a special shock-absorbing insole (SAI) featuring an elastic medial arch support. A 99-capacitive sensor insole system was used to record plantar pressure distribution in both feet. Analysis of in-shoe pressure parameters at rearfoot, midfoot and forefoot and in the total foot was performed via a custom-software application developed in MATLAB. Perceived foot comfort (VAS 0–15) was also assessed. Results Pressure parameters recorded during walking and running were considered suitable for statistical analysis. In the whole foot region, pressure parameters were 18–22% lower in military boots fitted with the SAI during walking and 14–18% lower during running. SAI resulted in better comfort (+25%) with respect to the prefabricated boot orthotics (median comfort: SAI = 15/15; STI = 12/15; p = 0.0039) both during walking and running. Conclusions Shock-absorbing insoles can be an effective solution when fitted inside military boots. The present functional evaluation shows that wearing a prefabricated shock-absorbing insole can provide a significant amelioration of perceived foot comfort and plantar pressure parameters. Further studies are now needed with a larger population and more demanding exercises.

Background: Plantar fasciitis is an inflamma­tory problem that occurs in the foot area that causes pain. Its prevalence rates range from 4% to 7% in the elderly population, 8% in athletes and up to 25% in runners. One of the treat­ments used to reduce the degree of pain is the use of foot orthosis. A number of related arti­cles stated that the use of foot orthosis can reduce the degree of pain in plantar fasciitis patients. The purpose of this study was to esti­mate the magnitude of the effect of using foot orthosis on pain reduction in plantar fasciitis patients by conducting a meta-analysis on the same number of articles. Subjects and Method: The meta-analysis was carried out by systematically reviewing the same number of articles from PubMed, Science Direct, and Google Scholar. By using the search keywords "foot orthosis" OR "FO" AND "custom foot orthosis" AND "foot pain" AND "plantar fasciitis" AND "plantar fasciopathy" AND "effect foot orthosis for plantar fasciitis" AND "treatment for plantar fasciitis" A "rando­mized controlled trial". The intervention given was the use of a foot orthosis with a comparison without using a foot orthosis with the study subject of plantar fasciitis patients. The study outcome was pain reduction. The article used is a full text article with a randomized controlled trial design that reports the value of the effect size (mean and standard deviations). Articles were collected using the PRISMA flow chart and analyzed using the Review Manager 5.3 application with random effect models. Results: A meta-analysis of 7 randomized controlled trial studies from Brazil, Virginia, Turkey, Germany, China, and Australia sug­gested that the use of foot orthosis was -0.54 times better at reducing pain in plantar fasciitis patients compared to those without foot ortho­sis (ES= -0.54; 95% CI -1.11 to 0.03; p= 0.06). Heterogeneity I 2 = 82%. Conclusion: Foot orthosis reduces pain in plantar fasciitis patients compared to those without foot orthosis Keyword s : Plantar fasciitis, pain, foot orthosis Correspondence: Atika Febri Anggriani, Masters Program in Public Health. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: atikaanggriani07­@gmail.­com. Mobile : 085728794960 Journal of Epidemiology and Public Health (2020), 05(03): 309-319 https://doi.org/10.26911/jepublichealth.2020.05.03.05

Objectives The aim of this study is to investigate the effect of customized preformed foot orthoses on pain, quality of life, swollen and tender lower joints and foot and ankle disability in children with JIA. Methods Parallel group design. Children diagnosed with JIA were recruited from the three children’s hospitals in New South Wales, Australia. Participants were randomly assigned to a control group receiving a standard flat innersole (sham) with no corrective modifications. The trial group were prescribed a preformed device that was customized based on biomechanical assessments. Pain was the primary outcome and was followed up to 12 months post intervention. Secondary outcomes include quality of life, foot and ankle disability and swollen and tender joints. A linear mixed model was used to assess the impact of the intervention at each time point. Results Sixty-six participants were recruited. Child-reported pain was reduced statistically and clinically significant at 4 weeks and 3 months post intervention in favour of the trial group. Statistical significance was not reached at 6 and 12-month follow-ups. Quality of life and foot and ankle disability were not statistically significant at any follow-up; however, tender midfoot and ankle joints were significantly reduced 6 months post intervention. Conclusion Results of this clinical trial indicate customized preformed foot orthoses can be effective in reducing pain and tender joints in children with JIA exhibiting foot and ankle symptoms. Long-term efficacy of foot orthoses remains unclear. Overall, the trial intervention was safe, inexpensive and well tolerated by paediatric patients. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12616001082493.

The purpose of this study was to clarify the 2-year clinical and radiological outcomes of nonoperative treatment using foot orthosis for hallux valgus patients.Patients who underwent nonoperative treatment using foot orthosis were surveyed prospectively. Foot orthoses were made by one certified orthotist using the standardized method. Pain and quality of life were evaluated using subjective and objective assessment measures at 3, 6, 12, 18, and 24 months. Furthermore, radiological outcomes, patient satisfaction, and adherence to treatment were surveyed.A total of 53 patients (50 women and 3 men; median age, 63 years) were included for analysis. The pain visual analogue scale score significantly decreased over time, with the lowest score observed at 12 months. The treatment effect was maintained over 24 months (median score, 52, 21, and 27 points at baseline, 12 months, and 24 months, respectively; P .001). The Japanese Society for Surgery of the Foot hallux scale, American Academy of Orthopaedic Surgeons Foot and Ankle Scale, and 36-Item Short-Form Health Survey bodily pain subscale also improved, although the treatment effects were maximal at 6 months and decreased thereafter. At 24 months, 43 (81%) patients continued to use the orthosis, with the median visual analogue scale score for patient satisfaction of 76 points. The hallux valgus angle and intermetatarsal angle did not change during the 24-month period.Nonoperative treatment using foot orthoses decreased pain in patients with hallux valgus. The effect of treatment was maintained up to 2 years with a relatively high degree of patient satisfaction. However, treating physicians should inform patients to set realistic expectations and be aware that a limited degree of pain reduction is expected.

Background Foot orthoses are widely used to manage plantar heel pain (PHP). However, the evidence concerning the effect of foot orthoses on PHP is not conclusive. The study aims to identify the characteristics of patients with PHP likely to achieve a positive outcome after customized foot orthoses and to verify the concept that patients who respond positively to anti-pronation taping would achieve a positive prognosis after wearing foot orthoses for six months. Methods This is a prospective observational cohort study. Seventy-four patients with PHP underwent a baseline examination and received anti-pronation taping to their painful feet. The taping effects on pain and function were assessed at the 7-day follow-up visit. Then, all patients received an intervention for their PHP with customized foot orthoses for six months. Outcome was assessed with a numeric pain rating scale, the patient-specific functional scale, the foot function index, and the global rating of perceived change. Significant reduction of pain, increase of function, and perception of a meaningful improvement were considered a positive response. Results Of 74 patients, 49 had a positive response to the customized foot orthosis treatment. Five predictors were identified: (1) the average pain intensity decreased by over 1.5 points with taping, (2) the range of ankle plantarflexion > 54 degrees, (3) the strength of ankle plantarflexors on the symptomatic side was equal to or stronger than that on the other side, (4) the range of hip internal rotation 45 degrees. The presence of three or more predictors increased the rate of achieving positive outcome from 66 to 89%. Conclusions The predictors of customized foot orthosis outcome in patients with PHP are related to several physical measures of a lower extremity. Findings of the study can be used to screen and select patients with PHP for foot orthosis intervention. Moreover, patients who respond positively to anti-pronation taping would also benefit from the customized foot orthoses. However, since there was no control group in the current study, it is inappropriate to draw conclusions about the effectiveness of the foot orthoses treatment. Trial registration The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12617000119392).

