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"Tackling the 10 Myths of Barefoot Running"

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Jan 5, 2012.

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  1. No, Bronwyn, this is not what I do. I don't sell my patients over-the-counter arch supports with color-coded plugs that fit on the plantar aspect or use the video line from the Barefoot Science lady: "So, Barefoot Science is not an orthotic is it?"......"No, it is better!"

    What a joke!:bang::butcher::boxing:
     
  2. Kenva

    Kenva Active Member

    Hi all
    I got this one a couple of weeks ago and next to the fact it started to irritate my foot on the area where the bump is, the information leaflet got me irritated even more...
    It simulates barefoot walking - now what simulates barefoot walking better then walking barefoot???
    as a practitioner, I'm in 'healthcare' not 'health business' - so i tend NOT to sell a product.
    The day you start selling an orthotic to put in your shoe and state that this is going to "de-orthoticise" your foot... i'm completely lost...
    I have to tell my patient to wear a 'nonthotic', build it up gradually - by switching the plugs, to support the foot and get it back to it's natural state...:bash:
     
  3. Blaise Dubois

    Blaise Dubois Active Member

    OK Simon,
    I will pay your beer.

    PS don't run away again next time
    See you next year;)
     
  4. Blaise Dubois

    Blaise Dubois Active Member

    Are you driving a Ferrari with the money from ASICS?

    To know how to profit from other people and lead them up the garden path, see this very good video
     
  5. BEN-HUR

    BEN-HUR Well-Known Member

    Is it now? You made some claims Bronwyn which you need to justify – that is provide answers to. Why?... well apparently I & others here are pushing a "product" that doesn't work (& can even cause harm)... is apparently inferior to your product (Barefoot Science) i.e. as it prevents muscle movement as well as weakens the foot muscles (as outlined in post 143)... I for one would like to know how & why (as asked back in post 143). Particularly when I reside in the same region the following ad was placed... I (& potentially my clients) would like to know why my practices/techniques/devices are inferior & potentially harmful to them!

    [​IMG]


    Really?!... "most can't wear orthoses..." Where do you get findings of this nature from (your clinic?)? That's certainly not my experience, & quite frankly a load of rubbish in a likely quest to substantiate your skill/knowledge/product base (or lack thereof)... at the expense of others. Tell me, what degree of expertise/knowledge is required to get a prefab off the shelf to fit a foot within a size range & then plug a desired density object underneath? Like I said before; just because you didn't have success in orthotic therapy (for whatever reason of which I won't speculate here) doesn't mean you can dish out on research testifyable techniques/practices used by others (who also would have a varying level of skill/knowledge base to each other & yourself). By all means do what you think is best but don't bad mouth other techniques/devices in the process (based on your experience)!

    Did these colleagues also bag out on orthotic therapy... say that the techniques/practices of which is of little to no use... potentially harmful even? Are you saying that an orthotic isn’t a "sensomotoric" device”? What’s your definition of sensomotoric?
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    Some of you may recall the Barefoot Science thread Ray Anthony started a few months back:

    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=73285

    I have been in touch with Patrick Malleret and true to his words he sent me 9 pair of these insoles. Patrick was interested in a fair evaluation of their insoles for common conditions we see, I obliged him fitting 8 patients (5 for plantar fasciitis, 2 for metatarslagia, 1 with midtarsal pain (cyclist) and I tried a pair myself).

    The outcome wasn't at all what their literature or Ms. Cooper would have you believe. I plan on posting the results on the original thread. I'm sure it is a good product as far as an OTC insole can be but claiming to treat specific conditions and their claims of superiority over custom foot orthoses, a medical service, needs to be addressed. It is simply not true in this small sample that I treated where 6/8 went on to customs after 3 weeks and at 6 weeks 5/6 were resolving or had resolved after being afforded CFO's.

    Ms. Cooper what is your interpretation of "proprioception" and how is the body baffled and weakened via use of an orthotic device that does not limit range of motion, muscle function etc such as a rigid cast?

    There simply is no atrophy of muscles with in-shoe devices. There simply is no diminishment in muscle function or "proprioception" with in-shoe devices and unless you can provide evidence otherwise your claims are simply unsubstantiated opinion contrary to acceptable practice.

    Even Patrick Malleret admits the claims and marketing of the Barefoot Science company prior to his tenure there is questionable:

    http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=242380&postcount=20

    Please read his comments and then tell us you are willing to stake your professional reputation and your patient's welfare on a company who freely admits their claims and marketing are flawed?

    Sincerely,
     
  7. Dear Arena gladiators,
    Well well, the heat is certainly"off" the running topic for the moment, but really where it sits is with "natural" -so called "barefoot" foot function. I note no-one has commented on my back pain patient mentioned in post of 28/3.
    To answer Kevin's question:
    1.Frequently I do not have to de-orthoticise the patient, they have done it themselves, often presenting with a bag of orthotic devices that they believe have not only not helped, but has made them worse, can't fit in shoes etc. An all too familiar story.
    If i have to restore foot function, I use whatever technique is appropriate for that patients condition. The devices all just happen to be ones that stimulate plantar sensory input, reduce peak forces activate neglected postural muscles etc. The patient at least has a choice, to proceed with treatment option or not. Almost all choose to proceed because the feel much improved at the time, shoes no longer too tight and at a fraction of custom orthoses. And they love they fact that someone can actually help them - many have been sent off by others with the sad tale "I'm sorry there nothing more I can do for you".
    Can i guarantee that all people will have there problems resloved? Of course not, but my success rate is extremely high and remember at least 50% have failed custom orthotics, repeat therapy sessions etc. At the very least these people will have improved posture and be able to walk more comfortably.

    2. Anyone who shuffles in or can't stand unsupported on one leg doesn't of course get tested. The 88 year old who can't even walk down the hallway without deviating into the wall is a classic example.Incidentally, he had a 4 week old pair of new orthoses, despite 2 other recent pairs, but this approach was never going to help this man (post TKR and months in hospital with Golden Staph post op, hip and spinal surgeries too, all since age 80, but nothing wrong with foot anatomy, just weak from not being able to walk). Otherwise i do functional muscle testing where applicable.

