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Somnio Running Shoes

Discussion in 'Biomechanics, Sports and Foot orthoses' started by RobinP, Apr 5, 2010.

  1. RobinP

    RobinP Well-Known Member


    Members do not see these Ads. Sign Up.
    Does anyone have any opinions on the Somnio Runners?

    Here is the fitting process

    http://www.somniorunning.com/finding-the-perfect-fit/video-of-process

    In case I am accused of profiteering, I would like to state that I have no relationship with Somnio.

    I am curious to know if it is worthwhile advising them to my patients. Reviews so far seem to have been mediocre. Asics latest offerings seem to be generally better accepted. Criticisms centre around them being rather unforgiving. Maybe already some threads on this - I couldn't find them

    Regards

    Robin
     
  2. Griff

    Griff Moderator

    Re: Somnio Running Trainers

    I have seen a few patients who have used these (triathletes - no suprise there!). For me the jury is still out and I remain healthily skeptical. We should hold these up to the same level of critique regarding their claims as we do the barefoot community in my opinion.

    My main problem with their theory is that it seems to have 're-alignment' at its heart, and it seems to also be entrenched with other out of date concepts such as the choice of shoe based on static arch height etc.

    Jonathan Hedges of MAR systems is linked to this shoe and is a member of the forum - hopefully he will comment on this.

    Ian
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. Paulo Silva

    Paulo Silva Active Member

    Re: Somnio Running Trainers

    I have been selling Somnio's since mid January with very positive results.


    As far as I'm aware, the brand's goal for resellers (at least for Europe) is to use cinematic motion analysis software (adapted from currex's templo), to choose the shoe. Not the arch height, witch is used only tho choose the insole's height.

    My experience tells me that with the correct shoe and wedge combination we can change the runner kinematics to some extend (OK, before you all fall over me; that's what I observe = the marker's in the shoe and lower leg).

    The midsole inserts are also very useful to among others, adjust the midsole shore to the runners weight, adapting the midsole stiffness to the loading forces.


    This shoe concept is actually a development from the body geometry insoles from specialized cycling brand
     
  5. RobinP

    RobinP Well-Known Member

    Re: Somnio Running Trainers

    I agree.

    In saying that, does having greater selection of "biomechanical" control make it a more customisable option and therefore more applicable to someone with pathomechanics? i.e. is it better than having a trainer with 3 levels of control, based on a wet foot print test?

    In the hands of the right practitioner, the concept would seem to be sound. However, I have a fundemental problem with these in the same way that I have with MBT. For the right person, they can be a great success. For the wrong person, potentially disastrous and if misprescribed/misfitted, give a good product a bad name.

    Might have to get me a pair and try them out

    Regards,

    Robin
     
  6. RobinP

    RobinP Well-Known Member

    Re: Somnio Running Trainers

    Hi Paulo,

    I think you raise an interesting point about use of different shores of EVA to create motion control or limited material compression through midstance on the medial aspect of the trainer.

    Would I be correct in saying that the shore hardness of, for example, the midsole of an Asics anti pronation trainer(the grey bit) is the same for a size 4 ladies trainer (7 stone lady?) as it is for a size 13 gents trainer(15 stone bloke)?

    If this is the case then having the adjustability of midsole shore hardness offered by the Somnio seems like a great concept.

    Regards,

    Robin
     
  7. CraigT

    CraigT Well-Known Member

  8. Paulo Silva

    Paulo Silva Active Member

    Re: Somnio Running Trainers

    Hi Robin

    Actually if you look closely will see the inserts are positioned in the rearfoot on the lateral and in the forefoot in the medial aspect. Even so, you can use the different midsole inserts in combination with the insole wedges to built the better combination for each runner, eg: in the rearfoot a softer shore can be used to slow the speed of transition from initial contact to midstance (in heel striker runners), in the forefoot a harder insert con be used to extend the support.

    The key component used for support are the wedges, witch result in a smother control not "against the foot" like traditional double density or "footbridges".

    The insoles height is used as a fit issue, not support.

    In my humble opinion the system offers far better possibilities than regular running shoes, and is a good step towards having a fully customized shoe to every individual, although due to the construction method used to allow the use of the midsole inserts the shoe gains stability but result a little bulk (some how inflexible). Also the use of solid rubber outsole, and not using foam as the last construction closing, all contribute to a less responsive shoe.

