Childrens insoles

My opinion: any prescription of orthotics on long term for kids with no foot pain (especially in prevention or to correct a 'supposed' abnormal biomechanics) is inappropriate !!

I will remember our conversation when we will speak about my 13y of prescription of minimalist shoe

 

Blaise, Read MacDonald and Kidd (about) 1998 in the Australian Journal. We took a heap of **** for that. essentially, you have just said the same. Rob

 

So you should only use foot orthoses if a child is in pain? What about the child with cerebral palsy with gait/biomechanical/balance issues? Barefeet or minimalist footwear is going to help them?

 

Blaise and Kevin are both full of frustration and are resorting to personal attacks because like the rest of us, neither high level, longitudinal, non biased evidence upon which to stand, PERIOD.
Kevin's power rests upon a pedestal of Newton's Three Laws and Evidence. To admit that he has no real high level evidence or that biological structures do not obey Newtion's primary laws or that he has no real high level evidence, personal or otherwise to justify his position basically renders him weak.

Blaise and I can admit that we have no Level 1-2 Evidence because our strengths are based on facts, dictums, anecdotes, clinical and life successes and low level evidence just like him.

I have been in practice for 42 years, I have treated my share of feet with orthotics with what I anecdotally consider to be good results.

So, my clinical experience and credentials are not as impressive as yours Kevito but they are more impressive than Mr. Duboise. I am raising questions for you to answer and in doing so, I am eliminating your personal, self serving degradation of Blaise to unfairly reduce the power of his opinion.

1. I would like to know what evidence, beyond ego and profit motive low level, personal anecdotes (Level V) you have in stating that the orthotics that you dispense in your practice have "excellent clinical results"? and

2. Beyond anecdote and personal ego and a desire to reap profits in practice or elsewhere what evidence do you have to state that your orthotics are ""correctly made"?

I think that the main reason that barefoot running, midstance and forefoot closed chain contact gait is so verboten in biomechanics EBM is that these gait patterns, as compared to heel contact gait patterns (which almost all high level gait evidence is based upon) converts Peroneus longus into more of a primary pronator of the forefoot (something good) and less of a primary pronator of the rearfoot (something bad) which reduces the level, value, applicability and import of much of your evidence, drawings and discussions.

I realize, as an acknowledged international authority of biomechanics that you would like us to never walk sideways, backwards, lift or strain upwards or downwards.

IMHO, your "correctly made orthotics" would provide less than excellent results when tested on a football defensive cornerback pedaling backwards off the line of scrimmage who presented to your practice complaining of FHL tendonitis.

Dennis

 

Surely this discussion is going nowhere & again, like so many posts people make, becomes a mud slinging match that achieves nothing. Please stop. Go somewhere else. I genuinely come here to learn but I find more & more posts are turning me off.

 

Don't worry, Blaise. No more conversations with someone like you who preaches to a whole profession but with no clinical experience in the subject.

Blaise, why don't you go back to preaching to the poor people who actually think you may know something useful?! Honestly, I haven't seen that you do know anything of use. I'm done with you.

 

So Zac, do you have any Evidence?

List some or be a man and state that you don't have any in order to level the playing field here.

Instead of asking me to go away, stop asking me to provide evidence in order to weaken my case (or Blaises or Dr Dananberg or Dr Glaser or Dr. Segal or..... here on The Arena. We are all free thinkers and entitled to our opinions until proven otherwise.

Doing that would greatly reduce my reactive mudslinging as you wish to call it. I call it making reasonable demands for answers to questions that The Arena would rather selfishly shy away from.

Dennis

 

:good:

hi to all
thanks for reply me...
at first i correct my qoute,no eight years old but by five or six years old, However, for flatfoot children.
i read subject from Wikipedia site ...
A portion of text:
The appearance of flat feet is normal and common in infants, partly due to "baby fat" which masks the developing arch and partly because the arch has not yet fully developed. The human arch develops in infancy and early childhood as part of normal muscle, tendon, ligament and bone growth. Training of the feet, especially by foot gymnastics and going barefoot on varying terrain, can facilitate the formation of arches during childhood, with a developed arch occurring for most by the age of four to six years. Flat arches in children usually become proper arches and high arches while the child progresses through adolescence and into adulthood.

