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Balance Improvement: Abstract

Effects of Orthotic Intervention and Nine Holes of Simulated Golf on Club-Head Velocity in Experienced Golfers
David E. Stude, DC, and Jeff Gullickson, DC

Objective:
To measure improvements in balance and proprioception, before and after the nine holes of simulated golf, in experienced golfers, after wearing Foot Levelers custom-made orthotics continuously for six weeks.


Methods:
Subjects were tested using the Cybex Functional Assessment System for Testing and Exercise. The tests challenged human performance skills beyond those required for golf, to provide the relative effects of orthotic intervention for all individuals. Foot Levelers’ orthotics were used for the investigation because of their abilities to control motion and absorb shock.


Results:
Balance and proprioception before and after nine holes improved with orthotic use. More specifically, proprioceptive inequalities between left and right sides were not apparent after wearing the orthotics on a daily basis during the six-week period.


Discussion:
Joint motion affects proprioception and it is well documented that disturbances in the proprioceptive feedback mechanism cause biomechanical disabilities. Lower-limb proprioception training in non-injured individuals can prevent many injuries.


Conclusion:
Orthotics are made to address structural deficiencies, such as excessive pronation and arch integrity, and minimize differences in structural alignment. In a small population of experienced golfers, Foot Levelers’ custom-made, flexible orthotics improved symmetrical balance ability and enhanced proprioception.

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Prolonged Standing: Abstract

Chiropractic Adjustments Plus Orthotics Reduced Symptoms for Workers Standing Six Hours Daily
John Zhang, Ph.D., M.D. and Joe Zhou, D.C. Logan College of Chiropractic


Objective:

To determine the effect of chiropractic care and orthotics on reducing discomfort in individuals who spend long hours standing during working hours.


Methods:

The subjects filled out a patient information sheet and prescreening foot pain questionnaire. The chiropractic treatment was performed using the Activator technique. In-home exercise was prescribed to the subject receiving orthotics and chiropractic care.

Foot and Ankle Outcome Score (FAOS) was used for the specific region survey. FAOS was developed to assess the patients’ opinion about a variety of foot- and ankle-related problems. FAOS consists of five subscales: pain, other symptoms, activities in daily living (ADL), function in sport and recreation, and foot- and ankle-related quality of life (QOL). The study used a computerized scan offered by Foot Levelers Inc. to record and analyze the foot data. Based on the data collected, the need for orthotics (Spinal Pelvic Stabilizers) was determined and the data were sent to Foot Levelers Inc. for creating the orthotics.


Results:

Two cases, one from experimental and one from control groups, are reported. The experimental case was a 56-year-old female who presented with complaints of both feet pain, right dorsal foot numbness, and right hip pain after long standing at work. After chiropractic and orthotics, the preorthotic and postorthotic foot pain questionnaire from the beginning of the study to the end of the 2nd week showed improvement of the pain score from 50 to 83, the symptom score from 75 to 82, the ADL score from 52 to 94, the score of function in sports and recreational activities from 50 to 95, and the QOL score from 44 to 56. The control case was a 42-year-old male research assistant who presented with a chief complaint of bilateral heel pain after prolonged standing or walking. The subject also complained of lower back pain and knee pain once or twice a month. Without chiropractic care and orthotics, the preorthotic and postorthotic foot pain questionnaire from the beginning of the study to the 3rd week revealed no significant changes in all items.


Discussion:

These case studies were directed to the evaluation of the effectiveness of chiropractic care and orthotics on reducing the effects of prolonged standing. The first case showed significant improvement compared to the second (control) case in function in sports and recreational activities, ADL, and reduction of the pain.


Conclusion:
It seems that chiropractic care combined with Stabilizer orthotics made a difference in function in sports and recreational activities, in ADL improvement, and improvement in the pain subscale. The changes in symptoms and quality of life may be improved further with time.