    Regarding the midsole hardness of most running shoes its been said exactly what you point; they use the same material hardness from the smaller to the biggest size, I don't have data on this.
     
  9. Griff

    Griff Moderator

    Re: Somnio Running Trainers

    Paulo,

    Given what some of us have been discussing on this thread regarding surface (shoe) stiffness and its relationship with leg stiffness I am interested in the process one would go through in order to ascertain the most appropriate midsole stiffness - is it purely chosen based on body mass?

    Ian
     
  10. Paulo Silva

    Paulo Silva Active Member

    Re: Somnio Running Trainers

    Yes it is solely the body mass but...

    In my case , since I'm fitting this shoes in a podiatry clinic we choose the components after a functional assessment made by me and the podiatrist eg; many times we use the forefoot insert to try to influence the 1st ray mechanics.

    Even so, I personally see it as a working base , by trying and observing the runner in the slow motion software the initial selection is not all the times the final "prescription".
     
  11. planger

    planger Member

    Greetings All,

    I've had the opportunity to talk to the developers of Somnio and have been fit for a pair. I do not have a financial relationship with the company. I believe that footwear will continue to move toward mass customization and this is one of the earlier examples of what we will increasingly see from footwear manufacturers.

    While I have found the shoes to be comfortable and have run in them a few times, I do have some criticisms both in terms of the fitting process and the structural features. There are many issues at play here in terms of the training of the person doing the fitting to assessing kinematic changes but those are issues I'll leave for another post.

    In terms of the fit process, assessing knee alignment using the 1/3 knee bend with the laser tracking has some validity but there is no mention in the video that knee alignment is influenced not only by foot alignment but also by proximal structures especially core muscle strength/balance. If a retail running employee "corrects" a runners knee alignment because he is assuming that the foot is the source of this alignment issue when in fact it may be a weak gluteus medius then where does that leave the runner?

    Structurally, I do think that it makes sense to vary the midsole durometer based on a runners weight but who really knows the "optimal" durometer? How is running surface, running speed, footstrike pattern factored in? Also, the midsole cartridge for the forefoot is inserted from the medial aspect and does not extend all the way to the lateral aspect of the midsole. Likewise, the rearfoot cartridge is inserted from the lateral aspect and does not extend to the medial aspect. This seems odd. Curiously, there is no way to alter the durameter of the medial rearfoot or midfoot where traditional midsole motion control devices are used. Somnio does make different models of shoes one of which is a stability shoe with a dual density midsole.

    My biggeest concern with the shoe structure however has to do with the varus wedges which are used. I cannot recall the exact degrees but I believe they are available in 1, 2 or 3 degree varus posting. These are full length thin, plastic inserts that are placed under the insole. My concern is that the posting runs along the full length of the medial column - from the medial rearfoot and extending distal to the 1st mtpj. This extrinsic forefoot posting is going to affect 1st ray function but I do not hear them addressing this in the video. As we know this could cause consequences for some runners.

    I know that Nike has developed prototypes of customizable shoes with replaceable "elements" that can be changed/replaced as needed but they have not brought anything to market yet. I am not surprised that a smaller footwear manufacturer introduced this to the running community first. As mentioned above I expect we will see more and more cutomizable footwear in the near future.
     
  12. CamWhite

    CamWhite Active Member

    Somnio Shoes will be arriving at my store next week, but my staff has tested the shoes and have noticed a significant improvement in the way they feel when they run in the shoes.

    A colleague and marathon runner visited my store and I shot a short video of Tish describing her experience wearing Somnios:

     
    Last edited by a moderator: Sep 22, 2016
  13. admin

    admin Administrator Staff Member

  14. Jonathan

    Jonathan Active Member

    Hi Ian – yes I am linked to this shoe, so I won’t promote it just answer questions.

    Re wedges - - practically all manufactures have a varus correction built into the design of their shoes, some full length. This varus correction can be between 2-4 degrees and some as much as 6 degrees. Personally I think this information should be made available to all podiatrists so it can take this into consideration when prescribing an orthosis.

    Somnio do not have a varus correction and therefore neutral, if a varus correction is required one of three wedges (2, 3 or 4 degree) can be added. Obviously if you have built a varus correction into your orthosis then no wedge is required thus reducing the confusion about what the shoes varus angle is.