Because young children are unlikely to suspect or identify flat feet on their own, it is a good idea for parents or other adult caregivers to check on this themselves. Besides visual inspection, parents should notice whether a child begins to walk oddly or clumsily, for example on the outer edges of the feet, or to limp, during long walks, and to ask the child whether he or she feels foot pain or fatigue during such walks. Children who complain about calf muscle pains or any other pains around the foot area, may be developing or have flat feet. Pain or discomfort may also develop in the knee joints. A recent randomized controlled trial found no evidence for the efficacy of treatment of flat feet in children either for expensive prescribed orthoses (shoe inserts) or less expensive over-the-counter orthoses.

Regards

 

Sorry to have contributed to the diversion of this thread on this very important clinical topic: the effective treatment of children's foot and lower extremity mechanically-based pathologies with foot orthoses.

I think I have found the solution to prevent me from doing it again:

 

Dennis

South American MD's determined longitudinally that when it comes to children "growth" is defined as lengthening, widening and flattening of the foot.
Can you point to even one article that finds any of your conjectural opinions to resemble fact.

 

I wanted to include this illustration but couldn't do it so please add this to my recent post as a visual.
Please note that fitting with the architectural piece of Foot Centering, the baby's foot is not unlike an Architectural Arch.



Dennis

 

Why? I know it has been mentioned before but are you including those I see who have C.P.? Why should they be denied due to age? These kids do not walk or balance well without the orthoses. You are inferring that they should be denied the ability to play with their friends because they are not yet of the right age for help?

 

To Dennis, I come on here to learn. I make an occasional post to voice my views but in the main, I have posted questions & received significant guidance & support. So when you challenge me to provide support, I cant help but get slightly annoyed. My comment about mud slinning applies to anyone, not just you. I said it because I get frustrated that so many threads get "ruined" & diverted from their initial focus.

 

Sorry.

Dennis

 

Hi Everyone

I think I should say a few words. Our 2010 systematic review showed very poor evidence but our literature review (2012) should some very good evidence on the use of insoles/foot orthoses but were not randomised clinical trials. There are two schools of thought about treating or not treating children with insoles/foot orthoses relating to flatfeet.
If you have an opportunity to attend this year’s APODC conference in Sydney you will hear Professor Russell Volpe, an expert from New York talking about treating kids. You may well want to listen to Dr Angela Evans and other clinicians on their views.

 

Thank you Mr. Krome. Is this what you are referring to?

http://www.japmaonline.org/content/98/5/386.abstract

 

Hi

The articles relate to:

Evans AE, McKenzie, A, Rome K. The efficacy of non-surgical interventions for paediatric flexible flat foot: a critical review. J Pediatr Orthop 2012; 32:830–834.

Rome K, Ashford R, Evans A. Non-surgical interventions for paediatric pes planus (review). Cochrane Systematic Review 2010; 7.

 

Thank you

 

Keith:

Thanks for chiming in. This discussion is always a very interesting one when I lecture on this topic at seminars.

I think Dr. Volpe and I are pretty much on the same page when it comes to treating children with flatfoot deformity. I believe we both use the same treatment philosophy for treating children's flatfeet as does Ron Valmassy, DPM, and as did John Weed and Mert Root, DPM. Also, please say hi to Russ for me while he is in Sydney.

I see no problem with making children with painful feet and lower extremities, due to excessively pronated feet, in-shoe wedges, modified over-the-counter orthoses or custom foot orthoses. These in-shoe devices invariably are very helpful for the child.

In addition, if a flatfooted child has a gait abnormality due to their flatfoot, then again I have no problem treating them with in-shoe wedges, modified OTC orthoses or custom foot orthoses. However, I don't treat asymptomatic children with mild to moderate flatfoot deformity if they function normally in gait and don't have a family history of painful adult flatfeet.

I would be interested to see if Dr. Volpe ideas of treatment of these children aligns well with what I have said above. I believe he does.

