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Journal of Foot and Ankle Research Nov 2021Flatfoot is characterised by the falling of the medial longitudinal arch, eversion of the hindfoot and abduction of the loaded forefoot. Furthermore, flatfoot leads to a... (Review)
Review
BACKGROUND
Flatfoot is characterised by the falling of the medial longitudinal arch, eversion of the hindfoot and abduction of the loaded forefoot. Furthermore, flatfoot leads to a variety of musculoskeletal symptoms in the lower extremity, such as knee or hip pain. The standard conservative treatment for flatfoot deformity is exercise therapy or treatment with foot orthoses. Foot orthoses are prescribed for various foot complaints. However, the evidence for the provision of foot orthoses is inconsistent. The aim of this systematic review is to synthesize the evidence of foot orthoses for adults with flatfoot.
METHODS
A computerized search was conducted in August 2021, using the databases PubMed, Scopus, Pedro, Cochrane Library, and the Cochrane Central Register of Controlled Trials. Intervention studies of any design investigating the effects of foot orthoses were included, apart from case studies. Two independent reviewers assessed all search results to identify eligible studies and to assess their methodological quality.
RESULTS
A total of 110 studies were identified through the database search. 12 studies met the inclusion criteria and were included in the review. These studies investigated prefabricated and custom-made foot orthoses, evaluating stance and plantar pressure during gait. The sample sizes of the identified studies ranged from 8 to 80. In most of the studies, the methodological quality was low and a lack of information was frequently detected.
CONCLUSION
There is a lack of evidence on the effect of foot orthoses for flatfoot in adults. This review illustrates the importance of conducting randomized controlled trials and the comprehensive development of guidelines for the prescription of foot orthoses. Given the weak evidence available, the common prescription of foot orthoses is somewhat surprising.
Topics: Adult; Flatfoot; Foot; Foot Orthoses; Gait; Humans; Lower Extremity
PubMed: 34844639
DOI: 10.1186/s13047-021-00499-z -
Annals of Palliative Medicine Nov 2020Recently, three-dimensional (3D) printing technology has gradually been applied to the field of orthoses. This narrative review aimed to investigate the effect of 3D... (Review)
Review
Recently, three-dimensional (3D) printing technology has gradually been applied to the field of orthoses. This narrative review aimed to investigate the effect of 3D printed orthoses compared to conventional orthoses (non-3D printed orthoses). We searched MEDLINE for articles published up to July 27, 2020, and the main search phrases for identifying related articles were "3D printed orthosis", "3D printed orthoses", "3D printed braces", "3D printed splints", "3D printing orthosis", "3D printed orthoses", "3D printing braces" and "3D printing splints". We included articles that applied 3D printed orthoses to patients or healthy participants and excluded those not written in English, conference abstracts or presentations, and reviews. A total of 237 papers were identified, and qualifications were evaluated based on the title, abstract, and full text. A total of 22 articles were finally included in the analysis. The 3D printed orthoses showed similar or superior effects on biomechanical parameters and kinematic parameters such as wrist-hand function, wrist spasticity, arch height index, foot plantar pressure, and joint range of motion (ROM). In addition, 3D printed orthoses had high satisfaction and comfort compared to conventional orthoses. We believe that 3D printed orthoses can replace conventional ones, and they are expected to gain more popularity in the future.
Topics: Braces; Humans; Orthotic Devices; Printing, Three-Dimensional
PubMed: 33040564
DOI: 10.21037/apm-20-1185 -
Journal of Sport Rehabilitation Jul 2020Plantar fasciitis is one of the most common foot injuries. Several mechanical treatment options, including shoe inserts, ankle-foot orthoses, tape, and shoes are used to...
CONTEXT
Plantar fasciitis is one of the most common foot injuries. Several mechanical treatment options, including shoe inserts, ankle-foot orthoses, tape, and shoes are used to relieve the symptoms of plantar fasciitis.
OBJECTIVES
To investigate the effectiveness of mechanical treatment in the management of plantar fasciitis.
EVIDENCE ACQUISITION
The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. A systematic search was performed in PubMed, CINAHL, Embase, and Cochrane up to March 8, 2018. Two independent reviewers screened eligible articles and assessed risk of bias using the Cochrane Collaboration's risk of bias tool.
