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What are peoples opinions on these OTS orthoses that are widely produced and sold by companies such as talarmade, sidas etcc... I see my patients buying these all the time and they report success but i cant see the benefit?
. I see my patients buying these all the time and they report success but i cant see the benefit?
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I see my patients buying these all the time and they report success
Surely this is the benefit - you know, the whole success thing?
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Any foot orthotic will work if it has the design feature(s) to deliver the prescription variable(s) that reduces the stress in the tissue that hurts, which could happen by design or by accident.
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I think that, frequently but not always, they can be a first class modality, achieving a huge reduction in patient symptoms at a greatly reduced cost. There has at least one formal randomised controlled trial - a Doctoral thesis before one wishes to criticise methodology - that showed that bespoke were no better. Rob
Surely this is the benefit - you know, the whole success thing?
Pmsl!
An orthotic is just a bent bit of plastic. If you can find a bent bit of plastic otc which is more or less the same shape as the custom made bent bit of plastic, it will do more or less the same job. And the custom bent bits of plastic are fairly homogenised in the lab!
An orthotic is just a bent bit of plastic. If you can find a bent bit of plastic otc which is more or less the same shape as the custom made bent bit of plastic, it will do more or less the same job. And the custom bent bits of plastic are fairly homogenised in the lab!
Something to mull over your Sunday roast Robeer: does it even need to be a similar shape to achieve similar kinetic effects?
The answer is proably no. We found, in my time on the staff at Northampton that a varus heel wedge was as likely to achieve success as a valgus heel wedge. The point was that it was altering the status quo mechanics. That is, it was affording rest to an area. Rob
The answer is proably no. We found, in my time on the staff at Northampton that a varus heel wedge was as likely to achieve success as a valgus heel wedge. The point was that it was altering the status quo mechanics. That is, it was affording rest to an area. Rob
Rob, while I take your point regarding clinical outcomes. The question I posed Robert Isaacs was regarding kinetic effects of foot orthoses. Is it possible to have two orthoses with different surface topography have the same kinetic effects?
It is probably time to be politically incorrect, even by my standards. you talk about different surface topography. You would need to to demonstrate that these were 1) statistically and 2) clincaly different before making any judgment. Are they? I know not, but I do know the question needs asking. I am essentially disinterested in various heel skives etc, but in order to rate them as being of any academic interest, one would first have to demonstrate 1) and 2) above. I am uncertain as to whether this has been been done. Rob
Rob, while I take your point regarding clinical outcomes. The question I posed Robert Isaacs was regarding kinetic effects of foot orthoses. Is it possible to have two orthoses with different surface topography have the same kinetic effects?
No it doesn't need to have the same surface topography, just the surface topography I want. In addition I'm not sure it need be plastic
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I see you girls checkin' out the front of my trunks
I see you girls lookin' at my junk, then checkin' out my rump, then back to my sugarlumps
sarcasm aside, what i was meaning in saying i cant see any benefit was functionally they seem to offer very little correction - if any. Is the reported success in the mind, im not convinced that very different symptoms/patients/foot types can be treated successfully with a generic 'bent bit of plastic'
sarcasm aside, what i was meaning in saying i cant see any benefit was functionally they seem to offer very little correction - if any. Is the reported success in the mind, im not convinced that very different symptoms/patients/foot types can be treated successfully with a generic 'bent bit of plastic'
Are we trying to 'correct' when we issue a device?
As has been discussed on here at various times, the research is split on whether foot orthoses provide any kinematic change (and whether they need to in order to 'work').
Two mechanisms of action of devices that we can't easily see/measure in clinic: (1) Kinetics (2) Psychological.
Any device will change (1). Some will also change (2).
To the OP - the fact is that some of these devices do work as well as custom orthoses.
The problem is that to some other professions (particularly orthopaedics in the UK) an orthotic is an orthotic is an orthotic.
Something I see from time to time (saw one last month).