 

The facts are that there is little high level EBM to reinforce any low level expert opinions, textbook accomplishments, lectures or non-peer reviewed magazines such as Podiatry Today and Podiatry Management.

Neither Kevin or Russell (both acknowledged and admired experts) have not published any valid evidence on this subject nor can they point to any longitudinal, high level studies that reinforce their opinions (nor can I). Although I agree with Kevin foundationally, foot typing allows me to be more aggressive with inherited pediatric flatfoot as foot types are inherited and can be easily pointed out to relatives. It also allows me to present a more realistic picture to parents of the disasters that lie ahead in many cases such as they themselves have suffered.

On an internet blog, Kevin states with apparent certainty and without supporting evidence regarding pediatric flat foot:
Some of these children grow up into adults who have feet with normal arches
It is very important that children with flatfoot deformity be evaluated by a podiatrist to determine if they need treatment.

The flatfoot deformity in children causes a number of changes to the structure of the foot which is easily recognizable by the trained podiatrist.
Most cases of flatfoot deformity in children are also associated with excessive flexibility in the joints of the foot which is commonly caused by ligamentous laxity.

Treatment
Treatment generally starts with both supportive shoes, such as high tops, and some form of in-shoe insert such as arch padding for the milder cases of flatfoot deformity.
More significant cases of flatfoot deformity may require more exacting control of the abnormal motion of the foot such as that offered by functional foot orthotics.
Functional foot orthotics limit the abnormal flat arch shape and rolling in of the heel bone during standing, walking and running activities improve the appearance and function of the foot,

greatly reduces the symptoms in the foot or lower extremities.

Calf muscle stretching exercises are also commonly prescribed for children with tight calf muscles since the tight calf muscles can worsen the flatfoot deformity with time and make the child's symptoms worse.

These claims represent Kevin's expert opinion and have no more validity or applicability than mine in an evidence based milieu such as The Arena.

Dr Volpe, whom I admire and respect as well, is an international biomechanics authority but as the Chairman of the Orthopedics Department tagged to the largest and most active pediatric foot clinic in the U.S. has produced little to no high level, peer reviewed evidence regarding the pediatric flat foot (just like me).

Childishly putting me on an ignore list rather than evening the playing field with admissions of fact confirm my arguments. The facts can't be ignored.

I am much more aggressive with the moderate to severe cases of pediatric flat foot probably at an earlier age, especially when they present with juvenile tie beam expansion. That is fueled every time I meet an untreated teenage or older patient with a double flex foot type whom I know will suffer for the rest of their lives from biomechanical pathology that could have been diagnosed and treated at a younger age. I have a trail and active, healthy kids and their parents that confirm my opinion.
Dennis

 

If I may quote you a moment?

"""
On an internet blog, Kevin states with apparent certainty and without supporting evidence regarding pediatric flat foot:
Some of these children grow up into adults who have feet with normal arches
It is very important that children with flatfoot deformity be evaluated by a podiatrist to determine if they need treatment.

The flatfoot deformity in children causes a number of changes to the structure of the foot which is easily recognizable by the trained podiatrist.
Most cases of flatfoot deformity in children are also associated with excessive flexibility in the joints of the foot which is commonly caused by ligamentous laxity.

Treatment
Treatment generally starts with both supportive shoes, such as high tops, and some form of in-shoe insert such as arch padding for the milder cases of flatfoot deformity.
More significant cases of flatfoot deformity may require more exacting control of the abnormal motion of the foot such as that offered by functional foot orthotics.
Functional foot orthotics limit the abnormal flat arch shape and rolling in of the heel bone during standing, walking and running activities improve the appearance and function of the foot,

greatly reduces the symptoms in the foot or lower extremities.

Calf muscle stretching exercises are also commonly prescribed for children with tight calf muscles since the tight calf muscles can worsen the flatfoot deformity with time and make the child's symptoms worse."""


And that statement by Kevin I happen to agree with. But I agree with it not to shake a pom pom for Kevin I mean he did share great information with me and I hardly know him. (Thanks again Kevin), but more so because it has been my experience along the way so therefore how can I disagree with it? He's right and I have been alongside many kids through to late teens and I believe what he says. (Although looking at it from an older model or ideal it seemed!)
The ability to "influence" a movement as opposed to "forcing it" into a more load efficient live structure is a good thing. I do not believe it age specific at all when one is going to work with the child. I believe it Independent of age in fact.

