Foot Orthotics in the Medical Literature

On this page is a list of a few of the many scientific articles published on treatment with custom orthotic devices.

The therapeutic efficacy of custom foot orthoses has been well documented in the medical literature. In addition, the literature helps us determine the best way to cast for orthotics and how to write the best orthotic prescription for specific problems. In order to ensure the best outcomes from your orthotics, be sure that your practitioner is familiar with recent research on orthotic therapy.

To make an appointment to be evaluated for orthotics go to our appointments page.

Below are listed a sample of recent articles related to custom orthotic therapy. The articles have been put into the following categories:

• Patient Satisfaction with Foot Orthotics
  
• Casting Technique and Foot Orthotics
  
• Plantar Fasciitis and Foot Orthotics
  
• Metatarsal Pain (Ball-of-Foot Pain) and Orthotics
  
• Arthritis and Foot Orthotics
  
• Ankle Sprain and Foot Orthotics
  
• Knee Pain and Foot Orthotics
  
• Back Pain and Foot Orthotics
  
• Flat Foot and Orthotics
  
• Cavus (high-arched) Foot and Foot Orthotics
  
• Runners and Orthotics
  
• Orthoses and Muscle Function
  
• Pressure on the Foot and Foot Orthotics
  
• Balance and Foot Orthotics
  
• Children and Foot Orthoses

Patient Satisfaction with Foot Orthotics
The following studies evaluated how satisfied patients were with the effectiveness and comfort of their orthotics.

In a 2004 study of 275 patients that had custom foot orthoses for over a year, the majority of subjects obtained between 60-100% relief of symptoms with only 9% reporting no relief of symptoms.
Walter JH, Ng G, Stoitz JJ: A patient satisfaction survey on prescription custom-molded foot orthoses. JAPMA, 94:363-367, 2004.

In a 1993 study, 83% of 520 patients were satisfied and 95% reported their problem had partially or completely resolved with orthoses.
Moraros J, Hodge W: Orthotic survey: Preliminary results. JAPMA, 83:139-148, 1993

In a study of 81 patients, 91% were “satisfied with orthoses” and 52% “wouldn’t leave home without them”.
Donnatelli R, Hurlbert C, et al: Biomechanical foot orthotics: A retrospective study. J Ortho Sp Phys Ther, 10:205-212, 1988.

Casting Technique and Foot Orthotics
The position of the foot when the cast or image of the foot is taken is the most important determinate of how well an orthotic will function. Several studies indicate that the foot should be held non-weightbearing when the cast or image of the foot is taken. The foot should never be bearing weight when the cast or image of the foot is taken if the orthotic is to offer the best clinical outcomes. For more on the importance of proper casting for orthotics go to the casting for orthotics page of this site.

A comparison of four methods of obtaining a negative impression of the foot. McClay-Davis I, Laughton C, Williams, DS. J Am Podiatr Med Assoc. 2002 May;92(5):261-8

Forefoot to Rearfoot Angle – A Comparison of Orthotic Casting Techniques. McPoil, TG; Schmit, D. Phys Ther. 1989 Jun;69(6):448-52

Position of the First ray and Motion of the First MTP. Roukis, et. al. 1996 JAPMA. Vol. 86:11

The Effect of Rearfoot Eversion on Maximal Hallux Dorsiflexion. Harradine, Bevin:; JAPMA,. 2000

Plantar Fasciitis and Foot Orthotics
A number of studies have demonstrated the effectiveness of orthotic therapy in the treatment of plantar fasciitis, heel spur syndrome, heel pain and arch pain.

75% reduction in disability rating and a 66% reduction in pain rating with foot orthoses occurred.
Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM: The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. J Ortho Sp Phys Ther, 32:149-157, 2002.

This 2004 article review stated that the evidence suggests that foot orthoses produce reductions in pain and disability associated with plantar fasciitis
Karl B. Landorf, Anne-Maree Keenan, and Robert D. Herbert Effectiveness of Different Types of Foot Orthoses for the Treatment of Plantar Fasciitis J Am Podiatr Med Assoc 2004 94: 542-549

This prospective clinical outcome study during eleven months that compared custom orthotic therapy with and without steroidal or non-steroidal therapy on 84 patients with 133 painful heels. The study demonstrated that 89% patients receiving only the orthotic therapy had total or more than 80% relief of their symptoms. 7% received partial relief and 4% no relief. Maximum relief was achieved at an average of 5.4 weeks.
Scherer, PR, et al. Heel spur syndrome, pathomechanics and non-surgical treatment. Journal of the American Podiatric Medical Association 1991; 81:68-72

This prospective study of 85 patients with plantar heel pain found that after 12 weeks of treatment with custom functional orthoses 70% of the patients achieved good to excellent results while only 30% of the patients receiving viscoelastic heel inserts received good to excellent results.
Lynch DM, Goforth WP, Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 1998 Aug;88(8):375-80.

