'Proprioceptive' insoles and diabetes

Mark,

Your generalizing again. Be specific. Where on my website am I selling any specific proprioceptive insole (there are at least three that I know of, on the market today). In fact, my website is purely information. It is NOT a commerical site, in fact if you wanted to purchase the insole I invented, you would have no idea where to buy it after reading the 100+ pages on my site.

The site presents my research on the PMs foot and a particular insole I invented to treat this specific foot type.

Again, if you are willing, pick a page on my website, start a thread, and let's debate (I believe this is my third invitation).

best regards,
Brian R

 

Dare I enter????

Q1 To indentify the "PM deformity" the foot is placed in the talo-navicular congruency position - WHY? What is the justification for this?

Q2 If we identify a foot abnormality when placing the foot in "neutral" and deem motion that occurs in gait as a "compensation for the deformity", exactly how is this an advance on the theorectical approach of Mert Root and co-workers in the 60's/70's?

Q3 What evidence is there that the effect from the "PM foot-type" orthotic is "proprioceptively" induced?

If there is no evidence for a proprioceptive effect and what you are suggesting is that with putting the foot in STJ neutral we can identify forefoot deformities then I dont get what is so special here??

 

Proprioceptive Insoles - need for training

Good questions, but this forum is on the diabetic foot not the PMs foot type. If you would like to learn more about the PMs foot type visit my website at www.rothbartsfoot.info or attend the Annual SOT Convention in St Louis this October where there will be a full morning presentation on the PMs foot type. If you would like more information write Dr Charles Blum at drcblum@aol.com

regards,
Brian R

 

What a class act!!

Duh!

 

I was under the impression the same device was being advocated for both issues. Is the device you're using in the diabetes study different?

 

Spoonerisms

Simon

I think calling it a personality disorder is a bit strong. We all enjoy the occasional vent and like playing a violin, the better you do it the more you enjoy it! You obviously enjoy it A LOT. Good for you. Fun for us. Less good for any poor sod brave enough to stick there head above the parapet! By the by do you have any plans to run seminars on Spoonerisms or is it a one on one learn-from-the-master type deal?

Brian and Ed

Thought i should mention that whilst I (we?) may give you a hard time and occasionally even mock you (through the medium of poetry amoungst other things) i think you deserve huge credit for having the courage to put your views on the forum for discussion. We are all enriched by your views and involvement and you often get the Sh***y end of the stick for your trouble.
Seriously, Big up respect init.

Regards to all

Robert

 

It's just a shame they don't directly answer the questions that the members on Podiatry Arena ask of them... it just seems like we are referred around in circles to these websites that don't answer our questions concisely enough!

 

Proprioceptive Insoles - Other Comments

Your assumption is incorrect. There are many different types of proprioceptive insoles (Vabene, Fusco, PCIs, Pernarella etc). On my website, I discussed the Vabene (See www.rothbartsfoot.info/OtherProStim.html) The purpose of this diabetic study was to evaluate the effectiveness of proprioceptive insoles (as a class of insoles), not to endorse any specific type or manufacturer.

PCIs, one type of proprioceptive insole, must only be used with the Primus Metatarsus Supinatus foot type. Prior to dispensing, using microwedges, you must determine the PMs values (See http://www.rothbartsfoot.info/RFS.html ). This measurement determines the presence, or not, of this foot type; and, also helps determine the strength of the stimulation. Failure to do so, places the patient at risk.

regards,
Brian R

 

Dear Donna,

I can understand you frustration as what you perceive as an evasiveness to answer questions directly. Please understand, if I do appear evasive, it is unintentional. I am struggling in trying to answer your questions, the best I can. My website was setup for basically three reasons: (1) To keep in contact with other research teams around the world, (2) As a review for healthcare providers who have attended my workshops, and (3) least stressed, a few of the pages on my website are geared towards laypeople to give them a general idea about proprioceptive insoles. My website was NOT set up to teach this technology from scratch.

