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Alot has been said about the effectiveness of foot orthoses.
Has anyone got any research papers or references on exactly HOW the orthoses work.
It seems that "for every degree of pronation at the STJt there is an equal amount of internel rotation of the tibia" which causes a genu valgum, LLD etc etc has gone out of fashion.
I need articles on what the orthoses does and what effect it has on posture.
Alot has been said about the effectiveness of foot orthoses.
Has anyone got any research papers or references on exactly HOW the orthoses work.
It seems that "for every degree of pronation at the STJt there is an equal amount of internel rotation of the tibia" which causes a genu valgum, LLD etc etc has gone out of fashion.
I need articles on what the orthoses does and what effect it has on posture.
Please help.
Thanks
I would suggest a good starting point would be to read the list of references Prof. Kirby listed in the skives and posts thread.
There is only one way foot orthotics work: They reduce stress in injured tissues.
Quote:
for every degree of pronation at the STJt there is an equal amount of internel rotation of the tibia"
Where did you get that from? - it never been true. there is plenty of good data that says otherwise
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
One big thing I got from CP last weekend on how foot orthoses work was - they reduce forces! Its amazing how simple it can be. Why all the focus on degrees and angles and motion?
Dear All,
We know that the mechanism of custom orthotic therapy for the painful cavus foot is by reduction and redistribution of plantar pressure (Burns J, et al. Effective orthotic therapy for the painful cavus foot: A randomized controlled trial. JAPMA 2006;96:205-211.)
Perhaps this mechanism is also true for the 'normal' and planus foot types? Redmond et al (2000) has shown that in individuals with 'excessive' pronation, foot orthoses also have the effect of reducing and redistributing plantar pressure (Effect of cast and noncast foot orthoses on plantar pressure and force during normal gait. JAMPA 2000;90:441-9). However, this improved plantar pressure distribution has not been shown to result in a reduction of patient symtoms in patients with excessive pronation (yet?).
Regards
Joshua Burns
NHMRC Australian Clinical Research Fellow
However, this improved plantar pressure distribution has not been shown to result in a reduction of patient symtoms in patients with excessive pronation (yet?).
We got a paper 'in press' at JAPMA that shows no correlation between between changes in the pattern of rearfoot motion and changes in patient symptoms. We also got some exciting data that preparing at the moment on failed orthoses in plantar fasciitis that surprising shows a very consistent and obvious change in some plantar pressure parameters in the orthoses that failed.... we live in exciting times...
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
There is only one way foot orthotics work: They reduce stress in injured tissues.
I need to disagree with you here, Craig. Foot orthoses do not only "work" by reducing "stress in injured tissues". Foot orthoses, more specifically and accurately, reduce the magnitude of pathological forces and/or stresses acting on selected structural components of the foot and lower extremity that are either currently injured or that may be currently uninjured to either try to heal current injuries or to prevent injuries from occurring in the future. Foot orthoses are also commonly used to improve performance in sports activities such as in alpine skiing and ice skating. Foot orthoses are commonly used likewise to improve the function of gait, such as in treating abnormal gait patterns in children and adults. I would agree that the major function of foot orthoses is to reduce stress in injured tissues, but to say that "there is only one way foot orthotics work: they reduce stress in injured tissues", would not be an accurate reflection of the multiple clinical uses and performance-enhancing capabilities of foot orthoses.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
This thread gives me a chance to raise something I was going to start a new one on....
In the context of Karl's study (Effectiveness of Foot Orthoses to Treat Plantar Fasciitis) that showed no difference between prefabs and custom made for plantar fasciitis and comments made by Ed in the Skives & Posts thread and many other threads we have had ... what is the role of foot orthoses. I think we can agree on the altering force thing, but where I see a lot of disagreemnt that does happen is in the concept of:
"Masking of symptoms" vs "biomechnical correction"
Its obviously in the professions best interest to claim the prefabs "mask symptoms" and custom made achieve "biomechancial correction" -- but what really is "biomechanical correction"? I certainly do not think we can agree on what it is and there is certainly no evidence to say what it is. Is it really important to achieve "biomechanical correction" rather than "mask symptoms" .... to me this is where the "can of worms" lie...
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
]
Its obviously in the professions best interest to claim the prefabs "mask symptoms" and custom made achieve "biomechancial correction" -- but what really is "biomechanical correction"? I certainly do not think we can agree on what it is and there is certainly no evidence to say what it is.
Good point Craig.
Clearly biomechanical correction hails back to the bad old days when it was largely accepted that anything deviating from the "norm" (ie lower third of the leg perpendicular to the supporting surface and heel and mets in the same plane) was abnormal and needed "correcting".