Patient presents with chronic foot pain and brings with him/her a one-piece UCBL-type of device made from EVA and provided by the NHS. Couldn't wear them because they wouldn't fit into normal shoes. Actually this particular orthotic squashed up as soon as any weight was placed on it - something I've seen in NHS devices produced in several areas of the UK, so I suspect it's pretty common.
Orthopaedics, who originally asked for orthotics to "try", now know that orthotics are not going to work for this patient.
Never mind the fact that they were run off with no regard to patient weight, activity level or sex.
So in their mind orthotics are something to try - "keep the cost down old chap, because they probably won't work, but we have good old surgery to fall back on".
What is really annoying to me is that this type of device is clearly too flimsy to have much effect, and even if it did, to last for very long, but with a bit of thought and a little more spent on materials a device of sorts could be made which would at least have more chance of being successful. EVA, being a relatively cheap material, and cheap to machine too, suggests to my rather cynical mind (it's an age thing) that the NHS Depts churning these things out are less bothered about results and more bothered about ticking boxes cheaply.
To the OP - the fact is that some of these devices do work as well as custom orthoses.
The problem is that to some other professions (particularly orthopaedics in the UK) an orthotic is an orthotic is an orthotic.
Something I see from time to time (saw one last month).
Patient presents with chronic foot pain and brings with him/her a one-piece UCBL-type of device made from EVA and provided by the NHS. Couldn't wear them because they wouldn't fit into normal shoes. Actually this particular orthotic squashed up as soon as any weight was placed on it - something I've seen in NHS devices produced in several areas of the UK, so I suspect it's pretty common.
Orthopaedics, who originally asked for orthotics to "try", now know that orthotics are not going to work for this patient.
Never mind the fact that they were run off with no regard to patient weight, activity level or sex.
So in their mind orthotics are something to try - "keep the cost down old chap, because they probably won't work, but we have good old surgery to fall back on".
What is really annoying to me is that this type of device is clearly too flimsy to have much effect, and even if it did, to last for very long, but with a bit of thought and a little more spent on materials a device of sorts could be made which would at least have more chance of being successful. EVA, being a relatively cheap material, and cheap to machine too, suggests to my rather cynical mind (it's an age thing) that the NHS Depts churning these things out are less bothered about results and more bothered about ticking boxes cheaply.
how do you may a UCBL out of EVA? i thought they would need to be some kind of thermoplastic to coome up the sides?
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how do you may a UCBL out of EVA? i thought they would need to be some kind of thermoplastic to coome up the sides?
Precisely my point. The sides are EVA - the whole thing is one-piece machined from EVA.
The clinician wears a white coat (figuratively speaking), the foot is casted, and in a clinical environment. The device looks like a UCBL, but it can't work.
But to the uninitiated it is a UCBL - which didn't, unfortunately, produce the desired results.
Over the years I have seen these things come from Podiatrists in PP, and Orthotists in the NHS.
They may or may not be slightly more effective than a piece of insole-shaped poron with a felt "D" pad stuck to it (NHS - I've never seen this from a PP, yet).
[quote=Rob Kidd. The point was that it was altering the status quo mechanics. That is, it was affording rest to an area. Rob[/QUOTE]
Ride on Rob.
That sums it up.
Almost invariably the injuries are repetitive stress injuries.
If the nature of the stress is altered by someone who, in general terms, knows what they are doing, ie they are not advocating bed of nail insoles, then combining that with the bodies ability to adapt and if possible giving the patient the choice of a number of different types of insole/insert/orthosis and allowing them to choose the one that is most 'comfortable' (that's a word that could do with some unwrapping) it is likely to allow a broad range of 'interventions' to produce a 'satisfactory' outcome. To reduce the risk of recurrent repetitive stress injuries change the prescription every three to six months, ie alter the "status quo mechanics" but in an 'expert' way.
IMHO all practitoners (of every health care discipline) need to remember that that the answers lie in a rather unholy combination of art and science. Science is good - and I am first and foremost a scientist, but practice requires all sorts of degrees of pragmatism to provide the best health care outcomes for the patients. I don't remember this being taught at podiatry schoool! Rob
Precisely my point. The sides are EVA - the whole thing is one-piece machined from EVA.
