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DEAR COLLEAGUES
I have recently had one of my patients advise me that their chiropractor had informed them that the orthoses I had issued were not working ....
The pt. was assessed by the chiropractor in their shoes walking across a pressure mat ,the pt. was then assessed again with my orthoses in their shoes walking across the pressure mat . From this analysis the pt. was advised that their orthoses were not working .. a colour print out was issued .
Can a pressure mat really show the effectiveness of an orthotic through the sole of a shoe ?
Pressure mats look interesting and colourful !! I don`t use any form of in or out shoe pressure analysis , but I`m aware of the useful information that can be collected and used as part of ones assessment , diagnosis and treatment plan .
I will be seing the chiropractor in the near future, but as a podiatrist who is not using a pressure system, I would like to inform him of our views as a profession regarding the realistic parameters of such systems ... ALL VIEWS would be gratefully received.
1. Step to step variabiliy is so great, that one reading/step across a pressure mat is of dubious value (we use software to average lots of steps)(in response to this question they will probably have no idea what you are talking about:) )
2. Ask them what parameter(s) they were looking at that was not changed with and without the use of the foot orthoses to determine they were not working. Then ask what does the change in that parameter actually have to do with patient outcomes (wait for the marketing spin and absence of facts in response to this question:) ).
3. Which pressure mat are they using? Ask him how often is it calibrated (wait for the marketing hype in response to this question:) ).
We are pretty close with our research to nailing down what parameter(s) foot orthoses need to change that are correlated to a reduction in symptoms (ie outcomes). So far, changes in the pattern of rearfoot motion is NOT one of the parameters that predict outcomes. So far, the changes in paramaters that appear to be predictive of outcomes (we still got a bit of work to finish) can not be measured with pressure mats.
Well searched Luke!
I've got the triaxial force sensors sitting on my desk next to me and I've got two insole systems up and running. It's very early days, but we'll see how it goes. If you'd like more info on the sensors, have a look at the pages on the Kent website - http://medical.kent.ac.uk/research/gait/gait.html, or alternatively have a look at the realprof project website - http://www.realprof.eu.com/
It'll be interesting to see how they compare to inshoe pressure systems and force plates.
Lee
Really? No way! Back to the drawing board then!
That old pressure/force conundrum gets me every time.
I'm not comparing force measurements to pressure measures. It's more from a clinician and user point of view.
Last edited by Lee : 3rd December 2004 at 09:08 AM.
2. Ask them what parameter(s) they were looking at that was not changed with and without the use of the foot orthoses to determine they were not working. Then ask what does the change in that parameter actually have to do with patient outcomes (wait for the marketing spin and absence of facts in response to this question:) ).
3. Which pressure mat are they using? Ask him how often is it calibrated (wait for the marketing hype in response to this question:) ).
We are pretty close with our research to nailing down what parameterparamaters that appear to be predictive of outcomes (we still got a bit of work to finish) can not be measured with pressure mats.
CONCLUSION: Its just marketing hype
I'm 100% with CP on this one.
I'm in private practice, see mostly biomech referrals from orthopaedics, and use a Tekscan pressure mat for pretty much all my patients.
The limitations of this mat, when compared with, say, the much more expensive Musgrave pressure plate, would seem to lie with the reliability of specific pressure measurement of the type you may need for diabetic patients for example. However, as an educational tool for patient awareness, as a baseline measurement tool for gross gait parameters such as angle of gait in paediatrics, and for gross pressure measurement during ambulation (it shows 1st ray excess pressure during toe-off nicely) etc, the mat works weel and I wouldn't be without it.
I don't use my mat to rubbish other practitioner's work, presumably with a view to selling your patient a second pair of devices . Reprehensible behaviour which should be reported to the chiropractic professional body (along with various quotes from this site).
