Rothbarts Devices-the Snake Oil Stops Here?

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Dear All......this thread is meant to carry on from the discussion on new Biomechanical models, which seems to have run out of steam.
I draw attention to the thread posted on 20/2/07 by Dr. Petros Kattou on "That Foot Site".........the actual data, and description of the 3D Formetric equipment used can be found on www.rothbartsfoot.info pages 288 289 293 297. It makes interesting reading.

Just as Rootian Bx started as being purely anecdotal, till the science caught up with it.....from the study quoted here, surely Rothbart's embryological PMS foot type should be looked at seriously again. In the 2 years since I've been using the devices, I've come to the not altogether surprising conclusion that looking at the patients posture instead of smaller and smaller parts of the foot gets me better results. The foot problems we're seeing in surgery are compensatory sure.....but they're part of a much larger symptom pattern.
My work with these devices has brought me into professional contact with physios/osteopaths/sacral occipital teknik practitioners/Bowen therapists/dentists and cranial osteopaths.......all of which has made my practice a sight more interesting!
We are always complainig that we are not taken seriously, and patients undervalue our skills.....you help their hip/knee/back pain with devices that are comfortable and fit into everyday shoes and they start taking you very seriously. A refreshing change.
There's a whole big professional world out there that doesn't revolve around podiatry...and these guys are taking Rothbarts theories seriously. For the reason they're getting results.

Go have a look at the website, see the photos and ask the question....can I do the same with the devices I'm currently prescribing?........and now you have scientific evidence to back up your alternative choice!!

Brian Rothbart is holding a 2 day seminar in London on MAY 19/20, so, if you're really interested in a new Biomechanical paradigm come along and discuss/argue(!)/ and learn.

For details I can be contacted at alexcatto@blueyonder.co.uk

 

Alex:

Are you also prescribing proprioceptive insoles for your patient's infertility as Brian Rothbart has recommended on his website???

 

Hi Alex

While I understand your comments and they have some sympathy from me in terms of I never choose to throw out the bathwater never mind the baby (nor can I argue the niceties of all this stuff) I feel that much of what you describe in terms of effect of devices does not necessarily need Brians approach alone. Nor need it be singulaly linked to the insoles alone either.

I do agree with you that Pods have long missed their opportunity to impress other disciplins, but perhaps it is because we have been to precious about our way and understanding and failed to get to grips with where these disciplins come from and what they need from us!

I can only say that for more than 10 years I have approached podiatric biomechanics from a perspective of head to foot rather than foot to head.

I started working with physio's and assessing pts alongside physios over 10 years ago and readily suggest that many pts have had postural improvement and what appears to be more efficient forms of gait (i.e. efficient in terms of whole body actions which is what I look to see) as a result of the combined approaches. Yes, I have preferred this to relying upon any particular type of device.

I have had a couple of times when a psychotherapist approached me with a view to seeing if postural changes and devices might help their clients. My answer is I don't know but willing to give it a try and have witnessed, on a number of occasions, low self esteem individuals become more proactive and confident as posture has improved using combined approaches, I have heard quiet voices discover confidence and seen their faces light up and their sense of life change. So what Brian is suggesting in terms of changes achievable does not surprise me but it is not new to me.


What has also been very helpful for me for 10 years also is the judicious use of heel raises from as small as 1mm up 6mm. This is a vastly underated intervention and becomes more clearly so when you work in terms of addressing whole postural issues. (I see that the Rx lab school have someone giving a talk on it this year). I feel that using orthoses (choose your type), mobilisations and even the smallest heel raise allows me to control my aspect of intervention more and perhaps leads into or follows on from physio or chiro or osteo interventions quite nicely. Another thing I like about this approach is that it possibly throws a bit more responsibility back onto the patient to take their rehab seriously.

I'd agree that if we could lose some of the snake oil man tag accusations that fly around it could be helpful. Equally it needs the accused to be a bit more ready to being critiqued and careful about claims.

