**3. Results**

Of the 125 patients included in the study, there was a predominance of males versus females (54.4% vs. 45.6%), with a mean age of 46.0 ± 19.2 years. The body mass index was 28.0 ± 6.2 kg/m2 , with a median of 27 and a range of 13.8 to 45.3 kg/m2 .


#### **Table 1.**

*Description of the general characteristics of the patients attended in the study period, reasons for consultation and applied treatment.*

#### *Satisfaction with Orthopedic Treatments DOI: http://dx.doi.org/10.5772/intechopen.96090*

Regarding the reason for consultation, the most frequent was hindfoot pain (58.2%) followed by forefoot pain (41.8%). Regarding the diagnosis, the most frequent was plantar fasciitis (29.7%), followed by metatarsalgia (18.6%). The type of orthotic treatment performed most frequently was the corrective (68.5%), followed by the accommodative (31.5%). In relation to the treatment objectives, the most frequent was the control of pronation (52.3%), followed by the cushioning of supports (18.9%) (**Table 1**).

The degree of use of the orthosis, satisfaction and evolution of pain during the follow-up are shown in **Table 2**. In the majority of patients the degree of use was 4–8 hours in the first month as well as in the third and sixth months (75.9%, 77.8% and 75% respectively). Regarding the satisfaction with the treatment, almost two thirds of the patients treated said they were very satisfied with the treatment that has been performed in the first month as well as in the third and sixth (61.2%, 63% and 50% of the patients respectively). And if we evaluate the evolution of pain it is observed that most of the patients have experienced improvement of their pain (noticeable or slight).

Considering the evaluation that the patients made of the satisfaction with the orthosis and of the evolution of the pain in its first review in the clinic (independently of whether it was at one month, three months or six months after treatment) (**Table 3**). 81.8% of them were quite or very satisfied with the treatment, and they also reported a slight or notable improvement in the pain they experienced.

With reference to age, a statistically significant difference in age was observed between satisfied and unmet patients, with significantly younger patients being satisfied than those with little or no satisfaction (44.9 vs. 57.3 years; p = 0.026).

In turn, patients less satisfied with the treatment showed higher BMI values, although without statistically significant differences (29.4 vs. 27.6, p = 0.132).


#### **Table 2.**

*Degree of use of the orthosis, satisfaction and evolution of pain during follow-up.*

A greater percentage of satisfaction with the orthosis was observed in men than in women (86.4% vs. 75.8%, p = 0.232), as well as in patients who consulted for forefoot pain compared to those who presented pain of hindfoot (89.3% vs. 76.6%, p = 0.172), although in none of the cases did the differences reach statistical significance. There were also no differences in the degree of satisfaction according to the established diagnosis, the type of treatment or its objective (**Table 3**).

The evolution of pain self-reported by patients after treatment with the orthosis, according to different variables, is shown in **Table 4**. Patients who report mild or notable improvement are significantly younger (44.8 vs. 57.8 years, p = 0.018) and have a lower body mass index (27.5 vs. 29.8 kg/m<sup>2</sup> ; p = 0.061), although in this case without reaching statistical significance. Again men report a greater percentage of pain improvement than women (86.4% vs. 75.8%,


#### **Table 3.**

*Analysis of the satisfaction of patients with the treatment at the first visit that come to review the clinic, according to different variables.*

#### *Satisfaction with Orthopedic Treatments DOI: http://dx.doi.org/10.5772/intechopen.96090*


#### **Table 4.**

*Analysis of the evolution of pain with self-reported treatment by patients at the first visit to which they come to review the clinic, according to different variables.*

p = 0.232), as well as patients with forefoot pain compared to those who complain of hindfoot pain (89, 3% vs. 76.6%, p = 0.172), although these differences are not statistically significant. The established diagnosis, the type of treatment applied or the objective of the treatment are not associated with the degree of pain improvement (**Table 4**).

