Evidence of Foot Orthotics in Medical Literature

Foot Orthotics and Patient Satisfaction:

Several studies have been conducted to determine the level of satisfaction patients experienced with their orthotics in terms of both comfort and effectiveness. Here are the results:

2004: A survey pertaining to custom foot orthotics being used for over one year was given to 275 patients. It was found that most patients experienced relief of symptoms at a range of 60-100%, and only 9% of those surveys reported no relief at all.

Walter JH, Ng G, Stoitz JJ: Survey: A patient satisfaction survey on prescription custom-molded foot orthoses. JAPMA, 94:363-367, 2004.

1993:  Of 520 patients surveyed 83% experienced relief of symptoms and fully 95% of patients indicated that the use of orthotics had partly or fully resolved their foot problems.

Moraros J, Hodge W: Orthotic survey: Preliminary results. JAPMA, 83:139-148, 1993

1988: This particular study indicated that out of 81 patients surveyed, 91% of them were “satisfied with orthoses”. Of those same 81 patients 52% said they “wouldn’t leave home without [their orthotics]”.

Donnatelli R, Hurlbert C, et al: Biomechanical foot orthotics: A retrospective study. J Ortho Sp Phys Ther, 10:205-212, 1988.

Foot Orthotics and Plantar Fasciitis

Several studies have been conducted to determine the effectiveness of the use of orthotics in treating cases of plantar fasciitis, heel spur syndrome, heel pain and arch pain.

2002: This study indicated a 75% reduction in the level of disability and a 66% reduction in the level of pain experienced when foot orthotics were used to treat plantar fasciitis.

Gross MT, Byers JM, Krafft JL, Lackey EJ, and Melton KM: The impact of custom semi-rigid foot orthotics on pain and disability for individuals with plantar fasciitis. J Ortho Sp Phys Ther, 32:149-157, 2002.

2004:  This article stated that study results suggest   that foot orthotics provide a reduction in levels of pain and disability resulting from plantar fasciitis.

Karl B. Landorf, Anne-Maree Keenan, and Robert D. Herbert Effectiveness of Different Types of Foot Orthoses for the Treatment of Plantar Fasciitis, J Am Podiatr Med Assoc 2004 94: 542-549

1991: This eleven month study compared custom orthotic usage with and without steroidal or non-steroidal usage using 84 patients with painful heels. Of those patients surveyed 98 had pain in both heels while 33 patients had pain in only one heel. The survey concluded that 89% of patients using orthotics only had either a full reduction in pain or a minimum of 80% relief of their discomfort; 7% experienced only minimal relief and 4% experienced no relief at all. It took an average of 5.4 weeks for the maximum amount of relief to occur.

Scherer, PR, et al. Heel spur syndrome, pathomechanics and non-surgical treatment. JAMA, 1991; 81:68-72

1998: This study followed 85 patients with plantar heel pain for 12 weeks and found that 70% of the patients experienced good or excellent results using custom foot orthotics. On the other hand, only 30% of the patients using generic visco-elastic heel inserts experienced good or excellent results.

Lynch DM, Goforth WP, Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 1998 Aug; 88(8):375-80.

1999: The purpose of this study was to demonstrate that adding appropriate orthotic devices to the foot reduces tension on the plantar fascia. A 1996 journal published by the same researchers also indicated that a custom UCBL orthotic greatly reduced tension on the plantar aponeurosis in all patients. (P<0.05)

Kogler G, Veer FB, Solomonidis,SE. The influence of medial and lateral placement of orthotic wedges on loading of the plantar aponeurosis. Journal of Bone and Joint Surgery; 1999;81A:1403-1413

2002: This study proved that when custom orthotics were used on patients suffering from plantar fasciitis a 75% drop in disability ratings was recorded, as was a 66% drop in pain ratings. This study was crucial in quantifying the effectiveness of introducing custom orthotics to treat foot and heel pain.

Gross, MT, Byers, JM, Krafft, JL, Lackey, EJ, Melton, KM. The impact of custom semi-rigid orthoses on pain and disability for individuals with plantar fasciitis. Journal of Orthopaedic and Sports Physical Therapy 2002; 32:149-157.

Ball-of-Foot Pain (Metatarsal) Pain and the Use of Orthotics
Pain reduction in the ball of foot resulted from decreased pressure in this particular metatarsal. The introduction of orthotics to the foot has proven effective in reducing pressure and thus relieving pain. There have been several articles written supporting studies that have outlined the uses of orthotics for metatarsal pain, and focused particularly on the effect that pad placement has on the quality and quantity of results seen:

Aligning anatomical structure from spiral X-ray computed tomography with plantar pressure data.Hastings MK, Commean PK, Smith KE, Pilgram TK, Mueller MJ.Clin Biomech (Bristol, Avon). 2003 Nov; 18(9):877-82.

