Sports Medicine: Just the Facts

Osternig, 1978). Donatelli reported 96% of patients

with knee pain, ankle pain, shin splints, or chondro-

malacia experienced pain relief and 70% were able to

return to prior level of activity (Donatelli et al, 1988).

Gross, in a large study, reported 76% of long distance

runners had complete recovery or substantial

improvement in a variety of lower quarter injuries

with orthotic management (Gross, Davlin, and

Evanski, 1991). More recently both Nigg (Nigg,

Nurse, and Stefanyshyn, 1999) and Nawoczenski

(Nawoczenski, Cook, and Saltzman, 1995) agree that

at least 70% of runners with lower extremity symp-

toms will show symptom reduction with orthotic use.

GOALS OF ORTHOTIC MANAGEMENT

• The classic balanced foot orthosis is aimed to allow
  the subtalar joint to function near and around its neu-
  tral position by maintaining the angular anatomical
  relationships of the forefoot to the rearfoot and the
  rearfoot to the ground; and control functional patho-
  mechanics in the lower quarter (Foot and Ankle,
  2002).


• An orthotic device should alter foot function with the
  expectation that it will control excessive movement of
  the foot through the stance phase of gait, through
  stimulation of the somatosensory system, to promote
  overall biomechanical efficiency and reduce abnormal
  tissue stress (Valmassy and Subotnick, 1999;
  Cornwall and McPoil, 2003).

INDICATIONS

• Numerous clinicians and authors have proposed vari-
  ous indications for the rationale to prescribe custom
  biomechanical foot orthoses.
  
  
  1. Support and correction of rearfoot and forefoot
     intrinsic deformities (Foot and Ankle, 2002)
  
  
  2. Reduce the frequency of lower quarter injuries by
     altering applied tissue stresses. (James, Bates, and
     Osternig, 1978; Donatelli et al, 1988; Gross, Davlin,
     and Evanski, 1991; Gross and Napoli, 1993)
     3.Support or control range of motion (ROM)
     (Nawoczenski, Cook, and Saltzman, 1995; Cornwall
     and McPoil, 2003; Eng and Pierrynowski, 1993;
     Nawoczenski, Cook, and Saltzman, 1998; MacLean,
     2001; Tillman et al, 2003)
  
  
  3. Treatment of postural dysfunction caused by foot
     abnormalities (Dannanberg and Guiliano, 1999)
     5.Improve sensory feedback and proprioception
     (Nigg, Nurse, and Stefanyshyn, 1999; Cornwall
     and McPoil, 2003; Nigg, 2001)
     6. Dissipation of pathologic ground reaction forces,
     improved shock absorption (Nigg, Nurse, and
     Stefanyshyn, 1999; MacLean, 2001; Shiba et al,
     1995)
     7. Improve neuromuscular responses (Nigg, Nurse,
     and Stefanyshyn, 1999; MacLean, 2001)
     8.Redistribute plantar weight bearing forces
     (Cornwall and McPoil, 2003; Landorf and Keenan,
     2000; Cornwall and McPoil, 1997; Postema et al,
     1998)
     9. Improve lower extremity biomechanics/kinemat-
     ics:
     a. Decrease amount of pronation, reduce maximal
     velocity of pronation, reduce time to maximal
     pronation, and decrease total rearfoot motion.
     (Cornwall and McPoil, 2003; Razeghi and Batt,
     2000; Genova and Gross, 2000)
     b.Significant orthotic effects shown for rotation
     from heel contact to peak tibial internal rotation,
     and in the coupling relationship between tibial
     transverse rotation and calcaneal inversion/ever-
     sion. (Nawoczenski, Cook, and Saltzman, 1995;
     McPoil and Cornwall, 2000)
  
  
  
  

CLINICAL CONDITIONS

• Patellofemoral dysfunction:The successful use of
  custom foot orthoses as a primary therapeutic inter-
  vention for treatment of patellofemoral pain syndrome
  (PFPS) has been well documented in the recent liter-
  ature. Biomechanical foot orthoses have been shown
  to be effective as a primary treatment intervention in
  patients with moderate to severe PFPS allowing
  faster return to sport. Orthotic management in con-
  junction with a specific biomechanical exercise pro-
  gram has also been demonstrated to be an effective
  means of treatment. A significant change in medial
  patellar glide was shown with a rearfoot medial
  posted semirigid device. (Donatelli et al, 1988; Gross
  and Napoli, 1993; Eng and Pierrynowski, 1993;
  Pitman and Jack, 2000; Way, 1999; Klingman, Liaos,
  and Hardin, 1997; Powers, Maffucci, and Hampton,
  1995; American Physical Rehabilitation Network,
  1984; Saxena and Haddad, 1998; Powers, Maffucci,
  and Hampton, 1995; Benard et al, 2002)


• Plantar fasciitis:Semirigid custom orthoses with fore-
  foot medial post and medial longitudinal arch support
  have been shown to be effective in the management of
  plantar fasciitis to decrease tissue loading stress,
  (Benard et al, 2002; Gross, 2001; Sobel, Levitz, and
  Caselli, 1999; Lynch, Goforth, and Martin, 1998).


• Posterior tibial tendon dysfunction:Orthotic man-
  agement has been described for all four stages based

434 SECTION 5 • PRINCIPLES OF REHABILITATION