The majority of studies of treatment effects of FOs have significant deficiencies that must noted before any conclusions or recommendations can make. Many studies are simple retrospective “patient satisfaction” surveys, and few utilize a randomized, controlled, prospective study design. In most cases, the type of orthosis is not described in detail, and description of the foot types of the subjects is often lacking. Still, enough reports have been published that certain consistent findings should notice.
Patient Satisfaction Surveys
- Over the past 40 years, numerous patient satisfaction surveys have published, with 70-80% overall patient satisfaction when foot orthotic devices were used to treat lower extremity injuries.
- Three different studies using semirigid polypropylene custom orthotics to treat patellofemoral pain syndrome have shown that at least 75% of patients report relief of pain attributed to this treatment.
- Another story of 180 people treated with custom rigid orthosis for a variety of athletic injuries. Its revealed that 70% of the patients stated that the orthotics had “ helped” their condition and no adverse effects reported from a use of the rigid orthotics in athletic activity.
- Two severe types of orthosis materials (Rohadur and TL-61) studied in the treatment of heel spur syndrome. Thirty-four of 41 patients improved with orthotic therapy and physical therapy combined. Without good controlled studies, it is difficult to know if it was the therapy, orthosis, or just time that helped cure.
- A prospective study compared the treatment effects of two types of FO materials prescribed for 40 professional and recreational athletes. A composite material (TL-2100 SF) preferred over the standard polypropylene material by the subjects. Overall, 70% of the subjects reported good to excellent relief of symptoms with semi-rigid, custom orthotic treatment.
- An extensive retrospective survey of 453 patients, 14 weeks after receiving functional FOs for numerous lower extremity overuse injuries, showed general satisfaction with the orthotic therapy reported by 83% of the subjects.
Effects of Foot Orthotics on Plantar Pressures
- Numerous studies have shown that FOs can significantly reduce vertical force and pressures on various areas of the plantar surface of the foot.
- Peak pressures can be reduced, at the most, by about 20% with an FO. In terms of injury, the significance of this weight reduction remains speculative.
- FOs have been shown to decrease plantar callus size in patients with diabetes. Patients with leprosy were noted to have improved healing of plantar ulcers with custom FOs.
- A semirigid custom foot orthotic was shown significantly to reduce the incidence of femoral and metatarsal stress fractures in military recruits.
- A prospective 9-week study of military recruits showed that a neoprene insole reduced overuse injuries and tribal stress syndrome from 32 to 23%.
Changes in Foot and Leg Alignment
- Kinematic Studies have primarily focused on the effects of foot orthotics on hindfoot alignment. Most of these studies have performed in running athletes. These studies have demonstrated relatively modest improvements. One study found a mean reduction in hindfoot pronation of 2-3ยบ.
- Rather than causing a noticeable change in foot and leg alignment, FOs may have other effects on kinematics. The Range of motion of skeletal segments and velocity of motion may translate into soft tissue and joint injury.
- Semirigid and soft orthotics have shown a significant effect in reducing the velocity of pronation in both runnings and walking subjects.
- More recent studies have shown that medially posted custom FOs can reduce the overall range of pronation, the maximum angle of calcaneal eversion, and the range of internal tibial rotation associated with pronation.
- The results of kinematic studies have led most research to conclude that these devices do not function to realign the skeleton. These devices can, however, significantly alter the kinetics of lower extremity segmental function, as documented by many studies on a change in joint moments with orthotic intervention.
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