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impact of footwear type on effectiveness of orthoses

Discussion in 'Biomechanics, Sports and Foot orthoses' started by angermayer, Oct 11, 2013.

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  1. angermayer

    angermayer Member


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    Hi,

    I am gathering ideas for my undergrad final dissertation. My chosen topic is a non-surgical management of tibialis posterior tendon dysfunction.

    I would like to propose a research on the impact of footwear on the effectiveness of foot orthoses for stages I and II of the dysfunction. I am thinking of comparing a group of patients wearing a good leather or nylon over-the-ankle lace-up boots (hiking-style) along with custom orthoses with a group of patients provided with custom orthoses alone. I would like to incorporate ultrasonography as a diagnostic measure.

    Research in the field of nonoperative management of PTTD is very limited. Furthermore, I am struggling to find papers on impact of footwear on the effectiveness of foot orthoses...

    As I am hugely inexperienced in the field of research, I would like to hear your opinions on the topic I have chosen and perhaps any possible guidance. Has anyone come across any research I may refer to in my literature review? Any help and advice is highly appreciated.

    Many thanks
    Michal
     
  2. caf002

    caf002 Active Member

    Dear Michael,
    You have touched on an issue close to my heart. As pedorthists, we see many patients with Post. Tib Dysfucntion at various stages of the deformity. They are either referred or they come and see us direct. Each patient is different. Some can be managed with a strong pedorthic depth shoe +/- a foot orthoses. Some need pedorthic footwear and which ae then re-lasted to accommodate deformities. This usually accompanied with a custom made foot orthoses. Others still need custom shoe and always with a custom made foot orthoses.
    I am almost certain that research into outcomes will be confined to anecdotal only evidence only. Perhaps an approach to the Pedorthic Association of Australia (PAA) maybe worth your while. Also, an approach to the Pedorthic Footcare Association (PFA) in the USA may also be of benefit.
    Regards
    Casper Ozinga. C Ped (Au), C Ped (USA)
     
  3. angermayer

    angermayer Member

    Dear Casper,

    Many thanks for your response and suggestions. Do you have any experience of the efficacy of widely available hiking-style boots (rather than bespoke footwear) as a supportive measure for a treatment with bespoke foot orthoses? In my research I will be limiting to TPTD stage I and II.
    I need to keep my dissertation within a range of competence of a podiatrist in the UK, where I currently study and bespoke footwear is something I cannot involve in my project proposal.

    I have found some empirical evidence published by Kevin Kirby in 2000 who recommends lace up boots for his patients with TPTD but does not support these interventions by any research.

    Many thanks in advance.
     
  4. Michal:

    Now, 13 years later, I still use high-top hiking boots to treat patients with posterior tibial tendon dysfunction (PTTD). In fact, I have found in the approximately 800 patients that I have treated with PTTD with specially-modified custom foot orthoses and high-top hiking boots over the past quarter century, that their symptoms have improved dramatically or have been eliminated.

    And, no, my observations have not specifically been supported by any research. However, my use of the medial heel skive technique in the treatment of PTTD, which I first suggested with my paper on the medial heel skive (Kirby KA: The medial heel skive technique: improving pronation control in foot orthoses. JAPMA, 82: 177-188, 1992) from 21 years ago, and which is now used routinely by podiatrists around the world for the orthosis treatment of PTTD, also has not been supported by any research for the treatment of PTTD.

    If you are looking for good research to support the treatment of pathological conditions with foot orthoses, you will find that the vast majority of the pathologies we routinely treat successfully with foot orthoses have little to no research to support their continued use. Please keep that in mind when you are writing your paper so that proper perspective of the difference between clinically useful therapeutic measures and research evidence in regards to custom foot orthoses is acknowledged.
     
  5. angermayer

    angermayer Member

    Hi Kevin,

    Many thanks for your reply.



    Would you be so kind and specify the main features of the orthoses you prescribe for your PTTD affected patients?

    Also is there any particular boot model that you favour or any particular qualities that the recommended footwear should have?

    Thank you for your time.

    Regards,
    Michal
     
  6. Michal:

    For patients with posterior tibial tendon dysfunction (PTTD), here are my most common foot orthosis prescription variables:

    1. 5-6 mm polypropylene shell
    2. 2-6 mm medial heel skive
    3. 16-18 mm heel cup depth
    4. Normal to minimal medial arch fill on positive cast
    5. 2-3 mm heel contact point thickness
    6. Vertical to 3 degree inverted cast balancing (heel bisection reference)
    7. 4 degree/4 degree polypropylene rearfoot post
    8. Forefoot varus or forefoot valgus extensions depending on foot structure and gait exam

    In regards to the forefoot extension type, I will only add a forefoot varus or forefoot valgus extension if either the patient is not responding to the orthosis as expected, using my patient subjective assessment and gait examination findings.
     
  7. efuller

    efuller MVP

    So, if the research question is boots + orthotic is better than orthotic alone then you have to figure out how you are going to measure "better." There are validated questionaires discussed elswhere on the arena. Are you thinking about using ultrasonography to measure better? Can it give you a number that says that something is better than something else?

    It is a good research question.

    Eric
     
  8. angermayer

    angermayer Member

    Hi Eric,

    I do realise it is difficult to prove the efficacy of treatment with orthoses, let alone having footwear involved in this research. Bearing in mind I have never written a project proposal before, I'll most likely come up with something leading to no conclusions at all... It appears I need to see my supervisor here at University of Salford before I go too far in a wrong direction...

    I was hoping to use US to monitor tendon regeneration, if such occurs in follow up appointments. Sonography in MSK is something I am building my interest around and would like to treat this project as a learning tool.
    I have not decided on my outcome measures but I am thinking of FFI, single support heel raise, walk on toes over 5mins + pain immediately after on VAS. Are they good choices? Any suggestions?

    May I ask you to suggest what follow up period would be most appropriate for this kind of study?

    Many thanks and kind regards,
    Michal
     
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