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Minimalist Running Shoes for Kids

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Aug 31, 2012.

  1. NewsBot

    NewsBot The Admin that posts the news.

  2. Admin2

    Admin2 Administrator Staff Member

  3. BEN-HUR

    BEN-HUR Well-Known Member

    I feel this is a very important topic to consider when assessing the foot attire needs of young/developing (potential) athletes... just as much so (if not more) as it is for adults. Hence there should be a vast range of good athletic footwear which qualify as "minimalist" (we should now at this stage come up with a more appropriate name than "minimalist" for this 'genre')... particularly with a zero or minimal (< 4mm) heel to forefoot pitch.

    After all, we wouldn't want these young athletes developing bad habits would we? ;)

    Then we should remove 'food' items found within crinkly bags... particularly from school canteen type places. Then there is the P.C/electronic devices issue which also are inhibiting optimal physical development (i.e. muscle tone/strength, coordination etc...)... but I suppose this should be a separate topic all together.
  4. Craig Payne

    Craig Payne Moderator

    I don't see what the fuss is about. The standard advice for kids with shoes has always been to use shoes that do not interfere with normal development.

    It obvious from the article linked above that the authors have no experience treating kids with a painful flat/pronated foot. I have seen several lately who do spend most of their time barefoot. Just today dealt with one who only wears non-supportive shoes for the ~6 or so hrs for school; does gymnastics and ballet 2x a week barefoot (how strong must the feet be?) ... yet the 'flat foot' is painful. I wish the minimalist fanatics would explain this?
  5. CraigT

    CraigT Well-Known Member

    Yes... and if they have pain, then surely they are more likely to then do less... isn't that more likely to cause deconditioning than being very active in a pair of shoes???
  6. BEN-HUR

    BEN-HUR Well-Known Member

    One would hope that if any child who was experiencing ongoing foot pain (regardless of foot attire) a red flag would rise within the carer’s mind... & individual assessment sort. I have seen many children at my practice with varying foot pain ailments & none of them from memory would be considered "minimalist" shoe wearers (as this concept is relatively unknown within the general public still, particularly within children’s footwear). In fact the opposite is the case as it has been well & truly entrenched (i.e. via the media) that children need "support for their developing feet" - hence "supportive shoes" reign supreme in the minds of most parents. Now, of course some children most definitely do need some element/degree of support for their individual foot structure (i.e. possibly those “flat/pronated” feet)... yet, some do not... & I don’t consider footwear as the most effective means for addressing this area. Besides my main gripe with traditional footwear is the heel to forefoot pitch.

    Being that children are at school for most of the time the school shoes are an important factor & the traditional black leather school shoes under the Australian (uniform) school system are not what I would consider optimal foot attire. In fact I often get quietly annoyed when assessing some of the school shoes that come my way. There is one particular brand (if I could remember the name I'll state it) which seems to be quite popular with girls that has a very large heel on it (with shallow upper). I can only imagine what a shoe like that is doing to a developing foot with the amount of walking, running & jumping that usually occurs on a school day (5 days a week). Then there is the Clarkes 'supportive insole' phenomenon... which has "arch support" written on the insole itself - but there is absolutely nothing. Parents often say... "look these have an arch support so they must be good” - I take out the insole & there is no such thing there. Clarkes probably think they can fool the public by printing “arch support” on the insole... & they’re succeeding as people actually believe there is one present.

    I can only imagine what influence/impact past footwear trends have had on children’s feet which in turn have influenced adult foot/lower limb related pain some time down the track (I suppose hard to determine the extent). Sports/running shoes are also a factor here due to the associating exacerbated forces on developing limbs – with subsequent potential for injury... & if there is ongoing pain then an educated opinion should be seeked. Those “minimalist fanatics” & traditional shoe fanatics will always have their opinion on the matter regardless of the, dare I say... foot type (& biomechanics).
  7. Boots n all

    Boots n all Well-Known Member

    By this statement you must be in NSW
    "... quite popular with girls that has a very large heel on it (with shallow upper)."

    They are banned in all the schools that l know of in Victoria, no (higher)heels allowed.
    The trend here is low to no heels, t'bar, but some schools are about to put a stop to that also.

