Ball Kevin Arthur, Afheldt Margaret J
Biomechanics/Gait Research Laboratory, Foot Levelers Gait Research Program, New York Chiropractic College, Seneca Falls, NY 14450, USA.
J Manipulative Physiol Ther. 2002 Feb;25(2):116-24. doi: 10.1067/mmt.2002.121415.
To present a critical review of the evolution of foot orthotics theory and clinical practice.
Several classic publications were consulted because of their overwhelming influence. The work of Merton L. Root and his colleagues in the 1970s was carefully examined. Careful evaluations were performed to determine how faithfully Root's central concepts were subsequently followed. Studies attempting to validate this and other orthotic paradigms were also reviewed.
Epidemiologic studies provide strong support for the clinical advantages of orthoses, yet explanations of foot orthotic mechanisms remain elusive. Considerable variability has crept into the literature with respect to Root's core theoretical concepts of how and why to determine the neutral position of the subtalar joint (weight-bearing vs non-weight-bearing, palpation vs range-checking). Numerous studies document poor clinical reliability and validity; indeed, this paradigm appears to favor supination, thereby violating its "neutral" premise. Mechanisms other than those of the classic Root theory must be at work. Accordingly, successes have been achieved with alternate paradigms that use much simpler casting techniques. Although less frequently cited, successes have been gained with various viscoelastic materials that enhance shock-absorption and proprioception, as well as custom-made flexible orthotic designs that emphasize the 3 natural arches of the foot.
The use of foot orthoses is well documented for the treatment of many maladies, yet clinical successes have been achieved both inside and outside of the classic Root paradigm. Clearly, a more complete theoretical understanding of the mechanisms of foot orthotics awaits discovery.
对足部矫形器理论与临床实践的演变进行批判性综述。
查阅了几本具有重大影响力的经典出版物。仔细研究了默顿·L·鲁特及其同事在20世纪70年代的工作。进行了仔细评估，以确定鲁特的核心概念在随后的实践中得到了多大程度的遵循。还对试图验证这一及其他矫形范式的研究进行了综述。
流行病学研究为矫形器的临床优势提供了有力支持，但足部矫形器作用机制的解释仍然难以捉摸。关于鲁特确定距下关节中立位的核心理论概念（负重与非负重、触诊与范围检查），文献中出现了相当大的差异。大量研究记录了临床可靠性和有效性较差的情况；事实上，这种范式似乎倾向于旋后，从而违背了其“中立”前提。必定存在经典鲁特理论之外的其他作用机制。因此，采用更简单塑形技术的替代范式已取得成功。虽然引用较少，但使用各种增强减震和本体感觉的粘弹性材料以及强调足部三个自然足弓的定制柔性矫形器设计也取得了成功。
足部矫形器用于治疗多种疾病已有充分文献记载，但在经典鲁特范式内外均取得了临床成功。显然，有待发现对足部矫形器作用机制更完整理论上的理解。
