Consensus‐based recommendations of Australian podiatrists for the prescription of foot orthoses for symptomatic flexible pes planus in adults

Abstract

BackgroundFoot orthoses are commonly used for symptomatic flexible pes planus in adults. However, there are no clinical guidelines for the prescription of customised foot orthoses that are specific to this population. The aim of this study was to investigate prescription habits of Australian podiatrists for customised foot orthoses for symptomatic flexible pes planus in adults and to develop consensus-based practice recommendations for the prescription of these foot orthoses.MethodsA four round Delphi survey was undertaken with 24 podiatric experts to establish current use and rationale for individual prescription variables of customised foot orthoses for symptomatic flexible pes planus in adults. Round one determined prescription use (consensus) and rounds two, three and four determined the rationale for use (agreement) of prescription variables across the rearfoot, midfoot, forefoot, as well as accommodation and materials used. For consensus and agreement to be accepted, 70% of the respondents were required to use or agree on the rationale for use of individual prescription variables.ResultsConsensus was reached in round one for two variables, choice of shell material (polyolefin) and when to prescribe a forefoot post balanced to perpendicular. In rounds two, three and four, agreement was reached for 52 statements related to the rationale for use of individual prescription variables, including when to prescribe: an inverted cast pour [heel in an inverted position], an inverted rearfoot post, a medial heel (Kirby) skive, minimal/maximum arch fill, a medial flange, a forefoot post and common orthotic accommodations.ConclusionThis study found consensus or agreement for the use of several prescription variables for customised foot orthoses for symptomatic flexible pes planus in adults. The findings were used to develop the Foot orthosis Prescription Recommendations for symptOmatic flexible Pes planus in adults (FootPROP) proforma, to guide clinicians and researchers in the prescription of customised foot orthoses for this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-014-0049-2) contains supplementary material, which is available to authorized users.

Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis

“…Regarding the ‘custom-made’ foot orthoses included in this review, all devices were derived from a three-dimensional representation of each individual's foot yet the majority of prescription variables were standardised (eg, same materials, thickness of material, etc) 34 35 37. This is in contrast to current clinical practice as custom-made foot orthoses are generally prescribed by taking into account an individual's biomechanical and physical characteristics 46. Only one trial attempted to individualise the custom-made orthoses by using a thicker material for heavier individuals; although the individualisation was minimal as no other prescription variables were considered 37.…”

Peer Review #2 of "When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists (v0.1)"

“…Round one was developed based on common assessment questions including child's subjective history, as described in the GALLOP assessment tool developed (Cranage et al 2016) and common prescription variables for foot orthoses as established from previous work in an adult population (Banwell et al 2014). Prior to conducting the survey, the preliminary survey and Round one was piloted by two Australian podiatrists independent t study, for feedback on structure, clarity, ordering and framing of the questions.…”

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“…There is information regarding the preferences related to prescribing habits in specific geographical areas [32], studies regarding recommendations based on specialists consensus for the prescription variables for certain pathologies [33][34][35] or comparisons between medical devices made by different categories of specialists in relation to the treatment objective achievement [36]. In the context of the continuously developing medical devices field the question arises whether the eligible prescriber's competencies are up to date with this evolution.…”

“…This plant is of economic importance since it has been used as a flavoring agent in food products, perfumes, cosmetics and drugs. This culinary and medicinal plant is widely distributed and mainly cultivated for the seeds which contain an essential oil (ranges between 0.3% and 1.1%) [33]. The essential oil and various extracts from coriander have been shown to possess antibacterial, antidiabetic, anticancerous, antimutagenic, antioxidant and free radical scavenging activities [34,35].…”