Abstract
BackgroundFoot orthoses have been demonstrated to be effective in the management of a range of conditions, but there is debate as to the benefits of customised foot orthoses over less expensive, prefabricated devices.MethodsIn a randomised, cross-over trial, 15 flat-footed participants aged between 18 and 45 years were provided with semi-rigid, customised orthoses and semi-rigid, contoured, prefabricated orthoses. Pressures and forces were measured using an in-shoe system with subjects wearing shoes alone, wearing customised orthoses, and again when wearing contoured prefabricated orthoses. Two weeks acclimatisation was included between cross-over of therapy. Repeated measures ANOVA models with post-hoc, pair-wise comparisons were used to test for differences.ResultsWhen compared to wearing shoes alone, wearing either the customised orthoses or the prefabricated orthoses was associated with increases in force and force time integrals in the midfoot region. Peak and maximum mean pressure and pressure-time, and force-time integrals were reduced in both the medial and lateral forefoot. There were, however, no significant differences between the customised orthoses and the prefabricated orthoses at any site.ConclusionThere was a similar change in loading with both the semi-rigid customised and the semi-rigid prefabricated orthoses when compared to the shoe alone condition. However, while customised devices offered minor differences over prefabricated orthoses in some variables, these were not statistically significant. The results suggest that there may be only minor differences in the effects on plantar pressures between the customised and the less expensive prefabricated orthoses tested in this study, however further research is warranted.
Highlights
Foot orthoses have been demonstrated to be effective in the management of a range of conditions, but there is debate as to the benefits of customised foot orthoses over less expensive, prefabricated devices
Prefabricated orthoses are mass produced devices made to fit to a generic foot shape, and include a variety of flat insoles, arch supports, and single plane wedges; as well as contoured devices that mimic many of the physical characteristics of customised devices
Objective results from a study of the mechanical effects are important, but further studies incorporating a range of the broader, patient-reported factors such as symptom relief and comfort are needed to further inform the debate. In this study both customised and prefabricated orthoses altered plantar loading in a shod foot compared to wearing a shoe without an orthosis
Summary
Foot orthoses have been demonstrated to be effective in the management of a range of conditions, but there is debate as to the benefits of customised foot orthoses over less expensive, prefabricated devices. A range of customised, and less expensive prefabricated orthoses are prescribed [6]. Customised foot orthoses are semi-rigid devices, made to a cast of the patient's foot with an individualised prescription, and are generally considered the gold standard [6]. Results from recent clinical trials have demonstrated that some contoured prefabricated devices are as beneficial in reducing patient symptoms as more expensive customised orthoses for certain conditions [5,15,16]. Most research studies have focussed on "gold standard" customised orthoses, and little data has been published on the mechanical effects of prefabricated devices
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