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Proprioceptive Insoles

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A Rothbart, Nov 18, 2006.

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  1. Brian A Rothbart

    Brian A Rothbart Active Member

    Members do not see these Ads. Sign Up.
    In 2002 Craig Payne wrote a letter to the Jour Bodywork and Movement Therapies expressing his concerns about placing a medial wedge underneath the 1st MPJ. He wrote: "The use of medial column support, as advocated by the author (Rothbart), would inhibit the first metatarsal from plantarfexing and this would restrict 1st MPJ dorsiflexion ...... resulting in a very unstable foot during propulsion."

    In my clinical experience, and the collective experience of others, over 20,000 patients have been fitted with this technology with no ensuing pathology within the 1st MPJ. However, I can understand Craig's concerns because this collective body of experiences could be argue not scientific enough and a more rigorous study was necessary. In fact Craig, quoted a paper by Rouskis (1996) that argued the importance of dorsiflexion in the 1st MPJ.

    A paper has just been published in the AJPMA that states that a 4mm skive underneath the first MPJ does not decrease the range of dorsiflexion within the 1st MPJ, but actually increases the range of dorsiflexion within this joint. (Scherer et al 2006). These observations are consistent with my own clinical findings.

    A second paper, written in 2004, states that forefoot posting will not automatically limit the range of motion within the 1st MPJ (Nawoczenski). Abstracts of both of these papers can be found on my website at http://www.rothbartsfoot.info/Links.html

    Brian R

    Nawoczenski DA, Ludewig PM 2004. The effect of forefoot and arch posting designs on first metatarsaophalangela joint kinematics during gait. Journal Orthopedics Sports Physical Therapy;34(6):317-327.

    Scherer PR, Sanders J, Eldredge DE, Duffy SJ, Leee RY 2006. Effect of Functional Foot Orthoses on First Metatarsophalangeal Joint Dorsiflexion in Stance and Gait. J Am Podiatr Med Assoc 96(6):474-481.
  2. Brian:

    You may want to read Paul Scherer and coworker's paper again. The 4 mm skive was a medial heel skive placed into the orthosis that acts plantar to the heel, not the 1st MPJ. In addition, Scherer and coworkers plantarflexed the first ray in their negative casts, not dorsiflexed the first ray. Varus forefoot extensions, such as are included in your "proprioceptive insoles", will tend to dorsiflex the first ray and lead to decreased first MPJ dorsiflexion range of motion.

    You may want to change your website's reference to the paper by Scherer and coworkers, since you have already included this misinformation on it http://www.rothbartsfoot.info/Links.html

    By the way Brian, is that you in your briefs posing on the website for your product?? :eek: http://www.rothbartsfoot.info/CanHelpYou.html

    Also, I still see that you are still claiming multiple health benefits of your insoles. Do you think that if I wore your proprioceptive insoles that this will also help the anxiety that I commonly develop when podiatrists promote their products like snake oil salesmen?? :p

  3. Brian A Rothbart

    Brian A Rothbart Active Member

    I respectfully disagree with you. You are correct, they did plantarflex the 1st ray in the cast, BUT, they placed a 4mm medial skive underneath the 1st metatarsal which increased the range of dorsiflexion in the 1st MPJ.

    Have you read Nawoczenski's paper? I believe you will find their conclusions very different from what I believe you are saying.

    Regarding the changes noted with Proprioceptive Insoles, are you familiar with the writings of Pierre Marie Gagey, Weber, Sasaki, Aboukrat and other Posturologists in France. They have been writing about some of the same changes I have noted on my website. In fact, if you read my website, you will find comments by Dr Gagey regarding my research. If you like, I can put you in direct contact with him.

    Brian R
  4. Craig Payne

    Craig Payne Moderator

    Brian - very typical of your approach - you conveniently forgot to mention all the other references that showed the opposite. And you totally misread the results of the Shearer research!!!
  5. Brian:

    The "medial skive" that these researcher used is the "medial heel skive" that I described in JAPMA 14 years ago (Kirby KA: The medial heel skive technique: improving pronation control in foot orthoses. JAPMA, 82: 177-188, 1992). It produces a varus wedge plantar to the heel, not a varus wedge plantar to the forefoot. I have known about this research by Paul Scherer and coworkers for over a year now and you have again misread and misquoted the paper. If you will note, on page 476 of the article, they cite my paper in reference to "4-mm medial skive technique". Furthermore, if you read their paper closely, they say the exact opposite from what you are claiming. They are saying that plantarflexing the first ray increases 1st MPJ dorsiflexion, which is the exact opposite of what you are saying.
  6. Brian A Rothbart

    Brian A Rothbart Active Member

    I stand corrected. I misread the application of the 4mm skive. (And Craig, I apologize for not being infallible, I do make mistakes.) Thank you for bringing this to my attention.

