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PubMed1995

The use of orthotic devices to correct plantar callus in people with diabetes.

Foot problems are a major cause of morbidity in people with diabetes. Plantar callus is common and is a sign of abnormal foot pressures. Shear stresses at these areas of high foot pressures may ultimately result in ulcer formation. This study compared the effect on plantar callus of the use of rigid orthotic devices and conventional podiatric care. Twenty diabetic subjects participated in the study and were randomly allocated to conventional treatment (n = 11) or orthotic device treatment (n = 9). After 12 months the patients in the orthotic group showed a significant reduction in callus grade, whereas the conventionally treated group showed no significant change. There were no adverse effects from wearing the orthotic device. Rigid orthoses have a beneficial effect on plantar callus presumably through the lowering and redistribution of abnormal foot pressures.

Aged↗
PubMed2001

Orthotic devices for tennis elbow: a systematic review.

Lateral epicondylitis (tennis elbow) is af requently reported condition. A wide variety of treatment strategies has been described. Asy et, no optimal strategy has been identified. The aim of this review was to assess the effectiveness of orthotic devices for treatment of tennis elbow. An electronic database search was conducted using MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trial Register Current Contents, and reference listsf rom all retrieved articles. Experts on the subjects were approachedfor additional trials. All randomised controlled trials (RCTs) descrbiing individuals with diagnosed lateral epicondylitis and assessing the use of an orthotic device as a treatment strategy were evaluatedfor inclusion. Two reviewers independently assessed the validity of the included trials and extracted data on relevant outcome measures. Dichotomous outcomes were expressed as relative risks and continuous outcomes as standardised mean differences, both with corresponding 95% confidence intervals. Statistical pooling and subgroup analyses were intended. Five small-size RCTs (n = 7-49 per group) were included the validity score ranged from three to nine positive items out of 11. Subgroup analyses were not performed owing to the small number of trials. The limited number of included trials present few outcome measures and limited long-term results. Pooling was not possible owing to the high level of heterogeneity of the trials. No definitive conclusions can be drawn concerning effectiveness of orthotic devices for lateral epicondylitis. More well-designed and well-conducted RCTs of sufficient power are warranted.

Evidence-Based Medicine↗
PubMed1985

Orthotic devices in running injuries.

The most significant problems that we found in our running population were hamstring contractures, which affected 80 per cent, and Achilles tendon contractures, which affected 40 per cent. On first seeing a running patient who has a connective tissue stress type of injury in his or her lower extremity, we first place the patient through a 6-week trial of stretching our contractures, as this will usually correct the problem. We can correct up to 50 per cent of the problems we see just by pursuing a good stretching program. In general, the running injuries most helped by orthotic devices are the posterior tibial syndrome and pes planovalgum. It is easy to understand how the orthotic device works in these situations because it actually controls the subtalar joints and prevents increased stress on the arch of the foot and the posterior tibial tendon. Orthotic devices are also very helpful for metatarsalgia and calcaneal spurs. By directly relieving the stress area in these two conditions, one can usually expect a good result.

Adult↗
PubMed2002

Orthotic devices for treating patellofemoral pain syndrome.

BACKGROUND: Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms of taping of the knee, active training devices, knee sleeves and in-shoe orthotics to support the foot have been advocated to treat this condition. OBJECTIVES: To assess the effectiveness of foot and knee orthotics for treatment of patellofemoral pain syndrome. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001), the Cochrane Controlled Trials register (Issue 2, 2000), MEDLINE (January 1966 to March 2000; EMBASE (January 1988 to March 2000); CINAHL (January 1982 to March 2000) and PEDro (up to March 2000). Relevant orthotic companies were contacted. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing the effectiveness of knee or foot orthotics for treatment of patellofemoral pain syndrome were selected. Trials describing the use of orthotic devices in conjunction with operative treatment were excluded. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed methodological quality of the identified trials by use of a modified version of the Cochrane Musculoskeletal Injuries Group assessment tool, consisting 11 items. Two reviewers extracted data without blinding. Trialists were contacted to obtain missing data. MAIN RESULTS: Five trials involving 362 participants were included in this review. Five other trials await possible inclusion if further information can be obtained and one awaits further assessment. Due to clinical heterogeneity, we refrained from statistical pooling and conducted analysis by grading the strength of scientific evidence. The level of obtained research-based evidence was graded as limited as all trials were of low methodological quality. This limited research-based evidence showed the Protonics orthosis at six week follow-up was significantly more effective for decrease in pain (weighted mean difference (WMD) between groups 3.2; 95% confidence interval (CI) 2.8 to 3.6), functional improvement on the Kujala score (WMD 45.6; 95% CI 43.4 to 47.7) and change in patellofemoral congruence angle (WMD 17.2; 95% CI 14.1 to 20.3) when compared to no treatment. A comprehensive programme including tape application was significantly superior to a monitored exercise programme without tape application for decrease in worst pain (WMD 1.6; 95% CI 0.4 to 2.8) and usual pain (WMD 1.2; 95% CI 0.2 to 2.1), and clinical change and functional improvement questionnaire scores (WMD 10, 95% CI 2.07 to 17.93) at four weeks follow-up. The trials reported statistically significant differences in patient satisfaction after applied therapy (WMD 3.3; 95% CI 0.5 to 6.1) in favour of the McConnell regimen compared with the Coumans bandage at six weeks follow-up. REVIEWER'S CONCLUSIONS: The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of knee and foot orthotics for the treatment of patellofemoral pain. Future high quality trials in this field are warranted.