    3. MBT, FitFlop, Earth shoes all have research on muscle activity on websites or direct from their companies. I have one patient whose triple arthrodesis hasn't failed, but foot position is less everted after wearing these devices for years. Go figure? Even he agrees but we never photographed him prior. However, can get new X-Rays done, was about to when he got a Golden Staph in THR.
    Earth has been around since the fifties. Interestingly,"barefoot" shoes have a zero heel drop, Earth less again. Some chronic heel problems and a recent CMT patient are even better with this approach, the opposite to what we have mostly thought was the way to go. But of course I don't believe the sports shoe companies ever researched this before elevating heels from the late 60's on. I asked Dennis Janise why he thought the CMT gentleman's gait coordinationwas so much better , he saw the 3 videos. We both concurred that it was most likely the increased sensory nerve pressure under centre of arch that was accentuated by the negative heel! Patients wife said this was the first time in 20 years he walked this co-ordinated.

    4. "Good" shoe stores is just an industry term that we all use, in my case in the hope they will really become that. Too many rely on each individual shoe companies "sell". We could certainly take a leaf out of Bill Rossi's book and take a cold hard look at what shoes really do. Maybe its time to repeat the US Federal Trade Commission's enquiry into kids shoes, 1948, when not a single company could provide evidence that their therapeutic claims could be supported, BUT apply it to the sports shoe industry.

    There are 2 patient videos posted under footgear clinic on our website, with before and after videos showing immediate gait improvement that support orthotics could not have achieved. In particular, reduction of post op and post trauma swelling is not usually improved with support ortotics at one week, partly because they wear these devices in lieu of barefeet in chronic cases until pain and inflammation have susbsided. Why not take a look and send me your comments.

    I certainly apologise if people have been offended by the approach that the parent company of Barefoot Science in Canada has taken. Patrick has previously agreed to re-examine marketing materialsand will do so. We are the Australian distributors to all health professionals and as the only preformed insole system working along these lines, you might actually find you can better help many geriatric, neurological deficit patients etc.

    People seem to have forgotten that "modern "Podiatric Orthotics were developed around 40 years ago, at the very time that sports shoes began to be "medicated"(Rossi). Why in Australia is there a big trend towards advertising "soft" orthotics in phone directories? Why have almost all sports shoe companies developed a shoe that more closely resembles those of racing flats and are talking about restoring good foot function? The mid range of nearly every company is now lighter and less structured. Don't you think that tells us something?
    There will always be a place for supportive orthotics, but do not underestimate their long term effects on the majority of their wearers. Has it occurred to you they might just be interfering with balance, postural alignment for the majority. There are no studies, of course, but you could start by surveying the wearers re satisfaction and put the results out for discussion.
     
  8. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks David for highlighting the above thread; wasn't aware of it... just skimmed through it where the following is worth now noting here...

    You may want to take note of the above two quotes Bronwyn... as well as inform the ignorant individual featured in the video present in post 143 & 159.

    Why?... should we??... where is it???... was it this one (link) found in another thread posted on the 27th - not the 28th? Best next time to provide a link to some obscure piece of information you would like others to address... & naturally after you have asked them to do so :confused:. On the other hand Bronwyn, you have been specifically asked questions pertaining to your views on this topic... of which you have ignored. I suppose this in itself should tell me the answer.

    Yes, I've experienced the same scenario - so? Obviously the devices were inappropriate. In this scenario I have sometimes modified the best of the inappropriate devices or had to start from scratch & prescribe another custom orthotic... as well as prescribing complementary exercises... where issues were then resolved. However, I don't all of a sudden lose faith in what I have been taught then rubbish this treatment regime after I have found a convenient alternative. There is another Podiatrist not so far from me who has... well let’s just say, a poor conduct & poor orthotic prescription/fabrication... but I don’t rubbish the profession or orthotic therapy because of this individual.

    Hmmm... this sounds familiar... as it would to many others on here. Our role as Podiatrists & any other conscientious practitioner involved in this area of therapy is to problem solve the individual situation against what is present before us, as well as the patient's past history.

    BTW, are your devices the only ones that... "stimulate plantar sensory input"? And once again for the third time now (at least by me) please comment on these so called... "neglected postural muscles"!


    What the @#%!... don't shirk the above conduct on the above entity... you are guilty of it yourself!... as well as the individual in the above mentioned video!

    "Soft" orthotics??... what's your definition of a "soft orthotic"? Should not the more appropriate classification be referring to rigidity &/or flexibility of the device? For the record, I feel orthotics should never be rigid & block the designed intended motion of the foot. I have seen these rigid devices & disagree to their use.

    Yes, it probably should be telling us similar conclusions I discovered whilst a high school runner getting over a bout of Plantar fasciitis. I started training in racing flats at least 20 years ago... & been developing this thought ever since... which also included not succumbing to the ignorant notion that everybody else is the same as me & should be doing likewise (here is where my Podiatry education came into play later on). The sooner this “one for all, all for one” mindset is dispelled in therapy/topics of this nature – the better.
     
  9. I believe we've seen this pattern many a time. And My rt Hon colleague Mr Hur has asked this as well. But Bronwyn, you really need to be able to provide evidence for your claims!

    For Eg
    Evidence and explanation please.
    Evidence please. Preferably with a comparison to a flat bit of poron (which will also reduce peak forces) and an explanation as to how reducing plantar peak pressures dovetails with increasing plantar sensory input.

    Explanation. What is to "activate" a muscle (most muscles are already active to greater or lesser degrees), What is to neglect a muscle? And which muscles do you mean by postural muscles?
    And then, of course, evidence. Can you support the above claim with evidence?

    And for an encore, The poster says it is clinically proven to build strong feet. If the class actions against the fittness shoes (MBTs, etc) and now vibram have shown us anything, it is that one has to be careful about what one claims, especially if that claim is prefaced by "clinically proven". So by all means, what clinical evidence can you show which proves that these things "build strong feet". I'd love to know the measurement criteria you used for "strength" of feet.

