Abstract
BackgroundFoot orthoses are frequently used but little is known about which types are used in contemporary practice. This study aimed to explore the types of foot orthoses currently used by podiatrists and the prescription variations in a range of conditions.MethodsA web-based, cross-sectional survey was distributed through professional bodies in the United Kingdom (UK), Australia, and New Zealand. Questions focussed on foot orthosis prescription habits in relation to 26 conditions affecting the back and lower limb.ResultsTwo hundred and sixty-four podiatrists practising in 19 different countries completed the survey; the majority practised in the UK (47%, n = 124), Australia (30%, n = 79) and New Zealand (12%, n = 32). Respondents qualified between 1968 and 2016, and 147 (56%) were female. Respondents worked in different healthcare sectors and this varied between countries: 42 (34%) respondents in the UK worked solely in the public sector, compared to 3 (4%) in Australia and 2 (6%) in New Zealand. Forty-four (35%) respondents in the UK worked solely in private practice, compared to 64 (81%) in Australia and 14 (44%) in New Zealand.UK respondents prescribed more prefabricated orthoses per week (mean 5.5 pairs) than simple insole-type devices (±2.7) and customised devices (±2.9). Similarly, respondents in New Zealand prescribed more prefabricated orthoses per week (±7.7) than simple (±1.4) and customised (±2.8) devices. In contrast, those in Australia prescribed more customised orthoses per week (±4.4) than simple (±0.8) and prefabricated (±1.9) orthoses. Differences in the types of orthoses prescribed were observed between country of practice, working sector, and the condition targeted. Generally, prefabricated orthoses were commonly prescribed for the 26 highlighted conditions in the UK and New Zealand. Australian podiatrists prescribed far fewer devices overall, but when they did prescribe, they were more likely to prescribe custom devices. Respondents in all three countries were more likely to prescribe customised orthoses for people with diabetes complicated by peripheral neuropathy than for diabetes without this complication.ConclusionsFoot orthosis prescription habits vary between countries. Prefabricated orthoses were frequently prescribed in the UK and New Zealand, and customised orthoses in Australia. Prescriptions for people with diabetes differed depending on the presence of neuropathy, despite a lack of robust evidence supporting these decisions. This study provides new insight into contemporary practice.
Highlights
Foot orthoses are frequently used but little is known about which types are used in contemporary practice
We found that a higher mean quantity of customised Foot orthoses (FOs) compared to other FO types were prescribed by Australian respondents, and a higher mean quantity of prefabricated FOs were prescribed by New Zealand respondents compared to Australian respondents
This study has identified that FO prescription habits vary depending on the country of practice, the healthcare sector in which practitioners work, and the condition targeted
Summary
Foot orthoses are frequently used but little is known about which types are used in contemporary practice. A ‘customised’ FO is tailored to the individual based on a 3-dimensional (3D) model of the plantar aspect of the foot, whereas prefabricated FOs are mass-produced to a generic foot shape [2, 3] Their exact mechanism of action remains unclear, FOs are thought to alter the mechanics of the feet and lower limb in a systematic way. Both accommodative and functional FOs are reported to help a range of lower limb pathologies [4,5,6,7,8,9] by alleviating symptoms [8, 9] improving function [10], preventing deformity [11], and preventing injury [12]. They are recommended in national guidelines for a number of conditions, including rheumatoid arthritis [13], osteoarthritis (OA) [14], and diabetes [15]
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