Additional Resources

Optimum position of metatarsal pad in metatarsalgia for pressure relief. Hsi WL, Kang JH, Lee XX. Department of Rehabilitation, National Taiwan University Hospital, Taipei, Republic of China. Am J Phys Med Rehabil. 2005 Jul; 84(7):514-20.

A quantitative assessment of the effect of metatarsal pads on plantar pressures.
Holmes GB Jr, Timmerman L. Foot Ankle. 1990 Dec; 11(3):141-5.Related Articles, Links

Multistep measurement of plantar pressure alterations using metatarsal pads.
Chang AH, Abu-Faraj ZU, Harris GF, Nery J, Shereff MJ. Department of Orthopaedic Surgery, Medical College of Wisconsin, Foot Ankle Int. 1994 Dec;15(12):654-60.

Ankle sprain and Foot Orthotics

The use of orthotic devices in the treatment of chronic or severe ankle sprains is standard practice. Studies have shown that orthotic devices relieve excess pressure on the ankle ligaments by reducing postural sway and reducing undesirable movement in damaged or inflamed ankle mechanisms, including joints and tendons.

Guskiewicz KM, Perrin DH: Effects of orthotics on postural sway following inversion ankle sprain. J Orthop Sp Phys Ther, 23:326-331, 1996.

Knee Pain and Foot Orthotics

Foot orthotics have been used to reduce knee pain for decades but only recently have studies been used to demonstrate the degree to which relief can be expected from this use. These studies have also indicated the possible mechanics involved in the orthotic impact on knee pain reduction. 

2003: Of 102 athletic patients suffering patellofemoral pain syndrome 76.5% of participants experienced substantial improvements while 2% no longer showed sign of discomfort following 2-4 weeks of using custom foot orthotics.

Saxena A, Haddad J: The effect of foot orthoses on patellofemoral pain syndrome. 93:264-271, 2003.

2004: Significant decreases in internal rotation and adduction of the knee were seen in runners being studied for the impact of use of foot orthotics regarding the kinetics of the foot and lower leg. The findings were significant; 30 runners with medial knee problems fitted with foot orthotics designed with a five degree wedge height. After six weeks of use all of the participants experienced a reduction in pain and 28 participants found their orthotics comfortable.

Russel Rubin and Hylton B. Menz. Use of Laterally Wedged Custom Foot Orthoses to Reduce Pain Associated with Medial Knee Osteoarthritis: A Preliminary Investigation. JAMA, 2005 95: 347-352.

Back Pain and Foot Orthotics

A significant reduction of pain has been experienced by back pain suffers following the implementation of custom foot orthotics.

1999: Participants using foot orthotics to treat back pain experienced more than double the pain relief for twice the amount of time compared to participants undergoing traditional back pain treatments in this groundbreaking study.

Dananberg HJ, Guiliano M: Chronic low-back pain and its response to custom-made foot orthoses. 89:109-117, 1999

Treating Flat Foot with Orthotics

Having flat feet does not guarantee physiological problems or pain but it is a serious indicator that these problems are likely to occur, and when they do occur they are amongst the most debilitating problems seen in podiatry. Orthotic devices have been proven to be one of the most effective treatments for this condition.

Blake RL, Ferguson H: Foot orthoses for the severe flatfoot in sports. JAPMA, 81:549, 1991.

Pediatric flatfoot: evaluation and management. Sullivan JA. J Am Acad Orthop Surg. 1999 Jan;7(1):44-53. Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma College of Medicine, Oklahoma City 73126-0307, USA.

Rome K, Brown CL: Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clin Rehab, 18:624-630, 2004

Note: Of all the possible causes of flat foot a weak or ruptured posterior tibialis tendon is on the most difficult to treat. Inferior functioning of the tendon leads to “adult acquired flatfoot”, and it predicates a gradual flattening of the affected foot (or feet, as the case may be.) Special care must be taken to treat this problem before it becomes severe.

Kirby KA: Conservative treatment of posterior tibial dysfunction. Podiatry Management, 19:73-82, 2000.

Foot Orthotics and High Arches

High arches are a common cause foot pain that can become debilitating and lead to reduced usage and function the foot. Fortunately, custom orthotics are often successfully used to used this type of foot condition.

