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As I´ve increased my knowledge of different biomechanical theories I´m comming the realisiation that we know next to nothing about how the device that we issue to patients works.
The free fall began about 2 weeks ago after reading Niggs paper on leg stiffness in the orthoses thread and is getting worse with every article I read.
Alot of the articles are flawed from the beginning using Subtalar neutral and the really interesting ones come to the conclusion that this needs to be researched in more detail.
Is there light at the end of the tunnel or if a patient asks how do this orthotic work we should answer "I´m not sure".
Re: the greater your biomechancial knowledge the less you know about how orthotics work
Quote:
Originally Posted by m weber
I´m having abit a crisis of sorts at the moment.
As I´ve increased my knowledge of different biomechanical theories I´m comming the realisiation that we know next to nothing about how the device that we issue to patients works.
The free fall began about 2 weeks ago after reading Niggs paper on leg stiffness in the orthoses thread and is getting worse with every article I read.
Alot of the articles are flawed from the beginning using Subtalar neutral and the really interesting ones come to the conclusion that this needs to be researched in more detail.
Is there light at the end of the tunnel or if a patient asks how do this orthotic work we should answer "I´m not sure".
Michael, foot orthoses do seem to consistently reduce the internal inversion moment (see this thread: http://www.podiatry-arena.com/podiat...ad.php?t=37252) what we don't necessarily know yet are the details of why. We're working on it.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Shaking your faith in our sphere of practice does not actually make for confident willing young pods. I used to tell my young students that it is clear that orthoses help in a variety of ways for a range of conditions but knowing the precise mechanism and magnitude of each specific effect was still beyond us. Leaving them feeling like we know nothing and that what we teach them is all "made up" creates a fair bit of stress for them. It is clear that we can alter the focus/foci of plantar pressures. It is clear we can alter basic things like stopping (decelaration)time and stopping distance, and we know that when you change those things peak forces are altered, but just exactly how and why ????? I'm a believer in the "new wear patch theory". Change the line of transmission of the peak forces through joints and instead of wearing the same old patch out even more they are putting the peak forces through a less worn patch, which feels better. We have not actually "fixed" anything but given them a fresh (or fresher)patch of cartilage to wear out. And if this works until they fall of their perch then we have improved mobility and quality of life.
regards Phill
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by m weber
I´m having abit a crisis of sorts at the moment.
As I´ve increased my knowledge of different biomechanical theories I´m comming the realisiation that we know next to nothing about how the device that we issue to patients works.
The free fall began about 2 weeks ago after reading Niggs paper on leg stiffness in the orthoses thread and is getting worse with every article I read.
Alot of the articles are flawed from the beginning using Subtalar neutral and the really interesting ones come to the conclusion that this needs to be researched in more detail.
Is there light at the end of the tunnel or if a patient asks how do this orthotic work we should answer "I´m not sure".
Michael:
Actually, what you describe here, Michael, is a fairly normal occurrence among podiatrists who are exposed to new theories regarding foot orthoses, after being taught rather dogmatic older theories regarding foot orthoses in podiatry school.
If it makes you feel any better, I had a similar crisis during my Biomechanics Fellowship, during late 1984 (i.e. 25 years ago), when I started to note a lack of correlation of traditional "Root" biomechanical measurements to foot function, started seeing a good correlation of subtalar joint (STJ) axis location to foot function and foot pathologies and found that the STJ axis did not change directions at the midtarsal joint when using the palpation method, which I fully had believed would occur. You may want to read Thomas Kuhn's masterpiece, The Structure of Scientific Revolutions, in order to better understand the processes of change in scientific theory that has occurred within the scientific community for at least the last thousand years. (Thanks to Eric Fuller for first introducing me to this must-read book.)
Just be thankful that you hopefully won't have to spend the next 25 years of your life convincing your profession that your ideas are mechanically sound and make good sense.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by Simon Spooner
Michael, foot orthoses do seem to consistently reduce the internal inversion moment (see this thread: http://www.podiatry-arena.com/podiat...ad.php?t=37252) what we don't necessarily know yet are the details of why. We're working on it.
Thanks Simon, thats my point they seem to be and the details why are what I´m after as it seems you are too.
Quote:
Originally Posted by Craig Payne
Reminds me of the best bit of feedback I have ever had from a Boot Camp: "...in which you leave knowing less than when you arrived. . ."
