Thick shells and medially wedged posts increase foot orthoses medial longitudinal arch stiffness: an experimental study

BACKGROUND: Foot orthoses (FOs) are commonly prescribed devices to attenuate biomechanical deficits and improve physical function in patients with musculoskeletal disorders. It is postulated that FOs provide their effects through the production of reaction forces at the foot-FOs interface. An important parameter to provide these reaction forces is their medial arch stiffness. Preliminary results suggest that adding extrinsic additions to FOs (e.g., rearfoot posts) increases their medial arch stiffness. A better understanding of how FOs medial arch stiffness can be modulated by changing structural factors is necessary to better customise FOs for patients. The objectives of this study were to compare FOs stiffness and force required to lower the FOs medial arch in three thicknesses and two models (with and without medially wedged forefoot-rearfoot posts). METHODS: Two models of FOs, 3D printed in Polynylon-11, were used: (1) without extrinsic additions (mFO), and (2) with forefoot-rearfoot posts and a 6(o) medial wedge (FO6MW). For each model, three thicknesses (2.6 mm, 3.0 mm, and 3.4 mm) were manufactured. FOs were fixed to a compression plate and vertically loaded over the medial arch at a rate of 10 mm/minute. Two-way ANOVAs and Tukey post-hoc tests with Bonferroni corrections were used to compare medial arch stiffness and force required to lower the arch across conditions. RESULTS: Regardless of the differing shell thicknesses, the overall stiffness was 3.4 times greater for FO6MW compared to mFO (p < 0.001). FOs with 3.4 mm and 3.0 mm thicknesses displayed 1.3- and 1.1- times greater stiffness than FOs with a thickness of 2.6 mm. FOs with a thickness of 3.4 mm also exhibited 1.1 times greater stiffness than FOs with a thickness of 3.0 mm. Overall, the force to lower the medial arch was up to 3.3 times greater for FO6MW than mFO and thicker FOs required greater force (p < 0.001). CONCLUSIONS: An increased medial longitudinal arch stiffness is seen in FOs following the addition of 6(o) medially inclined forefoot-rearfoot posts, and when the shell is thicker. Overall, adding forefoot-rearfoot posts to FOs is significantly more efficient than increasing shell thickness to enhance these variables should that be the therapeutic aim.