Orthoses, AFOs, and shoe modifications: medical proof they work?

[DPMer]

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Foot and ankle orthopedists argue that there is no statistically significant medical proof in the medical literature (i.e. meta-analysis, randomized control trials, prospective studies, case series) that orthoses, AFOs, and shoe modifications have any use in standard medical treatments of the foot and ankle. There are only theories proposed by podiatrists like Dr. Root and anecdotal evidence. Thus, foot and ankle orthopedists tend to use orthoses, AFOs, and shoe modifications at a minimum at best in their practices.

I propose that the best podiatrists in the United States should organize a IRB-approved, peer-reviewed formal long-term clinical study (10 to 20 years, for example) like a randomized control trial that would show whether or not orthoses, AFOs, and shoe modifications help alleviate pathomechanical aspects of foot and ankle function in a statistically significant manner.

Is this possible and is there any formal IRB-approved medical study being conducted by American podiatrists now to address this issue posed by foot and ankle orthopedists?

 

[malleolusman]

Actually, there has been a randomized controlled trial (Level of clinical evidence 1) that shows that orthotics are indeed beneficial, particularly in preventing injuries in a subset of the active population. Even though it only involved this subset, I am pretty sure we can all make an inference as to the benefit of these devices in the general population, just like we infer that stripper shoe gear will likely exacerbate HAV, or even cause it.

The study was published in 2011 in The American Journal of Sports Medicine and involved military recruits.

http://ajs.sagepub.com/content/39/1/30

 

[DPMer]

Actually, there has been a randomized controlled trial (Level of clinical evidence 1) that shows that orthotics are indeed beneficial, particularly in preventing injuries in a subset of the active population. Even though it only involved this subset, I am pretty sure we can all make an inference as to the benefit of these devices in the general population, just like we infer that stripper shoe gear will likely exacerbate HAV, or even cause it.

The study was published in 2011 in The American Journal of Sports Medicine and involved military recruits.

http://ajs.sagepub.com/content/39/1/30

Nice! Are there any other articles out there, both new, recent, and classical?

 

[PADPM]

I'm not sure that I agree that foot/ankle orthopedists use a minimal amount of orthoses, shoe modifications or AFO's. There are several extremely busy foot/ankle orthopedists in my geographic area so our practice often sees many of the same patients as second opinions, cross over patients, dis-satisfied patients, etc., and I have found that these doctors prescribe a LOT of AFOs and write for a LOT of shoe modifications. They also refer a lot of patients out to a local supplier for custom orthotics.

I'm not sure what experience you have to state that foot/ankle orthopedists use a minimal amount of these products, but from my many years of experience practicing in the same area as several extremely busy foot/ankle orthopedists, my experience has been the exact opposite.

I have no opinion on their thoughts regarding a lack of sufficient studies to support the use of these products, since I haven't spoken directly with any of these doctors and can not be a spokesperson for an entire group of doctors.

 

[DPMer]

I'm not sure that I agree that foot/ankle orthopedists use a minimal amount of orthoses, shoe modifications or AFO's. There are several extremely busy foot/ankle orthopedists in my geographic area so our practice often sees many of the same patients as second opinions, cross over patients, dis-satisfied patients, etc., and I have found that these doctors prescribe a LOT of AFOs and write for a LOT of shoe modifications. They also refer a lot of patients out to a local supplier for custom orthotics.

I'm not sure what experience you have to state that foot/ankle orthopedists use a minimal amount of these products, but from my many years of experience practicing in the same area as several extremely busy foot/ankle orthopedists, my experience has been the exact opposite.

I have no opinion on their thoughts regarding a lack of sufficient studies to support the use of these products, since I haven't spoken directly with any of these doctors and can not be a spokesperson for an entire group of doctors.

Foot and ankle orthopedists in Texas and a good number of them in West Coast states have this belief. They only use these modalities as A LAST RESORT for non surgical foot and ankle medical care. These treatment modalities based on theories and anecdotal evidence for them are LAST RESORT routes if Evidence Based treatment modalities do not provide long term relief for the patient.

 

[PADPM]

Foot and ankle orthopedists in Texas and a good number of them in West Coast states have this belief. They only use these modalities as A LAST RESORT for non surgical foot and ankle medical care. These treatment modalities based on theories and anecdotal evidence for them are LAST RESORT routes if Evidence Based treatment modalities do not provide long term relief for the patient.

Once again you're generalizing quite a bit when you state "foot and ankle orthopedists in Texas" and a "good number of them in West Coast states".

Practice philosophies not only differ from office to office, but even within offices. Our practice has many doctors and it's accurate to say that we often don't agree on many topics, including orthoses. As I've stated in prior posts, I prescribe the least amount of custom orthoses in our practice since I believe orthoses are over-prescribed often for monetary gain.

I based my prior answer on my years of experience with several well known and well respected foot/ankle orthopedists in my geographic area. I'm simply asking you if your statements are based on first hand knowledge or "hear-say". Do you have personal experience(s) with the foot and ankle orthopedists in Texas or with a "good number" of foot and ankle orthopedists in West Coast states that have told you this information?

By the way, you stated that these doctors will utilize these products as a LAST RESORT if evidence based treatment modalities do not provide long term relief for the patient. First of all, I'd like to know how you've become a spokeperson for all of these orthopedists, and how you are so sure of each one of their practice philosophies? And you happen to know that it's factual, they they won't provide any care for any condition for any patient unless it's been through an evidence based study????

EBM is the new buzz term, but I can assure you that every practitioner of every discipline performs treatments on a daily basis that are not supported by EBM. It's a great shield to hide behind, but in reality there are treatments for everyday ailments that have not been tested by EBM.

Links to some articles by well known foot and ankle orthopedists;

http://www.eorif.com/AnkleFoot/Plantar%20Fibromatosis.html

http://books.google.com/books?id=Oc...AEwAA#v=onepage&q=wapner orthoses afo&f=false

http://www.orthobullets.com/foot-and-ankle/7020/posterior-tibial-tendon-insufficiency-ptti


These are just the first 3 articles I found and I'm confident there are more. Once again, the opinions of these foot/ankle orthopods does not reflect the opinion of all F&A orthopods and that's exactly my point. You can not generalize and the opinions differ among each practitioner and in the second reference, there are multiple articles which are referencing studies regarding orthoses, AFOs,etc.