Rothbarts insoles

Which research facilities? Hopefully we will see this research written up in index medicus linked journals?

 

I am still seeing nothing more than unsubstantiated claims and claims contrary to the evidence.

Brian - your publications in the Journal of the American Podiatric Association have nothing to do with the current topic !!!

 

Kevin

I can sympathise with much of what you write, however, there is an inference in your posts that these insoles are actually harmful to patients which you’ve only qualified in this first paragraph above. I wouldn’t have thought Brian Rothbart was advocating the use of these insoles except for applicable foot conditions, but I may have been mistaken, hence the initial enquiry. I had no idea the responses would be so passionate and entrenched!

One point of observation; if I read you correctly, your greatest problem with Rothbart is that he cannot explain adequately the science behind his theories to your (and others) satisfaction. On that basis you vehemently oppose the use of these devices in podiatric practice - snake-oil selling as you have written on a number of occasions. That being the case, I would suggest that 95% of podiatrists who prescribe and supply custom-made and prefabricated orthoses are doing exactly the same! How many colleagues fully understand what functional devices actually do -or even what they think they will do - to a pre-existing pathomechanical condition? Can you honestly say that you know this each and every time you prescribe a custom device? How many podiatrists actually have a competent working knowledge of biomechanics to be able to prescribe within the maxim of “do no harm”? That’s assuming the science of current biomechanics is correct and that laboratories work to the same standards and parameters. On your reasoning, most of the podiatric profession are snake oil salesmen! Maybe they are.

Some time ago, when I was leading a bit of a nomadic life, I used to call on the services of some of my colleagues – incognito - as I have moderately involuted toenails – a manifestation of wearing extremely tight footwear (rock boots before you get any ideas). If I feel like a bit of mischief I might ask a few leading questions or offer some phantom discomforts, just to see what they might say. It’s been good fun! I’ve seen podiatric surgeons, university lecturers, biomech specialists, public and private practitioners, good and bad. What I can say is that podiatrists all over the world are very enterprising folks. I’ve been diagnosed as having tibial inversion, compensated forefoot varus, pelvic tilt, hyperpronation, and a limb length discrepancy of between 2 and 5cms – none of which is true. The solutions varied from prefabricated orthoses to custom devices; the costs between $40.00 and $600.00 – each time with a sincere opinion that the podiatrist was absolutely correct in their diagnosis. I’ve had consultations from podiatrists throughout the UK and across the USA and each time I mention recurring knee pain, I get a different view. Once, on a memorable occasion in a hotel, I was even handed a 'VIP list' from a not unattractive lady clinician after she had finished her podiatric ministrations. You’ve no idea what she could do for $50.00 and the aqueous cream was free of charge too!

I am glad that Brian Rothbart has come to the forum to explain his theories and like you I'll be interested to see if he can bear the scrutiny. But at the end of the day his devices may still work, even though he might not be able to explain – to your or my satisfaction – why. What I tend to rely on more is feedback from other practitioners and from patients who have tried the devices, and in that respect Alex’s submissions have been valuable and I thank him for making them in the face of so much hostility. An open mind is a wonderful thing, especially when challenging others’ dearly held beliefs as I’m sure you will agree.

Kind regards

Mark Russell

 

That was my whole point I mentioned earlier in which I deliberatly left out the word "proprioceptive" in the title of the thread as they do not do that. ITS NOT PROPRIOCEPTION.

If foot orthoses have any neuromechanical/sensory effects, then it is by altering pressure on mechanoreceptors and the body some how uses that information to alter function. THAT IS EXTEROCEPTION and NOT PROPRIOCEPTION.

Brian Rothbart quotes a number of references to lend support to the use of "proprioceptive" insoles --- not one of those references do that (anyone can go and check them to verify that). All the references do is show how important plantar sensory input is for function and balance (which is an important function of the plantar surface), but what do they have with the effects of foot orthoses?

I am not denying for one minute that foot orthoses can not have neuromechanical effects, its just the dishonest use of references to claim they do.

