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eSole Custom Footbeds - Clever Marketing To Suckers Or A Better Option

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Malkor, Dec 28, 2006.

  1. Malkor

    Malkor Member


    Members do not see these Ads. Sign Up.
    Foot othoses and cycling

    Ok so custom footbeds are nothing new... Skiers have been using them for years, but now cyclists are getting in the on action. Being an avid cyclist myself I'm looking for any edge to realign my knees during pedaling. I've tried my lovely orthotics but had limited success. eSoles claim to be able to correct biomechanical defects to produce a more efficient pedaling action... dubious! So this is a call to any Podiatrist who has an opinion on how to realign the seated gait (Taking into account the contact points of the saddle and clipless pedals)! Far too many cyclists damage themselves from poor bike setup and poor pedal/shoe/foot interface and with the need for alternative means of transport... cycling will no doubt have a rise in popularity.
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. DaVinci

    DaVinci Well-Known Member

    Snake oil is right. Even their "running" ones are made of only 45 density EVA. :eek: :eek: :eek: :eek:
     
  4. admin

    admin Administrator Staff Member

    The posts previously in this thread about a generic discussion on foot orthoses and cycling have been moved here.
     
  5. CEM

    CEM Active Member

    i can think of many far better products for a fraction of the cost
     
  6. kevin miller

    kevin miller Active Member

    Where can I find out more info on eSoles? I assume some of you have seen these inserts. Can you tell me a little about their construction that makes them so bad? This thread is my first exposure to them. If they are this bad, who are they fooling in order to sell enough product to stay in business?

    Cheers,
    Kevin M
     
  7. Admin2

    Admin2 Administrator Staff Member

    Can't answer your question, but eSole just got this patent
     
  8. DaVinci

    DaVinci Well-Known Member

    The 45 density running orthotics is a big problem - do you realise how soft that is?
     
  9. Stanley

    Stanley Well-Known Member

    Re: Foot othoses and cycling

    I don't see many cyclists, but when I do, I make a different orthosis and approach it differently.
    In cycling, there is no push off because the first MPJ does not dorsiflex. Additionally, we do not have to worry about equinus as a contributory factor, as the pedal allows for adaptations of dorsiflexion.
    Since we are dealing with a modified midstance, we need a midstance orthosis.
    Richard Schuster spent a lifetime working on midstance, as he felt this is where the foot is most of the time. The device he made works well for a percentage of people, but the shortcomings are in propulsion, and the sagittal plane theory has made this device sad to say obsolete. I am extremely familiar with this type of device and have found it the best to change posture, and very effective at changing Q angle. Historically, podiatry was moved into public acceptance of our biomechanics by the running boom of the 1970's, and one of the key moments of this was when Richard Schuster treated George Sheehan for chondromalacia patella with orthoses. The results were that the medical editor of Runners World (Sheehan) wrote that if you have knee pain, see a podiatrist first.
    The way Schuster made the device was first put the feet in neutral calcaneal stance position by palpation (this was a more supinated position than other notable lecturers that I have seen) and to drop a perpendicular line. This captures the calcaneus to the ground in neutral position. Since the cast captures the forefoot to rearfoot relationship, balancing the negative cast to the line resulted in capturing neutral position. The way he captured the line in the negative cast was to wedge the negative cast before the plaster was poured so that the line on the calcaneus (which transferred to the negative cast) was perpendicular. When the plaster was poured, the top of the positive was parallel to the ground when the cast recreated the neutral position.
    In almost all the casts, there was a forefoot varus, and he made devices that had material directly under the first metatarsal head and this material tapered from this point forward.
    Again, this device is not a good device for propulsion, as this will result in restrictions of the first MPJ in a large percentage of patients; however, if the patient is in midstance 100% of the time, this is a better choice (as in cycling).
    For cycling, I would make a change to the Schuster device. I would make a full length rigid plastic device (polypropylene or graphite), as we do not want the first MPJ to dorsiflex, and this will assist the shoes in doing this. Schuster used leather which can flex for years without breaking down; and a latex wood flour mix, which also allowed for flexion. Since cycling does not have a push off, these materials are not required.

    Try it and let me know how it works.

    Regards,

    Stanley
     
  10. kevin miller

    kevin miller Active Member

    Yes, I know how soft a durometer of 45 is, but I didn't realize they were selling that as a high-performance insole for bikers!!

