The ISJ 3D Brace, a Providence Brace Evolution, as a Surgery Prevention Method in Idiopathic Scoliosis

Background: The high incidence of idiopathic scoliosis worldwide as well as the serious health problems it can cause in adulthood, make it necessary to seek effective treatments to prevent the progression of the disease to more aggressive treatments such as surgery and improve patients’ quality of life. The use of night braces, besides a less severe influence on the patient’s quality of life, is effective in stopping the progression of the curve in idiopathic scoliosis. Methods: A longitudinal study was performed with an experimental population of 108 participants who attended orthotic treatment at the University Hospital of Barcelona, with ages between 4 and 15 years old, with a main curvature greater than 25 degrees and a Risser between 0 and 3. The participants received treatment with Providence ISJ-3D night braces until their pubertal change (mean duration of 2.78 years for males and 1.97 years for females). Results: The implementation of night-time orthotic treatment in children with idiopathic scoliosis is effective in slowing the progression of the curve and in the prevention of more aggressive treatments such as surgery, maintaining the patient’s quality of life. Conclusions: The use of night braces is efficacious in the treatment of idiopathic scoliosis, although new studies including more sociodemographic data as well as curves from 20 degrees of progression are necessary.

Orthotic treatment of idiopathic toe walking with a lower leg orthosis with circular subtalar blocking

Background There is no universally accepted treatment standard for idiopathic toe walking patients (ITW) in the current literature. None of the established methods provide homogenous satisfying results. In our department we treat ITW patients with lower leg orthoses with a circular foot unit for a total of 16 weeks. In this study we reviewed our database to evaluate the success of our treatment protocol for a 24 months follow up period. Results Twenty-two patients were included in this study. Age at the beginning of treatment was 7.0 years +/− 2.9 (range 2.5-13.1). Percentage of ITW at the beginning of treatment according to the perception of the parents was 89% +/− 22.2 (range 50-100). Immediately after the treatment with our device, percentage of ITW dropped to 11% +/− 13.2 (range 0-50). After 12 months, 73% of the patients (16/22) walked completely normal or showed ITW less than 10% of the day. After 24 months, 64% of the patients kept a normal gait (14/22). Conclusion This study provides evidence that the treatment of idiopathic toe walking with lower leg orthoses with a circular foot unit results in satisfying long-term results in two thirds of the patients.

Satisfaction with Orthopedic Treatments

To determine the effectiveness and satisfaction with orthopodologic treatments in users of the University Clinic of podiatry at the University of A Coruña, according to various parameters. After approval from the ethics committee of the University of A Coruña, an observational retrospective study (n = 125). We analyzed the effectiveness and satisfaction with the orthopodologic treatments depending on the reason for consultation, diagnosis, treatment and goals of treatment. We performed a descriptive analysis of all variables collected. The most frequent reason for consultation was for pain of the hindfoot (58.2%).The most frequent diagnosis was plantar fasciitis, followed by metatarsalgia (29.7% vs. 18.6%). The orthotic treatment corrective was the most used (68.5%) with pronation control (52.3%). The majority of patients reported improvement in pain, and a high degree of satisfaction with the treatment used. The profile of the patient who consults the Podiatry clinic for a orthopodologic treatment is that of a man over the age of 50, who consulted for pain of the hindfoot. The most frequent diagnosis is plantar fasciitis and the treatment carried out the corrective for pronation control. The majority of patients used the brace between 4 and 8 hours a day, with a high satisfaction with the treatment and improvement in the evolution of the pain. The degree of satisfaction was significantly associated with age, younger patients more satisfied. The improvement of pain was significantly associated with age, younger patients who show improvement.