What I have achieved with my own approach (whatever the flack for my opinions) for one person with any combined approach has not worked on anyone else, I have had to change the combinations. Equally, I have had to look for more proximal influences and perhaps interne less distally to get the result. This may be why I see Brians approach as simply A N Other avenue.

At the risk of another slamming I still argue that while biomechanics is a hugely complicated subject, orthotic etc podiatric intervention can be more simple than we will admit and to give pods courage to professionally play (try things out) at what they do and not be so frightened of it is vital.

So when another professional says to me, do you think this will help my response is "don't know" but we can try.

Cheers
Ian

 

Dear Ian.....It's nice to know that I'm not the only one to take some flak for my opinions!! I like you am willing to try various approaches, which is why I started using these devices...... I just think that now an independant study (on scoliotic curves granted) has been posted regarding these devices, then perhaps the snake oil bit should be dropped, and just perhaps the evidence starts here.
On the subject of heel lifts........I too used to use them a lot. I can't remember the last time I used one, because I found that using a heel lift appears to lock the hip anteriorly in the acetabulum on the side it's applied to, eventually making the problem worse.

Dear Kevin.....If I could prescribe them for infertility I'd be rich. HOWEVER I have on record a lovely letter from a patient to her consultant stating that he should be made aware of these devices, as from the time she started wearing them, her feminine incontinence stopped. As we're dealing with pelvic mechanics here and not just foot mechanics.....I find this outcome not at all strange. But getting away from exotic topics like incontinence and infertility (specialize in these fields as a podiatrist and you'll probably have a short but happy professional creer!) I can't recall the last time I issued a pair of these devices for a foot problem (with probably 2 exceptions for cases of pl. fascitis, which is why I started using them in the first place). All my referrals are for back/knee/hip pain.
To sum up......these devices have had a bad press from people who have never used them. They are not a "one size fits all" ....there are definite parameters for their use. All I'm saying again is that we now have an independant study that has shown what seems to be quite extraordinary data in their favour.......over to you!

 

Hi Alex

"I too used to use them a lot. I can't remember the last time I used one, because I found that using a heel lift appears to lock the hip anteriorly in the acetabulum on the side it's applied to, eventually making the problem worse."

I take the point Alex, cannot say that I have actually encountered that problem but most often it is the smallest amount that I may use anyway so perhaps this accounts for it. Usually I look to see if the benefit of the raise is to improve symmetry in arm swing or side to side oscilations and rotations of the body in gait, does not often require much to do this, especially if the person is using an orthosis anyway.

Can't give an evidence base for.

Cheers
Ian

 

OMG not this again! I thought from my reading of the other topics that Rothbart's work was totally discredited. He had an incredible inability to not answer questions and discuss things (though from his messages he thought he was).

To equate Rothbarts work with Roots early work is very insulting.

Why put faith in some numbers and cases and photos of the promotor of a product with a vested financial interest on their website and not in a peer reviewed journal?

I notice the snake oil salesmans where very silent in this thread:
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=2893 in which proprioceptive insoles did NOT really change spinal position.

 

I assume you posted this as a joke. I do not see one thing on those pages thats supports the premise. You put something uncomfortable under anyones foot and you can change the position of the spine. Its only interesting from the point of view it proves the "snake oil" allegations.

The approach taken on that site and the previous discussions involving Brian Rothbart is the approach that is typically taken by the "snake oil salesman" .... those accusation will not stop until we see real independant science; not misquoting other research to support the premise; etc

Why the blind faith?

 

You mean uncomfortable like a rigid orthotic maby? All I have posted is my experiences with these devices, and to draw attention to the first independent study that I've found that provides evidence for this device.

The study quoted in Da Vinci's thread was not conducted using Rothbarts devices. By the sound of it, the researchers devised the devices on the spot...what criteria did they use for placing the pads? Not impressed. Where do you get the idea that I'm insulting Root? I merely said that his work was anecdotal till someone conducted independant studies to back up his theories. Rootian devices were being used clinically before there was an "evidence base " to back them up.
Rothbarts theories may be wrong.....this first independant study gives pause for thought. If I were him I'd publish it on my website...but I wouldn't be without these devices in my surgery.
I don't do blind faith .......I earn my living as a clinician and I use them because despite all the sneering.......the patients get better.

