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Can Foot Orthotics Prevent Injury?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, May 25, 2010.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Can orthotic insoles prevent lower limb overuse injuries? A randomized-controlled trial of 228 subjects.
    Mattila VM, Sillanpää PJ, Salo T, Laine HJ, Mäenpää H, Pihlajamäki H.
    Scand J Med Sci Sports. 2010 May 12. [Epub ahead of print]
  2. Griff

    Griff Moderator

    From a research methods point of view, when dealing with a sample size of 220 and then allocating them into a control group and a treatment group why would you do so with a 2:1 ratio?
  3. Random allocation. If we flipped a coin for each of the subjects to join either the control (heads) or study groups (tails), you would not necessarily see a 1:1 ratio after 220 flips of the coin. A better question is how well were the two groups matched in terms of other possible predictors of injury?
  4. Griff

    Griff Moderator


    Is there a 'minimum ratio' required between the two groups as far as research dictates? i.e If we flipped the coin and got 200 controls and 20 for treatment (giving us a 10:1 ratio would this still be acceptable?

    Seems to me the subjects were matched for age and activity but no real anthropometric measurements were taken - full article attached for your comments


    Attached Files:

  5. Basically it effects statistical power, once you go above a ratio of about 3:1 sample size starts to become unrealistic. You can prevent these uneven ratio's by various strategies, commonly block randomisation is employed.

    Thanks for the paper.
  6. And what orthotics they used in the study.

    Devices over here in the nordic countries are made generally with the same script, by P&O´s , physio´s etc *. Full length EVA with no rearfoot posting, Arch height with no modifications ,with a metatarsal dome. Does not matter what diagnosis you have or what biomechancial findings / if they were even looked at. ie a lateral deviated STJ axis with peroneal overuse gets the same device as a medial deviated STJ axis with Posterior tibial overuse. See it everyday. Sorry If a sound a bit negative.

    EDIT added this bit slightly different from what I wrote but the basic idea is the same everyone gets the same no one is different, go Socialism ... mutter... mutter .

    This is taken from the paper- not really a custom device, more of a basic arch support.

    So to say Orthotics don´t prevent injuries maybe read as This specific script of orthotics do not prevent injuries. But orthotics built for individual biomechanical makeup we have no idea.

    * Not by the Pods working in Sweden to my knowledge.
  7. That was going to be my next post, I haven't had time to read the paper yet, but if the subjects were free from injury when they entered the trial, how were the devices prescribed? Time to read the paper.
  8. Griff

    Griff Moderator


    I agree - the devices used in this study did not sound like they were what we would consider 'custom made foot orthoses':

    I think their conclusion that "Our findings suggest that routine use of orthotic insoles does not prevent physical-stress-related lower limb injuries in healthy young male adults" should be considered in this context.
  9. Griff

    Griff Moderator

    Mike - bit of a cross posting there! Great minds...
  10. Spooner will probably come back with OMFG who are these people etc etc. Then we can put this one to bed or you and Simon can keep discussing study stats and I´ll go get some lab work done .
  11. "The insoles (Thermo1Camel)
    were fabricated from firm-density polyethylene, and the hard
    plastic shell was three-quarters the length of the foot. The insole
    was strong enough to fill the arch area, thus providing support
    to the mid foot. The insoles were each molded to the foot by
    heating the polyethylene and having the individual stand and
    walk on the insole under the supervision of a professional nurse
    (T. S.), which resulted in the insole assuming the shape of the
    foot. No further modification was made to the orthotic insole."

    Ok so they heat up the insole, have the patient walk on it, so it now matches the maximal deformation position of the foot:bash::deadhorse:. Anyone here use this method of manufacture / prescription? I seriously doubt it.

