Does Everyone need Insoles?

Gerard:

I understand where you are coming from. It frustrates me also when I see see a patient who has been "sold" foot orthoses when there is no clinical indication for them or when I see a custom foot orthosis being made for a patient that actually makes them worse. The only worse thing is the patient that has had a foot and/or ankle surgery that ends up with more pain after the surgery than before the surgery and they are doomed to permanent foot/ankle pain and disability. I tend to think that I would rather have a bad orthosis that I can throw away and does no permanent harm than a bad surgery that causes me permanent pain and/or deformity. Don't you agree?

I use the spatial location of the subtalar joint axis, along with a standing and gait examination of the foot and lower extremity, along with other objective measurements of the lower extremity, along with the patient's history and, most importantly, the anatomic location of the patient's symptoms to decide how to most effectively treat patients with foot and lower extremity pathology. We call this approach the "Tissue Stress Approach" where the tissue that is injured is targeted so that we can design the most optimal therapeutic method by which to reduce the abnormal tissue stresses that have caused the injury without also causing any other pathologies in doing so. It is a highly effective approach and I have made orthoses for many of my orthopedic surgery friends and their families who have found these devices to be very helpful using this approach.

And, in regard to the mechanical significance of subtalar joint axis location, please answer me this question, Gerard: how do you explain the mechanical effect of the Evan's calcaneal osteotomy when used in the surgical treatment of flatfoot deformity? What mechanically-based theory is in existence that allows the foot and ankle orthopedist or podiatrist to create a "viable, predictable and effective treatment" by lengthening the lateral calcaneus surgically for the treatment of flatfoot deformity?

Thanks for contributing and welcome to Podiatry Arena.:welcome:

 

Hi Gerard
I don't think you will find too many people on this forum that would disagree with you...
But I am sure that you must realise that in your position you are not likely to see a high percentage of success stories with foot orthoses... after all they must still have a problem if they are seeing you!

I will say though that if I have a patient with a perceived negative outcome from the prescription of foot orthoses, I definitely what that person back to see me. I am sure that most of my colleagues on this forum feel the same way.

 

Hey Gerard

I'm afraid, as my colleagues note, I was being facetious. I've spent too long around Dr Spooner who tends to make his points by asking the right questions and allowing people to reach the right answer.

My last paragraph in the OP

My answer to the question in bold is, "No" IMO (and yours too it seems).

As I noted all of the models which demand insoles for all are highly disparate in all but this core factor. As such at least some or more of them must be wrong in their reasoning. You follow? If model A says the asymptomatic patient needs insole A, model B says insole B and Model C says insole C they cannot all be correct.

The house special among this particular group of podiatrists is the Tissue Stress model in which emphasis is placed very much on Attempting to directly address a presenting pathology rather than trying for a "Normal"

For an Idea of my views on some of the ways people get ripped off with orthoses (all in my opinion of course) you may enjoy a glance through This thread. It's tongue in cheek of course, but many of the scams on there are based on true stories.

It sounds to me as if many of the frustrations I wrote about there are ones you share. Here is an example from the above thread. To be clear, this is behaviour I see all the time and believe to be very wrong, the practice of using fear to sell people orthoses for pathologies they don't have yet.

Kind regards

 

Robert,

Wellness is a buzzword that is being tossed around and promoted by allied health fields in increasing fashion these days. As many of you know, I am not a chiropractor who sells the wellness concept but I have mixed feelings about some aspect of it. Wellness also implies a certain level of personal responsibility for each of us and often someone to guide us in the processes, who better then those with training? Fact is, many allopaths are offering wellness care these days regardless of the lack of evidence supporting such practices.

That said, I prefer to think in terms of prevention rather than wellness, I just have a strong aversion to that terminology. We all practice some level of prevention do we not? I bet Gerard sees many patients at-risk for fracture due to osteoporosis or whose numbers suggest they should be put on medication, supplementation or weight-bearing resistance training (or probably all of them) to increase bone density and avert what may potentially be a devastating outcome for that patient. Is this prevention or wellness, or both? It certainly aims to prevent a potential problem and I doubt that anyone would disagree with it.

