Radiographic Evaluation of Weight-bearing Orthotics and Their Effect on Flexible Pes Planus
D. Robert Kuhn, DC, Nofa J. Shibley, DC, William Austin, DC, and Terry R. Yochum, DC
Objective: To determine whether any positive change in the alignment of the bones of the feet occur with the use of Foot Levelers custom-made flexible orthotics, cast by weight bearing, in individuals having flexible pes planus.
Methods: Anteroposterior and lateral radiographs were obtained with and without orthotics in place. The anteroposterior and lateral talocalcaneal angles and the lateral pitch of both the left and right foot were assessed.
Results: The radiographic measurements indicated statistically significant improvements in weight-bearing foot alignment with the use of Foot Levelers orthotics.
Discussion: Biomechanical faults in the pedal foundation can adversely affect any of the joints and structures of the foot/ankle complex, lower extremities, pelvis, and spine.
Conclusion: This study supports the use of Foot Levelers custom-made flexible orthotics for the improvement of pedal structural alignment.
Immediate Changes in the Quadriceps Femoris Angle After Insertion of an Orthotic Device
D. Robert Kuhn, DC, Terry R. Yochum, DC, Anton R. Cherry, and Sean S. Rodgers
Objective. To evaluate the effects of full-length, custom-made flexible orthotics (Spinal Pelvic Stabilizers) on quadriceps angle (Q-angle) in volunteers with bilateral foot hyperpronation.
Methods. Forty chiropractic student volunteers were selected. Inclusion criteria were asymptomatic, male, evidence of bilateral hyperpronation, and no history of ankle surgery. Custom-made, flexible orthotics were produced. Subjects’ Q-angles were measured before and after orthotic insertion.
Results. Orthotic insertion demonstrated reduced Q-angle, in the direction of correction, in 39/40 test subjects.
Discussion. Research suggests that the hyperpronated foot is an etiologic factor in many lower extremity complaints, including foot, knee, hip and low back pain. Literature indicates that custom-made, flexible orthotics can stabilize the pes planus foot and restore optimal degree of pronation. Reduced pronation decreases the amount of tibial and femoral internal rotation, with subsequent Q-angle reduction.
The Effectiveness of Custom-made Orthotics in a Standing Work Environment
Jeffrey D. Olsent, DC, Samuel A. Rowan, DC, William M. Austin, DC, CCSP, CCRD, Dennis L. Nosco, PhD.
Paper presented at World Federation of Chiropractic 2005 convention.
Objective: To address orthotics use with workers who worked continuously on concrete surfaces, and determine if the workers feel that orthotics offer positive benefits under such conditions.
Methods: Workers in shipping, receiving, or assembly departments were recruited to test flexible Spinal Pelvic Stabilizers and to complete pre- and about three-week post-initiation of Stabilizers questionnaires.
Results. Complete data sets were obtained for 66 workers. After wearing the Stabilizers for greater than 10 days, all sub-groups showed improvement in all categories after Stabilizer use. Significant inter-group differences included: more after-work comfort for females, less before-work pain in workers over 30 years old, most improvement noted in first 15 days of wear, and more positive responses from workers with recent foot pain history.
Discussion: Using five Visual Analog Scale categories, the short-term study data presented in this paper show a positive worker response on their pain levels after using custom-made, flexible Stabilizers on concrete floors.
Chiropractic Adjustments Plus Orthotics
Reduced Symptoms for Workers Standing Six Hours Daily
John Zhang, Ph.D., M.D. and Joe Zhou, D.C. Logan College of Chiropractic
Objective: To determine the effect of chiropractic care and orthotics on reducing discomfort in individuals who spend long hours standing during working hours.
Methods: The subjects filled out a patient information sheet and prescreening foot pain questionnaire. The chiropractic treatment was performed using the Activator technique. In-home exercise was prescribed to the subject receiving orthotics and chiropractic care.
