​
“Obviously, I'm a huge fan of evidence, but the bulk of what we do is not and will never be evidence-based in that there’s never going to be enough randomized control trials on everything we do; to support everything we do, so then we have to start using things like theoretical coherence, biological plausibility, and most importantly with the available evidence. . .”​
Craig Payne, Podiatrist: PodChatLive Ep. 1, Dec 2017.
All podcasts are presented by Notebook LM
Summary
This conference presentation outlines a paradigm shift in foot orthotic therapy, moving from a kinematic focus (motion) to a kinetic focus (forces). The presentation challenges the long-held belief that orthotics primarily correct foot posture through arch support and motion control, arguing instead that their therapeutic effects are largely due to modifying ground reaction forces to reduce excessive stress on foot and lower limb tissues. Research is cited to support the claim that kinematic changes from orthotics are often small, unpredictable, and patient-specific. The presentation concludes by advocating for a "tissue stress" approach to orthotic prescription, emphasizing force modulation rather than positional changes. Several practitioners' methods for achieving this kinetic effect are described.
​​
Summary
This podcast is taken from part of a lecture by Ray Anthony that explores a kinetic approach to foot orthotic management of Achilles tendinopathy and other MSK pathologies of the foot and lower limb. It emphasizes understanding the forces and moments acting on the foot, particularly focusing on how ground reaction forces and orthotic design influence these forces. The text explains how modifications to foot orthoses can alter these forces to reduce stress on injured tissues, promoting healing. It highlights a shift from a kinematic (motion-based) to a kinetic (force-based) perspective in orthotic treatment, advocating for a focus on managing tissue stress rather than solely on correcting foot posture. Finally, it stresses the importance of clinician expertise in identifying the injury, understanding tissue biomechanics, and utilizing orthotic design variables to achieve the desired kinetic effects.
​​
Summary
This research study investigated the effects of standard and inverted foot orthoses on lower extremity mechanics in runners. Researchers used three-dimensional motion capture and force plate data to compare kinematic and kinetic variables at the rearfoot and knee during running with different orthotic interventions. While rearfoot eversion showed varied responses, inverted orthoses significantly reduced rearfoot inversion moments and work. Furthermore, the study observed changes in knee adduction and abduction moments with inverted orthoses. The findings suggest potential benefits and risks associated with inverted orthoses for treating running-related injuries.
Summary
This research article investigated the influence of orthotic wedges on the plantar aponeurosis, a key structure in the foot that is often implicated in plantar fasciitis. The study used cadaveric feet to measure strain in the plantar aponeurosis under various conditions with different wedge placements. The research found that wedges placed under the lateral forefoot decreased strain, suggesting this could be an effective treatment for plantar fasciitis. Conversely, medial forefoot wedges increased strain, challenging the traditional approach of using medial wedges for this condition. Hindfoot wedges alone did not significantly affect strain. These findings provide insights into how orthotic wedges can be used to control load distribution in the foot.