Arthralgia↗
PubMed1985

A prospective study of the effect of a shock-absorbing orthotic device on the incidence of stress fractures in military recruits.

In a prospective study of stress fractures the hypothesis that a shock-absorbing orthotic device worn within military boots could lessen the incidence of stress fractures was tested. The incidence of metatarsal, tibial, and femoral stress fractures was lower in the orthotic group, but only the latter difference was statistically significant. The time of onset and the location of stress fractures between orthotic and nonorthotic users did not differ. These findings suggest that the incidence of femoral stress fractures, which are the most dangerous type of stress fracture because of their high risk of developing into displaced fractures, can be reduced by an orthotic device.

Fractures, Bone↗
PubMed1985

Clinical use and fabrication of molded thermoplastic foot orthotic devices. Suggestion from the field.

The semirigid or rigid molded thermoplastic foot orthosis can be used as treatment for a variety of foot and lower extremity disorders. The foot orthosis functions to decrease biomechanical dysfunction or to change plantar contact points on the foot. Clinicians providing foot orthotic device therapy can best meet the therapeutic needs of their patients by fabricating orthotic devices from a variety of materials according to the nature of each case.

Foot↗
PubMed2006

Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot.

BACKGROUND: Ground reaction forces from walking result in stress (pressure) and soft tissue strain at the plantar aspect of the foot. Excessive plantar pressure and tissue strain on the insensate foot may lead to ulceration. Our study investigated the effect of therapeutic footwear and custom-made orthotic inserts on pressure and tissue strain along the second ray of the plantar foot, and how these two variables are associated. METHODS: Twenty subjects (mean age 57.3 [SD 9.3] years, 12 male, 8 female, body mass index 32.5 [SD 7.4] kg/m2) with diabetes mellitus, peripheral neuropathy, and a history of a plantar ulcer participated. Plantar pressure data were recorded during computed tomography scans for four conditions (barefoot, shoe, shoe+total contact insert, and shoe+total contact insert+metatarsal pad). For each condition tested, tissue strain and plantar pressure were determined at the second metatarsal head and at 15 other points along the second ray. FINDINGS: Differences were noted between the 4 conditions for pressure (P<0.004) and soft tissue strain (P<0.042) at the second metatarsal head. Correlation coefficients demonstrated an association between pressure and strain (Barefoot r=0.81, Shoe r=0.75, Shoe+total contact insert r=0.73, and Shoe+total contact insert+metatarsal pad r=0.44). INTERPRETATION: Footwear and orthotic devices tested in this study decreased pressure and soft tissue strain at the second ray of the foot, and these two variables were strongly related. A better understanding of the role tissue strain plays in distributing plantar forces may lead to improvements in the design of orthotic devices.

Diabetic Foot↗
PubMed1996

An update on orthotic devices for the lumbar spine based on a review of the literature.