This invitro research study unequivocally demonstrates that adding particular mechanical inervention to the feet decreases the strain on the plantar fascia. In a previous (1996) article the same authors demonstrated that a custom functional UCBL orthoses significantly decreased strain in the plantar aponeurosis in virtually all subjects tested. (P<0.05)
Kogler G, Veer FB, Solomonidis,SE. The influence of medial and lateral placement of orthotic wedges on loading of the plantar aponeurosis. Journal of Bone and Joint Surgery; 1999;81A:1403-1413

This study demonstrated that when custom functional orthoses were given to patients with plantar fasciitis a 75% reduction in disability rating and a 66% reduction in pain prating occurred. This is a straight forward and conclusive study concerning quantification of effectiveness.
Gross, MT, Byers, JM, Krafft, JL, Lackey, EJ, Melton, KM. The impact of custom semi rigid orthoses on pain and disability for individuals with plantar fasciitis. Journal of Orthopaedic and Sports Physical Therapy 2002;32:149-157.

For more information on plantar fasciitis, go to our plantar fasciitis page.

Metatarsal Pain (Ball-of-Foot Pain) and Orthotics
Orthotics can be used to reduce pressure on the ball of the foot in order to relieve pain in this area. The following articles review orthotic therapy for ball-of-foot pain and in particular evaluate the exact placement of pads in order to achive the best possible clinical outcome.

Aligning anatomical structure from spiral X-ray computed tomography with plantar pressure data.
Hastings MK, Commean PK, Smith KE, Pilgram TK, Mueller MJ.
Clin Biomech (Bristol, Avon). 2003 Nov;18(9):877-82.

Optimum position of metatarsal pad in metatarsalgia for pressure relief.
Hsi WL, Kang JH, Lee XX. Department of Rehabilitation, National Taiwan University Hospital, Taipei, Republic of China. Am J Phys Med Rehabil. 2005 Jul;84(7):514-20.

A quantitative assessment of the effect of metatarsal pads on plantar pressures.
Holmes GB Jr, Timmerman L. Foot Ankle. 1990 Dec;11(3):141-5.Related Articles, Links

Multistep measurement of plantar pressure alterations using metatarsal pads.
Chang AH, Abu-Faraj ZU, Harris GF, Nery J, Shereff MJ. Department of Orthopaedic Surgery, Medical College of Wisconsin, Foot Ankle Int. 1994 Dec;15(12):654-60.

Arthritis and Foot Orthotics
Several recent studies have shown a strong effect of foot orthotics in relieving pain associated with several types of arthritis. Studies have focused on orthotic use in both adult and juvenile arthritis patients.

In a 2000 study, research on patients with rheumatoid arthritis (RA) showed a significant improvement in pain and a decrease in foot disability when the patients wore custom foot orthoses.
Chalmers AC, Busby C, Goyert J, Porter B, Schulzer M: Metatarsalgia and rheumatoid arthritis-a randomized, single blind, sequential trial comparing two types of foot orthoses and supportive shoes. J Rheum, 27:1643-1647, 2000.

In a 2005 study published in the Journal of Rheumatology, a randomized trial of 40 children with juvenile idiopathic arthritis were found to have significantly greater improvements in overall pain, speed of ambulation, foot pain and level of disability when they wore custom foot orthoses when compared to those in the study that received shoe inserts or shoes alone
Powell M, Seid M, Szer IA: Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: A randomized trial. J Rheum, 32:943-950, 2005.

In a study that measured pain relief in 64 subjects with osteoarthritis in the foot and ankle, 100% of the patients wearing orthoses had significantly longer relief of pain than those patients receiving only non-steroidal anti-inflammatory drugs Thompson JA, Jennings MB, Hodge W: Orthotic therapy in the management of osteoarthritis. JAPMA, 82:136-139, 1992.

