Testing Foot Orthotics - editorial

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http://biomech.com/showArticle.jhtml?articleID=170701827

September 2005

Testing orthodoxy requires vision - By: R.

There are a lot of questions that have been bouncing around the

biomechanics mainstream for longer than this magazine has been

publishing. What are effective treatments for chronic plantar

fasciitis? Is there such a thing as a patient compliant with night

splints? By what mechanism does a foot orthosis work; i.e., does the

device affect the skeleton and joints or the musculature?

Undoubtedly, you can add a few to the list (please do so and send

them to me; we'll try to write about them).

Freelance writer Charlie Kupperman spoke with some practitioners and

researchers who are thinking about the effects of foot orthoses in

different ways. The article highlights not only their research, but a

readiness to examine orthodoxy.

Taking a broader view, finding out the specific mechanism or

mechanisms by which orthoses affect gait and the kinetic chain is a

useful exercise for many reasons, but the answers in this particular

case aren't as important as the fact that researchers are willing to

pursue them. It's easy to go along with the accepted wisdom,

especially as some areas of study aren't as flashy as others. Yet

it's researchers like Anne Mundermann, PhD, and Benno Nigg, PhD-to

name two who are willing to put in the time and effort to compile

these data-who can change the accepted wisdom.

Let's be fair, orthodoxy didn't get to be orthodoxy without reason.

There are reasons that wounds heal; there are reasons that certain

rehabilitation programs work. In most research disciplines, there are

mountains of data dating back decades.

But for many practitioners, conducting biomechanics research isn't

like, say, conducting pharmaceutical research. How does a well-

intentioned, ethical practitioner do a double-blind research study on

prosthetic devices? How does a practitioner justify denying a patient

the benefits that come from new technologies, whether they're to do

with gait, a rehabilitation technique, or wound closure, in order to

control a study?

Which is all to say that conducting new research isn't always easy or

straightforward. It is easy for me to sit here and urge more research

(which is needed, make no mistake), but the money, the time, and the

appropriate conditions all have to be present. That's not an easy

assignment. And that doesn't even factor in the competing interests

on a practitioner's time or the need to avoid any appearance of

conflict of interest.

So when researchers are able to make the conditions work for them and

test the established tenets of thought, it's noteworthy.

Often in this issue we include a prosthetics source list, accompanied

by an article by contributing editor Andria Segedy. After a lot of

consideration on how our readers may best be served, we have decided

to replace the source list with an O & P focus section, rather than

limiting our subject matter to the " P " of O & P. Thus, we are expanding

our horizons and serving a broader portion of our readership. Have no

fear, if you want the source list information, you can get it online,

anytime, from our BioMechanics Desk Reference site

(www.bdronline.com). Which makes this the appropriate place to remind

you that our upcoming 2006 desk reference will be available soon. The

BDR is the easiest to use, most current guide to the hundreds of

manufacturers in the various fields BioMechanics magazine covers.

http://www.biomech.com