    KM
     
  11. Matt1976

    Matt1976 Member

    Hi Stanley,

    I found your last post on this thread really interesting reading. I'm suffering with a bit of cycling related knee pain myself, quite possibly chondromalacia patella so Schuster's work might well be of assistance to me.Just want to clear a couple of things in my mind though:

    Quote: In cycling, there is no push off because the first MPJ does not dorsiflex. ...
    Since we are dealing with a modified midstance, we need a midstance orthosis.

    I'm struggling to get my head around this concept. My natural assumption would be that the foot in cycling is in contact with the pedal interface at the forefoot which is in propulsion at the downstroke with most of the pressure going through the hallux and forefoot. Certainly with road cycling anyway?

    Regards

    Matt.
     
  12. Lab Guy

    Lab Guy Well-Known Member

    'm struggling to get my head around this concept. My natural assumption would be that the foot in cycling is in contact with the pedal interface at the forefoot which is in propulsion at the downstroke with most of the pressure going through the hallux and forefoot. Certainly with road cycling anyway?


    I agree with what your saying. Still, the force on the ball of your foot during the downward/power phase can cause a net pronation moment at the STJ/MTJ if the center of pressure is lateral to the STJ axis. Without a perfect balance of supination and pronation moments acting across the STJ, internal rotation of the tibia and adduction will occur as the knee is flexed. The patella will track medially leading to chondromalacia patella over time.

    The idea here is to support the STJ/MTJ and reduce the pronation moment to decrease non-sagittal plane rotational movements causing the patella to track straighter. Varus wedge placed between the cleat and shoe can be helpful as well as an orthotic with a high MLA. The rearfoot of the orthotic is not important since there is no force being applied there.

    Have yourself video taped on a stationary bike to view your kinematics.

    Kevin has a good chapter on this in his book.

    Steven
     
  13. Stanley

    Stanley Well-Known Member

    Hi Steven,

    Internal rotation of the tibia reduces Q angle which is a treatment for chondromalacia. External rotation of the tibia is what increases Q angle.
    I thought this was resolved 25 years ago.

    Regards,
    Stanley
     
  14. Matt1976

    Matt1976 Member

    Thanks Steven,

    That's handy as Kevin's book landed on my doorstep earlier in the week and been looking forward to getting stuck into it!

    Great explanation by the way, and thinking about what you're saying of course you need midfoot control too! I was aware of the varus wedges so I'm keeping them in mind. I also think a limb length discrepancy is maybe affecting it so yeah will do some video and see what transpires.

    Cheers,

    Matt.
     
  15. Lab Guy

    Lab Guy Well-Known Member

    Stanley,

    When the STJ/MTJ is pronated during the downward stroke or power phase, the knee is flexed and the tibia will internally rotate and the knee will adduct toward the midline causing the line connecting the anterior superior ilac spine (ASIS) with the midpoint of the patella to become more oblique. In this case the angle of this line (Q angle) to the line that begins at the tibial tuberosity and continues through the midpoint of the patella will increase.

    During the upward stroke or the recovery phase, the knees will abduct away from the midline causing the line connecting the ASIS with the midpoint of the patella to be less oblique. Here, the Q angle decreases.

    In Cycling, you want to minimize the side to side movement of the knee, therefore varus wedging of the shoe or orthotics can be of great benefit to keep the knees moving up and down in the mid-sagittal plane.

    Good technique is also important to save your knees. A great deal of vertical force is being generated during the power phase so you should use the lowest gear possible so you will be making more revolutions but maintaining the same speed, especially going up an incline. Using a higher gear will increase the force required push the pedal down during the power phase adding stress to the knees.

    Steven
     
  16. Stanley

    Stanley Well-Known Member

    Hi Steve,

    The motion in the knee is external rotation of the tibia with adduction of the knee.

    [​IMG]

    Look at his right leg.

    Regards,
    Stanley
     
  17. Lab Guy

    Lab Guy Well-Known Member

    Stanley,

    I could not find your image, must be doing something wrong.

    Here are two sites to look at for images:

    http://athleticmedicine.wordpress.com/2013/07/16/shin-splints-101/

    http://trishop.com/bike-fit look at step 3



    Think of it this way: You are sitting at your computer with your feet on the floor and your knees are flexed.