Effectiveness of an Indigenous Orthosis for the Management of Congenital Talipes Equino Varus - A Case Study

Background: Although the orthotic treatment of CTEV has mixed evidence, still it remains the mainstay of conservative management (Ponseti Casting Technique) in economically developing countries, where bracing is a critical component of the current standard of treatment for CTEV or clubfoot. Objective: Thus this study aimed to design a cost-effective Indigenous Orthosis for the Management of Congenital Talipes Equino Varus with Ankle foot orthosis. So that it can avoid unnecessary wearing of CTEV shoes. Study design: A case report Methods: The subject reported was a 2-year-old male child with a Pirani score of 5 congenital bilateral CTEV deformity. An Indigenous CTEV Orthosis with the combination of AFO and Denis Browne Splint was designed by the clinical team and the subject was followed prospectively for the next 1 year using the orthosis. Results: The Pirani score of 2 was achieved after the use of this Indigenous CTEV Orthosis which was 5 before using the orthosis. Conclusion: Indigenous Orthosis can be considered as a very excellent orthosis for the orthotic management of CTEV. As this orthosis fulfills all the desired function with some additions like lightweight, inexpensive, better correction of the angulations and the most important thing are that there is no need to wear any kind of shoes. Key words: CTEV, Pirani Score, AFO, Denis Browne Splint, Indigenous CTEV Orthosis.

Impact of body mass index on the initial in-brace correction in patients with idiopathic scoliosis

Background/Aim: Many factors affect initial in-brace correction and treatment outcome in patients with idiopathic scoliosis. Previous studies have observed contradictory results on the role of BMI in orthotic treatment. The aim of this study was to examine whether BMI impacts in-brace correction, isolated and in relation to other predictive factors (curve magnitude, curve location and Risser sign). Methods: A retrospective study has been conducted on patients with idiopathic scoliosis treated with Cheneau-Sobernheim brace, that had no prior treatment. The collected and analysed data included patient demographics, BMI percentile and radiological parameters (curve magnitude in Cobb angle, curve location, Risser sign). The initial in-brace correction was expressed as a percentage of Cobb angle reduction in the brace as opposed to Cobb angle out of brace. Patients were categorised into groups according to their BMI, expressed in percentiles, ie: low BMI (< 5 percentiles), normal BMI (5-85 percentiles) and high BMI (> 85 percentiles). To determine the significant difference and correlation relationship between the examined variables, variance tests, t-test with unequal variance, and Pearson correlation coefficient have been used. Results: The cohort study comprised 213 patients (170 females and 43 males) with a mean age of 13.5 years at brace prescription. Low BMI has been detected in 10 % patients, normal BMI in 78 % and high BMI in 10 % patients. No significant difference in in-brace correction has been found between BMI groups, nor has there been any significant correlation between BMI and in-brace correction. Regarding other factors, significant difference within BMI groups was found between in-brace correction and curve location, as well as in-brace correction and Risser sign. Lumbar curves had significantly better in-brace correction than thoracic curves. Significant correlations between in-brace correction and curve magnitude, curve location and Risser sign were detected. Conclusion: The results of the present study show that, as an independent factor, BMI does not impact in-brace correction. Other factors, such as curve magnitude, curve location and Risser sign, play a more significant role in the orthotic treatment of patients with idiopathic scoliosis.

Orthotic Treatment of Idiopathic Toe Walking with A Circular Lower Leg Orthosis

Background: There is no universally accepted treatment standard for idiopathic toe walking patients (ITW) in the current literature. None of the established methods provide homogenous satisfying results. In our department we treat ITW patients with lower leg orthoses with a circular foot unit for a total of 16 weeks. In this study we reviewed our database to evaluate the success of our treatment protocol for 24 months. Results: 22 patients were included in the study. Age at the beginning of treatment was 7.0 years +/-2.9 (range 2.5-13.1). Percentage of ITW at the beginning of treatment according to the perception of the parents was 89% +/-22.2 (range 50-100). Immediately after the treatment with our device, percentage of ITW dropped to 11% +/-13.2 (range 0-50). After 12 months, 73% of the patients (16/22) walked completely normal or showed ITW less than 10% of the day. After 24 months, 64% of the patients kept a normal gait (14/22). Conclusion: This study provides evidence that the treatment of idiopathic toe walking with lower leg orthoses with a circular foot unit results in satisfying long-term results in two thirds of the patients.

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

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.