The effect of orthotic treatment on midfoot osteoarthritis assessed using specifically designed patient evaluation questionnaires.

Midfoot osteoarthritis (OA) is a degenerative condition of the foot that can be treated non-operatively by the use of orthotics. This prospective study was conducted to determine the effects of custom-made semi-rigid foot orthoses (FOs) and rigid carbon fibre (CF) footplates for the treatment of midfoot OA evaluated using specifically designed questionnaires. Fifty-seven subjects diagnosed with midfoot OA were recruited through a private clinic for inclusion in the study. Subjects were required to complete pre-treatment questionnaires prior to receiving orthotic treatment. All subjects received a pair of custom-made full-length semi-rigid FOs and 36 subjects also received CF footplates that were incorporated into the soles of the shoes worn on the symptomatic feet. Subjects completed post-treatment questionnaires at six weeks, three months and six months after receiving the orthotic treatment. The results demonstrated that there were no significant differences between the results of the subjects who received CF footplates and those who did not. The results of the questionnaires demonstrated that subjects experienced significant improvements in pain, activity levels, walking ability and footwear comfort at all intervals following the orthotic treatment (p < 0.01). Subjects' satisfaction with the appearance of their footwear did not decrease with the orthotic treatment despite needing shoes to fit the FOs and CF footplates. The questionnaires also demonstrated that subjects were generally satisfied with the orthotic treatment for the management of their midfoot OA.

The effect of tone-reducing orthotic devices on soleus muscle reflex excitability while standing in patients with spasticity following stroke.

Orthoses are commonly prescribed for the management of spasticity but their neurophysiologic effect on spasticity remains unsubstantiated. The purpose of this study was to investigate the effect of three tone-reducing devices (dynamic foot orthosis, muscle stretch, and orthokinetic compression garment) on soleus muscle reflex excitability while standing in patients with spasticity following stroke. A repeated measures intervention study was conducted on 13 patients with stroke selected from a sample of convenience. A custom-made dynamic foot orthosis, a range of motion walker to stretch the soleus muscle and class 1 and class 2 orthokinetic compression garments were assessed using the ratio of maximum Hoffmann reflex amplitude to maximum M-response amplitude (Hmax:Mmax) to determine their effect on soleus muscle reflex excitability. Only 10 subjects were able to complete the testing. There were no significant treatment effects for the interventions (F=1.208, df=3.232, p=0.328); however, when analyzed subject-by-subject, two subjects responded to the dynamic foot orthosis and one of those two subjects also responded to the class 1 orthokinetic compression garment. Overall, the results demonstrated that the tone-reducing devices had no significant effect on soleus reflex excitability suggesting that these tone-reducing orthotic devices have no significant neurophysiologic effect on spasticity.

An investigation of the neurophysiologic effect of tone-reducing AFOs on reflex excitability in subjects with spasticity following stroke while standing.

Tone-reducing ankle-foot orthoses (TRAFOs) are said to improve the control and functioning of spastic lower limbs by their biomechanic and neurophysiologic effects. Unfortunately, there is limited evidence in literature to support the theory that TRAFOs can effectively decrease spasticity in the foot and ankle neurophysiologically. The primary purpose of this investigation was to determine the neurophysiologic effect of TRAFOs on soleus muscle reflex excitability in subjects with spasticity following stroke while standing. A repeated-measures intervention study was conducted on 15 adult subjects with stroke who were recruited from the community. Custom-made articulated ankle-foot orthoses (AFOs) and TRAFOs with orthokinetic compression garments (OCGs) were fabricated for each subject. Five conditions were tested: (1) Shoes only, (2) AFO, (3) TRAFO, (4) TRAFO with OCG, (5) shoes only, to determine if the TRAFOs were most effective in decreasing spasticity as assessed by the ratio of maximum Hoffmann reflex amplitude to maximum muscle response amplitude (Hmax:Mmax ratio) of the soleus. The results found that there were no significant treatment effects for the interventions (F = 0.992, df = 2.167, p = 0.388), however, when analysed subject-by-subject, four subjects displayed significant increases in their Hmax:Mmax ratios to at least one treatment condition. Overall, the results demonstrated that the tone-reducing devices had no significant neurophysiologic effect on soleus reflex excitability in subjects with spasticity, however individual responses showed that the TRAFOs increased spasticity in some individuals.

The practical application of multimedia technology to facilitate the education and treatment of patients with plantar fasciitis: a pilot study.

This study was designed to evaluate the efficacy of a multimedia patient education module when incorporated into the standard treatment protocol for patients diagnosed with plantar fasciitis. A thorough, standardized surgeon-patient education discourse took place following diagnosis. At the conclusion of the consultation, patients viewed the multimedia module. Questionnaires designed to assess understanding and satisfaction with information delivery were completed by patients following the consultation and again after viewing the module. Forty-one patients participated in the study. After viewing the module, patients achieved an average of 87% correct responses on the knowledge questionnaire, a significant improvement (P < .0001) over the 64% achieved following the surgeon-patient discourse. Ease of understanding of the information delivered by the module was rated significantly better (P < .0001) than the surgeon-patient discourse. Ninety-eight percent of patients indicated they felt well informed about plantar fasciitis following viewing the module compared with 68% following the surgeon-patient discourse. Sixty-three percent of patients indicated that the module best answered their questions, 7% preferred the surgeon, and 30% rated both equally. Multimedia plantar fasciitis educational material improved patient understanding of the standard treatment protocol and satisfaction with the information delivery in an orthopedic private practice.