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This month of August has left more work than expected and against my idea to avoid as far as possible brace Planting in summer, because this has been a month where I had to do more.

I have been encouraged to write this post after an investigation that I have been reading and referring to another study that did not convince me, which I agreed.

take to upload some photos of various plantar orthoses. At the end of the clinical cases presented the study cited.

In this batch of plantar orthoses and insoles (center) will present each case:

1 ° 2 on the left. 65 year old, is on holiday here for 2 months.

takes 30 years running and playing golf regularly.

6 months ago no longer run by plantar fasciitis. I derive from the physiological biomechanical study. The study

biomechanical ankle dorsiflexion seen more than 10 ° (plantar fasciitis many are given by gastrocnemius equinus, this is not the case.)

joints and muscles are within normal parameters so that the cause is due to tissue stress or a variation of up to level.

The plantar pressure is on the right foot (the affected) a delay in the diversion of forces from 2 ° to 1 finger where it increases the timing at this point, but finally launch by on 1 radio, it does so late and inefficient.

I hesitated with the material to use but I finally decided on a less aggressive treatment because if in 30 years never had problems and the change was due to something very timely, changing the gear we must be proportionality is also very aggressive.

The material used: 1.9 podiaflex resins and reinforcement max 1.3 herflux ASA AMT herflux 1.2 mm.

A small change in the right foot level with a wedge lateral forefoot forefoot valgus forefoot valgus but not for speeding up and help the diversion of cargo from lateral to medial, left unlined that area if we have to correct this wedge. In this case it was not necessary.

In 10 days of treatment the symptoms have decreased a lot, feel slight discomfort when running it takes 30 minutes and very little when you get up in the morning.

Previously I've tried using Kinesiotaping, ultrasound, electrotherapy, stretching, cryotherapy, and oral NSAIDs.

has commissioned other plantar orthoses to have 2 pairs, these new is the will of poly-lined Lunasoft 2mms SLW, on the ground still doubt whether to use 2 materials technicians to help with the reactive forces from the ground or covered at all with Luna SL. A more focused brace to run with them. (End of post information about it)

2 º Palmillas stress of 1 and 5 th metatarsal. Do not want braces to measure, so I have adapted to the shoe insole has brought me.

3 º patients who came for a chiropody and presents flexible 1, Radio dorsiflexed. Please be advised of possible consequences that may suffer long-term (mechanical back pain). Voluntarily agrees to support plant and biomechanical study. Resins

1.9 + 1.2 + 1.2 ASA-midtarsal reinforcement. Podialene and faux fur lining.

gastrosoleo Stretches for horses, hamstrings and lower back area.

Athlete 32 years he played in 2 º B football. Gained weight.

Bring 7 months in physiotherapy treatment overload the soleus (new artificial turf).

biomechanical examination is seen in lower limb asymmetry and walking with a limp in his right leg.

you mind when using soccer boots and when it takes 20 minutes of running with tennis shoes.

On examination confirmed that the soleus is not the only one affected but the pain comes back almost all of the tibial (shin splints).

with taping and neuromuscular training gets no hassle but remove regains inconvenience.

As plantar orthoses are for use with football boots need the thickness and width are minimized. I opted for a 3-mm poly-lined retrocapital podialene and heel of viscotene.

Within a week the results: no pain for 3 days of training in 1 hour and a half continuous running exercise, changes of direction, etc., with tennis shoes and plantar orthoses.

With boots on right now for mismatching between plant and shoe orthotics. However, due to previous use of plantar orthoses gets to play all the time nearing the end of it with tolerable discomfort.

plantar orthosis is reviewed and adjusts to the boot since being a little wider was slightly reversed and prevented the decline from the arc.

important to note that when making molds, a material such as poly 3-mms can not go very well adjusted but annoy. Take the pan with neutral position of the foot and pronation passively force the ASA to achieve a decrease in dynamic range.

orthoses

then the aforementioned case of 1 radio dorsiflexed:


dorsiflexed 1, radio (before siding plant)

This is a patient who has over 20 years with this iatrogenic.

is a patient living in another community so I referred to another colleague to see if you can do with this case. (Surgical)

About the study to which I referred at the beginning of the post, then hit the Abstract:

A case-series study to explore the Efficacy of foot orthoses in treating first metatarsophalangeal joint pain

Brian J Welsh1 * Anthony C Redmond2, Nachiappan Chockalingam3, Anne-

Maree Keenan2

1

Musculoskeletal and Rehabilitation Service, NHS Leeds Community Healthcare, St

Mary’s Hospital, Leeds, LS12 3QE, England

2

NIHR Leeds Musculoskeletal Biomedical Research Unit and Section of

Musculoskeletal Disease, University of Leeds, 2nd Floor, Chapel Allerton Hospital,

Leeds LS7 4SA, England

3

Faculty of Health, Staffordshire University, Stoke on Trent ST4 2DF, England

Abstract

Background

First metatarsophalangeal (MTP) joint pain is a common foot complaint which is

often considered to be a consequence of altered mechanics. Foot orthoses are often

prescribed to reduce 1st MTP joint pain with the aim of altering dorsiflexion at

propulsion. This study explores changes in 1st MTP joint pain and kinematics

following the use of foot orthoses.

