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Lateral wedge insoles for ankle instability

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jul 31, 2023.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Lateral wedge insoles and their use in ankle instability
    Inés Palomo-Fernández et al
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  2. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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  3. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Prescribing lateral wedges to offset ankle instability, IMO, is a misfeasance and should be construed as malpractice. The reason? It results in postural implosion (and associated musculoskeletal pain), extending into the jaw.

    This is an example of professional myopia, looking only at the ankle and ignoring what occurs distally. Anyone care to disagree?
     
  4. efuller

    efuller MVP

    No reducing the incidence of ankle sprains is not malpractice. Postural implosion is something Brian just made up. Pronation of the subtalar joint is not that scary.
     
  5. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    50 years of research and many publications say otherwise. And you are correct, I am a pioneer in this area and I have introduced many new terms.
     
  6. scotfoot

    scotfoot Well-Known Member

    Do you recommend foot/ankle strengthening exercises for chronic ankle instability?
     
  7. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Yes, it can definitely help. But will not provide a permanent solution if the ankle instability is due to either Rothbarts foot or the PreClinical Clubfoot Deformity.
     
  8. scotfoot

    scotfoot Well-Known Member

    If a person commits to exercises a couple of times a week, on an ongoing basis, why not?
     
  9. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    It depends on the primary etiology responsible for the chronic ankle instability.

    Referring to RFS or PCFD only: Both RFS and PCFD generate Gravity Drive Pronation (moderate to severe depending on the severity of RFS or PCFD). Chronic GDP that can result in chronic ankle instability. Muscle strengthening exercises (mse) will definitely ameliorate the ankle instability, if done on a consistent schedule. But mse will not eliminate the GDP resulting from either RFS or PCFD. So, if/when the mse is stopped, the ankle instability comes back with a vengeance.

    The only current method to eliminate GDP resulting from either of these two-foot structures is the protocol I developed using specific proprioceptive insoles. By Eliminating the GDP, the ankle instability automatically abates, requiring little or no strengthening exercises do so.
     
  10. scotfoot

    scotfoot Well-Known Member

    So your orthotics/insoles do not need to be worn on an ongoing basis?

    Also, if an orthotic with a Morton's extension can treat adult acquired flat foot as effectively as your proprioceptive variations ,which are specific to variations degrees of adult acquired flatfoot and cannot be used interchangeably, why would a clinician choose your insoles over the simple Morton's extension device?
     
  11. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    This varies from patient to patient, depending on many factors: severity of deformity, activity of patient, weight of patient, overall health of patient, etc.

    Morton's extension pad (mep) is prescribed to treat Morton's foot which is an entirely different foot structure than RFS or PCFS (even through many people think they are the same foot structure). I have discussed this in detail (Rothbart 2009), over 500 reads, available as a download in Researchgate. Using a mep to treat either RFS or PCFS should not be done.

    Regarding adult acquired flatfoot, this terminology has been used rather loosely (Rothbart 2009). To me it represents an observation, not a diagnosis. So you need to expand your question in order for me to answer it.

     
  12. scotfoot

    scotfoot Well-Known Member

    If I were a patient paying to get some help with my painful flat feet, and the treating physician did not tell me foot simple foot strengthening was one of the most effective treatments available, I would be pretty annoyed .

    The same would go for any foot condition I might be suffering from which research shows responds positively to strengthening exercises. IMO it is not for the clinician to decide not to tell me because he/she feels I likely wont comply.
     
  13. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I agree. However, the appropriate intervention will vary depending on the etiology of the painful flat feet. For example, if the flatfootedness is due to a complete tear of the posterior tibial tendon, no amount of strengthening exercises are not indicated. On the other hand, if the painful feet resulted from a period of prolonged bed rest due to a cardiac episode, muscle-strengthening exercises would definitely be beneficial.

    Again, I agree. But, talking about RFS or PCFD only, there has been no research publications that recommend muscle-strengthening exercises. And in my clinical experience, I have found it unnecessary to implement muscle-strengthening exercises to eliminate chronic musculoskeletal pain.

    Just a side note: In non-threatening medical conditions, my mantra is: the physician proposes, but the patient disposes.
     
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