First the Orthotic then came the Non-Orthotic!

ByStuart Gordon | 19 February, 2020

First the Orthotic then came the Non-Orthotic!
– Reasons Why Insole Choice Matters

Does this sound familiar…

A runner returns to clinic suffering with for instance, a persistent Achilles tendon injury bringing with them an array of insoles acquired over several years for you to critique and advise upon. This selection of off the shelf and bespoke orthotics have been worn pair by pair and now have been given up on, leaving you with a clinical conundrum.

• What do you prescribe as an adjunct to your treatment protocols and modalities?

• Do you suggest reintroduction of any of these or do you consider an alternative?

• Did the previous insoles or orthotics address the root cause of injury?

• How can you review your insole approach and are there new options to    investigate?

• Is there a valid way forward that’s both safe and immediately effective?

 

To this final question the answer is yes, there is… but this may well mean completely rethinking your approach to feet and insole prescription and consider an insole that provides progressive plantar surface proprioceptive stimulation that naturally and gradually improves the foots ability to better manage previously damaging tissue stresses.

An image of Barefoot Science Active range of insoles

Enter Barefoot Science insoles, a device that is proven to stimulate proprioception, improve balance, and in many cases is immediately capable of reducing supination resistance, first described by Kirby & Green in 1992 (1). This effective return of the foot from its pronated state at ground force reaction to a more supinated orientation ready for push off is often complimented by a rapid reorganisation of the appropriate sequencing of medial and lateral rotation of the tibia and femur in the gait cycle. The suggestion being that enhanced proprioceptive stimulus will provide the necessary spatial information not just at the sub-talar joint axis but throughout the whole chain of movement. Without the neural stimulus to re-supinate, the foot stays in its pronated position or becomes excessively pronated thus adversely affecting alignment and movement patterns.

Somatosensory information arising from the plantar surface of the foot has an important role in terms of postural awareness and balance, along with visual and vestibular cues. The application of thin plantar inserts appears to have different effects according to the location and duration of stimulation, with the suggestion being that prolonged use of exteroceptive plantar stimulation and the central location of plantar inserts may have a role in reshaping postural control (2).

The concept of neuromuscular stimulation using exteroceptive specific insoles to alter function, form and postural control is nothing new, and according to some of the many research papers the greatest effects are produced when the stimulus is centrally placed and maintained over time.

Research has also shown other fascinating outcomes by such centrally placed thin plantar inserts with improvements in postural control and modified vergence amplitudes (3). Furthermore, evidence-based studies using spatio-temporal analysis systems such as Optogait are now consistently demonstrating the ability of BFS insoles to progressively promote a return to left-right side symmetry of movement and contribute to increased cognitive speed of processing.

In the absence of sophisticated equipment a simple movement assessment and an incline board can provide valuable information on ground force reaction as well as balance, proprioception and stability before and after the introduction of a foot device.

Orthotics can be a very costly outlay for patients and to find that a device is ineffective, limited in its fitting versatility or worse still is contributing to non-resolution or deterioration of symptoms is as frustrating for therapists as it is to patients like our runner with persistent Achilles tendon issues.

So, does this help with your clinical decision making?

Are you ready to consider a change in insole design philosophy that provides an affordable yet innovative, versatile and comfortable insole that, instead of arbitrarily altering angles at the heel and/or forefoot, uses a mid-arch dome to progressively and incrementally stimulate receptors of the feet?

Is this a new era that we’re entering, not only in how we use insoles to treat common injuries but in how we can positively influence balance, functional symmetry and sporting performance with the introduction of BFS proprioceptive stimulating insoles?

Image of a runner crossing the finish line

Visit ‘All About Balance’ on stand 18 at the Physio First 2020 Brave New World Conference to discuss the points raised and let us know what you think.

References

1. Kirby, K. A., & Green, D. R. (1992). Evaluation and nonoperative management of pes valgus. In S. DeValentine (Ed.), Foot and Ankle Disorders in Children (pp. 295). New York: Churchill Livingstone.

2. Tramontano, M., Piermaria, J., Morone, G., Reali, A., Verara, M., Tamburell, F. (Published online 2019, Sept 13). Postural changes during exteroceptive thin plantar stimulation: The effect of prolonged use and different plantar localizations. Frontiers in Systems Neuroscience, 13: 49. doi: 10.3389/fnsys.2019.00049PMCID: PMC6753192.

3. Foisy, A., Kapoula. (Published online 2016, May 13). How Plantar Exteroceptive Efficiency Modulates Postural and Oculomotor Control: Inter-Individual Variability. Frontiers in Systems Neuroscience, 10: 228. Doi: 10.3389/fnhum.2016.00228.PMCID: PMC4866577

Anyone that puts Barefoot Science insoles in their shoes will have an increase in performance and a greatly reduced chance of injury. I now wear my Barefoot Science every day and recommend them to all of my clients.