    You can change the density of the fore/rear foot inserts to provide addition support/cushioning depending the runner’s weight and/or foot function/timing

    Often retailers get stuck when a choosing a shoe, because ‘Shoe - X’ is good for the left and ‘Shoe -Y’ is good for the right, the Somnio concept enables you to tune a base shoe to X and Y.

    The ‘laser line-up device’ and the ‘arch-o-meter’ are purely guides; neither is used to identify the base shoe.

    Craig T – if you’re at Staffs this weekend I’ll bring you a personalised- ‘Arch-O-Meter’ for your desktop.
     
  15. Griff

    Griff Moderator

    Hi Jonathan,

    Thanks for joining in mate. I'm certain this is probably the future as Paul said.

    However I suppose the main question for me still is - how do you delineate between a 2, 3 or 4 degree wedge for an individual? What factors is this decision based on?

    Cheers

    Ian
     
  16. Jonathan

    Jonathan Active Member

    The line-up device is used.
    The customers is placed barefoot on device whilst set at zero, the laser line is pointed at the PTT running down through the 2nd MPJ. The customers is asked to conduct a 1/3rd knee bend. if the knee tracks medially then the deviced is reset at the 2 degree position - if they track along the line then we use a 2 degree wedge, if not then to go to the 3 degree etc.

    It is open to discussion and not everyone will agree with it, however it is worth remembering that the differentail varus angle between a some of the major performance running manufactures is far wider than Somnio offer, also they cannot be changed if wrong.

    Other than this I guess we will just have to use the 3-Part Stability test and put everyone in a Brooks Beast:deadhorse:
     
  17. Jonathan is there Valgus wedges as well ?
     
  18. Jonathan

    Jonathan Active Member

    No, not yet
     
  19. Griff

    Griff Moderator

    Jonathan,

    Is there any published (or unpublished) research/data on the Somnio? Anything on the reliability of the 'measuring' process? Or on the kinematic changes at the rearfoot in Somnio shoes? If so it would be great of you could share it with us.

    Cheers

    Ian
     
  20. RobinP

    RobinP Well-Known Member

    Things i think are worth mentioning - positive and negative

    1. Despite the prescription variables and assessment procedures for the Somnio being debatable, surely being able to define the wedging amount makes for a more reliable shoe/orthosis combination prescription. As Jonathan mentioned above, the variance and non disclosure of the built in wedging for brands such as Asics, Brooks, Mizuno etc means that the shoe/ orthosis combination cannot be as accurately quanified by the prescriber

    2. The fitting process gives a guide to best fit and function. However, it is not definitive. In light of the patient's feedback, the prescription can be changed. Using another brand, if the shoe proves not to be correct after 5 miles running, new trainers are required.

    3. Again, despite the assessment procedures being dubious, they can be no more dubious than a wet footprint test or full speed running analysis by a shop assistant?

    4. Somnio trainers are more of a medicaldevice than many orthoses prescribed by clinicians daily - It seems flawed that essentially a shop assistant will be given the responsibility to determine prescription/setup.

    5. In the hands of a clinician, the trainers are ideal because the give a good degree of adjustability. We are also likely to follow up and adapt the trainers based on pateint feedback. This is unlikely to be the case at a sports shop and I can see a potentially good idea getting a bad press due to incorrect fitting/understanding of the requirements

    6. Do we need to determine the difference between using the trainers for pathological and non pathological issues. If someone just wants the most suitable trainer for them and is non pathological, we need to advise based on our criteria for normalcy? If pathological, we would perhaps apply a tissue stress theory approach?

    My conclusion: I like the idea,not sure about the logistics if not being supplied by the right person

    Robin
     
  21. Paul TG

    Paul TG Member

    Somnio biomechanical analysis

    This looks an excellent well thought out analysis. With some fine tuning to add some sagittal balancing and limb symmetry analysis I believe it could revolutionise the industry and start to bring some consistency to biomechanical analysis which is sadly lacking in this field of work. For example at present there are so many different variations of biomechanical assessment which each claiming superiority. The bottom line is that there is no consistent way to check what the orthotic is doing during gait and then for the same or another practitioner be able to follow this up to check the product is still doing what you want functionally several months later. It seems practitioners just rely on whether the patient feels better or not and if they are still in pain then the orthotic might be adjusted in an educated guess approach. If it does not work the patient might see someone else and get a different product and the whole hit or miss cycle starts again.