My point here is that I feel that custom foot orthoses can and do prevent some common foot related pathologies and that they are one aspect of prevention whose value has been grossly understated. It could also be that a prefab or change in footwear can have the same positive effect. Can anyone here say that they have never seen an adult flatfoot progress over time to a symptomatic posterior tib dysfunction? We may not be 100% sure that the patient will develop the condition until it they present with symptoms but are we doing the most appropriate thing for that patient by not explaining a potential condition based on examination and observation that may affect their health? A CFO may not be the only appropriate option or the most cost-effective; that is a judgment call and a decision that we all have to make in the best interest of the patient. I feel that as a conservative measure CFO's and insoles are often an appropriate first line of treatment and their risk to benefit ratio is excellent.

If we take Kevin’s example above of the Evan’s osteotomy and apply that to a CFO (you will never obtain this type of correction with a prefab) for a flexible flatfoot deformity you can see where an appropriate designed CFO could potentially avert or delay a surgical procedure. This type of conservative treatment should be the first line of treatment where possible, should it not?

We cannot seem to define what normal is with regard to subtalar range of pronation motion referenced with rearfoot to forefoot, but we can say what abnormal is based on clinical experience and similar presentations. Do we simply wait until the patient has painful symptoms that may require more invasive procedures or intervene early when we see excessive STJ pronation and compensatory heel valgus in a flexible deformity?

The same goes for those patients who may develop plantar fasciitis because their footwear is tragically non supportive, or it is summer and they wear flip flops every waking hour, they are gaining weight and attempting ill advised weekend boot camp type classes and were previously sedentary. Is it not important to assess the basic level of support of their medial long arch during walking and impact loading to offset these increased demands and ward off potential problems? Is this wellness or prevention...or is it just common sense and caring about your patients overall well-being?

I for one prefer to use some common sense and offer my patients all of their options and prevention is a professional and moral imperative in my opinion. At times that intervention may be a CFO and although I may never know if they for certain would have developed PTTD or PF, I sleep very well at night knowing that that potential insult never became a reality. We shouldn’t have to make excuses for quality preventive measures unless the criteria that we base those decisions on are purely financial. That is a whole other subject.

Does everyone need insoles or CFO’s, no? Is there a place for these interventions in prevention? I say absolutely yes!

 

David:

Probably one of your best posts of all time. I couldn't agree more.:good:

 

A non-trivial interjection: we were never designed to do anything. Rather, our species evolved whilst doing many things, adapting to do many of them very well.

Second, it may not be as nonsensical as you assume. Hard and flat like sidewalks, no. But relatively hard and relatively flat like hard-packed prairie/savannah game trails, probably.

If most of us do have inverted feet, and this inversion was/is useful on uneven/variable terrain but uncomfortable/injurious on city terrain, wouldn't it make sense to adopt the simplest and most straightforward method of compensating for flat and hard surfaces?

For example, reafoot varus is very common, and as K. Kirby showed, it's the GRFs at the lateral forefoot that tip everything into potentially pathological hyperpronation in these feet. If we're talking insoles for everyone, why not just put a full-length canted insole into these people's shoes - rearfoot and forefoot varus posting with no fuss? Forget the casting, arch supporting, etc.

Or better yet, a dual or tri-density insole or sockliner (medial-firm, middle-medium,lateral-soft)? (Does a product like this exist, BTW?)

If inverted feet are a mismatch with horizontal, flat and hard surfaces, why not just make the surface a bit softer and more varus-friendly?


On the other hand, the homogeneity of sidewalks and shoe insoles may also be important, in which case we're all screwed.

 

All I can do is add my opinion at this point.

The fact that some of us are questioning the overuse or appropriateness of insole use is a breath of fresh air.

Whilst working as a surgical registrar my use of orthoses certainly changed. Some of my fellow podiatrists accused me of experimenting on my patients by referring them for surgery. They had the mindset that EVERYTHING is fixable with a good orthoses.

I have seen in my 25+ yrs a significant change of treatment protocols. The orthoses has changed from the Big Hammer in the tool box to the only Hammer for some clinicians.