Objective To explore the perceptions of wearing an ankle-foot orthosis (AFO) in patients with peripheral artery disease (PAD) who did and did not adopt the AFO intervention. This follows a clinical trial of the effectiveness of an AFO in improving walking distances for patients with PAD-related claudication. Design A randomized crossover trial of standard of care and an AFO for 3 months. Semistructured interviews were conducted 1.5 months into the AFO intervention to understand acceptability, demand, implementation, and practicality. Data were analyzed using a summative content analysis approach. Setting Vascular surgery clinic and biomechanics research laboratory. Participants Patients (N=15; male, 100%; age, 71.9±.6.7y; body mass index [calculated as weight in kilograms divided by height in meters squared], 29.0±.5.5; ankle brachial index: AFO intervention withdrawal, 0.543; AFO intervention completion, 0.740) with claudication completed the study, and 6 withdrew prior to intervention completion. Interventions A certified orthotist fit participants with an AFO that was worn for 3 months. Main Outcome Measures Qualitative analysis of the semistructured interviews. Results Key differences were reported between AFO intervention completion and AFO intervention withdrawal. Six of 14 of AFO intervention completion participants described their initial reactions to the AFO as negative vs 3 of 6 AFO intervention withdrawal participants. Only 5 of 15 AFO intervention completion participants reported minimal use of the AFO compared with 5 of 6 AFO intervention withdrawal participants. The AFO intervention withdrawal group reported higher levels of physical discomfort with the use of the AFO (4/6 vs 7/15) and preexisting health issues becoming a barrier to the use of the AFO (3/6 vs 5/15). Positive aspects reported included ease in standing and walking for AFO intervention withdrawal (4/6) and AFO intervention completion groups (13/15) as well as walking straighter and longer with less pain for AFO intervention withdrawal (3/6) and AFO intervention completion groups (9/15). Conclusions Patients withdrawing prior to completion of AFO intervention tended to have more negative perceptions, more comorbidities, and more physical discomfort than those completing the intervention. Both groups reported positive aspects of the AFO. Implementation studies are needed to address barriers to AFO adoption., Highlights • Chronic peripheral artery disease causes muscle weakness that impairs walking. • An ankle-foot orthosis (AFO) may improve the distance patients with peripheral artery disease can walk. • Differences in perception between patients who used and did not use the AFO were explored. • Both groups of patients experienced barriers to AFO implementation. • Those who did not use the AFO had more negative perception, pain, and poorer health.

Introdução: O pé é composto por estruturas ativas, passivas, e componentes neurais. O arco longitudinal medial (ALM) é mantido pela interação dessas estruturas, e um componente importante para isso é a musculatura intrínseca do pé. Nos últimos anos tem se observado uma relação entre a fraqueza desses músculos e a fasciite plantar (FP). A FP é caracterizada por um processo inflamatório na região da fáscia plantar. Seus sintomas são dor região plantar, principalmente nos primeiros passos ao acordar, aumento de atividades como corrida, mudança de calçado, dor à palpação em região de fáscia plantar próximo ao calcâneo. Não há na literatura uma padronização dos exercícios para a MIP, e os guidelines de tratamento da FP não incluem exercícios para esses músculos, nem isolados, nem em comparação com alternativas, como o uso de palmilhas. Objetivo: Verificar o efeito do fortalecimento da MIP na altura do ALM e seu uso no tratamento da fasciite plantar comparativamente ao uso de palmilhas. Métodos: Foram realizadas duas revisões sistemáticas (RS): a primeira foi para verificar, na literatura publicada, os tipos de exercícios e características de treinamento de resistência (series e repetições), aplicados no fortalecimento da musculatura intrínseca. A segunda, para comparar o uso de palmilhas, customizadas ou pré-fabricadas, com o fortalecimento da musculatura intrínseca no pé para o tratamento de fasciíte plantar. Cada RS foi realizada de acordo com o modelo PRISMA, utilizando a estratégia PICO. Para ambas as RS a busca dos artigos foi feita nas seguintes bases de dados: Cochrane Central, Pubmed, PEDro, LILACS, Scielo, Embase, Cinahl e Science Direct. As palavras-chave foram escolhidas de acordo com o objetivo de cada RS. Foram aplicadas a ferramenta de risco de viés Cochrane e a escala PEDro para classificação da qualidade metodológica dos estudos selecionados. Resultados: Para a primeira RS, 4 ensaios clínicos aleatorizados (ECA) foram incluídos. O fortalecimento da MIP não promoveu aumento da altura do ALM em curto prazo, porém foi capaz de promover efeitos a médio prazo. Observou-se uma melhora da funcionalidade em curto e médio prazo na aplicação de exercícios para a MIP. Foram encontrados na segunda RS três ECA. O fortalecimento muscular é mais eficaz para dor e função em pacientes com FP em relação ao uso de palmilhas em médio e longo prazo. Não é possível identificar quais exercícios para MIP. Conclusão: Os exercícios de fortalecimento muscular apresentam influência na mudança de altura do arco longitudinal medial a médio prazo, e melhora dinâmica a curto e médio prazo. O fortalecimento da MIP pode ser uma alternativa a aplicação de palmilhas para o tratamento da FP, com bons resultados para a dor. Introduction: The foot is composed by active, passive, and neural structures. The medial longitudinal arch (MLA) is held by the interaction of these components and the intirinsic foot muscles (IFM) has an important part on this process. In recent years it is been observed a relation between the weakness of the IFM and plantar fasciitis (PF). PF is defined as an inflammatory process at the fascia. Its symptoms are pain on the plantar fascia, especially on the first steps in the morning and palpation of the calcaneus and plantar fascia. There is a lack of patronization on the literature about how to execute IFM strengthening, nor there is indications of its use for the treatment of PF, isolated or comparing with other gold standard treatments, such as the use of insoles. Objective: To analyze the information regarding the IFM strengthening and its use on the treatment of PF, comparing with foot insoles. Methods: Two Systematic Reviews (SR) were made. The first was to access the adequate training volume to generate changes in the IFM and MLA. The second was to compare the effects of the IFM strengthening training with foot insoles as treatment for PF. Both SR were made following the PRISMA statement, using the PICO strategy. The searching process was carried on the following databases: Cochrane Central, Pubmed, PEDro, LILACS, Scielo, Embase, Cinahl e Science Direct. The inclusion criteria and key words were chosen for with each RS objective. For methodological quality of the selected studies the Cochrane risk of bias table and PEDro scale were applied. Results: Four RCTs were included in the first RS. The IFM strengthening showed increase on the MLA height and medium term, and significant effects on functionality at short term and medium term. For the second RS, three RCTs were included. The resistance training showed more effect for changings in pain and function outcomes. However, there is no sufficient evidence to affirm witch IFM training is the best option. Conclusion: The intrinsic foot muscle strengthening training influences on the medial longitudinal arch height in the medium term and has better dynamic response in the short and medium term. The IMF strengthening can be an alternative to the application of foot insoles on the treatment of PF with satisfactory results for pain. Dados abertos - Sucupira - Teses e dissertações (2020)

Background Plantar fasciopathy is a common cause of plantar heel pain, with a reported prevalence of up to 10%. The choice of best practice in these patients is debated. Two randomised studies reported that radial extracorporeal shock wave therapy is effective, but a meta-analysis concluded that due to methodological limitations, the evidence is questionable. There are few studies reporting the effect of exercise programs with high-load strength training, despite widespread use. The objective of this placebo-controlled, observer-blinded and partly patient blinded trial is to compare rESWT, sham-rESWT, standardised exercise programme and usual care for alleviating heel pain at 6 and 12 months follow-up. Methods/design A double-blind, randomised, sham-controlled trial is conducted at a hospital outpatient clinic of physical medicine and rehabilitation. Patients with chronic (> 3 months) pain due to plantar fasciopathy, aged 18 to 70 years old, are eligible for inclusion in the trial. Patients will be randomly allocated in 1:1 ratio to receive rESWT, sham-rESWT, standardised exercises or usual care. The sample size is estimated to 200 patients, 50 in each group. rESWT or sham-rESWT will be given once a week for 3 weeks. A physiotherapist will supervise the exercises, with a total of 8 sessions over 12 weeks. The patients in the usual care group will receive information, advice and foot orthosis only. All patients, regardless of group, will receive the same information and get an individual customised foot orthosis made by an orthopaedic technician. The primary outcome measure is heel pain intensity during activity in the last week, using a numeric rating scale (NRS, 0 to 10) at the 6 months follow-up adjusted for baseline pain intensity. The secondary outcomes are at the 6- and 12-month follow-up and include Foot Functional Index Revised Short Version (FFI-RS), Patient Global Impression of Change Scale (7-point Likert scale), RAND-12 Health Status Inventory (RAND-12), NRS during rest and NRS during activity (12 months). The patients receiving rESWT/sham-rESWT and the outcome assessor will be blinded to the group assignment. Discussion This trial is designed in order to provide results important for future clinical practice. Trial registration ClinicalTrials.gov NCT03472989. Registered on 14 March 2018

