Orthotic devices as clinical interventions for foot pain

Orthotic Devices

Orthoses are a clinically successful podiatric intervention

Foot pain is a problem that can affect lives, making it difficult to perform everyday tasks. Many underlying foot conditions result in pain including plantar fasciitis, overpronation, Achilles tendonitis, and metatarsalgia. The most common treatment for these and similar conditions include orthoses designed to provide support to the portion of the foot where it is needed. Orthoses provide a simple solution to the problem in many cases. There are many types of orthoses available on the market. Some are hard and some are soft. Many types are available over the counter, but many require prescriptions. There are also specific types available based on the type of walking or activity that at person engages in on a daily basis.

Literature regarding the efficacy of foot orthoses, particularly those that alter biomechanical processes, are generally positive (Landorf & Keenan, 2000). One of the key problems with the assessment of the effectiveness of orthoses is that few controlled studies have been performed (Landorf & Keenan, 2000). The biomechanical rationale for the development of orthoses is well supported. However, a gap exists that supports the efficacy of orthoses in clinically-based trials. This research will support the hypothesis that orthoses are a clinically successful podiatric intervention.

Methods

One of the key concerns discovered during the literature review was the need to develop a valid measure for assessing patient pain levels and success. Pain is subjective and there are a number of factors that can affect the perception of pain and the effectiveness of treatments in various patients. One of the key challenges of this study will be the development of a research instrument that accurately and consistently can assess the pain level and discomfort of the patient. The following examines the research design that will be employed for the conduct of this study.

Development of the Research Instrument

Research into the efficacy of orthotic devices has many aspects. Pain is recognized to have many dimensional aspects including sensory, affective, and cognitive dimensions (Rowan, 2001). These dimensions were used in the development of the ROwan Foot Pain Assessment Questionnaire (ROFPAQ). This instrument allows clinicians to understand which dimensions of foot pain are most relevant to the patient (Rowan, 2001). Bennett, Patterson, Wearing, & Baglioni, (1998) conducted a survey of orthoses users, with the intention of developing a reliable research instrument for the evaluation of the effectiveness of orthotic devices. This instrument will be used in the conduct of this study, as reliability and validity data can be easily obtained. Budiman-Mak, Conrad, & Roach (1991) developed a similar scale to measure foot pathology in terms of pain, disability, and restriction of activity. This scale will also be administered to assess the degree of disability associated with foot pathology. This instrument demonstrated high construct validity and is considered a reliable indice of function.

These research instruments will be used in conjunction with each other in order to provide the most comprehensive information regarding pain and disability before use of an orthotic device and again after three months of treatment. Use of these three scales in combination will allow the research to explore many aspects of pain and disability, as opposed to focusing on only one aspect of the symptoms.

Data Collection Methods

This study will use a pre-treatment/post-treatment format on the sample population. The research instrument, consisting of three scales, will be administered to a selected group of patients presenting symptoms of plantar fasciitis. The ROFPAQ will be used to measure the sensory, affective, and cognitive dimensions of pain. The scale developed by Bennett, Patterson, Wearing, & Baglioni, (1998) will provide a subjective assessment of the condition. The Budiman-Mak, Conrad, & Roach scale will be used to measure the pain, disability and restriction of activity caused by the condition. It is believed that all of these aspects are necessary in order to understand how the patient's plantar fasciitis affects their life.

The sample population for the study will consist of 100 subjects between the ages of 20-45, who have recently diagnosed with plantar fasciitis. They will be both male and female and will not have had a previous experience with the condition. For all patients, this will be their first experience with the diagnosis.

Patients will be administered the three mentioned research instruments prior to use of orthotic devices. The group of patients will use the devices, as prescribed by the physician, for a period of three months. The patients will then re-take the three research instruments to assess aspects of their pain and disability after use of the orthotic device. A time of three months was chosen as a result of the study conducted by Landorf, Keenan, & Herbert (2006), which indicated that the greatest relief occurred in the first three months of treatment.

Results

The results of the study will be derived through the analysis of the three research instruments and the comparison of pre-treatment and post-treatment answers. The data will consist of two sets of data from the same subject. These results will be compared and analyzed using regression analysis, descriptive statistical techniques, and correlative measures. Results from the three research instruments will be compared.

Discussion

The literature review suggested that positive results were obtained in the few studies that could be found regarding the efficacy of orthotic devices (Landorf & Keenan, 2000). However, assessment of the effectiveness of the devices is difficult to measure using clinical methods. The amount of relief associated with various clinical devices is subjective, and therefore depends on the development of a reliable assessment tool. The effectiveness of orthotic devices depends on the ability to reduce pain and disability associated with the condition. It is expected that the pre-treatment and post-treatment tests will reveal a reduction in discomfort in patients.

Conclusion

Orthotic devices are one of the most common interventions for a number of conditions of the foot. However, despite their popularity, there is a considerable lack of clinical evidence to support the efficacy of the treatment option. This study will make two important contributions to the field. The first is the use of reliable scales to measure as many aspects of the patient's experience with the condition as possible. The second is the development of a research method that takes into account many aspects of the perceptions of patients regarding their condition and their treatment program. This study will play an important role in future medical decisions regarding the use of orthotic devices to treat foot conditions.