We do know how foot orthotics work. They have to lower the load in the tissues. How else can they work?
I agree Craig but how is it changed In the electric frequency of muscle as discussed by Nigg or does affecting the position of the Stj axis reduce Tissue load ?
Quote:
Originally Posted by pgcarter
Shaking your faith in our sphere of practice does not actually make for confident willing young pods. I used to tell my young students that it is clear that orthoses help in a variety of ways for a range of conditions but knowing the precise mechanism and magnitude of each specific effect was still beyond us. Leaving them feeling like we know nothing and that what we teach them is all "made up" creates a fair bit of stress for them. It is clear that we can alter the focus/foci of plantar pressures. It is clear we can alter basic things like stopping (decelaration)time and stopping distance, and we know that when you change those things peak forces are altered, but just exactly how and why ????? I'm a believer in the "new wear patch theory". Change the line of transmission of the peak forces through joints and instead of wearing the same old patch out even more they are putting the peak forces through a less worn patch, which feels better. We have not actually "fixed" anything but given them a fresh (or fresher)patch of cartilage to wear out. And if this works until they fall of their perch then we have improved mobility and quality of life.
regards Phill
Thanks Phil but I´m not a young Pod Ive been treating patients for the last 15 years I teach Biomechancial Theory to the 2nd year Pod here in Sweden I beleive understand the different theories I can tell the many different orthotic mods I make when Ive finished with a patient assessment. But what exactly are these mods doing I can also explain the theory behand the mods and even give you a % chance that these mods will work and the patient will get reduced symptoms but I really want to know what is the device doing in the body.
The new wear path theory fits perfect with tissue stress theory, but if you look at the new study done by Javier and Kevin ( and I need to read it again) the
Quote:
Results: There were statistically significant differences in the foot progression angle between the barefoot and varus wedge conditions and between the varus and valgus wedge conditions. There were no significant changes in peak internal tibial rotation among the three conditions tested. However, rearfoot varus wedges significantly reduced net ankle inversion moments compared with barefoot and rearfoot valgus wedges.
Conclusions: These results support the idea that foot orthoses work by methods other than by changing kinematic parameters. The present study supports the concept that foot orthoses work primarily by altering kinetics, with their effects on kinematics being secondary. (J Am Podiatr Med Assoc 99(5): 415–421, 2009)
So the results support the idea about varus wedge reducing ankle inversion moments, but the thing I find most intersting is that there was There were no significant changes in peak internal tibial rotation among the three conditions tested.
So if this is the case how do we control Tibial Position?
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
We shouldn't stress about this. Half of the common drugs used in society are equally mysterious in their mode of action. We shouldnt view orthotics any differently. If we focussed less on the *how* and more on *how well* we would be a far more productive and useful profession to society.
eg:
The precise mechanisms by which the antidepressant drugs exert their therapeutic effects remain unknown... Handbook of psychiatric drug therapy
Like organised medicine, let's move ahead with looking at how well these things do their job, and accept (at least for now) that the "exact mechanism of action for foot orthoses in foot pain remains unclear".
LL
__________________
***************************************** Remember, it's just a foot.
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Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by LuckyLisfranc
We shouldn't stress about this. Half of the common drugs used in society are equally mysterious in their mode of action. We shouldnt view orthotics any differently. If we focussed less on the *how* and more on *how well* we would be a far more productive and useful profession to society.
LL
Ok I agree the how well is important but I without stressing would like to know how. If I know the how then the how well ,will follow .
here is a made up example. What if new research comes out as finds definate proof that EVA shore 60 does reduced the effective nature of muscle and will infact cause a increase in muscle stress. It will not matter how nice you are, how well you explain to the patient your finding from their assessment, it will not matter how well finished your device is, it will be causing stress on the patient that you though you were reducing might be important to understand the how.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
We don't need to know the aetiology of a pathology or the mode of action of the treatment, but when we do know these, the efficacy of the care should surely improve.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by m weber
Ok I agree the how well is important but I without stressing would like to know how. If I know the how then the how well ,will follow .
here is a made up example. What if new research comes out as finds definate proof that EVA shore 60 does reduced the effective nature of muscle and will infact cause a increase in muscle stress. It will not matter how nice you are, how well you explain to the patient your finding from their assessment, it will not matter how well finished your device is, it will be causing stress on the patient that you though you were reducing might be important to understand the how.
Not sure I follow you.
