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Background There is currently limited evidence exploring the beliefs and application of forefoot lateral wedges in clinical practice by podiatrists. The study aimed to understand rationale and beliefs that guided the use of forefoot lateral wedges amongst Aotearoa New Zealand podiatrists. Methods A cross-sectional study of Aotearoa New Zealand podiatrists was conducted between 31st May 2021 and 26th July 2021. Data were collected anonymously using a web-based survey platform. The 30-item survey included questions to elicit participant characteristics, why and when podiatrists used orthotic modifications, what biomechanical assumptions influenced clinical decision making, and how podiatrists fabricated and placed forefoot lateral wedging. The survey findings were reported using descriptive statistics. Results Sixty-five podiatrists completed the survey. Most respondents were trained in Aotearoa New Zealand (91%), had over 10 years’ experience (70%), and worked with a mixed case load (60%). Seventy-seven percent (77%) prescribed 0 to 10 pairs of foot orthoses per week, with forefoot lateral wedges used in 44% of prescriptions. Forefoot lateral wedges were likely to be used in the treatment of peroneal tendon injuries (70%) and chronic ankle instability (64%). The most common belief being that forefoot lateral wedges increase first metatarsophalangeal joint range of motion (86%). Forefoot lateral wedges were regularly manufactured from 3mm (74%), medium density ethylene vinyl acetate (91%) and positioned from the calcaneo-cuboid joint (53%) to the sulcus (77%). Conclusion New Zealand podiatrists frequently use forefoot lateral wedges in clinical practice. Respondents were predominately guided by the underpinning belief that forefoot lateral wedging reduces tissue stress and have their greatest functional impact on first metatarsophalangeal joint range of motion. Forefoot lateral wedges are commonly manufactured from 3mm ethylene vinyl acetate, although it is important to be aware that this will translate to differing angles, dependant on width. Further research should be undertaken to explore the influence of forefoot lateral wedges on forefoot function and the effect of wedge length. |
