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Barefoot Science Foot Strengthening System

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Ray Anthony, Jan 7, 2012.

  1. Ray Anthony

    Ray Anthony Active Member


    Members do not see these Ads. Sign Up.
    Alhtough lengthy, I present this document entitled: Barefoot Science Foot Strengthening System, which is very critical of "traditional" foot orthotic therapy, for your interest, review and critical comment. See PDF attached.

    Happy New Year to one and all.

    Ray Anthony
     

    Attached Files:

  2. Ray:

    Good to see you up on Podiatry Arena again and thanks for the information. Here's some more on their company. http://www.barefootscience.com/us/ Nice to see the orthopedic surgeons jumping on the same patenting/trademarking bandwagon that Dennis Shavelson has been riding on for the last few years into oblivion.

    By the way, Ray....(now that rhymes pretty well).....I think you have much more to offer us than you have been giving recently. We need more of your comments here!

    New Year's Resolution for Ray Anthony: post at least once a week to Podiatry Arena!:rolleyes::drinks
     
  3. Craig Payne

    Craig Payne Moderator

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    I think we already had a thread on this, but a quick look and I could not find it. If I recall correctly, the person behind the company was in the thread arguing ... he went away defeated after it was pointed out that a weakness of the intrinsic muscles often foot actually led to a higher arched foot. ..... it kinda blew his whole argument away!

    The argument that he/they tried to make was a classic 'straw man' fallacy and they were getting pis**d that they were being called on this. The straw man argument they used was based on characterizing traditional foot orthotic therapy as something that it was not, then criticize that characterization. Smart people can see through that.... (you can clearly see it in the document Ray posted)

    There are now 3 studies that have reported on foot orthotics and muscle strength. Two actually showed an increase in strength (...and they weren't done by Podiatrists!) and one (done by podiatrists) showed no change (ie no weakening) ... nothing like the evidence to get in the way of a good argument.
     
  4. David Wedemeyer

    David Wedemeyer Well-Known Member

    In the end all of their claims are used to market an over-the-counter insole. It may be a decent prefab but as Craig pointed out their 'science' has holes in it. The parts that I read (and I had to stop because it is overkill; maybe that's the point?) even if 1/2 of it were true its still an OTC device sold on EBay...
     
  5. Craig Payne

    Craig Payne Moderator

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    In addition to this, every single published patient satisfaction study, clinical outcome study and randomized control trial done on the types of foot orthotics that they selectively choose to criticize actually shows that they work. Not one of the studies has shown that they do not work. I notice there is not one published study on their devices .... don't figure!
     
  6. Ray Anthony

    Ray Anthony Active Member

    David: "In the end all of their claims are used to market an over-the-counter insole. It may be a decent prefab but as Craig pointed out their 'science' has holes in it. The parts that I read (and I had to stop because it is overkill; maybe that's the point?) even if 1/2 of it were true its still an OTC device sold on EBay... "

    I find it interesting that one can wear a prefabricated insole (presumably in a shoe) and still be essentially running "barefoot!" Professor Benno Nigg evaluated a number of minimalist running shoes and concluded that “barefoot shoes” is a misnomer. While different shoes may incorporate specific aspects of the barefoot condition into their design, a “shoe condition is not a barefoot condition” [Nigg B.: Biomechanical considerations on barefoot movement and barefoot shoe concepts. Footwear Science 1: 73, 2009].

    Craig:" ... he went away defeated after it was pointed out that a weakness of the intrinsic muscles often foot actually led to a higher arched foot. ..... it kinda blew his whole argument away!"

    Is there any research evidence to support this statement?

    "There are now 3 studies that have reported on foot orthotics and muscle strength. Two actually showed an increase in strength (...and they weren't done by Podiatrists!) and one (done by podiatrists) showed no change (ie no weakening) ... nothing like the evidence to get in the way of a good argument."

    I'd like references for these papers if you have them.


    Kevin: I promise to contribute more when time permits.

