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Following on from a thread some months ago on MTSS i have just come across this recent article published in foot and ankle specialist.

Does any one fancy adding some comments on this study:

1. The use of off-the peg orthosis with no description of mods etc..
2. no control group, just one small group of 23 all given alimed basic insoles with calf stretches.
3. they used static measurements like navicular drop etc which has already been used in MTSS studies and shown to have no correlation with symptoms.
4. there is no mention in the study on the foot types and the biomechanical characteristics of subjects.

Just... Stuck some simple insoles in participants shoes, gave them some stretches and after 3 weeks of intervention Of the 23 partipants, 15 had successful
treatment outcome producing a 62.5% pretest probability of treatment success!

After reading this article im not sure how you would interpret the results. Is it a good thing to show MTSS improving with inserts ( i wouldnt call them functional foot orthosis) and or calf stretches and seen as thought there wasnt a control group or group with just orthosis and stretching how do we now which actually provided the best results.

Is it a bad thing that anyone without a clue of foot function can shove some insoles in a persons shoe without considering what there attempting to do to that foot. Does this mean that in the overall scheme of things just giving some one something in there shoes will make a difference? and if this is the case will we see more people attempting this?

Attached Files

MTSS.pdf (426.0 KB, 42 views)

Hi Matt,

Thanks for the article. Only had a cursory scan of it, but first major thing to strike me is, as you say, the lack of a control group. Not too sure why they didnt do it to be honest - it wouldnt have been that much more work. Perhaps an issue with recruitment?

I'd also like to see some more information about the navicular drop method. With a test such as this there is potential for measurement error (and hence a threat to validity of the study) so at the very least I'd expect to see stats on their intra-tester reliability of the navicular drop test (via test-retest). Along with this we'd need some inter-tester reliability figures if both authors took measurements - they do not tell us.

I'm sure theres lots more holes; someone with a far greater knowledge of research methods and stats than I (Simon, Craig et al) will hopefully comment.

Ian

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Hey Matt & Ian,

I just had a quick read over the article and the main thing that stood out to me as strange was;

"The purpose of this study was to determine the effectiveness of a basic treatment protocol, consisting of gastroc-soleus stretching and foot orthotics in diminishing the pain level in individuals with MTSS."

"However, because we did not measure dorsiflexion at the conclusion of the 3 weeks, we have no way of knowing if this range improved. We can speculate that it did improve, and perhaps with control of foot pronation with the orthotic and improved dorsiflexion, tissue stress along the medial tibia was minimized."

This is my first post (so be gentle ) but wouldn't you want to know if the strecthing made a difference (or not) in ankle ROM so that you could relate this to your results???? Or am I missing something... I'm not trying to start a debate on the relevance/reliabilty of ankle ROM by the way

Also, I don't recall any mention of the type of activities pre-intervention and whether the activity level/type remains constant peri-intervention as I would think a change or reduction in these activities could explain the reduction we are seeing in the "successful group" post-intervention.

Looking forward to other comments.

Tim Madden

Hi Tim

Yes of course you would want to know if ankle dorsiflexion improved, the problem is that a few studies have already looked at stretching exercises as part of the treatment for mtss and found them to have no significant effect - i think it was the jordan,schwellnus and noakes RCT study in military recruits. As with most studies based around stretching and orthosis there are many variables, and indeed as ian pointed out, there is a problem with measuring the navicular angles due to inter observer reliability. When you read the paper there are more holes to pick, even though the outcome suggest that orthosis have a role to play in treating MTSS i bet this studies impact factor is near to 0/10. Kevin Kirby has some really interesting ideas on the mechanics of the lower limb and their role in MTSS so hopefully he will chip in at some point.

I have written a new article on medial tibial stress syndrome, titled "Current Concepts In Treating Medial Tibial Stress Syndrome", which will be published in the April 2010 issue of Podiatry Today. I will post this article up on Podiatry Arena once it is published and available online.

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__________________
Sincerely,

Kevin

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Kevin A. Kirby, DPM
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Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

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