    However, you have not commented on Kawoczenski's paper which tends to support my findings. If you are unable to download the paper, you will find an abstract at the following URL http://rothbartsfoot.info/MedialPost.html
    I have found that in the PMs foot type, a forefoot tactile stimulation (or skive, if you prefer) does not result in a hallux limitus (as noted in Kawoczenski's paper). And this is after approx 10 years of using the technology.

    On my website there are many healthcare providers discussing their results using ProStims. This technology has proven to be very effective in treating the PMs foot type. However, I do not recommend using this technology on other foot types (e.g., preclinical club foot deformity).

    If you visit the Posturology and SOT websites, you will find many discussions linking ascending postural distortional patterns to visceral as well as musculoskeletal symptoms. Many of these are listed on my webpage that you most kindly reposted above. However, your accolades, giving me credit as being the first to report these findings, is flattering but undeserved.

    Point of fact: to date, over 20,000 cases of PMs cases reported world wide (indicated by the number of proprioceptive insoles dispensed). It will be interesting to see what the next five years will bring.

    Brian R
    Last edited: Nov 19, 2006
  7. Admin2

    Admin2 Administrator Staff Member

  8. markjohconley

    markjohconley Well-Known Member

    dear mr rothbart, would you be interested in giving the australian rugby union team an inspirational talking to, you're amazing, they're hitting you with bazookas mate and you still jump up to take more ... i love it
  9. For a professor, you have quite amazing diligence, Brian. No doubt the papers will remain on your website as primary testimonials advocating your "technology". Not surprised to note the other reference you provided (Ikechebelu JI et al. 2002. Positional Therapy for Infertility Associated with Uterine Retroversion. Journ College of Medicine, Vol 7(1):50-53) to support your claim that these insoles assist conception is still on your site despite previous exposures on Podiatry Arena. What a class act!
    Last edited: Nov 20, 2006
  10. Brian:

    I have read the abstract on Debbie Nawoczenski's paper (Nawoczenski DA, Ludewig PM: The effect of forefoot and arch posting orthotic designs on first metatarsophalangeal joint kinematics during gait. J Orthop Sports Phys Ther, 34:317-327, 2004) and would have to agree with you that they did not find consistent negative effects of varus forefoot wedging on hallux dorsiflexion during propulsion. Even though I have seen patients develop symptoms consistent with functional hallux limitus with varus forefoot wedges, I'm sure that other individuals may have no problem with this type of wedging.

    However, Brian, if you were really interested in the science of improving gait function, then you shouldn't be making these types of outlandish claims about the health effects of your insoles and shouldn't be displaying testimonials on your website. However, I am sure that your website, and the extraordinary claims that you make about your insoles on it, will continue to sell lots of your insoles for you.

    Brian, what is this all about? Is it about scientific research and objectivity? Or is it about selling an insole product over the internet for financial gain?? I tend to believe it is the latter. :(
    Last edited: Nov 20, 2006
  11. Atlas

    Atlas Well-Known Member

    Kevin has adequately corrected the thread originator here on the skive position, and he has in turn correctly apologised to CP.

    In relation to forefoot varus posts etc., the question still remains is that why the lack of detrimental results despite it being relatively commonplace years ago.

    I realise that dorsiflexing the 1st ray impacts on 1st mpj dorsiflexion ROM. But what we tend to forget is that dorsiflexing the 1st ray also places the ground further away from the plantar aspect of the hallux. With this co-effect of a pseudo-rocker-sole in situ, do we need as much 1st mpj dorsiflexion as we think?

  12. Brian A Rothbart

    Brian A Rothbart Active Member


    Another point that has not been discussed, but which I believe is pivotal in this discussion is that I only advocate the use of a medial tactile activator (e.g., the ProSTim insole) when you have the PMs foot type. I do NOT recommend this type of insole for any other foot type. So, if my esteemed colleagues believe this type of insole will create an hallux limitus in the PMs foot, we need first, to discuss the embryological changes associated with the PMs (very different from a non PMs foot). This information can be found at http://www.rothbartsfoot.info/EmbryolWheel.html.