Methods

The effect of modified, pre-fabricated foot orthoses (X-line) were evaluated in

thirty-two patients with 1st MTP joint pain of mechanical origin. The primary

outcome was pain measured at baseline and 24 weeks using the pain subscale of the

foot function index (FFI). In a small sub-group of patients (n = 9), the relationship

between pain and kinematic variables was explored with and without their orthoses,

using an electromagnetic motion tracking (EMT) system.

Results

A significant reduction in pain was observed between baseline (median = 48mm) and

the 24 week endpoint (median = 14.50mm, z = -4.88, p <>

analysis, we found no relationship between pain reduction and 1st MTP joint motion,

and no significant differences were found between the 1st MTP joint maximum

dorsiflexion or ankle/subtalar complex maximum eversion, with and without the

orthoses.

Conclusions

This observational study demonstrated a significant decrease in 1st MTP joint pain

associated with the use of foot orthoses. Change in pain was not shown to be

associated with 1st MTP joint dorsiflexion nor with altered ankle/subtalar complex

eversion. Further research into the effect of foot orthoses on foot function is

indicated.

All patients were prescribed pre-fabricated, foot orthoses (X-line, Healthystep,

Mossley, UK). Sagittal and frontal plane pronatory control was increased using high

density (400kg/m3) ethyl-vinyl acetate wedged posting, adhered to the medial

underside of the foot orthoses.

En el estudio conducted have found that using orthotic planting reduces the pain of the 1 st MTP joint but in the subgroup you want to associate the use of orthotics plantar and hand kinematics have found no relative changes between the motion of the metatarsophalangeal, ankle, and ASA and without plantar orthoses.

As we return to the same dilemma as always if plantar orthoses and foot work by cinematic, or rather on kinetic and sensory receptors.

the study aside, what caught my attention is the following sentence:

The

modified, prefabricated orthotic device Used in this study is of a type That Is Being

Favoured increasingly over more expensive, due to casted devices

Evidence That There May Be

little functional difference entre the two types of orthotic device

say the prefabricated orthoses in this study is of a type that is being used instead of the brace as it is cheaper and and the effects are very similar. This assertion is based on only 1 study and to which I have addressed quickly to try:

Contoured, prefabricated foot orthoses Demonstrate mechanical properties comparable to contoured, of customized foot orthoses: a plantar pressure study

Anthony C Redmond ^{1, 2} , Karl B Landorf ^{3, 4} and Anne-Maree Keenan ^{1 , 2}

¹ Section of Musculoskeletal Disease, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds LS7 4SA, UK

² NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds LS7 4SA, UK

³ Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, 3086, Australia

⁴ Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, 3086, Australia

Abstract

Background

Foot orthoses have been demonstrated to be effective in the management of a range of conditions, but there is debate as to the benefits of customised foot orthoses over less expensive, prefabricated devices.

Methods

In a randomised, cross-over trial, 15 flat-footed participants aged between 18 and 45 years were provided with semi-rigid, customised orthoses and semi-rigid, contoured, prefabricated orthoses. Pressures and forces were measured using an in-shoe system with subjects wearing shoes alone, wearing customised orthoses, and again when wearing contoured prefabricated orthoses. Two weeks acclimatisation was included between cross-over of therapy. Repeated measures ANOVA models with post-hoc, pair-wise comparisons were used to test for differences.

Results

When compared to wearing shoes alone, wearing either the customised orthoses or the prefabricated orthoses was associated with increases in force and force time integrals in the midfoot region. Peak and maximum mean pressure and pressure-time, and force-time integrals were reduced in both the medial and lateral forefoot. There were, however, no significant differences between the customised orthoses and the prefabricated orthoses at any site.

Conclusion

There was a similar change in loading with both the semi-rigid customised and the semi-rigid prefabricated orthoses when compared to the shoe alone condition. However, while customised devices offered minor differences over prefabricated orthoses in some variables, these were not statistically significant. The results suggest that there may be only minor differences in the effects on plantar pressures between the customised and the less expensive prefabricated orthoses tested in this study, however further research is warranted.

Although the differences were not significant, the customised orthoses compared to the prefabricated devices produced decreased loading at the heel by up to 12% and increased the contact area of the midfoot (44% greater contact area than control for the customised orthoses, compared with 33% for the prefabricated devices) – Figure 2 . The loading characteristics of the foot in response to both types of device, however, were comparable Both at the midfoot (0.2% to 8% difference) and forefoot (0.2% to 3.7% difference).

