Cath Lab Digest

   Custom contouring of the shape of the device to increase contact with the field of sensory receptors on the plantar surface of the foot would be recommended while also utilizing more rigid materials in the footplate construction of the orthotic. Adding medial and lateral flanges may increase the surface area of contact while also providing enhanced pressure on the perimeter of the foot to provide sensory feedback.

   Finally, obtaining patient feedback about the effects of footwear, orthotics or insoles may provide as much valuable information as any laboratory measurement. Most patients can immediately perceive the treatment effects of foot orthotics on balance and stability. Adding more posting or contouring to an orthotic device in the clinic, and then testing the device on the patient in double and single leg stance as well as dynamic gait should allow the opportunity for the patient to tell the practitioner that the device is improving stability.

In Conclusion

The evidence to support the notion that foot orthoses and footwear can have a beneficial impact on the neurophysiological system is promising. However, there is much more work to be undertaken in this area and the profession must still determine the optimal design to promote neurofacilitation and subsequently enhance postural stability.

   Clinicians should consider undertaking not only a musculoskeletal assessment but balance testing as well. Balance assessment and evaluation can occur with limited equipment and clinicians should work closely with other healthcare professionals, especially in the high-risk groups such as patients with diabetes and those older adults with a history of falls.

   Dr. Rome is a Professor in Podiatry at the Centre for Health and Rehabilitation Institute and School of Podiatry at AUT University in Auckland, New Zealand.

   Dr. Richie is an Associate Clinical Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a Fellow of the American College of Foot and Ankle Surgeons, and the American Academy of Podiatric Sports Medicine.

   Ms. Hatton is a Research Fellow at the Centre for Health, Sport and Rehabilitation Sciences Research at the University of Salford in Manchester, United Kingdom.

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