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Podiatry related medical myths - Busted?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Oct 25, 2010.

  1. Members do not see these Ads. Sign Up.
    Been wanting to start this one for awhile. Sometimes what we beleive is not so.

    Craig has talked about ---> re pronation NOT related to injuries.

    It has been discussed in a few threads about what is beleived v´s evidence. So I thought a thread which has some intersting papers which may bust a few myths.

    as a good example:

    Ian wrote a nice peice re plantar calcaneal ( heel spurs) that don´t form in the insertion of the plantar fascia - http://sportspodiatryinfo.wordpress.com/2010/10/18/plantar-calcaneal-heel-spurs/ incase you missed it.
  2. The classic Distial Transverse metatarsal arch that does not exist.
    Last edited by a moderator: Oct 26, 2010
  3. Plantar fasciitis v´s Plantar fasciosis ie the Faciitis v´s Fassiosis debate
    Last edited by a moderator: Oct 26, 2010
  4. Iliotibial band friction syndrome is it from friction at the lateral femoral epicondyle or.... Compression of a fat pad?
    Last edited by a moderator: Oct 26, 2010
  5. The Tendinitis v´s Tendinopathy debate.

    Note couple of these PDF´s you must scroll down to the correct section.
    Last edited by a moderator: Oct 26, 2010
  6. Griff

    Griff Moderator

  7. Craig Payne

    Craig Payne Moderator

    I have a lecture called mythbusting:

    1. Forefoot varus is common (its not)
    2. Motion is pathologic (its not)
    3. Forefoot supinatus is due to a calc gone past vertical (its not)
    4. Foot pronation is a compensation for a structural leg length difference (its not)

    I can think of a couple of others:
    Motion control running shoes do not control motion
    Shock absorning running shoes do not absorb shock

    Not necessarily a podiatry related myth, but a myth none-the-less:
    Barefoot running leads to less injuries (it actually leads to more)
  8. Evidenced by.........;)
  9. Craig Payne

    Craig Payne Moderator

    I phrased that badly. What I should have said is the the Evangelists from the Church Of Barefoot Running claim that barefoot running is the solution to running injuires.
    The anecdotal evidence that this is not the case is:
    Barefoot Running Injury Epidemic
    Vibram FiveFingers Cause Metatarsal Stress Fractures?
    Why are barefoot runners getting so many injuries?
    From one of the above refs:

  10. JB1973

    JB1973 Active Member

    cheers for the papers michael. hope this doesnt turn into another barefoot type thread!!

    here is one from me
    if all else has failed, steroid injections work..... for everything!

  11. The Myth of the LMTJA and OMTJA of rotation at the MTJ .

    The funny thing with this one is that maybe in the future the Nester et al papers listed below maybe seen as not correct also and the calcenocuboid and talonavicluar joint seen as independent structures not acting as one . Time will tell.
  12. The role of impact forces and foot pronation B Nigg One of my favourate what the moments.

  13. Great thread. I loved the fallacies thread, but this one has evidence with it!

    Amen. Spray and pray. Saw a patient yesterday, had had 1st mpj surgery, developed pain around 3rd MPJ some months later. Xrays unremarkable, had a steroid injection, pain improved for a fortnight or so then suddenly became MUCH worse, and the toe now sits somewhat dorsiflexed / dorsally subluxed from its fellows...

    Steroids. Not, perhaps, for everything.

    Can you post some references for these Craig? Particularly number 4. Its a real struggle to get people to believe that one. :deadhorse:
  14. The normal position of the forefoot is perpendicular to the rearfoot

    Garbalosa JC, McClure MH, Catlin PA, Wooden M (1994) The frontal plane relationship of the forefoot to rearfoot in an asymptomatic population. J Orthop SPorts Phys Ther 20(4): 200-206.
  15. That was the hope that people would find something that they read which made them think.... I had that wrong and post up a PDF and then others may read and think the same.

    And heres the PDF for anyone who wants to reads Roberts.
  16. I guess we could call this the Forefoot varus v´s Forefoot supinatus debate. I went looking for evidence but came up with some discussions here a couple of La trobe lectures, blog by Ken Van Alsenoy and paper by Robb Kidd which I could not read (listed below if anyone can find it).

