A comparison of four methods of obtaining a negative impression of the foot

Four methods are currently available for taking a negative impression of the foot for the purpose of fabricating an orthotic device: nonweightbearing plaster casting, partial-weightbearing foam impressions, and partial-weightbearing and nonweightbearing laser scanning. This study compares the reliability and accuracy of these methods. Each impression method was performed three times on each foot of 15 subjects. Measures of rearfoot and forefoot width, forefoot-to-rearfoot relationship, and arch height were obtained from the negative impressions. Additionally, rearfoot and forefoot width and forefoot-to-rearfoot relationship were measured clinically for each subject. This study found that 1) foot measures are significantly influenced by the method used to obtain a negative foot impression; 2) the methods differ in reliability; and 3) plaster casting may be preferable to the other three methods when it is important to capture the forefoot-to-rearfoot relationship, as in fabricating a functional orthosis.     

Casting methods and plantar pressure: effects of custom-made foot orthoses on dynamic plantar pressure distribution

Foot orthoses are widely used to treat various foot problems. A literature search revealed no publications on differences in plantar pressure distribution resulting from casting methods for foot orthoses. Four casting methods were used for construction of orthoses. Two foam box techniques were used: accommodative full weightbearing method (A) and functional semiweightbearing method (B). Also, two suspension plaster casting techniques were used: accommodative casting (C) and functional subtalar joint neutral position (Root) method (D). Their effects on contact area, plantar pressure, and walking convenience were evaluated. All orthoses increased the total contact area (mean, 17.4%) compared with shoes without orthoses. Differences in contact areas between orthoses for total plantar surface were statistically significant. Peak pressures for the total plantar surface were lower with orthoses than without orthoses (mean, 22.8%). Among orthoses, only the difference between orthoses A and B was statistically significant. Differences between orthoses for the forefoot were small and not statistically significant. The gait lines of the shoe without an insole and of the accommodative orthoses are more medially located than those of functional orthoses. Walking convenience in the shoe was better rated than that with orthoses. There were no differences in perception of walking convenience between orthoses A, B, and C. Orthosis D had the lowest convenience rating. The four casting methods resulted in differences between orthoses with respect to contact areas and walking convenience but only slight differences in peak pressures.     

The efficacy of functional foot orthoses in the control of pain in ankle joint disintegration in hemophilia

Sixteen subjects with hemophilia A of levels 1-5 stage of joint damage were tested over a 6-week period to evaluate the efficacy of functional foot orthoses. The level of ankle bleeds (hemarthrosis) before and after the intervention with functional foot orthoses was determined by evaluating pain, disability, and activity levels. All subjects reported a significant reduction of ankle bleeds coinciding with the intervention of functional foot orthoses. The use of a foot-pain disability measure clearly showed significant reduction in the level of pain experienced by the subjects and in their overall index score. However, the disability and activity index scores showed no significant improvement after the intervention with orthoses. This finding would support the use of functional foot orthoses to treat patients with hemophilia A, as significant reduction in pain levels appears to greatly improve the lives of the patients.     

Effect of foot posture and inverted foot orthoses on hallux dorsiflexion

A pronated foot posture is considered to be a factor in limitation of dorsiflexion at the first metatarsophalangeal joint during weightbearing. Customized foot orthoses are widely used to increase dorsiflexion at the first metatarsophalangeal joint in people with pronated feet. However, the effect of foot posture and customized foot orthoses on maximum first metatarsophalangeal joint dorsiflexion has not been widely investigated. This study sought to determine 1) the relationship between foot posture and static maximum first metatarsophalangeal joint dorsiflexion and 2) the effect of customized foot orthoses on static maximum first metatarsophalangeal joint dorsiflexion in people with pronated feet. Foot posture was assessed using the Foot Posture Index. Static maximum first metatarsophalangeal joint dorsiflexion of the right foot was determined using a goniometer while participants stood relaxed with and without Blake-style inverted (30 degrees) foot orthoses positioned under their feet. There was a significant negative correlation between Foot Posture Index and static maximum first metatarsophalangeal joint dorsiflexion (r = -0.587). Inverted (30 degrees) foot orthoses increased the magnitude of static maximum first metatarsophalangeal joint dorsiflexion from 83.4 degrees to 85.3 degrees in participants with an excessively pronated foot posture. However, this difference was not statistically significant. People with pronated feet are more likely to exhibit limitation of dorsiflexion at the first metatarsophalangeal joint during gait, and inverted foot orthoses are unlikely to be effective in increasing dorsiflexion at the first metatarsophalangeal joint in these people.     