 

How.?

 

How baffling. Does anyone have any idea why this might be? It's not like we're making unsubstantiated claims of highly unlikly sounding results... oh no wait. I think i see the problem.

-Sigh-


Heres a question.

of Primus Metatarsus Supinatus Foot

Is it not more likely that this is caused by an aquired deformity (forefoot supinatus)? Much more common to see this pattern in adults than children, why is that if it is an

Alex why do you do this to yourself. Given the VAST amount of time spent on this issue already you KNOW what the reactions are going to be! Do you enjoy swimming upstream or are you being Masochistic?

Regards
Robert

PS. Loved this picture on the website. That'll scare the punters into submission! If only this poor guy had some insoles!

 

Well Robert.......maby you're right. But I'll go on record now as saying that proprioceptive devices are a.n.other approach to Bx that we'll be hearing a lot more of in this profession....whether they come from Rothbart or another school of thought. Time will tell. As regards the teeth photo......There are dentists out there using these devices in conjunction with traditional orthodontic therapy. And they measure leg lenghts........now why should they be doing that I wonder?

 

There are fringe practitioners within every health profession....that's why.

 

Do they help with Chromihydrosis?

I'd quite like an answer on how the PMS foot type, as diagnosed by holding the foot in neutral and measueing the distance between the big toe and the ground is different from an aquired forefoot supinatus.

Robert

 

Red flags for problematic issues go up when:



1. The only people posting messages in support of the devices are those that have a vested financial interest in the product. We have seen that before in other threads (and usually if its people without a vested fianical interest, the messages were solicited by those who did.) They all get treated the same way around here and on other forums (even the non-podiatry ones)

2. Rothbart choosed to name a foot type after himself. No wonder he gets held up to ridicule and treated with contempt.

3. Many of the references used to support the "theory" or "devices", are either unobtainable (ie obscure conference abstracts) or do not actually say what they are said to be saying (ie misquoted).

4. When questions get asked, they are never satisfactorily answered (just read the previous threads).

5. Would you trust the research of anyone with a fraud conviction?

6. Conveniently ignore problems raised (eg why are they still called propriceptive devices when its been pointed put many times by many people that foot orthoses actually affect the exteroceptive pathways and NOT proprioceptive pathways?

7. The promotion of the "theory"/"devices" has all the characteristics of the "snake oil selling syndrome"; ie self promotion; lack of- or pseudo-science to support them; fail to satisfactorily answer questions; making up of words and terms; blind faith and not critical analysis; etc etc

Until these are dealt with the responses will be the same.

 

Craig:

We could name a foot type after you. We could call it the Payneful Foot. .................sorry, just couldn't resist that one. See you in Belgium.

 

Nice one

Dave

 

I would be honored.

On a serious note, it certainly is a sign of respect when peers name something after the inventor (eg Weil osteotomy; Kirby skive; etc) .... its just arrogance of naming something after one self (eg Rothbarts foot)

 

Having just returned from the snake oil mines in a state of blind faith, and having checked Pod Arena.........I can't let the previous posts go unchallenged.
Kevin.....I love the idea of maverick dentists (those that check leg lengths). Occlusion problems alter pelvic mechanics (that's a descending pain pattern) Functional leg length differences alter pelvic mechanics(thats an ascending pain pattern.) More enlightened dentists (or mavericks to you) that can't get full resolution by dental techniques are starting to take account of the foot connection in all of this........and most of the ones I've spoken to have been made aware of this dimension by Rothbarts papers, not Roots

There was a paper published "The Relationship of Functional Leg Length Discrepancy to Abnormal Pronation" by Rothbart in The Journal of the American Podiatric Medical Association Nov/Dec2006.......are you to tell me that this is an obscure non peer reviewed journal?

