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Mechanism of orthotic therapy for the painful cavus foot deformity.

Najafi B, Wrobel JS, Burns J - J Foot Ankle Res (2014)

Bottom Line: Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear.No relationship between change in pressure magnitude and change in symptoms was found in either group.Our data suggest that a primary function of effective orthotic therapy with CFO is redistribution of abnormal plantar pressures.

View Article: PubMed Central - HTML - PubMed

Affiliation: Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine, Tucson, AZ, USA. najafi.bijan@gmail.com.

ABSTRACT

Background: People who have extremely high arched feet or pes cavus often suffer from substantial foot pain. Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear. It is generally thought that one of the primary functions of CFO is redistributing abnormal plantar pressures. This study sought to identify variables associated with pain relief after CFO intervention.

Methods: Plantar pressure data from a randomized controlled trial of 154 participants with painful pes cavus were retrospectively re-analyzed at baseline and three month post CFO intervention. The participants were randomized to a treatment group given CFO or a control group given sham orthoses.

Results: No relationship between change in pressure magnitude and change in symptoms was found in either group. However, redistribution of plantar pressure, measured with the Dynamic Plantar Loading Index, had a significant effect on pain relief (p = 0.001). Our final model predicted 73% of the variance in pain relief from CFO and consisted of initial pain level, BMI, foot alignment, and changes in both Dynamic Plantar Loading Index and pressure-time integral.

Conclusion: Our data suggest that a primary function of effective orthotic therapy with CFO is redistribution of abnormal plantar pressures. Results of this study add to the growing body of literature providing mechanistic support for CFO providing pain relief in painful foot conditions. The proposed model may assist in better designing and assessing orthotic therapy for pain relief in patients suffering painful cavus foot deformity.

Trial registration: Randomized controlled trial: ISRCTN84913516.

No MeSH data available.


Related in: MedlinePlus

The association between foot pain score change post custom orthoses intervention as a function of (A) FHSQ initial foot pain score, (B) BMI, and (C) Foot Posture Index. The vertical dash line represents the mean value.
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Figure 4: The association between foot pain score change post custom orthoses intervention as a function of (A) FHSQ initial foot pain score, (B) BMI, and (C) Foot Posture Index. The vertical dash line represents the mean value.

Mentions: Figure 4 illustrates the scatter plot for the association between change in pain and baseline parameters, including participants’ initial pain score (Figure 4A), BMI (Figure 4B), and Foot Posture Index (Figure 4C). Results suggest that effective pain reduction depends on initial pain score. In other words, those who have higher pain levels may benefit more from the prescribed orthoses (R-partial = −0.4). On the same note, pain relief was mediated by an increase in BMI and lower Foot Posture Index (i.e., worse pes cavus foot deformity) after intervention with prescribed custom-made foot orthoses (R-partial = 0.54 for BMI and 0.24 for Foot Posture Index).


Mechanism of orthotic therapy for the painful cavus foot deformity.

Najafi B, Wrobel JS, Burns J - J Foot Ankle Res (2014)

The association between foot pain score change post custom orthoses intervention as a function of (A) FHSQ initial foot pain score, (B) BMI, and (C) Foot Posture Index. The vertical dash line represents the mean value.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3924916&req=5

Figure 4: The association between foot pain score change post custom orthoses intervention as a function of (A) FHSQ initial foot pain score, (B) BMI, and (C) Foot Posture Index. The vertical dash line represents the mean value.
Mentions: Figure 4 illustrates the scatter plot for the association between change in pain and baseline parameters, including participants’ initial pain score (Figure 4A), BMI (Figure 4B), and Foot Posture Index (Figure 4C). Results suggest that effective pain reduction depends on initial pain score. In other words, those who have higher pain levels may benefit more from the prescribed orthoses (R-partial = −0.4). On the same note, pain relief was mediated by an increase in BMI and lower Foot Posture Index (i.e., worse pes cavus foot deformity) after intervention with prescribed custom-made foot orthoses (R-partial = 0.54 for BMI and 0.24 for Foot Posture Index).

Bottom Line: Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear.No relationship between change in pressure magnitude and change in symptoms was found in either group.Our data suggest that a primary function of effective orthotic therapy with CFO is redistribution of abnormal plantar pressures.

View Article: PubMed Central - HTML - PubMed

Affiliation: Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine, Tucson, AZ, USA. najafi.bijan@gmail.com.

ABSTRACT

Background: People who have extremely high arched feet or pes cavus often suffer from substantial foot pain. Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear. It is generally thought that one of the primary functions of CFO is redistributing abnormal plantar pressures. This study sought to identify variables associated with pain relief after CFO intervention.

Methods: Plantar pressure data from a randomized controlled trial of 154 participants with painful pes cavus were retrospectively re-analyzed at baseline and three month post CFO intervention. The participants were randomized to a treatment group given CFO or a control group given sham orthoses.

Results: No relationship between change in pressure magnitude and change in symptoms was found in either group. However, redistribution of plantar pressure, measured with the Dynamic Plantar Loading Index, had a significant effect on pain relief (p = 0.001). Our final model predicted 73% of the variance in pain relief from CFO and consisted of initial pain level, BMI, foot alignment, and changes in both Dynamic Plantar Loading Index and pressure-time integral.

Conclusion: Our data suggest that a primary function of effective orthotic therapy with CFO is redistribution of abnormal plantar pressures. Results of this study add to the growing body of literature providing mechanistic support for CFO providing pain relief in painful foot conditions. The proposed model may assist in better designing and assessing orthotic therapy for pain relief in patients suffering painful cavus foot deformity.

Trial registration: Randomized controlled trial: ISRCTN84913516.

No MeSH data available.


Related in: MedlinePlus