    If only we could get them outside playing again after school, who cares the footwear for the main, if they are not active...
  8. BEN-HUR

    BEN-HUR Well-Known Member

    Yes, you are correct - live in Sydney.

    Wow, didn't know that.

    Yes, when I was a school child I either went training (running) or did something active... sometimes had to study at times though :mad: ;)
  9. Blaise Dubois

    Blaise Dubois Active Member

    Hope that nobody here think kids need elevated heel, cushion and rigid shoes...
    Hope that everybody here educate parents to have the minimum amount of shoe during the development!!!
  10. Craig Payne

    Craig Payne Moderator

    Blaise, I do not think anyone is saying that or advocating that. The standard advice for as long as I can remember has been the use of shoes in kids that do not interfere with normal development. Nothing has changed.

    What I am objecting to the is propaganda and rhetoric and blind faith put in articles like the one linked above by people who have never even seen, let alone treated, a kid with a painful flat foot (esp the one kid I referred to above who was "minimalist"!). If they consider themselves such experts in the topic, how do they think painful flatfoot in kids should be treated?
  11. Blaise Dubois

    Blaise Dubois Active Member

    So please precise:
    1. What's wrong in the article of Jay?
    2. Is the Kayano or nimbus of ASICS is a good shoe for kids?
    3. What's the best shoe for a 2 ... 5... 10... 15... and 20 years old person?
    4 . If you treat a kid with painful flat foot (I treat also that type of problem) it's with which treatment?
    5. If it's with BBS, please justify...
    6. If it's with more cushion interface and orthotics, how long do you use it?

  12. CraigT

    CraigT Well-Known Member

    1- Some aspects of the article are good- particularly when it talks about the importance of fit. I believe the weight of a shoe is the most important feature of a kids shoe if you are speaking in broad terms. However there is a role for suppportive shoes for kids, and I would be concerned that that this advice would cause the public them to ignore a problem that can be easily managed or possibly make it worse.

    There has always been more kids shoes with minimal support on the market than supportive shoes- go down to your cheap department store and have a look at the kids shoes... I would go to Target or KMart in Australia or Carrefour here in Qatar.

    2- Depends.
    3- Depends.
    4- Often with foot orthoses combined with appropriate footwear. What is appropriate? Usually a strong heel counter combined with a strong midsole (not cushioning).

    5- BBS? Blaise's B*** SH**? Well that would work for some I am sure...
    The footwear I usually give to children with painful flat foot (combined with foot orthoses) is chosen to counter increased mid tarsal dorsiflexion forces.

    6- It is a case by case basis.

    I think a major problem here, Blaise, is you have a fundamental lack of understanding about how foot orthoses work. The EVIDENCE says that they help a variety of problems. The EVIDENCE also shows that they have minimal effect in kinematics... so they must work via other mechanisms... changing kinetics? neuromuscular effects? (we are always learning more.)
    The EVIDENCE also says that they do not weaken muscles.

    You say you are 'here to learn', but frankly I have seen no EVIDENCE that you are willing to learn. You don't want facts to get the way of BBS (I like my acronym better than yours).

    So... How would YOU treat Craig P's patient???-

    As you are a physio, I guess you would do some TENS and Ultrasound (this is like you saying a Podiatrist would give the patient an 'arch support')
  13. CraigT

    CraigT Well-Known Member

    By the way Blaise- I actually think you have some good ideas and can contribute a lot... I wish you would realise that, just like everyone else, you don't know it all.
  14. Blaise Dubois

    Blaise Dubois Active Member

    Hope you don't speak about flat or pronated foot...
    Please precise the role of supportive shoes and how many % or the kids population need it

    It's maybe true in Europe (and Australia)... but NOT in AMERICA (marketing :)

    Sorry, it's unacceptable for kids with no health problem AND no specific foot pain
    Please tell me which kids under 16YO need that type of shoes (considering stiffness, ramp, stack, toe box shape)

    Please precise which characteristics have a shoe for kids with no pain but
    1. flat feet
    2. cavus feet
    3. regular-standard-normal-universal arch (don't know which term you use)

    Goood... How long? ... all his life?
    1. If the pain stop after 3weeks
    2. If the pain stop after 6 months
    3. If the pain don't stop

    Why this is a problem?