    The other point, and I know this is anecdotal, but I believe still relevant: over 20,000 PMs patients have been fitted with this insole. To date, none of the healthcare providers using this insole have reported jamming within the 1st MPJ. I would think that if this was a commonly occurring problem, I would have heard something about this from these physicians. In my own practice, I have not experienced this problem. But I am very careful who I put into this technology.

    This discussion will probably become academic within a very short period of time. Currently, in the US, a double blind study has started, to evaluate, among others things, the impact ProStims have on the 1st MPJ. It is being run by one of the largest research facilities in the US, and I believe will entail nearly 500 subjects. I am not at liberty to divulge specifics (it is not my study), but Bjorn Svae at GRD BioTech Inc has assured me that he will announce the details shortly.

    Kevin, I must address your repeated remarks about what you consider to be 'my outlandish claims' on my website. You have made your point quite clear. However, Posturologists and SOT Chiros have consistently noted these same links between function and visceral symptoms for years. Apparently, you have not had the chance to visit their forums. I believe you will find their discussions very interesting.

    Last edited: Nov 20, 2006
  13. Brian:

    I am not the only podiatrist that thinks your claims to cure infertility (among other things) with insoles are outlandish. However, if you want to see that I am not alone in my opinions, why don't you send in your thoughts on infertility and proprioceptive insoles to Barry Block's PM News website where a great many podiatrists in the United States can openly comment on your claims. I think that, if you are brave enough to do this, you will be able to see what others in our profession think about your ideas.
  14. Brian A Rothbart

    Brian A Rothbart Active Member


    We seem to be going around in circles. On many occasions I have suggested you visit the SOT forum and participate in a discussion regarding my research (which is very well known on that site). But you remain silent on that point.

    You may feel my research is 'outlandish', which is your prerogative. Personally, I may feel your opinions are narrow minded and self serving, which would be my prerogative. But the bottom line is none of that really matters. What really matters is helping our patients get better.

    Proprioceptive insoles have been used here in Europe for over twenty years with a great deal of success by many many healthcare providers. My intent was simply to introduce some of these concepts to US Podiatrists. I believe that has been accomplished. I also believe that more and more Podiatrists are becoming interested in these concepts - proof, look to your own journal (recent edition).

    Kevin, I just have no interest in bantering or chaffing with you. If you are interested in having a meaningful exchange of ideas, great. But the rest of this is getting old and not worth my time or yours, to respond to.

    By the way, congradulations Craig on the new additions to your family - twins girls?

  15. Brian A Rothbart

    Brian A Rothbart Active Member


    I was team Podiatrist for the Seattle Supersonics during the late 1980s. One thing I can tell you and be absolutely sure of, they definitely played better basketball after they were fitted with orthotics.

  16. dbelyea

    dbelyea Member

    Just interested Brian, in what type/style of orthotics you most commonly fitted elite basketball players?

    How did you know they played better? Did they win more games, have less lower limb injuries or other?


  17. Brian A Rothbart

    Brian A Rothbart Active Member

    In the late 1980s I was using an orthotic with a modified forefoot post (based on my first US Patent). At the time, I thought it was quite effective. For example, Dale Ellis severely twisted his ankle during game 1 of the playoffs in 1987 (I believe). We placed him in my orthotics, not only did he play (without taping the ankle), he had one of his best playoffs. Incidentally, the four seasons I served as team Podiatrist, the Supersonics made the playoffs three times (if my memory serves me correctly). Was this due solely to their using orthotics, I doubt it. But it certainly helped! I can remember on one occasion, their trainer (Frank Furtado) commented to me that he definitely could see an improvement in how they moved, when wearing the orthotics.

    While on staff at the Ballard Sport's Medicine Clinic (Keith Anderson was the director), I was also the team Podiatrist for the Seattle Mariners. I was used as a consultant for many of the foot related injuries (including chronic low back and knee injuries which abnormal pronation was implicated). Keith Anderson (DO) was a strong advocate for including Podiatrists on his healthcare team. (over 200 people employed in his clinic including several MDs and many DOs) And it was my pleasure to have been afforded the opportunity to work with him. Keith ran a number of research related projects, many dealt with foot related issues. Unfortunately, at the time, I was too busy to participate (one of my later regrets).

