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Foot orthotics for hip problems

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jun 12, 2008.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Sports-Related Hip Injuries and Orthotic Support
    Dynamic Chiropractic July 1, 2008, Volume 26, Issue 14
    Full text of article
     
  2. Craig Payne

    Craig Payne Moderator

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    No it hasn't - the opposite has been shown to be the case.
     
  3. Craig:

    I would have to disagree with you on this one.

    Here is, for example, the research that shows the association between medial tibial stress syndrome and excessive pronation.

    13 male distance runners without MTSS were compared to 35 male athletes with shin splints (MTSS) and found that those with shin pain had greater Achilles tendon angles, more STJ ROM, and more rearfoot pronation during running
    Viitasalo JT, Kvist M: Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. Am J Sp Med, 11:125-130, 2005.

    Unilateral standing navicular drop was found to be significantly greater in 125 high school XC runners that developed MTSS
    Bennett JE, Reinking MF, Pluemer B, et al: Factors contributing to the development of medial tibial stress syndrome in high school runners. J Ortho Sports Phys Ther, 31:504-511, 2001.

    Prospective study of 124 recruits showed that individuals with pronated foot type (using foot posture index) were significantly more likely to develop MTSS than those with normal or supinated feet
    Yates B, White S: The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sp Med, 32:772-780, 2004.
     
  4. Craig Payne

    Craig Payne Moderator

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    Cross-sectional studies do not count as they imply correlation and not causation. Only one prospective study (which imply causation) has shown a pronated foot is a risk factor (the Yates & White one you cited) for injury. The other 40-50 prospective studies on running injury show that a pronated foot is NOT is risk factor with a few showing that its actually protective for injury. (I am between students in clinical exams, but will get back with the references later)
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Here is a piece I recently wrote:
     
  6. Chris Webb

    Chris Webb Member

    Hi Craig

    I am just wondering that although the studies show that pronation is not a risk factor then why is it when i treat people with ITB, greater trochanter busitis and anterior knee pain etc with orthoses to decrease the pronatory moments occuring that there symptoms go. I dont understand how excessive pronation is not a risk factor? Often the patients have had months of physio , core stability or steroidal injects but have not got better yet orthoses cure them within 6-12 weeks.

    i am unsure if this is correct but my understanding is for a high subtalar joint axis for every degree of extra pronation there can be up to 4 degrees of motion at the hip so if there is say 4 degrees extra pronation then there is 16 degrees extra rotation if the hip? i would of though this would lead to injury? I am happy to be corrected but i am sure i have read that somewhere.

    cheers

    chris
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
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    Chris

    Thats the paradox! (eg see the thread on: Foot pronation and knee pain)

    1. We use foot orthoses clinicaly aimed at treating rearfoot pronation.

    2. However....The lab based biomechanical studies are evenly divided between those that show the foot orthoses do not alter rearfoot motion and those that show they do (and even when the do, the mean difference is only a degree or 2 change in rearfoot motion)

    3. However....The clinical outcome studies show that when we try to do that (ie try and change rearfoot motion) the patients do get better.

    4. However....the prospective studies are almost all showing the rearfoot pronation is NOT a risk factor for injury.

    5. Also ... there is no correlation between the change in rearfoot motion with foot orthoses and changes in symptoms.

    See the paradox? ....working hard on the solution (its all to do with changes in forces and not motion).
     
  8. Craig:

    The study by Ben Yates and White does show a significant increase in medial tibial tibial stress syndrome with a more pronated foot. Therefore, we do have one study that confirms my clinical experience (and a many other clinicians' experiences over the past 100+ years) that overly pronated feet are often associated with foot and lower extremity pathologies (Yates B, White S: The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sp Med, 32:772-780, 2004).

