Podiatry Portal » Orthotics

Pedorthics

admin — Mon, 02 Jan 2012 00:50:45 +0000

Pedorthics is defined as use of footwear and other supportive devices to treat disorders of the foot and related problems. Pedorthists recieve training ins lower limb anatomy and biomechanics; the use of footwear and footwear modification; and the use of different types of foot orthoses. The term ‘Certified Pedorthist’ is the title used after licensure from the College of Pedorthics of Canada or the American Board for Certification in Orthotics, Prosthetics and Pedorthics. To meet the criteria for the American Board, the pedorthist must have a high school diploma or higher; successfully complete Levels 1, 2, and 3 of an NCOPE approved pre-certification pedorthic educational program; and have a minimum of 1,000 hours of patient care experience in pedorthics. For more see the Pedorthist Forum.

Practitioner Differences in Foot Orthotics

admin — Tue, 06 Dec 2011 06:41:33 +0000

This is an interesting piece of research on foot orthotics.

Effects of foot orthoses: How important is the practitioner? by TL Chevalier & N Chockalingam in Gait Posture. 2011 Nov 18.
Here is the abstract:

Foot orthoses (FO) are commonly used in the treatment of numerous lower limb problems, pains and injuries. Whilst many studies report their positive effects, and most practitioners would confirm those findings, the available information appears to be anecdotal. As such, the exact mechanisms in which FO work are not fully understood. Therefore, a need exists to study the influence of the inter-practitioner variability in the assessment of orthoses performance. This investigation is central to the understanding of the performance variations in custom-made foot orthoses (CFO). Eleven practitioners took part in the study. Each practitioner completed a clinical assessment of one subject, after which a pair of foot orthoses was manufactured based on casts of the subject’s feet using a neutral non-weight bearing plaster cast. Ten trials per condition were recorded during which kinematic and kinetic data were collected. CFO did not have any systematic significant effects (p<0.05) on any kinetic except for the right-leg peak active force. In addition, systematic kinematic effects could be observed mainly for the sagittal plane for forefoot-to-hindfoot and hindfoot-to-tibia peak angles. The results from this study demonstrate that inter-practitioner variability is a major factor in orthotic intervention in treating a single patient and for a specific pathology. It is therefore strongly recommended to use caution when drawing general conclusions from research studies using custommade foot orthoses. The results suggest that CFO effects can differ between limbs. More importantly, their effects are also practitioner-dependant. Great caution should be used when comparing studies on CFO with different practitioners as conclusions could vastly differ.

The research is essentially saying the function of foot orthotic prescribed by different practitioners varies in the way that they affect foot function. That does not necessarily mean that the clinical outcomes will be different.

Link to article

Foot orthotic mechanisms of action

admin — Sat, 12 Dec 2009 10:55:34 +0000

A meta-analysis and systematic review in the British Journal of Sports Medicine shows just how little clear research there is on how foot work (Foot Orthoses and Gait: A Systematic Review and Meta-analysis of Literature Pertaining to Potential Mechanisms. Br J Sports Med. 2009 Dec 8)

The authors looked at the evidence for the biomechanical, shock attenuation and neuromotor paradigms. They concluded that:

Based on our review, we conclude with rudimentary guidelines for the prescription of orthosis to individuals with a range of injury histories. We also highlight the need for further research focusing on the role of injury, particularly in neuromotor modification and long term adaptation to orthoses.

While we all now and the evidence shows that foot orthotics do work, much work remains to done to explain how.

Foot orthotics in achilles tendonitis

admin — Thu, 20 Aug 2009 08:20:08 +0000

The use of foot orthotics for Achilles tendonitis is the subject of an interesting blog post. It is suggested that foot orthotic work in Achilles tendonitis because they change the supination moment. It is suggested that a heel raise does not help Achilles tendonitis by shortening the distance between the origin and insertion of the calf muscles. They cite evidence that supports this. They also mention a study in which foot orthoses designed by a podiatrist fixed those with Achilles tendonitis, but they all pronated more with the use of the foot orthotics. This is kind of paradoxical. More on Achilles tendonitis treatment.