Foot and Ankle Outcome Score (FAOS) was used for the specific region survey. FAOS was developed to assess the patients’ opinion about a variety of foot- and ankle-related problems. FAOS consists of five subscales: pain, other symptoms, activities in daily living (ADL), function in sport and recreation, and foot- and ankle-related quality of life (QOL). The study used a computerized scan offered by Foot Levelers Inc. to record and analyze the foot data. Based on the data collected, the need for orthotics (Spinal Pelvic Stabilizers) was determined and the data were sent to Foot Levelers Inc. for creating the orthotics.
Results: Two cases, one from experimental and one from control groups, are reported. The experimental case was a 56-year-old female who presented with complaints of both feet pain, right dorsal foot numbness, and right hip pain after long standing at work. After chiropractic and orthotics, the preorthotic and postorthotic foot pain questionnaire from the beginning of the study to the end of the 2nd week showed improvement of the pain score from 50 to 83, the symptom score from 75 to 82, the ADL score from 52 to 94, the score of function in sports and recreational activities from 50 to 95, and the QOL score from 44 to 56. The control case was a 42-year-old male research assistant who presented with a chief complaint of bilateral heel pain after prolonged standing or walking. The subject also complained of lower back pain and knee pain once or twice a month. Without chiropractic care and orthotics, the preorthotic and postorthotic foot pain questionnaire from the beginning of the study to the 3rd week revealed no significant changes in all items.
Discussion: These case studies were directed to the evaluation of the effectiveness of chiropractic care and orthotics on reducing the effects of prolonged standing. The first case showed significant improvement compared to the second (control) case in function in sports and recreational activities, ADL, and reduction of the pain.
The Effect of Custom Orthotics on the Vertical Leap of Athletes in a Sport Demanding Jumping William M. Austin, D.C., C.C.S.P., C.C.R.D., Dennis Nosco, Ph.D., Nosco Consulting, and Jeffrey D. Olsen, D.C.
Objective: To determine whether the use of custom-made orthotics can positively affect the vertical leap of a jump sport team in a controlled, blinded study.
Methods: Eleven female high-school-age volleyball players from a club team were recruited into this study; they were all fitted for Foot Levelers’ custom-made Spinal Pelvic Stabilizers. Standing and three-step approach vertical reach were measured on separate days with and without Stabilizers to minimize complicating fatigue factors. Leaps were measured to the nearest half inch.
Results: This pilot study showed “trends that would indicate that there is some benefit to orthotics in improving vertical leap, even in the limited exposure to orthotics (i.e., right before the test).”
Discussion: The pilot study was performed with the intention of determining if a larger, more well-controlled study should be undertaken.
The Reliability of the Associate Platinum Digital Foot Scanner in Measuring Previously Developed Footprint Characteristics: A Technical Note
M. Owen Papuga, MS,a and Jeanmarie R.
Objective: An ink pad and paper, pressure-sensitive platforms, and photography have previously been used to collect footprint data used in clinical assessment. Digital scanners have been widely used more recently to collect such data. The purpose of this study was to evaluate the intra- and interrater reliability of a flatbed digital image scanning technology to capture footprint data.
Methods: This study used a repeated-measures design on 32 (16 male 16 female) healthy subjects. The following measured indices of footprint were recorded from 2-dimensional images of the plantar surface of the foot recorded with an Associate Platinum (Foot Levelers Inc, Roanoke, VA) digital foot scanner: Staheli index, Chippaux-Smirak index, arch angle, and arch index. Intraclass correlation coefficient (ICC) values were calculated to evaluate intrarater, interday, and interclinician reliability.