 

Mark:

As I have now stated numerous times, I am not opposed to using insoles with varus forefoot extensions or Morton's extensions. In fact, I wrote a newsletter on using Morton's extensions for the treatment of metatarsus primus elevatus in June 1988, nearly 18 years ago (Kirby KA: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997, pp. 131-132).

However, these modifications should only be used in a select number of conditions since as many very well-respected podiatrists have stated, they can cause secondary problems. In my practice, I use Morton's extensions and/or varus forefoot extensions in less than 5% of the orthoses I make for patients. Now, in reading one of the many of Brian Rothbart's websites, it seems that the Morton's extension/varus wedging technique is being used very commonly. His evaluation technique and theories are based on his idea that any foot that has the first metatarsal head off the ground while standing in STJ neutral position has what he calls a "Rothbart Foot Structure" or a "Primus Metatarsus Supinatus Foot" http://www.rothbartsfoot.bravehost.com/RFS.html

If you go into his multiple websites and go through them with a fine tooth comb, as I done now for the past two years, you start to see a pattern of where he is claiming things that are not true, he is claiming to have been the first to discover things that have been previously described in the medical literature, he is claiming that his foot orthoses do many things that even the most open-minded podiatric professional would be afraid to say to his peers in even a poorly attended academic lecture. In other words, Brian Rothbart claims that by improving proprioceptive reception with his insoles that he can make menstruation more efficient, help eliminate the bowels more efficiently, allow for easier breathing, give the body more energy, help chronic fatigue syndrome, help heal diabetic ulcers and prevent foot amputations, cure infertility, reduce the frequency and intensity of headaches, and eliminate the pain from gastro-intestinal distress.

http://www.rothbartsfoot.bravehost.com/CanHelpYou.html

When I refer to "snake-oil", it is these claims that his insole is a "cure-all" for multiple disorders that I am referring to, not the actual varus wedged/Morton's extension insole that he markets. In fact, this idea of padding under the first metarsal is over 70 years old, if not older, and this was actually first described by Dudley Morton.

Now, you also thought that I was using snake-oil much too liberally. Let's do a little example for you so that you can see why I used this term "snake-oil" to describe Brian Rothbart's insoles. For example, do a google images search on snake oil to see one example of a snake oil poster (also check out the healthy skepticism website...this also applies to Brian Rothbart's websites): http://images.google.com/imgres?img...=&c2coff=1&rls=GGLR,GGLR:2006-11,GGLR:en&sa=N

Clark and Stanley's Snake Oil Liniment: A Wonderful Pain Destroying Compound. The strongest and best liniment known for the cure of all pain and lameness. Used externally only for rheumatism, neuralgia, sciatica, lame back, lumbago, contracted muscles, toothache, sprains, swellings, etc. Cures frost bites, chill blains, bruises, sore throat, bites of animals and insects. Is good for everything a liniment should be good for. It gives immediate relief.

Now, substitute into the above advertisement for snake oil liniment Brian Rothbart's proprioceptive insoles, along with the list of maladies he claims he can treat or cure with them, and you will now know why I have been using the term "snake-oil" very liberally in regard to this insole and it's claimed benefits.

Here is an example of one of Brian Rothbart's "very modest" descriptions of himself and his accomplishments on the internet:

Why the Posture Control Insole Works and How It Was Discovered

Thirty years ago, Dr. Brian Rothbart DPM owned a thriving surgical podiatry practice in California. About the only thing that bothered him about his practice was the fact that he thought too many of his and his colleagues’ patients re-developed the problems that were corrected during surgery. Dr. Rothbart suspected the reason for these reoccurrences was based on underlying factors unfamiliar to his profession and therefore not being considered. Driven by curiosity and a belief that there were undiscovered solutions, Dr. Rothbart returned to the college campus.

Dr. Rothbart DPM, PhD, is a skilled biomechanist who has dedicated 25 years of his professional life to studying the biomechanical relationship of hyperpronation as it relates to the body in motion. By combining biomechanics, and 21st Century 3D computer modeling, Dr. Rothbart described the complex motion of the bones in the foot and lower extremity during normal gait and was able to clearly demonstrate the mechanics of hyperpronation

Noting that as many infants hyperpronate, as do children and adults, Dr. Rothbart suspected that it was a congenital problem and not a condition developed during childhood. In studying the clinical literature on the development and growth of the fetus, Dr. Rothbart was able to fully explain the origin of hyperpronation and support all his biomechanical findings.