Background: Patellofemoral pain syndrome (PFPS) which is often used interchangeably with “anterior knee pain” or “runner’s knee” is the clinical entity of stiffness or pain or both on prolonged sitting with the knees flexed and pain with activities that load the patellofemoral joint, such as climbing or descending stairs, squatting, running and kneeling. Varieties of conservative treatments are suggested like quadriceps strengthening, stretching, braces and straps, electrotherapy, foot orthosis, patellar taping etc. Hence, comparison between the two techniques vastus medialis obliqus muscle strengthening and patellar taping were undertaken to determine their effectiveness with respect to pain and function. Materials and Method: After taking informed and written consent, 30 subjects diagnosed with unilateral or bilateral PFPS were randomly selected and allocated into two groups - Group A (VMO muscle strengthening and conventional physiotherapy treatment) and Group B (Patellar taping and conventional physiotherapy treatment). Both groups received five treatment sessions per week for 6 weeks. Pre and post pain and function were measured by visual analogue scale (VAS) and kujala patellofemoral scale (KPS) respectively. Wilcoxon Signed Rank Test and Mann Whitney ‘U’ Test were used for statistical analysis. Findings: There was significant improvement in pain and function in patients with Patellofemoral pain syndrome at the end of 6 weeks in terms of VAS and KPS within both groups (p

Epidemiological studies consistently report a 90% prevalence of foot pain. Mechanical and other non-pharmacological interventions such as orthoses and footwear can play an important role in managing foot pathology in patients whose systemic disease is controlled. The effectiveness of treatment with insoles has been examined in various randomised controlled trials, which have reported immediate clinical improvements, with reduced foot pain and disability and enhanced functionality. The aim of this systematic review is to determine the effectiveness of foot orthoses in patients with rheumatoid arthritis (RA), in comparison with other treatments, in terms of enhanced disability and reduced pain. A systematic review and meta-analysis was conducted of a number of randomised controlled trials focusing on patients with RA. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, SCOPUS and Cuiden, by means of an independent peer review. The Mesh terms and fields used were foot, ankle, joint, RA, foot, orthosis, insole and foot orthosis. Of the initial 118 studies considered, 5 were included in the final systematic review and meta-analysis. These five studies had enrolled a total of 301 participants, with follow-up periods ranging from 4 to 36 months. Although the use of orthoses seems to alleviate foot pain, our meta-analysis did not reveal statistically significant differences between control and intervention groups regarding long- and short-term pain relief and/or reduced disability. Foot orthoses can relieve pain and disability and enhance patients, but no significant differences were found between control and intervention groups.

IntroductionThis study aimed to identify risk factors associated with the development of common lower limb injuries during initial defence training in naval recruits who were enrolled in a randomised trial.MethodsThree-hundred and six naval recruits were randomly allocated flat insoles (n=153) or foot orthoses (n=153) while undertaking 11 weeks of initial training. Participant characteristics (including anthropometrics, general health, physical activity, fitness and foot characteristics) were collected at the baseline assessment and injuries were documented prospectively. Injury was defined as the combined incidence of participants with medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy and plantar fasciitis/plantar heel pain throughout the 11 weeks of training. A discriminant function analysis was used to explore the ability of baseline measures to predict injury.ResultsOverall, 67 (21.9%) participants developed an injury. Discriminant function analysis revealed that participants who sustained an injury were slightly younger (mean 21.4±SD 4.1 vs 22.5±5.0 years) and were less likely to be allocated to the foot orthosis group (40% vs 53%) compared with those who remained uninjured. The accuracy of these baseline variables to predict injury was moderate (78.1%).ConclusionsLower limb injury was not accurately predicted from health questionnaires, fitness results and clinical assessments in naval recruits undertaking initial defence training. However, although not reaching statistical significance, the use of foot orthoses may be protective against common lower limb injuries.Trial registration numberACTRN12615000024549; Post-results.

Background Foot orthoses are widely used in the prevention and treatment of foot disorders. The aim of this study was to describe characteristics of custom-made foot orthosis prescriptions from a Australian podiatric orthotic laboratory. Methods One thousand consecutive foot orthosis prescription forms were obtained from a commercial prescription foot orthosis laboratory located in Melbourne, Victoria, Australia (Footwork Podiatric Laboratory). Each item from the prescription form was documented in relation to orthosis type, cast correction, arch fill technique, cast modifications, shell material, shell modifications and cover material. Cluster analysis and discriminant function analysis were applied to identify patterns in the prescription data. Results Prescriptions were obtained from 178 clinical practices across Australia and Hong Kong, with patients ranging in age from 5 to 92 years. Three broad categories (‘clusters’) were observed that were indicative of increasing ‘control’ of rearfoot pronation. A combination of five variables (rearfoot cast correction, cover shape, orthosis type, forefoot cast correction and plantar fascial accommodation) was able to identify these clusters with an accuracy of 70%. Significant differences between clusters were observed in relation to age and sex of the patient and the geographic location of the prescribing clinician. Conclusion Foot orthosis prescriptions are complex, but can be broadly classified into three categories. Selection of these prescription subtypes appears to be influenced by both patient factors (age and sex) and clinician factors (clinic location). Electronic supplementary material The online version of this article (doi:10.1186/s13047-017-0204-7) contains supplementary material, which is available to authorized users.

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.

Background: Plantar fasciitis (PF) is one of the most common causes of plantar heel pain. Objective: To evaluate the effectiveness of three different treatment approaches in the management of PF. Methods: Sixty-three patients (44 female, 19 men, 48.4 &plusmn, 9.8 years) were randomly assigned into a manual therapy (MT), customised foot orthosis (FO) and a combined therapy (combined) group. The primary outcomes of pain and function were evaluated using the American Orthopaedic Foot and Ankle Society-Ankle Hindfoot Scale (AOFAS-AHS) and the patient reported outcome measure (PROM) Foot Pain and Function Scale (FPFS). Data were evaluated at baseline (T0) and at follow-up sessions after 1 month, 2 months and 3 months (T1&ndash, T3). Results: All three treatments showed statistically significant (p &lt, 0.01) improvements in both scales from T0 to T1. However, the MT group showed greater improvements than both other groups (p &lt, 0.01). Conclusion: Manual therapy, customised foot orthoses and combined treatments of PF all reduced pain and function, with the greatest benefits shown by isolated manual therapy.

The Ponseti method for treating idiopathic clubfoot is based on gradual manipulations and corrective plaster castings followed by a years-long period of use of a foot orthosis. The role of surgery is limited. The factors that may affect outcome and their influence are subject of controversy. The aim of the study is to systematically and objectively evaluate the results of Ponseti treatment in our region of Southern Israel and focus on the role of the Achilles tenotomy and compliance to foot orthosis as factors that may influence outcome. The use of Ponseti method was retrospectively studied (level of evidence IV) by searching computerized medical files and clinical photos. The severity of deformity was evaluated by Dimeglio score (D-score) at baseline and at last examination. During 2006-2014, 57 children with idiopathic clubfoot (total 90 feet) were enrolled. An Achilles tenotomy was performed in 55/90 (61.1%) of the feet. If the D-score was 15 or higher there was a 20% increase in the incidence of Achilles tenotomy. The parental compliance had a weak protective effect against relapse. The treatment of idiopathic clubfoot by the Ponseti method was successful and reliable, proving efficiency and universality of the method. A dominant predictor for relapse was not seen. An incidental observation was that extended time in cast may buffer the adverse effects of low compliance rate. Although the initial severity, or compliance to braces are important, there may be other factors that affect the outcome such as, accuracy of the casting technique, time in the cast, access to a dedicated clubfoot clinic, cooperation with nurses and pediatricians, economic status that allows purchase of new generation of braces, cultural perception, and education level of the patient population are some examples.