    In addition, we have the very nice study done by Williams, Davis and Baitch on runners who were not helped with normal orthoses that were then helped by Blake inverted orthoses. These runners had their peak rearfoot internal inversion moment and inversion work reduced significantly with Blake inverted orthoses and internal tibial rotation, knee adduction and knee abduction moments also significantly affected with the inverted orthoses (Williams DS, McClay-Davis I., Baitch SP: Effect of inverted orthoses on lower extremity mechanics in runners. Med Sci Sports Exerc, 35:2060-2068, 2003).

    I would, therefore, be clearly very comfortable in saying that the idea that both an excessively pronated position of the foot (Yates and White, 2004) and that excessive external STJ pronation moments (William, Davis and Baitch) have been shown to be correlated to lower extremity pathologies by research. That certainly does not mean that all excessively pronated feet are at more risk for injury since many very pronated feet are injury free. But, what it does mean to me and is supported by my clinical experience in the treatment of literally thousands of pronation-related injuries with foot orthoses, varus wedges or modified over-the-counter orthoses, is that reducing the external STJ pronation moments with these in-shoe devices is very successful and certainly supports the clinical idea that *excessive pronation* is the cause of many of the injuries we treat on a daily basis.

    *Excessive pronation*: defined as excessive pronated position of foot and/or excessive external STJ pronation moments acting on the foot.

    Going to be a great seminar in Sydney and Melbourne!!:drinks
     
  9. Craig Payne

    Craig Payne Moderator

    Articles:
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    But, the magnitude of risk in that study was relatively low (even though it was statistically significant). Being a female was just as much a risk factor as a pronated foot.
    But they showed no changes in the motion patterns; the changes in moments = change in forces in the tissue (solution to the paradox above)
    BUT, every other study so far has shown that NOT to be the case
    The moments have not been prospectively shown to increase risk for injury; they have been shown to be reduced by foot orthoses when the motion pattern was not changed.
    Lets had this discussion to the program :boxing: :drinks
     
  10. Craig:

    This isn't fair, you're on vacation and I'm at work now!!!

    However, the motion patterns have been shown to change with foot orthoses in many studies (here are two of them and the rest are on my home computer):

    Mündermann A, Nigg BM, Humble RN, Stefanyshyn DJ: Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomechanics, 18(3):254-262, 2003.

    MacLean CL, Hamill J: Short and long-term influence of a custom foot orthotic intervention on lower extremity dynamics in injured runners. Annual ISB Meeting, Cleveland, September 2005.

    Maybe the orthoses used just weren't "corrective" enough to show a change in motion patterns or our measuring techniques aren't sensitive enough to detect the change in motion??

    Bring it on, Payne. I'll argue about anything as long as I can still argue.....at least that's what my parents said about me. Does this mean I'm going to have to buy you beers in Oz??:rolleyes::boxing::drinks
     
    Last edited: Jun 14, 2008
  11. Craig and All Those Others Following Along:

    Here are the studies, to date, that show foot orthoses affect the motion patterns (i.e. kinematics) of walking and running.


    Decrease in maximum rearfoot eversion angle

    Bates BT, Osternig LR, Mason B, James LS: Foot orthotic devices to modify selected aspects of lower extremity mechanics. Am J Sp Med, 7:328-31, 1979.

    Smith LS, Clarke TE, Hamill CL, Santopietro F: The effects of soft and semi-rigid orthoses upon rearfoot movement in running. JAPMA, 76:227-232, 1986.

    MacLean CL, Hamill J: Short and long-term influence of a custom foot orthotic intervention on lower extremity dynamics in injured runners. Annual ISB Meeting, Cleveland, Sept. 2005.

    Nester CJ, Hutchins S, Bowker P: Effect of foot orthoses on rearfoot complex kinematics during walking gait. Foot Ankle Intl, 22:133-139, 2001.

    Nester CJ, Van Der Linden ML, Bowker P: Effect of foot orthoses on the kinematics and kinetics of normal walking gait. Gait Posture, 17:180-187, 2003.