Richard Pady, Canada
Triathlon Coach, Trainer and Competitor

I have used Barefoot orthotics on some of my toughest casesof plantar fasciitis, tibialis posterior tendinosis and metatarsal- gia and have had excellent results. These are people who have tried and failed traditional orthotics, stretches and various other devices. Barefoot orthotics are easy to sell as people can see the logic in the approach. Thoroughly happy with the product and service

Mark Gillham
Physiotherapist, Cowra NSW, Australia

Immediately from stepping onto my insoles with level one insert I felt a subtle but reassuring change in posture and balance. 8 weeks later I am up to level 6 and two weeks ago I was able to start running again pain-free for the first time in 14 months since a back injury. By way of an update; "Thank you Barefoot Science:- I am completely stoked as I just ran a personal best for a 10k trail over mixed terrain, pain-free!" ...........This afternoon's time was 57:28 - pretty ordinary for many but great for me as my goal has been to get 10k covered in under an hour......... and, after all, I am 186cm, 108kgs and 49 1/2 yrs old! I first 'ran' again in May and took 11 mins to cover 1.6km / 1 mile!

Tim in Alton, Hampshire
A member of EDC Crossfit

In our office, Barefoot Science (BFS) has been effectively used to help improve this proprioceptive deficit. Barefoot Science is a non-orthotic mid-arch stimulator. Due to its ability to create mid-arch activation, BFS mimics barefoot walking in sand and over time can dramatically help to reduce a proprioceptive deficit and improve foot strength. We highly recommend that all take a look at this wonderful product.

Dr. Peter Gorman and Dr. Chelsea Keesler
Chiropractors New York

I wanted to let you know how I’m getting on with the Barefoot Science insoles as I just moved up to insert no.5 after almost 6 months, which I am finding very comfortable. I can feel them, but in a comforting sort of way. I have to report that I have had hardly any instances of dizziness since about a week from starting to wear them. I am so IMPRESSED! I am trying to do a few balance exercises every day as you recommended, and as a near 70 year old with seven small grand-children, four of them only two so they need floor level attention, I am conscious of the need to keep my balance while getting down and back up! The knee bending is okay up to a point and I’m hopeful it will improve as I use it more. But, as far as the balance side of things go I am thrilled. I think it is positively miraculous and am very grateful to you for suggesting them.

Veronica Barratt
A Guildford lady with balance issues

Hi There, My name is Andrew Coltart. I was a golf professional on the European Tour for 19 years and a former Ryder Cup player. I now walk the fairways of the world commentating for a Major Satellite TV Company. My problem came to the fore when I was 47 years old. I had developed Plantar Fasciitis and it was becoming unbearable and debilitating with pretty much constant pain out on the course and in spite of various types of treatment no signs of improvement. I was starting to wonder if I’d be able to carry on working in my current role. Then I met Stuart Gordon of All About Balance and he explained The Barefoot Science Foot Strengthening System. Basically, because of these simple little nerve stimulating plugs that you insert into the underside of the insole, walking has become pain free and enjoyable again. These are no ordinary insoles. Don’t be fooled by expensive orthotics. The Barefoot Science Foot Strengthening System worked wonders for me, not only helping me continue in my work without any pain, they have also improved my balance…an essential factor in general life and massively important to achieving a consistent golf swing! I highly recommend investing in some.

Andrew Coltard UK
Former European Tour and Ryder Cup Golf Pro., Satellite TV on course Golf analyst.

I have been using Barefoot Science insoles consistently since the beginning of the year. They took me a while to use regularly but with the addition of extra pairs, I am able to ensure that I am using them on almost all occasions. This includes walking, CrossFit WOD's, running and every day wear. As you know, my flat feet caused me terrible pain with shin splints and tight calves every time I did any high impact training including running, even just the shortest distance. I haven't rushed through the stages and have only just moved onto level 3. Tonight I completed a 5km run with zero pain. This is the furthest I have run since 2011 and I even shaved 1 minute off my best 1 mile time!! I've found something comfortable that offers me a solution to pain free training, and I'm only half way through the 6 level programme. Thank you so much for introducing me to the Barefoot Science insoles. ☺

Claire Chivers
Crossfit athlete EDC Alton, Hants.

