3 results for Ashford, RL

  • Non-surgical interventions for paediatric pes planu [Intervention Review]

    Rome, K; Ashford, RL; Evans, A (2011-08-23)

    Journal article
    Auckland University of Technology

    BACKGROUND: Paediatric pes planus ('flat feet') is a common childhood condition with a reported prevalence of 14%. Flat feet can result in pain and altered gait. No optimal strategy for non-surgical management of paediatric flat feet has been identified. OBJECTIVES: To assess the effectiveness of non-surgical interventions for treatment of paediatric pes planus (flat feet). SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, Index to Theses, and Dissertation Abstracts (up to June 2009). SELECTION CRITERIA: All randomised and quasi-randomised trials of non-surgical interventions for paediatric pes planus were identified. The primary outcomes were pain reduction and adverse events; secondary outcomes included disability involving the foot, goniometric measurements, quality of life and patient comfort. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed the risk of bias of included trials. MAIN RESULTS: Three trials involving 305 children were included in this review. Due to clinical heterogeneity, data were not pooled. All trials had potential for bias. Data from one trial (40 children with juvenile arthritis and foot pain) indicated that use of custom-made orthoses compared with supportive shoes alone resulted in significantly greater reduction in pain intensity (mean difference (MD) -1.5 points on a 10-point visual analogue scale (VAS), 95% CI -2.8 to -0.2; number need to treat to benefit (NNTB) 3, 95% CI 2 to 23), and reduction in disability (measured using the disability subscale of the Foot Function Index on a 100mm scale (MD -18.65mm, 95% CI -34.42 to -2.68mm). The second trial of seven to 11 year old children with bilateral flat feet (n = 178) found no difference in the number of participants with foot pain between custom-made orthoses, prefabricated orthoses and the control group who received no treatment. A third trial of one to five year olds with bilateral flat feet (n=129) did not report pain at baseline but reported the subjective impression of pain reduction after wearing shoes. No adverse effects were reported in the three trials. AUTHORS' CONCLUSIONS: The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of non-surgical interventions for paediatric pes planus. Future high quality trials are warranted in this field. Only limited interventions commonly used in practice have been studied and there is much debate over the treatment of symptomatic and asymptomatic pes planus NON-SURGICAL INTERVENTIONS FOR FLAT FEET IN CHILDREN: This summary of a Cochrane review presents what we know from research about the effect of non-surgical treatments for pes planus (flat feet) in children.The review shows that in children with flat feet and juvenile idiopathic arthritis, custom foot orthoses:-may improve pain and function slightly-harms and side effects were not measuredWe often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. What are flat feet and what are non-surgical treatments?Children with flat feet, also called pes planus, do not have a normal arch. It means that when the child is standing, the whole foot touches the ground. Sometimes, this condition can cause pain, or change the way a child walks.There are many types of non-surgical treatments for the pain and disability caused by flat feet such as foot orthoses (shoe inserts), stretching, footwear selection and modifications, activity modifications, manipulation, applying a series of casts, losing weight (if appropriate) and medication for pain and inflammation.This review found information mainly on custom foot orthoses or shoe inserts. A custom foot orthosis is a medical device that is made from a custom mould of the child's foot, prescribed by a qualified health-care professional and which is designed by that professional to allow more normal foot and leg function and to decrease the pressure on parts of the foot that might be causing pain.Best estimate of what happens to children with flat feet: Pain:-children who used a custom-made foot orthoses in their shoes rated their pain to be 1.5 on a scale of 0-10;-children who wore their shoes only rated their pain to be 3 on a scale of 0-100;-children who used a custom-made foot orthoses in their shoes rated their pain to be 1.5 points better (Absolute improvement: 15%).Physical Function:-children who used a custom-made foot orthoses in their shoes rated their disability level to be 15 on a scale of 0-100;-children who wore their shoes rated their disability to be 34 on a scale of 0-100;-children who used a custom-made foot orthoses in their shoes rated their disability to be 19 points better (Absolute improvement: 19%).

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  • Non-surgical interventions for paediatric pes planus [Protocol]

    Rome, K; Ashford, RL; Evans, A (2011-08-24)

    Journal article
    Auckland University of Technology

    This is the protocol for a review and there is no abstract. The objectives are as follows: The aim of this review is to evaluate the evidence from randomised controlled trials for the non-surgical intervention of paediatric pes planus.

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  • Conservative interventions for mobile pes planus in adults: a systematic review

    Ashford, RL; Mathesion, I; Rome, K

    Journal article
    Auckland University of Technology

    Background. Adult pes planus (flat foot) is a common problem encountered by many health care professionals. Despite the perception that flat foot can cause pain and impair function, and the availability and widespread use of various treatments, there is no consensus on the optimal treatment strategy. Aim. To assess the effectiveness of conservative (non-surgical) interventions for pes planus in adults. Method. A systematic search of the literature was undertaken. This included: the Cochrane Central Register of Controlled Trials; the CMSG Specialized Trials Register; an electronic search was conducted using MEDLINE (1960 to June 2012), EMBASE (1980 to June 2012), and CINAHL (1982 - June 2012). Specialised journals, trial reference lists and review articles were hand searched. Selection criteria: Randomised or quasi-randomised trials of treatment interventions for pes planus in adults. Trials that included specific pathologies such as plantar heel pain, metatarsal stress fractures, posterior-tibial tendon dysfunction, ankle fractures, rheumatoid foot pathologies, neuromuscular conditions and diabetic foot complications were excluded. Data collection and analysis: Two authors independently screened the search results to identify those meeting the inclusion criteria and quality assessed those included using a checklist based on the Cochrane Collaboration Assessment of Risk of Bias tool. This tool focused on risk of selection, performance, detection, attrition and reporting bias. Results. Four trials, involving 140 subjects, met the inclusion criteria for the review. All four were judged to be at high risk of bias in at least one area, and were also at unclear risk of bias in at least one other area. All scored highly in relation to attrition bias, due to the short follow up times and experimental designs used. Data was not pooled due to the high level of heterogeneity identified in the interventions assessed, participants selected and outcomes measured. The results of one study suggest that after four weeks of use orthoses may result in a significant improvement in medio lateral sway, and may result in improved, although non-significant, general foot-related quality of life (Rome 2004). One study (Redmond 2009) suggests that their effect on plantar pressure distribution in the foot may not be dependent on whether they are custom or prefabricated devices. Although this study identified significant changes in some plantar pressure variables with both custom and prefabricated devices, another (Esterman 2005) failed to find any significant effect of ¾ length prefabricated orthoses on pain, injury incidence, foot health or quality of life in a group of air force recruits. The fourth study (Jung 2009) suggests that exercising the intrinsic foot muscles may enhance the effect of orthoses. Despite these findings, since each study incurred risk of bias in at least one area no conclusions can be drawn.

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