A Patient Satisfaction Survey on Prescription Custom-Molded Foot Orthoses John H. Walter, Jr., DPM, MS* Gregory Ng, DPM† Jennifer J. Stoltz, BA‡
A survey of patients treated at the Foot and Ankle Institute at the Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania, was conducted regarding their satisfaction with thermoplastic prescription foot orthoses. Two hundred seventy-five completed questionnaires from patients who had had their orthoses for 1 year or more were analyzed. Overall, the majority of respondents indicated that they were satisfied with their devices, obtaining significant (60% to 100%) relief of symptoms. Very few patients indicated total dissatisfaction; only 9% reported 0% relief of their symptoms. The data strongly suggest that custom-molded foot orthoses are an effective and viable treatment modality associated with a high level of patient satisfaction. (J Am Podiatr Med Assoc 94(4): 363367, 2004)
Prescribing and fitting foot orthoses is a large part of many podiatric and foot specialty practices. Custommolded foot orthoses improve foot mechanics, influence the amount of motion that occurs around these joints, and decrease pain while adding support.1 Dynamic alteration of lower-extremity mechanics and gait through orthoses may also help in the correction of pathologic conditions other than those of the foot and ankle, such as back, hip, or knee malalignment or pain. Orthoses are a noninvasive mode of treatment that allows the patient the freedom to wear a variety of footwear and still experience relief from pain (Fig. 1). Adverse side effects are minimal to *Department of Podiatric Orthopedics and Biomechanics, Temple University School of Podiatric Medicine, Philadelphia, PA. †Department of Podiatric Medicine and Surgery, Virtua Health Systems of South Jersey; private practice, Voorhees, NJ. ‡Temple University School of Podiatric Medicine, Philadelphia, PA. Corresponding author: John H. Walter, Jr., DPM, MS, Department of Podiatric Orthopedics and Biomechanics, Temple University School of Podiatric Medicine, Eighth at Race St, Philadelphia, PA 19107.
nonexistent compared with those associated with prolonged use of nonsteroidal anti-inflammatory drugs or pain medications and more invasive painmanagement therapies.2 A wide variety of foot and lower-extremity problems have been successfully treated with functional foot orthoses.
Materials and Methods A retrospective study of patients who were prescribed custom-molded foot orthoses was conducted at the Foot and Ankle Institute of the Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania. More than 600 patients who were prescribed orthoses by 14 podiatric physicians over a 5year period (1992–1997) were identified and sent brief, simple questionnaires to complete and return. All of the devices were polypropylene, custom-molded rigid orthoses. Two hundred seventy-five questionnaires were returned, and the data were evaluated. The questionnaire was geared toward evaluating the patients’ overall satisfaction with their custommolded foot orthoses (Fig. 2). Patients were asked to rate the effectiveness and quality of their orthoses
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A
B
Figure 1 A and B. Examples of custom-molded polypropylene foot orthoses used by survey respondents.
and to supply data on how long and in what type of footwear they were worn. Additional comments on the appearance of the orthoses and the reason for prescription were also solicited.
Results Functional foot orthoses are prescribed for a variety of problems (Fig. 3). Heel pain was the most prevalent complaint (21% of responses) reported by the patients surveyed. Painful arches made up 20% of the respondents’ complaints, while flat feet made up 14%. Knee or hip pain accounted for 8% of responses, bunions for 5%, high arches and back pain for 4% each, and foot or ankle arthritis for 3% each. Finally, 18% of the responses were “other.” Overall, most patients reported that the orthoses had helped their initial problem (Fig. 4). “Cured” (100% relief from pain) was cited by 45 of 266 patients (17%), while “a lot” (80% relief) was expressed by 91 patients (34%). Sixty-four respondents (24%) experienced 60% relief, and 22 (8%) were “somewhat” (40%) relieved by the orthoses. Twenty-one patients (8%) experienced “a little” relief (20%), and 23 patients (9%) stated that the orthoses did not help at all. When asked about the type of footwear worn with the custom-molded foot orthoses, “athletic shoes” was the most prevalent response (148/312, 47%) (Fig. 5). “All shoes” was the next most common reply (106/312, 34%). Boots were worn by 39 patients (13%), while 19 respondents (6%) wore dress shoes. Patients were asked to identify other medical specialists they had consulted for their initial problem (Fig. 6). Sixty patients (41% of responses) saw an orthopedist, 49 (34%) consulted a family physician, 17
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patients (12%) saw a chiropractor, and 19 (13%) replied “other.” Patients were asked to evaluate whether the orthoses provided the same support at 1 year as they did when they were new (Fig. 7). Most patients who responded to this question (209/264, 79%) felt that they did, while 55 (21%) acknowledged a change in the amount of support the devices provided. Because the amount of time the orthoses were worn may have played a role in their efficiency over time, patients were specifically asked if they were able to wear them all day. Of 159 responses, 132 (83%) reported being able to wear them all day. Patients were also asked how many hours per day they actually wore the custom-molded foot orthoses (Fig. 8). Most patients wore their orthoses all day (154/274, 56%). Thirty-seven respondents (14%) reported wearing the orthoses 9 to 12 hours daily; 34 (12%) reported wearing them 6 to 9 hours daily; 22 patients (8%) wore them 3 to 6 hours daily; and 27 patients (10%) wore them 1 to 3 hours daily. In an effort to further analyze orthosis-wearing habits, patients were asked when they wore their devices (Fig. 9). Most respondents (153/205, 75%) wore them all the time, or in no specific place during any specific activity. Some patients (23/205, 11%) wore their orthoses “only when necessary.” Fifteen patients (7%) wore them only at work, while 8 (4%) acknowledged wearing them just at home. Six patients (3%) stated that they wore their orthoses only until the pain went away or that they did not wear them at all. When asked about the appearance of their custom-molded foot orthoses (Fig. 10), the majority of patients (138/213, 65%) felt it was “good.” Fifty-six patients (26%) felt the appearance was “fair,” while
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Survey 1.
