Custom-made Orthoses Research Articles

New concept of orthosis treatment for knee osteoarthritis: Clinical and radiological outcomes.

Given the increasing numbers of young patients with knee osteoarthritis there is a need for treatments that can postpone a joint prosthesis (total knee replacement). As an alternative to the effective yet invasive knee joint distraction procedure, a knee orthosis was developed aiming to unload the affected knee and improving synovial fluid flow. The aim of this study was to examine the effectiveness of using a load-reducing orthosis for two months on functioning, pain, and disease progression (e.g. amount of damaged cartilage) in patients with symptomatic osteoarthritis of the knee for at least one year. This is an interventional single-center pilot study. Ten patients with symptomatic osteoarthritis of one knee (5males/5 females; median age 57; age range 42-59) used a custom-made orthosis for 60 days during daily life activities that involved knee loading (e.g. standing, walking, but not during stair climbing). Cycling was not allowed. Clinical outcomes were assessed up to 24 months after intervention at 6 timepoints using patient reported-outcome measures Western Ontario and McMaster Universities Osteoarthritis (WOMAC) range 0-100; Visual Analogue Scale (VAS), range 0-100 for pain. Minimum joint space width (mJSW) was assessed using knee images digital analysis (KIDA) and articular cartilage volume with magnetic resonance imaging (MRI) using custom software at baseline and at 12 and 24 months follow-up. Clinically beneficial effects were found for functioning (WOMAC improvement compared to baseline ranged between 18 points at 3 months follow-up and 31 points at 12 months follow-up, with only the 24-months follow-up (improvement of 27 points) not reaching statistical significance (p< 0.05)) and for pain (VAS improvement compared to baseline at follow-up time points ranged between 41-56 points; all p< 0.05). No improvements in mJSW- or MRI-derived parameters were found. This study demonstrates that use of a custom-made knee-unloading orthosis for 60 days can result in improved functional ability and decrease in pain in relatively young patients with knee osteoarthritis. No effect on disease progression could be evidenced.

A proximal interphalangeal joint custom-made orthosis in trigger finger: Functional outcome.

Trigger finger is a common and functionally limiting disorder. Finger immobilization using an orthotic device is one of the conservative treatment options for treating this condition. The most common orthosis previously described for trigger finger is metacarpophalangeal joint immobilization. There are limited studies describing the effectiveness of proximal interphalangeal joint orthosis for treatment of trigger finger. This study was a single group pretest-posttest design. Adult patients with single digit idiopathic trigger finger were recruited and asked to wear a full-time orthoses for 6 weeks. The pre- and post-outcome measures included Quick-DASH score, the Stages of Stenosing Tenosynovitis (SST), the Visual Analogue Scale (VAS) for pain, the number of triggering events in ten active fists, and participant satisfaction with symptom improvement. Orthotic devices were made with thermoplastic material fabricated with adjustable Velcro tape at the dorsal side. All participants were given written handouts on this disease, orthotic care and gliding exercises. Paired t-tests were used to determine changes in outcome measures before and after wearing the orthosis. There were 30 participants included in this study. Evaluation after the use of PIP joint orthosis at 6 weeks revealed that there were statistically significant improvements in Quick-DASH score from enrolment (mean difference -29.0 (95%CI -34.5 to -23.4); p < 0.001), SST (mean difference -1.4 (95%CI -1.8 to -1.0); p < 0.001) and VAS (mean difference -3.4 (95%CI -4.3 to -2.5); p < 0.001). There were no serious adverse events and patient satisfaction with the treatment was high. Despite our small study size, the use of proximal interphalangeal joint orthosis for 6 weeks resulted in statistically significant improvements in function, pain and triggering, and also high rates of acceptance in patients with isolated idiopathic trigger finger.

Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses

PurposeNo prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses.MethodsTwenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton’s neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes.ResultsMedian VAS and FFI before treatment were 8[5–8.5] and 45.85[32.4–59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0–5] and 0 [0–2.75], respectively) and median FFI (7.9 [3.95–20] and 0 [0–3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton’s neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters.ConclusionUltrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.

