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Training intrinsic foot muscles; orthotics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by happybanana, Aug 4, 2015.

  1. happybanana

    happybanana Member


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    https://www.facebook.com/IamPhysiotherapy/posts/856314827791513

    "Very interesting podcast where Prof. Irene Davis talks about why orthotics are not the best treatment for footpain.
    You have to train the foot muscles instead.
    She explains which exercises are best to train the intrinsic muscles of the foot.
    And she explains why midfoot strike in running is better, in patients with compartment syndrome, than heelstrike"

    What is everybody's thoughts on the matter?
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    We had this thread previously: 'Core stability' of the foot

    I replied to the facebook post with:
    I blogged about the concept:
    The concept of ‘core stability’ of the foot
     
  3. happybanana

    happybanana Member

    Sorry to repost, and thank you kindly for the links.

    I guess this debate really brings out the stereotypes:
    Physios believe rehab/strengething will cure all lower limb pain
    Pods believe orthotics will realign all biomechanics to cure lower limb pain :bash:

    PS I look forward to your boot camp next weekend at Perth
     
  4. The problem is, Banana, that some physiotherapists/physical therapists are actually very vocally "anti-orthosis", making claims that their goal is to get patients out of foot orthoses. One of the authors of the "core stability of the foot" paper has personally told me that her goal over the next few years is to get all of her patients out of foot orthoses. She also claims that foot orthoses "weaken feet".

    This myopic attitude is rather surprising coming from a PhD biomechanics researcher who has performed research on Blake Inverted Orthoses showing they are superior to typical Root style orthoses are treating running knee pain since there is really no convincing research that foot orthoses do weaken feet. This same researcher is a big advocate of barefoot running. Even researchers who claim that they "follow where the evidence leads them" have their own personal biases that prevent them from being totally objective.

    By the way, I don't know any podiatrists who go around the country lecturing that their goal is to prevent patients from strengthening their feet. The intelligent and unbiased sports podiatrists and physiotherapists/physical therapists that I know use a combination of foot orthosis therapy and foot and lower extremity strengthening/stretching to treat foot and lower extremity injuries. Why would you want to limit yourself to only one or the other treatment? It makes no sense
     
  5. Stanley

    Stanley Well-Known Member

    According to the paper ( The Relationship Between The Toe Exercises And The Medial Longitudinal Arch Takashi Shiro****a, Toru Fukubayashi)

    All subjects randomly performed the three toe exercises and the towel gathering exercise. Before and after each exercise, we assessed MLA using the navicular drop test (NDT)Brody developed.

    This is not the best paper to support your argument, as the paper shows that fatigued muscles do not support the MLA as well as non fatigued muscles.
     
  6. pod29

    pod29 Active Member

    Hi Craig

    With respect, I think your views of intrinsic foot muscle function aren't entirely accurate. See http://www.ncbi.nlm.nih.gov/pubmed/25551151 and http://www.ncbi.nlm.nih.gov/pubmed/24478287.

    These muscles certainly have the potential to alter longitudinal arch biomechanics and strengthening these muscles probably should be considered as part of a treatment program for a number of clinical conditions

    Regards

    Luke
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Luke - my point is that we have this proposed model about 'core' stability of the foot...

    For any model/theory/framework/etc to be useful it has to explain the preponderance of the evidence, be consistent with the preponderance of the evidence and have explanatory powers.

    The references that I "cherry picked" were the ones that the model is not consistent with; of course there are studies that the model is consistent with (and the paper referenced them, but did not reference the ones that it was inconsistent with).

    The core principle of the proposed model is the the intrinsic muscles stabilize the the foot (like they do in the back), so the larger muscles can be the prime movers (like they do in the back); if you look at any muscle fire timing chart then it is clear to me that this can not happen due to the sequences of activity of muscles during gait --> model flawed (probably fatal)

    That issue with the muscle fireing timing and the studies that the model is not consistent with or can not explain means that the model does not meet the criteria:
    I have no doubt about the value of including strengthening of these muscles in rehab and do that clinically... I just do not base in on the above model...
     
  8. pod29

    pod29 Active Member

    Hi Craig

    Thanks for the response. I am aware of the model and if anything I believe that idea of these muscles as local stabilisers actually understates their function. These muscles have a relatively large moment arm across the axis of the mid-foot and thus have the potential to act as "prime-movers" to effectively stiffen the arch. Based on our data, which is presented in the above linked articles, these muscles are active from terminal swing and therefore do have the capacity to perform the proposed function. I'm not necessarily advocating the "foot-core" model, but judgements should be made based on data, as you elude.

    Strengtheing these muscles will not improve static foot posture, as they are barely active in quiet bipedal stance. In order to determine if strengthening of these muscles
    has led to any changes in arch function, you would need to look at the dynamic arch function, ie the magnitude of arch defelction from foot contact to midstance.


    Cheers

    Luke
     
    Last edited: Aug 7, 2015
  9. Dennis Kiper

    Dennis Kiper Well-Known Member

    I was first approached over 25 years ago, by someone who theorized that orthotics weakened foot muscles and strength exercises were the key to eliminating orthoses.

    I responded immediately with my explanation that he was probably correct, because of the inherent flaws of traditional orthotics. I explained that orthotics do not properly balance the foot through stance phase and lack the stability for muscle function to be efficient and therefore his claim had substance.

    I tried to explain the difference in bio-fluid technology, but like Spooner, he wasn't buying it either.

    ?The good thing about science is, it's true, whether you believe it or not?--Dr Neil DeGrasse Tyson, astrophysisist
     
  10. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    ... but ALL the studies that have looked at foot orthotics and muscles strength have either shown that foot orthotics strengthen the muscles or do not weaken them.
     
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