Sample N = 15

plantar semi rigid orthoses used for "flat feet (flat feet put in quotes because I like to use this definition as a cause)

The results are that there is little difference between orthotics and bracing manufactured having a little effect on plantar pressure as orthoses.

And these are the braces used:

	Customised orthoses	Prefabricated Orthoses
Pre-manufacture p reparation
Casting	Yes	No
Measurements for individualised prescription	Yes	No
Characteristics of the d evice
Materials	Semi-rigid, 4mm polypropylene	Semi-rigid, 4mm polypropylene
Length of the device	10-15mm proximal to the metatarsal heads	10-15mm proximal to the metatarsal heads
Width of the device	Medial border – bisection of 1 st metatarsal. Lateral border - lateral aspect of foot.	Medial border – bisection of 1 st metatarsal. Lateral border - lateral aspect of foot.
Heel cup height	Approximately 12.0 mm	A pproximately 12.0 mm
Heel post	450kg/m 3 ethyl vinyl acetate	450kg/m 3 ethyl vinyl acetate
Contoured arch area	Yes	Yes
Extrinsic heel post	Yes	Yes

Polypropylene 4 mm in both and the rest is almost all the same, possibly the only difference is the more precise adaptation as plantar orthoses.

As we used poly 4mms, something that little is done in Spain, but in countries whites as England, Australia and the U.S. is something that if used more frequently. I do not know if the cop is equal 4mms we buy here than that used in other countries .

For the conclusion I have reached is that one can not extrapolate the findings of these braces plantar to the previous case, since it is a small sample, are different diseases and treatment would be different.

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I left the article a few days kept unpublished order add some more and the truth is that studying I found something interesting to say.

Robbins and coworkers proposed that athletic shoes cause negative effects in athletes by decreasing mechanical stability and compromising normal muscular activation necessary for dissipation of impact forces. They further suggest that athletic footwear has the potential to decrease the position sense of the foot. Conversely, foot orthoses can potentially enhance postural control. A variety of studies have been performed that shed light on the mechanism by which foot orthoses can enhance neuromuscular control over the ankle.

One of the new theories of biomechanics is the neuromuscular, proprioceptive (explaining the operation of Kinesio??) Is something that has time and talking to the effects that any brace that we put in the foot, whether the material they are, and work because they get a proprioceptive effect, mechanoreceptors that will make the muscles and joints work as we should, but we do not do the templates that purpose. It is an ignorance that has been helping us but many were or are aware of it.

In studies conducted by these authors, say that the running shoe can be detrimental to the person because when it provides plenty of cushioning, decreases the mechanical stability and normal muscle activation compromises necessary to dissipate the impact forces (on this subject, muscle activation is something I read in almost every article lately and it is impressive to see how important it is and we have no knowledge about it Biomechanical considerations of the lower limb.)

What if you break cruciate ligaments of the knee? "Increased instability? ¿2 endure so tiny ligaments the immense forces they are subjected? Or rather, is that the ligaments are activating receptors that help the vast corresponding feature extensive active?

Continuing with the preceding paragraph:

also suggest that athletic footwear has the potential to diminish the sense of foot position. On the contrary, the foot orthoses can potentially improve postural control. A variety of studies have been conducted to shed light on the mechanism by which foot orthoses may improve neuromuscular control over ankle.

is important not only read but also podiatry neuroscience, physiology, engineering movement, kinesiology for physical therapists, rehabilitation physicians, chiropractors, and other publications that enrich us and give us more points of view in order to make a more valid.

OBBINS SE, Gouw GJ: Athletic footwear: unsafe due to perceptual illusions. Med Sci Sports Exerc 23: 217, 1991.

ROBBINS S, WAKED E: Balance and vertical impact in sports: role of shoe sole materials. Arch Phys Med Rehabil 78: 463, 1997

• 
  

• ROBBINS S, WAKED E, GOUW GJ, ET AL: Athletic footwear affects balance in men. Br J Sports Med 28: 117, 1994.[Abstract/Free Full Text]

• ROBBINS S, WAKED E, ALLARD P, ET AL: Foot position awareness in Young and Older Men: The Influence of footwear sole properties. J Am Geriatr Soc 45: 61, 1997.

For today I think that is enough information. A reflection I ask is that I would like to see more publications on biomechanics, quality and new issues at the national level and we always have to go abroad to catch up. And it's not enough to present clinical cases, literature reviews should be done providing conclusions from reading numerous articles (many of them accessible to people who are at great distances from a university). Now with the bachelor's degree and doctorate think it's a moral responsibility to conduct studies. At the moment it is early but in 5 to 10 years should be growing exponentially.

dejaseis I would like constructive criticism, comments, information to which access, in that you do not agree and showing why in studies (again read and give my opinion if I was wrong.) So you can make this more interactive and what we can all learn (wrong we learning) and up to date, as not only good for us but for the profession.