    Evasive answer
    Please give me you average prescription

    That's a bad excuse to tell me that you have (some people hear) no answer to fundamental questions about the efficacy, use and effect of orthotics

    Some specific conditions... I Agree


    flimsy evidence!!!

    Note: it's better to say "SOME evidences show" than "THE Evidence shows" ;)

    I thing the parallel is not so good... except if you prescribe orthotics 4 times a year.

    The keys of the treatment are:
    1. Mechanical stress quantification
    2. treat the pain (arch support is a good tool for many foot problem)... some days... max some weeks
    3. increase tolerance to tissue stress (exercises strengthening, more minimal interference, barefoot exercises, ...)
    4. VERY rarely, addressing the pronation/flat biomechanics... (less than 1% of kids)
    5. NEVER passive intervention like IS-IF-TENS-Laser-
    6. Rarely Manual therapy

    more info and all the EVIDENCE to support that in a 2 day course:drinks
  15. CraigT

    CraigT Well-Known Member

    Firstly- People NEED water food and oxygen. People do not NEED foot orthoses. They may benefit from a range of solutions- including foot orthoses- to manage lower limb problems.
    So for my answers I will read 'NEED' to mean 'BENEFIT FROM'...

    Typically painful pronated feet.
    Footwear is one way you may alter forces which may be the cause of pain. If I have a patient who presents with pain, is wearing a flimsy shoes and following an assessment I can rationalise that the pain may be due to tissue stress... then changing to a more supportive shoe is often the fastest way to give them relief.
    I cannot say what percentage of the population may have this problem- as a Podiatrist, the population I see will always be likely to have foot problems (obviously)

    So places like K Mart and Walmart do not sell shoes???

    Sorry for what? Where did I suggest that this is acceptable?

    Which type of shoe? Do you want me to answer again?

    As Craig P said- The shoe should be comfortable and not interfere with normal development.
    I do not classify feet or prescribe footwear based on arch height.

    Again this is case dependent.
    For what it is worth I believe one of the prime roles of a foot orthosis is to improve postural awareness. Many people have lazy feet. Whereas you believe this is due to footwear, I believe it is more due to the fact that the majority of the time we are walking on a flat surface which never challenges our feet. We do the same thing every step.
    Everyone has different feet, yet we are all having to adapt to the same surface... some are better equipped to do this than others.

    For me, a sign that a foot orthosis is being effective is that the patient corrects their gait without the orthosis in place.

    So answering your question-
    (BTW- What sort of problem are you talking about that takes 3 weeks to 6 months to resolve with foot orthoses? I think you have much lower expectations that I do)
    For the sake of this I will assume that they have been effective within the first week.
    1. If you take away an orthosis after 3 weeks, often you will get return of symptoms- particularly if the only treatment they are doing is wearing the orthoses.
    2. If you take the orthosis away after 6 months, I would expect that the patient should manage and be more aware of their foot posture. They would be less reliant on the foot orthoses.
    3. A vague unrelated question. What do YOU do if the pain doesn't stop? If you want to learn all my tricks you can pay me $600, but it will take longer than 2 days...

    Seriously? Because it is the most common cause of excessive tissue stress..?? (A detailed explanation would be covered under the $600 fee)

    Not evasive. Honest.
    All of my patients are treated individually.

    Well you show me some evidence that orthoses cause muscle weakening and I will correct it

    You are missing my point. A competent Podiatrist has a range of methods to manage a problem... just as a Physio does. You speak as if all we do is dispense 'arch supports' which is like me saying physios just use ultrasound.

    So... as the patient described is already in minimal footwear, and does gymnastics and ballet, you are not really offering them too much...
    Surprised that you rarely use manual therapy.
  16. The problem here, Craig, is that some individuals are making money giving two day seminars on how bad foot orthoses are and how great shoes with thin soles are for just about every problem that occurs in the feet and lower extremity. They, of course, don't acknowledge the significant body of scientific research which not only shows that foot orthoses help relieve painful symptoms, but also can help heal foot ulcers, reduce peak plantar pressures, and positively alter the kinetics, kinematics and metabolic efficiency of gait.