Burns J, Crosble J. Effective Orthotic Therapy for the Painful Cavus Foot. J Am Pod Med Assoc. 96:3: 205 – 211. 2006

Schwend RM, Drennan JC. Cavus foot deformity in children. : J Am Acad Orthop Surg. 2003 May-Jun;11(3):201-11.

Foot Orthotics and Runners

Successfully treating injuries caused by running is effective 50-90% of the time according to various researchers. The success rate in treating running injuries with orthotics alone has been estimated by various researchers to be between 50 to 90%

D’Ambrosia, 1985; Dugan & D’Ambrosia, 1986; Eggold, 1981; Kilmartin & Wallace,1994.

1985: This retrospective study demonstrated that foot orthotic devices were shown to “definitely help” 70% of the 180 participants, all of whom suffered from athletic injuries.

Blake RL, Denton JA: Functional foot orthoses for athletic injuries: A retrospective study. JAPMA, 75:359-362, 1985.

1991: The use of orthotic devices resulted in ‘significant improvement’ to ‘total resolution’ in levels of injury symptoms in 76% Of 500 long-distance runners.

Davlin LB, Evanski PM: Effectiveness of orthotic shoe inserts in the long distance runner. Am. J. Sports Med., 19:409-412, 1991.

Additional Resources

Dugan RC, D’Ambrosia RD: The effect of orthotics on the treatment of selected running injuries. Foot Ankle, 6:313, 1986.

MacLean CL, Hamill J: Short and long-term influence of a custom foot orthotic intervention on lower extremity dynamics in injured runners. Annual ISB Meeting, Cleveland, September 2005.

Baitch SP, Blake RL, Fineagan PL, Senatore J: Biomechanical analysis of running with 25 degree inverted orthotic devices. JAPMA, 81:647-652, 1991.

Mundermann A, Nigg BM, Humble RN, Stefanyshyn DJ: Orthotic comfort is related to kinematics, kinetics, and EMG in recreational runners. Med Sci Sports Exercise, 35:1710-1719, 2003b

Smith LS, Clarke TE, Hamill CL, Santopietro F: The effects of soft and semi-rigid orthoses upon rear foot movement in running. JAPMA, 76:227-232, 1986.

Williams DS, McClay-Davis I, Baitch SP: Effect of inverted orthoses on lower extremity mechanics in runners. Med. Sci. Sports Exerc. 35:2060-2068, 2003.

Foot Orthotics and Foot Pressure

Heel pain and pain in the ball of the foot can be caused by excessive foot pressure and tension. Several studies have proven that the use of foot orthotics reduces this pressure and tension in the foot, resulting in a reduction of disability and discomfort.
1998: Research shows that foot orthotics are effective at reducing pressure on the plantar fascia and thereby effective at reducing the amount of pressure applied to injured and/or tender areas on the foot. Furthermore, the use of orthotics greatly reduced the pressure in the foot, and pain experienced, by 42 subjects suffering from metatarsalgia.

Postema et al.,1998.

2000: Participants who both did and did not suffer from rheumatoid arthritis experienced a significant decrease in plantar tension and load forces while in the stance phase of gait testing while wearing foot orthotics.

Li CY, Imaishi K, Shiba N, Tagawa Y, Maeda T, Matsuo S, Goto T, Yamanaka K: Biomechanical evaluation of foot pressure and loading force during gait in rheumatoid arthritic patients with and without foot orthoses. Kurume Med J, 47:211-217, 2000.

2001: The use of orthotic devices reduced maximum peak pressure in 30% of the 81% of Type II type diabetic patients who participated in this study.

Lobmann R, Kayser R, Kasten G, Kasten U, Kluge K, Neumann W, Lehnert H: Effects of preventative footwear on foot pressure as determined by pedobarography in diabetic patients: a prospective study. Diabet Med, 18:314-319, 2001.

2003:  This study observed that peak pressure and pressure-time integrals were significantly lower in 34 adolescents suffering from Type I diabetes.

Duffin AC, Kidd R, Chan A, Donaghue KC: High plantar pressure and callus in diabetic adolescents. Incidence and treatment. JAPMA, 93:214-220, 2003.

2005: By using three dimensional foot models that were tested with different orthotic constructions it was possible to show that shape is more important than stiffness when reducing peak plantar discomfort.

Cheung JT, Zhang M: A 3-dimensional finite element model of the human foot and ankle for insole design. Arch Phys Med Rehabil, 86:353-358, 2005.

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