    Last edited: Nov 21, 2006
  18. Brian,

    Were you still treating athletes as a licensed podiatrist in the state of Washington after 1995? http://www.doh.wa.gov/Publicat/2001_News/01-48.html
    Last edited: Nov 21, 2006
  19. Atlas

    Atlas Well-Known Member

  20. Brian A Rothbart

    Brian A Rothbart Active Member

    kevin, old news. I already openly discussed that on this very forum.

  21. makes you good at sport

    The real question is why being no good at sport (Baseball? american football? We don't have the "playoffs" on this side of the pond) is not on the list of conditions treated on http://www.rothbartsfoot.info/CanHelpYou.html. I can't dance worth a damn, or master Kata Bassai Dai, would they help me? ;)

    Kind regards

  22. Brian:

    This may be old news to you, but it is news to me and many others on this forum. Maybe you can point me to the link where you "already openly discussed" this topic on "this very forum".
  23. fittness for practice

    Can Facial Pain be secondary to abnormal foot motion Post # 16

    Interesting to see it from an external source though. Although i have to say i am far more interested in what Brian is saying than who / what he is and any past misdemeanors.

    Professionally speaking claiming your product cures everything for period pain to breathing problems is crime enough and is unashamedly nay proudly plugged every damn where you look!

    I predict this thread is about to get personal and nasty about now.


  24. David Smith

    David Smith Well-Known Member

  25. Brian A Rothbart

    Brian A Rothbart Active Member


    It takes two to tangle (so they say), and my only interest is discussing the research we have been doing at ISS (the main research facility in Italy). And I must say, of all the forums I have posted on, this is the strangest.

    Regarding your comments regarding the technology I have developed, the Prostims are only to be used when treating the PMs foot type. Therefore, how can one assume that this technology cures everything unless you make the claim that the PMs foot is the only foot distortion that one can encounter. Reading my website, you know that this is not the case. A foot structure we still have not found an effective prostim for is the Preclinical Clubfoot Deformity.

    This will be my last post on this thread, I am knee deep in work and Kevin's last remark does motivate me to continue this discussion. However, this past week I have received more queries from Podiatrist than I had received over the prior three months. Apparently, the more bad press Kevin, Mark or Craig throw my way, the more inquiries I receive. Very strange.

    Prof Brian A Rothbart
  26. It is amazing what the internet tells us about the professional integrity of some of the people who post on this "strange" academic podiatric website, advocating their products as the cure-all to all types of human diseases. I feel sorry for the people that are desperate, seeking cures for their medical conditions, and then visit Brian Rothbart's "proprioceptive insole" website and think that Brian's insoles are going to somehow cure their neck pain, jaw pain, respiratory illnesses, intestinal and bowel diseases, chronic fatigue syndrome, diabetic ulcers, infertility, menstruation abnormalities, headaches and fibromyalgia. In their uninformed quest for miracle cures, these poor individuals see Brian's slick website, send in their money and hope for a magic cure to their ills by wearing some varus wedged insoles.

    Now, that is the mark of a true snake oil salesman: claiming cures for multiple ailments with no scientific validity behind the claims, all for the purpose of financial gain, and with no consideration whatsoever for the false hopes that he is creating within the minds of these individuals who suffer daily in pain and who have the unrealistic hopes that sending in their hard-earned cash for his insoles will magically cure them of their diseases. This whole situation is very sad and disgusting to me. It makes me sick that this individual shares the same degree as I do.

    It really comes down to professional integrity. How is integrity defined? Possession of firm principles: the quality of possessing and steadfastly adhering to high moral principles or professional standards
    Microsoft® Encarta® Reference Library 2005. © 1993-2004 Microsoft Corporation. All rights reserved.

    The same individual that apparently practiced podiatry without a license in the state of Washington, was charged with "unprofessional conduct, misrepresentation or fraud" by the State of Washington on June 6, 2001, apparently treating patients without a license to practice, and apparently claimed that he was an orthotist when he was not one, has now moved to the internet to peddle his insole product, and make claims that it treats a "foot-type" that he named after himself!! Is this individual the one we want our podiatry students and podiatrists to emulate when we start to talk to them about professional integrity??? I'll let you all make your minds up for yourselves.

    Come on back soon, Brian, the water is just starting to get warm.