My research has spanned over 35 years (I believe the sheer size of my website indicates a fairly large volumn of work). Answering some of the excellent questions put forth to me, are very difficult to answer succinctly. Have you considered taking one of the workshops being offered around the globe on proprioceptive insoles by many different researchers. It must be very difficult for many of the members on this forum to follow my responses without a basic introduction into this new area of biomechanics, well, not so new, posturologists have been discussing these principles for over 30 years now (see Dr Gagey's remarks at http://www.rothbartsfoot.info/CommentsGagey.html ).

And Robert, thank you for your kind words.

regards,
Brian R

 

Website

Donna Makes a good point. I'm sure we've all had a look round the website, Heaven knows we've had the link given us often enough. However the Questions being asked are not adequatly answer on it, hence this forum. There is absolutly nothing wrong with proposing a theories without any evidence backing them up, they all start that way, but for the website site to be a resource rather than an "i think this" type forum it needs a bit more hard evidence and a bit less conjecture!

And forgive me if i'm covering old ground here but was there ever anything other than a assumption that reducing pronation improves blood and nerve supply?

Regards

Robert

 

Proprioceptive Insoles - Diabetic Study

The study at ISS was set up to test this theory. The theory was formulated on clinical experiences, that I have presented in prior posts.

What we know is that traditional insoles have failed. The percentage of foot amputation among diabetics has not changed over the past 10-15 years (references on my website).

To my knowledge, I am the first to suggest this correlation. Many at ISS have found this suggested link intriguing, intriguing enough to invest tremendous resources in man hours to set up this study.

You mention that in order for my website to be more than 'what if', there should be more substantiating or corroborating information. I believe I have meet this requirement: I have published several statistical papers on my research, one in press, in a major Podiatric journal. Also, as I have mentioned earlier, a major double blind study is underway evaluating the technology I invented (the specifics will be released by Bjorn Svae). This I believe is a strong validation on my work. To my knowledge this is a first, can you site any double blind studies published on any particular insole technology that has been conducted by a major research facility in the US?

best regards,
Brian

Brian R

PS I keep referring back to my website, because the information is already presented there. Maybe I am lazy, but I donnot want to spend the time retyping the same info on these responses.

 

Professor Potty in GaGa-Land

You call this presenting evidence??

This is not only factually incorrect and grossly misleading - it is a slur on all podiatrists who successfully prevent diabetic amputations using casted total contact orthoses and evidence based therapy. But let's not allow facts to stand in the way of your delusions....

Now I wonder why this might be so - could it be because it is complete nonsense?

More fool them.

That's the first accurate thing I've seen you write, but I could offer a few more adjectives as well.

This is becoming embarrassing.

Mark Russell

 

mark'sism

OUCH! Thats it. i'm changing my course of study from Spoonerisms to Marks'ism (Karl?). Presumably i will still have to start smoking so i can quit smoking and go through a painful detox to generate an appropriate level of vitriol.

Brian
Do your study. More power to you! if you can prove what we all hope you can our faces will be so red!

I think the thing that so obviously needles people is the way you appear (and if it is merely appearance and not fact my apologies) to claim your rather interesting hypothoses (plural, i'm counting the whole infertility thing as well here) are proven fact rather than interesting conjecture.

"You mention that in order for my website to be more than 'what if', there should be more substantiating or corroborating information. I believe I have meet this requirement:"

Sorry but you very very obviously have not. To be recognised as an academic resource and reliable information it must be valid in the view of everybody else as well as you! I can call myself sparky the space cadet but that don't make my Crappy ford Fiesta a rocket ship!

Regards
Robert

PS oh yeah, about the whole, "we know traditional insoles have failed" thing? Come on, by this time you know making gross sweeping generalisations is like rubbing yourself in sandpaper then going swimming in a shark tank. Do you enjoy the abuse? If not for pity sake keep your feet a little more firmly on the ground!

"Only those with there feet firmly on the ground can build castles in the sky"
Terry Pratchett

 

Robert,

I guess my aversion to repetition is painting an inaccurate picture of what I am saying. So, here goes, a change in presentation.