EVIDENCE SYNTHESIS
A total of 43 articles were included in the study, evaluating 2837 patients. Comparisons were made between no treatment and treatment with insoles, tape, ankle-foot orthoses including night splints and shoes. Tape, ankle-foot orthoses, and shoes were also compared with insoles. Follow-up ranged from 3 to 5 days to 12 months. Cointerventions were present in 26 studies.
CONCLUSIONS
Mechanical treatment can be beneficial in relieving symptoms related to plantar fasciitis. Contoured full-length insoles are more effective in relieving symptoms related to plantar fasciitis than heel cups. Combining night splints or rocker shoes with insoles enhances improvement in pain relief and function compared with rocker shoes, night splints, or insoles alone. Taping is an effective short-term treatment. Future studies should aim to improve methodological quality using blinding, allocation concealment, avoid cointerventions, and use biomechanical measures of treatment effects.
Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Bandages; Bias; Cohort Studies; Controlled Clinical Trials as Topic; Extracorporeal Shockwave Therapy; Fasciitis, Plantar; Female; Foot Orthoses; Humans; Male; Middle Aged; Orthotic Devices; Shoes; Splints; Treatment Outcome; Young Adult
PubMed: 31629333
DOI: 10.1123/jsr.2019-0036 -
European Journal of Physical and... Mar 2011The pediatric flat foot is a frequent presentation in clinical practice, a common concern to parents and continues to be debated within professional ranks. As an entity,... (Review)
Review
The pediatric flat foot is a frequent presentation in clinical practice, a common concern to parents and continues to be debated within professional ranks. As an entity, it is confused by varied classifications, the notion of well-intended prevention and unsubstantiated, if common, treatment. The available prevalence estimates are all limited by variable sampling, assessment measures and age groups and hence result in disparate findings (0.6-77.9%). Consistently, flat foot has been found to normally reduce with age. The normal findings of flat foot versus children's age estimates that approximately 45% of preschool children, and 15% of older children (average age 10 years) have flat feet. Few flexible flat feet have been found to be symptomatic. Joint hypermobility and increased weight or obesity may increase flat foot prevalence, independently of age. Most attempts at classification of flat foot morphology include the arch, heel position and foot flexibility. Usual assessment methods are footprint measures, X-rays and visual (scaled) observations. There is no standardized framework from which to evaluate the pediatric flat foot. The pediatric flat foot is often unnecessarily treated, being ill-defined and of uncertain prognosis. Contemporary management of the pediatric flat foot is directed algorithmically within this review, according to pain, age, flexibility; considering gender, weight, and joint hypermobility. When foot orthoses are indicated, inexpensive generic appliances will usually suffice. Customised foot orthoses should be reserved for children with foot pain and arthritis, for unusual morphology, or unresponsive cases. Surgery is rarely indicated for pediatric flat foot (unless rigid) and only at the failure of thorough conservative management. The assessment of the pediatric flatfoot needs to be considered with reference to the epidemiological findings, where there is consensus that pediatric flexible flat foot reduces with age and that most children are asymptomatic. Globally, there is need for a standard by which the pediatric flat foot is assessed classified and managed. Until then, assessment should utilize the available evidence-based management model, the p-FFP Future research needs to evaluate the pediatric flat foot from representative samples, of healthy and known disease-group children prospectively, and using validated assessment instruments. The preliminary findings of the benefits of foot exercises, and discrete investigation into the effects of shoes and footwear use are also warranted.
Topics: Adolescent; Child; Child, Preschool; Evidence-Based Practice; Flatfoot; Humans; Orthopedic Procedures; Orthotic Devices; Review Literature as Topic
PubMed: 21448121
DOI: No ID Found -
Europa Medicophysica Mar 2007Thoracic outlet syndrome (TOS) is a debated topic. While there are many clinical studies concerning the efficacy of surgical treatment, there are few regarding... (Review)
Review
Thoracic outlet syndrome (TOS) is a debated topic. While there are many clinical studies concerning the efficacy of surgical treatment, there are few regarding conservative treatment. It has not yet been established whether or not conservative treatment is effective and what the best treatment is. The aims of this study were to evaluate the efficacy of conservative treatment in TOS with particular reference to physiotherapy, orthotics, and taping and to make general recommendations for conservative treatment. The literature was reviewed. Medical databases consulted: Medline, Embase, CINAHL, Current Awareness, Pedro, Cochrane Library, Medscape. We used the following key words: thoracic outlet syndrome, double crush syndrome, entrapment, conservative, treatment, rehabilitation, and management. Languages of the articles reviewed: English, French, German, Spanish, Italian, and Portuguese. This analysis focussed on 10 studies of conservative treatment and 3 studies comparing the outcomes of conservative and surgical treatment, published from 1983 to 2001. This review found no randomised controlled trials, systematic reviews, or meta-analyses. Conservative treatment seems to be effective at reducing symptoms, improving function, and facilitating return to work, also when compared to surgery. We could not establish whether or not conservative treatment was better than no treatment or placebo, or what type of conservative treatment was the best.