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Pedal Alignment: Abstract

Radiographic Evaluation of Weightbearing Orthotics and Their Effect on Flexible Pes Planus

D. Robert Kuhn, DC, Nofa J. Shibley, DC, William Austin, DC and Terry R. Yochum, DC

Objective:
To determine whether any positive change in the alignment of the bones of the feet occur with the use of Foot Levelers custom-made flexible orthotics, cast by weight bearing, in individuals having flexible pes planus.


Methods:

Anteroposterior and lateral radiographs were obtained with and without orthotics in place. The anteroposterior and lateral talocalcaneal angles and the lateral pitch of both the left and right foot were assessed.


Results:

The radiographic measurements indicated statistically significant improvements in weightbearing foot alignment with the use of Foot Levelers orthotics.


Discussion:

Biomechanical faults in the pedal foundation can adversely affect any of the joints and structures of the foot/ankle complex, lower extremities, pelvis and spine.


Conclusion:

This study supports the use of Foot Levelers custom-made flexible orthotics for the improvement of pedal structural alignment.

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Foot Scanner Reliability: Abstract

The Reliability of the Associate Platinum Digital Foot Scanner in Measuring Previously Developed Footprint Characteristics: A Technical Note
M. Owen Papuga, MS, and Jeanmarie R. Burke, Ph.D.

Objective:
An ink pad and paper, pressure-sensitive platforms, and photography have previously been used to collect footprint data used in clinical assessment. Digital scanners have been widely used more recently to collect such data. The purpose of this study was to evaluate the intra- and interrater reliability of a flatbed digital image scanning technology to capture footprint data.


Methods:

This study used a repeated-measures design on 32 (16 male 16 female) healthy subjects. The following measured indices of footprint were recorded from 2-dimensional images of the plantar surface of the foot recorded with an Associate Platinum (Foot Levelers Inc, Roanoke, VA) digital foot scanner: Staheli index, Chippaux-Smirak index, arch angle, and arch index. Intraclass correlation coefficient (ICC) values were calculated to evaluate intrarater, interday, and interclinician reliability.


Results:

The ICC values for intrarater reliability were greater than or equal to .817, indicating an excellent level of reproducibility in assessing the collected images. Analyses of variance revealed that there were no significant differences between raters for each index (P N .05). The ICC values also indicated excellent reliability (.881-.971) between days and clinicians in all but one of the indices of footprint, arch angle (.689), with good reliability between clinicians. The full-factorial analysis of variance model did not reveal any interaction effects (P N .05), which indicated that indices of footprint were not changing across days and clinicians.


Conclusions:
Scanning technology used in this study demonstrated good intra- and interrater reliability measurements of footprint indices, as demonstrated by high ICC values. (J Manipulative Physiol Ther 2011;34:114-118)

Key Indexing Terms:
Flatfoot; Foot Diseases; Foot Deformities
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Comfort to Workers: Abstract

The Effectiveness of Custom-made Orthotics in a Standing Work Environment
Jeffrey D. Olsent, DC, Samuel A. Rowan, DC, William M. Austin, DC, CCSP, CCRD, Dennis L. Nosco, PhD.
Paper presented at World Federation of Chiropractic 2005 convention.


Objective:
To address orthotics use with workers who worked continuously on concrete surfaces, and determine if the workers feel that orthotics offer positive benefits under such conditions.


Methods:
Workers in shipping, receiving, or assembly departments were recruited to test flexible Spinal Pelvic Stabilizers and to complete pre- and about three-week post-initiation of Stabilizers questionnaires.


Results:

Complete data sets were obtained for 66 workers. After wearing the Stabilizers for greater than 10 days, all sub-groups showed improvement in all categories after Stabilizer use. Significant inter-group differences included: more after-work comfort for females, less before-work pain in workers over 30 years old, most improvement noted in first 15 days of wear, and more positive responses from workers with recent foot pain history.


Discussion:

Using five Visual Analog Scale categories, the short-term study data presented in this paper show a positive worker response on their pain levels after using custom-made, flexible Stabilizers on concrete floors. 


Conclusion:
This worker self-report study shows that Foot Levelers’ custom-made, flexible Spinal Pelvic Stabilizers provided increased comfort to workers whose main job responsibilities are accomplished while standing on hard concrete floors.