So is "biomechanical correction" an outmoded, and redundant concept?
I say yes.
Why fit devices?
I believe (and I have to be careful what I write here!) that orthoses, whether custom or pre-form, do little more than provide an interface between the foot and shoe/supporting surface. They allow the foot to work a little more around STJ equilibrium position on those surfaces which may otherwise force the foot into constant and repeated pronation.
My own preference for custom devices derives, not from the fact that they achieve "biomechanical correction", or even from profit motivation, but more from good customer service.
Custom devices, in my experience, fit shoes better, last longer (with many labs now guarranteeing their devices for life), are much more resistant to dog-chew etc etc.
Seems as though I have been too simplistic as the replies so far are just plain useless.
A Pt arrives in the clinic with knee, hip, lower back and neck pain. You assess the gait, do your biomechanical assessment etc, I'm not going to go too far into this.
You find that there is a bi-lateral HAV, genu valgum causing a LLD all on the left.
Left hip 20mm lower than right, functional scoliosis and right shoulder 10mm lower than left.
Pt complaining of shin splints on left, sciatica on right, left knee pain with crepitus and lower back pain, slight neck crepitus due to compensation, clicky jaw (one for you Rothbart), also headaches.
I have dummy insoles in clinic with medial wedges so I used these and the genu valgum reduces, hips become equal aswell as shoulders (this is where the supination and external rotation of the tibia comes in Mr Aussie, BTW I was taught this at Uni and I feel its true whatever the research says, seen it too many times to dismiss it).
Pt returns in 2 months and is pain free.
I feel that the tibia has externally rotated reducing the genu valgum, this in turn has levelled the hips and therefore no need for functional scoliosis which has resolved the sciatica.
Neck well, no need to compensate so inline with spine. Pelvis now in correct position so no kyphosis and jaw retracts to its normal position resolving clicking.
Now forgetting redistribution of forces as if we are talking about resolving callus or corns, PF etc.
POSTURALLY at every joint above the orthoses, WHAT IN YOUR OPINION DOES THE ORTHOSES DO.
Forget the plantar forces I am talking at the joints. Using the analogy above.
If the tibia does not externally rotate Mr Aussie how else would the orthoses resolve the knee pain (pat-fem syndrome).
Last edited by biomech : 30th June 2006 at 05:32 AM.
We got a paper 'in press' at JAPMA that shows no correlation between between changes in the pattern of rearfoot motion and changes in patient symptoms. We also got some exciting data that preparing at the moment on failed orthoses in plantar fasciitis that surprising shows a very consistent and obvious change in some plantar pressure parameters in the orthoses that failed.... we live in exciting times...
Craig,
When you say no correlation in bold letters do you mean that the linear model did not fit well? r square? Did you attempt to fit curvi-linear; cubic quadratic etc.? Did you attempt any scale adjustment- log etc.? As you know, saying "no correlation", may well be misleading to some readers.
When you say no correlation in bold letters do you mean that the linear model did not fit well? r square? Did you attempt to fit curvi-linear; cubic quadratic etc.? Did you attempt any scale adjustment- log etc.? As you know, saying "no correlation", may well be misleading to some readers
Pearson's r was used.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
...you will motivate people not to help and get replies like:
Quote:
hey mr biomech whatever you're on save it for the weekend........ you're unlikely to get a response when you address these "gentlemen" so......
and
Quote:
Nice attitude. Obviously went to the Spooner school of charm and grace. Cool Cool. But not the way to get what you want
and you expect a response from me when I do not know you and you say this:
Quote:
If the tibia does not externally rotate Mr Aussie how else would the orthoses resolve the knee pain (pat-fem syndrome).
.... anyone that knows me knows I am not Australian.
But I will respond anyway - where did I say "If the tibia does not externally rotate "? I said: "Where did you get that from? - it never been true"in response to your comment of "for every degree of pronation at the STJt there is an equal amount of internel rotation of the tibia" . I can only assume you are not familiar with all the research on coupling, that shows its not one to one and varies between pronation and supination. I assume you are also unfamilar with all the work on foot pronation/tibial rotation NOT being associated with knee pain (discussed here).
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
bugger off .... its 4.00AM Saturday and I on way to airport to talk all day in sydney.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
Alot has been said about the effectiveness of foot orthoses.
Has anyone got any research papers or references on exactly HOW the orthoses work.
It seems that "for every degree of pronation at the STJt there is an equal amount of internel rotation of the tibia" which causes a genu valgum, LLD etc etc has gone out of fashion.
I need articles on what the orthoses does and what effect it has on posture.
