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Pilot Study Quantifies Proprioceptive Insole

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Feb 28, 2023.

  1. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


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    In a recent article published by Romero et al (2023), using a 3mm shim underneath the 1st metatarsal head (see attached photo) decreases (in Newtons) pronation and increases supination (in Newtons).

    Their findings are almost identical to my research findings using Proprioceptive Insoles to treat RFS and PCFD.

    3mm Shim.jpg
     
  2. Rob Kidd

    Rob Kidd Well-Known Member

    The unit of Newtons is one of force. Pronation and supination are movements, in this context around joint axes and are measured in degrees. That is, as a proportion of a full circle.

    One cannot measure degrees of movements with a unit of force.
     
  3. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Agreed, but I was only referencing the paper.
     
  4. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    In the late 1990s, working with Janet Travel, I discovered what I thought was the previously unreported vertical component of Morton's foot. Later I documented (2002) this was not the case, but instead, a totally different embryological foot structure that I termed the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot).

    I devised an intervention to treat this foot deformity which basically was a shim placed underneath the 1st metatarsal, extending to and including the hallux. It proved to be a very effective intervention. The Generic insoles are being sold in thicknesses of 3.5, 6.0 and 9.0mm by a company in Tacoma Washington.

    Your paper, Effect of Morton’s Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation, attracted my attention because it parallels my findings (2004).

    Hopefully, in the near future, we can discuss this subject in more detail, possibly on this forum

    • Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
    • Rothbart BA 2004. Pressure Plate Analysis of the Medial Column Foot Insole. A Statistical Study. Online Journal of Sports Medicine (Italian), November Issue.
    Note - this communication was sent directly to the authors via ResearchGate
     
  5. scotfoot

    scotfoot Well-Known Member

    It's a mechanical intervention .
     
  6. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    My research revolves around the proprioceptive action of insoles/orthotics underneath the feet. Specifically their impact on posture globally (foot to jaw).

    Currently, most publications dealing with orthotics are mechanically based.
     
  7. scotfoot

    scotfoot Well-Known Member

    Below is the abstract of the paper in question .

    You said of this paper "Your paper, Effect of Morton’s Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation, attracted my attention because it parallels my findings (2004)."

    Are you saying that your insoles/orthotics give the same results as an orthotic with a Morton's extension? If so, why years of fuss!

    Pilot Study: Effect of Morton’s Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation


    Abstract

    This study focuses on the assessment of the mechanical effect produced by Morton’s extension as an orthopedic intervention in patients with bilateral foot pronation posture, through a variation in hindfoot and forefoot prone-supinator forces during the stance phase of gait. A quasi-experimental and transversal research was designed comparing three conditions: barefoot (A); wearing footwear with a 3 mm EVA flat insole (B); and wearing a 3 mm EVA flat insole with a 3 mm thick Morton’s extension (C), with respect to the force or time relational to the maximum time of supination or pronation of the subtalar joint (STJ) using a Bertec force plate. Morton’s extension did not show significant differences in the moment during the gait phase in which the maximum pronation force of the STJ is produced, nor in the magnitude of the force, although it decreased. The maximum force of supination increased significantly and was advanced in time. The use of Morton’s extension seems to decrease the maximum force of pronation and increase supination of the subtalar joint. As such, it could be used to improve the biomechanical effects of foot orthoses to control excessive pronation.
     
  8. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    The authors of the above paper used a 3mm vertical wedge. The insoles I designed use a supinatus wedge, the geometry is different. I have published many papers on this subject. Go on my site at Researchgate and read the papers on RFS and PCFD. If you have any questions, start a thread on RFS or PCFD and I we discuss this in more detail.
     
  9. scotfoot

    scotfoot Well-Known Member

    Brian , I know little of orthotics and thought there might be something in your devices since people do say they sometimes have a positive effect.

    However, in your first post you say "Their findings are almost identical to my research findings using Proprioceptive Insoles to treat RFS and PCFD."

    If a Morton's extension produces identical results to your "Proprioceptive Insoles " then effectively your orthotic insoles do the same job regardless of differences in geometry.

    You don't seem to have achieved anything new , not if results are near identical !
     
  10. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


    It would be arrogant of me to extol my research on proprioceptive insoles. Let posterity be the judge.
     
  11. scotfoot

    scotfoot Well-Known Member

    So you are going to stop ?

    Brian ,your research has been into a modified Morton's extension and in your first post of this thread you have confirmed that the modification is irrelevant to Morton's extension function.

    Morton's extension is regarded as being a mechanical intervention, though I suppose it may alter proprioceptive feedback significantly . In either event, it seems obvious to me that the bulk of the research you have carried out on your modified insoles is effectively about a Morton's extension used to treat progressively collapsing flat foot deformity .
     
    Last edited: Mar 5, 2023
  12. Emanuel Antunes Matos

    Emanuel Antunes Matos Welcome New Poster

    Hi to everyone, when we recomend an insole we should consider that it will have a kinetic (pressure, grf…) and kinematic (angular accelaration, velocity, torque neuromuscular effect ….), having this in consideration we shouldnt classify an insole being proprioceptive or mechanical, any structure that we place under the Feet Will have a kinetic, kinematic effect. An insole has a variaty of “intervencions” that Podiatrists apply to a specific patient with a specific pathology.
     
  13. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    What is a modified Morton's extension pad? And you have misquoted me (see above).
     
  14. scotfoot

    scotfoot Well-Known Member

    Your "proprioceptive insoles" do the same job as a plain old 3mm Morton's extension ,according to you( see post#1) .

    Also, you have finally given a clear definition of what you mean by Rothbart's foot. You said "Axial rotation of the talar head is the hallmark anatomical landmark in the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot). In Europe this deformity is termed Progressive Collapsing Foot Deformity.

    Or to accurately rephrase, Rothbart's foot=Progressive Collapsing foot deformity.
     
  15. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Start a new thread. Call it RFS vs PCFD and we can discuss this topic in detail.
     
  16. scotfoot

    scotfoot Well-Known Member

    Nothing more to be said really .
     
  17. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    To be absolutely precise, RFS (Rothbarts foot) is a milder form of the PCFD (PreClinical Clubfoot Deformity or in Europe referred to as the Progressive Collapsing foot deformity). This can be easily understood when one reviews the ontological development of the foot and I would encourage you to read Etiology of the Clubfoot Deformity, PreClinical Clubfoot Deformity and PMS (Rothbarts) foot deformity.

    That being said, it is important to understand that although RFS is a milder form of the PCFD, the proprioceptive insoles used to treat these foot deformations are dimensioned differently and are not interchangeable.

    Clarifying terminology
    • RFS = Rothbarts Foot Structure or Rothbarts foot
    • Primus Metatarsus Supinatus (PMS) = Rothbarts Foot Structure
    • PCFD = PreClinical Clubfoot Deformity or in Europe, Progressive Collapsing foot deformity
     
    Last edited: Mar 28, 2023
  18. scotfoot

    scotfoot Well-Known Member

    So
    Rothbart's foot =Progressive collapsed foot deformity
    Preclinical Clubfoot deformity = Progressive collapsing foot deformity

    Also, a Morton's extension gives the same results as your insoles when treating "Rothbart's foot" or "preclinical clubfoot deformity" but the modifications you have made to your insoles mean that two different types of insole/orthotic are required instead of the single design used by the researchers in the trial looking at Progessive Collapsing Foot Deformity.

    They used one design and got the same results you did using 2 " non interchangeable" designs . Surely Morton's design is superior to yours then, since it treats mild and more severe "Progressive Collapsing Foot deformity" giving " almost identical" results to your orthotics, but you need a diff design for different degrees of severity of PCFD.

    Anyway, as far as I am aware, the most effective way of treating pain from flat feet is muscle strengthening. Why are you stuck on less effective treatments ?
     
  19. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    In my clinical practice I found Muscle strengthening is not an effective long-term intervention when dealing with PCFD.
     
  20. scotfoot

    scotfoot Well-Known Member

    Have you ever done any research into foot strengthening exercises to reduce pain from flat feet?
     
  21. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    No, I have not. I am only expressing my opinion based on 50 years of clinical practice. The first 15 years of my practice was a mixture between foot surgery and biomechanics. (I became a Fellow in the American College of Foot Orthopaedics in 1973). The last 35 years of my practice I specialized in foot biomechanics/proprioception only.

    I worked in conjunction with a Physical Therapist and Chiropractor for many years. I even co-author papers with a P.T. and D.C. At that time, I frequently prescribed muscle strengthening exercises. Short term results were excellent, long-term results were disappointing.

    I stopped using P.T. approximately 20 years ago when I started using proprioceptive interventions which diminished the need for muscle directed interventions.

    So, IMO, muscle strengthening protocols certainly play a role in Podiatric medicine, but when dealing specifically with RFS or PCFD, they are not required for successful outcomes.
     
  22. scotfoot

    scotfoot Well-Known Member

    Foot strengthening is really about addressing the huge strength deficits caused by modern shoes. You can strengthen the foot using resistance exercises but the gains will not be maintain without a change in footwear for daily tasks .

    Exactly what aspect of footwear causes foot strength loss is open to debate but my money is on toe springs and springy soles.

    In any event if a small group of individuals with pain from flexible flat feet are prepared to do foot strengthening exercises every other day, to reduce pain, then they should be given instruction that allows them to do this.
     
  23. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I agree. If the individual is committed to a routine of muscle strengthening exercises, it can only help. My only caveat is that the patient understands that these exercises will not eliminate his structural problem (RFS or PCFD) which is the aetiology of his symptoms.

    (RFS and PCFD are common causes of weak muscles, foot to jaw, as well as poorly constructed shoes)

    Regarding shoes, I absolutely agree with you. The weak link in proprioceptive therapy are inappropriate shoes. Toes springs and spongy shoes will dramatically compromise outcomes.

    An analogy I offer gave to my patients was: No matter how well you construct your home (proprioceptive insoles), if you place it on quicksand (shoes), you will still have structural problems (continuation of symptoms).
     
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