    When you supinate your feet, your tibia is externally rotating and your knees are abducting (away from midline of body...genu varum)

    When you pronate your feet, your tibia is internally rotating and your knees are adducting (toward the midline of the body...genu valgum)

    With your knees flexed, you cannot prevent rotation of your leg or tranverse movement of your knee when you supinate or pronate your foot.

    Genu valgum is a contributing factor toward Chondromalacia patella as it increases the Q angle.


    Steven
     
  18. Stanley

    Stanley Well-Known Member

    Hi Steven,

    Where would the tibial tubersosity go to if you were to abduct and internally rotate the tibia? In one case the tibial tuberosity moves medially and in one case laterally. The net effect is no movement.

    In your first picture, look at the toe out. This is external rotation of the tibia.

    The second one doesn't show anything.

    Here is the point you are missing in this. Pronation of the foot is one movement, and the knee movement is a separate movement.

    Look at this picture:
    http://www.erikkonsmo.com/379/2013-a-fresh-start/skiing-ski-snow-desktop-hd-amazing-fresh/

    The knee is in valgus and the tibia is externally rotated. The foot is in a skiboot, so it cannot really move. This is knee and hip movement.

    The knee can compensate for a forefoot dysfunction, and well as the STJ. The compensation is what results in the problem with the body part.

    Regards,
    Stanley
     
  19. Stanley:

    I have been trying to follow your reasoning here and I don't know what you are saying here.

    The "Q" angle, measured by the angle formed by a line drawn from the ASIS to central patella and a second line drawn from central patella to tibial tubercle, will tend to increase as the subtalar joint (STJ) pronates in closed kinetic chain with the knee flexed. This STJ pronation will also increase the internal rotation of the tibia relative to the ground. However, if the tibial is also externally rotating relative to the femur, then the Q angle will also increase.

    Maybe when you describe internal and external rotation of the tibia, Stanley, you should describe which reference frame you are referring to for your tibial motion. Confusion can arise since in closed kinetic chain STJ pronation, the tibia can be internally rotating relative to the ground while also be externally rotating relative to the femur. I think that would help those that are attempting to follow along understand exactly what you are trying to say.
     
  20. Stanley

    Stanley Well-Known Member

    Hi Kevin,

    My definition of internal rotation of the tibia is the same as everyone else's.
    You said “if the tibia is externally rotating relative to the femur”. This means that as the tibia internally rotates secondary to pronation, the femur is internally rotating more than the tibia.
    I think we all know that during stance the femur is externally rotating (which decreases the Q angle), so why would it internally rotate (and increase the Q angle)?

    I agree that STJ pronation increases internal rotation of the tibia relative to the ground. If we are looking at a pure effect of subtalar joint pronation, this internal rotation results in a decrease of the Q angle.
    What would increase the Q angle is either external rotation of the tibia, which can be seen as toe out (we see this as a compensation for equinus), internal rotation of the femur (which can be seen as a compensation on a long leg), or as part of a "valgus-ing" of the knee, which is not pronation, but rather a knee compensation (we could see this as a compensation for any varus of the foot).
    In 1978, I sat down with Karl Klein and he told me that pronation caused external rotation of the tibia. He then showed me as he sat down and moved the knee inwards and outwards how the tibial tuberosity moved. As the knee moves into a valgus position, the tibia externally rotates and the foot pronates, and as the knee moved into a varus position, the tibia internally rotated and the foot supinated.
    However, if you were to sit down and pronate the foot at the subtalar joint, the tibia internally rotates and the knee does not significantly change its position.

    The point here is that we have two joints that have compensatory movements that are similar in some ways, but they are not the same.

    Regards,
    Stanley
     
  21. No Stanley. In a seated position, with the knees flexed, and the feet plantigrade, subtalar joint pronation causes internal tibial rotation, internal knee rotation and adduction of the knee. How can you say that the knee does not significantly change its position? I thought this was resolved 50 years ago??
     
  22. Lab Guy

    Lab Guy Well-Known Member

    Kevin, thanks for bringing clarity and closure to this, I was getting a bit frustrated and my head was hurting from :bang: .

    Steven
     
  23. Stanley

    Stanley Well-Known Member

    Hi Kevin,

    Could you define adduction of the knee? Does this mean the proximal end of the tibia is adducting?