Please help.
Thanks
I really have a difficult time convincing myself to spend any time to answer questions from individuals who don't have the courtesy to give me their real name in public forums. I'm sure I am not alone in my feelings on this. If you want a reply, then tell us who you are and ask respectfully, or you won't get what you want, at least from me.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
This thread gives me a chance to raise something I was going to start a new one on....
In the context of Karl's study (Effectiveness of Foot Orthoses to Treat Plantar Fasciitis) that showed no difference between prefabs and custom made for plantar fasciitis and comments made by Ed in the Skives & Posts thread and many other threads we have had ... what is the role of foot orthoses. I think we can agree on the altering force thing, but where I see a lot of disagreemnt that does happen is in the concept of:
"Masking of symptoms" vs "biomechnical correction"
Its obviously in the professions best interest to claim the prefabs "mask symptoms" and custom made achieve "biomechancial correction" -- but what really is "biomechanical correction"? I certainly do not think we can agree on what it is and there is certainly no evidence to say what it is. Is it really important to achieve "biomechanical correction" rather than "mask symptoms" .... to me this is where the "can of worms" lie...
Craig:
I think we probably agree, but I had to step in and clarify your "black and white statement" since foot orthoses do work and are commonly used in improving athletic performance and preventing injury in uninjured individuals. I'm sure you just rushed in writing your statement, getting ready for your talk in Sydney. Craig, do the Harbour Bridge Walk for me since I had a great time doing that the time I lectured there in 2002.
The term "masking of symptoms" is erroneous, misleading and is another one of Ed Glaser's terms I don't like. Orthoses don't mask symptoms, they cure injury. Does treating an infection with antibiotics "mask symptoms"? Does doing an ORIF on an ankle fracture "mask symptoms"? Does decreasing the tensile stress in the posterior tibial tendon during weightbearing activities so that the tendon heals and becomes nonpainful with a foot orthosis "mask symptoms"? No, no and no. A local anesthetic will mask symptoms since it prevents the central nervous system from being aware of a noxious stimulus. Ice application will mask symptoms since it numbs and temporarily reduces inflammation to an injured area. However, foot orthoses do not numb or block neural pathways to injured areas which would be the best clinical example of "masking symptoms". Foot orthoses mechanically reduce the pathological forces and stresses that allow injuries to heal so that the pain is reduced.
Orthoses do alter externally applied forces and pressures, alter internal forces, internal moments and inernal stresses, and alter motion patterns of the feet and lower extremities. We have the research evidence to support these mechanical effects that foot orthoses have on the human locomotor apparatus. Is this "biomechanical correction"? I don't really like the term "biomechanical correction" either, since this implies a permanent change in biomechanical function from foot orthoses. I think that a much better term for what foot orthoses do is biomechanical optimization.
Biomechanical optimization: An improvement of the kinetics and kinematics of the locomotor apparatus of an individual so that weightbearing function is enhanced and the likelihood of musculoskeletal injury is minimized.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Biomechanical optimization: An improvement of the kinetics and kinematics of the locomotor apparatus of an individual so that weightbearing function is enhanced and the likelihood of musculoskeletal injury is minimized.
Orthoses certainly have the capacity to alter kinematics and/ or kinetics, and, may even improve function, but optimization suggests making the best or most effective use of something. Can we say with certainty that this is what orthoses do?
Orthoses certainly have the capacity to alter kinematics and/ or kinetics, and, may even improve function, but optimization suggests making the best or most effective use of something. Can we say with certainty that this is what orthoses do?
Good point, Simon. Certainly our goal with foot orthoses is "biomechanical optimization" but we probably never achieve it with foot orthoses alone. However, "optimization" does describe a process where both the positives and negatives of a process are taken into account to achieve a goal, whereas "correction" describes more of a removal of defects in a system to make it function better. I am open to suggestions for a better term.
op·ti·mize
verb
1. vt enhance the effectiveness of: to make something function at its best or most effective, or to use something to its best advantage
cor·rec·tion
noun
1. alteration that improves: an alteration that removes an error
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I have been reading the latter discussion, and agree with that the foot orthoses operate reducing "stress in injured tissues", reducing the magnitude of pathological forces and/or stresses acting on selected structural components of the foot and lower extremity, …
I have been charmed with the concept of biomechanical optimization.
I think also that the foot orthoses work for the alteration that provokes in 4 ª dimension at which the foot is employed, the time. I think that the biomechanical optimization also happens to temporary level, since it would not be the same thing, to support a pronation of 5º during a second in the settled phase of the march, that during 5 seconds.