    Because this is getting tiresome now, I'll be blunt. I've seen nothing here which goes any deeper than standard marketing, and I think that most of these terms are meaningless waffle which whilst it might impress the layman, is frankly laughable to me / us. You've been questioned on the above points several points in the last thread and failed to give any kind of answer, instead treating us to a rambling post of vaguely positive sounding claims and prevarications. All we want, Bronwyn, is for you to explain and justify the claims you made and the statements you've written. If you can't do that then perhaps you should stick to making them to a less informed audience who will swallow a phrase like "activating neglected muscles" without knowing what it actually MEANS.

    Oh and

    Really?! Do you actually believe that?
     
  10. David Wedemeyer

    David Wedemeyer Well-Known Member

  11. BEN-HUR

    BEN-HUR Well-Known Member

    Yes David; as far as I can see, legitimate questions is all that were asked of her - I would have thought answering these questions would serve greater purpose on this peer/academic forum than dabbling in blogs. Then again, she's pushing a product - like she has attempted to do on here, which has not only been the innersoles in question but also those so called "barefoot Shoes" :confused: of which she also sells (i.e. MBT, FitFlop, Sketchers, Hoka Oneone etc...). [why must humans have to continually find ways to shirk away from the requirement of conscious exercise... & wear unnatural shoes of this nature?... marketed to the masses. Could it be laziness, lack of discipline, lack of knowledge, wanting a quick fix... :confused:]

    Like I said before, the silence on these professionally legitimate questions should be an answer to us - she has no answer... that does not fall outside the narrow realm of a sales pitch.

    I find it ironic that her first post on here started like...

    :boohoo:

    Anyways, I'm not sure if this interesting barefoot related video has been posted on this forum as yet - worth watching...

     
    Last edited by a moderator: Sep 22, 2016
  12. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    No one has come back to answer this from the previous page:
     
  13. Blaise Dubois

    Blaise Dubois Active Member

    I'm intriguing...
    Craig can you give us your references?

    My questions :
    1. Why many people have a hard time when they move to barefoot or minimalism from BBS or supportive orthotics... Is it not because the tolerance to the stress is decreased? (Giuliani 2011, Leong UP 2011)
    2. Is the 'strength' really important or the tolerance to mechanical stress more important... the thing that people with BBS and orthotics lost?
    3. Why the integration of shoes in younger age seems to make the foot less 'actively' supported (flatten foot arches)? (Sachithanandam 1995, Rao 1992, Robbins 1987)
    4. Why the integration of minimalism (flatter or more flexible shoes) or barefoot seems to strength the foot (Bruggemann UP 2005, Potthast 2005, Robbins 1987)
    5. The BBS and the orthotics are very interesting tools to protect the body...But why so many people want use it on long term (and decrease adaptation process)... is good evidence that justifying so important medical interventions?
     
  14. David Wedemeyer

    David Wedemeyer Well-Known Member

    1. Frank Mayer et al: Effects of short-term treatment strategies over 4 weeks in Achilles tendinopathy. Br J Sports Med 2007;41:e6 doi:10.1136/bjsm.2006.031732 . The calf muscles got stronger in the orthotic group.

    2. Jung DY, Koh EK, Kwon OY. Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: A randomized controlled trial. J Back Musculoskelet Rehabil. 2011 Jan 1;24(4):225-31. The muscles got stronger in the orthotic only group.

    3. Foot orthoses use does not affect muscle strength. Craig Payne & Gerard Zammit, Department of Podiatry, School of Human Biosciences, La Trobe University, Melbourne, Australia.

    Sixteen subjects were recruited (mean age: 44.5 (±16.3); 5 male; 11 female). The mean follow up was 4.5 (±0.8) weeks. The mean plantarflexion strength of the lesser toes at baseline was 37.3 (±14.9)N and at follow-up it was 40.2 (±16.3)N (p=0.23)

    This study has shown that there was no decrease in muscle strength after the use of foot orthoses for 4 weeks, giving no reason to be concerned with unsupported statements that foot orthoses can weaken muscles.

    Sorry to interject on a question asked of you Craig but it illustrates that anyone who is honestly searching for research disproving the unsubstantiated claims of the barefoot proponents can find evidence disputing their unscientific claims. On the other hand, they have zero evidence that i have seen thus far.


    Can you please post the study for us?

    Where is the research proving there is any "loss" at all Blaise? I have given you two solid RCT's which say otherwise and the study Craig conducted and I'll be sure and look for more. Don't bother with the research, we'll do it for you amigo ;)

    Can you please post the study for us?

    Can you please post these studies for us?

    What adaptation process, adaptation to what? Some evidence is important yes Blaise, no treatment has absolute proof but many enjoy a good level of study and no outcome study has ever shown that foot orthoses do not work. None has ever shown that they weaken muscles either to my knowledge so why you feel compelled to perpetuate such mythology is beyond us?
     
  15. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I emailed them to you a few days ago!

    My real point is that so often you see and hear the statement paraphrased: "Foot orthotics weaken muscles" ...if someone is going to make a statement like that, you would assume that they have some evidence to back it up. .... in reality the evidence is the opposite, so it intrigues me why people make the claim that is the opposite of the evidence. I really want to know why people make statements that are the opposite of what the evidence says.

    Correlation is NOT causation.
    Minimalism does appear to make the foot stronger, but does that mean it was "weak" to start with? Why does minimalism make the muscles stronger? Is it because they have to work harder? Is muscles working harder a sign of an inefficient gait?
    I do not see any problem with that if that is what they want to do.
     
  16. Blaise Dubois

    Blaise Dubois Active Member

    Finally some time to answer

    * 4 weeks it's too short to know the effect on possible weakness with an intervention like orthotics. Calf is not the good muscle tested. Who believe that an orthotics will weaken the calf???

