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Success Rates of Orthotic Therapy

Discussion in 'Biomechanics, Sports and Foot orthoses' started by TedJed, Apr 6, 2007.

  1. TedJed

    TedJed Active Member

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    I'm interested to know if any of our esteemed academians can provide a link(s) to Lit Reviews or summaries that quantify the 'success rates' of orthotic therapy. I am presuming that any such studies would be under pathology categories such as 'heel pain' or 'plantar fasciitis' but would appreciate someone telling me 'where to go!'


  2. DaVinci

    DaVinci Well-Known Member

    There are 100 or so studies I have seen references to. They show 70-90% success, but it depends on what you mean by success.
  3. TedJed

    TedJed Active Member

    Thanks DaV, do you have list for me to explore?
  4. Here are the references I have. If you want the pdf article of the paper I was invited to write on the subject, then contact me privately (Kirby, KA: Foot orthoses: therapeutic efficacy, theory and research evidence for their biomechanical effect. Foot Ankle Quarterly, 18(2):49-57, 2006).

  5. Scorpio622

    Scorpio622 Active Member

    I am frequently perplexed with the responses I see to orthotic therapy. I have had patients do wonderfully with them and others fail miserably- many times the outcomes surprise me either way. I also have patient come in with orthoses from previous practitioners where the response surprises me as well. Some come in with device that were prescribed and made appropriately (something that I would have issued), and report zero response or sometimes a negative response. On the other hand, I had a woman yesterday that I treated for a toe fracture. She was obese and had 3/4 polyprop orthoses that had a completely flat shell, zero posting in the rearfoot and no discernible intrinsic ff posting. She stated these were a miracle and she could not live without them. I would have prescribed something different and would probably not have had as good as a result.

    I do consider other issues- calf tightness, weight, activity, foot-type, shoes - but I must admit my prognostic skills with respect to orthotic outcomes are not as good as my diagnostic skills.

    Any thoughts??

  6. Nick:

    Join the club. Any podiatrist (or other foot-health professional) who says they know what the best orthosis is for every patient doesn't know what they are talking about. I am surprised nearly every week at some of the responses I see to foot orthoses. However, the more years and the more orthoses I do, the more confident I become since I can predict orthosis responses much better now (due to improvements in theory and improvements in my knowledge) compared to when I first started over 20 years ago. I still am surprised every now and then, but am not as confused as I previously was. Becoming a successful biomechanics clinician is a lifelong learning pursuit.
  7. CraigT

    CraigT Well-Known Member

    Put up your hand if you have ever had a patient return for an orthotic review, heaping praise on you for the miracle you have performed, only for you to find out they are wearing the devices the wrong way around....
  8. David Smith

    David Smith Well-Known Member

    Oh! Me Me :D but not for a long time since now I alway make a point of showing the correct fitting and marking the orthoses left and right.

    Yeah - Nice one CraigT

    LoL Dave
  9. Simm

    Simm Welcome New Poster

    Thanks for that very honest reply kevin. I issue many orthotics to patients, and am constanly surprised at the range of results. Despite if their from casted orthoses or semi-bepsoke.
  10. david3679

    david3679 Active Member

    Hi Guys

    Craig you are so right and David i go thought the same precedure of fitting the insole and marking and some IQ's must be low as they still come in with them in the wrong shoes.:hammer:
    The other issue i find with results is that the patient has issues remembering what their pain is and how bad it has been from the start to the review stage and this comes down to note taking


  11. Hand up.

    Worse, I had a patient with simples once who had them in back to front! :wacko:.

    Simon gave a good definition of how orthotics work on another thread but as we are presently arguing, there are elements of how orthotics work we don't fully understand! Not least the placebo effect!

    Something I played with a while back was something I called Iatrogenic Malignant Hypertonia. I noticed that some patients, particularly the "chronic pain" types had abberactions to ANY kind of orthotic. They would tense up all their intrinsic muscles and find walking painful as a consequence. I have had patients for whom a 3mm poron sheet with a cavity for a corn was "to harsh" and which caused tibialis pain.

    I wonder if their is a reverse of that, a mechanism by which people relax more and walk more fluidly if they THINK that a problem has been fixed.

    There is probably a funky experiment using an F scan and hypnosis there! Does background muscle tone affect gait? Any volunteers?;)

  12. david3679

    david3679 Active Member


    very interesting point.

    I work closely with some friends of mine who are personnel trainers and employ a method from the states founded by a gent called Gary Gray.

    He works on the methodology and has shown good success with it that the area of dysfunction is antagonised with a specific set of exercises for each body segment and looking for the planal dominace and in somecases is using techniques that we would deam as contrary to our clinical aim with an orthotic.
    That may tie into similar grounds as to what you were mentioning


  13. I doubt it, but that's another story due to be told.
  14. Or kinetic or kinematic measurement tool of dealers choice
    Are we talking proximal stuff here? Do you have any links for bedtime reading?


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