Background Guidelines recommend foot orthoses for people with both early (

[Purpose] The biomechanical effects of foot orthoses on malalignment syndrome have not been fully clarified. This experimental investigation was conducted to evaluate the effects of orthoses on the gait patterns of patients with malalignment syndrome. [Subjects and Methods] Ten patients with malalignment syndrome were recruited. For each participant, kinematic and kinetic data were collected under three test conditions: walking barefoot, walking with flat insoles in shoes, and walking with a biomechanical foot orthosis (BFO) in shoes. Gait patterns were analyzed using a motion analysis system. [Results] Spatiotemporal data showed the step and stride lengths when wearing shoes with flat insoles or BFO were significantly greater than when barefoot, and that the walking speed when wearing shoes with BFO was significantly faster than when walking barefoot or with shoes with flat insoles. Kinetic data, showed peak pelvic tilt and obliquity angle were significantly greater when wearing BFO in shoes than when barefoot, and that peak hip flexion/extension angle and peak knee flexion/extension and rotation angles were significantly greater when wearing BFO and flat insoles in shoes than when barefoot. [Conclusion] BFOs can correct pelvic asymmetry while walking.

Different types of foot orthoses have been prescribed for patients with flatfoot. Results of several studies have shown that orthoses were able to change balance parameters in people with flatfoot. However, the possible effect of orthosis flexibility on balance has not yet been investigated.The aim of the current study was to investigate the immediate effect of a rigid University of California Berkeley Laboratory (UCBL) foot orthosis, a modified foot orthosis, and a normal shoe on the postural sway of people with flexible flatfoot.Quasi-experimental.In all, 20 young adults with flatfoot (aged 23.5 ± 2.8 years) were invited to participate in this study. The Biodex Stability System was employed to perform standing balance tests under three testing conditions, namely, shoe only, UCBL, and modified foot orthosis. Total, medial-lateral, and anterior-posterior sway were evaluated for each condition.The results of this study revealed no statistical difference in the medial-lateral and anterior-posterior stability indices between foot orthoses and shoed conditions. The overall stability index with the UCBL foot orthosis, however, was significantly lower than that with the modified foot orthosis.The UCBL foot orthosis was able to decrease total sway and improve balance in people with flexible flatfoot.Results of previous studies have indicated that foot orthoses were able to affect the balance of people with flatfeet. However, the possible effects of flexible orthoses on balance have not been examined. The results of this study may provide new insight into material selection for those people with balance disorders.

Controlled laboratory, repeated measures.Posterior tibial tendon dysfunction is a common musculoskeletal problem that includes tendon degeneration and collapse of the medial arch of the foot (flatfoot deformity). Ankle-foot orthoses (AFOs) typically are used to correct flatfoot deformity. Correction of flatfoot deformity involves increasing forefoot adduction, forefoot plantar flexion, and hindfoot inversion.To test whether a foot orthosis with a lateral extension reduces forefoot abduction in patients with stage II posterior tibial tendon dysfunction while walking.The gait of 15 participants with stage II posterior tibial tendon dysfunction was evaluated under 3 conditions: a standard AFO, an AFO with a lateral extension, and a shoe-only control condition. Kinematic variables of interest were evaluated at designated time points in the gait cycle and included hindfoot inversion/eversion, forefoot plantar flexion/dorsiflexion, and forefoot abduction/adduction. A 3-by-4, repeated-measures analysis of variance (brace condition by gait phase) was used to compare variables across conditions.The AFO with a lateral extension resulted in a significantly greater change in forefoot adduction compared to the standard AFO (2.6°, P = .02) and shoe-only conditions (4.1°, P.01) across all phases of stance. Forefoot plantar flexion was significantly increased when comparing the standard AFO and AFO with a lateral extension to the shoe-only condition. The AFO with the lateral extension also demonstrated significantly increased hindfoot inversion during the loading response and terminal stance phases.Off-the-shelf and standard AFOs have been shown to improve forefoot plantar flexion and hindfoot eversion, but not forefoot adduction. A lateral extension added to a standard AFO along the forefoot significantly improved forefoot adduction in participants with posterior tibial tendon dysfunction while walking.

Background:Sarcopenia is a progressive systemic skeletal muscle disorder associated with an increased likelihood of adverse outcomes including physical disability, falls, and mortality. The muscle mass of patients with rheumatoid arthritis (RA) is lower than that of age-matched healthy individuals, and a high prevalence rate of sarcopenia has been reported1). In particular, foot deformities may increase the prevalence rate of sarcopenia because of inactivity due to foot pain on walking. Treatment with a foot orthosis (FO) can reportedly reduce pain2); however, whether a FO can resolve inactivity and sarcopenia is unclear.Objectives:To elucidate the effectiveness of a FO on physical activity and sarcopenia in patients with RA.Methods:Thirty patients with RA with foot deformities were enrolled from April 2017 to December 2019. Sarcopenia was diagnosed using the algorithm of the European Working Group on Sarcopenia in Older People, and the cut-off values of the Asian Working Group for Sarcopenia were applied. We also collected the clinical variables of patients with concurrent RA and sarcopenia who continued to use a FO for 6 months. The primary outcome was physical activity determined by the International Physical Activity Questionnaire. The secondary outcomes were foot pain measured with a visual analog scale; activities of daily living (ADL) measured with the Health Assessment Questionnaire; and body mass index, body fat percentage, and the skeletal muscle mass index measured with a body composition device. The clinical variables were compared between baseline and 6 months after continuous treatment with a FO.Results:The prevalence rate of sarcopenia was 76.6% (23/30), and nine patients with RA continued to use the FO for 6 months. Table 1 shows outcomes at baseline and after 6 months of treatment with a FO. The only clinical variable that showed a significant difference was foot pain. Physical activities, ADL, and body compositions were maintained after 6 months.Table 1.Outcomes of 6-month treatment with FOBaseline6 monthsp valuePhysical activityIPAQWalking, MET-min/weekModerate, MET-min/weekVigorous, MET-min/week132 (66, 594)0 (0, 0)0 (0, 0)594 (396, 2376)0 (0, 0)0 (0, 0)0.071.000.32Foot painVAS score4.6 (3.1, 7.4)2.8 (1.1, 4.7)0.02ADLHAQ1.5 (1.1, 2.3)1.1 (0.9, 1.5)0.07Body compositionBMI, kg/m2BFP, %SMI, kg/m221.4 (20.7, 22.7)31.1 (24.2, 37.6)5.2 (4.8, 5.3)20.7 (19.3, 22.1)32.9 (26.3, 36.5)5.2 (5.0, 5.2)0.890.820.61IPAQ: International Physical Activity Questionnaire, VAS: visual analog scale, ADL: activities of daily living, HAQ: Health Assessment Questionnaire, BMI: body mass index, BFP: body fat percentage, SMI: skeletal muscle mass indexData are presented as median (lower quartile, upper quartile)Conclusion:The prevalence rate of sarcopenia in patients with RA with foot deformities was much higher than previous reported1). However, 6 months of treatment with a FO not only reduced foot pain but also maintained physical activity and muscle mass. Physical therapy has recently been recommended for patients with inflammatory arthritis. physical activity and muscle mass of patients with RA and concurrent foot deformities may be increased by combining physical therapy with orthotic treatment.References:[1]Tada M, et al. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis. 2018; 21 (11): 1962-9.[2]Hennessy K, et al. Custom foot orthoses for rheumatoid arthritis: A systematic review. Arthritis Care Res (Hoboken). 2012; 64 (3): 311-20.Acknowledgments:This work was supported by JSPS KAKENHI Grant Numbers JP19K11420.Disclosure of Interests:None declaredDOI: 10.1136/annrheumdis-2020-eular.3143

