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foot orthoses; why not for long-term load management

Discussion in 'Biomechanics, Sports and Foot orthoses' started by markjohconley, Oct 24, 2018.

  1. markjohconley

    markjohconley Well-Known Member


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    I can comprehend the use of foot orthoses as short-term "...arrow in the quiver..." for rehab but say for laterally deviated STJ axis driven? lateral ankle stability why not long-term?
    please refer me back to a relevant thread(s) if applicable, thanks, mark
    note: am watching 'sportinjurymatt' podcasts; so more interesting and thought provoking with podcasts nowadays, thanks craig and ian
     
  2. efuller

    efuller MVP

    This gets back to the use of orthoses in injury prevention. It would be nice to have evidence that the treatment prevents future problems like how medications are used to reduce high blood pressure. In that example, we have good evidence that prolonged high blood pressure causes problems and that use of medication lowers blood pressure and that you see, with medication, there is reduction of the problems caused by high blood pressure.

    We need measurements, and studies of those measurements to justify the long term use of orthotics. I don't think that neutral position related measurements will be predictive of pathology. There is also no coherent theory on why treatment of those measurements would reduce pathology. On the other hand, STJ axis location in the transverse plane is a measurement upon which predictions can be made. For example, a laterally deviated STJ axis will be more likely to have peroneal tendonitis. So now we need some studies that need to show that treating a laterally deviated STJ axis with an orthosis designed to increase pronation moment from the ground will lower the incidence of peroneal tendonitis.

    I do know that I have a medially deviated STJ axis foot and I prefer to wear orthoses with a medial heel skive. My foot feels better. N = 1

    There have been some threads on preventive use of orthoses.

    Eric
     
  3. markjohconley

    markjohconley Well-Known Member

    Thanks Eric,
    Why do the studies by highly regarded podiatrists/ biomechanists eg. SEMRC @LaTrobe uni. usually use 'neutral STJ' based foot orthoses as the intervention. It's very frustrating.
    My wife and daughter (N=2) likewise. However I can not as my medial side of b/knees gives me jip when i trialled them
    All the best, mark
     
  4. efuller

    efuller MVP

    Tradition!!!. My guess is that they use those measurements because that it was done most often in clinical practice. Things change very slowly.
     
  5. Do eye doctors recommend prescription eyeglasses only for the short-term, but then recommend "eye-strengthening exercises" so patients can "be weaned off of eyeglasses"? No. Neither should podiatrists, nor physiotherapists for that matter, recommend that foot orthoses should only be worn for short-term treatment. There is no research evidence to support this bizarre recommendation that foot orthoses should only be worn in the short-term. This all came out of the barefoot running fad and somehow crossed over to foot orthoses. When the people who make these claims can provide any research evidence for their recommendation to only use foot orthoses in the short term, then I will listen. Until then, this idea of orthoses only being used for a short time period is nonsense.
     
  6. markjohconley

    markjohconley Well-Known Member

    Thanks Kevin,
    In my failed attempt at Optometry (most boring tertiary course i ever started; only lasted 6/52) they never got to the 'can exercises increase the eye's ability to see'. If, as i am assuming, they can not then surely it is 'drawing a long bow' to use them as an analogy, yes?



    Isn't there evidence to support physiotherapists Tx of tendinopathies whereby they initially reduce / eliminate loading from everyday activities but instigate rehab. programs initially and immediately involving isometric exercises on a reduced muscle length then ... to increase the tissue's 'load capacity' with the everyday activities? Is this not a reasonable analogy to using a foot orthoses to initially reduce the everyday loading?
    I don't include the anatomical anomalies(?) here.
    thanks again to you and Eric, mark
     
  7. efuller

    efuller MVP

    I think we also have to consider the effects of father time on the body. It seems that a lot of patients that have lived a pretty good life and then they develop tendonitis as they get older. I don't see any reason for the location of the axis of the STJ changing and making the load higher. However, as we get older we don't heal as quickly. If someone has an extreme STJ axis location, a tendon that could survive that when it was young may not be able to handle the high stress when it is older. I'm speaking more from personal experience than knowledge of the literature on aging and healing.
     
  8. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,
    Interesting title for this thread.

    Mark could you please describe-define "load management"?

    If we can manage the loads on exoskeletons and prosthetics can we do the same with foot orthotics?

