Satisfaction with Orthopedic Treatments

*Cristina Gonzalez-Martin, Sonia Pertega-Diaz, Rocio Seijo-Bestilleiro and Maria Teresa Garcia-Rodriguez*

#### **Abstract**

To determine the effectiveness and satisfaction with orthopodologic treatments in users of the University Clinic of podiatry at the University of A Coruña, according to various parameters. After approval from the ethics committee of the University of A Coruña, an observational retrospective study (n = 125). We analyzed the effectiveness and satisfaction with the orthopodologic treatments depending on the reason for consultation, diagnosis, treatment and goals of treatment. We performed a descriptive analysis of all variables collected. The most frequent reason for consultation was for pain of the hindfoot (58.2%).The most frequent diagnosis was plantar fasciitis, followed by metatarsalgia (29.7% vs. 18.6%). The orthotic treatment corrective was the most used (68.5%) with pronation control (52.3%). The majority of patients reported improvement in pain, and a high degree of satisfaction with the treatment used. The profile of the patient who consults the Podiatry clinic for a orthopodologic treatment is that of a man over the age of 50, who consulted for pain of the hindfoot. The most frequent diagnosis is plantar fasciitis and the treatment carried out the corrective for pronation control. The majority of patients used the brace between 4 and 8 hours a day, with a high satisfaction with the treatment and improvement in the evolution of the pain. The degree of satisfaction was significantly associated with age, younger patients more satisfied. The improvement of pain was significantly associated with age, younger patients who show improvement.

**Keywords:** foot orthosis, orthopedics, orthotic device, patient satisfaction

#### **1. Introduction**

Podiatry has evolved very quickly in recent years; much progress has been made in: posturology, adapted and individualized plantar orthoses of minimal dimensions, and all with a single purpose, to restore an optimal balance [1].

The realization of customized foot supports has been suffering a constant evolution, although it has not always been accompanied by scientific criteria, but rather by clinical experiences.

Currently, orthopedic treatments are highly demanded by patients and have a high prescription rate in the pathology of the adult foot, whether metatarsalgia (forefoot pain) or talalgia (back pain). In the adult, foot pain, whether due to inflammatory or mechanical causes, is very frequent and results in numerous sick leave and social disturbances [2]. Up to 10% of the population may have pain in the foot, either later or earlier in their lives [3].

In the adult, the pain of the feet, either of mechanical or inflammatory origin, is very frequent and is the cause of numerous sick leave and social upheavals.

There are numerous studies found in the literature that evaluate the efficacy of plantar orthoses, but all are focused on certain pathologies or alterations, most of these studies are focused on treating very specific alterations of the foot [4–7].

The University Clinic of Podiatry (CUP) of the University of Coruña (UDC), has been providing podiatric service to a large number of patients of all types for more than 10 years, among which the vast majority have multiple pathologies that need conservative treatment par excellence, the plantar orthosis. During the years in which this type of treatment has been carried out, the satisfaction of the patients with the same or the degree of pain improvement has not been evaluated, which is why there is a need to know the satisfaction with the plantar orthosis and the evolution of the main ailment of each patient.

The performance of this study may be justified due to:

The University Podiatry Clinic (CUP) of the Universidade da Coruña (UDC) has been providing podiatric service to a large number of patients of all kinds for more than 10 years, among which the vast majority have multiple pathologies that need conservative treatment due to excellence, the plantar orthosis. During the years in which this type of treatment has been carried out, patients' satisfaction with it and the degree of pain improvement have not been evaluated; therefore the need arises to know the satisfaction with the plantar orthosis and the evolution of the main ailment of each patient. Due to the lack of scientific evidence on the efficacy of orthotic treatments in general, the need has arisen to carry out this study, which aims to make known the estimated reality of the state of the patients we treat, to know their satisfaction with the prescribed treatment and if the same, it has been useful in the disappearance of the pain manifested at the beginning of the consultation.

With the aim of determining the effectiveness and satisfaction with orthopodological treatments in users of the University Clinic of Podiatry (CUP) of the University of Coruña, this study is carried out.

### **2. Methods**

An observational retrospective follow-up study was carried out in the university podiatric clinic (CUP) of the University of Coruña (UDC), located in the Naval Hospital of Ferrol (A Coruña). Those patients who came for the first time to the orthopedic service of the University Clinic of Podiatry in the period between September and December 2017 and who gave their written consent to the data collected in the medical history could be used were included in the study for research purposes.

Included in this study were: Patients who attended the orthopodology service of the University Podiatry Clinic of the University of La Coruña for the first time in 2017. Patients who gave their written consent that the data collected in the history can be used for research purposes.

Exclusion criteria: The following were excluded from the study: Patients who did not undergo any orthopedic treatment. Patients whose medical records show that they did not give their written consent that the data collected in the record can be used for research purposes.

We included 125 patients who met the inclusion and exclusion criteria. This sample size allows us to know the effectiveness of the treatment and patient satisfaction with an accuracy of ±8.8% and 95% safety.

The following sociodemographic and clinical variables were studied from each clinical history:

Sociodemographic variables: Age, sex.

Anthropometric variables: Weight, height, body mass index.

Clinical variables: Reason for consultation: forefoot pain, hindfoot pain.

Diagnosis: plantar fasciitis, calcaneal spur, metatarsalgia, flat/pronged foot, first radius insufficiency, others.

Treatment: accommodative plantar orthosis, corrective/functional plantar orthosis.

Treatment objectives: supination control, pronation control, support damping, selectively discharging, compensating for differences (**Figure 1**).

Evaluation of the treatment: In the university clinic of Podiatry of the University of La Coruña, the patients, once the orthopedic treatment has been performed and delivered, the following revisions are made: revision to the month, to the 3 and to the 6 months, and in them it is evaluated: The degree of use of the treatment (it is not used, if it is used and how long), the satisfaction with the applied treatment (little, enough or very satisfied) and the evolution of the main ailment (worsens, without difference, improves slightly or notably).

The effectiveness of the treatment was evaluated by the evolution of the main ailment, according to the self-reported by the patient. Satisfaction with the treatment applied was also recorded according to what was recorded in the clinical history.

The study is authorized by the UDC ethics committee (EC 05/2016). All patients included in the study have previously given their consent for the use of their medical history for research purposes.