Background It was well known that patellofemoral pain (PFP) has multifactorial aetiology. Increased navicular drop measures and especially more pronated foot posture in stance phase have been reported as distal factors.1,2 Foot orthosis are recommended as distal interventions but remained passive.3 For this reason, short foot exercise (SFE),4 as an active approach, may be of significant benefit in patients with PFP. Objectives The aim of this study was to investigate the effects of SFE on pain, knee and foot biomechanics in patients with PFP. Methods Twenty-two patients with PFP, mean age was 40.91±10.73, included in this study. They were randomly divided into two groups. The first group (KHE) was followed under the exercise program including knee and hip exercises, and the second group (SFE) was followed under SFE in addition to the same exercise program 2 days per a week for 6 weeks. At the beginning and the end of the study, for pain at walking, sitting, squatting, climbing stairs Visual Analogue Scale (VAS) and Kujala Patellofemoral Symptom Scale (KPSS); for knee and foot biomechanics measurement of Q angle, Navicular Drop Test (NDT), Calcaneo-tibial angle (CTA) and Foot Posture Index (FPI) were performed. Results As a result of this study, it was found that all parameters were improved in both groups, whereas the improvements in the pain intensity (VAS) of sitting and stair activities, values of Q angles, NDT, CTA and FPI were statistically significant in SFE group compared to KHE group (p Conclusions In conclusion, it was shown that SFE has positive effects on pain, knee and foot biomechanics in patients with PFP. At this point, SFE is an exercise approach in order to increase the success of the rehabilitation program in patients with PFP. References [1] Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. 2012;42(2):81–94. [2] Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47(4):193–206. [3] Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, et al. 2016Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):839–43. [4] McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015;49(5):290. Disclosure of Interest None declared

Foot orthoses have been applied for the management of lower limb disorders, mainly for those who develop foot pain. The Central Stabilizer Element (CSE) is a new element that contains the midfoot laterally when a plantar insole is manufactured.To determine the effect on foot pain of adding the Central Stabilizer Element during the manufacturing process of foot orthosis, and to describe the proportions of Central Stabilizer Element in terms of width and length of this element.A clinical study.A sample comprising 130 patients (57 males and 73 females) with foot pain was recruited for this study, with the patients having supinated, neutral, pronated and overpronated feet. All the patients received a custom-made foot orthosis with the Central Stabilizer Element. The Central Stabilizer Element was made of resins of polyvinyl chloride, and is a device insert in foot orthosis that contains the midfoot laterally to control pronation and supination movements. Perceived patient's foot pain was collected using a Visual Analog Scale at baseline, 15, 60 and 90 days after treatment.A statistically significant decrease was found after foot orthosis application at all times in all foot types. There was a statistically significant correlation between all the ratio proportions according to foot posture (Foot Posture Index scores), except for heel length proportion.The Central Stabilizer Element, applied at midfoot level of a custom-made foot orthoses through a directly mould technique, can reduce foot pain, when a previous foot posture status is considered.The Central Stabilizer Element can be of interest for those professionals who are involved in the manufacturing process of foot orthosis, throughout the control of an excesive pronated or a supinated foot condition that is provoking foot pain.

Objective To evaluate the effect of custom molded foot orthoses on children with growing pains of the lower extremities. Methods Children with growing pains were recruited during a clinic visit. None had any bony deformities, inflammatory joint disease or depression. Resting calcaneal stance position (RCSP) and calcaneal pitch angle were measured, and individual custom molded rigid foot orthoses were prescribed using the inverted orthotic technique to control for foot overpronation using the RCSP angle. Pain sites, degree and frequency of pain, and balance ability were evaluated using Balance Master computerized posturography prior to foot orthosis fitting, and 1 and 3 months later. Results Twenty children completed the study. Seventeen (75%) had overpronated feet. Significant improvements were noted after 1 and 3 months in pain degree and frequency, and after 3 months in balancing ability. Conclusion The use of custom molded foot orthoses is a good method for treating children with multiple musculoskeletal pains in the leg.

Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus.To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus.Quasi-experimental.Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention.The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p0.05). In the medial midfoot region, peak pressure, maximum force, and contact area were significantly higher with the foot orthosis than shoe-only before and after the intervention (p = 0.00).A foot orthosis with medial arch support could reduce pressure beneath the hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology.Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology.

Additive manufacturing (AM) of custom foot orthosis (FO), ankle-foot orthosis (AFO) and prosthetic socket is reviewed and compared to the traditional plaster molding fabrication techniques. A study was first conducted at the University of Michigan Orthotics and Prosthetics Center (UMOPC) to study the quantity and revenue of various types of orthoses and prostheses. FO and AFO were identified as the highest revenue orthoses. Together with the prosthetic socket, which is prevalent among amputees, the current fabrication procedure at UMOPC and a detailed review of the design and AM research of these three types of orthoses and prostheses in the past 25 years are investigated. The laborious steps and long fabrication time of the traditional manufacturing method and the progress and benefits of AM for custom orthoses and prostheses are evident. The study concludes that there are still clinical, financial and technological barriers for full-scale implementation of AM in a service system for custom orthoses and prostheses.

Background Foot orthoses have been advocated in the management of a wide range of clinical foot and lower limb problems and are within the scope of podiatry, orthotic and physiotherapy practice. Previous reports into the provision of orthoses have consistently identified significant issues with services and devices, but data were never specific to foot orthoses. The aim of this first of a series of papers was to report the first ever national multi professional profile of foot orthosis provision in the United Kingdom. Methods Quantitative and qualitative data were collected from podiatrists, orthotists and physiotherapists via an online questionnaire. The topics, questions and answers were developed through a series of pilot phases. The professions were targeted through electronic and printed materials. Data were captured over a 10 month period in 2016. Results A total of 499 responses were included in analysis, including 357 podiatrists, 93 orthotists and 49 physiotherapists. The results reveal wide ranging practices across podiatrists, orthotists and physiotherapists, provision of orthoses through different health care departments (uni and multidisciplinary), for different health conditions (acute and chronic), and involving different types of orthoses (prefabricated and customised). Conclusion Foot orthoses in the United Kingdom are provided in areas of well recognised health and rehabilitation priorities. A wide range of orthotic devices and practices are employed and different professions provide foot orthoses in different ways. Electronic supplementary material The online version of this article (doi:10.1186/s13047-017-0215-4) contains supplementary material, which is available to authorized users.

Background Foot pain and deformity is almost ubiquitous in RA and results in considerable physical and psychosocial impairment [1]. Epidemiological studies consistently suggest a 90% prevalence of foot pain despite advances in pharmacological therapy [2]. Mechanical and other non-pharmacological interventions such as orthoses and footwear, have an important role in managing foot pathology in patients with their systemic disease controlled [1,3]. The effectiveness of treatment with insoles, especially in early periods, was studied in a randomized controlled trial, which results suggested an immediate clinical improvement, reducing foot pain, disability and limited functionality.[1] Objectives The aim of this study is the effectiveness of foot orthosis in patients with rheumatoid arthritis in terms of quality of life and pain. Methods A systematic review and meta-analysis was conducted of randomized controlled trials. Participants: Patients with rheumatoid arthritis were included. The criteria of exclusion were Juvenile Rheumatoid Arthritis, analysis of gait, Intervention: Studies had to compare foot orthosis Comparison: Other type of treatments, other type of foot orthosis, sham Outcomes: Evaluation of Pain or Quality of life with any tool that measure this outcomes The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, LILACS, and Cuiden. An independent peer review was carried out. The Mesh term and fields used were foot, ankle, joint, rheumatoid arthritis, foot, orthosis, insole, foot orthosis. Results After the analysis of 71 studies, 4 were included for the systematic review. The 4 studies enrolled 285 participants. Follow-up periods varied from 6 to 30 months. Only two studies were included in the meta-analysis [4,5], both of them with pain (measured with Foot Function Index) as the selected outcome. A meta-analysis of the two trials showed that use of FO resulted in a non-significant improvement in disability compared with control (MD (95% CI): 4.37 (-6.24, 14.98); N=64) (Figure 1). Conclusions Foot orthoses showed improvements in pain and disability/quality of life, but no significant differences between groups were found.Future research needs to increase the number of RCTs in this topic because results are not conclusive. References Woodburn J, Barker S, Helliwell PS. A randomized controlled trial of foot orthoses in rheumatoid arthritis. J Rheumatol. 2002;29:1377–83. Otter SJ, Lucas K, Springett K, Moore A, Davies K, Young A, et al. Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFalpha therapy: an epidemiological study. Rheumatol Int. 2011;31:1515–9. Hennessy K, Woodburn J, Steultjens MPM. Custom foot orthoses for rheumatoid arthritis: A systematic review. Arthritis Care Res (Hoboken). 2012;64:311–20. Conrad KJ, Budiman-Mak E, Roach KE, Hedeker D, Caraballada R, Burks D, Moore H. Impacts of foot orthoses on pain and disability in rheumatoid arthritics. J Clin Epidemiol. 1996 Jan;49(1):1–7. Novak P, Burger H, Tomsic M, Marincek C, Vidmar G. Influence of foot orthoses on plantar pressures, foot pain and walking ability of rheumatoid arthritis patients–a randomised controlled study. Disabil Rehabil. 2009;31(8):638–45. Disclosure of Interest None declared