I would like to note that I have watched tissue remodeling take place using orthoses on the same child over years as they grow. In many children. And I'm thinking everyone who has would agree that when they watch a child grow they watch those changes occur and your influence or not on them. Your subtleties are really their benefit. I believe this is the impetus? of what Kevin meant?
Not a good time for some of these kids sometimes. Helping them in any way you can (which sometimes means monitor only) is a good thing in my humble opinion.

 

A few few colleagues have asked why I contribute less and less and this thread is one of the primary reasons. This is the children's section, to talk about them and not act like one. Would you all say in person what you are actually typing? Demanding evidence over and over while not actually giving any to support a claim is unprofessional and totally disrespectful to people who donate their time to helping other health professionals here.

I have read plenty of evidence and treated children for the past 19 years and like many other experienced clinicians, support the use of different in shoe therapies for treatment of the symptomatic flat foot. There continues to be more research being conducted in this area. I have rarely come across any clinician treating asypmtomatic flat feet so I am not sure what all the who-ha is here about this?

Kids aren't meant to hurt. Kids are meant to be able to run as far and fast as they want. Kids are meant to be able to play at the park and not have to sit due to fatigue from poor biomechanics and muscle imbalances. These are the kids that when you are using appropriate valid and standardized measures you can prove that your impact may not always be a change in foot posture but a change in a child's participation and quality of life.

I primarily just see kids under the age of 18 and would probably only treat about 30-40% of the kids who present with a flat foot and I am yet to regret ever doing it. When they come back and tell me and show me what they can do now, it is one of the reasons I enjoy what I do so much.

 

Ditto

I disagree with your posting but even more importantly, in the world of EBM, I place it at a very low level, anecdotal, expertly opined one that has no more power than any posting that I might keyboard. The importance of those days, chided here on The Arena, are long gone. That's why I continue to call for evidence from others even though I have none of my own.

I have read my share of evidence and treated children for 42 years. Does that make my opinion stronger than yours. It doesn't but you seem to point out your expert status as if it makes your case stronger. Shame on you.

When you work with TS, or any other BMX theory that begins with a complaint, what would prompt would you treat an asymptomatic pediatric flatfoot?

Research being conducted has no import in EBM. it only has relevance once harvested. Currently (correct me if I'm worng) there is no high level, longitudinal evidence for treating or not treating asymptomatic pediatric flat feet exist as yet.

Are you saying that because you don't personally come across something an opposing position such as mine, that exists without you being able to counter beyond your experiential opinion with evidence, doesn't deserve inspection or trial?

That certainly justifies all of us treating painful pediatric flatfoot. That is not in question.

Is there any science or EBM to verify or explain the purpose of this seemingly unscientific statement?

Agreed

Can you please show us your proof?

[COLOR="Navy"This sentence defines the location of difference when it comes to treating peds if I am reading you correctly.
You would reduce a child's participation and quality of life and I would see what I could do to work with his/her weight, foot type, shoe gear, muscle engine strength and balance, etc, before destining him/her to a poorer quality of life or possible adult sequelae (not proven or disproved) even if asymptomatic, especially if there is a history of familial adult flatfoot sequelae.[/COLOR]

[Quote]I primarily just see kids under the age of 18 and would probably only treat about 30-40% of the kids who present with a flat foot and I am yet to regret ever doing it.[/Quote]
[COLOR="Navy"]You mean to state that you are positive (or proven) that none of the remaining 60% of the pediatric flatfeet that you encounter could have benefited from treatment as peds? If you do, I question that [/COLOR]

So here do you mean to state that 100% of the 30-40% of your treated pediatric flatfeet "come back"? and, do you mean to state that they do not have adult flat feet with any sequelae 100% of the time?

For me, the two previous paragraphs that you posted are poorly evidenced and are merely opinions that upon inspection, I consider to be unscientific (I'm not using the word that you have chosen (childish) to avoid being inflammatory as you have chosen to be.