Orthoses are often used to treat lumbar spine disorders, although their indications have rarely been evaluated in clinical trials. We reviewed the literature for data on the effects of lumbar spine orthoses. Apart from bermuda corsets, restriction of intervertebral mobility seems limited at the most distal levels (L4-L5 and L5-S1). Restriction of extreme gross spinal motions can be achieved and is more marked for lateral bending than for forward bending or extension. Stiff corsets provide greater motion restriction than flexible corsets, although there are wide interindividual variations. Stiff orthoses are associated with decreased intradiscal pressure and increased intraabdominal pressure. Studies of the electrical activity of trunk muscles have produced conflicting data as a result of marked interindividual variability. In most studies, use of orthotic devices did not induce muscle wasting. Although lumbar spine orthoses are often prescribed with the goal of inducing analgesic, proprioceptive and preventive effects in the workplace, whether such effects are actually obtained, has not been adequately evaluated. Based on our literature review, we have drawn a list of the main indications for orthotic devices according to the desired effects in various disorders of the lumbar spine.

Biomechanical Phenomena↗
PubMed2002

Immediate changes in the quadriceps femoris angle after insertion of an orthotic device.

OBJECTIVE: To measure changes in the quadriceps femoris angle (Q-angle) after the insertion of full-length flexible orthotics. SETTING: Outpatient health center of Logan College of Chiropractic. SUBJECTS: A total of 40 male subjects were included in the study population. The selected population all demonstrated bilateral pes planus or hyperpronation syndrome. DESIGN: Before-after trial. METHOD: A cohort demonstrating bilateral hyperpronation was recruited. The subjects were cast according to standard protocols provided by the manufacturer. Subject right and left Q-angles were measured with and without the orthotic in place. The landmarks used were marked with a permanent marker, and great care was taken to accurately assess the angles formed. The evaluator was not told whether the measure was before or after orthotic insertion. A modified quailcraft goniometer was used. DATA ANALYSIS: The data set was collected and assessed by the t test. RESULTS: Thirty-nine of 40 test subjects showed reduced Q-angle, which was in the direction of correction. A 2-tailed matched sample showed statistically significant mean reduction in Q-angle measures. There was a minority of patients who showed asymmetrical Q-angle measures. Within this group there was greater symmetry of Q-angle measures after placement of the orthotic. CONCLUSION: Insertion of full-length, flexible orthotic devices significantly improves the Q-angle in hyperpronating male subjects. If the literature accurately links an increase in the Q-angle with a predisposition for knee injury, then the possibility of long-term benefits following the use of flexible orthotics exists. More research is required to determine whether these biomechanical changes are maintained after use of these orthotics.

Adult↗
PubMed1996

The stabilizing effect of orthotic devices on plantar flexion/dorsal extension and horizontal rotation of the ankle joint. An experimental cadaveric investigation.

The mechanical stabilizing effect of nine different orthotic devices on physiological and pathological plantar flexion/dorsal extension and horizontal rotation of the ankle joint subjected to artificial lateral ligament lesions was investigated in 20 cadaveric ankle joints under standardized conditions using an experimental apparatus. All of the braces tested significantly reduced plantar flexion/dorsal extension, as well as internal/external/external horizontal rotation, under the experimental conditions. In so far as these results can be transposed into a clinical setting, our data favour that bracing significantly reduces the instability. But, other criteria, such as the stabilizing effect on talar tilt and anterior drawer sign, the price and the convenience of wearing such devices have to be taken into consideration when choosing the optimal brace.

Analysis of Variance↗
PubMed1976

Hand orthotic device influence on fine neuromuscular control.

With the aid of electromyography, voluntary control of fine neuromuscular activity of deltoid and extensor digitorum communis muscles was studied in patients with motor dysfunction of the upper limb. A sequential training procedure was carried out both while the patient was wearing and not wearing a hand orthosis, during a static posture and dynamic hand movements. There was no difference between the levels of neuromuscular control achieved while wearing and not wearing the orthotic device, but the quality of the neuromuscular control was superior in the proximal limb muscle to that in the more distal muscle.

Adolescent↗
PubMed2006

Efficacy and mechanism of orthotic devices to unload metatarsal heads in people with diabetes and a history of plantar ulcers.