Static stance response to different types of foot orthoses

Many different types of foot orthoses are used to treat biomechanical dysfunction of the foot. Little evidence is available to guide clinicians in the selection of foot orthoses. The aim of this project was to determine whether resistance of the foot to supination or the Foot Posture Index could predict the static stance response to different types of prefabricated foot orthoses. The Foot Posture Index score was determined and resistance to supination was measured in 18 subjects (36 feet). Changes in the frontal plane calcaneal angle and navicular height were then measured as the subjects stood on six different types of foot orthoses. All orthoses resulted in an increase in navicular height, but only three orthoses changed the calcaneal angle in the frontal plane. Resistance to supination did not predict the response to the different types of orthoses, but the Foot Posture Index score was associated with changes from using some of the orthoses.     

Effects of prefabricated foot orthoses and soft insoles on postural stability in professional soccer players

Postural stability is an important component of skilled athletic activity. However, the effects of foot orthoses on stability have not been adequately addressed. This study measured postural sway in 30 asymptomatic professional soccer players in three standing positions and four underfoot conditions. The results revealed that the underfoot condition had no significant effect on sway in the mediolateral or anteroposterior planes; however, there was a trend toward less mediolateral sway when subjects stood in a unipedal position with prefabricated orthoses. These results suggest that insoles and foot orthoses have no significant beneficial or detrimental effects on postural stability in asymptomatic subjects. Clinically, this suggests that no improvements in balance performance could be expected with prophylactic use of insoles or orthoses but that clinicians may prescribe insoles and foot orthoses without fear of impairing postural performance in elite athletes.     

Evaluating the clinical effectiveness and cost-effectiveness of foot orthoses in the treatment of plantar heel pain: a feasibility study

This study evaluated the clinical effectiveness and cost-effectiveness of two different types of foot orthoses used to treat plantar heel pain. Forty-eight patients were randomly assigned to receive either a functional or an accommodative orthosis. General (EuroQol) and specific (Foot Health Status Questionnaire) health-status measures were used. Data were also collected using economic questionnaires relating to National Health Service costs for podiatry, other health-service costs, and patient costs. Data were measured at baseline and at 4- and 8-week intervals. Thirty-five patients completed the study. The results demonstrated a significant decrease in foot pain and a significant increase in foot function with the functional foot orthoses over the 8-week trial. The accommodative foot orthoses demonstrated a significant reduction in foot pain only at 4 weeks. The cost-effectiveness analysis demonstrated that functional orthoses, although initially more expensive, result in a better quality of life. Use of functional orthoses resulted in an increased cost of pound 17.99 (32.74 dollars) per patient, leading to an incremental cost per quality-adjusted life year of pound 1,650 (3,003 dollars) for functional orthoses.     

Foot orthoses: a review focusing on kinematics

Orthoses have been broadly used by clinicians to treat mechanical misalignments, such as abnormal foot pronation. As such, the influences of orthoses on lower-limb kinematics have been studied numerous times, with many articles reporting nonsystematic results; the aim of this review, therefore, was to examine the recognized effects of foot orthoses on lower-limb kinematics. The findings from this review suggest that foot orthoses seem to have certain generic and common effects on the lower limb when designed to control rearfoot pronation. We also discuss the possible reasons behind the lack of consistent results between studies. Based on the findings, a list of recommendations is presented for future research on foot orthoses to facilitate comparisons between studies and enable the scientific and clinical communities to better comprehend the effects that these variables might have on the kinematics and, possibly, the treatment outcomes.     

Comparison of orthotic materials on foot pain, comfort, and plantar pressure in the neuroischemic diabetic foot: a case report

Foot pain and lower-limb neuroischemia in diabetes mellitus is common and can be debilitating and difficult to treat. We report a comparison of orthotic materials to manage foot pain in a 59-year-old man with type 1 diabetes mellitus, peripheral neuropathy, peripheral arterial disease, and a history of foot ulceration. We investigated a range of in-shoe foot orthoses for comfort and plantar pressure reduction in a cross-sectional study. The most comfortable and most effective pressure-reducing orthoses were subsequently evaluated for pain relief in a single system alternating-treatment design. After 9 weeks, foot pain was completely resolved with customized multidensity foot orthoses. The outcome of this case study suggests that customized multidensity foot orthoses may be a useful intervention to reduce foot pain and maintain function in the neuroischemic diabetic foot.     

In-shoe pressure measurement and foot orthosis research: a giant leap forward or a step too far?