The clinician wears a white coat (figuratively speaking), the foot is casted, and in a clinical environment. The device looks like a UCBL, but it can't work.
I'm afraid I can't have that. Can't work? Please define "work".
An EVA orthotic with a deep heel cup and high medial flange will have a kinetic effect. It will change internal mechanics in a different way to either a poring device or a polypropylene device. Different. Not better, not worse.
If we agree on that then we agree the phrase can't work must be wrong.
I'm afraid I can't have that. Can't work? Please define "work".
An EVA orthotic with a deep heel cup and high medial flange will have a kinetic effect. It will change internal mechanics in a different way to either a poring device or a polypropylene device. Different. Not better, not worse.
If we agree on that then we agree the phrase can't work must be wrong.
Hello Rob,
I suppose I meant to say "can't work in the way it was meant to".
But by your definition of work, wouldn't a drawing pin "work"? A mild heel-height change certainly would, but you wouldn't necessarily call that an orthotic.
The point I was making was that EVA devices which are shaped the same as a UCBL device, at least the one's I have seen, are pretending to be a functional device.
There may be some departmental budget expediency in making these devices this way.
Who knows.
In my original post I also made the point that these devices are often made (indeed the one I saw a few weeks ago was definitely made) without regard to sex, bodyweight or activity level.
When I have an EVA device on my desk which I can flatten with one hand, when I know the patient for whom it has been prescribed is over ten stones, and when I factor in that in single-support phase there is at least ten stones coming down on that device I reserve my right to give the manufacturer the benefit of the doubt.
I like to assume that he or she is pleasant enough, but simply not trained particularly well, and has not realised that the device is going to flatten when it is worn.
For the record, in our profession (Orthotist) a UCBL is a thermoplastic moulded orthosis - heel-cup with high medial and lateral walls, traditionally, Originating from the University or California Biomechanics laboratory.
UCBL's are useful for controlling heel eversion, but more importantly resist forefoot abduction with the combination of lateral wall in footwear - particularly good for controlling advanced plano-vagus posturing/hyerpronated foot like with advanced stages of Tib-Post dysfunction.
I have never heard of a UCBL being made of EVA, yes you can make a heel cup style EVA orthoses, but in our world, they would never be called a UCBL in the true sense. I would never expect an EVA orthosis to control or alter machanics anywhere near the extent a UCBL can achieve, if made correctly, that can be tolerated, that is often a challenge in these foot types that require this type of device.
For the record, in our profession (Orthotist) a UCBL is a thermoplastic moulded orthosis - heel-cup with high medial and lateral walls, traditionally, Originating from the University or California Biomechanics laboratory.
UCBL's are useful for controlling heel eversion, but more importantly resist forefoot abduction with the combination of lateral wall in footwear - particularly good for controlling advanced plano-vagus posturing/hyerpronated foot like with advanced stages of Tib-Post dysfunction.
I have never heard of a UCBL being made of EVA, yes you can make a heel cup style EVA orthoses, but in our world, they would never be called a UCBL in the true sense. I would never expect an EVA orthosis to control or alter machanics anywhere near the extent a UCBL can achieve, if made correctly, that can be tolerated, that is often a challenge in these foot types that require this type of device.
Exactly so, although to be fair the EVA devices were not actually called UCBLs, they just looked awfully like them - deep heel cup, high medial and lateral flanges, posting (of sorts) forefoot and rearfoot.
I was delighted to compare a proper UCBL side-by-side with one of these devices recently and I can assure people that to the uninitiated they look the same, except for colour. It's only when downwards force is applied that people can see the difference. One flattens, the other doesn't.
For the record, in our profession (Orthotist) a UCBL is a thermoplastic moulded orthosis - heel-cup with high medial and lateral walls, traditionally, Originating from the University or California Biomechanics laboratory.
UCBL's are useful for controlling heel eversion, but more importantly resist forefoot abduction with the combination of lateral wall in footwear - particularly good for controlling advanced plano-vagus posturing/hyerpronated foot like with advanced stages of Tib-Post dysfunction.