As is often the case, once you are able to describe the problem in detail, the key elements of the solution become self-evident. The approach to reduce and even eliminate hyperpronation became clear and could be implemented with simple tools.

Dr. Rothbart described hyperpronation as a particular motion of the bones in the foot and ankle. As weight transfers to the forefoot during the gait, the ankle rolls inward and downward. The collapse of the body foundation,(the foot and ankle) in turn affects the posture and motion of the entire

When a typical hyperpronator stands with the feet in a subtalar neutral position, the first metatarsal and big toe are not in weight bearing contact with the ground. When the foot is released to its natural weight bearing stance, the first metatarsal and big toe travel a distance downward to become weight bearing. The ankle follows the motion of the big toe and collapses toward the ground. This motion exaggerates as the weight is shifted onto the forefoot.

Dr. Rothbart is the first to describe this relationship, so we call this foot mechanics “Rothbart’s Foot Structure” (RFS).


http://www.posturedyn.com/manual/Page 12.htm

Mark, being open-minded is not the same thing as being gullible. Do you think, Mark, that Brian Rothbart's insoles are able to possibly do all the things that he says? If you do believe all of Brian Rothbart's claims, then I am afraid that I could not consider that you have a healthy skepticism. As such, if you do believe all of his claims then your resultant lack of healthy skepticism would neither be beneficial to your patients nor would your lack of healthy skepticism be beneficial to those students who you may instruct on foot orthoses and on foot and lower extremity biomechanics.

 

Kevin

I can see that you have an issue with Brian Rothbart and I am not all that unsympathetic to your position for many of the reasons you wrote. After 25-odd years in podiatry I have a healthy scepticism to most things that pass my way - including established and developing biomechanial theories - for many of the reasons outlines in my last post.

Why is it, for example, that if established principles are so robust, there is no difference in outcomes between custom-made and prefabricated devices in randomised clinical trials? Why do Rothbart's insoles perform well with patients too - and not just in PMS? Obviously there are many mitigating factors that influence clinical outcomes - clinician skill, variation in manufacturing process, cast evaluation, patient compliance - and that makes the science even more complex, but I find it curious nonetheless that you are so vocal against one particular approach - Rothbarts (although I can appreciate why) - when you are silent in comparison to all the inherent difficulties and failings in established Bx theory and practice. You allude in your posts that Rothbart is simply using his websites and devices for self-promotional & commercial gain, but, and I say this as a devil's advocate and without any presumptions whatsoever, you also have vested interests insofar as you are a director of a custom orthtoic laboratory (Precision Intricast). Perhaps you could take this opportunity to dispel any doubts over any conflict of interest anyone may have?

Also, you didn't answer my points about the competency of practitioner prescribing with custom-made and prefabricated devices. Maybe you can do so now?

Kind regards

Mark Russell

 

Re SnakeOil

Kevin,

In all due respect, you need to get your facts straight. The passage your quoted about who I am was NOT written by me, nor is it on my website. You will find those remarks on www.mortonsfoot.com.

Re SnakeOil, again in all due respect, and I apologize for having to say this, but Kevin you need to stop repeating yourself. For instance, the link I made on my website re: infertility and linking it to pelvic tilts, is quite factual. Dr Christian Pope, Consulting Staff, Department of Obstetrics and Gynecology, St. Luke's Hospital discusses this in detail in on the Emedicine website. The paper is entitled Malposition of the Uterus and was published March 6, 2003. The coauthor on this paper is Prof / Dr John P O'Grady, Professor of Obstetrics and Gynecology, Tufts University School of Medicine.

The impact proprioceptive insoles have on the musculoskeletal and visceral systems are immense, and would be difficult to believe it you haven't seen it first hand. However, at this point I suggest we go on to the more germane (in my opinion) issues; for instance, a discussion on the embryological development of the foot and how that links to the PMs and Preclinical Clubfoot deformities.