    Regards,
    Stanley
     
  24. Knee adduction: movement of the knee toward the midsagittal plane of the body.
     
  25. Stanley

    Stanley Well-Known Member

    Hi Kevin,

    Here is a simple experiment:
    In a seated position, with the knees flexed, and the feet plantigrade, place two fists between the knees, so they cannot adduct. See if you can still pronate the feet.

    Regards,
    Stanley
     
  26. Stanley,

    This little experiment you suggest only proves that the internal subtalar joint (STJ) pronation moments from contractile activity of the peroneals can still pronate a non-maximally pronated STJ causing the forefoot to evert relative to the ground. In your experiment, the tibia is being prevented from internally rotating and the knee is being prevented from adducting by an external force on the medial knee (i.e. fists between knees) that causes an external knee abduction moment and an external tibial external rotation moment.

    Your experiment in no way shows that when fully weightbearing, with the knees flexed, closed kinetic chain (CKC) STJ pronation will not tend to cause internal rotation of the tibia, internal rotation and adduction of the knee and internal rotation of the hip joint.

    The point here is that for every CKC rotational motion of the STJ, since the STJ is a triaxial joint, this STJ rotational motion will tend to produce transverse plane rotations of the tibia, knee joint axis and femur relative to the ground. In the knee flexed position, however, these transverse rotational motions of the tibia, knee joint axis and femur will be accompanied also by changes in frontal plane alignment of the tibia and femur, since now the flexed lower extremity will be rotating within the transverse plane causing a relative valgus in the tibia with internal rotation and a relative varus in the tibia with external rotation, again relative to the ground and the midsagittal plane of the body.

    Again, Stanley, how does the knee not adduct toward the midsagittal plane in the knee flexed position during CKC subtalar joint pronation? Maybe you can draw me a picture of how this occurs and post it up here for all those following along because the only way I can see this unusual event occurring is if the tibia is prevented from internally rotating from some other external force (such as your fists between your knees) and the STJ pronation therefore causes forefoot eversion relative to the ground, and no internal rotation of the tibia and no knee adduction relative to the ground.
     
  27. Stanley

    Stanley Well-Known Member

    Hi Kevin in a recent post you stated:

    I guess in this case you only prove that the internal subtalar joint (STJ) pronation moments from contractile activity of the peroneals can still pronate a non-maximally pronated STJ causing the forefoot to evert relative to the ground.

    In my experiment it is very easy to pronate the foot with no pressure on the fists, so there is no external knee abduction moment. As far as an external tibial external rotation moment, the fists are touching the femur, and are in line with the vertical axis of the tibia, hence they cannot provide an external tibial external rotation moment.

    At the least it proves that the foot can pronate without having to have adduction of the knee.


    Relative to the ground and the midsagittal plane of the body, the motion that you are describing of relative valgus in the tibia with internal rotation and a relative varus in the tibia with external rotation is the motion that occurs as a primary knee movement, and not one that is secondary to pronation.

    Again Kevin, it is a primary knee motion that you are looking at the causes the knee adduction.
    If you were to tape a foot with a J tape so that the calcaneus is maximally inverted, and placed this foot on the ground with the knee flexed to 30 degrees, and allowed the foot to become flat on the ground, the Q angle would increase.

    Regards,
    Stanley
     
  28. I give up. :bash::bash::bash:
     
  29. efuller

    efuller MVP

    Cycling is different than walking or standing. The body above the femur is supported by the seat. Agreed, the connection between the calcaneus and the talus with STJ pronation the talus will internally rotate in the transverse plane. This transverse plane rotation will tend to internally rotate the tibia. In cycling, we have to look at both the top and bottom of the tibia. With STJ pronation there will tend to be medial displacement of the talus in the frontal plane. This medial displacement will tend to increase adduction of the tibia in the frontal plane. Whether or not the adduction (bottom of part moving toward the midline) increases depends on what happens at the top of the tibia. Say we are looking at a leg with the pedal at 90 degrees during the push. What will happen to the position of the bottom of the femur and the top of the tibia will depend a lot on which muscles are active at the hip. If the hip abductors are creating more abduction moment applied to the femur, then the bottom of the femur will abduct and you will get an increase in frontal plane angle of the tibia relative to vertical in the direction of adduction. Kevin's point about reference frame is very important here. Even though the tibia is adducting in the frontal plane, it may not be adductiong relative to the femur.