    Gentlemen, thanks for your kind replies.

    Ray
     
  7. Remember, Ray, I've still got that classic photo of you shooting hoops in front of my house from 1999......at least once a week....;)
     
  8. Craig Payne

    Craig Payne Moderator

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    Think about what happens in early diabetic motor neuropathy (the "intrinsic minus foot") and early charcot-marie-tooth disease when the motor neuropathy only starts to affect the intrinsic muscles of the foot. What happens? ---> you get a higher arched foot!
    1. Frank Mayer et al: Effects of short-term treatment strategies over 4 weeks in Achilles tendinopathy. Br J Sports Med 2007;41:e6 doi:10.1136/bjsm.2006.031732 . The calf muscles got stronger in the orthotic group (discussed here)

    2. There was our study that showed no weakening (abstract and discussion here)

    3. Jung DY, Koh EK, Kwon OY. Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: A randomized controlled trial. J Back Musculoskelet Rehabil. 2011 Jan 1;24(4):225-31. The muscles got stronger in the orthotic only group (Discussed here)

    Nothing like the facts to get in the way of a good rant trying to sell a product.
     
  9. Craig:

    Did this study ever get published? How would I reference it in one of my lectures?
     
  10. Craig Payne

    Craig Payne Moderator

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    Embarrassingly no...will get to it one day ...just reference the abstract.
     
  11. pmalleret

    pmalleret Welcome New Poster

    Hello there,
    My name is Patrick Malleret and I am in charge of sales at Barefoot Science, an OTC insole solution provider for certain foot and lower limb related issues.
    I am not a C.Ped nor a DPM. I have an understanding of the mechanics of the foot and general anatomy but I am certainly not an expert in that realm. I am thankfully surrounded by a number of DPM's and C.Peds that are more educated than I in these realms.
    I have been charged for the past few months with expanding the sales of Barefoot Science products that include insoles and footwear. One of the main aspects of my growth strategy is stop the "orthotic" bashing that was the norm with the previous management of this company and simply concentrate on what our products can and can't do to help people. Barefoot Science insoles obviously work for a lot of people but they are not a miracle cure and they certainly cannot replace custom made orthotics when custom made orthotics are the right solution for the client.
    I am very interested in what the professional podiatric community has to say, not only about our products, but in general.
    In 2012 we will be marketing our product to 3 distinct sectors; Pain relief in particular plantar fasciitis; Type 2 diabetics and Sports Performance.
    We will be redesigning the Barefoot Science www.barefoot-science.ca website in the coming months and the emphasis will be on selling what we are able to offer and removing the negative attitude towards orthotics.
    I will be happy to arrange for samples to be sent to each of you to either try out yourself or to fit inside the shoe of someone you know who may benefit from them.

    Craig - You mention 3 studies that have reported on foot orthotics and muscle strength. Would you be so kind as to direct me to those studies?

    Kind regards,
    Patrick Malleret
    Barefoot Science Products & Services Inc
    Telephone: 905 399 8591
    E-mail: pmalleret@barefoot-science.ca
    Web: www.barefoot-science.ca
     
  12. David Wedemeyer

    David Wedemeyer Well-Known Member

    Hello Ray, great place you reside. Are you the same Ray Anthony of RX labs?

    I read a bit more of this today and what really stood out is that the physicians who endorse the product in their literature are also on their medical advisory panel. If there is a disclaimer divulging a financial interest in the product I cannot find it in the document. Conflict of interest?:


    From their literature:

    http://www.barefootscience.com/us/index.php?option=com_content&view=article&id=6&Itemid=94

    The clincher for me that it isn't worthy of a full read is the mention of resolving TMJ, claw toes and that young ladies pigeon toes...:rolleyes:
     
  13. Craig:

    Do the "tipover" paper first. I drew some great illustrations for that paper...would still be good to see our names together on a paper.:drinks
     
  14. Craig Payne

    Craig Payne Moderator

    Articles:
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    Here:
     
  15. Ray Anthony

    Ray Anthony Active Member

    David (7th January 2012 06:13 PM):

    I sold RX Labs to Langer UK just over 3-years ago. They appear to have kept the brand alive as their "high-end" orthotics division. I now work at a private hospital in the Cayman Islands (www.chrissietomlinson.com) and I own a specialist shoe store, gait analysis centre, and CAD/CAM orthotics lab (www.solesloutions.ky) on the island; just for my own patients, it's not a commercial lab.