Alterations in the ground reaction force of dogs during trot after immobilization of the stifle joint: An experimental study.

This study aimed to evaluate changes in the vertical and fore-aft force generation of the hindlimbs in dogs with stifle orthoses. Custom-made orthoses were used on the right stifle joint. Force plate and marker data from four beagle dogs in trials without orthoses, with fixed orthoses, and with unfixed orthoses were collected. The vertical ground reaction force of the right side was increased with fixed orthoses and decreased with unfixed orthoses compared to that of gait without orthoses. When compared to that of gait without orthoses, the fore-aft ground reaction force changed with fixed orthoses but not with unfixed orthoses. It is suggested that the level of constraint of the orthosis affected the ground reaction force pattern.

Studying the Effects of Using Two Types of Afos on the Hip Joint Kinematics and Kinetics during Walking in the Sagittal Plane for a Patient with Severe DDH; Part 1

Developmental Dysplasia of the hip DDH is considered as one of the most common Orthopedic Disorders, referring to a range of conditions from mild to severe dislocation of the hip joint. However, there are unclear gait alterations in individuals with DDH such as the investigation of the Ankle and Knee devices AFOs and their effect on the kinematics and kinetics of the joints during walking and running. This paper aimed to study and evaluate the kinematics and kinetics of the ankle and knee joints during walking in the sagittal plane for a patient age 26 with severe dysplasia of the left hip who is experiencing using two different types of ankle-foot Orthosis (Custom-made, and Leaf-AFO). The data were collected using ten cameras and one force plate. We used an inverse dynamic approach to calculate sagittal joint angles, moments and power. The results pointed out that the planter flexion angle reached the maximum during the time between the Toes-off the ground phase and the initial swing phase significantly by mean difference (21.1, 14 deg). Moreover, the results indicated that the fabricated orthosis has decreased both the right and left extensor moments significantly during the load-bearing phase in comparison to Barefoot by mean difference (0.29, and 0.43 Nm/kg) respectively for both limbs. The paper concluded that the kinematics and kinetics of the ankle joint improved by the Custom made-Orthosis more than that of the Leaf AFO-Spring Orthoses. Finally, it concluded that both AFOs did not change much the kinematics of the knee joint; however, there were some improvements in the moments and power generated.

A Comparative Study on Short-Term Effects of Compression Orthosis and Exercises in the Treatment of Pectus Carinatum: A Randomized Controlled Pilot Feasibility Trial.

Pectus carinatum (PC) is a congenital chest wall deformity which is characterized by the protrusion of the sternum and costal cartilages. Although orthotic and exercise therapies are commonly offered by physicians for PC treatment, there is a lack of evidence on the benefits of exercises and how long the orthosis should be worn. The aim of this study is to investigate the effects and feasibility of custom-made compression orthosis and exercises in the treatment of PC. Patients with PC aged 7 to 17 years old were randomized into three groups: compression orthosis 23 hours, compression orthosis 8 hours, and control group. All groups received exercises for 1 hour a day for 3 weeks. Additionally, compression orthosis 23 hours group wore the orthosis for 23 hours a day, while compression orthosis 8 hours group wore the orthosis for 8 hours a day. PC protrusion, pressure of correction, thorax lateral and anteroposterior parameters, external chest wall measurements, and Nuss Questionnaire were evaluated before and after the treatment. Also, adverse effects, retention, and compliance were assessed. Feasibility was evaluated by calculating the percentages of recruitment, retention, and safety. The compression orthosis 23 hours group showed greater improvements than the other groups. After treatment, all groups showed significant changes in protrusion, pressure of correction, and external chest wall measurements. Adverse events occurred with similar frequency across groups. Retention percentages did not differ among groups. Compression orthosis use for 23 hours can be recommended rather than its use for 8 hours because 23 hours of orthosis use has better correction and similar adverse effects.