In defence of the Orthoses Vs Surgery an inappropriate orthoses rarely does more than mortally wound the wallet.

If Dr's and surgeons were only allowed to practice evidence based medicine they would have a lot more family time so we all must test our own assumptions to sleep well at night.

I ended up not completing my surgical training due to a number of personal reasons but feel at least for my Australian colleagues more time with a good surgeon will balance their views.

I enjoy watching a good game of "Chase your Tail".

regards

Colin

 

Hi Bill,

I think some of their ideas weren't so far from the truth.
Consider this quote from Norman Lake - "A well-developed foot, judged by evolutionary
criteria, may stand up to considerable abuse, failing only
when the maltreatment becomes excessiVe; but a badly
adjusted foot may fail under the normal stresses of ordinary locomotion without any misuse whatsoever."
BMJ. LONDON SATURDAY JANUARY 10 1942. EVOLUTION AS AN AETIOLOGICAL FACTOR IN FOOT DISORDERS - Norman Lake.

As I think you know, I believe the hard, flat surfaces are much more of a causitive factor in foot pathology than has hitherto been acknowledged.

It is now generally accepted that we have had a little more time to develop/evolve than the Victorians believed.
At that time it was thought by evolutionists that we evolved from the great apes. We now think that hominids and the great apes evolved from a common ancestor around 10 million years ago. I may be a little out on the timescale - the goalposts tend to change according to latest anthropological findings.

Cheers,

Davidh

 

Hey David

I largely agree with you here. I have no problem with preventative orthoses per se. My area, as you know, is Paediatrics where a great deal of what I do is to prevent recurrance of symptoms. The devil is in the detail of what we consider to be a reasonable threshold level of what we consider to be predictive.

You have your "trigger points" and I have mine. I don't doubt many of them overlap. But the point is that we both admit the theoretical possibility that some people DON'T meet those criteria. That there are some people who when they come to clinic, asymptomatic, we send away with fulsome congratulations and standard advice.

Many models don't allow for that. They are the ones I have an issue with.

 

and here is some evidence for prevention medicine. There is a few maybes but .....

Lateral wedges decrease biomechanical risk factors for knee osteoarthritis in obese women

Elizabeth M. Russell , Joseph Hamill

Abstract

Obesity is the primary risk factor for the development and progression of medial compartment knee osteoarthritis. Laterally wedged insoles can reduce many of the biomechanical risk factors for disease development in osteoarthritis patients and lean individuals but their efficacy is unknown for at-risk, obese women. The purpose was to determine how an 8° laterally wedged insole influenced kinetic and kinematic gait parameters in obese women. Gait analysis was performed on fourteen obese (average 29.3 years; BMI 37.2kg/m2) and 14 lean control women (average 26.1 years; BMI 22.4kg/m2) with and without a full-length, wedged insole. Peak joint angles, the external knee adduction moment and its angular impulse were calculated during preferred and standard 1.24m/s walking speeds. Statistical significance was assessed using a 2-way ANOVA (α=0.05). The insole significantly reduced the peak external knee adduction moment (mean decrease of 3.6±3.9Nm for obese and 1.9±1.8Nm for controls) and its angular impulse in both groups. The wedged insoles also produced small changes in ankle dorsiflexion (obese: 1.2±1.4° increase; control: 1.5±1.4° increase) and eversion range of motion (obese: 1.3±1.9° decrease; control: 1.5±1.2° decrease) but did not alter peak angles of superior joints. Although the majority of obese women may develop knee osteoarthritis during their lifetime, a prophylactic insole intervention could allow obese women with no severe knee malalignments to be active while preventing or delaying disease onset. However, the long-term effects of the insole have not yet been examined.

Highlights
► Obesity is the primary modifiable risk factor for knee osteoarthritis. ► We examine how insoles affect biomechanical risk factors for disease development. ► Lateral wedges decrease the adduction moment and its impulse. ► Obese may prevent or delay knee osteoarthritis onset with lateral wedges.

PS Ian G any chance ?

 

Am I reading this right? That a lateral wedge decreased eversion ROM? I'd have thought it would increase eversion.