Cheers,
Davidh
Force plate measurements with shod and unshod feet would be completely different. They do not measure the same thing. Here in South Africa the Physio's and Chiropractors are trying to capitalize on orthotics for their patients. A bad thing! Their knowledge on foot biomechanics is very limited. One way to try convince the patient is with force-plate measurements. A dangerous tool in their hands I would say. Vernon Lever
l saw a pressure Mat been used in a shoe store, the pressure mat sits 5cm high and they asked the client to walk across it, only one foot is on whilst the other strikes the ground 5cm lower...what is that going to tell you that's of use to anyone
Maybe your Chiro mate is doing the same.
The one question not being asked so far is what is the Chiropractor trying to gain out of these claims. The first point of call on a professional level would be to approach the practitioner and raise concerns and not just throw theses claims to the patient who then relays it back to yourself.
I have spent numerous years working along side Chiropractors and boy do these guys know how to sell stuff
Also the model of muscularskeletal treatment and alignment is also an issue. my experience of a chiroporactic model would say that unless your foot is in perfect alignment with blocked excessive movement then ORF COP COM mean nothing to the principals of treatment.
I would summise that the chiropractor is trying to sell his own type of orthotic and they would follow a model like foot levelers or rothbarts for simplicityor off the shelf models
There are way too many variables being introduced for the DC to make such a statement. The fit, condition, and suitability of the shoes for orthotics are major factors. Also, I wonder what the patient was being treated for by the DC. Was it the same complaint? How long had the patient worn the shoes and broken them down before inserting the orthotics?
l saw a pressure Mat been used in a shoe store, the pressure mat sits 5cm high and they asked the client to walk across it, only one foot is on whilst the other strikes the ground 5cm lower...what is that going to tell you that's of use to anyone
Maybe your Chiro mate is doing the same.
Hi David, I cant believe what they do! In a shoe store as well. Anyway what you have mentioned in my opinion is just a sales pitch, as you would get some useless information from what you have described, especially since the mat was 5cm higher....what a crock of S---. Stay well. VBernon.
They are set up in a large chain of Athlete type shoe store's, the strike area is 34cm X 34cm, so accuracy is essential, most of the stores have a little ramp on three sides of them and a vertical stand on the four side, the ramps are about 20cm wide.
If you ever get a chance, sit outside one of these stores and watch how they use these wonderful marketing tools, l am yet to see one of the store staff check to see the improvement after the sale of the right shoe for the job.
l have one also, but wont use it just yet...for me it could be okay for showing the client how they "stand" but not how they walk, each to their own l guess.
Did anyone realise the original post was back in 2004???? I wonfer what happened to the rest of the story.
Anyway, interesting discussion.
Was reading an advertisment by a prefab making company regarding their insoles and they highlighted as parts of their features, how much their insoles could affect rearfoot motion.
Then I read Craig's above statement "So far, changes in the pattern of rearfoot motion is NOT one of the parameters that predict outcomes." I am interested in reading up on that study Craig was referring to though. Anyone have an idea which article those outcomes got published in?
I believe that an article which is related with same problem is :
"Effect of foot orthotics on rearfoot and tibia joint coupling
patterns and variability", Reed Ferbera, Irene McClay Davisb, Dorsey S. Williams IIId, Journal of Biomechanics 38 (2005) 477–483
Orthoses are not working if the patient's treatment goals are not being met (unable to wear orhosis, pain not improving, not able to return to running etc.). You don't need a pressure mat to determine this. The marketing hypothesis is probably correct.
I think an in-shoe pressure system is more useful if you are trouble shooting an orthotic that isn't working. There is a lot of variability with the pressure mats. Speed approaching the mat varies with each step. Also, patients sometimes inappropriately target the mat when they step on it. The center of pressure rocks back and forth like a 3 year with a new blue crayon when this is the case.
I like Craig's comments and hope we can find a consensus on what variables predict good orthotic outcomes for different clinical situations.
Foot Pressure Mat Warning
Que?
. Reprehensible behaviour which should be reported to the chiropractic professional body (along with various quotes from this site).
Linear Mode
