Beliefs About and Use of Forefoot Lateral Wedging in Podiatric Medical Practice: A Survey of Podiatric Physicians in New Zealand

Abstract

Background: Evidence is limited exploring the beliefs and application of forefoot lateral wedges (FLWs) in clinical practice by podiatric physicians. We aimed to understand rationale and beliefs that guide the use of FLWs among podiatrists.

Methods: A cross-sectional study of New Zealand (NZ) podiatrists was conducted between May 31 and July 26, 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 orthosis modifications, what biomechanical assumptions influenced clinical decision-making, and how podiatrists fabricated and placed FLWs.

Results: Of 65 survey completers, most were trained in NZ (90.8%), had more than 10 years’ experience (70.8%), and worked with a mixed case load (60.0%); 77.3% prescribed zero to ten foot orthoses per week, with FLWs used in 44% of prescriptions. Peroneal tendon injuries and chronic ankle instability were most likely to be treated with FLWs. The most common belief was that FLWs increase first metatarsophalangeal joint range of motion (86.2%). The FLWs were regularly manufactured from 3-mm (73.8%), medium-density ethyl vinyl acetate (92.9%) and positioned from the calcaneocuboid joint (54.8%) to the sulcus (78.6%).

Conclusions: Podiatrists in NZ frequently use FLWs. These were generally manufactured from 3-mm, medium-density ethyl vinyl acetate and positioned from the calcaneocuboid joint to the sulcus. The most common rationales for use were to increase first metatarsophalangeal joint range of motion, shift the center of pressure medially, and balance the foot. A discordance was found between the theories of foot function on which clinicians placed the greatest importance and the biomechanical outcomes they thought were being achieved. Survey data also highlighted inconsistency in the nomenclature used to describe FLW thickness and inclination.