Abstract
BackgroundThere is a need for evidence of clinical effectiveness of foot orthosis therapy. This study evaluated the effect of foot orthoses made by ten podiatrists, ten pedorthists and eleven orthotists on plantar pressure and walking convenience for three patients with metatarsalgia. Aims were to assess differences and variability between and within the disciplines. The relationship between the importance of pressure reduction and the effect on peak pressure was also evaluated.MethodsEach therapist examined all three patients and was asked to rate the 'importance of pressure reduction' through a visual analogue scale. The orthoses were evaluated twice in two sessions while the patient walked on a treadmill. Plantar pressures were recorded with an in-sole measuring system. Patients scored walking convenience per orthosis. The effects of the orthoses on peak pressure reduction were calculated for the whole plantar surface of the forefoot and six regions: big toe and metatarsal one to five.ResultsWithin each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p < .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and pedorthotists.ConclusionThe large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups.
Highlights
There is a need for evidence of clinical effectiveness of foot orthosis therapy
A variety of foot impairments such as rheumatoid arthritis and diabetes are associated with elevated plantar forefoot peak pressures and metatarsalgia[1]
Reduction of forefoot plantar pressure through foot orthoses is a common treatment for these conditions and for non-specific metatarsalgia
Summary
There is a need for evidence of clinical effectiveness of foot orthosis therapy. This study evaluated the effect of foot orthoses made by ten podiatrists, ten pedorthists and eleven orthotists on plantar pressure and walking convenience for three patients with metatarsalgia. Dutch medical specialists and general practitioners prescribe foot orthoses which are mainly provided by podiatrists, pedorthists (orthopaedic shoemaker) and orthotists (orthopaedic technician) Each discipline has a specific focus on particular foot problems, all three disciplines provide foot orthoses for comfort shoes to treat foot impairments associated with elevated plantar forefoot peak pressures: e.g. higher than 700 kPa[24,25]. It is not known what the consequences of these differences are for the extent of pressure reduction. The relationship between the importance of pressure reduction as stated by the therapist and the effect on plantar peak pressure through foot orthoses was evaluated
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