Tag Archives: biomechanics

Foot Orthotic Dosing

The concept of foot orthotic dosing is something that has been bubbling away under the surface for a long time now, but for some reason, not a lot of noise gets made about it, or when noise is made about it, tends to get dismissed by those who want to protect the way they did things.

To introduce the concept, consider this hypothetical analogy: what if a really well conducted clinical trial was done on a very low dose of an anti-hypertensive drug and it shows that the drug does not work at that dose. Should that be used as evidence that the drug is not effective? Of course it shouldn’t, but that is exactly what is done with clinical trials of foot orthoses at low doses. As the methodology and analysis of that hypothetical drug trial was sound, should it be included in the systematic reviews and meta-analyses? It will meet all the textbook criteria to be included in a systematic review and meta-analysis, but, of course, it should not be included as the dose was low. To include it would probably be unethical as it would unreasonably bias the systematic review and meta-analysis in the direction of the drug not working (unless the review stratified the study results into different doses). It makes sense to exclude that study because of the low dose. So, why then is it acceptable to do exactly that in systematic reviews and meta-analyses of foot orthoses?

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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”.

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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.

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The models, paradigms or frameworks that underpin the clinical practice of biomechanics*

Clinical practice is always going to be underpinned by models, paradigms or frameworks. Life is underpinned by such approaches, so there is no reason to assume that clinical practice isn’t as well, despite what we might believe of the role of evidence based practice. For example, in politics there has always been and always will be the left/liberal approach compared to the right/conservative approach. Models, paradigms or frameworks are really coloured lenses that we view the world through. A scientific fact may be, for example, the unemployment rate (if we accept the shortcomings of how it is actually measured). That fact will be interpreted by a left wing liberal as something bad that needs something done about it, whereas a right wing conservative probably sees it as nothing more than the markets working efficiently. So it is with clinical practice, we all have lenses that which we view the same thing through. Members of different health professions will look at the same thing differently because of the models, paradigms or frameworks that they are viewing it from. This may be as wide as the traditional ‘medical’ model vs the ‘psychosocial’ model vs the attempt to integrate them as the ‘biopsychosocial’ model.

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