After years of reading conflicting posts on this website (perhaps the definitive source of debate on orthoses anywhere), I think we can safely say there are only some basic concepts that some people and the research agree on.
What is also clear to me, is that for decades thousands of podiatrists, physio's and orthotists etc use have used foot orthoses daily with reasonable levels of clinical success. Some evidence supports this, some is lacking, some conflicts with this.
There are various hypotheses, various theories but no exact single mechanism of action that is agreed upon.
We can keep going in circles, on we can start moving on and accept there are some limitations in our understanding. This needn't be a barrier to not start producing lots more meaningful outcomes studies, or indeed treating foot conditions at the coal face with incompletely understood non-surgical methods such as foot orthoses.
If the pharmaceutical industry worked in this way people would still be dying of AIDS rather than living productive lives, and the 5 year survival rate for most cancers would still be appalling.
LL
__________________
***************************************** Remember, it's just a foot.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by LuckyLisfranc
We can keep going in circles, on we can start moving on and accept there are some limitations in our understanding. This needn't be a barrier to not start producing lots more meaningful outcomes studies, or indeed treating foot conditions at the coal face with incompletely understood non-surgical methods such as foot orthoses.
If the pharmaceutical industry worked in this way people would still be dying of AIDS rather than living productive lives, and the 5 year survival rate for most cancers would still be appalling.
LL
Lucky,
I take your point.
Bunion surgery has been performed for a long time, do you think our improved understanding of foot function and the biomechanical effects of the various surgical procedures performed has improved the efficacy of hallux valgus surgery over the years?
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by Simon Spooner
Lucky,
I take your point.
Bunion surgery has been performed for a long time, do you think our improved understanding of foot function and the biomechanical effects of the various surgical procedures performed has improved the efficacy of hallux valgus surgery over the years?
I think it is broader than just foot function. Good outcomes in surgery are equally attributable to understanding and compensating for medical, physiological and pharmacological issues. More attention is paid to this than the functional issues - which are often distilled down into bullet points on position, degree of 1st MT head degeneration, length, and passive mobility of the sesamoids and main articulation.
Our understanding of patient selection (or who shouldn't have surgery at all), medical factors, predicting those likely to suffer complications, the role of adjunctive pharmacotherapy (eg DVT prophylaxis), and outcomes research on the benefits of differing surgical approaches has improved outcomes. Don't ask me for a reference though...however, the 'disasters' that I use to see as a new graduate are a lot less common these days as orthopaedics and podiatry develop more refined (yet simple!) guidelines and accepted practice for these procedures.
Such that now, there are rarely more than 3 different types of bunion correction procedures used for the vast majority of all patients. Scarf +/- Akin (UK podiatry and orthopaedic circles), Chevron/Austin (US and Australian podiatry), and proximal osteotomies for large IM angles (not so common).
I feel surgical research and outcomes in foot surgery are more commonly accepted in the craft despite the same innumerable functional variations. Most procedures (arthrodesis, arthroplasty, osteotomy and translation) are reasonably reliable and predictable, with accepted and small rates of failure or complications.
In my view, clinical guidelines and acceptable standards of peer review and practice (distilled from the research) are more palatable to foot surgeons than orthotic practitioners. It is more a case of 'get on with the job' according to the best available evidence, rather than worrying why one form of bunion fixation should be used over another.
However, like orthoses, they are equal measure of art and science - and some of the exact science remains unclear.
Just my humble opine.
LL
__________________
***************************************** Remember, it's just a foot.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by m weber
The new wear path theory fits perfect with tissue stress theory, but if you look at the new study done by Javier and Kevin ( and I need to read it again) the
So the results support the idea about varus wedge reducing ankle inversion moments, but the thing I find most intersting is that there was There were no significant changes in peak internal tibial rotation among the three conditions tested.
So if this is the case how do we control Tibial Position?
No change is peak internal tibial rotation was found in our study probably because we were just using simple rearfoot wedges, not well-shaped, anti-pronation custom foot orthoses.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
If we focussed less on the *how* and more on *how well* we would be a far more productive and useful profession to society.
Yes and no.
If we know that an intervention works, but not how, we are limited to that intervention. Learning other interventions becomes little more than trial and error. If we (or at least some of us) know HOW they work then we can modify, refine, improve and redesign.
