[Insoles in the treatment of pes planovalgus : A prospective, randomised, double-blind, placebo-controlled comparative trial of sensomotoric and supportive insoles]

Abstract

Background: In adults, flexible symptomatic flat foot is treated conservatively with supportive foot orthoses. Sensorimotor foot orthoses, however, are controversial due to insufficient data.

Purpose: Comparison of the effectiveness of sensorimotor and supportive foot orthoses in adults.

Material and methods: In 73 patients, in addition to foot gymnastics, supportive, sensorimotor or placebo insoles were compared over 3 measurement points during 1 year as part of a double-blind, prospective, randomised placebo-controlled clinical trial using Numeric Rating-Scala, the Foot and Ankle Disability Index, as well as pedobarography and valgus index. The statistical analysis was performed using ANOVA with repeated measures.

Results: The valgus index increased significantly with supportive foot orthoses. In the follow-up, the foot contact area was only significantly reduced with sensorimotor foot orthoses in static and dynamic measurements. Supportive foot orthoses led to a faster reduction in pain, but without reducing the contact area of the foot. There were no relevant differences in functionality.

Conclusions: The reduction of the contact surface in combination with sensorimotor foot orthoses shows the potential for muscular addressing of the flexible flat foot. There were no disadvantages compared to other treatments. Supportive foot orthoses led to a faster reduction in subjective complaints, but appear to weaken the muscles supporting the arch of the foot. In the longer term, consistent foot muscle training also appears to be effective, as wearing placebo foot orthoses also led to an improvement in subjective well-being without significant biomechanical changes.

Keywords: Adults; Foot contact area; Foot deformity; Foot function; Foot muscle exercises.

Abb. 1

Der Blauabdruck mit Linien und Punkte zur Berechnung des Valgus-Index. (A Malleolus lateralis, B Malleolus medialis, C Schnittpunkt zwischen der mittleren hinteren Ferse über den Digitus pedis III). In der Formel eingesetzt: ½ × (7‑2,6) × (100/7) = 31,5; (hoher Valgus-Index). Das starke Einknicken zeigt sich bei den stark nach medial gerichteten Malleolenprojektionen

Abb. 2

Verwendete Schuheinlagen (oben: sensomotorische Schuheinlage [Springer aktiv AG, Berlin, Germany]; Mitte: stützende Schuheinlage [Kork/Leder]; unten: Placeboschuheinlagen [ca. 4 mm fester, in Form geschnittener Schaumstoff])

Abb. 3

a Foot and Ankle Disability Index (FADI; dimensionslos); b EuroQol-5D (EQ5D; dimensionslos): Erhobene Werte für alle Studienarme (sensomotorische Einlage, stützende Einlage und Placeboeinlage); ZP0 Ausgangsmessung, ZP1 1. Follow-up, ZP2 2. Follow-up, Mittelwert mit Standardabweichung (SD)

Abb. 4

Vergleich der Numerischen Rating-Skala (NRS; dimensionslos) bei allen Studienarmen im Verlauf; ZP0 Ausgangsmessung, ZP1 1. Follow-up, ZP2 2. Follow-up, Mittelwert mit Standardabweichung (SD)

Abb. 5

Statische Auflagefläche (links) und dynamische Auflagefläche (rechts) in Prozent für alle Studienarme (sensomotorische Einlage, stützende Einlage und Placeboeinlage); ZP0 Ausgangsmessung, ZP1 1. Follow-up, ZP2 2. Follow-up, Mittelwert mit Standardabweichung (SD)

Abb. 6

Valgus-Index (VI) bei allen Studienarmen (sensomotorische Einlage, stützende Einlage und Placeboeinlage); ZP0 Ausgangsmessung, ZP1 1. Follow-up, ZP2 2. Follow-up, Mittelwert mit Standardabweichung (SD)

Abb. 7

Dynamische pedobarographische Messung mit Drucklinie während der mittleren Standphase (maximale Auflagefläche); links Ausgangsmessung, rechts 2. Follow-up