title: Effect of therapeutic insoles on the medial longitudinal arch in patients with flatfoot deformity: a three-dimensional loading computed tomography study.
abstract: BACKGROUND
  Insoles are frequently used in orthotic therapy as the standard conservative treatment for symptomatic flatfoot deformity to rebuild the arch and stabilize the foot. However, the effectiveness of therapeutic insoles remains unclear. In this study, we assessed the effectiveness of therapeutic insoles for flatfoot deformity using subject-based three-dimensional (3D) computed tomography (CT) models by evaluating the load responses of the bones in the medial longitudinal arch in vivo in 3D.
  
  
  METHODS
  We studied eight individuals (16 feet) with mild flatfoot deformity. CT scans were performed on both feet under non-loaded and full-body-loaded conditions, first with accessory insoles and then with therapeutic insoles under the same conditions. Three-dimensional CT models were constructed for the tibia and the tarsal and metatarsal bones of the medial longitudinal arch (i.e., first metatarsal bone, cuneiforms, navicular, talus, and calcaneus). The rotational angles between the tarsal bones were calculated under loading with accessory insoles or therapeutic insoles and compared.
  
  
  RESULTS
  Compared with the accessory insoles, the therapeutic insoles significantly suppressed the eversion of the talocalcaneal joint.
  
  
  CONCLUSIONS
  This is the first study to precisely verify the usefulness of therapeutic insoles (arch support and inner wedges) in vivo.
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Kido
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: kazuya@koto.kpu-m.ac.jp.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ikoma
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hara
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Imai
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Maki
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Daisaku
authors.initials: D
authors.lastname: Tokunaga
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Inoue
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kubo
mesh_terms: D000328:Adult; D005260:Female; D005413:Flatfoot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D061826:Foot Orthoses; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging; D017060:Patient Satisfaction; D013312:Stress, Physiological / Q000502:physiology; D013639:Tarsal Bones / Q000000981:diagnostic imaging; D013977:Tibia / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT; Flatfoot; Insoles; Loading; Medial longitudinal arch; Three-dimensional image