I have never heard of a UCBL being made of EVA, yes you can make a heel cup style EVA orthoses, but in our world, they would never be called a UCBL in the true sense. I would never expect an EVA orthosis to control or alter machanics anywhere near the extent a UCBL can achieve, if made correctly, that can be tolerated, that is often a challenge in these foot types that require this type of device.
For the record, UCBL devices were originally made from a Nylon and glass fibre composite. I've attached Henderson and Campbell's original paper on fabrication.
Hey David. Its a pleasure to rub brains with you again. I seem to remember going around this particular stump before.
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I suppose I meant to say "can't work in the way it was meant to".
As you know, I don't like to be pedantic . But how do you know how it was meant to work? What if, on that persons prescription, was written "provide something squeltchy to decellerate pronation and reduce the peak residual moment without altering the maximally everted position.
Then I would argue that it can work the way it was meant to. And nothing wrong with that as rationale for a device IMO.
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But by your definition of work, wouldn't a drawing pin "work"?
Again, depends what you mean by work.
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A mild heel-height change certainly would, but you wouldn't necessarily call that an orthotic.
I would. It meets the definition.
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The point I was making was that EVA devices which are shaped the same as a UCBL device, at least the one's I have seen, are pretending to be a functional device.
How exactly was it "pretending". Did it have "functional device" printed on it or did it slither by night into the functional orthotics cupboard and hide amidst the polypropylene, cuckoo like.
A functional device is a device which changes function, which is almost anything. A high flange EVA device most certainly will.
A functional foot orthotic could be defined one of two ways, either as Roots concept (which is a specific type of device which I suspect very few people use in the purist sense) or in the more general sense as an orthotic which changes the way the foot functions, which is pretty much any orthotic or insole.
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I would never expect an EVA orthosis to control or alter machanics anywhere near the extent a UCBL can achieve,
Controlling mechanics now are we? You're a better man than I am if you can control foot mechanics. Could you, for example, tell me how many degrees eversion in the rearfoot there will be at 37% of the gait cycle after you've put your insole in? Control is a brave word. Alter or influence is a bit more realistic I think.
As to whether a UCBL can alter mechanics to the extent an EVA device can it depends what you want to alter the mechanics TOO. Its apples and oranges. Be like saying a crash mat cannot affect somebodies fall from a platform so the extent of a pile of concrete slabs. Both will ALTER the mechanics of the fall. If you're trying to alter the fall to "one which won't kill you" then the concrete can't alter it to the same extent as the crash mat. If you're trying to alter it to "one which won't allow any body parts within 12 inches of the ground" then the crash mat can't alter it as much as the slabs.
It seems to me that you make a comparison between a shank dependant device sitting on a table to a shank indepent device sitting on a table.
I frequently use EVA devices on people of more than 10 stone that have high activity level and are male(presumably bigger). It doesn't really matter. As has been talked about frequently on here, how do orthoses work? I take the qualification about working as they are supposed to but how do you even know that your UCBL in plastic is doing that. My answer would be that it resolves the problems of the patient. EVA devices resolve the problems of the patients too - with no regard to budget or PP vs NHS(or activity level/sex/weight)
Anyone who only prescribes the same device for a 6 stone, inactive lady with tib post dysfunction and a 6 stone runner with mild plantar fascia pain and "normal" sub talar joint axis alignment is just as misguided as someone who takes no account of sex, weight and activity level
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I see you girls checkin' out my trunks
I see you girls checkin' out the front of my trunks
I see you girls lookin' at my junk, then checkin' out my rump, then back to my sugarlumps
Off the shelf orthotics
be some departmental budget expediency in making these devices this way.
I seem to remember going around this particular stump before. 
. But how do you know how it was meant to work? What if, on that persons prescription, was written "provide something squeltchy to decellerate pronation and reduce the peak residual moment without altering the maximally everted position.
How exactly was it "pretending". Did it have "functional device" printed on it or did it slither by night into the functional orthotics cupboard and hide amidst the polypropylene, cuckoo like. 
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