Foot orthoses are believed to exert their therapeutic effect on the human locomotor apparatus by altering the location, magnitude, and temporal patterns of ground reaction forces acting on the plantar foot during weightbearing activities. In-shoe pressure-measurement systems are increasingly being used by clinicians and researchers to assess kinetic changes at the foot-orthosis interface to better understand the function of foot orthoses and to derive more efficacious treatments for many painful foot and lower-extremity abnormalities. This article explores how the inherent three-dimensional surface topography and load-deformation characteristics of foot orthoses may challenge the validity, reliability, and clinical usefulness of the data obtained from in-shoe pressure-measurement systems in the context of foot orthotic therapy and research. The inability of in-shoe pressure-measurement systems to measure shearing forces beneath the foot, the required bending of the flat two-dimensional sensor insole to fit the pressure insole to the three-dimensional curves of the orthosis, the subsequent unbending of the sensor insole to display it on a computer monitor, and variations in the load-deformation characteristics of orthoses are all sources of potential error in examination of the kinetic effects of foot orthoses. Consequently, caution is required when interpreting the results of orthotic research that has used in-shoe pressure insole technology. The limitations of the technology should also be given due respect when in-shoe pressure measurement is used to make clinical decisions and prescribe custom foot orthoses for patients.     

Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed.     

Chronic low-back pain and its response to custom-made foot orthoses

A new approach to treating chronic low-back pain with custom-made foot orthoses was investigated. The Quebec Back Pain Disability Scale was used to objectively assess the functional disability of 32 subjects at different times. Subjects in this prospective study experienced more than twice the improvement in alleviation of pain, and for twice as long, compared with subjects in a study using traditional back-pain treatment. The authors believe that the findings of this study may provide a new method by which patients with chronic low-back pain can be evaluated and treated.     

Assessment of subtalar joint neutral position: a cadaveric study

Background Subtalar joint （STJ） neutral position is the position typically used by clinicians to obtain a cast representation of a patient＇s foot before fabrication of biomechanical functional orthosis. But no method for measuring STJ neutral position has been proven accurate and reproducible by different testers. This study was conducted to investigate the STJ neutral position in normal feet in cadavers.
Methods Twelve fresh-frozen specimens of amputated lower legs were used. Pressure-sensitive films were inserted into the anterior and posterior articulation of STJ. The contact areas for various foot positions and under axial loads of 600 N were determined based on the gray level of the digitized film. The STJ neutral positions were determined as the ankle-foot position where the maximum contact area was achieved, because the neutral position of a joint was defined as the position where the concave and convex surfaces were completely congruous.
Results In ankle-foot neutral position, the contact area of STJ was （2.79±0.24） cm^2. In the range of motion of adduction-abduction （ADD-ABD）, the maximum contact area was （3.00±0.26） cm^2 when the foot was positioned 10° of ABD （F=-221.361, P 〈0.05）. In the range of motion of dorsiflexion-plantarflexion （DF-PF）, the maximum contact area was （3.61±0.25） cm^2 when the foot was positioned 20° of DF （F=-121.067, P 〈0.05）. In the range of motion of inversion-eversion （INV-EV）, the maximum contact area was （3.14±0.26） cm^2 when the foot was positioned 10° of EV （F=-256.252, P〈0.05）.
Conclusions Joints, such as STJ, therefore, are not necessarily in neutral position when the ankle-foot is placed in the traditional concept of neutral position. The results demonstrate that the most approximate STJ neutral position was in the foot Dosition of 10° of abduction, 20° of dorsiflexion and 10° of eversion.     

足底板对类风湿性关节炎患者足底压的影响

目的 :测定类风湿性关节炎病人足底压 ,评价足底板的生物力学效应。方法 :12名女性类风湿性关节炎病人和 8名健康女性进行年龄和体重匹配。用 F- Scan系统进行动态足底压测量 ,Kistler床反力平台用以校正测量精确性。测量足底峰压和垂直分力 ,评价足底板的生物力学表现。结果 :类风湿性关节炎病人中足底压明显高于健康人。使用足底板后 ,足底总的峰压明显降低 ,前足、后足峰压减低 ,中足峰压增高。而垂直分力改变不大。结论 :足底板能显著降低足底压力 ,使足底压力重分布 ,减轻类风湿足痛。特殊设计的足底板对类风湿足痛的治疗能起重要的作用     

