The Effects of a 12-Week Custom Foot Orthotic Intervention on the Intrinsic Muscles of the Foot, and Dynamic Stability During Unexpected Gait Termination in Healthy Young Adults
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Protopapas, Katrina,
Theses and Dissertations (Comprehensive). 2017
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Interesting to see how this plays out ...
I only have access to abstract and not full methods to appraise, but it looks OK from the abstract. Lets see if it gets published in full.
So what we have:
1 cross sectional case control study showing a weakness (published)
1 cross sectional study showing orthotic group stronger (unpublished but in public domain))
1 prospective study showing a decrease in strength (unpublished thesis abstract)
2 prospective studies showing an increase in strength (published)
1 prospective study showing no change in strength (unpublished but in public domain)-
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" With the plantar intrinsic muscles of the foot being in direct contact with the CFO, it puts these structures at risk for disuse muscle atrophy as a result of being offloaded."
I'm still trying to figure out how the orthotic being in contact offloads the intrinsic muscle. That statement doesn't really matter if the research question is do orthotics change the strength of intrinsic muscles. They would still have to look for both increase in strength and decrease in strength. -
My guess is that the orthosis is reducing the demand on the plantar intrinsics over time thereby reducing it's cross sectional area. It remains to be seen 1) does a small decrease in plantar intrinsic muscle cross-sectional area result in any functional differences in foot function (I tend to doubt it), and 2) what is the minimum muscle strength needed in the plantar intrinsics in order for the CNS to allow the foot function normally (we don't know that either).
I predict that there will be a number of physiotherapists and barefoot/minimalist shoe advocates who will latch onto this study to declare that foot orthoses should only be used short term since they cause "foot weakness" over time. I'm sorry, after treating ten's of thousands of people with foot orthoses over the last 30+ years, I have yet to see one single patient develop "foot weakness" from wearing their orthoses on a regular basis. I tell all my patients to keep their orthoses inside their shoes if they are making them more comfortable, but take them out if they are causing discomfort. There are no negative health consequences to wearing well-made custom foot orthoses for years upon years. If someone tells you that, ask them to produce the evidence otherwise. There is none.-
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"With the plantar intrinsic muscles of the foot being in direct contact with the CFO, it puts these structures at risk for disuse muscle atrophy as a result of being offloaded."
How does this work? No muscle is in 'direct contact' with the foot orthoses. If 'in contact' how would that necessarily 'offload'? -
This is pure conjecture and makes me worry about whether the researchers doing this study had a pre-research agenda to push across that foot orthoses "weaken" feet. It really is nonsensical since the skin is first in contact with the orthosis, then the subcutaneous fat, then the plantar aponeurosis and finally the plantar intrinsic muscles. Why don't the skin, adipose and plantar fascia atrophy also when wearing foot orthoses? Ridiculous!-
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Last edited by a moderator: Oct 16, 2017
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Haven't read the full paper, but really? Might as well speculate the 'intrinsic' musculature was hypertrophied due to abnormal foot instability and recruitment of intrinsics in an attempt to stabilize the foot, a condition which was then restored with the use of foot orthosis.
What's next, the world is flat (wait, it might be....) -
If skeletal muscle is subjected to repeated compression , such as would occur in the abductor hallucis with the use of an orthotic that included a medial arch support , would this lead to a muscle with a reduced intersitial fluid content ,and hence reduced cross sectional area ?
Also , in the case of older individuals with age related intrinsic muscle atrophy , I wonder if the exercises of Mickle et al 2016 , might improve orthotic efficacy by restoring intrinsic volume . What say you Dieter ?
Gerry -
On a similar theme , would increasing the volume of the intrinsic foot muscles in the intrinsic minus foot help improve the effectiveness of a medial arch support ? I believe it would .
So can this volume increase be achieved ? We are about to find out . (see PDF link below )
Could be a very important piece of research .
Evaluating a foot strengthening exercise program to improve foot ...
https://249kl22iwv073rrkjr3zufqg-wpengine.netdna-ssl.com/.../Project_Summary_te...18 Apr 2017 - Evaluating a foot strengthening exercise program to improve foot function ... Victoria University: Dr Karen Mickle, Professor Rezaul Begg and ... -
This is of relevance to the findings of the above study:
Correlations Do Not Show Cause and Effect: Not Even for Changes in Muscle Size and Strength
Scott J. Dankel et al
Sports Medicine January 2018, Volume 48, Issue 1, pp 1–6
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Hello everyone, first post here :s.
Very interesting study, although I might not understand it as an english-speaking person will, I guess I still got the gist of it.
I have also been taught in french podiatry schools that orthotics and especially "arch height" will render our tibs lazy and weak. Then, when talking with serious podiatrists in France, they told me that it was something thought without really much consistency. I wish they could be here to explain that themselves but english is not their main language so I will try to do it myself and stay genuine to their utterances. I do not master it as they do so there might be some inconsistencies. Here is what they said :
If you put something hard under the foot, this compresses sensors in muscles and tendons in contact and they contract as a response. If, my memory is not lazy (must be my orthotics that cause that ;)) I think this was due to Golgi sensors which cause muscle contraction when pressured.
as opposed, if something soft is placed under the foot, sensors will not be triggered and no muscle response will happen.
Even though this is not a serious study, I remember that we did the test with the plateforce and the "game" was to observe the different reactions people had when poron and a stiff material of 70 shore+ were put under some parts of the foot. Even though, that did not work 100% of the time, for most of it the soft material would " attract " the foot to its location ("shutting down" sensors = no muscle reactions to counter ground reaction force) and the stiff material would "repulse" the foot.
