Cyclists bring a particular challenge to podiatric practice. Running and other sports have a swing phase to gait when the foot is off the ground and not weight bearing. Cycle “gait” does not really have a swing phase and the foot is constantly “weight bearing”. This makes for an unusual injury risk profile due to the constant “stance phase”. Added to that is the relatively tight cycling shoes that cyclists tend to wear means that there is not a lot of room in the cycling shoe if foot orthotics or some sort of in-shoe modification is needed. The set up of the cycling for efficient biomechanics is the first step. Cycling foot orthotics can be challenging but when they are needed, they are needed. Given the distances and days that cyclists compete over, the risk for overuse injury is high if the mechanics are not set up properly. You often learn more about the problems of cyclists on cycling forums than cycling on podiatry forums.
The Cluffy Wedge is an extension for a foot orthotic that has been getting some attention lately. All it is aimed at doing is slightly dorsiflexing the hallux, which many call preloading the hallux. The effect of this is to bring the windlass mechanism into effect earlier, which is really helpful for those with a delay in windlass action (they require more dorsiflexion before the resistance of the windlass is felt). It is also use for functional hallux limitus. The Cluffy Wedge was developed by Dr James Clough who published a paper on it in JAPMA and has lectured on it. There are a number of You Tube Videos on the Cluffy Wedge.
You certainly see these claims made often. Someone with an anti foot orthotic agenda will say “Do not use foot orthotics as they will weaken the arch muscles“. Those with an anti-running shoe agenda will say something like “Running shoes will weaken the muscles which is why you should run barefoot.” Given the strength that these assertions are made with, you would expect there was some good evidence backing them up. Well, there is no evidence that foot orthotic or running shoes weaken the muscles.
There was this commentarty on running shoes: Do running shoes weaken muscles? and this commentary on foot orthotics: Do foot orthotics weaken the arch muscles?
From what I can understand is that running shoes do not weaken the msucles and foot orthotic do not either – they may even increase it!
How do foot orthotic work in Achilles tendonitis? It always used to bug me how so many claim a pronated foot can cause Achilles tendonitis and you should use foot orthotics for it. I could never understand the rationale behind how a pronated foot could cause achilles tendonitis. There is no doubt that foot orthotics do help Achilles tendonitis (and there is at least one study showing that). Achilles tendon treatment is obviously multifactorial and involves a lot more than just foot orthotics, but I finally understand that rationale for foot orthotics. The soleus muscle that attaches to the Achilles tendon is a very power supinators of the foot (as the Achilles attaches medial to the subtalar joint). Several studies have showed the reduction in the ankle inversion or supination moment with inverted foot orthotics. Foot orthotics reduce the force that the soleus muscle has to contract with and lessons the load on the Achilles tendon. Problem solved.
Most things that affect our health are regulated. Things like drugs and medicine have to go through a rigourus testing and regulation before they can be used. Even those who use them are also regulated by a registration or licensing system (depending on the country). Foot orthotics also affect our health, in that they are used to treat a wide range of foot and leg problems. They obviously not in the same league as drugs or medicine, but why should they not be? Most health professionals who use foot orthotics are also registered or regulated. But, you do not have to be regulated to prescribe and use foot orthotics as a treatment. The importance of this is that if something goes wrong, then they can be held accountable through professional regulation. The health professional’s responsibility for a duty-of-care can be upheld through the regulation. This was brought to a head in the UK recently with the bankruptcy of the foot orthotic firm, Parish & Bell. Judging by the forum, message board, consumer groups and blog posts, they have left a lot of disgruntled patients. None of the ‘foot orthotic’ staff were licensed or registered as health professionals, so there was no one for them to be accountable to. Podiatrists can not practice without being registered or licensed. Unfortunately the foot orthotic industry is full of ‘cowboys’ so its buyer be aware.