    Decrease in maximum rearfoot eversion velocity

    Smith LS, Clarke TE, Hamill CL, Santopietro F: The effects of soft and semi-rigid orthoses upon rearfoot movement in running. JAPMA, 76:227-232, 1986.

    MacLean CL, Hamill J: Short and long-term influence of a custom foot orthotic intervention on lower extremity dynamics in injured runners. Annual ISB Meeting, Cleveland, Sept. 2005.

    Nester CJ, Hutchins S, Bowker P: Effect of foot orthoses on rearfoot complex kinematics during walking gait. Foot Ankle Intl, 22:133-139, 2001.

    Nester CJ, Van Der Linden ML, Bowker P: Effect of foot orthoses on the kinematics and kinetics of normal walking gait. Gait Posture, 17:180-187, 2003.


    Decrease in maximum internal tibial rotation

    Nawoczenski DA, Cook TM, Saltzman CL: The effect of foot orthotics on three-dimensional kinematics of the leg and rearfoot during running. J Ortho Sp Phys Ther, 21:317-327, 1995.

    Williams DS, McClay-Davis I, Baitch SP: Effect of inverted orthoses on lower extremity mechanics in runners. Med. Sci. Sports Exerc. 35:2060-2068, 2003.

    Woodburn J, Helliwell PS, Barker S: Changes in 3D joint kinematics support the continuous use of orthoses in the management of painful rearfoot deformity in rheumatoid arthritis. J Rheum, 30:2356-2364, 2003.


    Decrease in internal rotation and adduction of the knee

    Stackhouse CL, Davis IM, Hamill J: Orthotic intervention in forefoot and rearfoot strike running patterns. Clin Biomech, 19:64-70, 2004.


    Decrease in maximum ankle dorsiflexion angle

    MacLean CL, Hamill J: Short and long-term influence of custom foot orthotic intervention on lower extremity dynamics in injured runners. Annual ISB Meeting, Cleveland, September 2005.


    Many other studies show that foot orthoses don't significantly affect the kinematics of walking and/or running.

    One question I would then ask regarding this "paradox", especially considering what some researchers call "foot orthoses", is whether these studies that showed no changes in kinematics with orthosis intervention would have shown a signficant change in kinematics if a more "corrective" foot orthosis had been used? My guess is that the studies where an orthosis is made to be "state of the art" in "abnormal feet", that kinematic changes will be evident routinely in rearfoot motion.

    Secondly, I also wonder with the known error in skin vs bone movement and the resultant measurement error that there is more change in bone motion with orthoses than what we are measuring? My guess is that the bone is moving in response to well-made foot orthoses but the angular changes are too small to be detected with the variability of skin markers.

    Lastly, I wonder that if researchers were able to measure joints distal to the subtalar joint with bone pins, that we wouldn't see relatively large changes in kinematics? My guess is that the talo-navicular, naviculo-first cuneiform and first metatarsal-cuneiform joints will all show large changes in kinematics when bone pins studies are done pathologic feet with and without foot orthoses. We must remember that nearly all studies that have been done and currently are being done are on "normal feet", not the "abnormal feet" we all see on a daily basis in our practices!

    Some more to talk about in Sydney and Melbourne, Craig....can't wait.;)
     
  12. Craig Payne

    Craig Payne Moderator

    Articles:
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    But NONE of those changes have been correlated to changes in symptoms.
    Which is the point I keep making about the results from the research being mixed and not consistent.
    I guess we will not know that, except in the Williams & Mclay study, they showed no systematic kinematic changes with the aggressive Blake inverted devices....
    Always a possibility.
    :butcher: :drinks
     
  13. Don't know about that one, Craig. In my reading of their paper, there were significant kinematic changes in the tibia and knee. ;)

     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Prefabricated contoured foot orthoses to reduce pain and increase physical activity in people with hip osteoarthritis: protocol for a randomised feasibility trial
    Matthew G King et al
    BMJ Open. 2022 Sep 6;12(9):e062954
     
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