Why did you receive the arch support (orthotics)? (CHECK ALL THAT APPLY) __ painful heel(s) __ painful arches __ hammertoes __ foot arthritis __ back pain __ high arches
2.
Are you able to wear the orthotics all day?
3.
How long in each day do you wear them? __ 1–3 hours __ 9–12 hours __ 3–6 hours __ all day __ 6–9 hours
4.
When do you wear the arches? __ never __ just at work __ until the pain went away
__ __ __
__ yes
flat feet ankle arthritis other
__ __
bunions knee and/or hip pain
__ no
__ __ __
all the time just at home only when necessary
5.
In what shoes do you wear the orthotics? (CHECK ALL THAT APPLY) __ boots __ dress shoes __ athletic shoes __ all shoes
6.
Have the orthotics helped to relieve your discomfort? __ not at all __ a little (20% relief) __ somewhat (40% relief) __ a good bit (60% relief) __ a lot (80% relief) __ cured me (100% relief)
7.
What other professionals did you see for your pain, if any? (CHECK ALL THAT APPLY) __ family doctor __ orthopedist __ chiropractor __ other
8.
Do the orthotics give the same support as when new?
9.
What is the appearance of your orthotics? __ good __ fair __ poor __ cannot wear
__ yes
__ no
Figure 2. The questionnaire that was completed by 275 patients who were prescribed custom-molded foot orthoses.
11 (5%) and 8 (4%) patients, respectively, felt it was “poor” or “unable to be worn.”
Conclusion The data collected in this survey of 275 patients indicate that patients were largely satisfied with their custom-molded foot orthoses in the treatment of foot and ankle problems, as well as other pathologic conditions, including of the hip, knee, and back. Patients were prescribed orthoses mainly for foot and ankle
conditions. Other health-care professionals were often consulted in addition to podiatric physicians. The respondents reported wearing a variety of footwear, with athletic shoes being the predominant choice. Respondents overwhelmingly reported that their orthoses provided adequate support, even over time. The quantitative data also suggest that the devices provide a significant level of pain relief, reaching 100% in some patients. It can be concluded from the responses gathered in this sample that the use of
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120 –
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Figure 3. Reasons for prescription of orthoses among survey participants.
Figure 4. Degree of symptom relief provided by the orthoses among survey participants.
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Figure 5. Types of footwear worn with the orthoses among survey participants.
Figure 6. Professionals other than podiatric physicians consulted by survey participants.
thermoplastic prescription orthoses is a very effective and promising tool in treating lower-extremity pathology.
References
Acknowledgment. This research was funded by a grant from the American College of Foot and Ankle Orthopedics and Medicine.
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1. SANNER WH: Clinical methods for predicting the effectiveness of functional foot orthoses. Clin Podiatr Med Surg 11: 279, 1994. 2. M ORAROS J, H ODGE W: Orthotic survey: preliminary results. JAPMA 83: 139, 1993.
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Figure 7. Amount of support provided by the orthoses after 1 year of use and patients’ ability to wear them all day.
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Figure 8. Length of time orthoses were worn per day by survey participants.
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Figure 9. Environments in which orthoses were worn by survey participants.
Figure 10. Appearance of the orthoses worn by survey participants.
Additional References
2000. P RATT DJ: Dynamic foot orthoses: principles and application. JAPMA 90: 24, 2000. SOBEL E, LEVITZ SJ, CASELLI MA: Orthoses in the treatment of rearfoot problems. JAPMA 89: 220, 1999. THOMPSON JA, JENNINGS MB, HODGE W: Orthotic therapy in the management of osteoarthritis. JAPMA 82: 136, 1992.
BENNETT PJ, MISKEWITCH V, DUPLOCK LR: Quantitative analysis of the effects of custom-molded orthoses. JAPMA 86: 307, 1996. MC POIL TG, C ORNWALL MW: The effect of foot orthoses on transverse tibial rotation during walking. JAPMA 90: 2,
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