Craig.....would you care to enlighten me with details of Rothbarts fraud conviction? It's news to me (and probably to him)

Am I right in assuming that all the other pods contributing to this thread have no vested financial interest in prescribing orthotics whatever product they're endorsing ........we're all doing it out of the kindness of our hearts are we?

All I said to start this thread was that Rothbarts foot model should be looked at again in the light of an INDEPENDANT study carried out by a guy in Cyprus....and what we appear to have ended up with is 2 biomechanic paradigms (which I think complement each other,) with strongly held views on each side. Great. Shows people still care.
But from the last posts.......it appears that what has REALLY miffed you is that he's called a foot condition after himself.........?!

 

Alex:

You wrote:

I replied:

First of all, I called these dentists "fringe practitioners", not "mavericks".

Fringe: outer limit: the outer edge or something considered to be on the outer edge and not central to an activity, interest, or issue (often used in the plural) outposts on the fringes of civilization
Microsoft® Encarta® Reference Library 2005. © 1993-2004 Microsoft Corporation. All rights reserved.

Maverick:independent person: somebody who holds independent views and who refuses to conform to the accepted or orthodox thinking on a subject
Microsoft® Encarta® Reference Library 2005. © 1993-2004 Microsoft Corporation. All rights reserved.

I believe the term "fringe practitioners" or "fringe elements within a profession" much better describes what these dentists are doing. "Maverick" is much too positive of a term for these individuals. I am sure that many dentists would agree with me.

In reading your posting above, you also would probably call Brian Rothbart "enlightened". I would call him something much different. You may want to check the previous postings I made to him earlier on Podiatry Arena about his history and his frequent moves from one country to another to practice whatever it is he practices.

Alex, if all you have to use to justify the results of these insoles is Brian Rothbart's website and his "research", then, in my opinion, you are standing on a very slippery slope. It's too bad that we all don't know you for something else other than being a supporter of Brian Rothbart and his insole products. Have you ever published research or had an article published that we could possibly better judge you more favorably by?

 

Alex, you have not answered my above, reasonable, question but have continued to justify your opinions.

Also, your detailed evidence instills me with such confidence:

Im sold. Where do I sign up?

 

Well......you could look up my article on Private Practice in the UK Society of Chiropodists & Podiatrists journal "Podiatry Now" Nov. 2004. My lectures these days are concentrated on the practice management side of our profession, and trying to up the profile of private practice in the UK, together with getting practitioners to take a more business like approach to practice.
I was one of the speakers at this years Annual Convention of the Soc. of Chiropodists in Brighton, where Craig had also been invited to speak....so I'm in the front line!
The reason I'm sticking up for Brian Rothbart, is that 20 odd years ago, I was introduced to the theories of another "fringe " practitioner......Dr. Taufiq Kahn.

This guy introduced the use of homeopathy in general and specific species of Marigold as topical applications in particular to this profession.

The only research was his. All the evidence was anecdotal. He ran the Marigold Clinic at the London Homeopathic Hospital in London, went into print before any independant studies were there to back up his work........and got crucified. The fact that he was a researcher/speaker of international repute cut no ice.The trouble was....those of us stupid enough to use his preparations found that the patients were getting better.
His theories are now accepted, his preparations used in Podiatric Colleges here and post grad courses are held under the auspices of the Faculty of Homeopaths.

So, I don't know if Rothbart's theories are right. And you're right I've only got his "research" to go on, and it may be incomplete or downright wrong.......but I've been here before, and for the moment I'll stick with it, as the patients, like before, are getting better. You're right though, more independant studies are needed. I just drew attention to the first one.

 

Dear LCBL (who ever you are) ...your posting came through as I was typing the above. At least Kevin and I disagree under our own names.

As far as I'm concerned the patients get better according to Rothbarts theory of engramming. Why not? You come up with a better theory and I'll sign up to it(maby) if it works as well.

All I know is that I have a cohort of patients who are pain free after using these devices for varying lengths of time AND WHO ARE NO LONGER RELIANT ON THE DEVICES. ........Maby I should start another thread asking the question....DOES THE LONG TERM USE OF RIGID/SEMI RIGID ORTHOSES WEAKEN THE POSTURAL MUSCLES OF THE FOOT? Now, there's something to get your teeth into!