    A hui hou,
    Steve
     
  9. Seamus McNally

    Seamus McNally Active Member

    Yes the tendinitis versus tendinosis time of life. (I'm in the older very active field too)
     
  10. markjohconley

    markjohconley Well-Known Member

    Goodaye Steve, how either the load on a tissue or the ability of the tissue to cope with load is managed. I was referring specifically to the effect a change in contour & stiffness at the foot-(contact surface) a foot orthoses provides to the load on a tissue. Load management can be by use of foot orthoses or, more commonly in sports medicine field, by increasing the load capacity of that tissue by strengthening.
     
  11. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,
    Sounds good.
    May some also call it kinematics and kinetics?
    It is kinda tough to strengthen an already injured and aging tendon but that should be the first and the least of our efforts.
    We just need to build-test better orthotics and shoes that can mitigate and manage ground reaction forces.

    A hui hou,
    Steve

    GFR is the Star.
    If you think my thoughts are a bit off kilter perhaps it is because of my background music...
    Remember that "Then sun is the same in a realitive way but your older" and so are your tendons.
     
  12. toomoon

    toomoon Well-Known Member

    I agree Kevin.. there seems to be a bit of a knee jerk reaction here without strong evidence. I have recently read that "For the majority they may be far more likely to be a short to medium term intervention rather than a life sentence."
    Now this was part of a thoughtfully presented piece, and I understand (i think) the premise of the statement, but I wonder how and why similar views are being seen as mainstream. Surely the answer lies, as it did with the barefoot argument.. it is not good and it is not bad. If you understand the implications, it can be used to help a runner. Same old same old.. the duration of use of an orthotic device is surely defined on a case by case basis?
     
  13. davidh

    davidh Podiatry Arena Veteran

    Hi, This "the duration of use of an orthotic device is surely defined on a case by case basis?" is only relevant if we assume that our feet have somehow adapted for life on our usual supporting surface. I think the evidence will eventually show that we have not.
     
  14. efuller

    efuller MVP

    For those who have a traumatic injury to their foot, there is the expectation that it will get better. For this kind of injury you use crutches until the body part heals and then the crutches are no longer needed. A small subset of the population may use the orthotic as a crutch while the injury heals. The vast majority of what we see is an injury caused by overuse of a particular body part. Normal activity caused the injury. After the injury heals there is a high probability for re injury because the conditions that caused the injury in the first place have not changed. An orthotic that reduces the everyday forces on a previously injured structure should be used long term.
     
  15. Simon:

    Agreed. Much of this call for foot orthoses to be used only on a short term basis is based on the false concept that foot orthoses somehow weaken the foot and lower extremity and it appears to be coming directly from physiotherapists and physical therapists. Not only is there no scientific research evidence that foot orthoses somehow weaken the foot and lower extremity or cause any long-term damage to the body over time, after making over 20,000 pairs of foot orthoses for patients over the past 33 years I have certainly not seen any cases of foot or lower extremity atrophy from their 10 year, 15 year, 20 year, 25 year or 30 year use. Ever!

    Instead I continue to see patients in my podiatric practice who have been wearing foot orthoses for 15 or more years who are extremely happy with them since they have allowed them to stay active without pain. Please someone explain to me how allowing someone to run, jump, walk and do all their weightbearing activities during their days, weeks, months and years with well-made foot orthoses "weakens" someone's feet and legs? This notion that foot orthoses weakens feet and lower extremities over time is simply a made-up idea by people who think that all foot and lower extremity pathologies can be treated with stretching and strengthening exercises. These same people don't have a clue how effectively and efficiently custom foot orthoses can work for many individuals. They only are seeing orthosis failures, not orthosis successes.

    My advice to those podiatrists who interact and lecture to physiotherapists and physical therapists is to realize that you are the experts on foot orthosis therapy and you should be saying there is no good scientific evidence that foot orthoses weaken feet and should just be used short-term, all in an attempt to keep the physiotherapist or physical therapist communities happy. They aren't the foot orthosis experts, we are. And unless they have the clinical experience with foot orthosis therapy that we do as podiatrists, then they are only guessing that patients with foot pain are best-served only with the short-term use of foot orthoses.
     
  16. Eric:

    Good points. Many physiotherapists and physical therapists think that foot orthoses are "braces" limiting the ability of a joint to move. If this is the case, which joints of the foot do foot orthoses prevent movement? They don't wrap around a set of joints like a neck brace does. They don't wrap around a set of joints like a cam-walker boot does. They don't wrap around a joint like a straight-leg knee brace does. Simply put, foot orthoses modify the external forces and moments that result from the mechanical actions of ground reaction force acting on the plantar foot. Foot orthoses don't prevent foot motion at any of the joints and lower extremity. Shoes, by themselves, by wrapping around multiple foot joints are more likely to cause a restriction of joint motion and "foot weakness" than do foot orthoses.
     
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