Even I have thought of doing a review on the topic, to do a brief publication.
Would that thinks about this concept, be in the certain thing?
Why is it that too many of you hang your profession only on published studies, any studies.
Why is it that too many of you disregard the years of real life, real practice expereince?
Comments on two Subjects:
Orthotics
Some please explain to me why in my 28 years of practice experience, I find that my patients who failed pre-fabs and other initial conservative care, do remarkedly well with prescription functional orthoses - made from plaster casts. Further, explain to me why so many of them call to have 2nd and 3rd pairs for other shoes/activities? Oh, and in case you aren't following this runaway train wreck for podiatry, even if their first pairs were paid for by insurance, the 2nd and 3rd pairs are paid for outof the patient's own pocket. And, why is it that my more serious athletes, yearly, come in religiously for new prescription functional (not just customed, but corrective) orthotics.?
Why isn't my hands on practice experience more valuable then a study that could be biased.
ESWT
Why do some of you continue to bring up the totally flawed study done by an unqualified radiologist? The last time I checked, radiologist don't touch patients and lack the training and experience to examine, diagnosis, or treat sports medicine conditions.
Again, I want to throw in your face, real practice experience. When the Dornier EPOS Ultra is used in the method approved by the US FDA, and applied to the patients that meet the criteria that accepted and approved by the US FDA, remarkable results are seen? Why are my patients - going back nearly 7 years - recommending ESWT to their family members and friends, and come back to have the symptomatic other foot treated, begging me not to make them go through the 6 months of hell that the US FDA requires?
Why? Why? Why?
Dr. Payne,
I see you are coming to Chicago in December. I want to promise you two things, a taste of a Chicago Winter, and a taste of a Chicago dinner on me. Are you up for it ??
__________________
Robert Scott Steinberg, DPM, DABLES, FACLES
Surgical Instructor, Department of Podiatric Medicine and Surgery
Norwegian American Hospital, Chicago
Office 847-885-8806 Doc@FootSportsDoc.com
I see you are coming to Chicago in December. I want to promise you two things, a taste of a Chicago Winter, and a taste of a Chicago dinner on me. Are you up for it ??
Unfortunatly I have had to pull out of the mtg :( ... twins on the way and due then :) ... me in big trouble if go :(
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
Unfortunatly I have had to pull out of the mtg :( ... twins on the way and due then :) ... me in big trouble if go :(
Craig:
Glad to see that the twins are now public news. Give my regards to Mimi and wishing you the two the best with the new additions to your family.
By the way, I'm "expecting" my first grandchild in the next few weeks and I'm feeling very old as a result. My wife and kids now tell me that I need to soon decide if I will be called Grandpa, Papa, Grandad or some other "old" name. I have been told that the best thing about being a grandparent is if you get tired of the grandkids, you can always send them back home to the parents.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
How and what does the orthoses do to elleviate the pain in the knee
How and what does the orthoses do to elleviate the pain in the lower back.
How did it level the hips and resolve a functional scoliosis?
Simon was a tutor down south at Plymouth University I think. I can just see him now asking this question to his students.
Statement earlier..."that the foot orthoses operate by reducing "stress in injured tissues", reducing the magnitude of pathological forces and/or stresses acting on selected structural components of the foot and lower extremity, …"
but how does it do this. What is happening to the skeleton itself, what is rotating, shifting etc to explain the reduction in the above.
Anyone can make the statement above but HOW does it do this.
Simon was a tutor down south at Plymouth University I think. I can just see him now asking this question to his students.
Statement earlier..."that the foot orthoses operate by reducing "stress in injured tissues", reducing the magnitude of pathological forces and/or stresses acting on selected structural components of the foot and lower extremity, …"
Biomech, as far as I know, I don't know you and you don't know me, so until such time that you reveal you identiity, I would prefer it if you didn't make sweeping statements as to what I may or may not have asked as questions to students when I was a Lecturer and/ or Head of School of Podiatry at the University of Plymouth.
You clearly have a far greater understanding of biomechanics than myself or any of the other people who have responded to your initial request, which was: "I need articles on what the orthoses does and what effect it has on posture". Since after I gave you direction to a list of references which may have helped you resolve the question, you then decided that this was not what you wanted and really what you want to know is: how a pair of orthoses which you give little, if any, detail on had a beneficial effect in a patient whom none here, but yourself has seen and to which you have offered little if any detail regarding. So enlighten us, what mechanical effect did these orthoses have and how did you measure this?
Quote:
Originally Posted by biomech
Anyone can make the statement above but HOW does it do this.
Biomechanics and foot orthoses
Only joking on a Friday night.
Linear Mode