 

Sorry, I'm just not buying in to this argument. Those who know me, also know I am far from an inflammatory person. I was labeling the behaviors in this thread and not being specific to anybody but if you want to own it, go for it.

I don't believe there is evidence to support the treatment of a paediatric asymptomatic flat foot. I believe there is evidence to support treating an symptomatic flat foot. My opinion and if you want to search, I believe you will find the same.

I also don't believe anyone here really knows what the original question is as many have been answered and ignored. I never once discounted anyone else's experience, simply giving my opinion and take on the evidence I have read and see, for what it's worth.

 

Talk about childish.
I am responding to your words intimating there were those of us who were acting like children on a grown up site. Thinking that I think I am one of them assumes that you know what I think and is simply wrong). I am arguing the scientific strength of your words and therefore their import here on an evidenced based site as it pertains to treating asymptomatic flatfeet.
It is your right to opt out but in doing so, for me, that serves as an admission that you have no response that raises the level of your comments beyond anecdote and expert opinion.

I agree

I agree as well. The question here is, where do we go from there when faced with an asymptomatic pediatric flat foot in practice?

But we know what we are debating. Your words that I have quoted so please stop diverting and respond.

So, are you admitting that you have no evidence to back up your superlative opinion therefore reducing its value as an argument against treating asymptomatic flatfoot. In debate, that makes my side of the argument as superlative as yours and not worthy of your chides.

The Conundrum that exists for me on The Arena is that it is full of low level arguments that are basically founded on expert opinion, conjecture, gut and foundational beliefs which have no high level, longitudinal evidence to back them up making them weak and poorly defensible scientifically.
Since those defending these arguments cannot be proactive, the position against those with differing opinions to The Arena Faithful position is to claim that opposing arguments are basically founded on expert opinion, conjecture, gut and foundational beliefs which have no high level, longitudinal evidence to back them up making these arguments weak and poorly defensible scientifically.
My summary here is that both sides are unproven and poorly evidenced and therefore lack strength. For the moment, you seem comfortable stating that you will not "Buy into this argument" as your argument as if you are playing a "get out of jail free card" on a Monopoly Board. Why don't you defend your words that I have quoted and challenged instead of behaving like an Ostrich that we can still see?
Dennis

 

Drsha,
Can I ask what your definition would be of an assymptomatic flatfoot would be?
I understand your frustration in that there is little evidence supporting the treatment of paediatric flatfoot, and that the arguments being levelled at you are subjective and anecdotal. However, I think we would all agree that when presented with a symptomatic flatfoot, we have an obligation to help alleviate the problem. In my humble opinion, the active intervention of orthoses or footwear intervention can help, and would feel that to allow a child to leave without any intervention, be it poorly evidence based, is certainly better than doing nothing. This is a debate that will continue to rage and will continue to do so until rigorous evidence is provided one way or the other! Until then do no harm, but dont ignore!!
regards
Tony

 

Tony:
Your comments are well appreciated.
The asymptomatic ped flatfoot that I offer to treat presents with precursors that lend me to believe that during his/her biomechanical timeline, there will be pain, deformity, performance or quality of life issues that I can reduce/prevent with an intervention.
Looking for and working with these patients for 40 years has given me a clinical, intrapersonal success rate that is worth continuing in practice as it continues to draw new patients and referrals.

While TSers are seemingly waiting for pain and evidence to arrive, foot typers are, in addition to treating symptomatic ped flat feet, selecting asymptomatic ped flat feet and depending on individual factors, suggesting levels of intervention that may address future pain, deformity, performance and quality of life issues. The intervention is based on our functional foot typing, our practice skills, the existing evidence and the individual patients history, findings and needs. There are asymptomatic flat feet that are simply monitored or don't wish to intervene.

I recall a patient who was an Olympic middle distance runner for Rumania. She defected and years later, while training for a NYC Marathon her two previous sets of orthotics were not helping her PT tendonitis. We typed her, gave her a MERF plan and foot centering orthotics and watched her feet strengthen and her performance improve in addition to calming down her PTTD. She ran the NJ marathon last weekend in 3:52 (I think).