In a study using foot orthoses in patients with Hemophilia A, foot orthoses were found to significantly decrease ankle bleeds and decrease pain, decrease disability and increase activity over a 6 week period in 16 subjects with hemophilia A
Slattery M, Tinley P: The efficacy of functional foot orthoses in the control of pain and ankle joint disintegration in hemophilia. JAPMA, 91:240-244, 2001.

In another study on patients with rheumatoid arthritis, foot orthoses in patients with rheumatoid arthritis showed significant reductions in rearfoot eversion during stance and also showed a reduction in internal tibial rotation after 12 months of wearing the orthoses.
Woodburn J, Helliwell PS, Barker S: Changes in 3D joint kinematics support the continuous use of orthoses in the management of painful rearfoot deformity in rheumatoid arthritis. J Rheum, 30:2356-2364, 2003.

In a 2000 study, both normal and rheumatoid arthirtis subjects showed significant reductions in plantar pressures and loading forces during the stance phase of gait with foot orthoses.
Li CY, Imaishi K, Shiba N, Tagawa Y, Maeda T, Matsuo S, Goto T, Yamanaka K: Biomechanical evaluation of foot pressure and loading force during gait in rheumotod arthritic patients with and without foot orthoses. Kurume Med J, 47:211-217, 2000.

In a 2006 study of osteoarthritis sufferers, people with high arches were more likely to have arthritis in their hips, while those with flatter feet developed the condition in their knees.
Anne Reilly K, Louise Barker K, Shamley D, Sandall S. Influence of foot characteristics on the site of lower limb osteoarthritis. Foot Ankle Int. 2006 Mar;27(3):206-11.

Woodburn J, Barker S, Helliwell PS: A randomized controlled trial of foot orthoses in rheumatoid arthritis. J Rheum, 29:1377-1383, 2002

Ankle sprain and Foot Orthotics
Orthotic devices are a standard part of our protocol for treating chronic ankle sprains.

Guskiewicz KM, Perrin DH: Effects of orthotics on postural sway following inversion ankle sprain. J Orthop Sp Phys Ther, 23:326-331, 1996.

Knee Pain and Foot Orthotics
Knee pain has been treated with foot orthotics for decades. In the past few years a number of studies have started to show how much relief can be expected and have also shown the possible mechanisms by which orthotics reduce knee pain.

In a 2003 study of 102 athletic patients with patellofemoral pain syndrome, 76.5% of patients improved and 2% were asymptomatic after 2-4 weeks of receiving the custom foot orthoses
Saxena A, Haddad J: The effect of foot orthoses on patellofemoral pain syndrome. 93:264-271, 2003.

Experimental studies that have measured the effects of foot orthoses on the kinematics and kinetics of the foot and lower extremities in runners have shown significant mechanical results including a decrease in internal rotation and adduction of the knee.
Stackhouse CL, Davis IM, Hamill J: Orthotic intervention in forefoot and rearfoot strike running patterns. Clin Biomech, 19:64-70, 2004.

A study of 30 persons with medial knee osteoarthritis were given foot orthoses with a 5 degree lateral wedge. At 6 weeks, all subjects had some relief and 28 found the orthoses comfortable.
Russel Rubin and Hylton B. Menz. Use of Laterally Wedged Custom Foot Orthoses to Reduce Pain Associated with Medial Knee Osteoarthritis: A Preliminary Investigation. J Am Podiatr Med Assoc 2005 95: 347-352.

Back Pain and Foot Orthotics
In this 1999 study, subjects experienced more than twice the improvement in alleviation of pain, and for twice as long, compared with subjects in a study using traditional back-pain treatment.
Dananberg HJ, Guiliano M: Chronic low-back pain and its response to custom-made foot orthoses. 89:109-117, 1999

Flat Foot (Pes Planus Foot) and Orthotics
Not every flat foot causes problems, but some do and often some of the worst mechanical problems seen in feet occur due to flatfoot. Orthotics are a proven treatment for many flat foot related conditions.

Blake RL, Ferguson H: Foot orthoses for the severe flatfoot in sports. JAPMA, 81:549, 1991.

Pediatric flatfoot: evaluation and management. Sullivan JA. J Am Acad Orthop Surg. 1999 Jan;7(1):44-53. Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma College of Medicine, Oklahoma City 73126-0307, USA.

