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Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis--critical appraisal and commentary
J Athl Train. 2011 Jan-Feb;46(1):103-6.

 

I love a paper with a punchy title!

I still don't get the whole prefabricated device versus custom made discussion and why it seems so important to study. Does anyone actually care what is used to achieve the desired result?

Some people get upset about being charged £40 for a prefab, when to the clinician, it only costs £20. Does it do the reduce your heel pain? Yes it does. If I gave you £40 quid, could I have it back? No you can't It is worth £40 then. (I think it may have been Dr Kirby that wrote that particular article?)

The same applies to a custom made except the prices are higher. If the clinician does not feel confident that a patient will tolerate a prefab due to issues of interphase pressure or that the pathological force reducing properties of a prefab are insufficient then a custom device is warranted.

My rambling point being that the type of device is irrelevant isn't it? In a custom orthosis the variables are infinite. The same could be leveled at a prefab device in the respect that factors external to the device are variable - patient weight, activity level, pathomechanics, footwear. So what do any of the prefab vs custom studies really show - nothing relevant would be my thought but I'll be happy to be convinced otherwise.

I know that wasn't the point of this article but it somewhat jumped out at me at the end and I have been meaning to think about it for a while.

Robin

 

If you look at all the studies in that systematic review and look at how the custom made orthotics were actually made/designed in all those studies .... you will find that NO ONE actually makes/uses custom made devices that way! - that systematic review/meta analysis is redundant.

A custom made/prescribed foot orthoses, for example, uses a thicker plastic if the person is heavier; uses a first ray cut out if FnHL is present; uses a plantar fascial groove if the fascia is prominent; uses some sort of medial wedging designs if a greater reduction is needed in the inversion moment; etc etc .... if you look at the studies included in the above review, none of the "custom made" orthotics did any of this - they were just pieces of plastic heat moulded to a cast of the foot and a heel post added. Of course, they were "custom made", but they are not close to what people actually use in clinical practice.

Having said that if a true "custom prescribed" foot orthoses was used and compared to a "prefab", they may or may not have still got the same results. We just do not know. Its a shame that the above systematic review/meta analysis reached the conclusion that it did, when the studies they included did not support the conclusion.

EXACTLY. I can not see why people can not get over this.

At the end of the day, its all about having the design features in the foot orthotic to deliver the prescription variables needed. If the foot orthotic design can deliver what is needed, then who cares if its custom moulded, custom made, prefabricated etc etc .... its all about delivering the variable.

Any study comparing a custom device to a prefab device will always show no differences as long as the prescription variable that is needed is delivered ... people will get better.

 

The cynic in me might say that this was published by a group of physios which is why they're trying to show there's no difference between prefabs (which anyone can dispense) and customs (which only a podiatrist can dispense).

"You don't need to go to the podiatrist and pay $400 for a pair of orthotics Mrs Smith. These $100 orthotics that I have for you will do the same job - the reserach say so!"

As I said, just the cynic in me...

 

Agree wholeheartedly with Kent. Seems as thats definitely been the case with patellofemoral studies coming out of certain parts of Oz recently...

 

I'm not sure what world Dr. Payne practices in but in my world, many, many custom orthotics are cast and dispensed exactly the way this articles purports.

Look at the sample orthotics proudly displayed on many major orthotic fabrication labs such as Langer, Precision Intracast, Prolab, Bergman, Ortho-Rite, etc.

NO FF posting, No 1st Ray Cutouts, no grooves, no skives.........
just what the doctor ordered in this retrospective.

My personally biased assessment is that this retrospective puts to rest the ability to preach that Root STJ Neutral examination and casting (what many high tech prefab and custom orthotic shells are based on) and that we need a new vision of custom shell casting and prescribing for the masses

The fact is in DPM Land, custom and prefab devices STJ Neutral devices are virtually the same and the evidence is reflecting just that.

I would also like to have the readers reflect on their own personal biases and consider how they would have valued, utilized and applied this piece of research if it concluded that custom made devices worked on overuse syndromes and prefabs didn't because its amazing how The Arena, The Barefoot Community, The Shoe Industry, The Pharmal Industry and The Medical Community (DPM's included) almost never funds, accepts or quotes literature and research that does not back up their claims until they are forced to do so by overwhelming successful opposition.
EBM is such a manipulative tool, especially when controlled by brilliant, fame and profit oriented guru's.

Dr Sha

 

:craig:

Good Grief!!! Do we have any emoticons that have their eyes actually rolling out of their heads? One, or even a couple of them would be rather apposite here I think!!

:bang:

 

Perhaps this emoticon is the most appropriate...?

 

:D :D

Now, how do we get that into the emoticon or 'smilies' section on the right hand side of the 'Reply to Thread' box? ;)

Thanks Ian. :drinks