PO 18252 - Advanced surgical salvage therapy for infected diabetic feet

Introduction: Foot infections are common among diabetic patients with peripheral neuropathy and/or peripheral arterial disease and may be the main factor that leads to major or minor lower-extremity amputation. Most deep infections in diabetic feet are preceded by an unnoticed lesion with local penetration of pathogens into deeper tissues. Knowledge of critical issues for diabetic foot management, such as ischemia, wound-healing principles, immunology and microbiology, has changed the traditional approach to the diabetic foot and has led to new advances. The application of tissue engineering, biomedicine and biotechnology with corrective and instrumental surgical techniques for the management of this disease has become an emerging field with demonstrable advantages. This study provides an updated overview of the orthopedic management for extremity salvage of the diabetic foot with deep infection. Methods: Nine patients (10 feet), 7 men and 2 women, whose mean age at hospital admission was 53 years (ranging from 34 to 72), were evaluated retrospectively after salvage therapy of the extremities. We considered the functional clinical outcome good when the patient was able to wear shoes for insensitive feet, acceptable when the patient had residual deformity requiring custom-made orthosis and poor when the patient required extremity amputation. Results: After a mean follow-up of 6 months (ranging from 4 to 14), an average of 7 surgical procedures were performed (ranging from 2 to 23), including angioplasty in 5 patients and amputation at the level of the Lisfranc joint in one patient. Outcomes were good in 9 feet and acceptable in one foot with braceable residual deformity. Conclusion: We believe that an aggressive approach and the use of new technology has numerous attributes that can help to salvage the extremities of seriously ill patients.

Comparison of the effect of nocturnal use of commercial versus custom-made wrist orthoses, in addition to gliding exercises, in the function and symptoms of carpal tunnel syndrome: A pilot randomized trial

BackgroundConservative treatment for carpal tunnel syndrome (CTS) often includes wrist orthosis. However, there is no consensus on whether commercial or custom-made wrist orthosis is better for the treatment. PurposeTo assess feasibility of a study comparing nocturnal use of commercial versus custom-made wrist orthosis in the treatment of mild/moderate CTS and estimate their potential effects on function and symptoms. Study designRandomized clinical trial. MethodsTwenty-four individuals with mild/moderate CTS were randomized to wear either a commercial orthosis (n = 12) or a custom-made orthosis (n = 12). Participants used the assigned orthosis at night for 45 days and performed gliding exercises at home/work. We collected data on access to eligible population and feasibility of protocol. Data on use of orthosis, performance of exercises, and symptoms were collected through a dairy filled by the participant. Outcomes were pain (using Numeric Pain Rating Scale), symptom severity and functional status (using Boston Questionnaire), pinch strength (by dynamometry), and electromyographic activity of forearm muscles (sampled during a reach-to-grasp task). Outcomes were measured before and after the intervention. ResultsThere were no loses to follow-up in either intervention group. After treatment, we found increased tripod pinch strength and better symptoms and function in both orthosis groups, with better outcomes for the custom-made orthosis, although the differences were not statistically significant. ConclusionsThe preliminary results showed a potential for better outcomes from the custom-made orthosis. We established that a larger study would be feasible and could be designed and conducted based on the estimates provided by this study. Trial registrationBrazilian Registry of Clinical Trials (ReBEC) – registration number: RBR-74rqnz.

Bracing in clubfoot: do we know enough?

PurposeThe Ponseti method is widely used in clubfoot treatment. Long-term follow-up shows high patient satisfaction and excellent functional outcomes. Clubfoot tendency to relapse is a problem yet to solve. Given the importance of bracing in relapse prevention, we ought to discuss current knowledge and controversies about bracing.MethodsWe describe types of braces used, with its advantages and disadvantages, suggesting bracing schedules and duration. We identify bracing problems and pinpoint strategies to promote adherence to bracing.ResultsWhen treating a clubfoot by the Ponseti method, the corrected foot should be held in an abducted and dorsiflexed position, in a foot abduction brace (FAB), with two shoes connected by a bar. The brace is applied after the clubfoot has been completely corrected by manipulation, serial casting and possibly Achilles tenotomy. Bracing is recommended until four to five years of age and needs to be fitted to the individual patient, based on age, associated relapse rate and timing when correction was finished. Parental non-adherence to FAB use can affect 34% to 61% of children and results in five- to 17-fold higher odds of relapse. In patients who have recurrent adherence problems, a unilateral lower leg custom-made orthosis can be considered as a salvage option. Healthcare providers must communicate with patients regarding brace wearing, set proper expectations and ensure accurate use.ConclusionBracing is essential for preventing clubfoot relapse. Daily duration and length of bracing required to prevent recurrence is still unknown. Prospective randomized clinical trials may bring important data that will influence clinicians’ and families’ choices regarding bracing.Level of EvidenceV