There is a point here. The insoles decreased knee adduction moment. Fair enough. But what ELSE did they do? Would they increase any other risk factors? For Eg, if a lateral wedge were to increase pronation moment, or pronate the foot more, would it cause a medial shift in STJA?

And would a medially wedged (preventative) insole in the same group increase Knee adduction moment? I've never fully grasped how a lateral wedge can decrease Knee adduction moment but a medial one DOESN'T increase it.

We don't want to injure Peter

 

If there was a Kinematic change ie more pronation yes the STJA will be more medial, but if the foot is unable to pronate any more ie maximally pronated then there will be kinetic change but no kinematic change and therefore not increased medial position of the STJA.

I believe a medial wedge will change the kinetic relationships re adduction/abduction moments at the knee but due to distial to proximal power flows at the stage of the gait cycle the medial wedge is unable to have the desired effect. (- But I´m not really sure on this point, hence the I believe)

re Peter that was one of the big conclusions - ie the long term effects of the lateral wedges.

 

Robert:

In this case, the researchers are reporting reduced external knee adduction moments, or, in other words, ground reaction force tended to not adduct the tibia on the femur so forcefully with the valgus wedged insoles.

And yes, varus wedged insoles would increase external knee adduction moments, but would also simultaneously increase internal knee abduction moments.

Hope this helps.

 

Gerard:

I am still interested in the theory you feel best explains the biomechanical effect of the Evan's calcaneal osteotomy.

You seem to object to the measurement of "subtalar angles" and how these may relate to foot pathology. However, my observations over the past 26 years of practice have been that foot and ankle orthopedic surgeons and surgical podiatrists routinely do surgeries that they simply have insufficient experimental research evidence to actually know how their surgeries work biomechanically.

Here we have surgeons cutting bones, ligaments and tendons of the foot and ankle and then rearranging these structures into new positions, but the people actually doing the surgery have no research basis regarding the biomechanical effects of these surgeries by which to make sure they are offering their patients what you call "viable, predictable and effective treatments". In other words, how many of the surgeries you routinely perform are no longer in the theoretical stage and have moved into the stage where they can be considered to be solidly backed up by good scientific research evidence?

Regarding this seeming disparity between what the theory is and what the research shows in regards to most treatments that we all offer, my question to you is which treatment is the one that should be first offered to patients with foot and/or lower extremity mechanically-based pathologies:

1) a custom foot orthosis that may work based on our previous clinical experiences with treating similar patients with orthoses and that has a firm theoretical basis by which to guide orthosis treatment, but has limited research to back up its continued use or,

2) a foot/ankle surgery that may work based on our previous clinical experiences with treating similar patients with foot/ankle surgery and that has a firm theoretical basis by which to guide foot/ankle surgery treatment, but has limited research to back up its continued use?

I anxiously await your reply.

 

Gerard,

Do you do calcaneal slides for people with flat feet or posterior tibial dysfunction. When I was training, it wasn't heard of. I would suggest that Kevin's popularization of STJ axis location and rotational equilibrium theory has provided the rationale that has made this procedure more popular. The procedure is designed to put more of the foot medial to the STJ axis so that the pronation moment from ground reaction force will be less. Still waiting for outcome studies, but it does have a nice theoretical basis.

Eric

 

Kevin: Thank you. I see the trend to "sell" patients the more expensive items without regard to medical necessity more often from retail outlets and from labs with certain questionable "theoretical" constructs.

Robert: I completely understand what you are saying and yes there are people who do not meet those criteria. I agree with that.

Mike: Thank you for the study. I realize that the patient population in the study was chosen for a particular risk factor for developing medial knee compartment OA; obesity. The irony is that obesity itself is probably preventable in most of the population. If they perform a long-term trial, weight loss and lifestyle should be a goal included in that study because we know that intervention in obesity prevents numerous other comorbidities.

I know, I know...they've studied this in lean individuals so they were attempting to study wedging to reduce OA in obese women but this is one of those "trigger points" Robert referenced that sets me off!