    The only debate here would be if the Somnio assessment is credible but as this evolves it could encompass other alignment factors and be more comprehensive. In reality practitioners can only cant frontally, heel lift, offset asymmetry or increase surface area contact inside the shoe and the more the changes can be evaluated AFTER the product is supplied the better. Also this tecnique enables the shoe to be set up for the individual. Different shoes might need a different set ups to achieve the same functional result. I think practitioners often miss the fact that different shoes affect the orthotic function. So even if you have a top class product this will function differently in different shoes with a variation on performance.

    I see the future of biomechanical analysis as people having their shoes individually set up to optimise mechanical function for different lifestyle activities. It would make sense for this to start being done by retailers selling shoes. Once mechanics are optimised then from a musculoskletal medicine perspective symptoms can be treated if better alignment alone does not solve the problem. This is really what is being done already by Podiatrists etc but in a very inconsistent way.

    If I go for an eye test I expect any optician to give me pretty much the same glasses prescription. This is what is needed in biomechanics and it will be interesting to see who will actually be providing this service in the future. Does it have to be a Doctor, Podiatrist or physio etc who does this or could a retail person do this just as well. This is not about a medical diagnosis, just simply adjusting the body in an engineering way with consistency.

    Good luck to Somnio for starting the ball rolling commercially, they might just be the Microsoft of the biomechanics world of the future.

    Paul
     
  22. David Smith

    David Smith Well-Known Member

    Re: Somnio biomechanical analysis

    Paul

    I’m going to assume that that you are connected with Somnio promotion in some way. If your not then read on as you need enlightenment.

    Somnio look like great shoes for running but the 'biomechanics' pitch is really just that, a pitch for people who don't understand biomechanics by people who understand that people don't understand biomechanics.

    You wrote

    It's not - end of :rolleyes:

    Somnio's web site is based on old basic flawed principles wrapped up as new perfect paradigmn.


    Really! All that study on forces and moments and material properties and foot function etc, all the stuff that I learned at uni, was just wasted, blimey if only you had come along earlier eh!

    Basically your constructing your own axiom of biomechanical principles and then fulfilling it. Sounds a very familiar ploy.

    And other biomechanical systems do not? Somnio's only address arch height, sole durameter for shock attenuation (in a completely rubbish way) and medial heel wedging. How individual can that be if by individual you mean custom or bespoke.

    You (or someone from Somnio) play on the well worn axioms that ‘new is better than old’, ‘pronation is bad’, ‘it's all about alignment'. They use the usual straw man argument to point out the shortcomings of the ‘old’ (implying outdated and useless) biomechanical intervention and so imply that their system does not suffer from this although they do not specify how or why.

    You, one the one hand , favourably compare your shoe additions to custom orthotic designs and on the other imply that traditional custom orthoses do not achieve their purpose, further implying that you shoe additions can, but you don’t say how or give any reasonable evidence to support any of these claims.

    Then they do the, use terminology to baffle with B-llsh-t ploy, intrinsic, extrinsic, direct, indirect, Pronation (of course pronation because pronation is bad and we must get rid of it at all costs) archometers (you nicked that one from Robert Isaacs) and laser alignment (a torch on a stick).

    You wrote
    So what are you doing, you’re putting a medial heel wedge in a shoe adjusting the arch height and adding some padding, that’s it! Is that really revolutionary or NEW? I don't think so. It may be consistent but so what, I can consistently nail my foot to a brick but it won’t do my running any good.

    You wrote
    Doh! Doh! Doh! Doh!:bang: Doh!:bang:

    So what are you saying? - as long as the alignment is correct by your criteria then you take no notice of patient symptoms and never adjust an orthotic, presumably because with the perfectly consistent system you never get it wrong!! PMSL. By what criteria do gauge a successful intervention.

    From Somnio web site
    And yet they focus on form – is this your philosophy function follows form?

    From your web site
    So you assess the running using a static assessment of a squat???:bash: If you want to assess the typical running why not assess a person running typically.

    You wrote
    How does Somnio do this then? and why can Somnio do this better than anyone else?

