I can comprehend the use of foot orthoses as short-term "...arrow in the quiver..." for rehab but say for laterally deviated STJ axis driven? lateral ankle stability why not long-term?
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please refer me back to a relevant thread(s) if applicable, thanks, mark
note: am watching 'sportinjurymatt' podcasts; so more interesting and thought provoking with podcasts nowadays, thanks craig and ian
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This gets back to the use of orthoses in injury prevention. It would be nice to have evidence that the treatment prevents future problems like how medications are used to reduce high blood pressure. In that example, we have good evidence that prolonged high blood pressure causes problems and that use of medication lowers blood pressure and that you see, with medication, there is reduction of the problems caused by high blood pressure.
We need measurements, and studies of those measurements to justify the long term use of orthotics. I don't think that neutral position related measurements will be predictive of pathology. There is also no coherent theory on why treatment of those measurements would reduce pathology. On the other hand, STJ axis location in the transverse plane is a measurement upon which predictions can be made. For example, a laterally deviated STJ axis will be more likely to have peroneal tendonitis. So now we need some studies that need to show that treating a laterally deviated STJ axis with an orthosis designed to increase pronation moment from the ground will lower the incidence of peroneal tendonitis.
I do know that I have a medially deviated STJ axis foot and I prefer to wear orthoses with a medial heel skive. My foot feels better. N = 1
There have been some threads on preventive use of orthoses.
Eric-
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Thanks Eric,
Why do the studies by highly regarded podiatrists/ biomechanists eg. SEMRC @LaTrobe uni. usually use 'neutral STJ' based foot orthoses as the intervention. It's very frustrating.
My wife and daughter (N=2) likewise. However I can not as my medial side of b/knees gives me jip when i trialled them
All the best, mark -
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In my failed attempt at Optometry (most boring tertiary course i ever started; only lasted 6/52) they never got to the 'can exercises increase the eye's ability to see'. If, as i am assuming, they can not then surely it is 'drawing a long bow' to use them as an analogy, yes?
I don't include the anatomical anomalies(?) here.
thanks again to you and Eric, mark -
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Aloha,
Interesting title for this thread.
Mark could you please describe-define "load management"?
If we can manage the loads on exoskeletons and prosthetics can we do the same with foot orthotics?
A hui hou,
Steve -
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Aloha,
Sounds good.
May some also call it kinematics and kinetics?
It is kinda tough to strengthen an already injured and aging tendon but that should be the first and the least of our efforts.
We just need to build-test better orthotics and shoes that can mitigate and manage ground reaction forces.
A hui hou,
Steve
GFR is the Star.
If you think my thoughts are a bit off kilter perhaps it is because of my background music...
Remember that "Then sun is the same in a realitive way but your older" and so are your tendons.
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Now this was part of a thoughtfully presented piece, and I understand (i think) the premise of the statement, but I wonder how and why similar views are being seen as mainstream. Surely the answer lies, as it did with the barefoot argument.. it is not good and it is not bad. If you understand the implications, it can be used to help a runner. Same old same old.. the duration of use of an orthotic device is surely defined on a case by case basis? -
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Agreed. Much of this call for foot orthoses to be used only on a short term basis is based on the false concept that foot orthoses somehow weaken the foot and lower extremity and it appears to be coming directly from physiotherapists and physical therapists. Not only is there no scientific research evidence that foot orthoses somehow weaken the foot and lower extremity or cause any long-term damage to the body over time, after making over 20,000 pairs of foot orthoses for patients over the past 33 years I have certainly not seen any cases of foot or lower extremity atrophy from their 10 year, 15 year, 20 year, 25 year or 30 year use. Ever!
Instead I continue to see patients in my podiatric practice who have been wearing foot orthoses for 15 or more years who are extremely happy with them since they have allowed them to stay active without pain. Please someone explain to me how allowing someone to run, jump, walk and do all their weightbearing activities during their days, weeks, months and years with well-made foot orthoses "weakens" someone's feet and legs? This notion that foot orthoses weakens feet and lower extremities over time is simply a made-up idea by people who think that all foot and lower extremity pathologies can be treated with stretching and strengthening exercises. These same people don't have a clue how effectively and efficiently custom foot orthoses can work for many individuals. They only are seeing orthosis failures, not orthosis successes.
My advice to those podiatrists who interact and lecture to physiotherapists and physical therapists is to realize that you are the experts on foot orthosis therapy and you should be saying there is no good scientific evidence that foot orthoses weaken feet and should just be used short-term, all in an attempt to keep the physiotherapist or physical therapist communities happy. They aren't the foot orthosis experts, we are. And unless they have the clinical experience with foot orthosis therapy that we do as podiatrists, then they are only guessing that patients with foot pain are best-served only with the short-term use of foot orthoses. -
Good points. Many physiotherapists and physical therapists think that foot orthoses are "braces" limiting the ability of a joint to move. If this is the case, which joints of the foot do foot orthoses prevent movement? They don't wrap around a set of joints like a neck brace does. They don't wrap around a set of joints like a cam-walker boot does. They don't wrap around a joint like a straight-leg knee brace does. Simply put, foot orthoses modify the external forces and moments that result from the mechanical actions of ground reaction force acting on the plantar foot. Foot orthoses don't prevent foot motion at any of the joints and lower extremity. Shoes, by themselves, by wrapping around multiple foot joints are more likely to cause a restriction of joint motion and "foot weakness" than do foot orthoses.
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