    While I agree that FF varus is not seen that often is there any peer review research in to how much etc.

  17. No worries JB , Funny you should write that, I just saw this on the rssfeed - Cortisone injections NOT the best options for tendon Problems
  18. Griff

    Griff Moderator


    I've got a paper copy (how old school) of a Bob Kidd paper at my Dad's house. When I'm next there I'll grab it and scan it on:

    No access to the one you referenced I'm afraid. Nor to this one: http://www.japmaonline.org/cgi/content/citation/76/7/390

  19. Nice one Ian I saw the JAPMA one but no text even from JAPMA.?

    Also be great if you can put a couple papers re pronation is bad myth - if you get a chance. Becoming a nice thread hopefully it can grow with references and evidence.
  20. Griff

    Griff Moderator

    Back to the myths, and one of my favourite papers of the last few years - is the STJ in 'neutral' when the ankle-foot is placed in the traditional concept of a neutral position?
  21. Craig Payne

    Craig Payne Moderator

    We had several threads on it:

    And these two publications found the long leg does not pronate more usuing 3D kinematics:
    Bloedel PK, Hauger B:The effects of limb length discrepancy on subtalar joint kinematics during running. J Orthop Sports Phys Ther. 1995 Aug;22(2):60-4.

    Walsh M, Connolly P, Jenkinson A, et al: Leg length discrepancy: An experimental study of compensatory changes in three dimensions using gait analysis. Gait Posture 12:156–161, 2000

    (not to mention our publication that I keep promising to get published)

    I wrote about it here:
    http://www.clinicalbootcamp.net/leg-length.htm and here:

    No study has ever shown it to be the case and the 3 studies that have looked at it all say it dosen't --> myth busted.
  22. admin

    admin Administrator Staff Member

    For legal and copyright reasons, all articles that were attachments have been removed.
  23. Rob Kidd

    Rob Kidd Well-Known Member

    Since I am being talked about behind my back, so to speak, maybe I had better say something! The 1984 writing in the UK journal was my first, and I am not crash proud of it. However, I hope we all agree that all things have to be put in the context of the day. I still have a copy, and when I get home from my wanderings (currently I am in West Australia, been living in a campervan for five months), I will post a copy for public download. What I find amusing, is that in my time as a posiatry educator - 1980-2000 - I made waves in the literature, first by prosletising Root theory, and then by burying it. The first and last writings I contributed to the podiatric press were on FFS. Root theory is so full of holes you could drive a 747 through it - and you do not need me now to tell you what these are. But I still maintain that in that lot, there is a good clinical story trying to get out, but it has dressed in so much rubbish and ras-ma-tas, that it is difficult to find. It could have been good, but made us a laughing stock, in a way not that different to the emporer with no clothes. The holes in Root theory cover the whole spectrum from flawed science (tautologies abound), to false assumptions, right over to ethical considerations. Either alone, or in the company of the appropriate colleagues, I have addressed many of these over the years. What you may not be aware of is the negative press, sometimes even down to overt hate mail, that I received for my thoughts. One example: when McDonald and Kidd wrote about ethics of mechanical therapy in children, we were rewarded by a comment from a major orthotics lab owner that stated something like: "How dare the criticise this: do they know how much money I have invested in it?". I rest my case. I am very gratified to watch over the years how original thinking has been allowed back into the profeession, now that I no longer practice or really contribute (apart from anatomical stuff to hospital in-service days). Root theory was a classic example of supporting the unsupportable; it is directly analagous to The Creation Science guys. Rob
  24. Craig Payne

    Craig Payne Moderator

    Another myth busted:

    You can not heat mold shank dependant PU or EVA prefab orthotics.
  25. Someone send out the dogs ?- The funny thing is I would bet 99% of the articles posted could be found via google or another search engine - which is how I find most of my stuff.

    Understand, no point getting stress, all seems a bit negative as it´s all education and from these types of discussion and PDF´s I am about to sign up to another journal, but I guess a line must drawn somewhere. Hope the bite didn´t hurt much.

    Just like Elvis the evidence just left the building.
  26. Sure you can. You just have to fill the void with something or grind the base flat so it stays shank dependant.

