In a recent article published by Romero et al (2023), using a 3mm shim underneath the 1st metatarsal head (see attached photo) decreases (in Newtons) pronation and increases supination (in Newtons).
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Their findings are almost identical to my research findings using Proprioceptive Insoles to treat RFS and PCFD.
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One cannot measure degrees of movements with a unit of force. -
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In the late 1990s, working with Janet Travel, I discovered what I thought was the previously unreported vertical component of Morton's foot. Later I documented (2002) this was not the case, but instead, a totally different embryological foot structure that I termed the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot).
I devised an intervention to treat this foot deformity which basically was a shim placed underneath the 1st metatarsal, extending to and including the hallux. It proved to be a very effective intervention. The Generic insoles are being sold in thicknesses of 3.5, 6.0 and 9.0mm by a company in Tacoma Washington.
Your paper, Effect of Morton’s Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation, attracted my attention because it parallels my findings (2004).
Hopefully, in the near future, we can discuss this subject in more detail, possibly on this forum
- Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
- Rothbart BA 2004. Pressure Plate Analysis of the Medial Column Foot Insole. A Statistical Study. Online Journal of Sports Medicine (Italian), November Issue.
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It's a mechanical intervention .
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Currently, most publications dealing with orthotics are mechanically based. -
Below is the abstract of the paper in question .
You said of this paper "Your paper, Effect of Morton’s Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation, attracted my attention because it parallels my findings (2004)."
Are you saying that your insoles/orthotics give the same results as an orthotic with a Morton's extension? If so, why years of fuss!
Pilot Study: Effect of Morton’s Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation
This study focuses on the assessment of the mechanical effect produced by Morton’s extension as an orthopedic intervention in patients with bilateral foot pronation posture, through a variation in hindfoot and forefoot prone-supinator forces during the stance phase of gait. A quasi-experimental and transversal research was designed comparing three conditions: barefoot (A); wearing footwear with a 3 mm EVA flat insole (B); and wearing a 3 mm EVA flat insole with a 3 mm thick Morton’s extension (C), with respect to the force or time relational to the maximum time of supination or pronation of the subtalar joint (STJ) using a Bertec force plate. Morton’s extension did not show significant differences in the moment during the gait phase in which the maximum pronation force of the STJ is produced, nor in the magnitude of the force, although it decreased. The maximum force of supination increased significantly and was advanced in time. The use of Morton’s extension seems to decrease the maximum force of pronation and increase supination of the subtalar joint. As such, it could be used to improve the biomechanical effects of foot orthoses to control excessive pronation.
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The authors of the above paper used a 3mm vertical wedge. The insoles I designed use a supinatus wedge, the geometry is different. I have published many papers on this subject. Go on my site at Researchgate and read the papers on RFS and PCFD. If you have any questions, start a thread on RFS or PCFD and I we discuss this in more detail.
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However, in your first post you say "Their findings are almost identical to my research findings using Proprioceptive Insoles to treat RFS and PCFD."
If a Morton's extension produces identical results to your "Proprioceptive Insoles " then effectively your orthotic insoles do the same job regardless of differences in geometry.
You don't seem to have achieved anything new , not if results are near identical ! -
It would be arrogant of me to extol my research on proprioceptive insoles. Let posterity be the judge. -
Brian ,your research has been into a modified Morton's extension and in your first post of this thread you have confirmed that the modification is irrelevant to Morton's extension function.
Morton's extension is regarded as being a mechanical intervention, though I suppose it may alter proprioceptive feedback significantly . In either event, it seems obvious to me that the bulk of the research you have carried out on your modified insoles is effectively about a Morton's extension used to treat progressively collapsing flat foot deformity .Last edited: Mar 5, 2023 -
Hi to everyone, when we recomend an insole we should consider that it will have a kinetic (pressure, grf…) and kinematic (angular accelaration, velocity, torque neuromuscular effect ….), having this in consideration we shouldnt classify an insole being proprioceptive or mechanical, any structure that we place under the Feet Will have a kinetic, kinematic effect. An insole has a variaty of “intervencions” that Podiatrists apply to a specific patient with a specific pathology.
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Also, you have finally given a clear definition of what you mean by Rothbart's foot. You said "Axial rotation of the talar head is the hallmark anatomical landmark in the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot). In Europe this deformity is termed Progressive Collapsing Foot Deformity.
Or to accurately rephrase, Rothbart's foot=Progressive Collapsing foot deformity. -
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That being said, it is important to understand that although RFS is a milder form of the PCFD, the proprioceptive insoles used to treat these foot deformations are dimensioned differently and are not interchangeable.
Clarifying terminology
- RFS = Rothbarts Foot Structure or Rothbarts foot
- Primus Metatarsus Supinatus (PMS) = Rothbarts Foot Structure
- PCFD = PreClinical Clubfoot Deformity or in Europe, Progressive Collapsing foot deformity
Last edited: Mar 28, 2023 -
So
Rothbart's foot =Progressive collapsed foot deformity
Preclinical Clubfoot deformity = Progressive collapsing foot deformity
Also, a Morton's extension gives the same results as your insoles when treating "Rothbart's foot" or "preclinical clubfoot deformity" but the modifications you have made to your insoles mean that two different types of insole/orthotic are required instead of the single design used by the researchers in the trial looking at Progessive Collapsing Foot Deformity.
Anyway, as far as I am aware, the most effective way of treating pain from flat feet is muscle strengthening. Why are you stuck on less effective treatments ? -
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I worked in conjunction with a Physical Therapist and Chiropractor for many years. I even co-author papers with a P.T. and D.C. At that time, I frequently prescribed muscle strengthening exercises. Short term results were excellent, long-term results were disappointing.
I stopped using P.T. approximately 20 years ago when I started using proprioceptive interventions which diminished the need for muscle directed interventions.
So, IMO, muscle strengthening protocols certainly play a role in Podiatric medicine, but when dealing specifically with RFS or PCFD, they are not required for successful outcomes. -
Exactly what aspect of footwear causes foot strength loss is open to debate but my money is on toe springs and springy soles.
In any event if a small group of individuals with pain from flexible flat feet are prepared to do foot strengthening exercises every other day, to reduce pain, then they should be given instruction that allows them to do this. -
(RFS and PCFD are common causes of weak muscles, foot to jaw, as well as poorly constructed shoes)
Regarding shoes, I absolutely agree with you. The weak link in proprioceptive therapy are inappropriate shoes. Toes springs and spongy shoes will dramatically compromise outcomes.
An analogy I offer gave to my patients was: No matter how well you construct your home (proprioceptive insoles), if you place it on quicksand (shoes), you will still have structural problems (continuation of symptoms).
<
Free body diagrams and biomechanical foot models
|
Treatment options for Achilles Insertional Calcific Tendinopathy
>
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