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(bennett J E Et Al. 2001) practical Application Of Padding. There Are Many ...

(Bennett J E et al. 2001)

Practical application of padding.
There are many practical applications of padding. One example could be for the treatment of an interdigital neuronal (or similar) when a teardrop shaped pad can be utilised as part of an orthotic device to spread the toes (if placed in an interdigital space) or to spread specific metatarsals

Orthoses.
The topic of orthoses is already responsible for a huge volume of literature and clearly cannot be adequately covered in a paragraph or two. We can observe that the topic suffers from a lack of a good quality evidence base with much of the literature actually being anecdotal or opinion based on critical analysis. Landorf (K B et al. 2004) presented a critical overview of the papers on the subject
While these papers have included results which are generally quite supportive of Foot orthoses, the majority have found either inconclusive or negative results. Much of the research to date could be improved upon and from this perspective, it is clear that further randomised controlled trials assessing outcomes for specific clinical conditions are necessary.

Again, we will adopt the mechanism of considering one case as an illustrative example.

Richie (D H 2003) makes the comment

Out of all the pathologies that podiatric physicians can prescribe foot orthoses for, the one condition which has the most compelling scientific evidence justifying orthotic use is the one least likely to be considered for orthotic treatment. This condition is chronic instability of the ankle.

We will use this example and consider the evidence base to support it. There are currently seven good quality studies published in this area

Orteza (L C et al. 1992) produced a randomised controlled study comparing moulded orthotics to flat inserts in cases of ankle instability. The authors found statistically significant results demonstrating that the moulded orthotics were effective in both reducing instability and relieving pain. Other studies (Guskiewicz K M et al. 1996 and Ochsendorf D T et al. 2004) confirm these results
A more recent paper (Hertel J et al. 2005) considered the topic in more detail and concluded that medial posting reduced the degree of lateral instability to a much greater degree than did lateral (valgus) posting by virtue of its effect on reducing pronation
Although we have considered foot orthoses specifically it should be noted that they are only of real value if they are used as part of an overall programme of functional rehabilitation and this is true, not only in this specific condition, but in virtually all cases of orthotic use.

To consider the question of contraindications to orthotic use we note that the main contraindications are dependent on the type of orthotic used.


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