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Langer shearstep shoe

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Sep 6, 2010.

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    At the Rx biomechanics summer school 2010 Phil Reece presented on the new Langer shoe designed for diabetics - details here: http://www.lbguk.co.uk/images/Langer-Shearstep.pdf

    I find the idea that the sole is designed to place the foot at certain angles/ positions at certain points during the gait cycle interesting. We used to think we could use foot orthoses to place the foot in certain positions at certain times during the gait cycle, but it seems unlikely that they do. If you follow the link above you can see the basic design features. Take a look at the centre of force (pressure) pathway. What are the implication in terms of subtalar joint moments here (assuming a vertical vector)? Kinetics versus kinematics being a problem here.

    Is that conical shaped forefoot rocker acting as a huge (if memory serves its 13 degrees) forefoot varus post?
     
  2. robby

    robby Active Member

    Simon

    I have seen the shoe, and yes i agree it appears that it is a large forefoot varus post, from the paper i saw it appears that the main point being claimed is the reduction in the force time integral over the forefoot. if this shoe works it would be the 'Holy Grail' and would reduce the need for TCIs. I assume that it isnt suitable for all patients but for some.

    Rammi Abboudd was talking about this type of shoe a few years ago at the North Staff Biomech conf, and I know that Sue Barnett has been using functional orthoses in Diabetics to reduce forefoot loading, by changing timeings, maybe this shoe does the same ?
     
  3. Phil Wells

    Phil Wells Active Member

    I don't know about anybody else but I can't get the link to work.
    Do you have to be a Langer customer to see it?
    Maybe 'Robby' can help???


    Phil
     
  4. Works for me.
     
  5. You may have a net reduction in the net vertical force seen in the force time curves, but what about the discreet forces / time integrals under specific points? Moreover, the vertical force component may have been reduced in this individual, what has happened to the shear components? What is your interpretation of the centre of force (pressure) pathway presented? Take a look at the image, I've overlaid an average STJ axis, what changes might the changes in the center of pressure pathway have on the moments acting about this joint axis? As I said previously we do not know the kinematic changes that might have occurred, which makes it difficult to analyse this fully. What is your take on this path...


    From a kinematic point of view we might see that the STJ will move in the same direction as the COP. That is a lateral shift in COP might occur due to the STJ supinating, whereas a medial shift in the COP might occur due to the STJ pronating. In which case the forefoot of that shoe is doing, shall we say "interesting things" to the foots kinematics. However, if we don't see these kinematic changes in association with the change in COP position, we might conclude that a lateral shift in the COP results in increased STJ pronation moment, whereas a medial shift in the COP results in an increase in STJ supination moments, in which case the shoe is doing "interesting things" to the foots kinetics... take your pick.

    N.B., I'm not saying they are good things or bad things, I'm saying they are interesting things that need further investigation.
     

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  6. P.S. would be interesting to see what is happening at the foot-shoe interface, as oppose to the shoe-ground interface. But the proof of the pudding..... will be a clinical trial.
     
  7. J.R. Dobbs

    J.R. Dobbs Active Member

    Or a lawsuit!
     
  8. You'd have to demonstrate that the shoes were the cause of the problem. But I guess if Oscar Pistorious can convince people that having two carbon fibre springs attached to his legs were not providing a mechanical advantage, anything is possible :rolleyes:
     
  9. ssbath

    ssbath Member

    Do Langer have the resources to carry out the clinical trials required to prove the hypothesis
     
  10. What's the hypothesis?

    What I mean is: lets say the hypothesis is that the Langer shearstep shoe prevents ulceration in diabetics suffering from neuropathy. We run a trial, how do we know whether the shoe prevented ulceration or whether the specific individuals in the trial would not have ulcerated anyway? We could do a cross-over and see if those who wore the shoe first subsequently went on to ulcerate in a different shoe design. Or those that wore a different shoe design first subsequently went on to ulcerate once they started wearing the Langer shoe, but what if the subjects ulcerate in the alternative shoe first, before we even get to put them in the Langer shoe or vice versa?
     
  11. Boots n all

    Boots n all Well-Known Member

    Every product has its place but this is not going to work for all as has been said.
    and it is hard to pass judgment without knowing more.

    But for a large(?) company l can not believe the botched up job on the marketing, lets compare apples with apples, what do these images really show us? not much or at best not as much as they could have.

    They should be have done an in-shoe pressure mapping of "another" shoe and the same client in-shoe pressure mapping of their shoe, then we can see some real differences? of course we will see a difference from bare foot to a shoe:bash:.
     
  12. To be fair, when the shoe was presented at Rx Biomechanics Summer School, there was comparative data with another shoe- but not in-shoe data.
     
  13. Phil Wells

    Phil Wells Active Member

    Just had a play with a patient by comparing load with and with out shoes and found similar results to the data presented in regards to the 'forces'.
    My worry about 'forcing' or directing the foot is the impact of the direction of GRF's - e.g. the shoe is applying a medio-lateral GRF and the foot is experiencing lateral-medial GRF - which one is right. Could interstitial shear be an issue if the co-efficient of friction at the skin interface is high e.g. gel based?
    I understand the need for sagital plane progression and its impact on duration of load but the relevance of transverse and frontal does not seem to be as clear cut.

    Having said all this, it may be a useful approach but a bit more evidence is needed.
    On a commercial point, it better be cost effective otherwise non of the above will matter.

    Phil
     
  14. I agree, I think transverse plane knee joint torques may be an interesting area of study.
     
  15. ssbath

    ssbath Member

    It is all a moot point now as the inventor and brain behind the project now works for Reed Medical. With Rob Bradbury also moving to Talar Made, Langer now have NO technical backup for this project or indeed for ANY of their orthotic products.
     
  16. That's not strictly true.
     
  17. ssbath

    ssbath Member

    From that I assume you ARE acting as his consultant / publicist ?
     
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