    Also, in reading the paper it seems they opted for a 2:1 ratio, since they used computer generation of the random sample. I'm not sure why they would do this as it just means they needed a bigger sample size. Perhaps, I'm missing something?
  12. Griff

    Griff Moderator

    So do I. Maybe it's a Finnish Orthopod thing? I also thought the introduction/literature review was poor but what do I know. Shame - I got a little bit excited when I saw the title of the study. Anti-climax.
  13. CraigT

    CraigT Well-Known Member

    Not according to the authors...
    'Because our study included a large homogenous population and a long follow up period, the information provided by these data finally put this topic to rest. Based on the results of this study, we conclude that the use of orthotic insoles is not an effective strategy for preventing lower limb overuse unjuries in healthy young adult males exposed to a rapid increase in intense physical stress'

    I wonder how many times we will see this one referenced...

    A better conclusion would be that randomly giving a simple insole to people who may or may not benefit from any type of support will not prevent injuries in this population.
    By the way... they exclude those who had orthoses already
  14. When someone asks you the question, "Can foot orthoses prevent injury?", tell them, "Yes, here is the evidence."

  15. A strange beast is research. I'd have thought a preventative action would be much harder to prove than a curative function. Thanks for the refs.

    The standing on a hot insole thing is sadly not so rare.
  16. It assumes that the risk of injury is the same in both groups. Was it? What factors predict injury?

    Standing on a hot insole while the clinician / shop assistant attempts to manipulate the foot into a certain position I've come across, but walking on the hot insole...
  17. robert bijak

    robert bijak Banned

    It appears from the responses someone's religious beliefs have been challenged by the Finns. Ignore the biomechanic behind the curtain. I believe,I believe.
  18. Griff

    Griff Moderator

    Have you actually read the whole study Robert? Or when faced with a new article do you just skip to the closing line of the conclusion and believe whatever you read?
  19. robert bijak

    robert bijak Banned

    To Ian: The last line of the article corroborates what I and hundreds of thousands experience empiricaly. The historical and financial success of Arch supports off the shelf (viz a viz Dr. Sholls, etc) vs. "custom" arch supports empiricaly demonstrates "custom" supports do not merit the credit, money or investigational time proving their worth. Similarly, religious zealots spend their life "proving" the tenets of their beliefs. I see this in biomechanics. That's why most scientists and insurance companies don't recognize them as making much more difference than a placebo or off the shelf arch suports. Call them orthosis if the euphemism makes your years of study seem more valid. Rotational this, ground force that, antipronatory force dissipators...Whooey. Arch support is the best description. Now, just like a criticizing a religious belief, the ire of the mechanics will start shrilling heresy!
  20. Griff

    Griff Moderator


    I am not even going to entertain discussing the paper above with you as you either haven't read it, or you have a severe lack of understanding of critical anaylsis and research methods/design.

  21. robert bijak

    robert bijak Banned

    The first "priest" has come to the pulpit and cried BLASPHEMEY! Now, let the procession of acolytes begin.
  22. Ian:

    I wouldn't even waste your time trying to reason with this man. He is a cynical old podiatrist. He still wishes he had been able to get into medical school and regrets he even became a podiatrist. He blames everyone else for his perceived misfortune and can't possibly see that his own personality traits may be the reason for his own misery. He is determined to spend the rest of his life trying to poison podiatry because he couldn't get into medical school to be a "real doctor". To see someone with this much life experience wanting to spend the last few years of his life in such negative pursuits.....is actually quite sad.
  23. Cock.
  24. robert bijak

    robert bijak Banned

    I see Dr. Kirby is now a practicing psychiatrist. How arrogant, yet I knew I would raise the ire of the true believers. I'm sorry, I should remain silent during this religious service which I'm sure will continue.
  25. Alex Adam

    Alex Adam Active Member

    Well the answer to the original question is varied:
    1. if the device reduces the need for the skeletal system to compensate for gravitational effect then the soft tissue around the associated joints are less stressed thereby allowing them to absorb a greater force at impact,
    2 if the device accomadates the inherent dysfunction then little change would be noted and
    3. if the device was to over compensate then this would see an increase loading on the soft tissue is is required to compensate for the over correction, eg Blake orthotics used in a normal gait situation sees overload on the medial colateral lig. of the knee. In this circumstance an orthotic would increase the risk of injury, especially in a lateral contact sport such as soccer or hockey.

    So the device is the critical element in the discussion, how it was manufactured under what controls and what parameters the Podiatrist was trying to establish.

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