Topics: Databases, Bibliographic; Humans; Orthotic Devices; Physical Therapy Modalities; Thoracic Outlet Syndrome; Treatment Outcome
PubMed: 16955064
DOI: No ID Found -
Clinical Orthopaedics and Related... Feb 2020To improve ankle stability in patients who have experienced an ankle sprain with residual symptoms of instability and/or objective joint laxity, external supports (such... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To improve ankle stability in patients who have experienced an ankle sprain with residual symptoms of instability and/or objective joint laxity, external supports (such as taping, bracing, and orthotic insoles) are used sometimes. However, available randomized trials have disagreed on whether restraints improve balance in those individuals. In this situation, a network meta-analysis can help because it allows for comparing multiple treatments simultaneously, taking advantage not only of direct but also indirect evidence synthesis.
QUESTIONS/PURPOSES
The aim of this network meta-analysis was to assess (1) the impact of taping and orthotic devices on dynamic postural control in individuals with ankle instability and (2) the presence of a placebo effect in participants treated with sham taping and complications resulting from the administered treatments.
METHODS
We searched the PubMed, Scopus, and CENTRAL databases up to February 13, 2019 for completed studies. Randomized trials assessing the results of real and/or sham taping, wait-and-see protocols, ankle bracing, and foot orthotics for ankle instability as determined by one or more ankle sprains followed by ongoing subjective symptoms and/or mechanical laxity were included. We evaluated dynamic postural control in terms of the Star Excursion Balance Test in the posteromedial direction (SEBT-PM), which is considered the most representative of balance deficits in patients with ankle instability. Standardized mean differences were re-expressed to percentage differences in SEBT-PM, with higher scores representing possible improvement. Subsequently, those data were checked against the established minimal detectable change of 14% for this scale to make judgements on clinical importance. We also assessed the presence of a placebo effect by comparing the results of sham taping with no treatment and complications resulting from the administered treatments. Additionally, we judged the quality of trials using the Cochrane risk of bias tool and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. A total of 22 trials met our inclusion criteria, 18 of which were deemed to be at a low risk of bias. A network of treatments consisting of 13 studies was created, and the level of evidence was judged to be high. As far as participants' allocation to treatment arms, 85 patients followed a wait-and-see protocol, 29 received placebo taping, 99 were treated with taping, 16 were treated with bracing, 27 were administered insoles, and six individuals were offered a combination of insoles with bracing. Of note, with statistical power set at 80%, a minimum of 16 patients per treatment group was required to provide sufficient statistical power and detect a SEBT-PM percentage difference of 14%.
RESULTS
A network meta-analysis did not demonstrate a benefit of taping or bracing over no treatment (percentage difference in SEBT-PM between taping and bracing versus control: -2.4 [95% CI -6 to 1.1]; p = 0.18, and -7.5 [95% CI -15.9 to 1]; p = 0.08, respectively). This was also the case for sham taping because the measurement increase failed to exceed the minimal detectable change (percentage difference in SEBT-PM between sham taping and untreated control: -1.1 [95% CI -6.9 to 4.7]; p = 0.72). Importantly, there were no reported adverse events after treatment application.
CONCLUSIONS
Evidence of moderate strength indicated that external supports of any type were no more effective than controls in improving dynamic postural control in patients with at least one ankle sprain and residual functional or mechanical deficits. Therefore, implementing those tools as a standalone treatment does not appear to be a viable strategy for the primary management of ankle instability. It is conceivable that combinations of rehabilitation and external supports could be more effective than external supports alone, and future trials should evaluate the potential of such combinations in enhancing not only clinician-reported but also patient-oriented outcomes using long-term follow-up measurements.
LEVEL OF EVIDENCE
Level I, therapeutic study.
