STUDY DESIGN: Experimental laboratory study supplemented by a case series. OBJECTIVES: (1) To assess the effect of a 4-week intervention with a full-length insert on functional outcomes in patients with midfoot arthritis; (2) to examine the effect of the custom molded three-quarter-length (3Q) and full-length (FL) carbon graphite insert on plantar loading in patients with midfoot arthritis. BACKGROUND: Given the coexistence of pain and lower-arched foot alignment in patients with midfoot arthritis, arch-restoring orthotic devices such as the 3Q insert are frequently recommended. However, patients continue to report foot pain despite using the 3Q insert. The FL insert has been proposed as an alternative, but objective data examining its efficacy are lacking. METHODS: Twenty female patients with midfoot arthritis participated in the study. Functional outcomes were assessed using the Foot Function Index-Revised (FFI-R). Plantar loading during walking was measured in the following conditions: shoe only, shoe with 3Q insert, and shoe with FL insert. Repeated-measures analyses of variance with post hoc analyses were used for statistical analysis. RESULTS: FL insert use for 4 weeks resulted in a 12% improvement in total FFI-R score (mean ± SD before, 35.6 ± 10.9; after, 31.1 ± 9.8 [P = .03]). FL insert use resulted in a 20% reduction in medial midfoot average pressure loading (mean ± SD, 64.8 ± 20.4 and 51.0 ± 15.4 kPa, with 3Q and FL insert respectively [P = .015]) and an 8.5% reduction in medial midfoot contact time (mean ± SD, 84.9% ± 6.4% and 76.4% ± 7.1% of stance, with 3Q and FL insert respectively [P<.01]), compared to the 3Q insert. No differences in plantar loading were discerned between the shoe-only and FL conditions. CONCLUSION: Symptomatic improvement in patients with midfoot arthritis treated with a FL insert was accompanied by reduced magnitude and duration of loading under the medial midfoot. These preliminary outcomes suggest that the FL insert may be a viable alternative in the conservative management of patients with midfoot arthritis. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2009;39(7):522-531. doi:10.2519/jospt.2009.2900

KEY WORDS: Lisfranc, orthoses, tarsometatarsal

STUDY DESIGN: Case report. BACKGROUND: Misdiagnosed or undertreated sesamoid bone pathology in dancers may result in prolonged pain, disability, and career limitation. A thorough understanding of sesamoid disorders and appropriate treatment facilitates timely recovery. The potential loss of hallux plantar flexion strength consequent to sesamoidectomy is a major consideration for dancers. CASE DESCRIPTION: An 18-year-old dance student sustained a delayed-union fracture of her lateral (fibular) sesamoid. Treatment included an inductive coupling external bone stimulator with pulsed electromagnetic field, activity and weight-bearing restrictions, protective padding, strengthening, functional retraining, and progressive return to dance. OUTCOME: Following use of an external bone stimulator for 12 months, the dancer successfully returned to her previous level of dancing. Repeated SF-36 and Dance Functional Outcome System scores confirmed this improvement. DISCUSSION: Loss of hallux plantar flexion strength with sesamoid resection can be devastating to a dancer who requires push-off strength for multiple turns and jumps. Treatment with bone stimulation was therefore selected over more invasive measures. The dancer was compliant with systematic functional progression. Improvement, as seen on radiographs and outcome scores, accompanied her full functional recovery.

J Orthop Sports Phys Ther. 2007;37(9):529-540, published online 20 June 2007. doi:10.2519/jospt.2007.2472

KEY WORDS: bone stimulator, dance injury, foot, hallux