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MBT's and achilles tendonitis

Discussion in 'Introductions' started by Clare Beale, Dec 19, 2008.

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  1. Clare Beale

    Clare Beale Welcome New Poster


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    Greetings all! I have spent a lot of time reading the postings but so far never contributed myself. I have a patient with repeated acute flare-ups of achilles tendonitis. In addition to physio he has been recommended to me for orthotic therapy which is underway. He has also been advised by an MBT retailer that these shoes would help him and strengthen the achilles preventing over-pronation. This is condradicting my views on the effects of MBT's and I would really appreciate other opinions. Thank you, Clare
     
  2. Euan McGivern

    Euan McGivern Active Member

    Clare,

    I'm a student so please excuse any naivety in my response.

    There are, as I would see it two issues here, 1. the suitability of MBT shoes working with any orthoses based management, and 2, the question of MBT as a therapeutic modality in this type of case.

    1. The natural instability of MBT (IMO) makes it difficult to predict the action of any device placed into them. When I first was exposed to MBT the company was telling retailers not to recommend the use of orthoses in the shoes as they "cancelled each other out." They have recently relaxed this approach and now don't suggest this, the problem, as I see it, is that if a patient has been prescribed orthoses before buying MBT the clinician involved is unlikely to have made the device with such a shoe in mind.

    Nigg et al (2006) showed increased movement in COP in MBT vs a stable control shoe, this is not an unexpected result and I would wonder how much control, especially in the frontal plane you could achieve with your management.

    2. MBT's to reduce overpronation? Doesn't exactly concur with increased COP movement, however, when customers are fitted for the shoes they are given an intro session into 'how to walk in mbt.' This involves encouraging them not to consciously allow the foot to excessively evert. (not scientific I know, define excessive?) The idea, as I understand it, is to facilitate a better proprioceptive awareness of rear-foot movement and allow the customer to 'correct' their overpronation themselves. (not convinced how well this is achieved but these are the concepts as they were explained to me when working in retail).

    MBT's and the Achilles; in the Nigg et al (2006) paper they showed "significantly increased ankle dorsiflexion during the first half of stance phase," in subjects wearing MBTs maybe I'm off track but to me that would indicate eccentric contraction of tirceps surae and therefore more Achilles tightness.

    I'm not trying to be negative and I may be way off base here, there are plenty of more learned minds here who could do this answer more justice, and I wont be offended to be proven wrong, but thought I would give my 2 cents.

    Regards
    Euan

    Ref: Nigg, B., Hintzen,S., and Ferber R. (2006) Effect of an unstable shoe construction on lower extremity gait characteristics. Clinical Biomechanics 21 82–88
     
  3. drsarbes

    drsarbes Well-Known Member

    " He has also been advised by an MBT retailer that these shoes would help him and strengthen the achilles preventing over-pronation. "

    Hi Clare:

    by MBT retailer I assume you mean salesperson. A rose by any other name...... I wouldn't use "advised" in the same sentence as "retailer".......we get advise from someone who supposedly knows more than the average person about a subject. Who are shoe salespersons? Could be anyone really.

    Why not over-promise MBTs if you are in sales trying to push your product? No different than diet pills, supplements, sports cars, home mortgages...
    sales people ALWAYS embellish, it's how you sell things.

    I've had patients et al tell me they were promised : calf strengthening, no more back pain, no more heel pain, help with knee and hip pain, fibromyalgia help, won't need arthritis meds anymore, on and on.......

    Truth is they are negative "spongy" heel at contact with a proximally positioned rocker bottom.
    OK, some might like it, some might not.
    They do make you taller!!!!!

    Steve
     
  4. Euan McGivern

    Euan McGivern Active Member

    Clare,

    Apologies, I just realised this was posted in the introductions thread, so :welcome: if it hasn't been said earlier.

    Your question may be better placed in the biomechanics or footwear forums, if you speak nicely to Admin it could maybe be moved and you may receive more responses.

    Dr Arbes has a very good point about the ease with which people in sales find it easy to push product on health related grounds without real evidence or understanding.

    I know in the UK MBT have a clinical advisor (Physio) who is available to answer questions and give information directly to health professionals, he will obviously have a barrow to push, but it might be worthwhile getting in touch with him at MBT's offices for some more information.

    Hope I'm being helpful
    Euan
     
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