    Why won't these individuals acknowledge the existing literature on the positive benefits of foot orthoses? It is either because they are totally ignorant of how foot orthoses work or it is because of the fact that if they did analyze the data objectively and truthfully, then they wouldn't be able to charge $600.00 per person for their two day seminars, that is why.

    They are not on Podiatry Arena to learn, as they claim. They are on Podiatry Arena in an attempt to sell more tickets for their two-day seminars and make a bigger name for themselves....at the expense of all the rest of us.
  17. Blaise Dubois

    Blaise Dubois Active Member

    I cannot be 'NOT agree' with you. I don't know if it's because you avoid to answer clearly to questions by "political" technique... OR because we are not so fare one to the other.

    To clarify that, what do you thing of my treatment plan?

    For that type of case... I think manual therapy is useless.
  18. phil

    phil Active Member

    Hi Blaise,

    As a Podiatrist, I treat many kids with foot and lower limb injuries. These kids are routinely barefoot and in $15 minimalist shoes.

    I routinely use custom foot orthoses and shoes with a significant heel height differential with great success. The patients are happy, their parents are happy. The injury is gone.

    What is your suggestion for the treatment of these children? Gait retraining? Minimalist shoes?

    I doubt you have the clinical experience or skills to contribute much useful insight for the treatment of paediatric foot or lower limb injuries. It's just not your area of expertise. And that's ok! It's a great relief know your own limitations, don't you think?

  19. Blaise Dubois

    Blaise Dubois Active Member

    Hi Phil,
    As a PT I treat many teenagers and some younger kids. Most of them have shoes with heel lift, rigid sole, (BBS)... I prescribe minimalist shoes and more barefoot time and the patients are happy, their parents are happy. The injury is gone.

    I have no experience with neuro-paediatric and special diseases (polio, Charcot, spina bifida, cerebral Palsy, ...) but since 14 years, I treated many kids for orthopaedics lower limb injuries.

    Prescribing heel lift to a kids CAN BE a short term treatment to decrease stress on some structure like the post chain (ex: Sever).

    - No sens on long term
    - Not supported by literature
    - Potentially harmful on long term
    - Will created a dependency
    - Will decrease the tolerance of some tissues
    - Will change some biomechanical aspect of walking and running
    - ...

    I think that one of the cause of the Sever Disease is the shoes and heel lift.
  20. BEN-HUR

    BEN-HUR Well-Known Member

    I too am a Podiatrist, I also treat many children with foot & lower limb injuries... & aches/pains (which would likely potentially turn to injury if some of these children were active enough ;) ). Some of these children do come in with shoe characteristics which have minimalist qualities (i.e. casual shoes which are flexible & with lower heel-forefoot pitch), yet being that most of these children are also of school age, most spend a fair bit of time (6-8 hours for 5 days/week) in what I would consider a rather rigid shoe (for their weight/strength) with a significant heel to forefoot differential (i.e. Clarkes school shoe). In fact all school shoes I know of are of this nature. I personally don't feel this is good for optimal foot development & I certainly don't feel a shoe with a significant heightened heel-forefoot pitch is of any good either. I really can't see the point (i.e. high heel differential) in it (unless the child had some sort of congenital/osseous equinus issue).

    However, I see so many children with poor structural stability/osseous congruity - i.e. medial deviated STJ/MTJ... some are quite bad (it's at this point genetic entropy comes to mind :rolleyes: particularly when I then glance over at the parent’s lower limbs... & notice a resemblance :eek:). Being a Podiatrist I suppose I would see this more than others in other fields. I do feel like posting photos of some of these to show at what extent it can be. One just can't ignore "cause & effect" here when you are watching a child walk with this type a structural alignment... whilst the history of the pain/injury is running through one's mind. For anyone to say that support isn't necessary to address such poor structural stability/osseous congruity is speaking out of ignorance/narrow mindedness. I am most definitely sure that it also isn't a coincidence that once this poor structural stability/osseous congruity is controlled/reduced, the child's symptoms disappear... then when the orthotics start to get small after around 12 months or so these symptoms start to return. I shouldn't think that any placebo effect kicks in here for these young minds either... i.e. for at the start of orthotic therapy or at some point in time where their foot outgrows the orthotic (of which they are usually oblivious to).

