The effectiveness of foot orthotics

NewsBot · Aug 21, 2008

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Effectiveness of foot orthoses for treatment and prevention of lower limb injuries : a review.
Hume P, Hopkins W, Rome K, Maulder P, Coyle G, Nigg B.
Sports Med. 2008;38(9):759-79.

Healthcare professionals prescribe foot orthoses (FOs) for treatment and prevention of lower limb injuries, but previous reviews of the effectiveness of FOs have been inconclusive. We have therefore performed a review emphasizing the magnitude of treatment effects to evaluate the clinical effectiveness of FOs in the treatment and prevention of lower limb injuries.Qualifying studies were mainly controlled trials, but some uncontrolled clinical trials of patients with chronic injuries were analysed separately. Injuries included plantar fasciitis, tibial stress fractures and patellofemoral pain syndrome; these were included because of the large treatment costs for these frequent injuries in New Zealand. Outcomes were pain, comfort, function and injury status. Continuous measures were expressed as standardized differences using baseline between-subject standard deviations, and magnitudes were inferred from the intersection of 90% confidence intervals with thresholds of a modified Cohen scale. Effects based on frequencies were expressed as hazard ratios and their magnitudes were inferred from intersection of confidence intervals with a novel scale of thresholds. The effects of FOs for treatment of pain or injury prevention were mostly trivial. FOs were not effective in treating or preventing patellofemoral pain syndrome. Some studies showed moderate effects for treatment of plantar fasciitis. Only a few studies showed moderate or large beneficial effects of FOs in preventing injuries.Customized semi-rigid FOs have moderate to large beneficial effects in treating and preventing plantar fasciitis and posterior tibial stress fractures, and small to moderate effects in treating patellofemoral pain syndrome. Given the limited randomized controlled trials or clinical controlled trials available for the injuries of interest, it may be that more or less benefit can be derived from the use of FOs, but many studies did not provide enough information for the standardized effect sizes to be calculated. Further research with randomized controlled trials is needed to establish the clinical utility of a variety of FOs for the treatment and prevention of various lower limb injuries.
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DaVinci · Aug 22, 2008

Am I missing something here? The abstract appears contradictory:

NewsBot said: ↑

FOs were not effective in treating or preventing patellofemoral pain syndrome.
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Customized semi-rigid FOs have ....small to moderate effects in treating patellofemoral pain syndrome.
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Anyone have the full paper?

Atlas · Aug 22, 2008

NewsBot said: ↑

FOs were not effective in treating or preventing patellofemoral pain syndrome.
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Another example of the clinical world and research planet being poles apart.

You will no doubt get young (and maybe older) practitioners doing the "right" thing with EBP, and hence when the next patient walks in with PFJ syndrome...the dogmatic response will be "foot orthoses don't help that....".

An interesting question is, how was PFJ pain syndrome unquestionably diagnosed in the study.

DaVinci · Aug 22, 2008

I have just read the full paper. Those from New Zealand will know the significance of the agency that funded the review (ACC) and their hidden agenda.

deco · Aug 24, 2008

can the full paper be uploaded on the site?

Thanks

Declan

DaVinci · Aug 30, 2008

deco said: ↑

can the full paper be uploaded on the site?
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I see Admin has put the full text in the Supporters forum. You have a buy him a beer to access the supporter forum.

admin · Aug 30, 2008

DaVinci said: ↑

I see Admin has put the full text in the Supporters forum. You have a buy him a beer to access the supporter forum.
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You are right. Putting the full text of journal articles up on the site is 'skating on thin ice' due to copyright issues. It is in the Supporters Forum after Buying Admin a Beer - the beer is used to say thank you to the prolific posters here (see this thread)

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