    You wrote
    Oh yeah great philosophy FOR SOMEONE PROMOTING SELLING INSOLES VIA SHOE SHOPS. How does a shoes sales person know when our mechanics are optimised.
    Do the mechanics dance down the street singing you can't get better than a Kwik Fit Fitter (UK joke and a bit convoluted at that) Optimise your mechanic with Somnio.
    MRI at McDonalds. Dentistry at the Cake shop, diabetes checks by Tate and Lyle.
    :craig:


    Don’t get me wrong Paul, sometimes alignment and pronation and cushioning are valid consideration in biomechanical intervention and design. However, Somnio's claim that their one design (with variation in parameters) ‘one size fits all’ solution is the very best a runner can get. That is a completely preposterous claim, absurd and irrational and illogical and just humbug..

    Somnio's assessment and design paradigm falls down at every hurdle, either they know nothing about the subject or, as I suspect, they are knowledgeable but just using flimflam and trickery to sell a product.

    All the best Dave:rolleyes:
     
  23. Re: Somnio biomechanical analysis

    Well said that MAN. That was 1st idea on reading Pauls post, he works for or sells lots of Somnio shoes for a living.
     
  24. Personally, I'm enjoying the use of the word "flimflam".
     
  25. David Smith

    David Smith Well-Known Member

    Simon, Michael

    Yeah Flimflam, its got a nice feel to it eh!

    Not really attacking the shoe and the modular intervention design in itself. This is a neat idea when used by the right qualified person. I'm thinking of having a high street practice with a specialist shoe department. I would sell these Somnia shoes but supply them using the experience and knowledge I have. What I don't like is the assertion that this is the answer to all running problems and any one with a few hours training (or not perhaps) can get great results with no risk or come backs.

    Here is just one scenario that doesn't fit the model.

    Forefoot strike runner, equinus forefoot and ankle, stands RCSP with max pronated STJ and has very weak hip abductors. Fore foot valgus. 1st ray / mpj low and stiff to GRF.

    What prescription will he get when assessed from a standing single leg squat using laser alignment to assess knee position? Will it address the inversion sprains he gets when he is running and stands on a small stone?

    Cheers Dave
     
  26. CamWhite

    CamWhite Active Member

    Somnio shoes just arrived at my shoe store in Austin, TX. Here is my "un-scientific" impression of the brand thus far.

    Out of the box , the shoes are lightweight, cushioned and very comfortable. Nice secure fit.

    The laser alignment system provided a better "guide" to fitting the shoes. Once I "tuned" the shoes, based on the fitting tool, the shoes felt noticeably better. Next, I experimented with the different durometers of heel and forefoot cushioning and found the combination that felt perfect. I charted that configuration.

    Next, I played with a wide variety of insoles, cushioning and varus wedges. There was a noticeable difference in the "feel" of each configuration.

    Early conclusions:

    1. The fitting process requires a commitment to customer service and customer satisfaction. Patience is required, but the end result can be very satisfying.

    2. This shoe will only be carried/adopted by retailers committed to customer satisfaction. I suspect most retailers will have a strong pedorthic focus. Most running shoe stores measure success by the number of shoes the "sell" on an hourly basis. They don't have the time or the training to perform a "boutique" fitting experience.

    3. Any configuration of the shoe can be "re-configured" if the wearer isn't completely comfortable. Once again this requires customer service, and the willingness to stand behind your work.

    My staff has been wearing their Somnios for just over a month and rave about them. I just got mine yesterday and I'm very impressed. Most importantly, almost every person I have contacted swear by them, and many have noticed a marked decrease in running pain.

    In the almost complete absence of negative feedback from actual wearers, I am optimistic about the potential of this brand. Once the company is really up and running, then the funding may be in place for independent, peer-reviewed studies.

    I think the term flim-flammery isn't warranted at his time. That term is usually appropriate when a product is hyped, and woefully under-delivers on its claims (i.e. Gravity Defyer shoes).
     
  27. David Smith

    David Smith Well-Known Member



    Cam

    There are two different agendas here

    1) The shoe as a sports shoe that is comfortable and adjustable and can help some runners - Great

    2) The shoe as a customised orthotic that replaces "old outdated technology " in the form of bespoke orthoses that are prescribed after in depth biomechanical assessment using well established and researched methodology. - Flimflam

    Cheers Dave
     
  28. CamWhite

    CamWhite Active Member

    I don't think Somnio's intent is to debunk custom orthoses from highly trained practitioners. I have met and spoken in depth with Somnio's president on several occasions, and I do not get the sense that he is trying to discredit your profession.

    Most runners we see are a stubborn bunch. They want instant gratification at a low cost. They follow current trends (barefoot running) and follow the hype like lemmings. If the Somnio shoe can help them run with less pain, it's a far better solution.