    Attached Files:

    Last edited: Nov 21, 2006
  27. Bassai

    Cheers for the link Dave, Unexpected and bizarrely off topic (i know, i started it!) but very useful for me. I have doubts about some of her stances, and her body position at step 36 seems all to C**k to me but its a useful resource!

    If you want to experiance the effects of extreme torsional force on the STJ you can't beat a bit of Kiba dachi!

    I thought It was about to get nasty! I can see how if you had invested your professional life in the advancement of the science its abuse must be particularly galling! However have no fear Kevin, There is a cure for your Nausea! Remember if you have

    ... Type symptoms an proprioceptive orthotic will help! If it does not you could always try burning the insole it and burying the ashes, that might also make you feel better. :p

    Kind regards and cheers again Dave

  28. Interesting that Brian reports an upsurge in sales of his "technology", presumably some of them in the UK. Given the fact that the regulator (HPC) has taken an interest in the prescription of foot orthoses for patients, one wonders whether clinicians who supply Rothbart's devices could be considered complicit to some of his more outlandish claims as illustrated in Kevin's recent posts. There is a disciplinary hearing scheduled for a podiatrist on the basis that:

    If podiatrists who supply these insoles are propagating the myth that they assist conception, improve vascular flow in diabetics and thus prevent amputation, and improve facial pain, I would imagine that FTP hearings will increase substantially - adding further to the cost of all our fees. The sale of medical devices is regulated by the MHRA in the UK but Internet sales of foot orthoses is still a grey area. However, with the recent intervention of the HPC in the above case, it would appear that the clinician may not be exempt from individual prosecution. Given the foregoing, it might be an idea to ask the MHRA to consider whether Rothbart's insoles should be supplied in the UK when the 'inventor' continues to maintain his claims despite overwhelming evidence to the contrary.

    Mark Russell
    Last edited: Nov 22, 2006
  29. DaFlip

    DaFlip Active Member


    listen champion, the person appearing to act right now with reduced professional integrity is you!

    Enough already hey, you have been going on and on with this theme for a long time. Brian does his thing, you do yours. He is willing to put his theories up for evaluation. You appear to oppose many. He does not appear to come back with answers which you believe appropriately answer said questions. He is not going to answer these questions adequately for you, ever. Get over it hey!

    End result you delve into personal insults and internet searches to discredit Brian. What can we conclude from this? Well Kev it may say more about the searcher than the searchee. However i think we should be aware if you are starting to question professional integrity you may have crossed the line yourself. Depending upon your state laws, you may have more to worry about following criticising like professional qualified person than Brian has to worry about.
    So i think admin should be putting the finishing touches on Kevin replying to Brian for a while to let this cool down, before Big Kev finds himself losing his own professional integrity altogether.

    Anways enough from me already, that was all like serious and DaFlip needs a cold shower to recover.

    DaFlip :mad:
  30. DaFlip or whatever your real name is:

    Thank you for sharing your opinions. You are always welcome to express them in this forum. Always lovely to hear from an individual who doesn't give us his real name and has a :mad: after his name every time he has contributed to this academic forum.

    By the way, DaFlip :mad:, since you think I don't have professional integrity, do you believe that Brian Rothbart's insoles cures neck pain, jaw pain, respiratory illnesses, intestinal and bowel diseases, chronic fatigue syndrome, diabetic ulcers, infertility, menstruation abnormalities, headaches and fibromyalgia? I take it, from your comments, that you believe all of his health claims for his insoles.
  31. DaFlip

    DaFlip Active Member

    Kevin, get a grip, i am always welcome to express them in this forum, like you own it. Champ until Admin boots me off i am welcome to post here. As always very quick to point out the name thing when someone does not agree with you. Very very predictable, i thought maybe you would have grown more placid with age.

    i said 'losing' professional integrity not lost. So the point of my posting is regarding you and not Brian. For a man who prides himself on his clinical knowledge, 500 years of experience and 10 million patients successfully treated or whatever it is you always use to justify your own statements it is rather pathetic to watch these posts unfold. so before you take it from my comments that i agree with Brian the obvious answer is no i do not agree. However my point is for a man of self determined scientific standing it is rather poor form for you to have dig up 'dirt' to try to publically ridicule a fellow professional regardless of wether you agree with them or not. More importantly kevin remember karma, what goes around comes around.
    DaFlip :mad:
    Poddy (for musmed)
    Michael Flip(for Kevvy)
  32. admin

    admin Administrator Staff Member

    This topic has run its course.
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