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Therapeutic effect of foot orthosis on chronic musculoskeletal pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by scottma, Jan 11, 2008.

  1. scottma

    scottma Member

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    Dear All:
    I have some questions on therapeutic effects of foot orthosis.
    1. What's the limitation of foot orthosis with respect to chronic musculoskeletal
    pain? or What's the best outcome can be achieved through foot orthosis
    2. To what extent foot orthosis can improve body posture or body mechanics?
    3. If patients do'nt have 100% of pain relief, what else could be done?
    Any reply is very much appreciated. Thank you all in advance.
    scott ma, dds
  2. Craig Payne

    Craig Payne Moderator

    Foot orthotics work brilliantly on improving body posture, body mechanics and chronic musculoskeletal pain provided that abnormal function, structure or posture of the foot is the cause of the poor body posture, poor body mechanics and the chronic musculoskeletal pain.

    IMHO, when they don't work, they should never have been used in the first place.
  3. scottma

    scottma Member

    Dear Dr.Payne:
    Thank you very much for your promp reply. You said: when they don't work, they should never have been used in the first place. If a well fabricated foot orthosis doesn't work, I assume it is not supposed to aggravate the condition. Why is it not used? Please explain further. What else could be done to help patients?
    Scott Ma, dds
  4. Craig Payne

    Craig Payne Moderator

    The biggest reason I see for foot orthotic failure is the non-mechanical nature of of symptoms (ie the symptoms are not related to mechanics that can be altered by foot orthotics).

    If foot orthotics make the symptoms better, then generally and philosophically we can assume it was due to abnormal foot mechanics that we susccessful altered with the foot orthoses (ignoring for now the potential of a placebo effect)

    If foot orthotics make the symptoms worse, then generally and philosophically, that would indicate the problem is related to foot mechanics, we just got the expected mechanical change with the foot orthotics wrong.

    If foot orthotics make no change to symptoms, then generally and philosophically, that would indicate the problem is either:
    1. Not related to foot mechanics
    2. Is related to foot mechanics, but we got the alteration in mechanics with the foot orthotics wrong
    3. Is related to foot mechanics, but other interventions are needed to afford a symptomatic change (ie physical therapies etc).

    The challenge is how do you tell if it (1), (2) or (3) and I have no idea!
  5. Scott:

    These are some good basic questions on foot orthoses. However, since I am taking the time to answer your questions, please answer a few questions for me. Why are you, as a dentist, so interested in foot orthoses?? Are you treating patient's feet also??

    I don't understand your question completely since I don't know what "limitation" refers to exactly. The limitation of foot orthoses is they don't work when people don't wear them, they don't permanently change structure or appearance of the foot and many people don't want to wear them for various reasons, mainly cosmetic reasons. Foot orthoses don't work to cure all musculoskeletal conditions but do work for a good number of them, and sometimes foot orthoses work better than any other therapeutic option. Contrary to what the snake oil salesmen of the Internet say, they can't cure blood-borne diseases, they can't cure systemic diseases and can only cure musculoskeletal disorders that are ultimately caused by abnormal tissue stresses acting on or within the body due to the effects of ground reaction forces on the plantar foot.

    Complete healing of the injured structural component of the patient's body, production of normal gait function and an increase in duration and intensity of physical activity to the level that is desired by the patient.

    Body posture overall can be affected by foot orthoses when the orthoses are being worn and these affects may carry over for a short time period while the orthoses are not being worn. Foot posture can be dramatically affected while the patient is wearing the orthoses both standing, walking and running. Lower extremity alignment may be slightly affected during standing and may be significantly affected during walking and running by foot orthoses. Trunk, upper extremity, neck and head posture may be slightly affected by foot orthoses during gait. Research has repeatedly shown that not only the kinetics but also the kinematics of the foot and lower extremity may be significantly affected by properly designed custom foot orthoses.

    1. Make a better orthosis.
    2. Use other therapeutic options (e.g. in no specific order: physical therapy, cortisone injections, change shoes, shoe modifications, modify activities, lose weight, stretch muscles, strengthen muscles, ice/heat therapy, immobilization casts, braces, strapping, surgery, medications)
    3. Refer the patient to someone more knowledgeable than yourself.
    4. Tell the patient that there is nothing more that can be done and they will need to learn to live with the pain.
  6. scottma

    scottma Member

    Dear Drs.Payne and Kirby:
    Thank you very much for your teachings. I am much appreciated.
    Podiatry is not a recognized profession in Taiwan. There is no podiatry school and possibly no officially qualified podiatrist. I have no place to refer to. I treated many temporomandibular disorder patients. What I said limitation really infers from occlusal therapy for TMD. When a perfect occlusion is established, the patient may not always have !00 % free of pain. Therefore, I assume that a perfectly fabricated foot orthosis may not always relieve 100% pain. I had extensively studied books of musculoskeletal pain area and found that foot orthosis might very well be the path to the solution. Yes, I do use prefabricated foot orthosis to treat paients musculoskeletal pain. Only less than 10 patients were treated. However, the responses are very encouraging.
    I personally think tissure stress theory is very helpful to explain chronic musculoskeletal pain. Most chronic musculoskeletal pains are probaly the results of Force + Time> tissue healing, then symptoms(pain) develop. However, How do we know the tissues are injured when the patient does'nt have symptom yet? Do muscle length, joint range of motion, structural alignment of joint,or image stydy can reveal tissue inlury?
    What you said 1. make a better orthosis, How do we know the foot orthosis is perfectly fabricated already, could,nt be better?
    4. Tell patients learn to live with the pain. Many patients came to me and they had heard from other docters already. I personally feel it's crude to say so. Chronic musculoskelatal pain certainly is not a life-threatening condition, but some patients did feel suffer a lot and life was worthless( 3 patients told me). I personally feel we health profession do'nt work hard enough. We need to work harder.
    Thak you very much for your kindly teaching again.
    scott ma,dds

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