    Once again, it's early but I am cautiously optimistic. I am also very curious to see how the variable cushioning of Somnio shoes will work in conjunction with functional orthoses cast for runners.

    A big positive for these shoes is that they are completely neutral out of the box. There is no degree of varus midsole posting. So it might be possible that these shoes could work very well with custom prescribed orthoses. The variable cushioning could make the difference depending on the runner's weight, running surfaces and other considerations.
     
    Last edited: Apr 28, 2010
  29. David Smith

    David Smith Well-Known Member

    Cam

    Regards Dave
     
  30. Are runners any different than, say, a blue-collar worker with chronic plantar heel pain? Are runners any more "stubborn" than less athletic individuals? Do runners want "instant gratification at a low cost" any more than less athletic individuals?

    Who do you think is more likely to do calf stretching exercises three times a day for their foot/lower extremity problem? A runner or a less athletic individual?
     
  31. CamWhite

    CamWhite Active Member

    I apologize for the gross over-generalization of the running community. Of course there are runners that pay excellent attention to their running style, their gait, their footwear selection and everything related to their passion. They monitor their routines, stretch and are extremely body aware. Sadly, I don't see many of these people.
     
  32. David Smith

    David Smith Well-Known Member

    Kevin

    In general I have to agree with Cam, runners as distinct from any other sports are difficult to deal with. I have on my past list of customers, long distance walkers and golfers and rugby and football players and ramblers but the runners are, most times, the most difficult.

    They want instant results and do not want to rest, they want it cheap, they know everything there is to know about their running biomechanics and how they think it should be and what type of orthoses they need. They are impressed by flash advertising b-llsh-t and don't want to listen to good advice by someone that may actually know something useful. They will buy 10 pairs of shoes, at £100 a pair, that promise reduced pronation and increased performance (even tho they still have the same problem) but baulk at the idea of spending under £300 on some orthoses and a treatment / therapeutic / rehab program. Plus they nearly always have Princess and the Pea syndrome. And when they do get better more often than not they put it down to some other thing that they did or bought from the local chemist or shoes shop.


    Obviously, by your comments, you do not have this experience with the running community, this may of course be my problem of perception and approach and expectation. It might also be that you are more trusted as a well known runner in your area. Your customers/patients probably think that since you are an enthusiastic runner that you will understand their running problems all the more and so trust your professional qualifications and judgement all the more. This makes sense of course but we can't all be high profile running athletes. If judo Karate and MMA players needed footwear to improve performance then I dare say they would beat path to my door. Shame;)

    Perhaps someone could run a course 'The psychology of treating running athletes' there's probably a lot to learn.

    This is where Somnio's and most other sports shoe manufacturer's philosophy scores high, they address the 'common knowledge' that is entrenched in the running brain of the everyday athlete that is commonly seen at a sports shoe shop - i.e. Pronation bad, alignment good, knee control essential, I need just the right type of cushioning to suit me, New flash gimmicks, revolutionary, guaranteed, expensive enough to prove how good they are. I need New shoes to go faster for longer. I know everything so give me what I know I need. Show me that I am right by confirming it with machines that go ping and technology I don't understand but pretend I do and then some.

    Does that sound jaded? :empathy:


    Regards Dave
     
  33. David Smith

    David Smith Well-Known Member

    Oh yeah here's a typical case

    Yesterday a woman, who runs to keep fit, came to book an appointment. She had a left knee pain and thought it was because her feet rolled in ad misaligned her knee. She thought she had tracking problems. Then she said "do you use orthoses"? "Yes"sez I, "Oooh"sez she, - "is that a problem" sez I, noting the face and tone of voice. "well I've had orthoses before and they made my knee worse" I explained I was a podiatrist and that the foot was my area of focus and orthoses were commonly used to address problems arising from its dysfunction. "Your last orthoses may have not been the right prescription" She avoided answering the question about where they came from and who made them.

    "Ah! she said, "only I've been told to avoid orthoses as they don't do any good"
    I also used other modalities such as mobilisation and stretching and strengthening exercises, strapping and supports etc. "Your first assessment is free of charge so if you don't like what I say or reccommend then you have no obligation". "OK" "Have you seen a Physio or GP or any other medical specialist"? "No" "Who told you that orthoses do no good then"? "Oh just some people".