The appropriate thing to do would be to offer them Lap-Band® surgery because medical procedures should always be the first line of treatment, correct? Damn to Hell all conservative approaches, personal responsibility, nasty and unproductive exercise etc..:bang:

 

I have been reading most of the posts such as the ones on this discussion point and all I feel is frustration.
I think (or thought) that I do my best for my patients. If we cannot establish a common
assessment and procedure for the advising of wearing orthotics then how can we know that what we do is right. And how can we adequately defend any such treatment if opinions are so varied. But conversely, if we do nothing are we not equally culpable?
Did opticians have the same problems before establishing a mean by which to prescribe spectacles?

 

I feel your pain.

The optician comparison does not really work. You can tell what pair of glasses work best, then and there, in the assessment. Not so simple for us.

Opinions ARE varied, but they are not all equal. Some are evidence based, others are not. Some are consistent and logically coherent, others are not.

 

Surgery for tib post failure consists in my hands of FDL transfer, spring ligament plication (at level of t-n joint) and previously calcaneal osteotomy but more recently insertion of an arthroresis screw to prevent valgus at the hindfoot. The idea of holding the hindfoot more neutral is as someone has suggested to prevent an abduction moment at the subtalar joint whihch would throw the foot flat again. I like to think correcting the hindfoot will prolong the life of my transfer since sending FDL in to replace tib post is "A boy on a mans errand" , at least till it strengthens up over time. Is there strong biomechanical evidence for this treatment - possibly not and we are the worse for it. I would love to see a biomechanical study looking at the effects of calcaneal slides etc on the forces in the hindfoot but if it exists I have not seen it. I guess all I can go on is clinical success in my mentors hands and in my own over theyears.

As far as the study of obese women and knee forces. I was not aware obesity was the greatest risk factor, I thought knee alignment and adductor moment and family history were all stronger. I am not a statistician but the changes did not seem that different due to the large SD (3.8 +/_ 3.9). I also challenge anyone to pick a 1 degree change in ROM.

I also would love to see proof of any condition that is categorically prevented by orthoses (Only well conducted Level 1 or 2 studies please.

Gerard

 

Gerard while you keep bashing away at orthotics and treatment of conditions using orthtoics and the use of orthotic by Podiatrists and other medical professionals the same type of arguement can be used against orthopedic surgeons and where does it get us.

No where, that is where - The fact of the matter is orthotics work and work well for a lot of patients - not all but they work.

Yes they do get mis-prescribed but a device can be taken from a shoe and more often than not do not cause everlasting damage where as a bad surgery completed by a surgeon claiming to be a foot specialist who has no understanding of foot biomechanics can not be reversed or damages the patient for life.

So in my opinion until you can show us evidence on every type of surgical procedure for every single cutter your argument serves no purpose.

 

Depends what you mean by evidence. Inductive outcome studies? No. But one could make a very solid case based on deductive evidence for a good rationale.

The only things that insoles could catagorically prevent are things which are only ever caused by foot function. Would you settle for statistically significant evidence of risk reduction?

 

although I am not as advanced as you on biomechanics Robert my philosophy when approaching any suspected biomechanical abnormality is and has always been the same- " DON'T FIX WHAT DON'T HURT"

and i have seen plenty of people over the years which I have been quite astounded that they display no symptoms whatsoever even though they display an obvious problem.

So even if this model of 8 degree inversion were true, which sounds far fetched to me anyway, the moral of treatment should be to leave it alone if it causes no pain or discomfort, and has no other affect on the entire musculo-skeletal system.:dizzy:

 

We do recognize there is a population that need orthotics, and many who don't. I agree with Dr. Tanner, and would suggest we pose a different question focusing on whether a patient can benefit from the orthotic. As Dr Tanner points out, individuals will (or may) each derive a different benefit from the orthotic.
Just my thoughts

 

Hello.
I think that everyoe would walk better with personal well adapted soles.
We usually walk on artificial floors and our feet are originally made to walk over natural floors.
Almost all professional sport practioners, at least, in Spain wear insoles to prevent feet, legs and back demages. And all sport shoes have insoles that imitate a standard foot, your own foot would be better, would not be it?
Thank you.

