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Foot rehabilitation with orthotics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by frederic G, Apr 14, 2008.

  1. frederic G

    frederic G Active Member

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    Can we rehabilitate the foot with functional orthotics ? Is it possible to correct a forefoot varus with orthotics and then allow the patient to leave them.
    Can we find studies about that?

  2. Craig Payne

    Craig Payne Moderator

    By definition, forefoot varus is a congenital fixed osseous condition, so theoretically is not correctable.

    By definition, forefoot supinatus is an acquired soft tissue condition, so theoretically is correctable if the deforming force is removed.
  3. efuller

    efuller MVP

    Hi Fred,

    Agree with Craig and have a story to add.

    My wife had heel pain. I made her some orthotics the pain went away. While she wears the orthotics the pain stays away. She tires of wearing shoes that the orthotics fit into. She quits wearing the orthotics. Between 2 weeks and 6 months the pain returns. She wears the orthotics pain goes away. Repeat.

    Me, my 1st mpj hurt a day after non wearing mine. I'm sure there are people who are helped by the orthotics when they have an acute injury and then never wear them again without problem.

    So with a study of N = 2 (But, good follow up) the foot is not permanently corrected by wearing orthotics for a period of time.


  4. CraigT

    CraigT Well-Known Member

    This is a common question that patients ask, and I agree with what Craig said above.
    I have heard many argue that orthoses weaken the foot (without any evidence), and suggest that you become dependent on them. This may be the case with some people, however I believe that one of the roles of orthoses is to teach the foot 'good habits'.
    I liken this to the use of a chair which is designed to promote good posture.
    If you use it, you tend to sit in a good position. If you take it away immediately, you quickly return to your old habits. If you continue to use it, you learn what a good posture is, and when it is removed you tend to maintain this good posture for longer. This is more effective if you can strengthen your postural muscles at the same time.
    Doing strengthening exercises alone is not as effective as you do not have the guidence to teach the posture day to day. You would not learn good posture in the back by sitting in a bean bag...
    I have worn orthoses for the past 15 years. I have naturally classic pes planus. When I walk barefoot now, I maintain what would be classed as a good foot posture. It now feel strange when I stand and fully relax into a pronated position (n=1)
    When I have a patient report a similar feeling, I class this as a great success- they have learnt to maintain a good foot posture. They are then less reliant on them, however, if they stopped wearing their orthoses for an extended length of time, I think they are likely to return to the old habits.
  5. I agree with other contributers. We "know" from EMG studies that foot orthoses influence the activities of certain groups of muscles. If muscles contribute to posture then it would seem to follow that posture may be altered by foot orthoses. The question raised by previous contributers is: how long is any change maintained when orthoses are removed?
  6. chrisdel

    chrisdel Member

    I often tell my patients that a pair of orthotics is like a pair of glasses; they only work when you're wearing them. Gravity is a hard habit to break!


    Chris Delpierre
    Sports Science Institute of South Africa
    Newlands, Cape Town
  7. pgcarter

    pgcarter Well-Known Member

    As is often shown by people becoming symptomatic at some variable point during their life, not when they first stand up.....what develops into a problem can perhaps be worked back the other way a bit by a change in forces.......for how long is completely individual I think....like the problem in the first place. I also believe that what passes for a suitable answer to problems will vary over a persons life as larger joints and spine up the body begin to stiffen, lose quality of articular cartlege and as muscle bulk and strength decreases what was once a functional answer becomes no longer suitable......it gets harder to find good comfortable gait.....and perhaps not possible at all, then we are just looking for the best possible option.

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