• 1

    Lynch DM, Goforth WP, Martin JE, et al: Conservative treatment of plantar fasciitis: a prospective study. .JAPMA 88::375. ,1998. .

  • 2

    Sobel E, Levitz SJ, Caselli MA: Orthoses in the treatment of rearfoot problems. .JAPMA 89::220. ,1999. .

  • 3

    Stacoff A, Reinschmidt C, Nigg BM, et al: Effects of foot orthoses on skeletal motion during running. .Clin Biomech 15::54. ,2000. .

  • 4

    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. ,2003. .

  • 5

    Nigg BM, Khan A, Fisher V, et al: Effect of shoe insert construction on foot and leg movement. .Med Sci Sports Exerc 30::550. ,1998. .

  • 6

    Nigg BM, Nurse MA, Stefanyshyn DJ: Shoe inserts and orthotics for sport and physical activities. .Med Sci Sports Exerc 31::421. ,1999. .

  • 7

    Neptune RR, Wright IC, van den Bogert AJ: The influence of orthotic devices and vastus medialis strength and timing on patellofemoral loads during running. .Clin Biomech 15::611. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Curran SA, Dananberg HJ: Future of gait analysis: a podiatric medical perspective. .JAPMA 95::130. ,2005. .

  • 9

    Kerrigan DC, Thirunarayan MA, Sheffler LR, et al: A tool to assess biomechanical gait efficiency. .Am J Phys Med Rehabil 75::3. ,1996. .

  • 10

    Maltais DM, Pierrynowski MR, Galea V, et al: Habitual physical activity levels are associated with biomechanical walking economy in children with cerebral palsy. .Am J Phys Med Rehabil 84::36. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Kerrigan DC, Viramontes BE, Corcoran PJ, et al: Measured versus predicted vertical displacement of the sacrum during gait as a tool to measure biomechanical gait performance. .Am J Phys Med Rehabil 74::3. ,1995. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Maltais DM: High Energy Cost of Walking in Cerebral Palsy [PhD thesis], McMaster University. ,2004. .

    • PubMed
    • Export Citation
  • 13

    Pierrynowski MR: Measurement properties of simple biomechanical measures of walking effort. .Comput Math Methods Med.. In press.

  • 14

    Finestone A, Novack V, Farfel A, et al: A prospective study of the effect of foot orthoses composition and fabrication on comfort and incidence of overuse injuries. .Foot Ankle Int 25::462. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Trotter LC, Pierrynowski MR: The short-term effectiveness of full-contact custom-made foot orthoses and prefabricated shoe inserts on lower-extremity musculoskeletal pain. .JAPMA 98::357. ,2008. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Trotter LC, Pierrynowski MR: Ability of foot care professionals to cast feet using the nonweightbearing plaster and the gait-referenced foam casting techniques. .JAPMA 98::14. ,2008. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Glaser ES: The Bottom Block. Course Manual, Lyles, TN, Sole Supports Inc. ,1999. .

    • PubMed
    • Export Citation
  • 18

    Hopkins WG: A new view of statistics. Available at: http://www.sportsci.org/resource/stats/index.html. Accessed May. 2007. .

    • PubMed
    • Export Citation
  • 19

    Rome K, Gray J, Stewart F, et al: Evaluating the clinical effectiveness and cost-effectiveness of foot orthoses in the treatment of plantar heel pain: a feasibility study. .JAPMA 94::229. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Kitaoka HB, Luo ZP, Kura H: Effect of foot orthoses on 3-dimensional kinematics of flatfoot: a cadaveric study. .Arch Phys Med Rehabil 83::876. ,2002. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Eng JJ, Pierrynowski MR: The effect of soft orthotics on three-dimensional lower-limb kinematics during walking and running. .Phys Ther 74::836. ,1994. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Nurse MA, Nigg BM: The effect of changes in foot sensation on plantar pressure and muscle activity. .Clin Biomech 16::719. ,2001. .

  • 23

    Nigg BM: The role of impact forces and foot pronation: a new paradigm. .Clin J Sport Med 11::2. ,2001. .

  • 24

    Landorf KB, Keenan AM, Herbert RD: Effectiveness of different types of foot orthoses for the treatment of plantar fasciitis. .JAPMA 94::542. ,2004. .

Changes in Gait Economy Between Full-Contact Custom-made Foot Orthoses and Prefabricated Inserts in Patients with Musculoskeletal Pain

A Randomized Clinical Trial

Leslie C. Trotter Foot-Knee-Back Clinic, Ancaster, Ontario, Canada.

Search for other papers by Leslie C. Trotter in
Current site
Google Scholar
PubMed
Close
 DC, MBA, MSc, CPed(C)
and
Michael Raymond Pierrynowski School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.

Search for other papers by Michael Raymond Pierrynowski in
Current site
Google Scholar
PubMed
Close
 PhD

Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot orthoses and prefabricated shoe inserts.

Methods: In this crossover randomized controlled trial, 40 participants wore custom-made orthoses and prefabricated inserts for 4 weeks each, consecutively. The path length ratio was used to quantify walking economy by comparing the undulating path of a point in the pelvis with its direct path averaged across multiple strides.

Results: For the prefab-custom group (n = 27), significant decreases in path length ratio (improved economy of gait) were noted at the initial introduction of prefabricated inserts (P = .02) and custom orthoses (P = .02) but maintained a trend toward improved economy only while wearing custom orthoses (P = .08). For the custom-prefab group (n = 13), there was worsening of the path length ratio that was significant after removing the custom-made orthoses for 4 weeks (P = .01).

Conclusion: For patients with lower-extremity musculoskeletal pain, immediate improvements in economy of gait can be expected with both interventions. It seems, however, that only the custom-made orthoses maintain economy of gait for 4 weeks. Patients who begin wearing custom-made orthoses and then wear prefabricated insoles can expect a decrease in economy of gait. (J Am Podiatr Med Assoc 98(6): 429–435, 2008)

Corresponding author: Leslie C. Trotter, DC, MBA, MSc, CPed (C), Foot-Knee-Back Clinic, 3 Wilson St E, Ancaster, Ontario L9G 2B3 Canada. (E-mail: leslietrotter@cogeco.ca)
Save