 

This is an excellent question that will always become a great topic for discussion. Outside of the scientific research and a logical point of view will state that not everyone will require insoles. And by insoles I do mean orthotic support of some sort depending on the design, type, or method of fabrication.

Three things will always set of a guarantee of requiring some form of increased support. These are:
1) PAIN !!!!! it is always the best marker and sign that something is amiss and needs attention, whether or not it must be long-term or custom-made that will be evident though a detailed evaluation of the type of pain, amount, time frame, and bio-mechanical attributes associating with their pain.
2) Weight loss or gain - We are talking a drastic amount (eg. 40+ lbs or so). This changes the entire anatomical movement and muscular control of the limbs in particular of the feet. This includes weakening or overworking of the tendons/muscles and in many cases the ligaments are being stretched or have been stretched too much due to overwork.
3) Health concerns - (eg. diabetes and arthritis etc...) There are many more of these categories that will directly influence requirement of insoles and the amount of support.

These are general and practical applications not a scientific view. I have found in my experience that science can give us answers to a point as there will always be exceptions which disprove our hypothesis. Each human being is different and we cannot state that all require insole or the reverse and there is no hard fast rule either scientific or otherwise that would provide an ultimate answer.

 

Hi All,
Great thread to read, and welcome to Gerard for being game enough to put his head above the trench. Another theme to what we do is something I often think about. There are two fundamentally different approaches to use of orthoses
1. Functional, where the aim is to change function, to regain lost performance or obtain aspects of function not previously attained by an individual. (all sorts of debates about what is ideal or normal or best)
2. Palliative. I have done a lot of work in aged care rehab etc and diabetes.....here we are protecting and supporting structures that disease, over use and age have eroded beyond the point where we can reasonably expect recovery of ideal function.
These are two quite different things I think. Due to the previously stated large individual variation in anatomy, health and age I prefer to think that I am facilitating the best (least painful, most viable ability to walk) function of what's left of a particular individual. This circumstance requires ethics and expertise but perhaps less application of the theories that try to reduce everybody to the same set of common denominators.
regards
Phill Carter

 

Hi Again,
As far as the surgery vs orthoses debate....is it feasible for all to admit that nobody is perfect? and that practitioners on both sides have less than ideal outcomes? For a whole range of reasons, some of which may be understood and some not? Of all the hip replacements I have dealt with over the years there's a few I've seen with permanent foot drop due to nerve damage......these people often wish they had not had the surgery as they swallow the neurological pain killers that cost quite a bit and will be necessary for the rest of their lives. I'm yet to see a pair of orthoses cause damage even close to that kind of scale. Considering how many people spend $3oo to 400 on a pair of sunglases and don't count the cost I think the possible upside of pain relief via orthoses is not bad value.
And the downside is usually only financial.....but when was the last time you got a refund for the drug that did not work after it was prescribed?......let's just call off the whole argument?
regards Phill Carter

 

There is no doubt that orthotics form a very useful and powerful therapeutic tool in the treatment of a variety of foot ad ankle problems and possibly even in certain knee conditions. Management of diabetic neuropathy also remains a mainstay of orthotic treatment. My problem however is the widespread prescribing of rigid orthotics for normal variants in particular flexible flat feet to prevent problems and the continued use of orthotics forever once the painful condition has resolved, in particular in the treatment of plantar fasciitis, metatarsalgia and overuse tendon injuries. There is little proof that the continued use of orthotics in many of these conditions is required or will prevent a return of symptoms yet patients are advised they need orthotics forever.
Orthotics remain a valuable therapeutic aid but like other therapeutic modalities such as antibiotics and anti-inflammatories should be used only as required and ceased when not required.
Gerard

 

So, Gerard, we should be able to apply your logic to other therapeutic modalities...such as prescription eyeglasses.........ankle foot orthoses.....?

Prescription eyeglasses remain a valuable therapeutic aid but like other therapeutic modalities such as antibiotics and anti-inflammatories should be used only as required and ceased when not required.

Ankle foot orthoses remain a valuable therapeutic aid but like other therapeutic modalities such as antibiotics and anti-inflammatories should be used only as required and ceased when not required.