Introduction: The desired goal of the neurological rehabilitation is the restoration of neurological deficit. Some compensatory means including assistive devices and orthoses improve client’s activities of daily living (ADLs) and instrumental ADLs (IADLs). In the rehabilitation for malignant central nervous system (CNS) tumor clients, providing their caregivers with assistive techniques sometimes seems effective in order to bring good quality of life (QOL). Authors report the experiences of the rehabilitation for malignant CNS tumor clients. CASE 1: Female; 62Y.O. She had undergone the surgery and radiotherapy 16 years before in a cancer center hospital owing to the right breast cancer. Hormone therapy was being continued. Magnetic resonance (MR) image showed a tumor in the right parietal area. This was assessed as the metastatic tumor. She underwent the cerebral tumor resection since she had fallen a lot of times. Her ADLs became worse owing to the left hemiparesis. Even after the hemiparesis improved by the rehabilitation in our hospital, she fell a few times due to stereoagnosis. An assistive device improved her ADLs and IADLs in home. Her participation in social activities was achieved with her husband’s assistive techniques. CASE 2: Male; 64Y.O. He had undergone several times of surgery, radiotherapy, and chemotherapy because of anaplastic astrocytoma in the left parietal area during 12 years at a university hospital. Right hemiparesis and memory disturbance deteriorated his ADLs after the last surgery. Histological examination showed glioblastoma. The rehabilitation in our hospital enabled him to walk with an ankle foot orthosis in 2 weeks. His wife’s assistive techniques were also helpful in the return to his domestic situation. Meningeal dissemination was found in MR image 6 weeks after the beginning of the rehabilitation. He underwent chemotherapy at the former hospital and died several weeks after the transition to home. DISCUSSION AND conclusions: The rehabilitation for malignant CNS tumor patients may have had little importance in the treatment owing to the rapid exacerbation of their diseases. While many patients survive by the developed treatment of malignant CNS tumors, the neurological deficits require the rehabilitation. The rehabilitation needs to aim not only to recover ADLs and IADLs, but also to aid the preparation for the client’s good QOL. Every rehabilitation staff needs to consider how the client will act in home and participate in the community. This view of consideration possibly benefits the client’s QOL. Assistive techniques can be useful for the client’s QOL even when the independent ADLs or IADLs are not expected during the inpatient rehabilitation.

Objective To investigate the mode‐of‐action and patient experience of functionally optimized foot orthoses in patients with early rheumatoid arthritis (RA). Methods We conducted an investigation of 2 functionally optimized foot orthoses (selective laser sintering [SLS] and fused deposition modelling [FDM]) in 15 patients with RA of

A statistical orthosis selection model was developed using the Random Forest Algorithm (RFA). The model's performance and potential clinical benefit was evaluated. The model predicts which of five orthosis designs - solid (SAFO), posterior leaf spring (PLS), hinged (HAFO), supra-malleolar (SMO), or foot orthosis (FO) - will provide the best gait outcome for individuals with diplegic cerebral palsy (CP). Gait outcome was defined as the change in Gait Deviation Index (GDI) between walking while wearing an orthosis compared to barefoot (ΔGDI=GDIOrthosis-GDIBarefoot). Model development was carried out using retrospective data from 476 individuals who wore one of the five orthosis designs bilaterally. Clinical benefit was estimated by predicting the optimal orthosis and ΔGDI for 1016 individuals (age: 12.6 (6.7) years), 540 of whom did not have an existing orthosis prescription. Among limbs with an orthosis, the model agreed with the prescription only 14% of the time. For 56% of limbs without an orthosis, the model agreed that no orthosis was expected to provide benefit. Using the current standard of care orthosis (i.e. existing orthosis prescriptions), ΔGDI is only +0.4 points on average. Using the orthosis prediction model, average ΔGDI for orthosis users was estimated to improve to +5.6 points. The results of this study suggest that an orthosis selection model derived from the RFA can significantly improve outcomes from orthosis use for the diplegic CP population. Further validation of the model is warranted using data from other centers and a prospective study.

[Purpose] The purpose of this study was to examine the effects of a functional foot orthosis on the knee angle in the sagittal plane of college students in their 20s who had flatfoot. [Subjects and Methods] The subjects of this study were 20 college students diagnosed as having flatfoot. The variations of their knee angle (Q-angle) in the sagittal plane during the stance phase were measured using the VICON Motion System (Vicon, Hansung, Korea) before and while wearing a foot orthosis. The experimental data were analyzed using SPSS 12.0 for Windows. [Results] The Q-angle in the test group during the stance phase showed statistically significant declines on the right and left sides while wearing the foot orthosis during the gait-phases of loading response and midstance. During initial contact, terminal stance, and preswing, the Q-angle also decreased on the right and left sides after wearing the foot orthosis, but the changes were not statistically significant. [Conclusion] The college students with flatfoot exhibited declines in the Q-angle in the sagittal plane while wearing a foot orthosis. In this regard, the application of active gait training using orthotic shoes for long hours is likely to help individuals with flatfoot to achieve normal gait.

This article is based on educating readers and physicians about the use of footwear and orthotics for themselves and their patients, to treat diseases and enhance functionality in sports and daily life.

randomized, double-blinded, clinical trial.Low back pain is one of the commonest disorders affecting the back. The literature reflects how over time excessive pronation of the foot has become to be recognized as linked to chronic low back pain, and how the problem can evolve for the better with the use of compensating foot orthoses.The main objective of this study is to answer the question of whether the use of a certain type of custom-made foot orthosis alleviates low back pain.In a sample of 51 participants with excessive subtalar pronation and chronic low back pain (43 women and 8 men), the effect of custom-made foot orthoses in low back pain was studied. The study design was a randomized, double-blinded, clinical trial with two groups: experimental, treated with the custom-made foot orthoses, and control, treated with a placebo. Low back pain was evaluated by a visual analog scale for pain and Oswestry's Disability Index Questionnaire for lower back pain at two moments--on the day of inclusion in the study and after 4 weeks of treatment.The evolution of the low back pain showed significant differences in the experimental group, showing a significant reduction of pain and disability (p0.001, visual analog scale; p0.001, Oswestry's Index).In the sample studied, the use of custom-made foot orthoses to control foot pronation had a short-term effect in reduction of perceived low back pain.

