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Proprioceptive devices

Discussion in 'Biomechanics, Sports and Foot orthoses' started by cpoc103, Dec 11, 2009.

  1. cpoc103

    cpoc103 Active Member

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    Hi quick question does anyone have views as to proprioceptive devices (PDs) to used to correct foot position and function.

    The practice I work in recently purchased an Orthema sysytem, I had an orthotist from germany say for all their patients they use PDs for all pts they see. He puts a small wedge notch at talonavicular joint to initiate a supinatory moment, then adds another wedge notch to the calcaneocuboid joint as the antagonist to the previous wedge to activate Peroneal longus.

    I'm not sure I agree with this form of Rx, I am used to using varus/valgus wedges/ forefoot ext and med and lat skives to initiate a force moment and to activate extrinsic/ intrinsic muscles in order to achieve foot function and tissue stress release.
    Would be very intereseted to hear some views.

    Many thanks

  2. admin

    admin Administrator Staff Member

  3. Craig Payne

    Craig Payne Moderator

    1. Ask him for ONE piece of evidence that you can "activate" a muscle by actually doing that.
    2. Surely, increased muscle activity is a bad thing?
    3. Tell him to get out a dictionary and look up what propriocpetion actually is.
    4. And even if they do have some sort of neurophysiological effect, how does that actually reduce the stress in the structure that is painful?

    See my views here:
    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=4489 (post #3)
  4. Admin2

    Admin2 Administrator Staff Member

  5. cpoc103

    cpoc103 Active Member

    1. Ask him for ONE piece of evidence that you can "activate" a muscle by actually doing that.
    2. Surely, increased muscle activity is a bad thing?

    Hi Craig, thanks for reply, Thats exactlly my argument, propriocetion will not activate or even deactivate muscle function. So I am a little bit confused as to what he is trying to achieve, not only that but he is trying to teach other staff in this technique.

    My understanding is where he is putting this notch is directly proximalplantarly to cuboid in turn will cause a dorsiflectory subluxation moment, with a possibilty of jamming and causing interosseus compression...hhhmmmm

  6. Boots n all

    Boots n all Well-Known Member

    l have just come back from Germany where we visited Lothar Jahrlings clinic, l dont know if his insoles are the same, but sounds like it.

    l dont know if he has any documented research either on this method? but the glowing testimonials and the large number of signed pictures thanking him for his help from sportsmen and women like tennis ace Roger Federer are everywhere in his rather large clinic where he employs about 40 staff, cant be doing too much wrong.

    Here is a link for you.


    or if you can read German


    We have used the system here, only on Habitual toe walkers with 100% success rate in about 4months of applying this flexible type insole.
  7. Craig Payne

    Craig Payne Moderator

    I caught his lecture in Melbourne a couple of years ago. There was nothing in his presentation that convinced me that it had anything to do with proprioception. The only link that the types of devices he used had to do with propropriception was his claim that they did. When I looked at what he was doing, the effect could easily be explained by mechanical means. One of the cases he presented was a neurological one, that do tend to respond to stimulation of certain reflexes - bit this is a different kettle of fish (but again, go back to the dictionary to see that this is NOT proprioception).

    Take this:
    ...why can't the wedge notch at the talonavicular joint reduce the inversion moment (ie purely mechanical) and the notch under the cc joint facilitate transfer from BM's hypothetical oblique axis to the transverse axis and help the windlass get established (ie purely mechanical).
  8. If you cut a small triangle shaped depression into the heel cup of an orthotic it will increase quadratis plantae activity and align the pull of the long flexors reducing lesser toe deformity.

  9. Since everyone else seems to be making completely arbitary and unsupported claims for what insoles do I figured I'd join in.
  10. Sounds like the marketing department got hold of it called it Propricopeptive insoles.

    Col maybe you should forget the name and marketing hype and have a look at the device from a mechancial standpoint. See if you can see any benefits for your patients by changing function. If so use it when required if not put it in the ´snake oil´department.

    It can always be good to have another option in the treatment plan. So look at it maybe get a pair made for yourself walk around check them out in terms of function just forget the marketing crap.
  11. I already patented the triangle in the heel cup proprioceptive modification......it's called the Kinematic Wedge.:cool::eek::santa:

    not true....jes havin' sum fun on a Saturday monin'
  12. Damn you Kirby! Always one step ahead! First the spikeorthotic tm, now the kinematic wedge as well!

    So long as my latest invention remains a secret. NO ONE will be able to trump my latest breakthrough, I've worked out that if I cast the foot reeeeeeally supinated it will make an isole with a really high arch! That MUST be better than anything presently on the Market!

