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Christian Louboutin Shoes UGG Seline Boots ChestnutThe following
articles report on research completed, in whole or in part, under a grant from
ACFAOM. Thanks to all those whose voluntary contributions to ACFAOM's Research
Fund make such grants possible. Comparing Negative Casting Techniques: Foam
versus Plaster of Paris Richard Berenter, DPM, FACFAOM Introduction: This study
was undertaken to determine whether there was any difference in the clinical
outcomes related to the type of negative casting technique utilized in the
manufacture of functional foot orthoses. Those practitioners who favor foam
casting blocks argue that the technique is cleaner, faster, more cost effective
and just as reliable a method to produce functional foot orthoses versus the
plaster of Paris technique. On the other hand, a number of practitioners have
argued that the foam block technique is inferior because the foam is incapable
of capturing the shape of the foot with the subtalar joint in neutral position
and the midtarsal joint maximally pronated thereby leading to an inferior foot
orthosis, which will be less effective at reducing patient symptoms. Materials
and Methods: A total of 38 patients were enrolled in the study. All of the
patients presented with lower extremity symptoms associated with abnormal lower
extremity function as determined by gait evaluation. At the time of the initial
visit, each patient signed a consent form and completed the top portion of the
data sheet which included both personal information and the amount of pain in
each extremity (patients were asked to circle the amount of pain on a scale from
0-10 with 0 being no pain and 10 being the worse pain ever felt). Upon
completion of all paper work, both feet of each patient were casted via the
semi-weight bearing foam block technique and by the non-weight bearing supine
plaster of Paris method. Both sets of casts were sent to a professional orthotic
laboratory with a prescription filled out for an orthotic shell with a medium
amount of arch fill, average heel cup depth, normal orthotic width (to the
lateral border of the 5th metatarsal and bisection of the 1st metatarsal shaft)
and a thickness of polypropylene which would behave in a semi-rigid behavior for
the patient's stated weight. A laboratory technician was instructed to randomly
select one of the two pairs of negative casts and keep track of which casts were
used without the knowledge of the principal investigator. In this way, a double
blind study was established since neither the principal investigator nor the
patient knew which casts were used to construct the foot orthotics.
Approximately 2-3 weeks following casting, the patient was dispensed a pair of
functional foot orthoses and asked to walk around for a minimum of 10 minutes to
gauge the comfort level of the orthotics. Each participant was asked to use one
of 4 descriptive terms (very comfortable, comfortable, slightly uncomfortable or
very uncomfortable) to describe the comfort level of 5 different regions on each
foot orthosis corresponding to the heel region, medial arch, lateral arch,
middle of the orthosis and distal edge. Patients were then sent home with
standardized break-in instructions for the functional foot orthoses and returned
to the clinic at intervals of 2 weeks and 4 weeks post-orthotic dispensal. At
each follow-up visit, patients were asked to fill out a data sheet gauging the
level of symptoms and comfort level of the orthoses. The data was then compiled
and saved in a spread sheet format and upon completion of the study, the
laboratory technician was contacted in order to identify which patients belonged
to which study group, the foam box or plaster of Paris casting technique.
Results: The data was compiled and the two study groups separated by casting
technique. An independent investigator (non-podiatrist) was contacted and asked
to analyze the data to answer the following questions: 1. Does the negative
casting technique (foam vs. plaster) make a difference in the ability of the
orthotic device to reduce symptoms? 2. Does the negative casting technique (foam
vs. plaster) make a difference in how comfortable the orthotic device feels to
the patient? The data was analyzed in a variety of methods such as the mean
reduction of pain, Fischer exact test and Chi-square with T-tests. A simple
comparison of the average reduction of pain after four weeks of orthotic therapy
indicates that the plaster of Paris orthoses achieved a mean decrease of 82.43%
of pain versus 61.14% reduction in pain with foam box cast orthoses, with a
level of significance p UGG
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