    Who were these people? the milkman, the next door neighbour who she goes running with, the taxi driver, because of course they all will know better than I do about her biomechanical problems.:cool:.

    "I just need something that will realign my knee and improve the tracking, orthoses don't do that properly"

    See she know everything about her condition and is completely blind to the blatant contradiction in her argument. That is the typical prejudice that we - or at least me and Cam have to deal with.

    Why did she come to me? she already knows what is wrong, she has no idea how to fix it yet she knows its caused by her feet rolling in and yet orthoses can't improve this??? Perhaps I can refer back to paragraph 5 of my last post here. :rolleyes:

    Cheers dave
     
  34. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I think it was George Sheehan (and those who have been aroound sport podiatry for a zillion years know who he was) once said something like, runners are like the farmers who want to pull up their carrots to see if they are growing ... think about it
     
  35. Paul TG

    Paul TG Member

    Dave

    Quote:
    In reality practitioners can only cant frontally, heel lift, offset asymmetry or increase surface area contact inside the shoe

    Really! All that study on forces and moments and material properties and foot function etc, all the stuff that I learned at uni, was just wasted, blimey if only you had come along earlier eh!

    How will all the stuff you acquired from college change what you can physically do to forces within the shoe? All mechanical treatment does is alter forces in the way the practitioners hopes will help symptoms and not cause additional symptoms. It would appear that biomechanical treatments performed by Podiatrists whatever theory they are based on can only be physically manifest as I have stated above.

    Different variations of these prescriptions will affect forces differently and different shoes will also affect the orthotic prescription. This means that ideally the shoe should be set up by the practitioner in whatever way they decide is best to influence force positively for an improvement in symptoms or some form of increased mechanical efficiency to improve performance perhaps. These would be the 2 most common reasons for a practitioner to alter force.

    There is no scientific evidence that one approach is better than another but some things such as frontal plane wedging and heel lifts seem to be accepted as being able to reduce symptoms in certain clinical scenarios. The Somnio approach just takes one of these and applies consistency to try and ensure that any positive result can be repeated with some level of predictability. Of course there are other factors relevant which is why I mentioned that the system needs refinement.

    No matter how much engineering theory and mathematical modeling you do I bet you treat your patients with the orthotic interventions I have suggested and there are limits as to how much you will be able to fit into the shoe or to adapt a shoe.


    Regarding custom orthotics – there is no evidence that these are better than over the counter products. Vasyli has several research papers on his products that are consistent with any custom products of a similar genre. All casted products do in my view is provide a better foot orthotic interface which might help with initial comfort but the functional elements will still be some form of frontal or sagittal plane correction. Dananberg’s sagittal plane cut out is just a hole!


    So what are you saying? - as long as the alignment is correct by your criteria then you take no notice of patient symptoms and never adjust an orthotic, presumably because with the perfectly consistent system you never get it wrong!! PMSL. By what criteria do gauge a successful intervention

    What I am saying is that biomechanics needs to look at optomising mechanical efficiency for the individual in their chosen activity. This might be different for running versus football for example. When a car wheels are aligned there is a constant to work with as a baseline and we need this for the human body taking into consideration the anatomical and physiological variations that exist. Some people are clearly going to be more naturally mechanically efficient than others and some will find certain activites highlight flaws. Some people are mechanical wrecks but don’t do much activty and don’t suffer aches and pains. A high level athlete might have a minor problem and this could be significant for them.

    I don’t think Somnio are making any claims apart from just trying to obtain repeatability in altering one mechanical parameter and letting the user judge the result subjectively. Obviously not all aches and pains will respond this way and practitioners working in this field will have more to offer by tweaking things personally for the patient based on their experience and understanding. BUT – this is very variable. You could personally prescribe an orthotic and unless we have a universal way of evaluating it I could not know what your product is doing to the patient. This is a really big flaw with clinical biomechanics.


    I don’t think there is any flim flam with Somnio but clearly they are starting to encroach on clinical practice and that will scare some people.

    Practitioners all seem to use some basic guidelines when treating musculoskletal problems involving adjusting biomechanics. Most focus on stopping extremes of motion. I agree about the overpronation thing but just what is overpronation? It might be relevant for a person when they run but not walk, relevant at 10 miles regarding accumulation of forces but not symtomatic at 5 miles etc etc.