For the record, I am no longer going to respond to any derogatory references regarding my research or comments about me personally. I am very open to discussing my work and research on this forum, but only if done in manner where we demonstrate mutual respect for one another.

regards,
Brian R

 

Mark:

Thanks for the reply. I am having a good time with this discussion since I am always interested in your thoughts. Over the years of reading your communications within the podiatry e-mail lists, I have always thought that you have a gift to analyze things reasonably and then communicate your thoughts eloquently. For these reasons, I appreciate you taking the time to read and reply to my messages.

First of all, you stated "but I find it curious nonetheless that you are so vocal against one particular approach - Rothbarts (although I can appreciate why) - when you are silent in comparison to all the inherent difficulties and failings in established Bx theory and practice".

As you hopefully know of having read my discussions, papers, books, and lecture notes over the 20+ years, I share a healthy skepticism for all biomechanics theories. I think if you were to talk to William Orien, Chris Smith, Ron Valmassy, Richard Blake, Tom McPoil, Irene Davis, Craig Payne, Howard Dananberg, Daryl Phillips, Eric Fuller, Simon Spooner, Norman Murphy, Bruce Williams, and many others who I have lectured with over the years on foot and lower extremity biomechanics, they will all acknowledge that I tend to be vocal and passionate about my beliefs and tend to disagree with many people, no matter who they are. I don't think anyone had ever made Mert Root or Bill Orien more angry in his lectures than I have on a few occasions when I publicly questioned their authority on foot biomechanics. If you don't believe me, just ask Jeff Root or Daryl Phillips or Don Green or many others who have seen me in action with Drs. Root and Orien. Maybe it seems like I am just picking on Brian Rothbart. But I tend to pick on anybody that I think is wrong or that I think is promoting ideas that are not based on firm mechanical grounds. So please don't think I have anything personal against Dr. Rothbart, I just don't agree with him.

If you want to talk about orthosis research, then I am all for it. There are numerous 3D motion analysis studies that show a difference between the kinetics of prefab orthoses vs custom made orthoses. Clinically, why do practioners modify prefab orthoses if they are so great? Are you saying then that you would recommend that clinicians should just hand out over-the-counter insoles to their patients because they work just as well as custom made orthoses? In fact, Mark, how many orthoses do you make per month for your patients? I now make about 90 pair of foot orthoses per month for patients and have made over 10,000 pairs of custom orthoses in my practice career. What does your clinical experience with foot orthoses show?? My clinical experience very clearly shows that even small changes in orthosis design sometimes makes huge clinical differences for patients. How are these going to be achieved using only over-the-counter orthoses?

Now, for the question that seems quite provocative, but is really not a problem for me to answer: "I say this as a devil's advocate and without any presumptions whatsoever, you also have vested interests insofar as you are a director of a custom orthtoic laboratory (Precision Intricast). Perhaps you could take this opportunity to dispel any doubts over any conflict of interest anyone may have?"

I have no direct financial interest in Precision Intricast, Inc. other than they pay me a consulting fee once a month to provide the service of writing their monthly newsletter and do consulting for them on an occasional basis. I am not reimbursed for anything but for my consulting services and do not own part of the business in any way, shape or form. I have preferred to keep the relationship this way with Precision Intricast so that I can remain as independent as possible in regard to conflicts of interest.

As an example of the relationship I have with Precision Intricast and our approach to podiatric education, the medial heel skive technique which I invented along with the technical assistance of the owner of Precision Intricast in 1990, is now being used all over the world in the manufacture of foot orthoses. However, Precision Intricast and I have never charged one cent for that modification either to the customer-physicians of Precision Intricast or to the other orthosis labs that have used it. We never licensed or patented the technique since we thought it was too valuable of a technique to have restrictions or licensing fees associated with it.

Tell me Mark, since you are now starting to question my interests with the orthosis lab that I have worked with for 20 years, what is your answer to this question:

What orthosis modification has been invented within the past 20 years that has been the most widely used internationally and that has not been licensed or marketed to other orthosis labs and that was initially published within the mainstream peer-reviewed podiatric literature for the sole purpose of helping podiatrists and their patients?