    Hence, custom type support is most definitely needed in some/many cases... yet I still do (& will likely always) question rigid shoes, in particular the heightened heel-forefoot differential.
  21. I am also a podiatrist that has successfully treated thousands of children with foot orthoses in different varieties of shoes, both "minimal" and "traditional" now for over 27 years. I also co-authored a chapter on the biomechanics and foot orthosis treatment of children's flatfoot deformity 20 years ago that has been referenced numerous times within the medical literature (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). Children routinely get better with foot orthoses, wear the orthoses for many years and the parents are very pleased at the clinical results.

    Anyone who says that foot orthoses are either ineffective at treating the typical mechanically-based pathologies seen in children or that all children should be wearing shoes with only thin soles obviously 1) doesn't have sufficient clinical experience with foot orthoses to know what they are talking about, 2) doesn't understand the abiility of the human body and central nervous system to adapt to varied terrain and/or 3) has an agenda that is biased and is not scientifically objective since they are continually trying to sell something.
  22. efuller

    efuller MVP

    Why do you think that Sever's is caused by shoes. Please don't tell me it's because all the people with Sever's, that you've seen, have worn shoes. How do you explain the treatment is the same as the cause?

    If you see a patient who has limited ankle dorsiflexion, a very early heel off in gait and has chronic arch strain/pain or forefoot pain, why wouldn't you give that patient a permanent heel lift, or surgery. Their "natural" foot is already dependent upon the lift. Changing a biomechanical aspect of their "natural" gait is a good thing.

  23. Blaise Dubois

    Blaise Dubois Active Member

    Kevin, You become completely irrational...

    Anyone who says that foot orthoses are effective at treating most of mechanically-based pathologies seen in children or that most of children should have orthotics 1) doesn't have sufficient clinical experience with not using foot orthoses to know what they are talking about, 2) doesn't understand the abiility of the human body and central nervous system to adapt to condition like barefoot and minimalist interface 3) has an agenda that is biased and is not scientifically objective since they are continually trying to sell something like ORTHOTICS.

    I know you are philosophically bias (like me to the other side) but I don't know how business bias you are. Question for you Kevin. Do you think that if podiatrist would receive the same money for prescribing or not prescribing orthotics, the number of prescription would be the same? ... and the length of the prescription to wear the orthoses?

    We can tell now that Dentists and Chiropractor with X-ray in their clinic prescribe it a lot more...
    We know that Physio with shock wave in their clinic prescribe it a lot more...
    We know that Doc will prescribe more of certain pill or product if they have a secondary financial interest

    Also, Some one have just one good study that explains to me the benefit of long term use of orthotics for children?
  24. David Wedemeyer

    David Wedemeyer Well-Known Member

    If this is true are your case studies included in your lectures? If so please share with us Blaise, I'm calling bulls**t on this one, finally time for you to prove what you say & sell

    I just peed myself. :empathy:
  25. Blaise Dubois

    Blaise Dubois Active Member

    We spoke 10 times about that on PA.. last time please... after that ask to Kevin, he knows everything.

    if you DEload a tissue by decreasing the mechanical stress on it, you decrease, on a long term process, his tolerance to have stress... (some call this weaken, become more fragile, ...)

    your kid are wearing BBS with heel lift of 8mm (that's enormous for the angle of the ramp). His Achilles tendon decrease it tolerance to be load in zero drop soccer shoes. He start to play soccer, and if the stress exceeded his capacity because he start too fast (increase his volume and intensity too fast), he will develop a pain on this same structure.

    The treatment will be first to protect (more heel lift).... but second to create tissue adaptation and increase tolerance to the stress : zero drop, eccentric exercise, ...

    Last time I explain that!!!
  26. Blaise Dubois

    Blaise Dubois Active Member

    I do that since 10 years, long time before you were using the word minimalist and barefoot... and I do it every day since...
    What was your question?
  27. Athol Thomson

    Athol Thomson Active Member

    I'm not sure Severs is always about the achilles tendon load or traction. I see plenty of junior athletes with a more than adequate weight bering lunge test for ankle dorsflexion that have severs. Compression at the apophysis may be an issue.