BACKGROUND AND PURPOSE: Total-contact inserts (TCIs) and metatarsal pads (MPs) frequently are prescribed to reduce excessive plantar stresses to help prevent skin breakdown in people with diabetes mellitus (DM) and peripheral neuropathy. The first purpose of this study was to determine the effect of a TCI and an MP on metatarsal head peak plantar pressures (PPP) and pressure-time integrals (PTI). The second purpose of this study was to determine a possible mechanism of pressure reduction by measuring contact area and loaded soft-tissue thickness (STT) under the metatarsal heads and second metatarsal shaft. SUBJECTS: Twenty subjects (12 men and 8 women; age [mean+/-SD]=57+/-9 years) with DM (duration [mean+/-SD]=16+/-11 years), peripheral neuropathy, and a history of plantar ulcers participated. METHODS: A repeated-measures research design was used, and outcome measures are reported for 3 footwear conditions: shoe, shoe with TCI, and shoe with TCI and MP. In-shoe plantar pressures were collected during walking and during spiral x-ray computed tomography (SXCT). The STT and identification of the pressure sensor and location of the MP in relationship to the metatarsal heads were determined by use of SXCT. RESULTS: The PPP and the PTI were 16% to 24% lower at the metatarsal heads in the TCI condition than in the shoe condition. The PPP and the PTI decreased an additional 15% to 28% (for a total reduction of 29% to 47%) with the addition of the MP. The contact area increased 27% with the TCI but not with the MP. The STT did not increase under the metatarsal heads in the TCI condition (compared with the shoe condition) but did increase 8% to 22% at metatarsal heads 2 to 5 with the addition of the MP. The PPP increased substantially (308%) and the STT decreased 14% under the shaft of the second metatarsal with the addition of the MP to the TCI-plus-shoe condition. DISCUSSION AND CONCLUSION: The TCI and the MP caused substantial and additive reductions of pressures under the metatarsal heads. The TCI reduces excessive pressures at the metatarsal heads by increasing the contact area of weight-bearing forces. Conversely, the MP acts by compressing the soft tissues proximal to the metatarsal heads and relieving compression at the metatarsal heads. These findings can assist in the design of effective orthotic devices to relieve excessive plantar stresses that contribute to skin breakdown and subsequent amputation in people with DM and peripheral neuropathy.

Biomechanical Phenomena↗
PubMed2001

Orthotic devices. Custom-made, prefabricated, and material selection.

Orthotic use has become a common adjunct to medical treatment for foot and ankle pathology. For pain and discomfort from overuse to pathology-specific problems, interventions involving foot orthoses are widely accepted. A wide range of accommodative, functional, and prefabricated orthoses is available. With the emergence of technology in the manufacture of raw materials and prefabricated orthoses and the training and expertise of technicians and practitioners, the quality and accuracy of foot orthoses have improved vastly, justifying their role in the treatment and rehabilitation of patients with simple and complex foot problems.

Construction Materials↗
PubMed2001

Active counterpositioning or orthotic device to treat positional plagiocephaly?

Active counterpositioning and orthotic helmets are the two main nonsurgical management options for positional plagiocephaly. The purpose of this study was to compare these two management regimens. We included a random sample of infants referred between January 1, 1998 and October 31, 1999 to Middlemore Hospital and Auckland Surgical Center, for management of positional plagiocephaly. Two-dimensional head tracings were taken for each infant, every 3 to 12 months. From these tracings, we obtained Cranial Index and Cranial Vault Asymmetry Index. Seventy-nine infants were assessed during an average of 48.2 weeks. Five infants had normal head tracings, and were therefore excluded from the study. Of the 74 infants included in this study, 45 were managed with active counterpositioning, and 29 with orthotic helmets. Average management time for active counterpositioning was 63.7 weeks, and 21.9 weeks for orthotic helmet treatment. For infants managed with active counterpositioning, the average change in Cranial Vault Asymmetry Index was 1.9%. In the orthotic group, average change in Cranial Vault Asymmetry Index was 1.8%. Orthotic helmets have an outcome comparable to that of active counterpositioning, although the management period is approximately three times shorter. Active counterpositioning generally had a slightly better outcome than orthotic management after the management period.

Cephalometry↗
PubMed1994

A new orthotic device for Chopart amputees.

The medical literature has, on the whole, passed seething criticism toward the Chopart foot amputation. The equinous, short, unbalanced stump is prone to pressure injury and the orthopaedic footwear has proved problematic. Many therapeutic modalities have been proposed, such as arthrodeses, tendon transfers, and tenotomies to improve functional ability. Many propose that the results of the Syme amputation are functionally superior and aesthetically more acceptable. The pros and cons of the Syme and Chopart amputations are discussed and a new orthotic device is suggested that improves the function of the Chopart amputation and minimizes the previously described complications.

Adult↗