The Efficacy of Modified Total Contact Orthosis in Decreasing Pain While Walking Indoors in Patients with Posterior Tibial Tendon Dysfunction: A Prospective, Randomized, Double-Blind Controlled Trial

Ploypapus Rachatacharoensap; Navaporn  Chadchavalpanichaya; Thana  Charoenvitvorakul; Hathaichanok  Arunsaengsin; Aphinat  Chirawattanaphan

Authors

Ploypapus Rachatacharoensap Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Navaporn Chadchavalpanichaya Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Thana Charoenvitvorakul Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Hathaichanok Arunsaengsin Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Aphinat Chirawattanaphan Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok

Keywords:

acquired adult flatfoot deformity, foot orthosis, flatfoot, orthotic Insoles, posterior tibial tendon dysfunction

Abstract

Objectives: To evaluate the effectiveness of a modified total contact orthosis (modified TCO) in reducing pain during indoor walking among patients with posterior tibial tendon dysfunction (PTTD). Patient satisfaction, complications, Foot Function Index (Thai version), and device compliance were also evaluated

Study design: A prospective, randomized, double-blind controlled trial

Setting: The Foot Clinic at Siriraj Hospital, a tertiary care academic medical center in Bangkok, Thailand

Participants: Forty-two patients aged 45–65 years with stage I–III PTTD lasting more than 6 weeks.

Methods: Participants were enrolled between November 2023 and June 2024 and randomized into two groups. The study group received a modified TCO, whereas the control group received a sham orthosis. Both groups used the orthoses indoors for 2 weeks. Pain scores, Foot Function Index (Thai version), satisfaction, and compliance were assessed at baseline and after 2 weeks.

Results: The participants, with a mean age of 62.2 (SD = 8.9) years in the study group and 63.2 (SD = 9.5) years in the control group, were predominantly female (90.5%) and had stage II PTTD. All participants completed the study. After 2 weeks, the study group reported significantly less pain at the posterior tibial tendon and demonstrated better total foot functionality compared to the control group (p < 0.001 and p = 0.03, respectively). Both groups expressed high satisfaction with the devices, using them for more than 80.0% of the time spent indoors.

Conclusions: A modified total contact orthosis can reduce pain at the posterior tibial tendon in PTTD patients during indoor walking and can improve the Foot Functional Index without serious adverse effects.

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