A randomised controlled trial and cost-consequence analysis of traditional and digital foot orthoses supply chains in a National Health Service setting: application to feet at risk of diabetic plantar ulceration

BackgroundDiabetic foot ulceration is a considerable cost to the NHS and foot orthotic provision is a core strategy for the management of the people with diabetes and a moderate to high risk of foot ulceration. The traditional process to produce a custom-made foot orthotic device is to use manual casting of foot shape and physical moulding of orthoses materials. Parts of this process can be undertaken using digital tools rather than manual processes with potential advantages. The aim of this trial was to provide the first comparison of a traditional orthoses supply chain to a digital supply chain over a 6 month period. The trial used plantar pressure, health status, and health service time and cost data to compare the two supply chains.MethodsFifty-seven participants with diabetes were randomly allocated to each supply chain. Plantar pressure data and health status (EQ5D, ICECAP) was assessed at point of supply and at six-months. The costs for orthoses and clinical services accessed by participants were assessed over the 6 months of the trial. Primary outcomes were: reduction in peak plantar pressure at the site of highest pressure, assessed for non-inferiority to current care. Secondary outcomes were: reduction in plantar pressure at foot regions identified as at risk (> 200 kPa), cost-consequence analysis (supply chain, clinician time, service use) and health status.ResultsAt point of supply pressure reduction for the digital supply chain was non-inferior to a predefined margin and superior (p < 0.1) to the traditional supply chain, but both supply chains were inferior to the margin after 6 months. Custom-made orthoses significantly reduced pressure for at risk regions compared to a flat control (traditional − 13.85%, digital − 20.52%). The digital supply chain was more expensive (+£13.17) and required more clinician time (+ 35 min). There were no significant differences in health status or service use between supply chains.ConclusionsCustom made foot orthoses reduce pressure as expected. Given some assumptions about the cost models we used, the supply chain process adopted to produce the orthoses seems to have marginal impact on overall costs and health status.Trial registrationRetrospectively registered on ISRCTN registry (ISRCTN10978940, 04/11/2015).

User perspectives on orthoses for thumb carpometacarpal osteoarthritis

Study DesignQualitative and interpretive description. IntroductionOrthoses are often the first-choice treatment for thumb carpometacarpal osteoarthritis (CMCOA). It is unknown to what extent the orthoses are used in the way intended by health professionals and why patients continue using the orthoses despite minimal pain reduction. Purpose of the StudyThe purpose of this study is to investigate user perspectives and experiences with 2 types of CMCOA orthoses. MethodsSemistructured interviews were conducted with 16 individuals with CMCOA who used the Push-Ortho-Thumb-Brace-CMC (Nea International BV, Netherlands) and a custom-made orthosis. The data were analyzed using the phenomenological and the framework approach. ResultsFour men and 12 women participated (mean age, 57 years; half of whom were employed). Five central phenomena were identified, explaining the essence of the relation between user and orthosis: the orthosis as stabilizer, tool, healer, preventer, and nuisance. Users mentioned better appearance and the ability to do a variety of activities as advantages of the Push-Ortho-Thumb-Brace-CMC and better support and the ability to do strenuous activities as advantages of the custom-made orthosis. The central phenomena were related to the users' understanding of the disease process and the working mechanism of the orthoses and affected the patterns of usage and orthosis preference. DiscussionIt is recommended that the provider recognizes user perspectives and discusses the disease process of CMCOA along with the working mechanism of the orthosis to support therapy adherence. ConclusionsThere is a wide variety in usage patterns of the CMCOA orthoses, which are influenced by different user perspectives.