    I have no connection to Somnio at all but I think biomechanics lends itself well to retail shoe sales. MBT is just a rocker sole with a soft heel and the sales volumes and subjective outcomes have been good. The research is not great but most people will probably see that the key element is the rocker sole so its great for propulsion inadequacies etc.

    Podiatrists, especially in the UK are quite new to musculoskletal medicine and the postings here clearly show there are many people practicing who are very inexperienced. In the Uk I believe that many cannot even order or interpret diagnostic imaging which clearly is a big problem regarding diagnostic ability. With regards biomechanical assessment there is no one agreed universal method and the practice is based purely on experience with the end result being that the patient is given some variation of my initial statement of this post.

    You may be critical of Somnio and accuse them of wanting to sell more shoes but what is wrong with this? Companies such as ASICS offer some minor frontal plane velocity correction and gel cushioning and another company some other variation on a theme and market enthusiastically to sell their shoes.

    The future of performance footwear is likely to start with some self customisation – reading glasses are already like that and then custom set ups with trained technicians will follow. There will still be a need for experienced Podiatrists etc but a retail system that offers repeatability and good subjective outcomes is better than what many Podiatrists are currently offering. I believe that companies like Somnio are the start of this process. Once Nike catch on and there is real cash behind this things will quickly pick up.

    Regards

    Paul
     
  36. Paul TG

    Paul TG Member

    There will be plenty of people like this and you will have to hope your experience is enough to get them better because no matter how much talk you have the bottom line for the patient will be the outcome. If you don't fix it another practitioner might be able to with a variation on a theme of your approach. Of course she might not have a mechanical problem but if there was a credible human body alingment method like a car wheel alignment at least you could take the mechanics out of the equation if it was optimised and the patient still symptomatic. The curent situation is that you have to hope your biomechanics experience is adequate - whats that phrase 'an orthotic never fails, it just needs adjusting'!

    Regards

    Paul
     
  37. Dave:

    I think it makes a huge difference for me in dealing with runners when compared to the average podiatrist in the average community because:

    1. I was, at one time, a fairly competitive distance runner (2:28 marathon PR).

    2. I practice in the same city where I grew up and where I ran many of my competitive races.

    3. I have been doing a free-screening clinic once a month since 1986 for runners at the best running shoe store in Northern California here in Sacramento. This shoe store tells the runners that I am "the" podiatrist to see for running injuries and orthoses.

    4. I have been in practice in Sacramento now for 25 years and many of my former patients tell other runners that I am "the" podiatrist to see for their running injuries.

    So by the time a runner sees me, 2/3rds of them have heard about me from someone else, and very few of them were as fast as I was in distance running. Therefore, when they tell me something that is wrong or is BS, I tell them so, and they generally believe me. It wasn't always like this for me in my early years of practice, but I have worked hard to get to this point in my practice. The main reason I initially got into podiatry in the first place was due to my interest and injuries in distance running.

    How many years have you been a distance runner and treating distance running injuries, Dave? From reading your somewhat negative posts on treating runners, is may be time to start doing some running and reading running magazines if you want to understand what runners are all about. If you aren't interested in the plight of runners, then the runners will sense this and will tell their other runner friends that you don't seem interested or knowledgeable so they won't recommend their runner-friends seeing you for their injuries. However, if you are interested and compassionate to their plight, then the runners will sense this and will tell their other runner-friends that you do seem interested, you do understand their problems and you are knowledgeable so they will recommend their runner-friends to see you, instead of anyone else, for their injuries. It is really as simple as that.

    By the way, most podiatrists don't need a course on the psychology of treating runners. The psychology is easy. Just imagine not being able to do an activity that makes you happier, more fit, less stressed, and healthier because of an injury and what you would do to keep doing this activity that makes you more happy, more fit, less stressed and healthier? Would you want to go to just an average doctor? No. You would want to go to the best in your area so that you aren't wasting your valuable money and time.

    What most podiatrists do need to more effectively treat runners are courses on the training habits, training philosophies, racing habits, racing philosophies, running biomechanics, running injuries, and injury prevention techniques of distance runners, in addition to a course on the history of running shoes and on running shoe biomechanics...that's all.;)
     
  38. :D:D:D:D;)
    When does one become experienced? After listening to Jimi?
     
  39. Paul just intersted what is your background?
     
  40. David Smith

    David Smith Well-Known Member

    Regards Dave Smith
     
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