 

My name is Dave Kingston....a fact that is known to some here and those that ask. The fact that I didnt set up an account with a name here is more to do with internet forum standard protocols.

Design it, research it, write it, publish it and promote it and I'll read it.

In your last post you admit ignorance of a theory but admit a willingness to see where it takes you based on a previous 'maverick' whose theories where eventually proved right (I know nothing of that work). That is your perogative. However, you want others to do the same. You say you want to promote the standing of a profession but ignore conventional research wisdom. That to me is a contradiction. I'm afraid in my less esteemed eyes you are approaching things from the wrong angle.

Good luck with your research and practice.

 

Been there, done that. They don't weaken the muscles:
Do foot orthoses weaken "arch" muscles?

 

LCBL be a good lad, lets just call him "Dave". For reference of the comedy use of the name Dave see only fools and horses, the fast show etc... (sorry Dave you posted your name as I was writing this, anyway he cool, cool double cool for those that don't know him. Spooners half time- lovely little thinker, but a bugger when he's ******)

Call me a radical or even maverick, but placebo? Show me the evidence for learned movement pattern.

Now I'm actually interested, instead of posting just for the laugh. Postural muscles show specific differences in fibre type population to "prime movers" which studies can you point to which define each of the plantar intrinsics into phasic and tonic muscles? When I was interested in this about 8 years ago I got really dissapointed when I found the research basically said that the muscles of the foot were pretty much of equal fibre type. Don't have full refs to hand but at least one was Journal of Bone and Joint Surgery.

BTW Anyone familiar knows that "podiatry now" is really a membership magazine, not an academic journal as such- the academic journal connected to the Society of Chiropodists and Podiatrists is the "British journal..." Although to be fair, papers not meeting the requirements for the British Journal may be put forward for publication in podiatry now. Moreover, neither of these publications is "academically rated". So while your "paper" in podiatry now may have been printed, I wouldn't confuse this with "academic" publication. In the same way, I do not include my article in the newspaper "The Evening Herald" within my publications list. While I'm on my box: I love people who include Member of the Society of Chiropodists in the letters after their name: viz- you haven't achieved a great deal. Great, but it fools the public- right?

BTW 2: My brother, typical Spooner, who is a dentist of 20 years experience thinks the theories you associate yourself with re: feet and teeth are "Utter cobblers. I've had better laughs peeling babies and rolling them in salt" (his words not mine). My sister-in-law, also a dentist of similar experience said- I doubt it very much (so you can see the genetic traits at work or not there- hmmmm)
Have a nice day. Suggestions of "out of you depth? Suit you Sir?"

 

How do we measure "strength" of the plantar intrinsics? Sorry Craig, but in my opinion, your methodology does not appear to withstand scrutiny. For example, how does the methodology described differentiate between individual muscles/ muscle groups? While flexing the toes may give a gross view, it's incapable of differentiation. Moreover, what about those plantar intrinsics which do not directly flex the toes?

 

Dear Simon......I was asked if I'd published anything. I didn't claim it to be a paper in an academic journal.
The term "utter coblers" is well known to me from the early homeopathic days, and your brother like a few others may end up eating his words.

A4-5 week study to show if orthotics weaken the muscles of the foot is irrelevant. Any one done 4-5 year studies? Most of my referrals gave up on orthotics as being uncomfortable or provoking other symptoms long before this.

There is one uncomfortable fact though.....despite all the "research" and academic papers.......how is it on a practical everyday level that the prescribing of orthotics heads the list of litigation claims against the Soc. of Chiropodists. And that isn't a load of cobblers.

 

Indeed he may, but at the moment I've seen nothing in your argument which demonstrates this. Moreover, I'm of the understanding that homeopathic research doesn't really hold water. Sorry that your paper wasn't academic and was on something irrelevant to this debate. I just wanted our international readership to understand the level of your publication. Perhaps though, publicising your practice in print is of greater importance to expanding the boundaries of podiatric knowledge. So maybe you're on the right track and those of us involved in this debate who actively engage in research and meaningful publication are barking up the wrong tree- I personally know Prof. Kirby has been barking for years after that "pig" incident.