Your answer will hopefully inform you a little about what I am all about in regards to my ethics, my love for my profession and for the well-being of other podiatrist's patients.

In addition, in regard to the ethics of Precision Intricast as a foot orthosis lab, even though Precision Intricast has paid me to educate their clients over the past 20 years, it has also actually lost money in publishing my two books of Precision Intricast Newsletters. They published these two books because they thought the information was so clinicially valuable for all foot-health practitioners that they should make it available to anyone who has an interest in this information, and not just their lab clients. My books published by Precision Intricast have been sold to podiatrists and other health professionals in over 10 countries now. In addition, Precision Intricast has also been very gracious in allowing Podiatry Arena to publish many of these newsletters publicly, free of charge, so that this information may be even more widely distributed. Am I or the lab making any money off of publishing these newsletters on Podiatry Arena? No. So tell me now Mark, what orthosis lab has done more in the last 20 years to educate podiatrists on foot biomechanics and foot orthosis techniques other than Precision Intricast?? Mark, do you know of any other foot orthosis lab in the world that has even funded the publication of one book, and not two books, on foot and lower extremity biomechanics? I certainly am looking forward to your answers on this one.

In regards to your last question, the competency of practitioners is very significant in regards to the results that they will get using any medical therapeutic technique. This is obvious to anyone who has taught orthosis techniques or surgical techniques or any other technique to clinicians. A good technician sometimes gets much better clinical results than the more academic clinician simply because they are better with their hands. Is that the question you wanted answered??

Good discussion, Mark. Looking forward to your replies to my questions. By the way, I am still waiting to hear if you believe that proprioceptive insoles can do the following: make menstruation more efficient, help eliminate the bowels more efficiently, allow for easier breathing, give the body more energy, help chronic fatigue syndrome, help heal diabetic ulcers and prevent foot amputations, cure infertility, reduce the frequency and intensity of headaches, and eliminate the pain from gastro-intestinal distress????

 

Brian,

I just went on the website that you listed above www.mortonsfoot.com. Please answer me this one question: how many separate websites do you sell your products through??

 

Netizens

To use Skakespeare "There are more things in heaven and earth, Horatio, then are dreamt of in your philosophy."

It is impossible to be definitive when it comes to proof and that is a fundamental flaw in scientific reasoning, however in terms of predicability the scientific method has advantages over serendipity.

Much of what passes as anecdotal is also caught in the mindset of the phenomenological, which often defies pure scientific analysis. In the end clinicians use judgement, much of which is driven by personal bias (frequently based on pragmatism ie. I know it works, therefore I will use it) sometimes in spite of evidence to the contrary.

On the topic of calling procedures and techniques after the person who developed them, the practice is frowned upon in scientific communities. The reason is both altruistic and more practically driven by better communication. After all it is easy to confuse a method which is not anatomically accurate. Perhaps those who chose or have their name thrust upon an innovation are but following a natural desire for immortality. The lecture tours and adoration, which can accompany such fame, are another responsibility borne stoically. In a philosophical context however it is a basic premise of Judo-Christian belief that making use of your natural talents is righteous. Whilst science would not contest this it would prefer altruism rather than individualismin the name of goodness.

As clinical scientists we need to consider making calculated judgements based on what relevant information is available. This can and does present the modern practitioner with many dilemmas. The important thing ifweare to progress as a discipline is to keep an open mind.


Cameron
Hey,what doI know?

 

Here we go again

Kevin,

I have two websites, the original one which was free and had commercials from the website host (which became very old). So I bit the bullet and enrolled in a contract for a site without commercials (and which is not free). So, to answer you question I have two websites. To recapitulate - www.mortonsfoot.com is not my website, nor is NIH.com or NASA.com or Ford.com (although I wish the last one was my website).

I find it quite curious you would ask me 'how many websites do I see insoles at' But to answer that question - N O N E

I am a researcher not a salesman. I have been approached by a lab to link my site with theirs, which would have immediately increased my hits. I reclined their kind offer, because I feel research and sales (which there is an admirable profession) do not mix. (Just my personal opinion).

Now, Kevin, why don't you lighten up and let's start talking about interesting things, like - How do you define normal pronation?

Brian R