Podiatry and the sports physician--an evaluation of orthoses

Fifty athletes with resistant symptoms, were jointly assessed by physician and podiatrist. Commonest symptoms were foot pains (38%), anterior knee pain (34%), ankle pains including chronic sprains (30%) and Achilles pain (16%). Simple clinical examinations were made for gait pattern, in which overpronation was specifically noted in 46%, posture, leg length and configuration, rearfoot and forefoot alignment. The commonest abnormalities were calcaneal inversion (varus) in 42%, forefoot malalignment (varus 24%, valgus 14%), tibial varus (12%) and leg length discrepancies (16%). Individually casted orthotic corrections were made using rigid (60%) or soft (32%) orthoses, both (6%) or a simple shoe-raise (2%). Results up to 3 1/2 years' follow-up show symptom relief in 56% and improvement in 8%. No change was reported in 14%, while 6% could not tolerate appliances and 16% were lost to follow-up. 54% were still using orthoses, 26% had abandoned them and 20% were lost to follow-up. Orthoses now cost up to pounds 90 stg. in UK. If only about two thirds of patients benefit from them and half continue their long term use, critical selection of cases is required in both clinical and economic grounds.