Many researchers have come to the conclusion that standard orthotics, as used commonly today, have proven ineffectively in reducing the rate of foot amputations in diabetics over the past 15 years (Hirzel 1986; Edmons 1987, Chantelau, 1990; Kustner, 1991; Giacomozzi, 2003).

God, that was alot of typing. It was so much easier simply to refer to a webpage with all this info already entered.

My comments regarding infertility and feet stand. A great deal of research has been done by the Posturologists and SOT chiros here in Europe, discussing these very same issues. Why don't you join the SOT forum and listen to what is being discussed.

Regarding the ISS study, my sole intent making this study known, was, I thought if would be of interest to this forum (not as a potential source of embarassment to the forum members).

Brian

Chantelau E, Kushner T, Spraul M, 1990. How effective is cushioned therapeutic footwear in protecting diabetic feet. A clinical study. Diabetic Medicine 7:355-359.
Edmonds ME 1987. Experience in a multidisciplinary diabetic foot clinic. In: Connor H, Boulton JM, Ward JD (eds), The Foot in Diabetes, 1st Edition, Wiley, Chichester, pp 121-134.
Giacomozzi C 2003. Methodologies and Measurement devices for an effective functional assessment of the diabetic foot. Rapporti ISTISAN 03/31.
Hirzel C, MIllan J, Boucher P, Naudin J, Diouf B 1986. Prevention des maux perforants plantaries: essai mene par una equipe mobile. Acta Leprol, (4):79-92.
Justner E, Bedyer J, Cyrus J, Lehnert H 1991. Der diabetische Fuss: Diagnose und Therapie einschlieblich rekonstruktiver Eingriffe. Med Welt, (42):957-963.

 

Robert,

I guess my aversion to repetition is painting an inaccurate picture of what I am saying. So, here goes, a change in presentation.

Many researchers have come to the conclusion that standard orthotics, as used commonly today, have proven ineffectively in reducing the rate of foot amputations in diabetics (Hirzel 1986; Edmons 1987, Chantelau, 1990; Kustner, 1991; Giacomozzi, 2003).

God, that was alot of typing. It was so much easier simply to refer to a webpage with all this info already entered.

My comments regarding infertility and feet stand. A great deal of research has been done by the Posturologists and SOT chiros here in Europe, discussing these very same issues. Why don't you join the SOT forum and listen to what is being discussed.

Regarding the ISS study, my sole intent making this study known, was, I thought if would be of interest to this forum (not as a potential source of embarassment to the forum members).

Brian

Chantelau E, Kushner T, Spraul M, 1990. How effective is cushioned therapeutic footwear in protecting diabetic feet. A clinical study. Diabetic Medicine 7:355-359.
Edmonds ME 1987. Experience in a multidisciplinary diabetic foot clinic. In: Connor H, Boulton JM, Ward JD (eds), The Foot in Diabetes, 1st Edition, Wiley, Chichester, pp 121-134.
Giacomozzi C 2003. Methodologies and Measurement devices for an effective functional assessment of the diabetic foot. Rapporti ISTISAN 03/31.
Hirzel C, MIllan J, Boucher P, Naudin J, Diouf B 1986. Prevention des maux perforants plantaries: essai mene par una equipe mobile. Acta Leprol, (4):79-92.
Justner E, Bedyer J, Cyrus J, Lehnert H 1991. Der diabetische Fuss: Diagnose und Therapie einschlieblich rekonstruktiver Eingriffe. Med Welt, (42):957-963.

 

Change in presentation

Brian

There you go, that wasn't so hard. The extra typing, pain in the butt though it may be represents the difference between coming over as an academic with a theory (even a slightly dodgy one) and, in Marks words "Professor Potty in GaGa-Land" (Cheap shot i thought). Easier it may not be but tragically it is required.

You'll notice that the esteemed Mr Kirby does'nt try to get away with "you'll find all the evidence you need in my book (S)". One of the reasons his views are respected.

