Any publication with the title of A Novel Treatment Approach to Over-Pronation Dysfunction is going to get my attention, mostly because of the nonsensical understanding of “overpronation”. I was not disappointed and it was as bad as I expected.
Even before I got the full paper, just reading bits like this in the preview: “The literature supports a forefoot varus as the most frequent cause of over-pronation compensation. 1,2“. The two cited references did not show that and one was him quoting himself saying that. The alarm bells start going off about a lack of academic rigour and lack of critical thinking skills. A true forefoot varus (based on the textbook definition) is actually quite rare and far from being a common casue of “overpronation”.
On reviewing the full paper, the author proposes a new treatment for forefoot varus (which he has a patent on), when they don’t even know what forefoot varus really is! The author is confusing the theoretical constructs of ‘forefoot varus’ and ‘forefoot supinatus’ and really has no clue how foot orthotics even work in those two different constructs. There is certainly a lack of critical thinking skills and academic rigour in what is being written by the author (not to mentioned the editorial and peer review processes that allowed it to be published). I have written many times before (eg) about this confusion between the two and the chicken and egg situation with research that is done on one or the other or both.
I went onto great detail on the difference between the theoretical constructs of forefoot varus and forefoot supinatus here. Both present as an inverted forefoot when the lateral column is loaded and the rearfoot about neutral. Basically, the construct of forefoot varus is that it is osseous, rare, not correctable and is a cause of “overpronation”; whereas the construct of forefoot supinatus is that it is a soft tissue contracture, common, is correctable, but is the result of “overpronation”.
A simple cursory read of the paper shows that the author had no idea about forefoot supinatus (and does not even mention it) and ascribes some of the characteristics of forefoot supinatus to confuse it with what he thinks is a forefoot varus (its not). As a forefoot supinatus is a soft tissue contracture, then what he proposes can be helpful, is not new and is not novel and has been like a number of strategies that have been used for a forefoot supinatus over the years. The nature of what he is proposing will facilitate the stretching out of the soft tissue contracture as have mobilisation techniques been doing that for years. So too has the nature of the short foot exercise been restoring the “arch height” of those with a forefoot supinatus. However, all those techniques, including the one proposed by the author, will fail in a forefoot varus as it is a bony or osseous issue.
The problem with a forefoot supinatus is something is causing it. This is not acknowledged by the author, let alone understood by him. The approach advocated by the author is destined to fail in the long term unless that cause is removed. Short terms gains in arch height could be expected with what he is proposing.
The author then justifies his approach by applying the “it worked for me” logical fallacy. Seriously? In a professional journal?
At least the journal did include a response by Robert D. Phillips, DPM to what was published. My only criticism of what Daryl wrote is that he was too polite and should have ridiculed the concept.
I do acknowledge that there can be a difference of professional opinions, but in this case, this is not a case of professional opinion, but a confused superfical misunderstanding of the literature and a misunderstanding and misuse of concepts and terminology. It certainly lacks the academic rigour to be published in a professional journal.
On one hand, I am perplexed how something as confused as this can make it through the editorial and peer review process of a professional journal. On the other hand, we are talking about JAPMA who regularly publishes papers that are below an acceptable standard (see my posts here and here) and for some reason, republished the paper that was previously published in another journal (Journal of Orthopaedic Physical Therapy Practice) that from what I can tell does not even exist as a journal. There is a magazine by that name, but not a journal!
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I have been an MSK Podiatrist for 25 years , and worked for HM Royal Marines for 20 years . I’ve looked, moved and reduced (In casting process) supinatus almost daily and almost never use a forefoot varus posting which is strictly against my religion….. wait for it… Unless there is a true forefoot varus and the remaining mechanical picture so requires it.
True bony varus is indeed rare as evidenced by my daily examinations and castings over this long period.
Anyone who might try to advise you otherwise ought to be treated with total scepticism. Fake news !11