Acupuncture is a good example. There is some pretty compelling evidence that it can be effective for certain things, but also huge rafts of studies in which it performs no better than a placebo. Because we do not understand how it works it is very hard to work out why some studies show one thing and others something different, and also to tell the things it can treat effectively from those it can't.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by LuckyLisfranc; 110,343
After years of reading conflicting posts on this website (perhaps the definitive source of debate on orthoses anywhere), I think we can safely say there are only some basic concepts and that some people agree on the research.
What is also clear to me, is that for decades thousands of podiatrists, physio's and Orthotists etc. have used foot orthoses use daily with reasonable levels of clinical success. Some evidence supports this, some is lacking, some conflicts with this.
There are various hypotheses, various theories but no single exact mechanism of action that is agreed upon.
We can keep going in circles, on we can start moving on and accept there are some limitations in our understanding. This need not be a barrier to not start producing lots more meaningful outcomes studies, or indeed treating foot conditions at the coal face with incompletely understood non-surgical methods such as foot orthoses.
Lucky:
I have a different perspective. The abundance of discussion on biomechanical theory that exists here on Podiatry Arena is in no way related to how much this type of discussion occurs in podiatry offices, between podiatrists or at podiatry seminars. In addition, just because a few of us choose to spend a large amount of our free time discussing theory, does not mean we are somehow withholding treatment from our patients with foot orthoses. I, for one, prefer to have an idea of how my treatments work so I can be more effective at designing better treatments for my subsequent patients.
It is because of this general lack of discussion on biomechanical theory among podiatrists within the international podiatry community, and because there is virtually no other place to discuss high-level biomechanical theory with the leaders in the profession that we do have so much discussion here on Podiatry Arena on these subjects. Where else can I have intelligent discussions on tissue stress theory, subtalar joint axis rotational equilibrium theory, the neuromotor effects of foot orthoses and preferred motion pathway theory with multiple podiatrists other than on Podiatry Arena? Considering the time constraints of my very busy practice, I don't have the hours in the day to publicly have these types of discussions, largely because the average podiatrist wouldn't have a clue of what I am talking about. I believe that this is why so much biomechanical theoretical discussion takes place on Podiatry Arena.
Podiatry Arena is the international mecca for discussion of foot and lower extremity biomechanical theory on the Internet.
And Craig, you can quote me on that!!
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by m weber
I´m having abit a crisis of sorts at the moment.
As I´ve increased my knowledge of different biomechanical theories I´m comming the realisiation that we know next to nothing about how the device that we issue to patients works.
You'll be alright. Just live and study with the assumption that learning never stops, until you become fertilizer for flowers. This past year for me involves not only growth because of my newer products, but also learning because of new demands. Personally, I'm loving the challenge.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by Kevin Kirby
No change is peak internal tibial rotation was found in our study probably because we were just using simple rearfoot wedges, not well-shaped, anti-pronation custom foot orthoses.
I will keep that in mind when I re read the paper again this weekend
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
I have read all these comments with interest and you lot seem to be the bio genius brigade. I on the otherhand didnt get it first time round in the 80's when it was rushed in 3rd year in the UK. I would like to ask your opinion on a number of things
!. Root et al is now out the window? so what about all those orthoses made with that theory in mind, did any really work?
2. Whats with all these gaitplate, Amfit, the strippey sock one, the computer does it all for you type set ups. Are some people in a circle of it cost me a fortune so therfore I must get my money back or are they superior assessment devices. Some I have seen in operation recently I thought had also gone out of fashion. Do you just need to know how to push the buttons?
3. Why does everyone get casted in neutral no matter what, car smashes, athletes?
4. Why do some quite eminent bio people sell orthotics for high heels. Is that not the ultimate rubbish?
5. I have been out of the bio exam for a number of years and am currently wading through Valmassey, after a period of serious headaches I took to reading a lot on here and looking at material from different companies. But everyone disagrees on everything
6. Will I ever get it?
Apart from that I'm signing up for Craigs Boot camp next year in Auckland, did want to do it this year but when i'm in Uk its on in OZ and visa versa.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
!. Root et al is now out the window? so what about all those orthoses made with that theory in mind, did any really work?
Yep. Lots of evidence.
Quote:
2. Whats with all these gaitplate, Amfit, the strippey sock one, the computer does it all for you type set ups. Are some people in a circle of it cost me a fortune so therfore I must get my money back or are they superior assessment devices. Some I have seen in operation recently I thought had also gone out of fashion. Do you just need to know how to push the buttons?
