Orthoses in the treatment of rearfoot problems

Orthotic management is helpful in the treatment of most orthopedic conditions involving the rearfoot, including plantar fasciitis, Achilles tendon disorders, posterior tibial tendon dysfunction, flatfoot, ankle sprains, and problems associated with diabetes, arthritis, and equinus disorders. A review of the effectiveness of orthoses in the treatment of these conditions is presented here. An in-depth analysis of the orthotic management of plantar fasciitis and a critical review of foot orthoses for the pronated foot are presented. Also discussed are the rationale and effectiveness of the tension night splint in the treatment of plantar fasciitis, orthotic devices for the different stages of posterior tibial tendon dysfunction, and the various categories of orthoses for off-loading the diabetic foot. The modern ankle brace, the effectiveness of prefabricated versus prescription foot orthoses, and recent developments in the ankle-foot orthosis are also reviewed.

Download Full-text

Biomechanical effects of three types of foot orthoses on a posterior tibial tendon dysfunction population during a stair climbing task

Footwear Science ◽

10.1080/19424280.2019.1606101 ◽

2019 ◽

Vol 11 (sup1) ◽

pp. S104-S105

Author(s):

Dominic Chicoine ◽

Marc Bouchard ◽

Samuel Trempe ◽

Simon Laurendeau ◽

Etienne L. Belzile ◽

...

Keyword(s):

Stair Climbing ◽

Posterior Tibial Tendon ◽

Foot Orthoses ◽

Posterior Tibial Tendon Dysfunction ◽

Posterior Tibial

Download Full-text

Orthotic treatment for stage I and II posterior tibial tendon dysfunction (flat foot): A systematic review

Clinical Rehabilitation ◽

10.1177/0269215520960121 ◽

2020 ◽

pp. 026921552096012

Author(s):

Isabel Gómez-Jurado ◽

José María Juárez-Jiménez ◽

Pedro V Munuera-Martínez

Keyword(s):

Risk Of Bias ◽

Stage I ◽

Cochrane Library ◽

Posterior Tibial Tendon ◽

Foot Orthoses ◽

Posterior Tibial Tendon Dysfunction ◽

Flat Foot ◽

Posterior Tibial ◽

Exercise Programmes ◽

Orthotic Treatment

Objective: To investigate whether orthotic treatment is effective for the treatment of posterior tibial tendon dysfunction stages I and II (flat foot). Data Sources: Five databases (PubMed, Scopus, PEDro, SPORTDiscus and The Cochrane Library) were searched for potential RCTs from their inception until August 2020. Review Methods: Only randomised controlled trials (RCT) that included subjects diagnosed with posterior tibial dysfunction in the initial stage and treated with orthotic treatments were selected. The outcomes assessed were whatever symptom related to posterior tibial tendon dysfunction stage I and II. Included RCTs were appraised using the Cochrane collaboration risk of bias tool. Results: Four RCT articles and 186 subjects were included. 75% were at high risk of bias for blinding of participants and personnel. Three different types of conservative treatment were used in the studies: foot/ankle-foot orthoses, footwear and stretching /strengthening exercises. Foot orthoses, together with exercise programmes, seemed to improve the effect of orthotic treatment. Foot orthoses with personalised internal longitudinal arch support were more effective than flat insoles or standard treatments in reducing pain. Conclusions: The use of orthotic treatment may be effective in reducing pain in the early stages of posterior tibial tendon dysfunction. Further research is needed into individualised orthotic treatment and high-intensity monitored exercise programmes.

Download Full-text

Nonoperative Management of Posterior Tibial Tendon Dysfunction

Foot & Ankle International ◽

10.1177/107110079601701204 ◽

1996 ◽

Vol 17 (12) ◽

pp. 736-741 ◽

Cited By ~ 103

Author(s):

Wen Chao ◽

Keith L. Wapner ◽

Thomas H. Lee ◽

Jeffrey Adams ◽

Paul J. Hecht

Keyword(s):

Surgical Treatment ◽

Nonoperative Management ◽

University Of California ◽

Posterior Tibial Tendon ◽

Foot Orthoses ◽

Posterior Tibial Tendon Dysfunction ◽

Posterior Tibial ◽

Ankle Foot Orthoses ◽

Shoe Inserts

Forty-nine patients with posterior tibial tendon dysfunction (4 patients had bilateral involvement) were treated with orthoses. Forty feet were treated with molded ankle-foot orthoses, and 13 feet were treated with University of California Biomechanics Laboratory shoe inserts with medial posting. A total of 37 women and 12 men were included in the study. The mean follow-up period was 20.3 months (range, 8–60 months). The average age of the patients was 66 years (range, 42–89 years). Sixty-seven percent of patients had good to excellent results, according to a functional scoring system based on pain, function, use of assistive device, distance of ambulation, and patient satisfaction. The average period of orthosis use was 14.9 months (range, 1.5–29 months), with an average length of daily orthosis wear of 12.3 hours. One patient elected to undergo surgical treatment rather than continuing with long-term orthosis use. Thirty-three percent of patients had discountinued using the orthosis at the time of follow-up evaluation. Three patients were unable to wear the orthosis because of concurrent medical conditions. Nine patients stopped wearing the orthosis after experiencing discomfort and inconvenience. Although these patients continued to exhibit signs and symptoms of posterior tibial tendon dysfunction, they were not disabled enough to consider further treatment. Four patients tolerated orthosis treatment poorly and were treated surgically. Patients with posterior tibial tendon dysfunction can be treated by aggressive nonoperative management using molded ankle-foot orthoses or University of California Biomechanics Laboratory shoe inserts with medial posting. Surgical treatment can be reserved for patients who fail to respond to an adequate trial of brace treatment. Nonoperative management using an orthosis is particularly useful for elderly patients with a sedentary lifestyle or for patients at high risk because of medical problems.

Download Full-text