## **4. Discussion**

In the present study we have tried to verify that the plantar orthosis is a conservative method of treatment that has been used in patients of all ages, and in

#### *Prosthetics and Orthotics*

multiple foot pathologies. 81.8% of the patients who attend the CUP are satisfied with the treatment main ailment has improved, compared to 18.2% who are not satisfied and their ailment remains the same. Patients who have improved are relatively younger, and with lower BMI.

The effectiveness of the orthoses performed at the University Clinic of Podiatry of the University of La Coruña, has been demonstrated in this study, where in most cases the satisfaction of patients, and the evolution of self-reported pain has improved.

In a review found in the literature, it is shown that in adults with different pathologies such as cavus foot, rheumatoid arthritis (RA), the custom-made foot orthosis reduces the patient's pain [4].

This review focuses only on tailor-made foot orthoses, which are defined in this review as removable, anatomical devices that are placed inside the footwear and are molded or manufactured from a foot print and manufactured according to the specifications prescribed by the doctor, in this case a podiatrist.

Foot pain may be experienced after an injury; overuse in the long term; infection; or systemic diseases that include any foot tissue, including bones, joints, ligaments, muscles, tendons, nerves, skin and nails. Foot pain can be generalized or diagnosed more specifically according to location (eg, heel pain), structure (eg, ligament or tendon damage) or disorder (eg, osteoarthritis) [8].

In another review found [9] carried out in children, the effect of non-surgical treatments for flatfoot is proven and shows that in children with flat feet and juvenile idiopathic arthritis, customized foot orthoses can slightly improve pain and function of the foot. Currently, the evidence from randomized controlled trials is too limited to draw definitive conclusions about the use of nonsurgical interventions for pediatric flatfoot. Future trials of high quality in this field are required. Only limited interventions that are frequently used in practice have been studied and there is much debate about the treatment of symptomatic and asymptomatic flatfoot [9].

We found several studies that speak about the use of plantar orthoses for the flatfoot [10–12] and the results of the studies speak of improvement in plantar pressures, as well as in the control of anomalous movements.

There are numerous studies in the literature that speak about the effects of plantar orthoses, both in the population with previous pathology such as arthritis, osteoarthritis, diabetic population, plantar fasciitis [13–18], as well as in people who practice sports and the effect that orthosis produces in the practice of certain sports practice [15].

For example, in the studies carried out by Hähni M [19] and Munteau S [20], the effectiveness of plantar orthoses in reducing plantar pressures and Achilles tendinopathies is highlighted.

It has been shown in the study by Coheña-Jiménez [7] that treatment with plantar orthoses is effective for plantar fasciitis. There are many studies that show the benefits of orthosis treatment, it would be good to carry out more studies focused on evaluating the efficacy in the treatment of flat feet, cavus for example. It is very difficult to evaluate patient satisfaction in this sense, since in most cases they are evaluated by pain improvement, so it would be good to have other measurement systems in which we could quantify patient satisfaction.

More studies are needed to evaluate satisfaction and effectiveness of the foot orthoses made to measure for the foot, especially to check if in certain pathologies it is possible to reduce pain and overload in the plantar pressures, something that would be very beneficial for the patient.

Selection biases Selection biases may arise from the inclusion and exclusion criteria determined for the execution of the study. In our case, they will also be

#### *Satisfaction with Orthopedic Treatments DOI: http://dx.doi.org/10.5772/intechopen.96090*

determined by the patients' decision to participate. To minimize these biases, the results will be compared with those of other similar studies.

Information biases: Information biases arising from how the data were obtained may occur: Variability produced by the type of procedure or test used to carry out the examinations, these biases can be minimized, as far as possible, through the establishment of validated questionnaires, calibrated instruments, training of observers.

Confusion biases Due to the absence of variables in the data collection that should have been taken into account for the realization of this study and that are not included due to ignorance of them. To minimize this bias, a multivariate logistic regression analysis will be performed.