The toys are great, but they are just toys. They don't provide a "superior assessment". Amfit can capture a nice 3d image. So can laser scanner, so can a foam box or plaster of paris. They're all just means to an end.
Quote:
3. Why does everyone get casted in neutral no matter what, car smashes, athletes?
My patients don't all get cast in neutral. I don't think there is anything special about a neutral position.
Quote:
4. Why do some quite eminent bio people sell orthotics for high heels. Is that not the ultimate rubbish?
Depends on the condition and the orthotic.
Quote:
5. I have been out of the bio exam for a number of years and am currently wading through Valmassey, after a period of serious headaches I took to reading a lot on here and looking at material from different companies. But everyone disagrees on everything
Broadly true. Perhaps there is some truth in the "wisdom of crowds" idea.
There are loads of areas to disagree on but also a few core elements which very few people would dispute. Perhaps the thing to do is to focus on the "canon". Sort of a biomechanics creed of central truths which we agree on. Good thread there.
6. Will I ever get it?
Depends what you want to "get". If you wonder if you will ever get to the point of full enlightenment then... no. The more you understand the more you will see to learn!
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Quote:
Originally Posted by pommypod
I have read all these comments with interest and you lot seem to be the bio genius brigade. I on the otherhand didnt get it first time round in the 80's when it was rushed in 3rd year in the UK. I would like to ask your opinion on a number of things
!. Root et al is now out the window? so what about all those orthoses made with that theory in mind, did any really work?
There is still some truth in Root. The partially compensated varus still exists. However, the STJ can't tell the difference between rearfoot and forefoot varus.
My orthotics work. Just because they work does not mean that the explanation of how they work is true. How exactly was casting the foot in neutral position supposed to help the foot that stands on the orthosis? Voodoo?
Quote:
Originally Posted by pommypod
2. Whats with all these gaitplate, Amfit, the strippey sock one, the computer does it all for you type set ups. Are some people in a circle of it cost me a fortune so therfore I must get my money back or are they superior assessment devices. Some I have seen in operation recently I thought had also gone out of fashion. Do you just need to know how to push the buttons?
If you change things under the foot, the stress on the foot will change. Your job is to figure out which changes will make things better and which will make them worse.
Quote:
Originally Posted by pommypod
3. Why does everyone get casted in neutral no matter what, car smashes, athletes?
Give someone a hammer and everything looks like a nail. Some people never questioned or experimented on different techniques. You can add wedging to device made from a weightbearing impression of the foot.
Quote:
Originally Posted by pommypod
4. Why do some quite eminent bio people sell orthotics for high heels. Is that not the ultimate rubbish?
If the patients are going to wear the shoes, then you can change the forces applied to the foot in those shoes. It's more difficult to make it work, but it can improve the patients comfort.
Quote:
Originally Posted by pommypod
5. I have been out of the bio exam for a number of years and am currently wading through Valmassey, after a period of serious headaches I took to reading a lot on here and looking at material from different companies. But everyone disagrees on everything
Just like with Root, you have to take what works and makes sense and discard what does not. Partially compensated rearfoot varus exists. The definition of neutral position is garbage. Measurement of forefoot to rearfoot relationship cannot be done accurately.
Quote:
Originally Posted by pommypod
6. Will I ever get it?
Keep thinking about it.
Regards,
Eric
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Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
hi, just wanted to say that there should be a counsellor at each podiatry degree currently running. I have just completed a degree in podiatry and can totally identify with this mans crisis. The crisis started for me in the first year of my degree and has not stopped.
For me (and my humble opinion!!) Hylton Menz latest article 'Foot orthoses: how much customisation is necessary?' helped me in this respect. He uses physiotherapy and their current understanding of lower back pain, where they divide their clinicians into 'lumpers' and 'splitters'. The former is a categorization of clinician who believes there is a generic or standard approach to treatment, and the latter the more detailed and analytical clinician.
Furthermore he goes on to say that we currently simply don't know the details ie. what conditions that orthoses work for. 'WE HAVE NO CLINICAL GUIDELINES' which is why it is so confusing for students and teachers alike.
The fact that some clinicians are pointing out the tissue stress model gets my blood boiling - is there actually ANY OTHER plausible model? when you cut yourself it hurts, when you overuse an area of the body it hurts- simple.