Efficacy of Thoracolumbar Bracing in Spinal Immobilization: Precise Assessment of Gross, Intersegmental, and Segmental Spinal Motion Restriction by a 3D Kinematic System

Various diseases of the spine are treated by immobilization via orthoses, although detailed evidence on the efficiency of orthotic bracing remains elusive. The present study sought to investigate the impact of 3 different orthoses on spinal immobilization using 3-dimensional (3D) kinematic measurements. Twelve healthy volunteers performed different motion tasks, including trunk flexion/extension and bilateral trunk bending. Movements were performed under 4 different conditions: 1) without orthosis, 2) while wearing a 3-point hyperextension brace (HB), 3) while wearing a custom-made semirigid orthosis (SO), and 4) while wearing a custom-made rigid orthosis (RO). Spinal motion was analyzed using a 3D optical motion capture system assessing regional, intersegmental, and segmental range of motion (ROM). Assessment of spinal motion was successfully accomplished in all subjects. Overall, orthoses significantly reduced spinal motion compared with no bracing. RO caused the greatest restriction of regional, intersegmental, and segmental spinal motion among all orthoses. For flexion/extension, the mean percentage decreases between T3 and L5 in full active ROM with HB, SO, and RO compared with no orthosis were 38%/30%, 48%/47%, and 51%/55%, respectively (P ≤ 0.05). Lateral bending was impaired by 28%, 44%, and 70%, respectively (P ≤ 0.05). Assessment of lateral bending revealed greater immobilization by SO and RO compared with HB (P ≤ 0.05). The present 3D kinematic system allows for precise assessment of spinal motion. Custom-made orthoses cause superior restriction on gross spinal motion compared "off-the-shelf" orthoses. If orthotic bracing is indicated, design, comfort, and patient compliance need to be carefully considered to guarantee successful therapy.

What are the most effective treatments for decreasing pain of plantar fasciitis?

EVIDENCE-BASED ANSWER The answer is unclear, but calcaneal antipronation taping and prefabricated heel cups/pads are better than stretching, and prefabricated heel cups/pads are better than full-length custom orthoses. The combination of night splints and full-length orthoses is better than orthoses alone (SOR: B, RCTs). Moderateintensity extracorporeal shockwave therapy (ESWT) and botulinum toxin type A injections are effective but comparison with other interventions is unknown (SOR: B, subgroup meta-analysis of RCTs and single RCT). Night splints, prefabricated or custom-made orthoses, and taping are recommended treatments (SOR: C, expert opinion).

Evaluation of gait, relapse and compliance in clubfoot treatment with custom-made orthoses

Relapse after successful initial correction of idiopathic clubfoot with the Ponseti method is often related to poor compliance with the foot abduction orthosis (FAO). The aim of this study was to evaluate treatment with custom-made dynamic orthoses. Twenty children with idiopathic clubfoot (30feet) who had been treated with dynamic orthoses after the correction phase according to the Ponseti casting technique were evaluated. Relapse rates during orthotic treatment were registered. A Vicon gait analysis system was used to measure gait parameters at the age of seven years. The overall gait quality was estimated with the Gait Deviation Index (GDI). Data were analyzed with a nested mixed model and compared with a control group of 16 healthy children. No relapse occurred during the orthotic treatment. High compliance with the orthoses was observed based on parents’ self report and physiotherapist observations. Gait analysis showed decreased ankle power and moment, increased internal foot progression, decreased dorsiflexion during stance, and increased plantar flexion at initial contact compared with the control group. Hip and shank rotations were normal. No calcaneus or equinus gait was observed. The mean GDI was 89.7 (range 71.6–104). The gait analysis outcomes and frequency of relapse were comparable to those of previous studies. Internal foot progression originated primarily from the foot level and was not, as frequently found after FAO treatment, compensated by external rotation at knee or hip level. In children exhibiting poor compliance with an FAO, this dynamic model is considered an effective alternative.

Effects of different seating equipment on postural control and upper extremity function in children with cerebral palsy.