Here is a little thing you can do : try putting a heel rise of 2mm of poron on your shorter leg. If you tend to put most of your weight on your longer one, normally what you will see in the plateforce is that your weight will shift onto your shorter leg. Hopefully with the above explanation, I made the relation clear. It did pretty well in dynamic too.
I am curious of what you guys think of it, as I haven't read much podiatry literature in my life it is hard to criticize another's opinion for me (I am also pretty new to podiatry).
Gregori. -
If the orthotic makes it so the person walks more, they will be using their muscles more. In gait, when the heel lifts off of the orthotic, the posterior tibial muscle will lose any help it was getting from the orthotic. So, with walking, the posterior tibial muscle is used even with orthotics.
Eric -
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Hi Eric
Just read this thread again today and found a funny emoji placed by yourself on post #14 . Could you tell me what you find funny about the post ? I greatly look forward to your response . -
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Thanks . The paper in question seems to me to be about lymphatic drainage , but I don't think the authors have considered this .
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The effect of a 12-week custom foot orthotic intervention on muscle size and muscle activity of the intrinsic foot muscle of young adults during gait termination
Katrina Protopapas et al
Clinical Biomechanics
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In this thread, this was just posted:
Comparison of the effects of low level laser and insoles on pain, functioning, and muscle strength in subjects with stage 2 posterior tibial tendon dysfunction: A randomized study
Cansu Koltak, Yasin Yurt
J Back Musculoskelet Rehabil. 2021 Jun 18
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No change in foot soft tissue morphology and skin sensitivity after three months of using foot orthoses that alter plantar pressure
Joanna Reeves et al
Footwear Science
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It's not foot orthoses that cause the feet of populations to be weak, it's shoes in general .
But since shoes are often necessary, what do we do ?
Goldmann et al 2021, compared the toe flexor strength of adolescent, elite, female gymnasts with that of adult male sports students and found the much smaller gymnasts to have toe flexor strength 80-86% higher than the men .
If the gymnasts have stronger feet from exercising barefoot, the natural condition ,then you could say that the accepted "norm" for toe flexor strength, from a researchers point of view, is only about 50% of natural levels .
No wonder Sacco et al found a x 2.4 reduction in running injuries when the foot was strengthened and that in another paper foot strengthening has also been found to significantly reduce knee pain .
It seems probably to me that strengthening exercises merely take weak feet up a bit closer to "natural" strength levels . -
I was taught, in my training over 50 years ago, "use it, or loss it". That is, use the muscle(s) or loss the strength in the muscle(s).
We see this clinically, when removing a cast on the foot and lower leg. Without exception, the leg muscles have atrophied.
Same thing occurs when placing an arch support under the foot. The intrinsic foot muscles atrophy. I have observed this happening countless number of times.
Pretty straight forward. Approximately 90% of what I was taught in Podiatry, over the years, has proven to be incomplete or inaccurate information. The use it or loss it apophthegm has weathered the course of time remarkably well and has remained axiomatic.
Just food for thought! -
I am aware of Dr Luke Kelly's PhD work, which shows intrinsic foot muscle EMG activity increasing with load up to about 150% bodyweight . This was with the rig shown below .
However, studies which look at EMG during actual gait ,show the intrinsics firing up later in stance as the heel clears the ground . As the heel leaves the ground, medial arch supports lose the ability to support the arch and so would not reduce intrinsic activity . So weakening would not be expected .
Recent evidence indicates that anything that interferes with digital purchase during late stance hugely impacts the intrinsics .
With regard to use it or lose it, most of us have never had it . Shoes from cradle to grave probably see us with 50% of the toe flexor strength we should have, and with a reduced ability to use it .
Incidentally , its an unusual twist of events that sees a person, who will soon be selling foot strengthening devices, arguing that orthotics don't weaken feet, and a trained podiatrist arguing that they do .
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Further evidence that the feet in shod populations are much weaker than "natural levels", has recently been produced by Dr Chris D'Aout and his colleagues from Liverpool University
Below is a link to the paper which demonstrates that shod feet are weakened by the splinting action of shoes and that merely walking about in minimal shoes can restore some of the strength deficits .
I am not a fan of running on concrete without a bit of padding between me and the ground, but it certainly seems like --
1 People that wear supportive shoes all day will have feet at least 60% weaker than nature intended .
2 Runners that strengthen their feet but continue to use their supportive bulk shoes will still more than half their injury rate ,on average .
Quote
"This study shows that foot strength increases by, on average, 57.4% (p < 0.001) after six months of daily activity in minimal footwear"
Link
Daily activity in minimal footwear increases foot strength https://pubmed.ncbi.nlm.nih.gov/34545114/ pic.twitter.com/oYsmyc1zQp -
Effects of a 9-weeks arch support intervention on foot morphology in young soccer players: a crossover study
Kohei Hikawa, Toshiharu Tsutsui, Takehiro Ueyama, Jin Yang, Yukina Hara & Suguru Torii
BMC Sports Science, Medicine and Rehabilitation volume 14, Article number: 193 (2022)
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My research is consistent with this paper. Cutaneous signals from the plantar foot pads impact the body in profound ways. Something I was not aware of as a Podiatry student 60 years ago. -
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The intrinsic muscle activity became very important to ascertain when I was surgically rerouting them around the hallux. -
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