    Kevin (7th January 2012 02:49 PM):

    Blackmail! I guess you've got me by the. . . basketballs. Kevin, that particular photograph should never see the light of day!

    Craig (7th January 2012 03:17 PM):

    Thanks for posting the references, very helpful.

    Patrick (7th January 2012 04:48 PM):

    I sometimes use an OTC insole with a "mid-foot saddle" (http://www.healthystepfootbeds.co.uk/), which I sometimes enhance with a small dome adhered to the inferior surface, and I get pretty good improvement of some symptoms, sometimes. Patrick, I've been using this type of OTC insole for over 20-years, so the concept is hardly a revolutionary approach to arch support; although your insole appears to be a neat way of applying ground reaction forces to the plantar aspect of the foot in this manner.

    Patrick, you must try to appreciate that for many specialists in clinical biomechanics, Bruce Commstock's endorsement of your product (http://www.barefootscience.com/us/index.php?option=com_content&view=article&id=31&Itemid=101) is equivalent to him saying that he witnessed aliens landing on the Whitehouse lawn, the second coming of the Messiah, Father Christmas putting presents under his tree this year, and the tooth fairy actually place a dollar under his child's pillow. Okay, I exaggerate, but only to make the point. I'm not sure this type of hyperbolic endorsement -- especially from a member of your advisory panel -- stands the company in good stead with other medical and paramedical professionals. Although, from a purely commercial POV, I would understand if this is not a genuine concern for your company as your insole is essentially a retail consumer product and the primary audience for your website is the general public who can purchase the product by mail order.

    Regards

    Ray Anthony
     
  16. For all of you who don't know, Ray Anthony is the father of the "Biomechanics Summer School" and is the author of probably the most complete book ever written on the manufacture of custom foot orthoses:

    Anthony, Raymond: The Manufacture and Use of the Functional Foot Orthosis. Karger, Basel, 1991.

    It was through Ray and lecturing for his Biomechanics Summer Schools in 2000, 2001, 2004 and 2007 that I came to better appreciate all the hard work that Ray put into improving the level of podiatric biomechanics education in the UK and, through those seminars, I also got to become acquainted with many of my best UK podiatry friends, such as Dr. Spooner.

    Looking forward to more of your contributions here, Ray!:drinks
     
  17. 2nd edition must be long over-due ;):morning:;)
     
  18. David Wedemeyer

    David Wedemeyer Well-Known Member

    I didn't catch this the first time Ray and I agree, it is a misnomer. They appear to promote the idea that the less supportive and more flexible the shoe the better. Shod is shod, it is not barefoot.

    I thought your name looked very familiar Ray. Good to 'meet' you and as Kevin stated I also hope to see you post more here. All that hospital is missing is a fine Chiropractor! ;)

    Best Regards,
     
  19. David Wedemeyer

    David Wedemeyer Well-Known Member

    Patrick thank you for your response, it is good to see a company take responsibility for and correct errors in their marketing. One item that probably galls all professionals who dispense custom foot orthoses is the innacurate misrepresentation that custom orthoses are somehow less effective than a premolded device. This is simply untrue as Craig has pointed out. There is an appropriate use for both prefab and custom devices and yet many companies prefer to prey on the fears of the public and misreport the efficacy of custom devices.

    I believe that a good starting point is represented in the post below by Ray below:

    When I see these types of fatuous claims it turns me off cold to that company and their product. That said and based on your post, feel free to contact me, I'd love to receive your product and give it a look.