Adaptive seating supports for cerebral palsy are recommended to develop and maintain optimum posture, and functional use of upper extremities. To compare the effectiveness of different seating adaptations regarding postural alignment and related functions and to investigate the effects of these seating adaptations on different motor levels. Prospective study. A total of 20 children with spastic cerebral palsy (Gross Motor Function Classification System 3-5) were included. Postural control and function (Seated Postural Control Measure, Sitting Assessment Scale) were measured in three different systems: standard chair, adjustable seating system and custom-made orthosis. In results of all participants ungrouped, there was a significant difference in most parameters of both measurement tools in favor of custom-made orthosis and adjustable seating system when compared to standard chair ( p < 0.0017). There was a difference among interventions in most of the Seated Postural Control Measure results in Level 4 when subjects were grouped according to Gross Motor Function Classification System levels. A difference was observed between standard chair and adjustable seating system in foot control, arm control, and total Sitting Assessment Scale scores; and between standard chair and custom-made orthosis in trunk control, arm control, and total Sitting Assessment Scale score in Level 4. There was no difference in adjustable seating system and custom-made orthosis in Sitting Assessment Scale in this group of children ( p < 0.017). Although custom-made orthosis fabrication is time consuming, it is still recommended since it is custom made, easy to use, and low-cost. On the other hand, the adjustable seating system can be modified according to a patient's height and weight. Clinical relevance It was found that Gross Motor Function Classification System Level 4 children benefitted most from the seating support systems. It was presented that standard chair is sufficient in providing postural alignment. Both custom-made orthosis and adjustable seating system have pros and cons and the best solution for each will be dependent on a number of factors.

Comparative Analysis of Rehabilitation Outcomes: Custom-Made Versus Prefabricated Orthotic Devices in Patients with Wrist Injuries

Background: Orthotic devices play a crucial role in the rehabilitation of wrist injuries, with custom-made and prefabricated options being commonly used. This study aimed to compare the effectiveness of custom-made versus prefabricated orthotic devices in improving rehabilitation outcomes for patients with wrist injuries. Methods: A randomized controlled trial was conducted with 115 participants, divided into custom-made orthotic and prefabricated orthotic groups. Key outcome measures included functional improvement, pain levels, grip strength, range of motion, patient satisfaction, and compliance rates. Results: Custom-made orthotic devices demonstrated superior outcomes compared to prefabricated devices in functional improvement, pain reduction, grip strength, range of motion, patient satisfaction, and compliance rates. Custom-made orthoses were associated with greater comfort, personalized fit, and overall patient satisfaction. Conclusion: The findings suggest that custom-made orthotic devices offer greater benefits in rehabilitation outcomes for patients with wrist injuries compared to prefabricated options. Personalization and customization play a significant role in enhancing patient comfort, function, and satisfaction during the rehabilitation process.

Non-contiguous Cervical Spine Injury in a 14-month old Child; Case Report and Review of the Literature

Introduction Cervical spine injuries in children are relatively rare. Pattern, severity and level of these injuries are age dependant. Most of the available literature differentiates between two age groups, younger and older than 8 years. The incidence of upper cervical injuries is higher among children younger than 8 years. Most of the available literature is retrospective analysis of databases or case reports. Patients and Methods: a 14-month old child was presented to our emergency unit after involvement in a road-traffic accident. A stiff neck cervical collar was applied at the accident scene. The child was conscious, oriented. He had tendency to move the right upper and lower limb better than the left side. He had torticollis with the head rotated to the left side. Neurological examination revealed a left-sided hemiparesis. He had no other injuries. Under general anesthesia CT and MRI of the skull and the cervical spine were done. These investigations showed a fracture of the axis with a rotary subluxation of C1/2, cord edema at the level of C1 predominantly on the left side and a disco-ligamentous injury at the level of C3/4. Controlled closed reduction under image intensifier and Minerva cast was applied for 3 weeks, and then replaced with a modified Minerva-Hartmann orthosis for another 3 weeks. A review of the literature for patients below the age of 3 years with cervical spine injuries was done in a trial to define an algorithm to clear the cervical spine and to outline the management of this age group. Results The patient was followed for one year with normal MRI findings at 6 months and normal clinical findings at one year follow-up with complete improvement of the neurological deficits. Conclusion Clearance of the cervical spine after trauma in children below the age of 3 is challenging. Articulation and cooperation during clinical examination and imaging investigation is limited. Imaging should be done under general anesthesia. Immobilisation is also demanding and definitive immobilisation for conservative treatment is usually using custom-made orthoses. results of conservative treatment are excellent if closed reduction and immobilisation were achieved.

