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Foot orthoses roundtable

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Sep 30, 2012.


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    All,

    This paper that Kevin and I contributed to recently has now been published:

    Kevin A. Kirby, Simon K. Spooner, Paul R. Scherer, and John M. Schuberth
    Foot Orthoses
    Foot Ankle Spec October 2012 5: 334-343

    and is available to download here: http://fas.sagepub.com/content/5/5/334.full

    For the purposes of the paper we were asked to answer a series of questions, these were:

    1) Many have suggested that over the counter (OTC) foot orthoses are “just as good” as custom foot orthoses (CFO) for treating most common ailments of the foot and lower extremity. What are the advantages and disadvantages of OTC and custom foot orthoses (CFO)?

    2) What foot and lower extremity pathologies do you believe can be treated effectively with an OTC foot orthosis and what pathologies are best treated with CFO?

    3) Does the obvious cost differential between OTC and CFO create the potential for over utilization of CFO or do you feel that CFO are underutilized by the medical profession as a whole for the effective treatment of many foot and lower extremity pathologies?

    4) There is an increase in alternative theories on foot and lower extremity biomechanics and foot orthosis therapy over the past 2decades. Why do you believe these newer theories have evolved and which theories do you believe currently show the most promise?

    5) In the United States, there seems to have been a growing disinterest in biomechanics and a growing interest in surgery over recent years. Why do you believe that is the case and is this also the case in other countries as well? How do you think that this relative lack of interest and education in biomechanics affects the methods by which our patients are treated for mechanically based foot and lower extremity pathologies?

    6) Even though foot orthoses have been studied by scientific methods such as force plates, pressure mats, 3D motion analysis, and computer modeling techniques such as inverse dynamics and finite element analysis, the ability to place any sort of “placebo” device into the shoe of a research subject that not only has no mechanical effect on the foot but is also indistinguishable by the subject from a foot orthosis is nearly impossible. What type of scientific research studies need to be done in the near future to give us better insight as to how well foot orthoses work at healing injuries, how foot orthoses mechanically function to produce their therapeutic effects, and as to what orthosis modifications work best for each pathologic condition?

    7) What do you see as future directions for foot orthosis technologies, including the 3D imaging of the foot, manufacturing methods of the orthoses, and possible new foot orthosis technologies that we may be seeing within the next few decades?


    I've read the answers we gave, but what answers would you have given?:drinks
     
  2. RobinP

    RobinP Well-Known Member

    I could do with about 2 hours to answer this. I suspect I could be the odd ove out on this. Thanks for the link Simon
     
  3. 1) Many have suggested that over the counter (OTC) foot orthoses are “just as good” as custom foot orthoses (CFO) for treating most common ailments of the foot and lower extremity. What are the advantages and disadvantages of OTC and custom foot orthoses (CFO)? In some cases OTC can be just as good or better that a CFO - it all depends on the foot, and what is required by the device, the key the practitioners skill set and the ability to recognize the requirements. While some may argue costs ie the OTC is cheaper in the 1st place sure, but if the patient is to wear the device for years it maybe the opposite - again the practitioners skill set is the important thing here.

    2) What foot and lower extremity pathologies do you believe can be treated effectively with an OTC foot orthosis and what pathologies are best treated with CFO? N= 1 and not all OTC devices are the same, so it is hard to say , but as a general rule any treatment plan which involves arch push that a softer device will work as a general rule

    3) Does the obvious cost differential between OTC and CFO create the potential for over utilization of CFO or do you feel that CFO are underutilized by the medical profession as a whole for the effective treatment of many foot and lower extremity pathologies? horses for courses, but as stated before a OTC maybe cheaper now but over the length of a CFO ii may in fact be more expensive

    4) There is an increase in alternative theories on foot and lower extremity biomechanics and foot orthosis therapy over the past 2decades. Why do you believe these newer theories have evolved and which theories do you believe currently show the most promise? Some of them are to make it easy for those in practice to issue device with no real understanding of biomechancis, just helps keep the money coming in, others are leaps forward in our understanding of biomechanics, but 1st what is alternative - is root still consider the base of biomechanics thinking if so there is a huge issue right there. As for new theories - the leg stiffness approach is one that is of huge interest to me. In fact stiffness as an explanation to lots of things such as Achilles tendon problems


    5) In the United States, there seems to have been a growing disinterest in biomechanics and a growing interest in surgery over recent years. Why do you believe that is the case and is this also the case in other countries as well? How do you think that this relative lack of interest and education in biomechanics affects the methods by which our patients are treated for mechanically based foot and lower extremity pathologies? To be honest money and the prestigious nature of being a surgeon is the cause of the reduction in biomechanical treatment in the US. As for other countries not at this stage but it may head that way.

    The reduction in mechanical treatments is a huge whole in the future of Podiatric medicine both in the US and the rest of the world - why cut when you can treat otherwise, the best way forward should be mechanically based treatment 1st and Surgery 2nd where ever possible not the other way around

    6) Even though foot orthoses have been studied by scientific methods such as force plates, pressure mats, 3D motion analysis, and computer modeling techniques such as inverse dynamics and finite element analysis, the ability to place any sort of “placebo” device into the shoe of a research subject that not only has no mechanical effect on the foot but is also indistinguishable by the subject from a foot orthosis is nearly impossible. What type of scientific research studies need to be done in the near future to give us better insight as to how well foot orthoses work at healing injuries, how foot orthoses mechanically function to produce their therapeutic effects, and as to what orthosis modifications work best for each pathologic condition?
    mass population studies in common problems, and greater use of ultrasound to measure effects on tendons and muscles with various devices

    7) What do you see as future directions for foot orthosis technologies, including the 3D imaging of the foot, manufacturing methods of the orthoses, and possible new foot orthosis technologies that we may be seeing within the next few decades?

    before we get new we need to get a greater understanding of how the old work - but I do hope we will get an ability to measure and implement devices to help tune stiffness in the future.

    Ok all answers are kind of short. but were written before I have read the paper so no outside influence
     
  4. OK Robin, you've had about 24 hours and a copy of the paper; your thoughts...
     
  5. RobinP

    RobinP Well-Known Member

    I meant 2 hours where I am not seeing patients or trying to get my kids ready for school. I promise I'll do it tonight Sir - honest!
     
  6. You know that two hours you're gonna spend on podiatry arena tonight? Yeah...
     
  7. As Simon mentioned, the roundtable that Dr. Spooner, Dr. Paul Scherer and I contributed to regarding foot orthoses is now available for download from Sage Publications, where you can access the pdf of the article by signing up (for free) for the journal on their website. I believe that this article, more than any other in recent memory, reflects the most current thinking on the biomechanics, function and use of foot orthoses within the podiatry profession (Kirby KA, Spooner SK, Scherer PR, Schuberth JM: Foot orthoses. Foot Ankle Specialist, 5(5):334-343, 2012).

    https://online.sagepub.com/cgi/register?registration=FT1088059
     
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