Results: The ICC values for intrarater reliability were greater than or equal to .817, indicating an excellent level of reproducibility in assessing the collected images. Analyses of variance revealed that there were no significant differences between raters for each index (P N .05). The ICC values also indicated excellent reliability (.881-.971) between days and clinicians in all but one of the indices of footprint, arch angle (.689), with good reliability between clinicians. The full-factorial analysis of variance model did not reveal any interaction effects (P N .05), which indicated that indices of footprint were not changing across days and clinicians.Conclusions: Scanning technology used in this study demonstrated good intra- and interrater reliability measurements of footprint indices, as demonstrated by high ICC values. (J Manipulative Physiol Ther 2011;34:114-118)
THE EFFECTIVENESS OF
CUSTOM ORTHOTICS AT REDUCING INJURIES IN A COLLEGE FOOTBALL TEAM
Brian Jensen, DC1,William Austin1, DC, J. Nathan Wilder2, MS, ATC, CSCS, Brent A. Ungar3, DC, CCSP, John Zhang4, MD, PhD, Dennis L. Nosco5, PhD, Mark Mandell1, DC, MBA
1-Foot Levelers, 2- Waynesburg College, 3- Private Practice, 4- Logan College of Chiropractic, 5- Nosco Consulting
Contribution from Foot Levelers Inc., Roanoke, VA
Objective: To determine the effect of custom-made orthotics on the injury rate for a college football team and the patients’ satisfaction level with their orthotics.
Methods: Inclusion criteria were: 1) a football player active on the team at the start of the study, and 2) a signed informed consent document. Consenting patients were fitted for custom-made, flexible Spinal Pelvic Stabilizers, and were asked to answer a pre-study and post-study questionnaire. The study used the previous year’s injury rate as the control.
Results: The findings on Foot Levelers’ orthotic use were that lower body-half injuries decreased from 148 to 126 (15% decrease); knee injuries decreased from 29 to 20 (31% decrease); and lumbar spine injuries decreased from 14 to 7 (50% decrease). Results from the pre- and post-study questionnaires revealed that nearly all player groups reported an above-neutral satisfaction level with their orthotics.
Foot Levelers’ Orthotics Improve Balance and Proprioception
Stude DE, Brink DK. Effects of nine holes of simulated golf and orthotic intervention on balance and proprioception in experienced golfers. J Manip Physiol Ther 1997; 20(9):590-601.
Objective: To measure improvements in balance and proprioception, before and after the nine holes of simulated golf, in experienced golfers, after wearing Foot Levelers custom-made orthotics continuously for six weeks.
Methods: Subjects were tested using the Cybex Functional Assessment System for Testing and Exercise. The tests challenged human performance skills beyond those required for golf, to provide the relative effects of orthotic intervention for all individuals. Foot Levelers’ orthotics were used for the investigation because of their abilities to control motion and absorb shock.
Results: Balance and proprioception before and after nine holes improved with orthotic use. More specifically, proprioceptive inequalities between left and right sides were not apparent after wearing the orthotics on a daily basis during the six-week period.
Discussion: Joint motion affects proprioception and it is well documented that disturbances in the proprioceptive feedback mechanism cause biomechanical disabilities. Lower-limb proprioception training in non-injured individuals can prevent many injuries.
Low Leg Pain Improves with Foot Levelers
Austin WM. Shin splints with underlying posterior tibial tendinitis: a case report. J Sports Chiro Rehab 1996; 10(4):163-168.
Objective: To discuss treatment protocols for a recreational middle-distance runner who suffered from anterior shin splints complicated by an underlying posterior tibial tendinitis, who was unable to train to his full capacities, and who turned to chiropractic care when standard medical protocols proved ineffective.
Methods: A multifaceted treatment approach was used. Foot Levelers’ custom-made, flexible orthotics -- to support the skeletal alignment in a more appropriate range for weightbearing posture -- provided increased heel-strike shock absorption and enhanced afferent-motor response. Manipulation of the navicular, cuboid, and metatarsal heads was administered. Ice massages were recommended, and evertors and invertors were strengthened with low-tech resistive exercises.
Results: After 3 weeks of care, the patient was able to resume running at a moderate pace and distance (2-3 miles every other day) and after 6 weeks, he was running 40 miles per week without pain and was released from care.
Discussion: It is not unusual for the chiropractor, especially the sports-minded practitioner, to be consulted for the vague pain and nonspecific symptoms accompanying the gradual onset of a stress reaction to the soft tissues and/or bone. These conditions can be effectively managed if identification is early and an appropriate treatment program is followed. Ultra-lightweight, flexible orthotics can play a major role in preventing many overuse injuries in runners and joggers.