Topics: Ankle Injuries; Ankle Joint; Athletic Tape; Biomechanical Phenomena; Chronic Disease; Equipment Design; Humans; Joint Instability; Network Meta-Analysis; Orthopedic Procedures; Orthotic Devices; Postural Balance; Randomized Controlled Trials as Topic; Range of Motion, Articular; Recovery of Function; Treatment Outcome
PubMed: 31625960
DOI: 10.1097/CORR.0000000000000946 -
Foot and Ankle Clinics Sep 2022Conservative treatment of Charcot neuro-osteoarthropathy (CN) aims to retain a stable, plantigrade, and ulcer-free foot, or to prevent progression of an already existing... (Review)
Review
Conservative treatment of Charcot neuro-osteoarthropathy (CN) aims to retain a stable, plantigrade, and ulcer-free foot, or to prevent progression of an already existing deformity. CN is treated with offloading in a total contact cast as long as CN activity is present. Transition to inactive CN is monitored by the resolution of clinical activity signs and by resolution of bony edema in MRI. Fitting of orthopedic depth insoles, orthopedic shoes, or ankle-foot orthosis should follow immediately after offloading has ended to prevent CN reactivation or ulcer development.
Topics: Arthropathy, Neurogenic; Conservative Treatment; Humans; Magnetic Resonance Imaging; Orthopedics; Orthotic Devices
PubMed: 36096554
DOI: 10.1016/j.fcl.2022.05.002 -
BMJ Clinical Evidence Mar 2009Bunions are prominent and often inflamed metatarsal heads and overlying bursae, usually associated with hallux valgus where the great toe moves towards the second toe.... (Review)
Review
INTRODUCTION
Bunions are prominent and often inflamed metatarsal heads and overlying bursae, usually associated with hallux valgus where the great toe moves towards the second toe. Hallux valgus is found in at least 2% of children aged 9-10 years, and almost half of adults, with greater prevalence in women.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of conservative treatments, surgery, and postoperative care for bunions? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: arthrodesis (Lapidus procedure); bone fixation (absorbable pin fixation, screw fixation plus early weight-bearing, standard fixation, suture fixation plus delayed weight-bearing, percutaneous Kirschner-wire fixation); chevron osteotomy plus adductor tenotomy; distal metatarsal osteotomy; early weight-bearing; Keller's arthroplasty; Keller-Lelievre arthroplasty; night splints; orthoses (including antipronatory orthoses in children); phalangeal (Akin) osteotomy plus distal chevron osteotomy; proximal osteotomy, and slipper casts.
Topics: Follow-Up Studies; Hallux Valgus; Humans; Metatarsal Bones; Orthotic Devices; Osteotomy; Weight-Bearing
PubMed: 19445756
DOI: No ID Found -
Journal of Manipulative and... Feb 2022The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to... (Review)
Review
OBJECTIVE
The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to suggest strategies for improvement based on these findings.
METHODS
Online databases of PubMed, Web of Science, and the Cochrane Library were searched for articles about patients' compliance with regard to lower limb assistive devices. In addition, a methodological quality control process was conducted. Studies were included if in the English language and related to compliance and adherence to the lower limb assistive device. Exclusion was based on first reading the abstract and then the full manuscript confirming content was not related to orthotic devices and compliance.
RESULTS
Twelve studies were included. The data revealed between 6% and 80% of patients were not using a prescribed device. Barriers to the use of the orthotic device included medical, functional, device properties and lack of proper fit. Strategies for improved compliance included better communication between patient and clinician, patient education, and improved comfort and device esthetics.
CONCLUSIONS
Individualized orthotic adjustments, rehabilitation, and patient education were promising for increasing adherence. Despite positive aspects of improvements in gait, balance in elderly, and a sense of security produced by using assistive devices, compliance remains less than ideal due to barriers. As compliance in recent studies has not improved, continued work in this area is essential to realize the benefits of technological advances in orthotic and assistive devices.
Topics: Aged; Humans; Lower Extremity; Orthotic Devices; Patient Compliance; Self-Help Devices
PubMed: 35753880
DOI: 10.1016/j.jmpt.2022.04.003 -
BMC Musculoskeletal Disorders Feb 2024Over the past years, the field of prosthetics and orthotics has seen incredible innovations that used to be perceived as science fiction. This editorial aims to shed...
Over the past years, the field of prosthetics and orthotics has seen incredible innovations that used to be perceived as science fiction. This editorial aims to shed light on such exciting developments, exploring how they are addressing the challenges faced by individuals with limb impairments and musculoskeletal conditions.
Topics: Humans; Artificial Limbs; Prosthesis Implantation; Orthotic Devices; Extremities
PubMed: 38347514
DOI: 10.1186/s12891-024-07246-y