    Pedal forces and tibal motion. When hip muscles extend the hip, the femur applies a downward force on the top of the tibia. Looking in the frontal plane, the pedal applies an upward force on the bottom of the leg. If the force on top of the leg is not alligned with the force on the bottom of the leg then there will be a frontal plane moment on the tibia.

    I'll add more later

    Eric
     
  30. efuller

    efuller MVP

    I'm not liking the term knee adduction. Adduction usually refers to a long bone and the knee is the junction between two bones. Adduction of the tibia or femur is where the distal end of the bone moves toward the midline. Abduction of the knee could refer to the distal end of the femur, where the joint between the two bones is located, or it could refer to relative motion between the tibia and femur which is the opposite motion.

    Eric
     
  31. efuller

    efuller MVP

    In cycling there is more to worry about than just center of pressure under the foot. The crank of the pedal is another constraint to available motion. Some feet with a lot of external position of the foot relative to the knee joint axis, will have the medial malleolus hit the crank. To avoid hitting the crank the pedalist will choose to supinate their foot creating relative adduction of the foot relative to the leg. When the cyclist does this there will be inversion of the foot and a lateral shift in the location of the center of pressure under the lower leg. A varus wedge under the foot will help move the center of pressure under the foot more medially when the stj is supinated. The loads in cycling are lower than when weight bearing so a person can hold their foot supinated for a longer period of time when cycling.

    Just some thoughts.
    Eric
     
  32. Stanley

    Stanley Well-Known Member

    Hi Matt,

    Sorry, I just saw this post. Push off starts when the heel rises off the ground. When this happens, the toes dorsiflex. In cycling there is no dorsiflexion of the toes.
    The best analogy I can give is from Olympic lifting. The lifter has the weight on the metatarsal heads, and the heel is in contact with the ground. At the second pull, he violently pushes against the ground forcing his body to straighten lifting the weight as high as he can. When he can not straighten anymore, the heel comes off the ground. There can be weight on the metatarsal heads (a push) without a push off.

    Regards,
    Stanley
     
  33. Stanley

    Stanley Well-Known Member

    Hi Eric,

    Are you talking about platform pedals, pedals with toe clips, or clipless pedals or all of them?

    Regards,
    Stanley
     
  34. efuller

    efuller MVP

    I was thinking of all of them. I mentioned several concepts. I can't think of a reason why they would be different. Can you?

    Eric
     
  35. Stanley

    Stanley Well-Known Member

    Clipless pedals don't allow for motion in the transverse plane unless specifically allowed to "float".
     
  36. efuller

    efuller MVP

    You still have to get your foot in the shoe. If you have an externally rotated foot, you are still going to have to supinate the STJ to get the adduction to not hit the crank.
     
  37. Stanley

    Stanley Well-Known Member

    Eric,

    I am not getting the picture of why the medial malleolus would hit the crank.
    Where is the foot pointing? Is the tibial perpendicular to the pedal?
    My interpretation of what you are saying is obviously wrong, so please explain.

    Regards,
    Stanley
     
  38. efuller

    efuller MVP

    Looking from above at the foot (transverse plane). The forefoot has to sit on the pedal. If there is high amount of external tibial torsion the forefoot will sit lateral to where the leg is. So, with the forefoot on the pedal, the leg will be much closer to the crank than the forefoot. It can be close enough for it to hit the crank when the pedal is near the bottom. The cyclist will have to adduct the foot so that the forefoot is in the same saggittal plane as the leg.

    In the frontal plane the tibia is perpendicular to the pedal. You should be able to visualize this as well in the frontal plane. The leg is medial to the forefoot.

    I had a patient who was a machinist and was having problems with 5th met head pain while cycling in relatively soft shoes. His platform pedal. had a lip at the lateral edge that was probably designed to keep the foot from sliding off the lateral side. This "lip" was right under his fifth met head when his abducted foot was on the pedal. He ground the lip off and the problem went away.

    Eric
     
  39. Stanley

    Stanley Well-Known Member

    Hi Eric,

    Now I understand, thanks.

    In a clipless pedal, the foot is locked in, so the medial malleolus may or may not hit the crank depending on the way the shoe is set to sit on the clipless pedal.

    Regards,
    Stanley
     
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