If we are to find a way forward we have to stop postulating and either get more specific, meaning treat each condition/pain with an orthoses as it occurs and note the prescription that works best (longitudinal study that has a central 'data bank' where all the data is stored and that is added to by each clinician every time they see a patient).
OR maybe we just have to accept that the outcome variables are too great at present - feet are just too different - some feet respond like so, others like so. In other words get real- and accept that orthoses have limitations. And if that is the case maybe we are going to have to consider and adopt many of the other treatment modalities (excuse my french!) that are available.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
ps. I think Pierrinowski (hope I spelt that right) and Nigg also have some literature on subtalar axis height and coupling movement of foot/ankle/tibial complex.
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
I feel so fortunate to be studying Podiatry for the same reason I find it difficult at times. :)
More on RF wedges: Murley and Bird (2006) “The effect of three levels of foot orthotic wedging on the surface electromyographic activity of selected lower limb muscles during gait”.
"4. Why do some quite eminent bio people sell orthotics for high heels. Is that not the ultimate rubbish?"
This is a really interesting question. One for which many un-verifiable opinions will exist. Perhaps the neuromotor theory may have more of an application for such a device? Who knows really? Exciting stuff. For some reason - for people in professional circles who feel compelled to wear unsuitable footwear - a cobra style orthotic may be providing just enough sensory feedback for the body so that there is minimal improvement in comfort levels. Has anyone done a qualitative study to see that there is such minimal improvements as a benchmark? Not that I can find. Probably not the Holy Grail of BMX.
The Australian Podiatry Council published a 1998 article “Clinical guidelines for orthotic therapy provided by podiatrists”. Furthermore, the American College of Foot & Ankle Orthopedics & Medicine (2004) set out: “Prescription custom foot orthoses practice guidelines”.
Nicolopoulos, Scott and Giannoudis (2000) did a good overview “Biomechanical basis of foot orthotic prescription”. Hume, Hopkins, Rome, Maulder, Coyle and Nigg (2008) reviewed some aspects: “Effectiveness of foot orthoses for treatment and prevention of lower limb injuries: a review”. As you will see guidelines are not as sophisticated as they will be with all the new research that will come out in the next 10 yrs. It is just the tip of the iceberg! My lecturer took a very detached approach to all this othosis stuff and as a consequently it really is evident how little evidence there is to guide our Tx. out there! Good man!
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
I hope i didnt sound unappreciative...not at all. I feel very privileged to be studying podiatry (d), of course. But maybe we should also appreciate that as we are specialists in the lower limb we should know to adopt the BEST possible treatments regardless of whether they come from trad chinese medicine, physio or osteopathy. Should we be so proud of our profession that we become blinded by other treatments that may work as well or better??!! I have heard people say that; 'that is for the physio to do!!' or 'we don't do those treatments'.. well we treat the lower limb, why can't we do it too? Especially considering the fact that we study three years of the lower limbs and should surely embrace all the best treatments.
With regards to the biomech lit; the problem i have sometimes is that so much of the literature is VERY analytical and does not have a direct application to practice. Much of the lit is directed toward how orthoses change
-Force (ie magnitude and time)
-kinetics (ie direction of force)
-kinematics (movement)
it speaks to me sometimes almost like justifying as opposed to directly testing orthoses on pathologies. I must surely be wrong. I dont believe technology will ever be a replacement for a good work up, but an adjunct maybe?
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
You'd have to think that amount of tibial rotation caused by a rear foot wedge will vary a great deal with the specific nature of the anatomy of the individual, ligamentous tone etc and joint axis angles are going to influence these results a lot....were these issues dealt with in any of these studies? or is it another lesson in how many variables there are rendering the results not worth much?
regards Phill Carter
Re: The greater your biomechancial knowledge the less you know about how foot orthotics work?
Phil,
I really like your last comment. I think this gets missed with research and not being specific with the foot structure and anatomy of individuals. Certainly with the nigg stuff, they went to the extent of putting pins in tibia's but then decided to use a bit of padding in the arch area of a shoe insole to act like an orthotic. This hardly represents what most Podiatrists would do. I think when we had the article ? Menz on orthotic therapy for cavus feet, it gave us good evidence to use them. I feel same should be done with examining specific foot types for each study rather than a collective group of all sorts.
The greater your biomechancial knowledge the less you know about how foot orthotics work?
Linear Mode
