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Clinical Efficacy and Cost-Effectiveness of Bespoke and Prefabricated Foot Orthoses for Plantar Heel

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jun 27, 2013.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Clinical Efficacy and Cost-Effectiveness of Bespoke and Prefabricated Foot Orthoses for Plantar Heel Pain: A Prospective Cohort Study.
    Ring K, Otter S.
    Musculoskeletal Care. 2013 Jun 25
  2. Admin2

    Admin2 Administrator Staff Member

  3. Craig Payne

    Craig Payne Moderator

    I did an evaluation of this study here:

    lots of issues!

  4. terigreen

    terigreen Active Member

    We been producing about 150,000 prefabs and 300,000 heat mold, direct contact orthotics this year, which is a 30% increase from last year. Many practitioners are searching for a cost effective, high profit margin alternative to custom orthotics. We don't discourage custom orthotics, but practitioners and patients need to know that there is an alternative.
    Teri Green, President
    Atlas Biomechanics
  5. Lab Guy

    Lab Guy Well-Known Member

    On your website you discourage custom orthotics when you write that that you can duplicate a lab quality orthotic. How is that possible?

    Atlas Biomechanics is a leading manufacturer and distributor of professional grade biomechanical products. We specialize in USA engineered and produced orthotic shells and heel lifts. Atlas sells to medical professionals and consumers. Many of our products are sold in case or bulk amounts for your savings. Duplicate a lab quality orthotic in your office for a fraction of the cost. Over 200,000 pairs of orthotics to date!

    This is an academic forum, not a forum to be exploited for new customers.

  6. CraigT

    CraigT Well-Known Member

    I have said it before- achieving a positive effect for someone with 'compromised mechanics' (vague and ill defined term I know) is very simple. Just about any device will feel better than nothing. Unfortunately differentiating a positive effect from the highest level of effectiveness is difficult, and this is what a custom orthoses should be achieving.
  7. I think that's a reasonable claim, in the same way as the paracetamol I buy is the same quality as the warferin.

    However what that does not prove is that one should consider paracetamol as an alternative to warferin.
  8. Rob Kidd

    Rob Kidd Well-Known Member

    Where is Karl Landorf? When he was on my staff he did his PhD on exactly this - unless my memory is totally wrong. Memory says that he found that customs were as good as bespoke for heel pain in a refereed PhD research publication.
  9. Craig Payne

    Craig Payne Moderator

    The difference with this study is that is would probably only get a 2 or 3 (or 4 if really lucky) out of 10 on the PEDRO rating scale for the quality of a clinical trial (ie really low). (Karl L's study would probably get a 8 or 9/10).

    Also the custom made devices were a low density EVA made off a foam impression.
  10. I think the problem with this, and the KL study, is much more profound.

    The orthoses were issued for plantar heel pain.

    Plantar heel pain is not a diagnosis. Its a symptom. One would not dream of trialing a drug for Myocardial infarction on 1000 patients with undifferentiated "chest pain" because it will be ineffective for all the people who had chest pain caused by pleurisy, or Bornholm disease, or cracked ribs, or hiatus hernia etc etc.

    Lets compare, say, a pain killer with a DMARD for "knee pain". The Rheumatoids will react to the dmard and the osteoarthritics to the pain killers. You might get 300 improved patients with each but that by no means indicates that the two can be interchanged based on cost!

    What we do as clinicians, or strive to do, is to diagnose and treat. Studying the efficacy of a treatment without reference to that diagnosis is an interesting and valuable academic exercise but cannot be directly extrapolated into the real world!
  11. CraigT

    CraigT Well-Known Member

    I have a problem with the concept of 'custom' as it is used in most of these outcome studies... (though in fairness it may, unfortunately, be symptomatic of what does happen in the real world many times.)
    Just simply making an orthosis from a scan, cast or impression of the foot does not make it custom.
    Custom means designing the orthosis with individually tailored aims.
    What I do know from studies on foot orthoses is that the same modification does different things to different subjects... surely this fact alone would dilute any outcomes where the same prescription is given to each subject.

    BTW Craig- 50 durometer EVA is soft, but shore 50 EVA is quite firm.
  12. Craig Payne

    Craig Payne Moderator

    That was my point in this thread:
    The Redundancy of Research on Custom Made vs Prefabricated Foot Orthotics

    and on my blog about this study:
  13. David Wedemeyer

    David Wedemeyer Well-Known Member

    I almost commented previously on Teri's apparent use of this site to self-promote but declined. This statement doesn't jibe with the study, which others have commented on is in reference to heel pain only. Prefabs have a place in the treatment of heel pain among other conditions but to compare prefab insoles to CFO's is ten miles of bad road. :empathy:
  14. Lab Guy

    Lab Guy Well-Known Member

    None of the devices in the studies were ‘true’ custom prescribed devices, but were a one-size-fits-all prescription with custom molding to the foot. Who in clinical practice would accept that or do that?

    This post is simply my own personal opinion. Maybe I am wrong and I am, thats great.

    I get that the study was flawed. Having said that, I would make a big bet that the vast majority of Podiatrists here in the USA simply take a mold of the foot and order their favorite orthotic from the lab they use.

    Clinically, if 1% of Podiatrists performed Jack's test or the Supination Resistance test that would be a lot. If 5% of Podiatrists did a Biomechanical exam or God forbid watched their patients walk, that would be a lot. I cannot think of a Podiatrist that ordered a plantar fascia groove, forefoot valgus extension, reverse Morton's extension, or medial heel skive on my orthotic form.

    I constantly have to educate my customers on how to take a cast and how to fill out a Rx. I will routinely get casts that are just pathetic. I exhibit at Podiatry conferences all over the USA. It is very rare to ever speak to an attendee that has an interest or in-depth knowledge in biomechanics.

    I do think quality prefabricated orthotics can work great for heel pain. I think heat moldable orthotics (that Teri Green was promoting) are a means to charge the same as custom orthotics (and no lab bill) but without providing a product that is any better than a quality prefab.

    IMO, patients are going to have superior results with custom orthotics than with prefabs if they were to have Practitioners with an interest and knowledge in biomechanics. Outside of the Podiatry Arena, in the real world, biomechanically competent and passionate practitioners are out there but are few and far between.

  15. NewsBot

    NewsBot The Admin that posts the news.

    Comparison of Customised Foot Orthosis and
    Prefabricated Foot Orthosis in the Management of
    Plantar Fasciitis: A Systematic Review

    Mansour Abdullah Alshehri et al
    Journal of Physical Therapy and Health Promotion 2016, Vol. 4 Iss. 1, PP. 34-42

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