    How about "you can't give a shank dependant device materials shank independant properties by heat moulding them"

    On another thread perhaps? This one is a doozy, be a shame for it to tangent.
  27. Oooo, I got a good one.

    "One can do no harm with orthoses"
  28. And another I hear a fair bit

    "orthoses reduce the load on the feet".

    (unless they are anti gravity orthoses...)

  29. admin

    admin Administrator Staff Member

  30. Hi Rob:

    I think our friend Brian Rothbart is also very interested in talar head torsion.

    Funny you say that you "buried" Root theory ten years ago. It must have been a very shallow grave since Root theory is still being taught worldwide with many ardent supporters at the world's podiatric medical colleges.

    Also, I wouldn't rest your case on the issue of treating children's flatfeet with orthoses quite yet. Regardless of whether you feel it is unethical or not, when I was lecturing in Rome, Italy, in May 2010, at a very large three day orthopedic-podiatric conference, the topic of treating children's flatfeet with orthoses was one of the hottest topics of discussion between the orthopedic surgeons, podiatrists, physiotherapists and orthopedic technicians.

    In fact, some of the smartest, most-respected podiatrists in the world, who still do practice and see lots of children with flatfoot deformity, don't think it is unethical to treat an asymptomatic child's flatfoot with custom foot orthoses, including Donald Green, Ronald Valmassy, Richard Blake, etc. Therefore. not everyone agrees with the idea that this type of treatment is unethical.

    However, over the years I do believe you have made some very good points and have contributed significantly to the podiatric literature. It should make for an interesting discussion if you decide to stick around long enough for a debate.

    Glad to see you contributing again to Podiatry Arena.:drinks
  31. Rob Kidd

    Rob Kidd Well-Known Member

    The reason for my re-birth is that I have retired from the university and may have to make a crust somewhere - I am still registered as a pod and may do some locums. Thus I must stay up to date!

    Take care
  32. Rob:

    I would tend to agree with your statement above if the shape of the medial longitudinal arch of the child's foot was our sole concern as podiatrists. However, as you know, the foot is the prime terrestial organ for mechanically interfacing the bipedal human with the ground and, as such, mechanical function of the foot and lower extremity should be the key concern of the child with a flat foot and a signficantly medially deviated subtalar joint (STJ) axis.

    Your analysis and use of the term "bent plastic" to describe the millions of known possible permutations of custom foot orthosis design bothers me. Your analysis is analogous to the eye doctor only measuring the optical characteristics and shape of the eyeball of their patients at age 6 and then at age 18. Then the eye doctor concludes that the use of "pieces of ground glass" did nothing to improve the dimensions and/or optical characteristics of the eyeball and states it is unethical to prescribe these "pieces of ground glass" since they do nothing to the shape of the eyeball or their optical characteristics over the years of using them. The more intelligent and knowledgeable eye doctor would rather consider the functional and therapeutic benefits that these "pieces of ground glass" had on the lives of the individuals who wore them on their faces throughout the day as a more reasonable assessment of whether it was "ethical or not" to provide these "pieces of ground glass" (i.e. glasses) to children with vision imperfections.

    Certainly, if custom foot orthoses don't improve gait function then they probably are an expensive waste of time and money for the asymptomatic child. However, in the vast majority of children that I have made these prescription devices for and are "asymptomatic", the gait function has certainly improved and the children enjoy wearing them since they have fewer "growing pains" and less fatigue while standing and walking and running during the daily activities. Should our only measurement be radiographic studies of static medial longitudinal arch height as to whether these orthoses are of therapeutic benefit? Of course not. More functional measures of the kinematics and kinetics of gait and inverse dynamic analysis of the joint loads throughout the lower extremity both with and without foot orthoses would be a more scientifically valid way of measuring gait dysfunction in the asymptomatic pediatric flexible flatfoot deformity, not static medial longitudinal arch height.

    Additionally, if we were to rely only on "studies" that conclusively proved that the medical treatments that we perform for our patients were helpful and not harmful over a 10 or 20 year period, then we, as clinicians who are assigned with the task of improving our patients' lives through improving their foot function and decreasing their disability/pain, would be severely limited in the good that we could do for our patients. Rob, please provide us all with a list of the types of treatments that podiatrists perform regularly for their patients with good conscience and good results that have been studied over a 10 to 20 period in a sufficient scientifically controlled fashion that allows us to conclusively state that this treatment is totally safe, totally beneficial and causes no harm. I'm sure it will be a short list.