    Have a look at the attached paper. The authors used a rigid custom-moulded heel cup to alter heel pad function with good effect. The severs group had thinner heel pads. The rigid heel cup altered heel pad function to improve symptoms.
  28. RobinP

    RobinP Well-Known Member

    Interesting, I often use what I call"box taping" the heel in cases where I believe there is a compression related element. Squeeze the fat pad mediolaterally with the sports tape and reduce the fat pad flattening and thinning upon weight bearing.

    I can't even remember why I started doing it!

    As an aside, I have seen (anecdotally) about a 30-40% increase in the number of pre teen kids I see (with many pathologies)with the one common denominator - flimsy plimsoles and ballet pumps.

    Goal#1 - reduce the tissue stress with footwear advice/orthoses/raises
    Goal#2 - improve intrinsic and extrinsic foot/ankle musculature whilst improving quality of motion and look to maintain reduction in symptoms long term without orthotic intervention. In most cases, however, they get pain free in leisure footwear but still choose to use orthoses in sports shoes.
  29. David Wedemeyer

    David Wedemeyer Well-Known Member

    So what you're saying Blaise is that your CLINICAL experience is what you are drawing on as proof, correct? Don't have any evidence right?

    Here is proof that Blaise vacillates. Anyone remember the recent LLD thread where like many threads Blaise asks for "proof" consisting of studies, prospective articles and such and states that the rest of us cannot back up our claims with SCIENCE?



    So here Blaise was asking for proof of causality of low back pain and LLD when it had been stated by the OP that the man complained of low back pain. Blaise wants an article proving the subjective symptoms of the patient apparently when an LLD is present and likely the cause. He also questions our use of objective CLINICAL experience but then promotes the same for himself in this subsequent thread. Unreal!

    Nothing new here Blaise, just you being your evasive, biased and argumentative self right? What, no PROOF of your assertions Oh I see, it is based on your CLINICAL experience:


    If anyone else mentions their own CLINICAL experience and judgement Blaise immediately requests studies and denigrates others for their lack of an evidence base. Keep in mind it is acceptable for Blaise though, he does have a family to feed fueled on fantasies and self promotion.

    Never mind a level playing field or the evidence; Blaise has all the answers and when he doesn't he just makes it up and claims EXPERIENCE but don't try using this line of reasoning for yourselves. It wont pass Blaise's Egoistic filter!

  30. For more resistant cases of Sever's disease (that don't respond to heel lifts or heel cups) in the children ages 8-14, for the past 15 years I have been prescribing a custom made, plastazote #3 orthosis with 14-16 mm heel cup and full length Spenco (neoprene) topcovers. The results are simply amazing with a near 100% cure rate in those young athletes I use this orthosis for (can't remember a patient where the pain wasn't improved by at least 50% in 3 weeks of wearing the orthosis). Because of this consistent clinical observation with this "soft orthosis", I agree that compression forces on the plantar calcaneal apophysitis are a very likely etiology (along with tension forces from the Achilles tendon) in many cases of Sever's disease.
  31. phil

    phil Active Member

    Totally agree. That's my plan of attack with 90% of my patients- Goal#1- moving to Goal#2 if possible.

    Those popular minimalist shoes you mention (flimsy plimsoles and ballet pumps) that all pre-teen and teens are wearing (in Australia at least) don't seem to be curing all adolescent musculo-skeletal injuries!! Sould they, Blaise? Might be the same as how minimalist running shoe's aren't curing all those common musculo-skeletal running injuries, hey?
  32. Blaise Dubois

    Blaise Dubois Active Member

    I will be brief,

    If you prescribe pills you need to show EVIDENCE that is safe and efficient.
    If you don't prescribe pills you don't need to show EVIDENCE that doing noting is safe and efficient
  33. toomoon

    toomoon Well-Known Member

  35. Blaise Dubois

    Blaise Dubois Active Member

  36. David Wedemeyer

    David Wedemeyer Well-Known Member

    Biase this takes all. So YOU don't have to justify anything but we do? Is that what you're saying Blaise, the rules (your rules) apply to us but not you?

