Tag Archives: biomechanics

How does stuff like this make it into professional journals?

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!

Please sign up for my newsletter when a new content is posted:




Craig Payne

University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad. Follow me on Twitter, Facebook and Google+

Sometimes academics do overthink things

I have to be careful what I say here as I am criticizing my professional colleagues, but …

A while back there was this a couple of studies on proximal changes in those with Achilles tendinopathy. I blogged about one of them here and the other one is here. Both studies found those with Achilles tendinopathy did have change in proximal function such as muscle activity and hip motion. Both studies did lead the author to discuss the role of the proximal structures in Achilles tendinopathy. This lead to responses in social media on how important the hip and core are and that we need to focus the treatment interventions there. This was despite that this is not what the studies showed as correlation is not causation.

Now, just today we get this systematic review on gait alterations in those with heel pain that showed that:

There was moderate to strong evidence of decreased rearfoot center of pressure duration, impulse, and peak vertical ground reaction force at loading response. In compensation there was increased contact time of the midfoot and forefoot, increased midfoot and forefoot impulse, delayed time to the mid-stance vertical ground reaction force valley, and decreased peak force at terminal stance. The only quantitative measure of pronation/supination included limited evidence of increased medial forefoot and rearfoot inversion-eversion total mobility, and medial forefoot plantar flexion.

Despite correlation ≠ causation they still managed to conclude:

The variables identified in this review may be used to assist in identifying movement-related gait dysfunction for treatment decisions

I am not sure how they could reach that conclusion as like the Achilles tendinopathy and proximal issues, those with heel pain will be walking differently because of the pain. I call that limping. It does not need to be over thought.

Phillips, A., & McClinton, S. (2016). Gait deviations associated with plantar heel pain: A systematic review Clinical Biomechanics DOI: 10.1016/j.clinbiomech.2016.12.012

Please sign up for my newsletter when a new content is posted:









Craig Payne

University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad. Follow me on Twitter, Facebook and Google+