Still don't agree as that particular premise does'nt match with my personal experiance with diabetics and orthotics. You could show me a dozen references which said that water is'nt wet i'll still tend to doubt it.

And anyway why is it significant to how well YOUR insoles work how well every one elses work? You don't need to prove chicken tastes bad to prove beef tastes good! Talk like that and people won't even try your beef cos knowing that chicken tastes good they'll doubt whatever else you say!

I'd love to join the SOT forum. What the hell is the SOT forum? THATS a link i would have appreciated!!

So far as the posting of the study, it IS of interest to the members of this forum as is evidence by the rapidity of the posting. You also asked what we thought. I think its fair to summarise the views as being ... less than positive. However for assorted reasons i suspect we're still all glad you did. As i stated before, i for one respect you for having the guts to stick your head up!

And i would'nt lose any sleep over your study being embarrasment to the forum. I'm sure we'll all survive! I'm slightly surprised you're show no signs of embarrassment yourself!

Off to check those references!

Regards
Robert

 

Dear Dr Rothbart

Can I suggest that some of the more contentious research, which is clearly causing a problem for the profession, is kept pass word protected on your web site.

The information is then readily available for your research teams around the world, for all the healthcare providers that have attended your workshops or those professionals you would like to grant access to.

Then your lay people do not get too confused with what is fact and what is fiction.

I have a problem with the ethics of desperate patients with diabetes, or their well meaning relatives, looking for any answer pre amputation.

GB

 

By request

Robert,

Thank you for the request. Ok. I know almost nothing of Rothbart's orthoses, so I will not venture to dismiss or attack them.

I do have respect for Craig's opinion and he seems to feel pretty strongly that they are unsound. I think I saw them recently at a seminar. What I saw was very flat with a small forefoot post.

Interesting how Sole Supports have been compared to these orthotics when they are so completely different. Sole Supports have the highest arch of any orthotic I have ever measured, are the actual shape of the foot (not the archfill) and lower the head of the first metatarsal not raise it (as with a forefoot post).

I think a closer comparison would be to standard posted or skived orthoses which also have relatively insignificant arches, and utilize varus wedging.

Whenever one is promoting a new theory of foot function and correction, they will always be under attack for self promotion especially if they are the only source for this technology. Being the first to go down a particular path is both a blessing and a curse.

Thanks Again,
Ed Glaser, DPM
CEO Sole Supports, Inc.
www.solesupports.com

 

By request

Thanks Ed, I value your opinion.

As you say about the only thing the two products have in common is that they are both promoting a new theory. Being such radically different theories i was slightly surprised the two of you had not crossed threads before.

As you say being the first to go down a particular path takes courage. This is because most of them are dead ends. Still without a few courageous soles progress would never happen. You have to kiss a lot of frogs!

By the by do your products improve circulation?

Thanks for playing

Robert

 

Robert,

You can access the SOT (Sacral Occipital Technic) forum by going to the following URL: http://groups.yahoo.com/group/SacroOccipitalTechnicForum/

I think you will find the discussions very interesting. You will find a great deal about the ascending postural distortion patterns, that is, the impact abnormal foot motion has on the fascial bones.

regards,
Brian R

 

Ed,

The one point that needs to be strongly emphasized is: the proprioceptive insole that I developed is ONLY meant to be used to reverse the postural distortions associated with the Primus Metatarsus Supinatus foot type. It is counterindicated for the other foot types Podiatrists have identified and treated for years.

It would be very difficult to compare Solesupports to PCIs because they are used on very different foot types.

regards,
Brian R

 

SOT forum

Thanks for the link Brian. It's always fun to expose oneself to new knowledge. I'll just go expose myself.

Regards
Robert

 

Dear Dieter,

The proprioceptive insoles you are wearing have a pronounced impact on gait dynamics. Go to the following webpage and view several frames taken from video analysis on the same patient, without and without stimulation. http://www.rothbartsfoot.info/GaitAnalysis.html

Heel pain can be one of the most difficult symptoms to treat. I am pleased you responded so quickly to the insoles.

best regards,
Prof B