    * 8 weeks it's too short to know the effect on possible weakness with an intervention like orthotics. Even the tolerance to weight bearing is probably not decrease. Most of people can take off their orthotics after 8 weeks with no real problem. Also there is no control (group with no orthotics). The only thing that this study concluded is that exercise with orthotics is better than orthotics alone.

    Big respect for Craig.
    Again 4 weeks is a lot to short. And like Craig says some time : this is flimsy evidence to support the use of plantar orthotics and say that there is no side effect! I don't agree with the conclusion of the study : "… giving no reason to be concerned with unsupported statements that foot orthoses can weaken muscles." When we speak about possible side effect of an intervention, we need to show more clearly the safety of the intervention. A conclusion like this one will be more appropriate: "More studies with longer follow-up are needed to validate or invalided the concern that foot orthoses can weaken foot muscles on a long term process"... OR "… giving no reason to be certain that foot orthoses can weaken some specific muscles on short term."

    When you say SOLID RCT's... are you joking?
    When you say “we’ll do it for you” do you included you in the “we”? I’m just intrigued. Do you publish some articles…
    Can you answer the questions bellow?

    Are you joking again? Are you telling me that there is NO GOOD RCT’s showing that plantar orthoses doesn’t works to decrease pain or improve function? Do you really believe that all the outcome studied are always positive with this intervention (Plantar orthoses)?

    [/QUOTE]
    I think you are joking again… you are a real clown:eek: Answer my questions bellow and you will answer yours. (ref : Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials, Gordon C S Smith and Jill P Pell, BMJ 2003;327;1459-1461)

    hope you know how to find an article with the name of the author and the years of publication… in case you don’t, see the reference bellow
    *Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners Giuliani J., Masini B., Alitz C., Owens B.D. Orthopedics 2011 34:7 (e320-e323
    *The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons Sachithanandam V., Joseph B. Journal of Bone and Joint Surgery - Series B 1995 77:2 (254-257)
    *The influence of footwear on the prevalence of flat foot. A survey of 2300 children Bhaskara Rao U., Joseph B. Journal of Bone and Joint Surgery - Series B 1992 74:4 (525-527)
    *Running-related injury prevention through barefoot adaptations Robbins S.E., Hanna A.M. Medicine and Science in Sports and Exercise 1987 19:2 (148-156)

    So now… ANSWER Please
    1. Why many people have a hard time when they move to barefoot or minimalism from BBS or supportive orthotics... Is it not because the tolerance to the stress is decreased?
    2. Why the integration of minimalism (flatter or more flexible shoes) or barefoot seems to strength the foot (at large… tolerance to stress)?
    3. Why so many people want use orthotics or BBS on long term... is good evidence that justifying this medical interventions AFTER (long term) that we decrease the pain and come back to a normal function?
     
  17. Blaise Dubois

    Blaise Dubois Active Member

    I think that the term weaken the foot is use at large (and I use it). Even with no data on that, it’s clearly observed that patients decrease their tolerance to pressure, to barefoot and to less supportive shoes by the daily use of orthotics and protective cushioning shoes. Some have a really hard time to move to minimalism or to take off orthotics… some time to take a shower barefoot!

    Agree with you… just challenging to observe this in a large population. When we find correlation it’s interesting to try to find the cause… the use of shoes on the developmental stage is still a possible cause of less active support… to validate!

    Everything is relative! Someone very sedentary will be absolutely not tolerant to the “muscle stress” and won’t be able to walk 30 min without muscle pain. Maybe his non-tolerance is not a problem for him because he does nothing very demanding … he is fully functional for his lazy life… He is still, for me, “weak”. The range of capacity is so narrow, that he has a higher risk to be injured if the challenge is just a bit bigger.

    Because the muscles work harder… (and barefoot is another higher step!)… exactly the opposite that wearing a cushion supportive high heel shoe during many months. If you run with this BBS, you will still strength the foot muscles (and calf)… but not like barefoot. (But you will strength more your tibialis anterior… )

    Yes… so much harder that if you are not gradual in your transition, you will be injured… and we can predict where! Always the same tissues weaken by the wearing of the BBS (foot ant posterior leg)

    Can be… but not necessary! Some work in one place (ex: muscle in the foot and calf) can reduce the muscle work in another place (ex: tib ant and quad). Also, are you less efficient at 15k/h than at 10k/h? Some people are more efficient at 15 (cover more distance/quantity of O2 consumption), but work harder with their muscle / step.

    I think that there is BBS on the market not because people want it or feel better on it, but because the marketing has imposed to the consumer a specific type of shoes (2 years ago BBS for runners was more than 95% of the market). Who ask to have a heel lift? Who ask to have a narrow toe box? Who ask to have a stack of 20mm?
    Me too, I have no problem to let people do their own choice… if they are inform and they have a real choice... I have a problem when we influence/convince/sell stuff that is potentially harmful for a business purpose... and using the business power, without real medical/scientific value.
    :drinks
     
  18. efuller

    efuller MVP

    Blaise, Just how long do you think would be long enough? We know that we see significant atrophy in a leg that's been in a cast for 6 weeks. Now that I'm over 50, I've noticed that I can get weaker in 2 weeks if I'm inactive.

    Eric
     
  19. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    If you look at our numbers there was actually a trend to the muscles getting stronger, but it was not statistically significant, so we reported it as no change in muscle strength.

    If foot orthotics did lead to a weakening of muscles, I would have thought that a trend downwards would be apparent by 4 weeks.

    HOWEVER, we did try and do a 3 month follow-up, but could only get 6/16 to come back for more testing, so we did not report there results. HOWEVER, of those 6 subjects, their muscle strength was the same as at baseline, so again no weakening becoming apparent at 3 months ... if foot orthotics were weakening muscles, even with only 6 subjects, you would have expected to at least see a trend downwards at that time, but there was not.

    I have been trying to dig up more literature on this and having trouble as its either not been done, or I using the wrong search terms or the search terms I use are returning too many results to browse. However:
    - I have found two studies on the use of knee braces in those with knee OA - both showed an increase in strength with the use of the knee braces
    - I found one EMG study on a back brace that found no differences between using the brace and not using the brace; now I know EMG activity is not a measure of muscle strength, but they concluded that it would not have affected strength and made some confusing statements about proprioception.

    Anyone aware of any other studies on this?

    ...so its not unprecedented that "braces" and "supports" do not weaken muscles.
     
  20. Eric, the effects of immobilzation are well reported in Soderberg G.L.:Kinesiology: application to pathological motion 2nd Ed. Williams and Wilkins 1997 pp. 44-50

    I paraphrase:

    Muscle-

    2 days post immobilization - swelling of terminal cisternae of sarcoplasmic reticulum; mitochondria more electron dense.

    5 days- many Z-discs were wavy, sarcomeres distorted; I bands almost impossible to detect; fibres at proximal and distal ends show greater change than at mid belly

    4 weeks- considerable distance between contractile elements and adjacent fibres, irregularity and changes in fibre size and shape. Considerable loss of muscle mass. Z-disks distorted and located obliquely or longitudinally.

    8 weeks- z-disks randomly orientated.

    14 weeks- muscle is significantly altered in comparison to normal: disorganised with significant loss of fibre mass and decrease in dry weight.

    He goes on to discuss connective tissue, collagen, ligament and the myotendinous junction.


    But, and its a big but, these are the changes observed with complete immobilization, usually in animal subjects like dogs and cats. First it needs to be demonstrated that foot orthoses immobilize in a similar manner to these experiments- they don't. Remember, we have lots of studies which show that foot orthoses don't alter kinematics: e.g. Rodgers & Leveau, 1982; Blake and Ferguson, 1993; Brown et al, 1995; Nawoczenski et al., 1995; Nigg et al. 1997; Butler et al, 2003; Stackhouse et al, 2003; Williams et al, 2003…etc And if they are not altering kinematics, they are not immobilizing the foot! Remember too that when foot orthoses do alter kinematics the effects are typically small, with 1 or 2 degrees change being observed: Bates et al, 1979; Smith et al, 1986; Novick and Kelly, 1990; McCulloch et al, 1993; Stell & Buckley, 1998; Leung et al, 1998; Genova & Gross, 2000; Nester et al, 2001; Woodburn et al, 2003…etc It should be noted that in some cases the orthoses increased the range of motion observed, so how is this "immobilization"?

    Of note too is that when a patient is in pain, they are often unable to exercise at all, yet when their foot orthoses allow them to exercise pain-free or with much reduced pain levels, they are then able to give the musculo-skeletal system a much better "work-out".
     
  21. Blaise Dubois

    Blaise Dubois Active Member

    Hi Eric,
    Good reason to never stop to stimulate your body... :)

    It's depending how 'off' is the muscle. So Approx :
    2 weeks after neuropraxia
    3 weeks after after a really restrictive cast
    6 weeks after unused by pain
    ...

    If we want to observe muscle atrophy or strengthening with the use of BBS compare to minimalist shoes it's essential to have more time than some weeks. (Bruggemann took 5 months) for the simple reason than the foot and the muscles continue to work! But probably not as much on BBS than in minimalist shoes.

    But again the problem is not just the muscle strength! It's the tolerance to stress... including bone, fat pad, cartilage, tendon ...
     
  22. Blaise Dubois

    Blaise Dubois Active Member

    Interesting...

    for you
    2007-TheEffects of External AnkleSupportonDynamicRestraint Characteristics of the Ankle in Volleyball Players / Wendy Midgley, MS, J. Ty Hopkins, PhD, Brent Feland, PhD, David Kaiser, PhD, Gaye Merrill, MS, and Iain Hunter, PhD
     
  23. Blaise:

    I am sorry, Blaise, but your contention that a Traditional Training Flat (TTF) running shoe or foot orthoses will somehow cause a runner to "lose strength" or "lose tolerance to stress...including bone, fat pad, cartilage, tendon.." is the biggest bunch of BS that you, and the rest of the barefoot advocates, are claiming as fact on this subject.

    First of all, there is absolutely not a shred of scientific evidence that foot orthoses or TTFs will decrease foot or leg strength in a shod population. Just the act of running will strengthen the foot and legs. Just the act of healing someone's foot and/or leg pain with orthoses so that they can walk, run and play sports without pain will increase muscle strength in the foot and legs over time. Have you considered these factors also?

    In all the thousands of runners I have seen who have run in both TTFs and foot orthoses over the past 27+ years, I have yet to see a single one of these runners have what I call a "weak foot" or a "weak leg". On the contrary, runners have very strong foot and leg muscles compared to their nonathletic counterparts which makes complete sense to me from an exercise physiology standpoint. Allowing normal exercise, by using TTFs and foot orthoses, will strengthen foot and leg muscles in many people. End of story.

    In addition, as Simon said, since foot orthoses work more by altering kinetics and not kinematics, how do you figure that foot orthoses actually cause muscle atrophy or weakening? Foot orthoses may restrict abnormal motions and abnormal muscle strain but they do not restrict normal motion or normal muscle activity. Please provide evidence that foot orthoses actually "immobilize" the foot or leg also. I won't hold my breath.

    If you want to complain that foot orthoses may negatively affect the metabolic economy of running due to their added mass to the shoe, then I think you may have a valid point. But if you and the other barefoot advocates keep making these absurd assertions that foot orthoses and TTFs somehow "weaken the foot", you will be on the losing end of that argument at all times.
     
  24. Blaise Dubois

    Blaise Dubois Active Member

    What's that? Is it a BBS or a racing flat that represent less than 5% of the market running shoes? Are you turning "minimalist" advocate?

    How do you explain your statement that there is more stress fracture when some one turn minimalism? more stress? more stress didn't = stimulate tissue and increases tolerance? Do you think that a barefoot runner will have a stress fracture in the metatarsal bone by running in racing flat or BBS?

    100% agree

    100% agree... But why continues to protect the body... use these devices when my patients are pain free? If a BBS (cushioning, support, …) is a good way to decrease stress on the foot and the post part of the leg, why using it all the time?

    100% agree.
    Do you thing that your patients will be stronger or weaker than My patients running with no pain, no orthotics and racing flat shoes?

    Again I agree with you. I think that orthotics absolutely don't change the biomechanics. One more raison to don't use it on long term. But orthotics and cushion shoes work to decrease specific pressure point under the foot… a good way to protect painful structure… or to “weaken” them on long term!!!
     
  25. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I did the 1000 step run here in Melbourne (very steep hill) yesterday in my orthotics and Hoka One One's and last week I did it in my New Balance Minimus ---- from my N=1 experience on that run, as I up on my forefoot during the run, the muscles were working just as hard in both shoes ... so why would they get any weaker in the orthotic/maximalist shoe vs the minimalis shoe?
     
  26. Blaise Dubois

    Blaise Dubois Active Member

    Nice job Craig,

    My opinion:
    If your biomechanics was similar in both shoes, the difference on your muscle work was probably minimal... But you know that forefoot strikers represent less than 5% of the runners... and for most of runners, the biomechanics is not the same on this two type of shoes!

    My questions :
    - Was you as comfortable in you hoka with orthotics than your minimus? (that's personal, but having trying this type of intervention I can tell you, of me (n=1) that I'm not!)
    - Did you perform better in one shoe than the other?
    - On a long term perspective what will you recommend to your patient if he has no problem?
    - Is the "more medicalized intervention" is better than the "less" one?

    see you
     
  27. Blaise:

    I will say it again. Foot orthoses do change the biomechanics of the foot and lower extremity. The research is quite clear on this subject. Foot orthoses change both the kinetics and kinematics of running and walking gait, however the kinetic changes tend to be greater than the kinematic ones.

    I have attached a book chapter I have written on this subject for you to read at your leisure.

    How many foot orthoses have you made Blaise? Please answer this question for me.

    I have made probably over 16,000 pairs of foot orthoses over a 27+ year period. I have literally thousands of patients successfully using foot orthoses long term for 20+ years with no problems with foot and/or lower extremity weakness. In fact, if anything, they became stronger by being able to function more normally during gait and being more physically active than before they got their foot orthoses from me. I wouldn't expect you to understand how helpful foot orthoses can be for many runners and walkers since you simply haven't had the training or positive clinical experiences with prescription foot orthoses that I have had.

    Do doctors tell their patients with prescription eye glasses, "You will need to remove the glasses eventually from your face since these glasses will eventually weaken your eyes."? No. Because eye glasses improve vision and continue to do so as long as the prescription is correct.

    In much the same way, we do not tell patients to remove prescription foot orthoses from their shoes, unless they are causing pain or dysfunction, since foot orthoses continue to improve the biomechanics and function of gait as long as the orthosis prescription is correct. Like eyeglasses that improve vision long term, correctly prescribed foot orthoses improve the kinetics and kinematics of gait long term with no observable side effects. Prescription foot orthoses promote more efficient use of the muscles of the foot and lower extremity. They can reduce the stress on structural components of the foot and lower extremity that are overstressed and symptomatic. They can allow the patient to resume normal activity and even allow increased physical activity and function.

    Why would I want to take something that works so wonderfully, like a well-functioning prescription foot orthosis, out of my patient's shoes? Just because some person,who has little experience treating patients with prescription foot orthoses, erroneously guesses that they are somehow weakening feet with no scientific evidence to back up their speculation?

    Foot orthoses do not weaken feet. Foot orthoses do not weaken legs. And for you, Blaise, to suggest that foot orthoses somehow weaken feet and legs is not only pure speculation on your part, but is going against the available scientific evidence that we do have at this point in time.
     
  28. Blaise Dubois

    Blaise Dubois Active Member

    I have a hard time with that. What's clear exactly???
    1. the only study with intracortical pins done on that topics show "The biomechanical changes brought upon by corrective plantar orthoses are slight and non-systematic, sometimes opposite to the expected results." (stacoff and Nigg 2001)
    2. Read the book of Benno Nigg again
    3. the review of Craig and Andrew showed "The studies included in this review are of low methodological quality... In contrast, current evidence suggests that a reduction in the rear foot inversion moment is the most consistent kinetic effect of foot orthoses during running" (just the rear foot... just 3 studies pro quality studies included... one with inverted orthotics...)

    Thanks, will read it

    0 made (except adaptation of insole with pad, hole, ...)
    2 prescribe per year
    50 withdraw per year

    Kevin, it's nice, but it's your experience.
    I have prescribe minimalism (no orthotics, racing flat to run, barefoot running when it's possible, and minimalist who for daily life) over the last 10 years. I have literally thousands of patients successfully using minimalism. In fact, if anything, they became stronger by being able to function more normally during gait and be more physically active than before they got this recommendation from me.

    For me it's a very bad parallel...
    But I understand your position because you believe that orthotics change biomechanics, that's there is a normal biomechanics, and that YOU know what's the normal biomechanics for your patient, and that correcting this 'abnormality' will fix your patient... :wacko:

    ???:wacko:

    So reduce the stress means not stimulate this structure to adapt on long term?
    Now it's time to answer the 3 questions I asked you many time on podiatry today and here to other podiatrist...

    One of my friend is an orthopaedic surgeon. He told me that he have better result to NOT treat a shoulder impingement by a surgery (acromioplasty) than by doing it. Just simple exercises are enough. The interesting think on that is that the science just start to show that this medical intervention was not working... and you know what? Many orthopaedic surgeon continue to do it... just by personal conviction that their intervention works.
    I think it's time for many "medical interventionists" to just ask them 'WHY'... Is more really better?... Why less won't be better?

    SO...
    Someone can answer my questions?
    1. Why many people have a hard time when they move to barefoot or minimalism from BBS or supportive orthotics... Is it not because the tolerance to the stress is decreased?
    2. Why the integration of minimalism (flatter or more flexible shoes) or barefoot seems to strength the foot (at large… tolerance to stress)?

    Kevin you can also answers the 2 from Podiatry Today
    1. What the science or the clinical logic supporting the promotion and the prescription of "modern" shoes with characteristics like : more than 9 Oz, stack more than 20 mm and drop more than 7mm) for a beginner or a child (majority of the recommendations by health professionals and retailers)
    2. What are the advantages of a "light trainer" or bigger (Ex: Brooks-Adrenalin) over more minimalistic running shoes (ex: racing flats (Brooks T7) or 'so-called' minimalist footwear (Pure line of Brooks) ... or even a Five Fingers?
     
  29. David Wedemeyer

    David Wedemeyer Well-Known Member

    Blaise it does not take more than two weeks for an "immobilized" muscle to begin to atrophy and show signs of decrease in strength. This is from another PT which I believe is your formal training:

    http://www.hughston.com/hha/a_14_2_3.htm
    Loss of Muscle Strength
    Another significant problem related to immobilization is muscle atrophy, or loss of muscle strength and size, which often begins around day 10 of immobilization

    You and others make claims that footwear and orthotics "immobilize" the muscles of the lower extremity and cause weakness and then hand us zero justification. You clearly do not know what you're talking about as Simon illustrated very well, the time period reported in these studies is sufficient to cause disuse atrophy if your claims were correct. Time and again we have shown you that you are not correct and you simply refuse to acknowledge the evidence.


    No, I am not joking so if you can find flaws in any of this research point them out. I do not publish articles on barefoot running no. Is it a requirement for a clinician to publish on a subject where no meaningful debate ever takes place because one side refuses to be sensible and tell the truth? Publishing doesn't mean a whole lot when the entire subject is subjective and not widely supported.

    I'm not joking, please find some and get back to us ;)


    We' re not playing conditional statement scientific chess here Blaise. Either stick to what was asked and answer intelligently, cease calling me a clown and act like less of a child or the scientific world will see that you have nothing and are an impudent child selling fantasies.

    On this side of the border we do not call people clowns to be polite. If I disagree with you are you going to resort to name calling Blaise?


    AFTER you answer the questions and produce a shred of evidence that supports your claims. Let's not deflect and stick to the facts and research Blaise.
     
  30. Blaise Dubois

    Blaise Dubois Active Member

    Please read the other posts… you need to learn that some weakness can be develop with a lot more time… and more gradually...

    Sorry man but you need to learn what a good RCT and I have no time to coach you on that (just read the book “Cochrane Handbook for systematic Reviews of interventions / Higgins)

    OK I will give you just 2 better RCT than your 2 “solid” RCT… after that you can seach by yourself
    -A Controlled Randomized Study of the Effect of Training With Orthoses on the Incidence of Weight Bearing Induced Back Pain Among Infantry Recruits (Charles Milgrom, SPINE Volume 30, Number 3, pp 272–275)
    - Can orthotic insoles prevent lower limb overuse injuries? A randomized-controlled trial of 228 subjects (V. M. Mattila, Scand J Med Sci Sports 2011: 21: 804–808)

    Sorry to offense you. Is ‘Joker’ acceptable? It was not my goal to be not polite… but with the kind of answers and arguments you bring in the topic, I cannot take you seriously.

    You do like some others... Are you running away from my questions? Commit yourself and answer! If you don’t, I will understand that you have no answers to my questions and that you are embarrassed by the confusion this question provoke in you.
     
  31. Blaise:

    You obviously are ignorant of the scientific research showing how foot orthoses signficantly affect the biomechanics of the foot and lower extremity:






    These are all of the references I currently have time to list that clearly show the significant affect that foot orthoses have on altering the biomechanics of the foot and lower extremity and on treatment and prevention of mechanically-based pathologies of the foot and lower extremity. Since you really don't seem to have any significant clinical experience in seeing the amazing effects of properly made prescription foot orthoses on a wide variety of pathologies, I wouldn't expect you to know very much about the biomechanics of foot orthoses.

    What did you say, Blaise, foot orthoses don't affect foot and lower extremity biomechanics?

    I think it may be time for you again to refresh your memory on what the definition of biomechanics is:

    By the way, I posted my Podiatry Today answers today....should be there by tomorrow after moderation approves them...hopefully.

    http://www.podiatrytoday.com/barefoot-versus-shod-running-which-best
     
  32. Blaise Dubois

    Blaise Dubois Active Member

    Kevin,

    Are we calling this Cherry picking?

    No single study show that orthotics didn't change biomechanics?

    I did a review about orthotics and pathology and I find 60 RCT-Case series and other... (including all those you expose here ;) )

    One good example of cherry picking is your 2 studies on stress fracture. (it's one of the subject I know pretty well because I'm the principal author of the Cochrane Review on that topics.) you forget many others... some better quality saying the opposite, like the study of Gardner...

    Foot orthoses reduce incidence of stress fractures in military recruits
    - Finestone A, Giladi M, Elad H, et al: Prevention of stress fractures using custom biomechanical shoe orthoses. Clin Orth Rel Research, 360:182-190, 1999.
    - Simkin A, Leichter I, Giladi M, et al: Combined effect of foot arch structure and an orthotic devi​
    ce on stress fractures. Foot Ankle, 10:25-29, 1989

    I'm leaving in Europe tomorrow... hope I will see one (juste one) answer to my questions. You are 4 to debate with me on those questions and nobody is able to answer clearly... Is it so painful to answer to my questions? ... find that funny...

    cheers
































    These are all of the references I currently have time to list that clearly show the significant affect that foot orthoses have on altering the biomechanics of the foot and lower extremity and on treatment and prevention of mechanically-based pathologies of the foot and lower extremity. Since you really don't seem to have any significant clinical experience in seeing the amazing effects of properly made prescription foot orthoses on a wide variety of pathologies, I wouldn't expect you to know very much about the biomechanics of foot orthoses.

    What did you say, Blaise, foot orthoses don't affect foot and lower extremity biomechanics?

