Otoform & evidence base

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I am wondering if anyone knows of any evidence either for or against the use of otoform in the treatment of any of the following pathologies: suspected neuroma, bursitis, capsulitis or degenerative change to the metatarsophalangeal joint.

I must admit I can't find any but it has been recommended as a first line treatment by one of our senior clinicians.

My own experience has been that at best they have had no positive effect and at worst increased painful symptoms.

I would be grateful for any links.

 

I wonder if the use of the word 'Otoform' is having an inhibitory effect as far as responses to your query are concerned? Is it particularly Otoform that you are having trouble with or is your concern related to all silicones or is it silicone devices generally or specifically that you find problematic?

If you could give a little more focus to your concern I think you might get a good response from readers.

Best wishes,

Bill

 

Yes, silicone devices would be a more appropriate term. Apologies for that.

 

Would it be fair to say there is no evidence to support the use of silicone devices for the conditions stated above? 250+ views and no reply. I must admit I could not find any. Does anyone have any anecdotal experience of using it for suspected neuroma, bursitis, capsulitis or degenerative change to the metatarsophalangeal joint? I know they are useful for interdigital lesions of course.

 

Depends what you mean by evidence. There has been no randomised controlled trials comparing outcomes with other interventions.

There have been studies on plantar pressures: http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=2222 and http://www.ncbi.nlm.nih.gov/pubmed/15153586

There was the study on claw of toes in rheumatoid arthritis, but can't find at moment.

 

Thanks for the links. By evidence I suppose I do mean randomised controlled trials (the only evidence that we can trust? - perhaps that is another debate!).

The links obviously show that the devices are useful in reducing plantar pressure lesions, but I'm not sure that I would class the above lesions I mentioned as plantar pressure lesions.

The reason I am asking is that I have been asked to try using otoform or silicone devices as part of a treatment package for the conditions I have already mentioned. I am not convinced that they will be an effective, or even cost effective way of managing the symptoms and will delay resolution of painful symptoms.

I try to use an in shoe Orthotic and footwear advice but if that is not successful I refer to my colleague who may consider a steroid injection. Adding the silicone is a waste of time I feel but if someone could prove me wrong I would be happier to pursue this line of treatment.

 

I believe it may be possible to find something if you haven't ruled out metatarsalgia as a search term, e.g.

A comparison of two podiatric protocols for metatarsalgia in patients with rheumatoid arthritis and osteoarthritis ("Our objective was to evaluate, in RA and OA patients, the efficacy of two protocols combining insoles in polypropylene terephtalate (PPT) and custom silicone orthoses for toes on disability and metatarsalgia") http://www.ncbi.nlm.nih.gov/pubmed/25436661

Use of ready-made insoles in the treatment of lesser metatarsalgia: a prospective randomized controlled trial (Silicone isn't mentioned in the abstract, but the search engine quotes "The Bauerfiend Viscoped is an off-the-shelf silicone insole with a fixed position of the metatarsal dome and a series...") http://www.ncbi.nlm.nih.gov/pubmed/9578099

 

Hi Greatwhite,

I wonder if the success or failure of the use of silicones in the conditions you identify in your first post will be determined by the rationale behind their use and the characteristics of design of each device.

I would think that inadequate or inaccurate answers to the following questions are liikely to be the determinants of success or failure.

What is the etiology of the condition?
What do I want the device to do?
Why do I want the device to do these things?
What shape of device do I think will meet the objectives identified above?
Why do I think the device will meet the objectives identified above?
What does the feedback tell Me?
In light of feedback do I need to modify the rationale, etc.

Of course the individual manual ability to construct an appropriate device can also be the difference between success and failure.

I think that rather than consulting the evidence base you are in a position to create the evidence base. That will probably determine how you organise things and how you record your evidence, analyse the evidence, etc.

Best wishes,

Bill