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Effective Orthotic Therapy for the Painful Cavus Foot

A Randomized Controlled Trial

Joshua Burns, PhD ^* , Jack Crosbie, PhD , Robert Ouvrier, MD ^*  and Adrienne Hunt, PhD 

^* Institute for Neuromuscular Research, The Children’s Hospital at Westmead, Sydney, Australia.
Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia.
School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia.

Corresponding author: Joshua Burns, PhD, Institute for Neuromuscular Research, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead 2145, Sydney, New South Wales, Australia.

Abstract

Patients with a cavus or high-arched foot frequently experience foot pain, which can lead to significant limitation in function. Custom foot orthoses are widely prescribed to treat cavus foot pain. However, no clear guidelines for their construction exist, and there is limited evidence of their efficacy. In a randomized, single-blind, sham-controlled trial, the effect of custom foot orthoses on foot pain, function, quality of life, and plantar pressure loading in people with a cavus foot type was investigated. One hundred fifty-four participants with chronic musculoskeletal foot pain and bilateral cavus feet were randomly assigned to a treatment group receiving custom foot orthoses (n = 75) or to a control group receiving simple sham insoles (n = 79). At 3 months, 99% of the participants provided follow-up data using the Foot Health Status Questionnaire. Foot pain scores improved more with custom foot orthoses than with the control (difference, 8.3 points; 95% confidence interval [CI], 1.2 to 15.3 points; P = .022). Function scores also improved more with custom foot orthoses than with the control (difference, 9.5 points; 95% CI, 2.9 to 16.1 points; P = .005). Quality-of-life data favored custom foot orthoses, although differences reached statistical significance only for physical functioning (difference, 7.0 points; 95% CI, 1.9 to 12.1 points; P = .008). Plantar pressure improved considerably more with custom foot orthoses than with the control for all regions of the foot (difference, –3.0 N · s/cm²; 95% CI, –3.7 to –2.4 N · s/cm²; P < .001). In conclusion, custom foot orthoses are more effective than a control for the treatment of cavus foot pain and its associated limitation in function. (J Am Podiatr Med Assoc 96(3): 205–211, 2006)

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