Computer-generated orthoses. A review.
It is obvious with the various casting techniques used in the study that the ease with which individuals adjust to the fashionette orthotic makes it a desirable device. It is tolerated well with higher-heeled shoes and shoes that are used more for fashion purposes. Future studies need to assess the degree of control compared with the type of deformity and the type of symptoms the patient has. These types of devices may be sufficient to minimize stress on a given deformity, such as a neuroma, but may not be sufficient enough to eliminate the need for the removal of the neuroma. Recurrence of the neuroma after it has been resected and the patient prescribed a fashionette orthosis also needs to be assessed. A neuroma is one example of a type of deformity that needs to be controlled and evaluated with regard to cause and response to orthotic therapy. Abnormal tylomas and pressure lesions need to be assessed on a symptomatic basis for their control with the different types of devices and the pathomechanic causing the pressure. This study indicates that milled orthoses are tolerated better than pressed orthoses. Milled orthoses require less adjustment and the adjustment is tolerated better, regardless of the casting position. The degree of position control had some variations. When comparing the pressed and the milled functional orthoses, there is a more rapid adjustment with the milled type of orthoses. This suggests that possibly the milled orthoses have less alteration in shape and loss of contour from the direct milling and the digitizing process compared with the pressing techniques. The long-term effect of pressing compared with milled orthotics was not assessed during this study with regard to fluid distortion of the polypropylene over time. The fluid nature has a tendency to suffer a loss of contour and progressive loss of function. The milled process theoretically has less change in the contour with the passage of time, although this needs to be assessed in further studies. Possibly, the fluid nature of the orthosis can be assessed by determining how soon the symptoms return between adjustments. Posting surfaces tend to wear over a period of time and distort with the fluid nature. The posting can break down from the type of material from which it is made. A model of assessment for future studies may be to check the duration of when heel spur types of symptoms or postural complex types of symptoms, such as knee pain or lower back pain, recur.(ABSTRACT TRUNCATED AT 400 WORDS)