Then she presented her daughter who was lethargic, ligamentously lax, poorly postured and with a double flex foot type (think she was 9 or 10). She was being pushed to run and participate in acomplimentary gym training as her mom and grandmother had done. She was failing miserably (although not in pain or with complaints). She just hated it.

She was fitted for foot centerings (three pairs now over the years) and given an aggressive training program to reverse PT and PL inhibition. She was put on a gradual running program increasing distance, speed and training times. She continued her gym program.

Each followup castings were able to place the daughter in a more vaulted position. Her genu valgus reduced, her posture became straighter and stronger. her compensatory tight TA has relaxed. Her feet are better posed in stance and her running now has her in a soccer and track program at her high school.

Her family is thrilled with the improvement and proclaims that it could not have been accomplished without the Wellness Biomechanics program that we designed and implemented.

They have been a great source of referrals over the years.

For me, this was a case of an asymptomatic pediatric flatfoot that was well worth treating as it was life changing for the child and her family.
Dennis

As I had no evidence that any asymptomatic care will work as well as this one, I relate to my ped patients and their families that there is no guarantee that my care will work. I offer a money back guarantee on the devices if the patient is not pleased with the results (that is the best any of us can do IMHO). I monitor regularly to guard agaist and deal with complications.

 

Anyone else going to address the elephant in the room here.....?

Dennis spends a great deal of time addressing what he perceives as a failure of many of us to address symptoms and potential problems before they occur. There are volumes of these posts on PA. Then in this thread he is arguing that there is no evidence to support the treatment of asymptomatic pediatric flatfoot but in his case he does just this? What the? You cannot have it both ways Dennis, outright absurd


Bug

Dennis

Don't bull**** us Dennis, you accept casts for ped patients and no you do not ask if they are symptomatic. Right? Right!

I guess the equation would appear thus: TS'er + asymptomatic pediatric flatfoot = wrong, wrong, wrong. FFT + asymptomatic pediatric faltfoot = OK if you FFT?

Makes one scratch their head...a lot...your thoughts are not linear :empathy:

 

I find it hard to rationalise why you would not treat a child below the age of 8 years old with orthotics if: the child was in pain AND you are able to identify the stressful forces which are likely to be causing the pain AND the orthotic will remove or reduce these forces.

 

I may only have 7 short years of clinical practice treating the short term symptoms, mid term repetitive strain injuries and the long term fixed acquired foot deformities that occur in the foot due to poor mechanics, but I have enough experience to look at someone with issues and I am able to see where that foot is going by recognizing the patterns and connecting the dots. It is not that difficult. Perhaps you should come and meet some of my patients Blaise, particularly my palliative cases. The geriatric fixed stage 4 adult onset flat foot started somewhere. It did not appear at age 65, it did not happen overnight.

Additionally, having personally lived in those 3, 8, 12 year old feet that desperately needed a properly trained and experienced Podiatrist in minimalist type shoes (cheap crap, my parents didn't know better), I know too well what can happen. Having only finally encountered a Podiatrist at the age of 20, I developed quite severe issues. And yes I was one of the unfortunate ones to have had my first pair of orthotics manufactured to an inadequate prescription. But instead of writing off this profession and biomechanics/orthotics, I decided to join it and do better for others than what was done for myself.

You will never convince me nor other leaders in this field that minimalist trumps a properly prescribed functional orthotic device for anyone three and up suffering with poor mechanics.

I am a clinician who can foresee the truly grim outlook some of my patients will face in the future regardless of age and I believe I have an ethical responsibility to do all I can to prevent them from becoming a palliative case. I assess each patient to determine what is the true etiology and treat it rather than mindlessly throwing neutral shells at every gullible patient that walks through my door.