Is that the correct logic you are trying to inform us of??

 

For a very personal N =1, when I go without my orthotics my feet hurt. I am absolutely positive that some people will prefer to wear their orthotics for the rest of their life.

Eric

 

This analogy is accurate- I have patients who wear glasses just for reading, others just for driving. I also have patients who wear their orthoses just for running.

Personally, I don't wear my foot orthoses permanently. I put them in when I feel my sciatica coming on, wear them for a while until the symptoms resolve then take them out of my shoes and put them back in the cupboard until I next feel the pain coming on. Works for me.

Other patients need to wear glasses all the time...

 

Hi All,
I would not contradict you there Gerard, little hard proof of lots of things. I tell my patients that when their anatomy appears to predispose them to the plantar fascial stress problems and they have had it for a year or two, or on and off for 5 years it seems unlikely that it will ever go away for ever. It seems to be a mechanical stress problem and if we remove the tensile stress from the painful structures effectively enough, along with stretching etc, the symptoms go away......but if we return to the same foot management that was in place before onset.? ....why won't the problem come back.? I don't tell my patients to wear orthoses forever.....I just tell them not to throw them away......even though making another pair for them in 5 yrs is better for me.
I do have a group of patients who handle this another way......they sit down and avoid mechanical stress on their feet as much as possible, but this approach seems to have other health related problems.....
regards Phill Carter

 

Once again Kevin you have taken the argument to the nth degree. Obviously there are certain severe permanent disorders that require permanent treatment with external devices. Your example of long sightedness is a permanent example. AFO's in neuromuscular weakness is another example but for most of my patients at least who do not have a permanent serious deformity or a major biomechanical abnormality ie it has not been present all their life and is only a recent problem. Temporary application of external treatment modalities seems to do the job. There are certain people who do find that when they cease wearing orthotics their problem recurs and I advise them to return to wearing them but at least I give them the option rather than dictating that all orthotics need to be continued ad infinitum without review.
Gerard

 

Yep. That seems reasonable to me. I wear orthoses some of the time.

However there is a major difference. One can instantly, easily, quantifiably and reliably test the effects of eyeglasses. One cannot instantly, easily, quantifiably and reliably test the effects of orthoses. So the analogy is a little skewed.

 

The amazing thing is that a lot of feet problems can be solved by adopting barefootedness and the fantastic thing is, it's FREE, however it must be introduced slowly so that the body can adapt after years of atrophy in shoes.

Barefoot walking and running strengthens the feet and ankles as well as simulating the nerve superhighway from the feet to the brain. :good:

 

What I find amazing is that I see so many foot problems in people who have moved to the Middle East and walk around the house barefoot. Is walking not introducing the barefoot concept slowly enough??? I know - it will because of those evil shoes they were wearing before...

Then why do I see the same problems in the local population who almost always wear open sandals or are barefoot???

I'll give you a tip Barry. Unless you are barefoot on a natural, variable surface, it is not 'natural'

 

Meaningless and asinine drivel. If you're a podiatrist barry, you should know better. if you're not, you really should not be her.

Nerve superhighway my flabby A**e

 

Gerard:

Patients will do what they want to. If you tell them that you only need to wear the orthoses half the day, they may prefer to wear them all the day since they are simply more comfortable. If you tell them that you need to wear them all the time, they may end up wearing them only 2-3 hours a day since they don't like wearing shoes.

Orthotics are always temporary and can always be taken out of the shoe when they are bothering the patient or uncomfortable. However, with a bad surgical result, the patient has no option but to live with the surgeon's poor judgement and technique forever. I think this issue of whether patients wear foot orthoses longer than you think they should is a relative non-issue compared to the issue of surgeons performing inappropriate foot surgery and giving people life-long pain that they can't "remove from their shoes". Don't you agree?

 

But then wearing shoes would be even less natural. :santa2:

This is logical as we weren't born with shoes on, were we?

 

I vote that we kick all of these barefoot idiots , like Barry Onion, out of Podiatry Arena permanently....they are ruining this great and clinically useful podiatric academic website!!:bang::craig::bash: