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.
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?
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.
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
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