title: Clinical acceptance, reasons for rejection, and reduction of in-shoe peak pressure with interdigital silicone orthoses.
abstract: BACKGROUND
  For several years, confectioned or customized interdigital silicone orthoses have been used to treat toe malformations; however, long-term clinical and biomechanical studies are missing. The aim of this study was to evaluate the biomechanical effects of these orthoses and their clinical acceptance.
  
  
  METHODS
  In 2008, 46 patients (30 women and 16 men; average age, 56.8 years) received interdigital silicone orthoses. All of the patients were included in the biomechanical and clinical study. Compliance and acceptance were measured by the Muenster shoe and foot questionnaire, which includes 13 items on pain, activities of daily living, satisfaction, and activity. Mean follow-up was 18 months. Ten feet (eight patients) were chosen by random and underwent pedobarography. One forefoot sensor and two single sensors were attached between the skin and the orthosis. Measurements were performed in-shoe three times with and without the orthosis without removal of the sensors.
  
  
  RESULTS
  Forty-four of the 46 patients (95.7%) were included. At the 18-month investigation, 19 patients no longer used their orthoses, most commonly because of pain and failure of the material. Twenty-two patients regularly used their orthoses (8 h/d on average). In-shoe peak pressure lowered significantly with orthosis use (P < .04). Patients who used the orthoses were mostly satisfied.
  
  
  CONCLUSIONS
  Interdigital silicone orthoses reduce in-shoe peak pressure. Patient satisfaction was good. The durability of the material has to be optimized, and manufacturing remains difficult. The effect on ulcer reduction must be evaluated in a large prospective study.
authors: Clinic for Technical Orthopedic Surgery, University Hospital of Muenster, Muenster, Germany.
authors: Ulrich
authors: U
authors: Illgner
authors: Tymo
authors: T
authors: Budny
authors: Marc
authors: M
authors: Hoyer
authors: Hans Henning
authors: HH
authors: Wetz
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D037801:Hammer Toe Syndrome / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D010349:Patient Compliance; D017060:Patient Satisfaction; D012775:Shoes; D012828:Silicones; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology*
chemical_list: D012828:Silicones