Rome K, Brown CL: Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clin Rehab, 18:624-630, 2004

One of the worst kinds of flat foot is due to the weakening or rupture of a tendon called the posterior tibialis. The condition is known by several names including posterior tibialis dysfunction, posterior tibial tendon dysfunction and tibialis posterior dysfunction. The weakening of this tendon leads to an “Adult Acquired Flatfoot” – a progressive flattening of one or both feet. The following articles are related to orthotic treatment of posterior tibialis dysfunction.

Kirby KA: Conservative treatment of posterior tibial dysfunction. Podiatry Management, 19:73-82, 2000.

High Arched Foot (Pes Cavus Foot) and Foot Orthotics
Patients with a high-arched foot frequently experience foot pain, which can lead to significant limitation in function. Custom orthoses are widely used to treat these problems.

Burns J, Crosble J. Effective Orthotic Therapy for the Painful Cavus Foot. J Am Pod Med Assoc. 96:3: 205 – 211. 2006

Schwend RM, Drennan JC. Cavus foot deformity in children. : J Am Acad Orthop Surg. 2003 May-Jun;11(3):201-11.

Runners and Foot Orthotics
The success rate in treating running injuries with orthotics alone has been estimated by various researchers to be between 50 to 90% (D’Ambrosia, 1985; Dugan & D’Ambrosia, 1986; Eggold, 1981; Kilmartin & Wallace, 1994).

Foot orthoses were shown to “definitely help” 70% of 180 patients with athletic injuries
Blake RL, Denton JA: Functional foot orthoses for athletic injuries: A retrospective study. JAPMA, 75:359-362, 1985.

Orthotic treatment resulted in complete resolution or great improvement in symptoms in 76% of 500 distance runners Gross ML,
Davlin LB, Evanski PM: Effectiveness of orthotic shoe inserts in the long distance runner. Am. J. Sports Med., 19:409-412, 1991).

Dugan RC, D’Ambrosia RD: The effect of orthotics on the treatment of selected running injuries. Foot Ankle, 6:313, 1986.

MacLean CL, Hamill J: Short and long-term influence of a custom foot orthotic intervention on lower extremity dynamics in injured runners. Annual ISB Meeting, Cleveland, September 2005.

Baitch SP, Blake RL, Fineagan PL, Senatore J: Biomechanical analysis of running with 25 degree inverted orthotic devices. JAPMA, 81:647-652, 1991.

Mundermann A, Nigg BM, Humble RN, Stefanyshyn DJ: Orthotic comfort is related to kinematics, kinetics, and EMG in recreational runners. Med Sci Sports Exercise, 35:1710-1719, 2003b

Smith LS, Clarke TE, Hamill CL, Santopietro F: The effects of soft and semi-rigid orthoses upon rearfoot movement in running. JAPMA, 76:227-232, 1986

Williams DS, McClay-Davis I, Baitch SP: Effect of inverted orthoses on lower extremity mechanics in runners. Med. Sci. Sports Exerc. 35:2060-2068, 2003

Orthosis Effect on Muscle Function and Kinematics
One of the ways by which foot orthotics function is to alter muscle activity or change the kinematics of the lower extremity. These studies are related to those areas.

Foot orthoses have been noted to significantly alter the EMG activity of the biceps femoris and anterior tibial muscles during running (Nawoczenski et al., 1999)

Foot orthotics have been shown to significantly alter the duration of anterior tibial muscle activity during walking (Tomaro et al., 1993).

Recent research has documented that certain foot orthosis designs can cause significant alterations in EMG activity in many of the muscles of the lower extremity during running
Mundermann A, Wakeling JM, Nigg BM, Humble RN, Stefanyshyn DJ: Foot orthoses affecct frequency components of muscle activity in the lower extremity. Gait and Posture, In Press, 2005.

Nawoczenski DA, Cook TM, Saltzman CL: The effect of foot orthotics on three-dimensional kinematics of the leg and rearfoot during running. J Ortho Sp Phys Ther, 21:317-327, 1995

Nawoczenski DA, Ludewig PM: Electromyographic effects of foot orthotics on selected lower extremity muscles during running. Arch Phys Med Rehab, 80:540-544, 1999.

Nester CJ, Hutchins S, Bowker P: Effect of foot orthoses on rearfoot complex kinematics during walking gait. Foot Ankle Intl, 22:133-139, 2001.

Nester CJ, Van Der Linden ML, Bowker P: Effect of foot orthoses on the kinematics and kinetics of normal walking gait. Gait Posture, 17:180-187, 2003.