A Cohort-Controlled Trial of Custom-Made Foot Orthoses in Anserine Bursitis

There is a lack of studies of foot orthosis use in the common condition of anserine bursitis. The aim of this study was to determine the proportion of subjects reporting recovery from anserine bursitis with prescribed custom-made foot orthoses in addition to local corticosteroid injection versus corticosteroid injection alone. Sixty-nine consecutive patients presenting with symptoms and findings compatible with a case definition for anserine bursitis were included in this study. A total of 35 subjects were prescribed a local corticosteroid injection into the anserine bursa under fluoroscopic guidance (control group), and 34 subjects were equally prescribed a fluoroscopically guided local corticosteroid injection with the addition of custom-made foot orthoses (orthoses group). All subjects completed the Oswestry Disability Index at baseline, and the number of subjects using prescribed analgesics for their knee pain was recorded at baseline and at follow-up of 8 weeks and 4 months. The subjects were asked at each follow-up if they felt that they had recovered from their knee pain. A total of 33 subjects in each group completed the study at 8 weeks, and 32 subjects in each group completed the 4-month follow-up. At 8 weeks, 55% reported recovery in the control group and 76% reported recovery in the orthoses group. The number of subjects who reported recovery at 4 months, however, was markedly different between the groups, with only 41% reporting recovery in the control group and 88% reporting recovery in the orthoses group. The addition of custom-made foot orthoses to local corticosteroid injection seems to improve the short- and long-term outcome with fewer recurrences. What is already known on this subject: 1) Anserine bursitis is a common condition. 2) There are no studies to date of foot orthosis use in the treatment approach. What this study adds: 1) This is the first controlled trial of custom-made foot orthoses in anserine bursitis, a common knee disorder. 2) Custom-made orthoses, when added to usual care for anserine bursitis, increase the likelihood of recovery at 8 weeks and 4 months. How it might impact on clinical practice in the near future: The addition of custom-made foot orthoses may increase the recovery rate from anserine bursitis.

Effects of foot orthoses on the temporal pattern of muscular activity during walking

BackgroundSeveral studies have described the biomechanical effects of foot orthotics, as well as their effects at the level of muscular recruitment. Although the latter effect is unlikely to be limited to muscular intensity, the temporal pattern of activity of the muscles involved in walking with orthoses is still unclear. MethodsTwelve adults with everted static rearfoot posture higher than 5° of valgus participated in the study. For all participants, the kinematic data and the muscular temporal activity of the tibialis anterior, the soleus, the gastrocnemius medialis, the gastrocnemius lateralis and the peroneus longus were measured under two experimental conditions, walking with and without custom-made orthoses. Data were recorded and analyzed using a motion analysis and a surface EMG system. FindingsThe results showed that, when walking with insoles, the activity of the tibialis anterior, the soleus, the gastrocnemius medialis, the gastrocnemius lateralis and the peroneus longus is shorter than walking without orthoses. Furthermore, when walking with orthoses, the activity of the soleus and the gastrocnemius medialis is delayed. InterpretationOur study corroborates that the realignment of the calcaneus with the talus decreases the range of eversion and inversion of midfoot. Moreover, it reports noticeable modifications on the start time and the duration of the muscular activity of the tibialis anterior, soleus, gastrocnemii and peroneus longus while using foot orthoses.

Objective assessment of custom-made orthoses benefit in improving balance among figure ice-skaters

Objective assessment of custom-made orthoses benefit in improving balance among figure ice-skaters