Although orthotic modification using the inverted technique is available for the treatment of flatfoot, empirical evidence for the biomechanical effects of inverted-angle foot orthoses (FOs) is lacking. The aim of this study was to evaluate the effects of different FO inversion angles on plantar pressure during gait in children with flatfoot. Twenty-one children with flexible flatfeet (mean age 9.9 years) were enrolled in this study. The plantar pressures were measured for the rearfoot; medial and lateral midfoot; and medial, central, and lateral forefoot as participants walked on a treadmill while wearing shoes only and shoes with the following 3 orthotic conditions: (i) orthosis with no inverted angle, (ii) orthosis with a 15 degrees inverted angle, and (iii) orthosis with a 30 degrees inverted angle. A one-way repeated measures analysis of variance (ANOVA) with the Bonferroni-adjusted post-hoc test was used to compare the mean values of each orthotic condition. Compared with the shoe only condition, the peak pressure decreased significantly under the medial forefoot and rearfoot with all FOs (p < 0.05). However, no significant differences in the peak pressure under the medial forefoot and rearfoot were observed between the FOs. The peak pressure under the medial midfoot increased significantly with all FOs, and a maximal increase in the peak pressure was obtained with a 30 degrees inverted angle orthosis. Furthermore, the contact area under the medial midfoot and rearfoot increased significantly with all FOs, compared with the shoe only condition (p < 0.05). Again, no significant differences were observed between the FOs. For plantar pressure redistribution, a FO with a low inverted angle could be effective, accommodative, and convenient for children with flatfoot.

The aim of this study was to describe the effect of an antipronation foot orthosis on motion of the heel relative to the leg and explore the individual contributions of the ankle and subtalar joints to this effect.Five subjects were investigated using invasive intracortical pins to track the movement of the tibia, talus, and calcaneus during walking with and without a foot orthosis.The antipronation foot orthosis produced small and unsystematic reductions in eversion and abduction of the heel relative to the leg at various times during stance. Changes in calcaneus-tibia motion were comparable with those described in the literature (1°-3°). Changes at both the ankle and subtalar joints contributed to this orthotic effect. However, the nature and scale of changes were highly variable between subjects. Peak angular position, range of motion, and angular velocity in frontal and transverse planes were affected to different degrees in different subjects. In some cases, changes occurred mainly at the ankle; in other cases, changes occurred mainly at the subtalar joint.The changes in ankle and subtalar kinematics in response to the foot orthosis contradict existing orthotic paradigms that assume that changes occur only at the subtalar joint. The kinematic changes due to the orthosis are indicative of a strong interaction between the often common function of the ankle and subtalar joints.

Objectives. Foot orthoses are commonly used in the management of knee OA, although the relationship between foot function and knee OA is still unclear. The purpose of the study was to examine foot function during walking in people with and without medial compartment knee OA. Methods. Motion of the tibia, rearfoot and forefoot in 32 patients with medial compartment knee OA and 28 age-matched control subjects was investigated. Multivariate analysis was used to compare the groups. Results. The knee OA group contacted the ground with a more everted rearfoot, demonstrated greater peak rearfoot eversion and exhibited reduced rearfoot frontal plane range of motion and reduced rearfoot peak inversion. The tibia was more internally rotated and laterally tilted throughout the gait cycle, with reduced peak external rotation. Conclusion. People with medial compartment knee OA exhibit altered foot kinematics during gait that are indicative of a less mobile, more everted foot type. The presence and degree of tibial malalignment and the available rearfoot range of motion during walking may affect individual responses to load-altering interventions, such as foot orthoses and footwear modifications. Trial registration: Australian New Zealand Clinical Trials Registry, www.anzctr.org.au/, ACTRN

Objective The purpose of the study was to collect preliminary data to address methodological considerations that may impact subject-specific reactions to foot orthotics during running. Methods Six endurance-trained recreational runners recruited from a chiropractic college campus wore their preferred running shoes and then inserted either their custom-made orthotics during 1 testing session or their shoe-fitted insoles during the other testing session. Comfort perception was measured for each footwear condition. Measurements of oxygen consumption (V o 2 ) at several moderate exercise intensities, to mimic recreational running, generated an individual's economy-of-running line. Predicted running velocity at V o 2max (vV o 2max ) was calculated as an index of endurance performance. Lower extremity muscle activity was recorded. Descriptive statistics, a repeated-measures analysis of variance model, and a paired t test were used to document any systematic changes in running economy, lower extremity muscle activities, and vV o 2max within and across subjects as a function of footwear conditions. Results Decreases in V o 2 at several moderate exercise intensities ( F (1,5)footwear = 10.37, P = .023) and increases in vV o 2max ( t 5 = 4.20, P = .008) occurred in all 6 subjects while wearing their orthotic intervention vs their shoe-fitted insoles. There were no consistent changes in lower extremity muscle activity. Conclusions Methodological decisions to use a sustained incremental exercise protocol at several moderate exercise intensities and to measure comfort perception of a custom-molded foot orthosis were effective at documenting systematic improvements in running economy among the 6 recreational runners tested. The development of a less physically demanding sustained exercise protocol is necessary to determine underlying neuromuscular mechanisms and/or clinical effectiveness of orthotic interventions.

OBJECTIVE To prevent overuse injuries related to excessively pronated feet, the strengthening of the foot intrinsic muscles has been recommended. The purpose of this study was to examine the effects of foot orthoses and a short-foot exercise intervention on the cross-sectional area (CSA) of the abductor hallucis (AbdH) muscle and strength of the flexor hallucis (FH) in subjects with pes planus. METHODS Twenty-eight subjects with pes planus were randomly assigned to the foot orthosis (FO) group or the combined foot orthosis and short-foot exercise (FOSF) group for an 8-week intervention. The CSA of the AbdH muscle and the strength of FH were assessed before and after intervention. Data were analyzed using a mixed-model ANOVA. RESULTS Significant group by intervention interaction effects were observed in CSA of the AbdH (p=0.009) and strength of the FH (p=0.015). The results of the post hoc paired t-test showed that that the CSA of the AbdH muscle and the strength of the FH significantly increased after the intervention in both groups (p=0.000). The mean CSA of the AbdH muscle and the strength of FH were significantly greater in subjects in the FOSF group compared with subjects in the FO group (mean difference of FO vs. FOSF=13.61 mm(2) in CSA of AbdH muscle; 0.90 kgf in strength of FH; p=0.008). CONCLUSIONS Results from this study demonstrate that foot orthoses combined with short-foot exercise is more effective in increasing the CSA of the AbdH muscle and the strength of FH compared with foot orthoses alone. Therefore, foot orthoses combined with short-foot exercise are recommended for improving strength of AbdH muscle in subjects with pes planus.

Context: Foot-orthosis (FO) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinically. However, the results of quantitative gait analyses have been equivocal. The foot models used, participants receiving intervention, and orthoses used might contribute to the variability. Objective: To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture. Design: Crossover study. Setting: University biomechanics and ergonomics laboratory. Patients or Other Participants: Sixteen participants with low-mobile foot posture (7 men, 9 women) were assigned randomly to 1 of 2 FO groups. Intervention(s): After a 2-week period to break in the FOs, individuals participated in a gait analysis that consisted of 5 successful walking trials (1.3 to 1.4 m/s) during no-FO and FO conditions. Main Outcome Measure(s): Three-dimensional displacements during 4 subphases of stance (loading response, mid-stance, terminal stance, preswing) were computed for each multisegment foot model articulation. Results: Repeated-measures analyses of variance (ANOVAs) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition (F1,14 = 5.24, P = .04, partial η2 = 0.27). Terminal stance repeated-measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal joint complex (F1,14 = 7.87, P = .01, partial η2 = 0.36). However, additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional orthosis (F1,14 = 4.32, P = .08, partial η2 = 0.38) or full-contact orthosis (F1,14 = 4.10, P = .08, partial η2 = 0.37). Conclusions: Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures. Furthermore, FO intervention might partially correct dys-functional kinematic patterns associated with low-mobile foot postures.

[Purpose] This study examined the effects of foot orthosis on the gait ability of college students in their 20s with flat feet. [Subjects and Methods] The subjects were 20 college students who had been diagnosed with flat feet. The subjects' step time, step length, stride time, stride length, and gait velocity were measured using the VICON Motion System (Vicon, Oxford, UK) prior to and while wearing foot orthoses. The resulting data were analyzed using SPSS v. 12.0. [Results] The subject's step time and stride time significantly decreased for both feet after they began using foot orthosis, and stride length and gait velocity significantly increased in both feet orthosis; however, step length did not significantly increase on either side. [Conclusions] College students with flat feet saw an improvement in elements of their gait while using the foot orthosis. The results of this study verified that students with flat feet might walk more efficiently if they received active gait training via long-term use of foot orthosis.

