More non-translatable foot orthotic research


I am having a bad weekend commenting on bad research. There were these two dumb studies on Homeopathy for Heel Spurs and this one on the non-existent anterior metatarsal arch. In the Clinical Biomechanics Boot Camp I really try to focus on the practical application of research, so really look for research that is translatable to clinical practice. If it’s not translatable, then what was the point of doing it? There is way too much foot orthotic research being done lately that is not translatable, wasting resources and not providing clinicians the sort of information that they need to do it better.

What brought this up for me today was this study in quite a prestigious online journal (PLoS ONE) that really tells us nothing. The only thing I get from this study is I can add it to the list of studies I use when trying to illustrate how not to do foot orthotic research.

The purpose of the study was to look at the effects of different arch heights on rearfoot and tibial motion and they found no systematic effects on eversion excursion or the range of internal tibia rotation. I have no problems with the design or analysis of this study.

What I have a problem with is the choice of foot orthotic design in the subjects used in the study:

  • all the subjects had “normal foot flexibility, ankle ROMS, normal arch height and the absence of any foot pathologies or deformities“, so are not the sort of people who would normally get foot orthotics in clinical practice. What was the point of doing that for?
  • the study focused on one design feature (arch height) and looked for generic effects of that and did not look at the effects of that design feature in the people that the design feature is designed for. What is the point of doing that for? I have no idea why. They should have tested the design feature in those who need that design feature (or subdivide the participants into those who would have that design feature indicated clinically and those that do not, so we can see if the design feature really does what we think it might do in those that do and do not need it – now that then would have been translatable research; that would have increased our understanding of the effects of different foot orthotic design features).
  • the choice of the particular design (arch height) being tested on the parameters they were looking at (rearfoot eversion and tibial rotation) is somewhat odd, as I would not have expected them to not have much effect, so why choose that to measure? A medial arch design of the types used by the authors in the study just inverts the forefoot on the rearfoot, so why would it affect the rearfoot? It probably does, but any effect of arch support design features on the rearfoot and more proximal structures has to be mediated via the midfoot joints first and how much effect they have will depend on the range of motion of those joints. The authors did not look at that or control for that. Any effect that the particular design feature has on the rearfoot or proximally will also be dependent on the location of the subtalar joint axis. Given the variability of that axis, how much of that arch support design is on the medial side of the axis? In some of the participants, the arch support would have been on the lateral side and have the opposite effect. The authors did not look at that or control for that. The windlass mechanism is an important natural way that the foot supports itself and has significant impacts on the parameters that the authors measured. If the plantar fascia was prominent in some participants, then the arch support design feature used by the authors would have interfered with the windlass mechanism. The authors did not look at that or control for that. These issues of what is the design feature for, the position of the subtalar joint axis, and the windlass mechanism would probably explain why they found no systematic effect.

The only positive I take from this study is that we need more studies that test individual design features and not just generic “foot orthotics”; those design features need to be tested on the populations that clinicians think that those design features are indicated for to see if they do what clinicians think they do. No problems testing them in populations who they are not indicated for, as long as they are compared with the populations that they are indicated for.

The above study also brings into focus about the parameter(s) that a study looks at. The above authors looked at the impact of arch support designs on rearfoot and proximal factors. What clinician with a good understanding of foot orthotics uses arch support design features to change those parameters? The study should measure the parameters that the design feature is used clinically to try and change, to see if it really does change it or not. That is translatable research.

There is no doubt that there is a divide between what researchers think is translatable foot orthotic research and what clinicians think they can use to implement into clinical practice. The clinician is the one that actually has to use it.

Wahmkow, G., Cassel, M., Mayer, F., & Baur, H. (2017). Effects of different medial arch support heights on rearfoot kinematics PLOS ONE, 12 (3) DOI: 10.1371/journal.pone.0172334

Advertisement:

SaleBestseller No. 1
Brightech LightView Pro 6 Wheel Rolling Base Magnifying Floor Lamp - Magnifier with Bright LED Light for Facials, Lash Extensions - Standing Mag Lamp for Sewing, Cross Stitch, Crafts
  • BIG, BRIGHT & DIMMABLE MAGNIFYING LIGHT TO SEE SMALL DETAILS EASILY: This magnifier lamp was designed to ease your close up focus, even with vision problems such as aging eyes or macular degeneration. This lamp includes a built in dimmer switch so you get exactly the right light. The 3" wide, diopter glass magnifying lens will magnify whatever you are working on up to 175%. The LED lights don't get hot so you can enjoy your hobbies comfortably.
  • COMFORT & EASE OF USE FOR PROFESSIONALS: HANDSFREE USE & SMOOTH ROLL EVEN ON BAD SURFACES: Free both hands to work thanks to the flexible arms and pivoting head get the light and lens right where you want it; the powerful springs then keep it in place. The 6 wheels roll easily, making it perfect for spas and salons, estheticians, dermatologists, beauticians, jewelers, tattoo artists, dentists etc. Facials lash extensions and other treatments are a cinch.
  • REVIEWS: GREAT FOR READING, SEWING, KNITTING, QUILTING, PUZZLES, CROCHET, CROSS STITCH etc: Reviewers say this light helps them enjoy hobbies by reducing eye strain and avoiding headaches. Plus they feel greater pride and achievement in as a result of more precise detail work. Beside those mentioned, soldering, painting (e.g. minis), woodworking, drawing, repair of small electronics and fly trying are other common uses.
  • REAL DIOPTER GLASS MAGNIFIES 1.75X & 20 YEAR LIFE LED LIGHTS FOR MAX DURABILITY - AVOID REPLACEMENT HASSLES - The genuine diopter glass means the lens doesn't warp with time or heat, and is also scratch resistant. So it lasts longer than cheap acrylic/plastic lenses. This model features 1.75X magnification with things in focus at a distance of 13 inches. The 9W & 800 lumen LED lights are built in and last 20,000 hours - about 20 years if you use the Brightech Lightview Pro 3 hours every day!
  • BRIGHTECH'S 3 YEAR PRODUCT WARRANTY: We proudly stand behind all of our products 100%, which is why we offer a full 3 year warranty. If your lamp has any defect or stops working within 3 years, we help you troubleshoot and/or send replacement parts or a whole new product. If any problems arise, please contact us because our number one goal is customer satisfaction.
SaleBestseller No. 2
McGlamry's Comprehensive Textbook of Foot and Ankle Surgery, Volume 1 and Volume 2
  • Used Book in Good Condition
  • Hardcover Book
  • English (Publication Language)
  • 2112 Pages - 11/17/2012 (Publication Date) - LWW (Publisher)
Bestseller No. 3
CYTING Foot Doctor Keychain The Human Foot is A Masterpiece of Engineering and A Work of Art Podiatry Keychain Graduation Gift for Podiatrist Appreciation Gift (Podiatrist Keychain)
  • 👣"The human foot is a masterpiece of engineering and a work of art" Podiatry keychain - Whether you're a Podiatrist, Podiatrist student or grad, or looking for a gift for one, this podiatrist keychain is a perfect keepsake!
  • 👣Are you looking for a fantastic gift that a Podiatrist will remember forever due to its uniqueness and thoughtfulness? Do you want an amazing looking gift dedicated to Podiatrists that will make their eyes light up as soon as they see it? A gift to a podiatrist and original gift for a surgeon.
  • 👣The podiatrist keychain is packed in a velvet bag ready for giving. This foot doctor keychain would be perfect for a podiatrist or for someone who works in a podiatrist office.
  • 👣Material👣: Stainless Steel and alloy, they are lead free and nickel free. Stainless steel is hypo allergenic, it doesn’t rust, change colour or tarnish.
  • 👣Measure👣: bar pendant: 5cm (1.97") * 1.2cm (0.47"), key ring diameter: 3cm (1.18"). A great design for yourself or your favorite Podiatrist!
SaleBestseller No. 4
The Podiatry Practice Business Solution: Everything You Need to Know to Flourish in Your Podiatry Business
  • Hardcover Book
  • Wishnie, Peter (Author)
  • English (Publication Language)
  • 174 Pages - 02/28/2020 (Publication Date) - Stonebrook Pub. (Publisher)
SaleBestseller No. 5
Mann’s Surgery of the Foot and Ankle, 2-Volume Set: Expert Consult: Online and Print (Coughlin, Surgery of the Foot and Ankle 2v Set)
  • Mosby
  • Hardcover Book
  • Saltzman MD, Charles L. (Author)
  • English (Publication Language)
  • 2336 Pages - 11/06/2013 (Publication Date) - Mosby (Publisher)
Bestseller No. 6
Podiatry Axial/Sesamoid Weight Bearing Sponge (Closed Cell)
  • Closed Cell - 13" x 8" x 4"
  • Closed Cell Sponges are made from a lightweight, radiolucent, non-porous foam. The perfect solution for any positioning need. These positioning sponges are entirely fluid resistant, easy to clean and extremely durable! Featured in a non-coated, premium charcoal grey color.
  • Closed cell sponges are 100% Radiolucent for artifact free imaging. Cleanable, fluid resistant surface. Lightweight and comfortable. Closed cell is the number one option in positioning sponges.
  • Stealth Sponges are designed with proprietary "flared" angles to offer significantly reduced artifacts during viewing. Flared sides will increase overall size. Non-Stealth Sponges are formed with traditional angles and do not feature our proprietary "flared" angles to offer significantly reduced artifacts during viewing. Non-stealth (or non-flared) sides may show artifacts when imaging, specifically when coating is applied.
  • Returns of this item can be made within ten (10) business days from delivery and are subject to a 25% restocking fee. All genuine Techno-Aide products are guaranteed for one year from the initial date of purchase for defects in material and workmanship. Proudly made in the USA and sold by a Veteran Owned Small Business.
SaleBestseller No. 7
Watkins' Manual of Foot and Ankle Medicine and Surgery
  • LWW
  • Watkins, Leon (Author)
  • English (Publication Language)
  • 732 Pages - 12/21/2016 (Publication Date) - LWW (Publisher)
SaleBestseller No. 8
Foot and Ankle Radiology
  • Hardcover Book
  • English (Publication Language)
  • 624 Pages - 12/31/2014 (Publication Date) - LWW (Publisher)
SaleBestseller No. 9
Operative Techniques in Foot and Ankle Surgery
  • Hardcover Book
  • English (Publication Language)
  • 1394 Pages - 10/19/2016 (Publication Date) - LWW (Publisher)
SaleBestseller No. 10
Professional Double Ended Nail Curette 1.5/2.5mm Dermal Ingrown Toenail Cleaner Scoop Chiropody Podiatry Tools
  • Manufactured from High Quality Medical Grade Stainless Steel
  • Nail Cleaning and Care Instruments
  • One End Has 1.5mm Scoop While the Other Has 2.5mm Cup
  • Dual-Use Tool is For Trimming Cuticles, Cleaning Fingernails and Giving Manicures Pedicure
  • Removes Non-living Tissue Around the Cuticles, Cleaning Under the Nails and Along Side Walls

I get commissions for purchases made through links on this website. As an Amazon Associate I earn from qualifying purchases

Leave a Reply

Your email address will not be published. Required fields are marked *