The effect of foot orthoses on transverse tibial rotation during walking

The purpose of this study was to determine the effectiveness of two types of foot orthoses in controlling the magnitude and rate of internal tibial rotation, measured by the tibial pointer device, during walking. Ten subjects between the ages of 23 and 43 years volunteered to participate in the study. Prior to data collection, each subject was issued two types of foot orthoses: a pair of rigid, plastic orthoses with posting in either the forefoot or the rearfoot, and a pair of soft, accommodative, premolded orthoses with no posting. All subjects wore standardized footwear. Following a controlled break-in period for both footwear and orthoses, each subject was asked to walk at a self-selected speed over a 12-m walkway while the movement of internal tibial rotation was recorded with a video camera during five trials. The results indicated that both the rigid plastic and the accommodative foot orthoses significantly reduced the magnitude and the rate of internal tibial rotation. No significant difference was noted between the soft and rigid foot orthoses conditions.     

Non-operative treatment of fractures of the humeral shaft: a comparative study.

Forty cases of diaphyseal fracture of humerus were treated by functional cast bracing (FCB). Results were compared with a series of 25 patients treated by U cast method. Average time taken for union was 7.5 weeks with a range of 5-14 weeks by FCB method. Fractures treated by U cast method took on an average 10 weeks to unite. Stiffness at shoulder and elbow was uniformly found in patients treated by U cast. More than 50% patients had varus angulation less than 5 degrees after treatment by FCB. Only 16% had varus angulation less than 5 degrees by U cast method while 32% had varus angulation more than 15 degrees. FCB is distinctly superior method of treatment for diaphyseal fracture of humerus.     

Effective orthotic therapy for the painful cavus foot: a randomized controlled trial

Patients with a cavus or high-arched foot frequently experience foot pain, which can lead to significant limitation in function. Custom foot orthoses are widely prescribed to treat cavus foot pain. However, no clear guidelines for their construction exist, and there is limited evidence of their efficacy. In a randomized, single-blind, sham-controlled trial, the effect of custom foot orthoses on foot pain, function, quality of life, and plantar pressure loading in people with a cavus foot type was investigated. One hundred fifty-four participants with chronic musculoskeletal foot pain and bilateral cavus feet were randomly assigned to a treatment group receiving custom foot orthoses (n = 75) or to a control group receiving simple sham insoles (n = 79). At 3 months, 99% of the participants provided follow-up data using the Foot Health Status Questionnaire. Foot pain scores improved more with custom foot orthoses than with the control (difference, 8.3 points; 95% confidence interval [CI], 1.2 to 15.3 points; P = .022). Function scores also improved more with custom foot orthoses than with the control (difference, 9.5 points; 95% CI, 2.9 to 16.1 points; P = .005). Quality-of-life data favored custom foot orthoses, although differences reached statistical significance only for physical functioning (difference, 7.0 points; 95% CI, 1.9 to 12.1 points; P = .008). Plantar pressure improved considerably more with custom foot orthoses than with the control for all regions of the foot (difference, -3.0 N . s/cm(2); 95% CI, -3.7 to -2.4 N . s/cm(2); P < .001). In conclusion, custom foot orthoses are more effective than a control for the treatment of cavus foot pain and its associated limitation in function.     

Use of laterally wedged custom foot orthoses to reduce pain associated with medial knee osteoarthritis: a preliminary investigation

Osteoarthritis of the knee is a common condition that can cause considerable pain and disability. Various forms of lateral wedging may be effective in the treatment of medial compartment osteoarthritis, but it is not known whether incorporating a lateral wedge into a custom-molded foot orthosis will achieve similar results. Therefore, 30 subjects (21 men and 9 women) aged 29 to 77 years (mean +/- SD, 58.1 +/- 11.6 years) with radiographically confirmed medial compartment knee osteoarthritis were issued custom-molded foot orthoses with a 5 degrees lateral heel wedge. Pain levels were recorded using a 100-mm visual analog pain scale on the date of issue of the orthoses (baseline) and again 3 and 6 weeks later. Mean +/- SD pain levels were significantly reduced at 3 weeks (34 +/- 22 mm) and 6 weeks (23 +/- 22 mm) versus baseline (69 +/- 19 mm) (F2 = 39.57). The degree of pain reduction was greater in patients with less severe osteoarthritis. At 6 weeks, all subjects had achieved at least some reduction in pain, and 28 reported that their orthoses were comfortable. This preliminary study indicates that laterally wedged foot orthoses may be beneficial in the treatment of mild-to-moderate osteoarthritis of the medial compartment of the knee. Further investigations using a larger sample, longer follow-up, and a no-treatment control group seem warranted.