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)

Plantar fasciitis is a common and hard-to-treat disorder of the foot. Numerous studies have compared various stretching exercises, but the use of a day-wear static progressive stretch brace has not been studied. A randomized, single-blinded trial was conducted to compare the effectiveness of a static progressive stretch brace to standard care of active stretching exercises. Thirteen subjects (12 women and 1 man; mean age, 42 ± 9.0 years) with plantar fasciitis participated in this study between January 2004 and March 2007. Subjects were randomized to either an exercise group (static stretch group, n = 8) or a brace group (static progressive stretch group, n = 9) for an 8-week treatment period and 1-month follow up. Both groups received basic off-the-shelf foot orthoses. Data were available for 7 subjects in the exercise group and 6 in the brace group. Pain and functional limitations were evaluated with the Foot Functional Index pain subscale, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, and great toe extension motion. Overall pain and morning pain improved in both groups as compared with baseline measures (repeated-measures analysis of variance, P = .04 and P = .02, respectively). Functional rating also improved in both groups (repeated-measures analysis of variance, P = .005). No changes were found in either group with great toe extension range of motion. In addition, there was no significant group difference or interaction with time and group with any measures. Both interventions (static, exercise, and brace stretching) were beneficial for treating pain and functional limitations, suggesting that static progressive stretch brace is an effective alternative option to static stretching exercises for people with plantar fasciitis.

Foot orthotic treatment is one of the major conservative methods used to handle foot problems. Total plantar contact foot orthoses are used to reduce and redistribute peak pressures. For the fabrication of a total plantar contact foot orthosis, the computer-aided design and computer-aided manufacturing (CAD-CAM) method has been applied. In this study, the plantar foot-orthosis interface pressure data during walking were collected by the Novel Pedar-mobile in-shoe plantar pressure measuring system. The data were collected under three conditions: (i) Flat insole, (ii) foot orthosis provided by the CAD-CAM method, and (iii) foot orthosis provided by the foam impression method. The Swiss Comfort CAD-CAM foot orthotics system was used in this study. For conditions (ii) and (iii), foot shapes were collected in partial weight bearing and subtalar neutral conditions. Thirty normal subjects were recruited for this study. The plantar foot surface was divided into eight plantar foot regions and then was investigated. These regions included the heel, the medial and lateral arches, the medial, mid and lateral forefoot, the hallux, and the lateral toes. The results showed that the orthoses provided by both the CAD-CAM and foam impression methods could decrease the peak pressure and the maximum force in the heel region, and increase the peak pressure and the maximum force in the medial arch region. Both orthoses redistributed the peak pressure and the maximum force from the heel to the medial arch region. The peak pressure in the mid forefoot region was different between the orthoses provided by the CAD-CAM and foam impression methods.

Background: Custom-made foot orthoses whilst effective can be expensive and time-consuming to manufacture making ready made devices an attractive option. This study, with follow up after 12 months provides longitudinal data not frequently available. Objectives: Longitudinal evaluation of the efficacy of a slim, ready made, 3/4th length semi-rigid foot orthosis. Method: Data was collected from 21 participants at baseline, at 4 weeks and via postal questionnaire after 12 months. Powerstep orthoses (Cuxson-Gerrard & Co Ltd., Oldbury, UK) were given to participants with the therapeutic aim of resolving or reducing their lower limb symptoms. Results: Participants reported an initial marked decrease in foot pain, found the orthoses fitted in footwear readily, had a sense of increased foot stability and a significant improvement in comfort (p < 0.0001). Some increase in pain levels reported after 4-weeks (p = 0.01), was accompanied by an equally significant increase in mobility (p = 0.01) which triangulated closely against diary records. After a mean of 15.1 months, 73% of participants still found the orthoses beneficial. Conclusion: Participants found ready made orthoses enhanced sense of stability and generally reduced symptoms over a period of at least 1 year.

Preintervention and post-intervention, repeated-measures experimental design.The objective was to investigate the effects of foot orthoses with medial arch support on ankle inversion angle and plantar forces and pressures on the fifth metatarsal during landing for a basketball lay-up and during the stance phase of a shuttle run.Proximal fractures of the fifth metatarsal, specifically the Jones fracture, are common in sports. Wearing foot orthoses with medial arch support could increase the ankle inversion angle and the plantar forces and pressure on the fifth metatarsal that may increase the risk for fifth metatarsal fracture,Three-dimensional (3-D) videographic, force plate, and in-shoe plantar force and pressure data were collected during landing after a basketball lay-up and during the stance phase of a shuttle run with and without foot orthoses with medial arch support for 14 male subjects. Two-way ANOVAs with repeated measures were performed to compare ankle inversion angle, maximum forces, and pressure on the fifth metatarsal head and base between conditions and between tasks.The maximum ankle inversion angle and maximum plantar force and pressure on the base of the fifth metatarsal during both tasks as well as the maximum plantar force and pressure on the head of the fifth metatarsal during the stance of the shuttle run were significantly increased (Por =026) when wearing foot orthoses. No significant differences were found in the maximum vertical ground reaction forces between foot orthotic conditions.Generic use of off-the-shelf foot orthoses with medial arch support causes increased plantar forces and pressures on the fifth metatarsal and may increase the risk for proximal fracture of the fifth metatarsal. Future studies are needed to investigate this risk, acknowledging that the differences noted in our study were small in magnitude and the foot type was not measured.

To measure the plantar pressure in four soccer-related movements in 15 male soccer players (mean (SD) age 20.9 (1.3) years, height 173 (4) cm, weight 61.7 (3.6) kg).To record plantar pressure distribution, the players wore soccer boots with 12 circular studs and with an insole pressure recorder device equipped with 99 sensors. Plantar pressure was recorded in five successful trials in each of the four soccer-related movements: running, sideward cutting, 45 degrees cutting and landing from a vertical jump. Each footprint was divided into 10 recorded areas for analysis.Compared with running at 3.3 m/s, maximal speed sideward cutting and 45 degrees cutting induced higher peak pressure (p0.05) under the second toe, medial forefoot, medial arch and medial heel. The peak pressure of the maximal jump landing was lower under the medial forefoot and lateral forefoot as compared with running (p0.05). The pressure-time integral showed that sideward cutting and 45 degrees cutting induced higher pressures (p0.05) than running for all recorded areas, except for the lateral forefoot and the lateral arch. In all the four soccer-related movements, a higher pressure was found on the medial side of the plantar surface as compared with the lateral side.These data suggest that the medial side of the plantar surface may be more prone to injuries, and that foot orthosis adoption, improved soccer boot design and specific muscle training could be considered to reduce pressure and the subsequent risk of injury.

Background The aim of this study was to evaluate the effects of insole configurations on plantar pressures and on walking convenience in patients with diabetic neuropathy. Methods Twelve different insole configurations were constructed for each of 20 patients with diabetic neuropathy. For this, different combinations of a metatarsal dome, varus and valgus wedges and arch supports with different heights were added on a fitted basic insole. Foot orthoses were evaluated while patients walked on a treadmill. Plantar pressure was measured with a Pedar Insole-system. Walking convenience was scored on a 10-point scale. Findings For the central and medial regions, plantar pressure reductions (up to 36% and 39%, respectively) were found when using a dome, standard and extra supports. The largest reductions were achieved with combination of a dome and extra support. There were no statistically significant pressure reducing effects of the insole configurations in the big toe and lateral regions, except for the effect of the combination extra support/varus wedge (21%), and for a dome (10%), respectively. The basic insole and a standard support received the best ratings for walking convenience and gradually worsened by adding extra support, a varus wedge and a dome. Interpretation A dome and the supports reduce plantar pressure in the central and medial forefoot. The combination of a dome and extra support seems to be the best choice for the construction of insoles. The results of this study are a step towards developing an evidence-based algorithm for the construction of optimal orthoses in therapeutic shoe design.