    Ps I'm also working on a disc shaped object with a hole in the middle into which a long pole inserts and can freely rotate. Should be able to find a use for that.
  13. CraigT

    CraigT Well-Known Member

    I have seen this method, and agree with Craig- I believe what he is actually doing and what he thinks he is doing are very different things.
    Having said that, the only thing that he showed me which I thought was quite interesting was his orthosis for toe walkers...
    So David, tell is about this orthosis and tell us why they work? Lothar gave his reason, and we thought it was for another reason.
    In fairness, you must remember that English is not his first language and some ideas may be confused in translation...
  14. Boots n all

    Boots n all Well-Known Member

    Okay as l have said in other threads on the subject l am under a confidentiality agreement, thats why l have directed you to the website of Lathar jahrling.

    They do use the approach to treat other issues but l have, at my own choosing, only been involved in the application for the toe walkers.

    There are plenty of sports applications, but l dont know that l understand/agree with them at this point and have pushed them to one side for the moment.

    The other guy that has written on the subject is Dr. W. Laube, MD, Sports Physician, l cant find it at the moment, l will try and find a link for you during the day if l can, as to whether he has any documented research on this method?

    foot note; They are now referring to the insoles as "Sensomotoric" as part of registering it for marketing l guess
  15. anhtar

    anhtar Member

    Hi Robert,

    could you eleborate on this statement? I am trying to understand how the hollowed out triangle area will help make it more active?

    Looking back at my anatomy, the quadratis plantae inserts into the Flexor Digitorum Longus, so it provides a more lateral pull to counteracts the FDL's medial pull.

    I have a 7 year old peadiatric patient who has flexible pes plano valgus with retracting toes and adducted Hallux. Could this be the case of the intrinisic agonists and antagonist muscles not working in synergy resulting in the flexor muscles working too much?


  16. Griff

    Griff Moderator


    If you read Rob's next post, which was this:

    ... I think he was making a funny...
  17. Ah now we see the forum heavies coming down on my idea just because its new! I was baited onto coming here you know!!! Just to be humiliated like this because I had a new idea!!! IT JUST DOES OK!?!?!

    Yes, sorry, I was being facetious. There is no particular evidence that a hollow under the QP should activate it, but then there is no evidence that a mirco wedge will activate any other muscles. The point being that anyone can make such a claim but that without any kind of evidence, or a really decent rationale, It is hard to take them seriously.

  18. Robeer,

    There mayt be a hint of truth in your throwaway comment...


    See also:
    J Am Podiatr Med Assoc. 2000 Jan;90(1):24-9.
    Dynamic foot orthoses. Principles and application.
    Pratt DJ.

    Southern Derbyshire Acute Hospitals NHS Trust, Derby, England.
    Previous research has identified areas under the foot where stimulation evokes specific tonic reflexes. The term "tonic" is used because these reflex movements occur slowly, as if tonus or tension were accumulating, in contrast to the abrupt phasic response of a tendon jerk. The concept of tonic reactions has now been incorporated into the design of dynamic foot orthoses to help provide improved orthotic treatment with a better functional outcome. This article describes the background of this technique, briefly describes the manufacture of the dynamic orthosis, and outlines some of its uses.
  19. Bug

    Bug Well-Known Member

    Just wondering how you explain to the parents of your toe walking patients how these insoles work?
  20. CraigT

    CraigT Well-Known Member

    I am under no confidentiality aggreement... :D

    If I recall correctly, the device was full length EVA, and for toe walking there was a raise under the phalanges. The other design features that were obvious were a bulge just proximal to the talonavicular joint, and a bulge sub calc- cuboid. There was also some forefoot contouring. They were for the most part relatively flat otherwise (this is very simplified from memory).

    He showed some videos of before and after. One was a GR 2 tib post dysfunction patient who he reported as being 'pain free for the first time in years'. While I cannot dispute this, and obviously did not see the patient in the flesh, there appeared to be a large amount of room for more control.
    It was not revolutionary in my eyes.

    I showed him a polypropylene device which he took one look and said 'No- that is far too hard and pushes on the arch'- Pretty amazing without seeing the patient...

    Interestingly, I believe his background is originally with cerebral palsy patients, and this may be why he tends to think of the effects as a neurological/ proprioceptive.

    Podiatry as a profession does not seem to really exist in Germany- they have Orthopaedic Shoes Makers which is more like an apprenticeship, Orthopods and Physios. My German wife had great difficulty explaining what I actually do to her family...
    This is an example of something which is quite different to the status quo there, and they have come up with an explanation as for why they work which is quite different to the explanation we would come up with.

    'Sensiomotor devices'
    Reminds me of a Monty Python sketch...
    " We use only the finest baby frogs, dew-picked and flown from Iraq, cleansed in the finest quality spring water, lightly killed, and then sealed in a succulent Swiss quintuple smooth treble cream milk chocolate envelope, and lovingly frosted with glucose."
    " That's as may be, but it's still a frog!"
  21. Craig Payne

    Craig Payne Moderator

    I have picked up on this sort of comment a number of times. Just look how many randomised controlled trials, outcome studies, patient satisfaction studies etc on people who have a rigid device that pushes on the arch .... funny how every one of them show patients actually get better ... don't figure that pushing in the arch is a problem!
  22. cpoc103

    cpoc103 Active Member


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