Comparing Lessons On Biomechanics And The Realities Of Clinical Experience

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The podiatry profession places too much emphasis on the subtalar and midtarsal joints, according to Christopher Nester, BSc, PhD. (Photo courtesy of Arnold Ross, DPM)
Guest Clinical Editor: Bruce Williams, DPM

Q: What research needs to be done in the next five to 10 years to prove podiatric biomechanics and orthotics are successful and cost effective in improving patient outcomes?
Dr. Williams advocates more multiple site studies, perhaps at podiatric medical schools, to document cost effectiveness and positive outcomes with orthotics. He suggests that the American Podiatric Medical Association (APMA) could fund research from a group of private practitioners to study certain aspects of foot function and outcomes with prescription foot orthotics.
Since the podiatric profession has discovered that changing rearfoot motion patterns with orthotics are not necessarily associated with positive clinical outcomes, Dr. Payne says DPMs should determine what an orthotic needs to change in order to achieve a positive outcome. He speculates that perhaps different foot types and pathologies need to require different changes to achieve a positive outcome.
Dr. Payne says the profession must also institute randomized controlled trials to investigate if changing the right parameter is truly associated with better outcomes and if changing the parameters is cost effective. He says since motion and posture of the foot do not necessarily need to change, the parameters showing the most promise for investigation are those associated with changes in forces. Such changes in forces make intuitive sense, according to Dr. Payne, who says the forces do the damage to the tissues.
Dr. Nester foresees growth in the funding and completion of quality clinical trials that will either prove or disprove the efficacy of orthotics. He expects that such studies may also reveal new ways in which orthoses are beneficial, new ways in which one should evaluate the orthotics and new reasons for prescribing orthotics. Dr. Nester says such studies will be wide ranging as far as assessing outcome.
“Healthcare providers need to know whether orthoses do for patients what patients want and how orthoses impact on their service agenda and possibly reducing demands on other services,” asserts Dr. Nester. “It is not enough to say the patient is satisfied.”

Dr. Nester is a Senior Research Fellow at the Centre for Rehabilitation and Human Performance Research at the University of Salford in the United Kingdom.

Dr. Payne is a Professor in the Department of Podiatry in the School of Human Biosciences at Latrobe University in Melbourne, Australia.

Dr. Williams is a Fellow of the American College of Foot and Ankle Surgeons, and is board certified by the American Board of Podiatric Surgery. He is a Fellow and the current Secretary/Treasurer of the American Academy of Podiatric Sports Medicine. Dr. Williams practices in Merrilville, Ind.

For related articles, see “Inside Insights On The Evolution Of Orthotic Therapy” in the February 2006 issue of Podiatry Today or check out the archives at

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