Agreed see my posting to Craig- However, you have evaded answering my question regarding this, so I'll ask again once more: could you give details of which intrinsic muscles of the foot are tonic and which are phasic ? This is important to the debate since muscles showing a preponderance of one fibre type over another behave differently to "immobilization".

(What is it with these guys and answering questions????????????)

See LCBL's signature for my opinion on this. Also, is it because people have stopped using pyrogalol now since this was always the prime reason?

 

Rothbart may be anything you think he is. BUT......He getting a wealth of free advertising here. AGAIN.

SOS Biomechanicals- The finest orthoses in the world ever. Get 'em while they're hot. They're lovely.etc etc.

 

Just where on earth does that remark about me advertising my practice come from?

 

I used the word publicising. So how do you propose to "up the profile of private practice in the Uk" without publicising? Since you are in private practice, your lectures publicise your practice. More to the point stop trying to drift off topic: about those muscles.....

 

Sorry to back track, only just spotted this little beauty. Wasn't he the one who published a paper in which he "reduced the HA angle" in hallux valgus using marigold therapy? No problems with that research at all, as noted by the stream of letters to the editor post publication. Except, as I recall, the pre and post treatment x-rays published in the paper were of different feet!!! Shame on the reviewers.

 

Wait for the publication .... we did not really measure the strength of the plantar intrinsics. We measured plantar flexion strength of the 4 lessor digits ... people can make the assumption or not of the relative contribution of the plantar intrinsics and the long flexors to that action.

 

One of my posts seems to be missing.......so I repeat, where did that comment about me publicising my practice come from? And while I'm on my soap box ......... your quote ......... " While I'm on my box: I love people who include Member of the Society of Chiropodists in the letters after their name: viz- you haven't achieved a great deal. Great, but it fools the public- right?"......

Would appear to rubbish about 95% of the profession. That's a really helpful and encouraging outlook.

 

And to top it all off, the pig was wearing Rothbart's proprioceptive insoles!

 

Alex, firstly your post is at the top of this page. Secondly, my reply is below it. Thirdly, 95% of the podiatry profession are not members of the Society of Chiropodists and Podiatrists. Finally, if by paying a subscription to the afore mentioned Society, you are then eligible to use the acronym for member of the Society after your name, how does this equate to any level of training or academic/ clinical standard? What can the public/ we infer about the practitioner when we see this after their name?

Most importantly though, how does this relate to which intrinsic muscles of the foot are phasic and which are tonic? I've answered your questions. You do not have to agree with my answers or point of view. As you started this thread, it would seem reasonable to attempt to answer the questions put to you by myself and the others who have taken the time to join in this debate.

 

Alex

Sorry to harp but you never answered my question about the difference between PMS and Forefoot supinatus as per the assessment criteria used on THE website.

Dr Khan may not to be the man to emulate BTW. Using x rays from two different patients for the before / after shots on your flagship research is dodgy by any standard! Oh how i laughed. You should hitch your wagon to brighter stars.

And simon, i'm worried

Is typical (funny name BTW) older or younger. If he's older have you been stealing the credit for the Spooner school of charm all this time? Were you just the padawan or did he learn his style from you?


Respectfully

Robert

PS
I get NO money from ANYONE for supporting ANY kind of insoles. Judging by what i read i feel left out! If anyone wants to pay me lots of money for doing this i am very open to very large bribes kickbacks and brown envelopes!

 

Robeer, (I've left that typo in. Sigmund, what do you think is on my mind right now?). My older brother is somewhat the sage. Less outspoken than I, but when he opens his mouth you need a net to catch the pearls which spill out.

 

RoBeer.

Brewed under licence in the UK. A sparkling alcohol free lager with a great flavour and full body.




RoBeer. The amber nectar.