title: Effectiveness of custom-made orthopaedic shoes in the reduction of foot pain and pressure in patients with degenerative disorders of the foot.
abstract: BACKGROUND
  Degenerative disorders of the foot often are painful during standing and walking. It is assumed that, because of bone deformity, callus, and deformity of the plantar pads, the plantar pressure distribution changes. Prescription of orthopaedic shoes for patients with degenerative disorders of the foot is based on the hypothesis that excessive pressure under the foot causes pain. The goal of this study was to evaluate the effectiveness of custom-made orthopaedic shoes, in terms of pressure and pain, in patients with degenerative disorders of the foot. Additionally, the relationship between plantar pressure parameters and foot pain was studied, with special emphasis on second and third metatarsal heads.
  
  
  METHODS
  Seventy-seven consecutive patients with degenerative disorders of the foot were recruited from the outpatient clinics of seven rehabilitation centers and rehabilitation departments of university hospitals in the Netherlands. The study was prospective. The Questionnaire for Usability Evaluation for Orthopaedic Shoes was used to measure perceived foot pain. To measure plantar pressures, the Pedar in-shoe pressure measurement system (Novel GmbH, Munich) was used. The effectiveness of custom-made orthopaedic shoes, in terms of pressure and pain in patients with degenerative disorders of the foot, was analyzed by means of a paired sample t-test. To select the pressure parameter (Pmax, P(TI,) and P(av)) most closely associated with walking pain, within-subject correlation coefficients were calculated.
  
  
  RESULTS
  Custom-made orthopaedic shoes significantly decreased perceived foot pain by at least 23%, and significantly reduced plantar pressure under all foot regions by at least 9%. A significant correlation (r = 0.521) was found between walking pain and the average pressure beneath the second and third metatarsal heads.
  
  
  CONCLUSIONS
  Based on these results, it can be concluded that custom-made orthopaedic shoes are effective in reducing foot pain and foot pressure. The moderate (significant) relationship between average pressure and walking pain can be used as a tool for evaluating custom-made orthopaedic shoes prescribed for patients with degenerative disorders of the foot.
authors.affiliation: Roessingh Research and Development, Roessinghsbleekweg 33B, Enschede, 7522, The Netherlands. m.jannink@rrd.nl
authors.forename: Michiel
authors.initials: M
authors.lastname: Jannink
authors.forename: Henk
authors.initials: H
authors.lastname: van Dijk
authors.forename: Maarten
authors.initials: M
authors.lastname: Ijzerman
authors.forename: Karen
authors.initials: K
authors.lastname: Groothuis-Oudshoorn
authors.forename: Johan
authors.initials: J
authors.lastname: Groothoff
authors.forename: Gustaf
authors.initials: G
authors.lastname: Lankhurst
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005534:Foot Diseases / Q000150:complications / Q000534:rehabilitation*; D005684:Gait; D006801:Humans; D008875:Middle Aged; D009989:Orthotic Devices; D010045:Outpatients; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D011312:Pressure / Q000009:adverse effects; D011446:Prospective Studies; D012775:Shoes; D011795:Surveys and Questionnaires; D016138:Walking