Pre fabs vs custom. How custom?

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Dear All

I was reviewing the threads on Pre fab vs custom orthotics here

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=141

and here

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=2330&highlight=pre-fab

and reading
Effectiveness of Foot Orthoses to Treat Plantar Fasciitis
A Randomized Trial
Karl B. Landorf, PhD; Anne-Maree Keenan, MAppSc; Robert D. Herbert, PhD

This rather interesting paper and a thought occurred.

The Methodology for this, and other similar papers tend to talk about "customized orthoses" as a given entity. The paper above for example talks about "semirigid plastic" and does not mention whether the clinician had the freedom to add modifications or use different materials where they felt it appropriate.

Are we actually looking at the difference between a pre fab orthotic and a set prescription of casted device? And if so can we really call them custom?

The devices I (and i'm sure most other Pods) issue are many and varied. Kirby skives for medially deviated axis, Planterflexed 1st rays where appropriate, ff varus extentions for sport, heel cushions where needed etc etc. The plantar fascitis is, for me, usually only a symptom so there is not a vast amount in common between devices i issue for this condition.

Are we comparing customised PRESCRIPTIONS (ie all the many and varied insole types, materials and mods) to a pre fab, or simply a pre fab neutral device to a casted neutral device? Are there any comparative studies which allow this degree of freedom in the custom device and are there any comparative studies which compare Kinematic (kinetic?) data between pre fabs and other devices?

Any thoughts?

Regards
Robert

 

Custom devices are by their very nature unique. Here lies the stumbling block of meaningful research into custom orthotics and their effects; n=1 is pretty problematic in research terms. As I've said previously, once placed inside a shoe the net mechanical effect of pre-fab devices are unique too.