Foot orthoses are widely used by podiatric physicians to treat a variety of foot and foot-related conditions. Nevertheless, the term “foot orthoses” describes a myriad of devices used to affect the foot in some manner. Historically, foot orthoses have been developed and prescribed in response to increased knowledge or assumptions about foot function. In addition, a practitioner’s previous clinical experience, both positive and negative, affects his or her prescription of orthoses. This considerable variation of prescription among practitioners is further compounded by a lack of research on the effects of different types of foot orthoses on foot pathologies. Without adequate research to provide an evidence-based platform, podiatric physicians vary considerably in what they prescribe. Furthermore, it is difficult to develop guidelines for orthotic prescriptions when conclusive scientific evidence is not available. Therefore, it is important for these variations to be investigated and reported.
Since Merton Root1 introduced the functional foot orthosis in the 1950s and 1960s, many modifications and new techniques have been proposed to advance his original ideas. For example, several modifications to the preparation of the positive cast have occurred, including the Hice method,2 intrinsic rearfoot posting,3 the inverted foot orthosis developed by Blake,4-8 the medial heel skive developed by Kirby,9 and the DC wedge,10 which originated in Australia. Other techniques have used similar principles, but have employed radically different methods, such as polysectional triaxial posting.11, 12 Techniques have also been developed and modified in which the orthosis is modified in response to a new theory of foot function. The kinetic wedge, for example, was developed in response to the sagittal plane facilitation model.13, 14
In addition to variations in the basic design of foot orthoses, there are other areas where differences occur among practitioners. First, many different materials are used in the manufacturing process.15-21 Second, foot orthoses can be manufactured in many different ways; practitioners generally manufacture the orthoses themselves or use a commercial orthotic laboratory. Finally, to further complicate matters, in the past 10 years there has been a relative explosion in the use of prefabricated foot orthoses, which have gained an ever-increasing share of the market.22 Due to this multitude of orthotic techniques, materials, and manufacturing habits, this research project was conducted to investigate the types of foot orthoses and the prescription variables used by podiatric physicians in Australia and New Zealand. An additional goal of this project was to develop a profile of a typical orthotic prescription, if one indeed exists.
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