    In conclusion, is it unethical to treat asymptomatic flat footed children with signficantly medially deviated subtalar joint axes who show significant gait abnormalities? No. Rather, given our current knowledge of foot and lower extremity biomechanics, I suggest it is unethical to not suggest treatment of children with signficant deformities of their feet and lower extremities that are affecting their gait function and may affect their ability to play and run and walk comfortably over the remainder of their lives. I believe that the modern podiatrist has an ethical responsibility to offer these children and their parents the safest and best medical treatment available to allow them to lead normally active and painfree lives as teenagers and adults. For me, and my quarter century of treating specific cases of significant flatfoot deformity (with medial deviation of the STJ) in children, that preferred treatment is over-the-counter foot orthoses for mild cases and custom foot orthoses for moderate to severe cases of these foot deformities.
  33. markjohconley

    markjohconley Well-Known Member

    Does the transverse plane component of the sub-talar joint axis change with age or does a, say, medially deviated stj always stay medially deviated? Any references to previous threads appreciated if this has been discussed already, mark
  34. Paul Bowles

    Paul Bowles Well-Known Member

    This statement interests me. Kevin whats your evidence base for suggesting which OTS orthoses assist with medial deviation of the STJ? Is there some that do and some that don't?

    I would imagine in a custom device you can more or less control this, and I also imagine that your answer will include the concept that you have to modify the OTS at the time of dispensation to achieve this?
  35. RobinP

    RobinP Well-Known Member

    Prolabs P3(?) prefab has a medial heel skive does it not?


  36. JFAR

    JFAR Active Member


    When a paper is accepted for publication in a journal using the traditional publication model, the author completes a copyright assignment form, which essentially transfers ownership of the material to the publisher. This is a legal document which enables the publisher to 'sell' the paper to individual or institutional subscribers. It is therefore a breach of copyright law to freely distribute this material, particularly in a forum such as this with a large number of subscribers.

    As an editor of an open access journal, I actually don't agree with the traditional model, as it restricts access to information and essentially means that taxpayers pay for papers twice - first, by funding salaries and grants of researchers, and second, by 'buying back' the material that is generated, either by personal or library subscriptions.

    The problems with this model were the main drivers of open access, which differs in that papers are published using the Creative Commons licence, which means that papers can be freely distributed provided that the original source is identified.

    If you're after (legally) free, full-text papers, there's two main sources - BioMed Central , a commercial open access publisher of over 200 journals, and PubMed Central, which is an archive of free full-text papers from a range of publishers. Some traditional journals provide full-text papers to PubMed Central after a certain period of publication. For example, the US edition of the Journal of Bone and Joint Surgery allows PubMed Central to distribute full-text papers 12 months after their original publication date. In addition, some traditional publishers now allow authors to pay a (rather hefty) fee to 'unlock' their papers, thereby allowing open access.

    Kind regards,


    A/Prof Hylton Menz
    Journal of Foot and Ankle Research

  37. Paul:

    Any orthosis that transfers ground reaction force medially on the plantar foot will increase the external STJ supination moments and decrease the internal STJ pronation moments during gait. The orthosis does not need to be a custom foot orthosis or have a medial heel skive in order to accomplish this mechanical task.

    I will modify all over-the-counter orthoses that I use in cases of children's pronation-related problems. The whole purpose of custom orthoses is that I can order anything I want in the orthoses and they better get done the way I order it, or they are sent back to the lab to be redone!
  38. Rod Wishart

    Rod Wishart Member

    Thanks Bob Kidd, best post I've read on the Arena for a long time...
  39. JB1973

    JB1973 Active Member

    No study has ever shown it to be the case and the 3 studies that have looked at it all say it dosen't --> myth busted.

    far be it from me to question this and i hope i'm not in for a slaughtering!! but how many studies have tried to show that its the case. Does " no study has shown it to be the case" mean the same as " its not ever the case"?

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