Sports Medicine: Just the Facts

CHAPTER 72 • FOOTWEAR AND ORTHOTICS 437

MODIFICATIONS

• Modifications to the device can be made based on
  specific goals for management of the lower quarter
  pathology, from the biomechanical evaluation and
  assessment of the patient using the device.
  
  
  1. Metatarsal head cut-out to accommodate a rigid
     plantar flexed 1st ray
  
  
  2. Heel cushioning for increased shock absorption in
     a rigid cavus foot
  
  
  3. Metatarsal pads to redistribute weight from 2–4th
     metatarsal heads to 1st and 5th with metatarsalgia
     or Morton’s neuroma
  
  
  4. Morton’s extension to redistribute weight from 2nd
     to 1st metatarsal
     5.Rigid forefoot extension to limit mobility of great
     toe with degenerative joint disease(DJD) or turf toe
  
  
  5. Toe crests can be added to prevent the toes from
     sliding back over the insole of the shoe and prevent
     clawing.
  
  
  
  

CONTROVERSIES/CONCLUSIONS/
FURTHER RESEARCH

• In a review of the literature Pratt judged 40 orthotic
  related articles using Sackett’s “levels of evidence”
  criterion for scientific merit, and concluded that the
  literature is rather weak with only one achieving a
  level of 2 and none achieving a level 1 qualification
  (Pratt, 2000).


• There are several different classification systems of
  evaluating foot type that have shown poor inter-rater
  reliability and measurement accuracy questioning the
  practical usefulness and validity (Razeghi and Batt,
  2000; Finestone et al, 1999; Payne and Chuter, 2001;
  Ball and Afheldt, 2002a).


• There is significant debate whether functional kine-
  matics and pathomechanics of the foot can be based
  principally on morphology. Mechanisms causing
  lower quarter injuries are poorly understood with very
  few adequate randomized controlled studies relating
  specific foot type or pathomechanics with injury inci-
  dence (Razeghi and Batt, 2000; Payne and Chuter,
  2001; Ball and Afheldt, 2002a).


• Recent research has debated the assumptions that the
  rearfoot achieves subtalar joint neutral position near
  midstance in gait and the functional significance of
  rearfoot neutral (Cornwall and McPoil, 2003;
  Razeghi and Batt, 2000; Ball and Afheldt, 2002a;
  2002 b).


• Studies have shown that static measurements in a clas-
  sic biomechanical examination are poor predictors of
  dynamic foot motion (Cornwall and McPoil, 2003;

Payne and Chuter, 2001; Ball and Afheldt, 2002b;

Heiderscheit, Hamill, and Tiberio, 2001).

• Research evaluating orthotic effectiveness in gait has
  substantial inadequacies including—various biome-
  chanical assessment tools for gait analysis; nonstan-
  dardized orthotic device or footwear; modifications to
  shoe counter; motion analysis markers on shoe or
  skin; differences in calibration of equipment; and
  anecdotal descriptions of gait changes (Cornwall and
  McPoil, 2003; Landorf and Keenan, 2000; Payne and
  Chuter, 2001; Ball and Afheldt, 2002b).


• The literature demonstrates a lack of controlled stud-
  ies consistently with poor methodology including
  variable orthotic prescription, patient presentation,
  fabrication of the orthoses, and outcome measurement
  tools (Landorf and Keenan, 2000; Payne and Chuter,
  2001).
  •Overall throughout the orthotic literature there is a
  significant amount of inconclusive or conflicting data
  (Landorf and Keenan, 2000; Ball and Afheldt, 2002a;
  2002 b).


• The review of the literature highlights the fact that the
  current research can be greatly improved upon with
  further randomized controlled trials for specific
  measurable clinical outcomes to more effectively pre-
  scribe a custom orthotic device for treatment and pre-
  vention of lower quarter injuries in our patients and
  athletes.
  •A recent trend in the research proposes orthotic inter-
  vention to influence lower quarter dynamic function
  by increased afferent feedback from cutaneous recep-
  tors in the foot; and minimizing muscle activity with
  the concept combining biomechanical control and
  proprioceptive feedback with custom fabricated bio-
  mechanical orthotics to reduce tissue stress. As with
  previous work more randomized controlled research
  must be completed to justify these hypotheses (Nigg,
  Nurse, and Stefanyshyn, 1999; Nawoczenski, Cook,
  and Saltzman, 1995; Nigg, 2001; Razeghi and Batt,
  2000).

FOOTWEAR

INTRODUCTION

• The running shoe industry changes rapidly with
  constant revisions and updates to shoe models.
  Many new marketing techniques have emerged to
  influence the consumer into believing that one
  brand is better than another. Clinicians will have
  better results recommending types of shoes based
  on construction and features over specific model
  designations.