    I think it may be time for you again to refresh your memory on what the definition of biomechanics is:



    By the way, I posted my Podiatry Today answers today....should be there by tomorrow after moderation approves them...hopefully.

    http://www.podiatrytoday.com/barefoot-versus-shod-running-which-best[/QUOTE]
     
  33. David Wedemeyer

    David Wedemeyer Well-Known Member

    Blaise again this is your opinion. Can you provide us with the evidence to support your opinions?

    Blaise this is the second time you have insulted me, this time my intelligence. I can read and grasp research.

    Conclusions. The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.

    That’s just great Blaise. This was a study of the efficacy of foot orthoses in mechanical low back pain. I think you must be joking? This isn’t even relevant to the subject or discussion. Focus Blaise, we are discussing your assertions that foot orthoses weaken muscles. A foot orthosis probably has no effect on TMJ disorders either but saying that based on this study for LBP that they do not work is the most obtuse, straw argument I’ve read in a some time on PA.

    I could be wrong but I see this all the time. Generalizations based on healthy samples without pathology, or noted pathology to evaluate LBP, not very useful except to say that orthotics may not alleviate LBP.

    I don’t have the second study but the devices appear generic as well (The insoles were molded to the shape of the foot to provide support during physical activity – this is a support). I cannot glean what specific injury(ies) they were attempting to treat, overuse is pretty broad?

    Again, what does this have to do with the original query?

    Joking is appropriate, joker is not. I refuse to get in a name calling match with you Blaise, I’ve read your discussions with Simon Bartold and you appear to enjoy disparaging rather than debate. Not with me amigo, not playing. You were asked specific questions regarding your claims that foot orthoses (and shoes) weaken muscles and then try to turn the conversation around and obfuscate the original premise.

    Not very effective or scientific Blaise, not with people who don’t readily accept opinions as fact, I will wait for your response to the original question we have all been asking of you.

    I'm not running away Blaise, are you? I am also no insulting you, so please do not insult me again or this discussion is over.
     
  34. Blaise:

    Don't bother responding since I can see you aren't really listening to anything I am saying here. I am done for now. I have better things to do than trying hopelessly to have an intelligent conversation with you. I see now why Simon Bartold feels the way he does about you.
     
  35. Blaise Dubois

    Blaise Dubois Active Member

    Keven and David,

    I just realize that you are in Podiatry Arena to joke and have fun. Like your friend Simon Bartold you just throw name of scientific articles, ask other to provide evidence, never have reflexion on other type of practice and above all NEVER answer questions that doesn't fit in you rigid model. I was hopping to learn from you (like I did with Craig... and keven in the past) but I realize that I'm in a circle and nothing make the discussion progress and evolve. Hope you will, one day, answer to my questions, like Simon finally did when he said "yes, the traditional shoe promote and sale by ASICS prevent running injuries"

    Keven, Thanks for your answer on Podiatry Today... better dosage or argument... I just feel there is a little of politics behind your argumentation, and again you didn't clearly answer to my question. If you want to comment our blog on your "10 thing about barefoot advocate" feel free to do it http://www.therunningclinic.ca/blog...la-chaussures-moderne-modern-shoes-defenders/

    No insult, keep your good job with your patient... will do the same.:drinks
     
  36. Blaise:

    I suppose if you want to believe I am joking and having fun, then it is your right to think so. The lack of progression in discussion is not my fault. As far as politics, maybe you had better first look in the mirror before you accuse others of being political.

    No insult, keep up the good work with your patients....I always do the same.:drinks
     
  37. David Wedemeyer

    David Wedemeyer Well-Known Member

    “To spend time is to pass it in a specified manner. To waste time is to expend it thoughtlessly or carelessly. We all have time to either spend or waste and it is our decision what to do with it. But once passed, it is gone forever.”

    – Bruce Lee

    I want to thank you Blaise for reminding me of this quote. 30 minutes of my life that I cannot retrieve to spend on worthwhile people and subjects .
     
  38. toomoon

    toomoon Well-Known Member

     
  39. CraigT

    CraigT Well-Known Member

    Wow. Blaise you need to look up the word 'irony'

    You state -
    Kevin has given you a huge number of studies demonstrating either lab recorded changes or clinical changes, yet you still believe this based on -
    Which study you are talking about?
    Is it this one?-
    Stacoff, A., Reinschmidt, C., Nigg, B.M., van den Bogert, A.J., Lundberg, A., Denoth, J.
    and Stüssi, E. Effects of foot orthoses on skeletal motion during running. Cl. Biomech.
    15(1): 54-64, 2000.

    You do understand limitations of research don't you? The biomechanical changes reported are kinematics of the tibia and calcaneus. That's all. Nothing to do with kinetics. Didn't look at other parts of the foot and a single type of orthotic for all subjects etc etc...

    Now you interpret this as 'orthotics absolutely don't change the biomechanics.'

    Most of the contributors here look at this and pick up the fact that foot orthoses don't change tibial and calcaneal kinematics as much as was previously thought (remember this is over 10 years old now) and the changes are not systematic- ie: one foot orthotic design will effect different people differently (not really ground breaking if you know anything about foot biomechanics)

    I have highlighted this reference particularly, but I see most of your other references are like this- limited and with questionable interpretation. This may impress the lay person, but I for one am unimpressed. It is disappointing because you know I really think you have some good ideas.
     
  40. Blaise Dubois

    Blaise Dubois Active Member

    Sir Barettold
    Kevin Finally answers very well to my question on Podiatry Today. Thanks Kevin

    Thanks Samon to be the representative of the tribe... can you answer my questions? David Wedemeyer, Kevin Kirby, Craig Tanner didn't answer to it. Maybe they think that there is no problem to move to barefoot or minimalism from BBS or supportive orthotics (there is just the 2 cases study -Giuliani- publish on that)... I know you don't think that (you tell in Austin that it was dangerous to run all the time in minimalism), so can you answer?


    1. Why many people have a hard time when they move to barefoot or minimalism from BBS or supportive orthotics... Is it not because the tolerance to the stress is decreased?
    2. Why the integration of minimalism (flatter or more flexible shoes) or barefoot seems to strength the foot (at large… tolerance to stress)?
     
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