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Low Back Pain: Abstract

Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Pilot Study
Jerrilyn A. Cambron, DC, PhD, Manuel Duarte, DC, Jennifer Dexheimer, BS, LMT, and Thomas Solecki, DC

Objectives:
The purpose of this pilot study was to investigate the feasibility of a randomized clinical trial of shoe orthotics for chronic low back pain.

Methods:
The study recruited 50 patients with chronic low back pain through media advertising in a midwestern suburban area. Medical history and a low back examination were completed at a chiropractic clinic. Subjects were randomized to either a treatment group receiving custom-made shoe orthotics or a wait-list control group. After 6 weeks, the wait-list control group also received custom-made orthotics. This study measured change in perceived pain levels (Visual Analog Scale) and functional health status (Oswestry Disability Index) in patients with chronic low back pain at the end of 6 weeks of orthotic treatment compared with no treatment and at the end of 12 weeks of orthotic treatment.

Results:

This study showed changes in back pain and disability with the use of shoe orthotics for 6 weeks compared with a wait-list control group. It appears that improvement was maintained through the 12-week visit, but the subjects did not continue to improve during this time.

Conclusions:

This pilot study showed that the measurement of shoe orthotics to reduce low back pain and discomfort after 6 weeks of use is feasible. A larger clinical trial is needed to verify these results. (J Manipulative Physiol Ther 2011;34:254-260)

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Vertical Leap: Abstract

The Effect of Custom Orthotics on the Vertical Leap of Athletes in a Sport Demanding Jumping
William M. Austin, D.C., C.C.S.P., C.C.R.D., Dennis Nosco, Ph.D., Nosco Consulting, and Jeffrey D. Olsen, D.C.


Objective:

To determine whether the use of custom-made orthotics can positively affect the vertical leap of a jump sport team in a controlled, blinded study.


Methods:
Eleven female high-school-age volleyball players from a club team were recruited into this study; they were all fitted for Foot Levelers’ custom-made Spinal Pelvic Stabilizers. Standing and three-step approach vertical reach were measured on separate days with and without Stabilizers to minimize complicating fatigue factors. Leaps were measured to the nearest half inch.


Results:

This pilot study showed “trends that would indicate that there is some benefit to orthotics in improving vertical leap, even in the limited exposure to orthotics (i.e., right before the test).”


Discussion:

The pilot study was performed with the intention of determining if a larger, more well-controlled study should be undertaken.


Conclusion:
The authors concluded that “there is a mean positive effect in both standing and three step approach when wearing orthotics during this test,” and that “further studies are warranted and needed to determine the magnitude, if any, of positive changes on vertical leap from orthotics.”

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Decreased Q-Angle: Abstract

Immediate Changes in the Quadriceps Femoris Angle After Insertion of an Orthotic Device
D. Robert Kuhn, DC, Terry R. Yochum, DC, Anton R. Cherry, and Sean S. Rodgers


Objective:

To evaluate the effects of full-length, custom-made flexible orthotics (Spinal Pelvic Stabilizers) on quadriceps angle (Q-angle) in volunteers with bilateral foot hyperpronation.


Methods:
Forty chiropractic student volunteers were selected. Inclusion criteria were asymptomatic, male, evidence of bilateral hyperpronation, and no history of ankle surgery. Custom-made, flexible orthotics were produced. Subjects’ Q-angles were measured before and after orthotic insertion.


Results:
Orthotic insertion demonstrated reduced Q-angle, in the direction of correction, in 39/40 test subjects.


Discussion:
Research suggests that the hyperpronated foot is an etiologic factor in many lower extremity complaints, including foot, knee, hip and low back pain. Literature indicates that custom-made, flexible orthotics can stabilize the pes planus foot and restore optimal degree of pronation. Reduced pronation decreases the amount of tibial and femoral internal rotation, with subsequent Q-angle reduction.


Conclusion:
Full-length, flexible orthotics significantly improve the Q-angle in hyperpronating male patients and offer the possibility of long-term benefits.

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