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3
that this seems to be the best choice for the construction of insoles. They
also highlighted that insoles should be considered alongside footwear in
the outcomes of this intervention.
Albert and Rinoie (1994)
found that in patients with a pronated foot
type, a custom-made foot orthosis can increase total contact area (redis-
tribute force) and is able to reduce plantar pressures by up to 40 per cent
under the first metatarsal head. Thus, an orthotic should reduce the risk
of ulceration in the diabetic neuropathic foot, provided that the patient
wears them (and the footwear that contains them) to a level that protects
the foot, particularly during periods of high-impact activity or high levels
of sustained activity. Further to this study, the effects of laterally and
medially wedged foot orthoses may have additional effects on the passive
and active soft tissues of the lower limb, and it is these changes that
result in the documented clinical success.
There have been a number of studies that support reduction in foot
pressures, describing a variety of orthosis designs and materials used in
their construction. It has become accepted practice to provide total
contact foot orthoses in a healing sandal as an alternative to a full walking
cast in the management of foot ulceration (
Figure 3.9
).
A recent study (Fauli et al 2008) investigating the properties of poly-
urethane, ethyl vinyl acetate (EVA) and polyethylene identified that EVA
and polyethylene foams within the low hardness range are the most
Figure 3.9
Total contact foot orthosis in a healing sandal