Personal, Barefoot Science testimonial 26 April, 2013 To my fellow Pod people and persons that have foot related problems, I've found a product called Barefoot Science. I like this product and I use it daily, both for myself, and my Podiatric patients, I personally have had foot related injuries and deficits that caused daily foot pain for years as a result of my military service, not any longer though with my Barefoot Science inserts. I would not go without these inserts in my shoes. I was introduced to this product at a foot healthcare symposium, by Mr. Derek Denton of Alamo Medical services... As an employee of a Podiatry Service of a VA hospital in Texas, I perform highly technical work involved in the design, development, fabrication, alteration, assembly, fitting and repair of orthotic foot braces and orthotic shoes for Veterans as related to their post military service, i.e.: disease ,injury and overuse of the feet and ankle(s). I interpret Podiatrist' prescriptions and perform all steps required in the fabrication and fitting of the several types of orthotic braces, for many of which there are no models or precedents, including but not limited to ankle, foot and lower limb, as related to Podiatric disabilities and advise physicians concerning all types of corrective devices available and modification necessary; to help heal or ameliorate these conditions. *Presently now with the Barefoot Science product(s) I personally have noticed over the years the Pedorthic/Podiatric appliances and more complex appliances in the Pedorthic /Podiatry labs were more accommodating to the “functional foot conditions” that kept the foot aligned and rigid, yet never strengthened the foot, although there is a myriad of devices that claim they do so. I have tried most and until now none of them worked for this purpose of strengthening the intrinsic muscles. I started working with Barefoot Science a few years ago, and it has really turned our practice into a healing clinic. Helping ameliorate painful Podiatric conditions such as plantar fasciitis, metatarsalgia, claw toes, hammertoes, corns, plantar fasciitis, patellar misalignments, chrodromalacia patella, ITB syndrome. I have been working in this field of Podiatry since the mid 1980’s, both with U.S. Navy and Marine Corps personnel, now with Veterans of all armed services as a triple Board Certified Pedorthist and Podiatric clinic manager. I wished we would have had this Barefoot Science product while I was on active duty as a Navy Corpsman, this may have prevented a lot of future/past foot related conditions that we see now. I have also noticed currently within our Podiatric practice a remarkable shift for continuity of care while using these barefoot science rehabilitative foot inserts. The patients get better and stronger while walking not sitting with their feet elevated and hoping the Nsaids do the job. I’ve noticed a reduction of fatigue from all our patients now that they can walk and repair themselves; we have reduced the need for pharmaceuticals (pain meds), orthotics, foot-braces, or surgical interventions, finally solutions ,for these chronic and painful foot problems! *I agree with the following statement of use, and I could not have said it better! Each Barefoot Science Arch Activation SystemTM comes with a pair of insoles to fit into your existing footwear and a series of progressive arch activation inserts. To start, just pop Level 1 into the underside of the insole, slide them in your shoes and get on with your day! It feels like a mini foot massage, sending waves of comfort throughout your body. That sensation is actually your foot muscles waking up and getting stronger. When the sensation fades, usually within a week, your feet are ready to move up to the next level. It’s that easy! With each step, your feet become stronger and more efficient. I recommend this product, and I am not just a practice of one, I work with Dr Karen Brooks, a Podiatrist, we tag team on every Veteran that enters our offices for Podiatric services, she too has over 25 years’ experience in Podiatry Practice and is also very happy with the results of this innovative design and the multiple uses of this barefoot Science rehabilitative and preventative shoe insert to help our Podiatric patients/Veterans. Sincerely, Mike Olden... P.S. Please note: We have a Zebris gait lab pressure measuring platform onsite in our clinic’s Pedorthic lab, that is used to measure our results on every patient pre and post usage of the Barefoot Science rehabilitative inserts. Both static and dynamic is monitored, along with postural sway, including the shoes that they are worn in. The proof is in the pudding, try it for yourself! Michael P.Olden, H.t; Ost; C-Ped; Pmac. Department of Veterans Affairs American Board for Certifications in Orthotics, Prosthetics and Pedorthics. *Board Certified Pedorthist cert no: Cped0724. KD DIV.HERT Team Decon Coordinator /Instructor KD DIV.Podiatry PAVE TEAM Coordinator/Trainer KD DIV.Local AFGE 2281 Steward+SGT-AT-ARMS KD-Disaster Emergency Medical Personnel System-Team Coordinator Advanced Disaster Life Support Instructor-Cert. Advanced Disaster Medical Response for Providers-Cert. AHA-Basic Cardiac Life Support Instructor-VA-Cert. ECU2 Containment Unit- Staff Trainer-KD-Div. Surgical Service, Code 11C Podiatry / Pedorthic Clinics KD -Div. South Texas Veterans Health Care Systems 3600 Memorial Blvd., Kerrville, Texas. 78028-5768 Wk: (830)-792-2660 Fax :( 830)-792-2532 VA Cell (830)370-2887 Twitter – DEMPS17 Email: Michael.Olden@med.va.gov

Michael P.Olden, H.t; Ost; C-Ped; Pmac.
Department of Veterans Affairs American Board for Certifications in Orthotics, Prosthetics and Pedorthics. *Board Certified Pedorthist cert no: Cped0724

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