149 Landorf Reprint

Foot orthoses (FOs) have been used for many years with the intention of alleviating symptoms, preventing deformity and enhancing performance. However, most reasoning for their use is anecdotal, with a lack of scientific evidence to support the claims many practitioners make. This lack of evidence will be one of the fundamental issues to confront foot science and the podiatric profession in the coming years. In future, government and other funding agencies will rapidly move towards policies that support modalities backed up by evidence—in reality, this process has already begun. Without this evidence, rebates and support for FOs, particularly more expensive forms of FOs, will be challenged and may be withdrawn, as occurred a few years ago in Western Australia (Personal communication: C Kippen, 5th March, 1998). To date, there has been a significant volume of literature published relating to FOs. Much of this literature supports their use, however there is a considerable amount that is either inconclusive or refutes their effect. Whilst this is confusing, the results can be directly attributed to the different methodologies used by the authors and the varying quality of the research. To counter this situation two steps need to be taken. Firstly, it is essential that there is further well-controlled research which evaluates orthoses under specific conditions—this is stating the obvious. Secondly, systematic and critical reviews of the literature relating to FOs are also required to assist practitioners and decision-makers in understanding and assimilating the available findings. It is the intention of this article to review the available literature and summarise the findings. As there are few well-controlled studies available on the efficacy of FOs, this review contains those articles that have met the following criteria: (i) they have researched FOs that have attempted to alter the biomechanical function of the foot, (ii) they have attempted to use an established research protocol, appropriate with the time of the study, (iii) they have been published in a peer-reviewed journal, or for earlier studies been subjected to some type of editorial process, and (iv) they have been published in the English language. However, before beginning this review, it is important to discuss the difficulties associated with researching the effects of FOs. Efficacy of Foot Orthoses What Does the Literature Tell Us?