    Sincerely,
     
  20. pmalleret

    pmalleret Welcome New Poster

    Firstly thank you Craig for forwarding the details on the 3 studies I requested further information on.

    Thank you Ray for your comments. The Barefoot Science insole is, as you so rightly put it, not revolutionary per sae, it is an adaptation of what has probably been used in podiatric circles for many, many years. The adaptation was henceforth patented by adding different density foam or visco elastic plugs. These plugs would be inserted into a cavity in the base of the insole that resulted in a change in pressure being applied to foot muscles as the foot planted for traction or onward motion.

    As for the comments by Messrs McClain and Comstock. It is my understanding, and I have to admit that these comments were made before my tenure, that neither of these professionals were paid to make the comments. I totally agree that some of the comments are "somewhat" fairytale in their delivery. These will not be used in the future website or marketing materials.

    David, your comments and suggestions are duly noted. Please provide me your address details and a list of sizes you would like to receive and I will arrange for samples to be sent for evaluation.

    The same applies for the other gentlemen involved in this post.

    My email address is pmalleret@barefoot-science.ca .

    It is my opinion that if the Barefoot Science system works for only 10% of clients that come through your door then it is a great product. I state categorically that Barefoot Science is certainly not a cure all and that without a qualified professional to consult at the time of examination then the client runs the risk of not receiving the right information assuming that that client has a condition that is not appropriate to the usage of Barefoot Science insoles. That said I have never been made aware that the product has actually damaged anybody.

    Kind regards,
    Patrick Malleret
    Barefoot Science
    1905 399 8591
    pmalleret@barefoot-science.ca
     
  21. User7

    User7 Active Member

    Craig, are you sure of this? Various authorities have stated, and various papers have shown, that the intrinsic muscles help support the medial longitudinal arch - they provide forefoot plantarflexion moments.

    Here is a thread from way back in 2005 where you and Kevin Kirby discuss the role and influence of plantar intrinsic muscles and your assertion that intrinsic muscles lower the arch, with your evidence then also being the "intrinsic minus" foot:

    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=395

    Here are three posts from that thread:

    Kevin Kirby in response to Craig Payne:

    Craig Payne in response:

    Kevin Kirby's response:

    The thread trails off at this point, leaving the question:

    So who was correct? Does the intrinsic minus foot acquire a higher arch? Or, as Kevin supposed, does the loss of intrinsic muscle volume only make the arch appear higher while destabilizing the foot and actually leading to catastrophic charcot arthropathy?

    I also found this post by Kevin Kirby in another 2005 thread that succinctly presented his opinion of the importance of intrinsic muscles (at that time):

    Above post here: http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=6389&postcount=4

    Kevin, have your views on the importance of the plantar intrinsics changed significantly since 2005?
     
  22. Rather than looking to the conjectures of two individuals posting on a blog-site. Wouldn't it make more sense to look at what the published literature suggests?
     
  23. Craig Payne

    Craig Payne Moderator

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    Just ask anyone who treats a lot of diabetes patients with intrinsic muscle atrophy from the motor neuropathy ... ditto with early Charcot-marie-tooth.

    The putative mechanism could be the lack of plantarflexory moment on the proximal phalanx from the weakened intrinsic muscle --> retrograde pressure to plantarflex metatarsals from the "claw toes" --> higher arch foot.
     
  24. Devils advocate Craig- what does the published literature tell us?
     
  25. Craig Payne

    Craig Payne Moderator

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    Nothing; except for one study that showed no relationship between arch height and muscle power.
     
  26. So no-one has studied the intrinsic minus foot in relation to cross-sectional area of the intrinsic muscles, nor muscle strength? It's time I did some CPD around the diabetic foot: what exactly happens in the intrinsic minus foot?
     
  27. Craig Payne

    Craig Payne Moderator

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    Two studies have looked at the intrinsic muscles and toe deformity in diabetes, but they did not look at arch height. See this thread: Intrinsic muscle atrophy in diabetes

    The classic textbook description of the "intrinsic minus foot" is of a high arched one.
     
