To get some debate going, I just posted this at Podiatry Arena:
"Foot orthoses outcomes and kinematic changes
1. We use various types of foot orthoses in clinical practice in an attempt to alter the pattern of rearfoot motion to "improve" biomechanics and make patients better.
2. Numerous outcomes studies, patient satisfaction surveys (many with methodological flaws) and RCT's show patient do get better with foot orthoses that attempt to alter the pattern of rearfoot motion.
3. The numerous kinematic studies (many with methodological flaws) are about evenly divided as to if foot orthoses do alter the pattern of rearfoot motion or not. Half show no differences in rearfoot kinematics and the other half show such small (but statistically significant) differences that the biological significance of those differences need to be questioned.
Does anyone see the paradox here? What we do clinically works, but not by trying to do what we think we are doing
In an attempt to resolve this paradox, one of our projects this year measured patient symptoms (FHSQ) at issue of foot orthoses and at 4 weeks follow up. At issue of foot orthoses, rearfoot kinematics was also measured with and without the use of the foot orthoses. Guess what we found? ---- there was no correlation between changes in the pattern of rearfoot motion and symptom reduction
This is troubling as I have spent most of my professional life trying to alter patient's pattern of rearfoot motion .... they get better, but not because of the changes in rearfoot motion
What say you? "
I don't think many people are grasping the significance of all the most recent reseach on foot orthoses, their effectiveness and how they work..... especially those with vested financial interests ;-)
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