Most memorable was a teenaged girl who had seen many other clinicians before me. Had done physiotherapy. Lots of barefoot. Pool side, swimming and lifeguarding. History of playing soccer, competitive level, running, very active and healthy. She had developed multiple repetitive strain injuries and was unable to continue with activity. Seeing her life slip away. Worried that she would never be able to return to her active lifestyle. Gained 50 lb. Stressed. Depressed. Met me and I fit her with a pair of SALRE based orthotics and prescribed an exercise plan to activate and strengthen her post tib muscles and achieve better muscle timing and coordination during gait. Second follow-up after dispense she had lost 30 lb, was completely pain free, and told me I had changed her life with my care.

 

I agree with Sarah. The reason quoted for not treating these young feet is the burden of proof. But, a lack of empirical evidence can sometimes be due to the difficulty with design of a study that will sufficiently test what you need, "that treating asymptomatic paediatric flatfoot will result in fewer pathologies in later life." As we know there are several difficulties with designing a study like this. The ethics of treating some children with an intervention which could possibly do them either harm or good is prohibitive. Also, retrospective studies are difficult because it is impossible to know what would've occurred without the intervention.
A balance of evidence based practice, experience and caution is probably a good blend.

 

Ditto

Now we're talking Sackett's version of EBM
Dennis

 

It is unethical to not treat these symptomatic flatfooted children under the age of 8 with foot orthoses given our current level of knowledge of foot and lower extremity biomechanics. Anyone who suggests otherwise has obviously not seen enough of the positive therapeutic results that can be achieved with properly made foot orthoses, or, has some other agenda (i.e. minimalist shoes cure all ills) that warps their logic.

 

Empirical: Knowledge gained by means of direct and indirect observation or experience.
Empirical evidence can be analyzed quantitatively or qualitatively. Through quantifying the evidence or making sense of it in qualitative form (a logical progression), a researcher can answer empirical questions, which should be clearly defined and answerable with the evidence collected.
Research design varies by field and by the question being investigated. Many researchers combine qualitative and quantitative forms of analysis to better answer questions which cannot be studied in laboratory settings or by the use of cadavers.
Empirical research is a way of gaining knowledge by means of direct and indirect observation or experience.
In medicine, empirical evidence can be analyzed quantitatively or qualitatively. Through quantifying the evidence or making sense of it in qualitative form, a researcher can answer empirical questions, which should be clearly defined and answerable with the evidence collected.

I would add, the addition of a biomechanically oriented podiatrist develop a multifaceted plan. The plan should contain expectations which lead toward a positive outcome. This DPM would then institute the plan and remain available to monitor, adjust and continue to make sense of the findings as long as the outcomes are satisfactory. This becomes the foundation of an evidence based biomechanics practice until valid evidence surfaces.

Waiting for evidence while waiting for children to develop adult disease, degeneration, deformity, performance issues and quality of life issues makes no qualitative sense (it is not a logical progression).
Dennis

 

It is unethical to treat asymptomatic flatfooted children with foot orthoses given our current level of knowledge of foot and lower extremity biomechanics. Anyone who suggests otherwise has obviously not seen enough of the positive results by NOT treating that type of people, or, has some other agenda (i.e. selling orthotics or promoting them) that warps their logic.

 

It is unethical to treat symptomatic or otherwise flatfooted adults and children with barefoot/minimalist "theories" given our current level of knowledge of foot and lower extremity biomechanics given the lack of evidence for the support, concensus or guidelines in any profession recommending them. Your logic, not ours.

 

It is unethical to treat asymptomatic flatfooted children with foot orthoses!!!

 

I just caught two fish with one cast!

Now, if I can just get Dana Rouche to also comment on my posting then I will have all three of the individuals on my "ignore list" on my line. Fish on!!

 

You appear to have rubbished the chessboard once again Blaise.

 

l am flying to Sydney tonight, there is no evidence that my plane will crash...but l am wearing a seat belt...mind you l dont think there is any evidence that the said seat belt will save me if the plane does crash:wacko:

l am going with the safe option if they have very flat foot, give it a number if you will, they will get an orthosis from me, prevention is better than cure.

If a child presents to me with a flat foot that is resulting in pain, tripping or stability issues that an orthosis can help with, they will be getting an orthosis from me, why wouldn't you help if you could.

l would love to put an orthosis on every client with Diabetes for the same reason, lets not wait for it to happen, lets be proavtive