  28. Craig Payne

    Craig Payne Moderator

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    Just thought I would Google intrinsic minus foot to see what turns up and found this I missed:

    Physical Signs of the Intrinsic Minus Foot

    and this quote in an article on pes cavus:
    http://www.foothyperbook.com/elective/cavus/cavusPathogenesis.html
     
  29. Not significantly.
     
  30. Craig:

    I think this idea that the intrinsic muscle atrophy seen in the "intrinsic minus foot" is somehow supportive of the idea that intrinsic muscle strength is not important for arch height is a weak one.

    The two biggest problems with this idea? 1) Plantar arch height will increase with decreased muscle mass in the plantar arch of the foot which does not necessarily correlate to the height of the foot skeleton's longitudinal arch, and 2) biomechanical modelling clearly demonstrates that the plantar intrinsic muscles cause a forefoot plantarflexion moment (i.e. arch raising moment).
     
  31. Yeah, but what does the clinical data show? What differences are there in the cross-sectional area of the plantar intrinsic muscles in "normal" versus "intrinsic minus" feet? The literature says...? Height of the navicular from the floor in "normal" versus "intrinsic minus" feet? The literature says...?
     
  32. Craig Payne

    Craig Payne Moderator

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    So why does the arch not lower when the weakness of the intrinsic muscles occurs in the 'intrinsic minus' foot and in early Charcot-Marie-tooth?
     
  33. I'm still wearing my horns: do the muscles weaken in intrinsic minus foot? Has this been evidenced?
     
  34. Craig Payne

    Craig Payne Moderator

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    No one as looked at it; but assume that of there is atrophy from motor neuropathy, then the muscle is weaker.
     
  35. I don't like to assume anything. So what we are saying is: no-one has looked at it, so we don't know. Interesting. I like things that we don't know.
     
  36. Simon:

    What does the literature say? Probably nothing.

    Of course, the literature doesn't say anything about so many things we discuss here...hope we don't start using "no research evidence" as an exclusion criteria for what we can and cannot discuss here on Podiatry Arena.
     
  37. Do we actually know that the arch of the foot doesn't lower with an intrinsic minus foot or are we just assuming that the arch gets higher because there is more plantar concavity in the arch of foot due to plantar intrinsic atrophy rather than due to a raising of the foot skeleton within the medial longitudinal arch?
     
  38. See my post above. We do need to be aware of the hierarchy of evidence though. With "because I said so" generally sitting near the bottom.
     
  39. When we don't have any research evidence, what sits at the top of the "hierarchy of evidence"?

    Where does the medial heel skive technique sit in the "hierarchy of evidence"?
     
  40. Pretty low because all we really have is an opinion piece describing the medial heel skive technique. There have, to the best of my knowledge, not been any controlled trials of this modification or even outcome studies or published case histories. So we have anecdotal case reports only and expert opinion. Such evidence would be classified as "poor". Actually rather than asking: "Where does the medial heel skive technique sit in the "hierarchy of evidence"? what we should ask is: what is the quality of the evidence which supports the use of the medial heel skive. The answer is "poor".

    Here you go Kevin:
    http://cys.bvsalud.org/lildbi/docsonline/5/9/195-52.pdf

    When we have no research evidence for something the evidence does not reach beyond the "poor" within the hierarchy since all we have is expert opinion, which in terms of evidence is classified as poor or the bottom if you like. The top of the hierarchy is still "excellent", but none of the evidence we have meets that standard. So the evidence relating to the height of the medial longitudinal arch in the intrinsic minus foot is "poor" since all we appear to have is expert opinion. The same is true for the medial heel skive. Does that make sense? Even though the expert opinion is the best evidence we have, it's still poor in terms of the hierarchy of evidence. Just because it's all we have does not mean it meets the standard required for "excellent" evidence.

    More science please.
     
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