Novick A, Kelley DL: Position and movement changes of the foot with orthotic intervention during loading response of gait. J Ortho Sp Phys Ther, 11:301-312, 1990

Pressure on the Foot and Foot Orthotics
Excessive pressure on the foot can lead to problems such as ball-of-foot pain and heel pain. The studies below demonstrate how foot orthotics help reduce excessive pressure on the foot.

Foot orthoses have been found to be effective at mechanically reducing plantar forces and plantar pressures on injured or painful areas of the foot. Orthoses were found to significantly decrease the force impulse, peak pressure and pain in 42 subjects with metatarsalgia (Postema et al., 1998).

Both normal and rheumatoid arthirtis subjects showed significant reductions in plantar pressures and loading forces during the stance phase of gait with foot orthoses.
Li CY, Imaishi K, Shiba N, Tagawa Y, Maeda T, Matsuo S, Goto T, Yamanaka K: Biomechanical evaluation of foot pressure and loading force during gait in rheumotod arthritic patients with and without foot orthoses. Kurume Med J, 47:211-217, 2000.

In 81 patients with Type II diabetes, orthoses produced a 30% reduction in maximum peak pressure under the foot.
Lobmann R, Kayser R, Kasten G, Kasten U, Kluge K, Neumann W, Lehnert H: Effects of preventative footwear on foot pressure as determined by pedobarography in diabetic patients: a prospective study. Diabet Med, 18:314-319, 2001.

In a 2003 study, both peak pressure and pressure-time integral was reduced in 34 adolescent Type I diabetic patients.
Duffin AC, Kidd R, Chan A, Donaghue KC: High plantar pressure and callus in diabetic adolescents. Incidence and treatment. JAPMA, 93:214-220, 2003

Three dimensional finite element modeling of the foot exposed to different orthosis constructions showed that the shape of the orthosis was more important in reducing peak plantar than orthosis stiffness
Cheung JT, Zhang M: A 3-dimensional finite element model of the human foot and ankle for insole design. Arch Phys Med Rehabil, 86:353-358, 2005

Balance and Foot Orthotics
The following articles demonstrate the ability of orthotic devices to help patients maintain balance when standing and walking. This is particularly important in elderly patients who feel unsteady when walking.

Foot orthoses significantly reduced postural sway in study participants when they were subjected to side-to-side and front-to-back movements which possibly indicated that orthoses may restrict undesirable motion at the foot and ankle and enhance joint mechanoreceptors to detect perturbations of motion.
Guskiewicz KM, Perrin DH: Effects of orthotics on postural sway following inversion ankle sprain. J Orthop Sp Phys Ther, 23:326-331, 1996.

In a 2001 study, significant decreases in frontal plane CoP length and velocity with medially posted orthoses were thought to indicate enhanced postural control when subjects stood on the orthoses in single leg stance.
Hertel J, Denegar CR, Buckley WE, Sharkey NA, Stokes WL: Effect of rearfoot orthotics on postural control in healthy subjects. J Sport Rehabil, 10:36-47, 2001.

In a 2004 study foot orthotics were shown to improve balance in excessively pronated feet (flat feet) via reductions in side-to-side sway during bipedal standing
Rome K, Brown CL: Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clin Rehab, 18:624-630, 2004

Children and Foot Orthoses
A number of problems experienced by children can be treated with foot orthotics. Details are available in the Kids section of this website. The following articles deal with some childhood conditions.

There is some evidence that some leg pain experienced by children, commonly called growing pains, may be associated with the over-pronated (excessively flat) foot. This study found that treating the excessive pronation with orthotic devices reduced the “growing pains” affecting the legs of these childrens.
Evans, AM. Relationship between "growing pains" and foot posture in children: single-case experimental designs in clinical practice. J Am Podiatr Med Assoc. 2003 Mar-Apr;93(2):111-7. PMID: 12644517

The effect of foot orthoses on standing foot posture and gait of young children with Down syndrome. Selby-Silverstein L, Hillstrom HJ, Palisano RJ. NeuroRehabilitation. 2001;16(3):183-93.

Pediatric flatfoot: evaluation and management. Sullivan JA. J Am Acad Orthop Surg. 1999 Jan;7(1):44-53. Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma College of Medicine, Oklahoma City 73126-0307, USA.

Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992 An evaluation of the use of gait plate inlays in the short-term management of the intoeing child. Levitz S, Sobel E. Foot Ankle Int. 1998 Mar;19(3):144-8.
 

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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
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