    What I am pointing out is that based on your past posts we are accountable to science but in the LLD thread you denounced clinical experience as invalid. Yet on other threads appear you satisfied with clinical experience:


    So which is it Blaise once and for all? You cannot have it both ways and can't even remember what your stance was from one post to the next. Does anyone else see this as self-serving and egoistic?

    How can any right minded individual take you seriously?
  37. Blaise Dubois

    Blaise Dubois Active Member

    David, I think you don't understand... maybe it's my qualood

    If you prescribe a treatment with potential risk... you need to be sure that your modality is safe and efficient. The way to do that is to take ALL the available literature, to analysed it and to make clinical guideline based on the risk reward ratio... For sure you can mix clinical experience with that... but not just YOUR clinical experience

    YOU want prescribe a heel lift or an orthotics? Please JUSTIFY...
    And because you cannot, please, MINIMIZE your interventions...
    You think it's clinically efficient to decrease a specific pain for a specific patient? Please take off it after the pain is gone...
    You realize that you will do half of you salary if you prescribe less orthotics? don't worry you will gain on credibility.
  38. phil

    phil Active Member


    Here is the justification for using heel lifts and orthoses: They are a safe and effective therapeutic tool. They have been shown to be effective for many lower limb muscluoskeletal conditions. Would you like references for this?

    I agree with MINIMISING interventions as well. And I believe that orthotic therapy should only be used while it is nessessary. But don't be so condescending about people making money by practicing health care. Don't forget that many of us have worked in publicly funded health systems with no incentive to use expensive treatments. AND, don't forget your own bias! Selling your own courses and treatments for hundreds of dollars?

    You talk as if orthotic therapy is some kind of high risk and unethical form of treatment. Have you ever had to treat somebody with Aquired Adult Flatfoot?
  39. David Wedemeyer

    David Wedemeyer Well-Known Member

    No Blaise, this is not correct nor reasonable. If you prescribe minimalist shoes and forefoot striking it is an intervention and therefore YOU must provide evidence that it is a valid and safe treatment. You've never given us ANY real evidence of what you claim and when you've been asked for it you resort back to YOUR clinical experience. Again, you choose whatever suits you, at times denouncing clinical experience as you did with Kevin in this thread and when backed against the wall advocating the same for yourself. It is here for everyone to read and you can't wriggle out of the inconsistency of your statements.

    Flip-flop, vacillater, hypocrite. Busted.

    You're about the most presumptuous person that I've ever encountered Blaise. Since the great majority of the orthotics that I dispense are on referral, you're just dead wrong.

    There is a much greater wealth of literature supporting the use of orthotic and shoe interventions than barefoot/minimalist.

    Please show us where (evidence not anecdote) in your physio clinical practice guidelines barefoot/minimalist is a supported treatment/intervention supported by your profession? You cannot.

    Please show us where (evidence not anecdote) it is recommended that an orthotic or shoe or modification that was implemented to treat a diagnosed condition is recommended it be removed "after the pain is gone". You cannot.

    Game over Blaise, check and mate. :sinking:
  40. RobinP

    RobinP Well-Known Member

    I think, Blaise, that you need to take cognisance of the fact that this is an international forum and that health care varies greatly throughout the world. Although it seems that private practitioners dispensing orthotic prescriptions in the US(not sure about Canada) do have a vested interest in "selling" orthotics (which you appear to have a problem with on questionable grounds of lack of evidence and also that it is simply a money maker), the UK has a great many practitioners for whom there is no financial incentive to provide orthotics. In fact, quite the opposite is true. In the current financial climate, practitioners are being asked to intervene less and spend less.

    As both private and NHS practitioner, I try to be as consistent as possible but find that I probably dispense less orthotics through my private practice as I am aware of cost for the patient. However, orthotic devices are successful at reducing pathology in many people and have been shown to work. They are not a panacea for treatment but one tool in the arsenal. The same is true of other modalities of treatment, yours included. As minimally invasive a your modality may be(you may not ever even touch the patient), you are still "prescribing" and that means that your intervention has to stand up to the same scrutiny as one that is far more invasive such as providing orthotics

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