The Archies Arch Support Thongs are a type of flip-flop developed by a physiotherapist in Australia. In Australia, they call flip flops, thongs!
These flip-flops or thongs are a significant part of the laid-back lifestyle in Australia, so they have proved to be very popular there. They have an arch support built into them. The height of the arch support is similar to that what you can get in an over-the-counter arch support or a prefabricated foot orthotic. This makes them both a good adjunct to foot orthotic therapy and in some cases an alternative to foot orthotics when the type of footwear may preclude the use of foot orthotics.
These have provided very popular with podiatrists in Australia (see: Archies Thongs are selling themselves) with many podiatry clinics selling them and many podiatrists using them for themselves and families. A lot of comments get made to the effect that you just need to try them on and you will not hesitate to buy them. You can buy the Archies Thongs from FootStore and get a coupon code.
An abductory twist is a characteristic of gait that is commonly observed by clinicians. Many people when they are walking, just as the heel comes off the ground there is a sudden and small movement of the heel medially (abduction). Many clinicians do not consider this to be of much significance as it is just a sign of an underlying problem rather than a problem on its own.
There are many different causes of this abductory twist. One is that the big toe joint must dorsiflex or bend just as the heel comes of the ground so that we can move forward. If that joint does not want to bend, then the foot will abduct to get around the block at the joint. Another common cause is overpronation of the foot. This is when the foot is rolling inwards at the ankle joint and the leg is externally rotating trying to roll the foot outwards. As soon as the heel comes off the ground the foot suddenly abducts due to the twisting.
A medial heel whip is something that does get confused with an abductory twist, but they are different. The twist occurs just as the heel comes off the ground and the whip is more of a circumduction of the whole foot as it comes of the ground. While the twist and whip are in the same direction, they are very different things and caused by different problems.
The abductory twist does not need to be treated as it is not a problem on its own. It is caused by something and that something is the cause of the problem, so that needs treating rather than just the abductory twist. The treatment will need to be directed at either the cause of a block in motion at the big toe or the cause of the overpronation of the foot. This means that the treatment may take on many different possible alternatives, so there is no one treatment for it.
Plantar fasciitis is one of the most common problem that affect the feet. As it is so common, everyone seems to have an opinion on it and there is so many misconceptions about it. As there is so much bad advice being given for it, there are so many cases of plantar fasciitis not getting better, so the field is ripe for snake oil salesman selling the next greatest cure for it.
Exactly what is plantar fasciitis? It is initially an inflammation of the plantar fascia which is a long ligament that connects the heel bone to the ball of the foot. After that initial inflammatory period, it then becomes a degenerative process. The cause is when the cumulative load on the plantar fascia is greater than what the plantar fascia can take, so it gets damaged. It is a problem of overuse of a “ligament” that can not take the loads. The typical symptoms of plantar fasciitis are pain under the heel that is usually worse after getting up from rest, especially in the morning after a nights sleep. While these same symptoms can be caused by other conditions, almost always these symptoms do indicate plantar fasciitis.
How should it be treated? The most obvious way is to go back to the above cause. Firstly you need to reduce the load on the plantar fascia with the use of calf muscles stretching, strapping of the arch and the use of foot orthotics and/or supportive shoes. This should start the recovery process. Once the very painful stage is over, exercises can then be used to strengthen the plantar fascia, so that it is better adapted to the load that is placed on it.
That is pretty much it. There are plenty of other approaches being advocated for plantar fasciitis, but they are mostly directed at healing the damaged tissues. There is nothing wrong with that, but the primary aim of whatever treatment is used should be to reduce the load in the damaged tissues and make the tissues stronger so that they can take the load.
Posterior Tibial Tendinitis is not a common tendinopathy that usually occurs in athletes such as runners. The symptoms occur either/or just above or below the medial malleolus and there may be some swelling. Typically the cause is when the cumulative load in the tendon exceeds what the tendon can take, usually from not enough time for the tendon to adapt to changes in load. It is typically associated with ‘overpronation’ if the forces of pronation are high.
This video rant from Podiatry Soapbox probably give the best overview of the condition and its treatment.
The management is not that difficult provided a logical sequence of events is followed, yet there are lots of questions in forums (eg here, here and here) with a mixture of the quality of advice being given.
Supination Resistance is a clinical test that is used to determine how hard or easy it is to supinate the foot. The test was first described by Kevin Kirby DPM. The test is performed clinically by placing two fingers under the posterior part of the arch and using the fingers to supinate the foot and raise the arch – an estimation of how resistant the foot is to supination is made. This helps decide how much force is needed to come from a foot orthotic. If the supination resistance force is high, then if a foot orthotic is needed, then it will have to push hard to resist that force or it may be less likely to work. If the foot orthotic pushes too hard in someone with a lower supination resistance, then it might sprain the ankle as it pushes to hard for the foot.
The clinical test became more popular in response to the understanding that “overpronation” was not the problem that is was widely assumed to be and the realization that it may not be the motion of pronation that is the problem, but more the force that are associated with that overpronation. The forces that are associated with the forces driving pronation are assumed to be the same as the forces needed to supination the foot, hence the name for the clinical test of supination resistance. There is also the understanding that forces are what does the damage to the tissues and not motion that does the damage. One study has found a very poor correlation between the posture of the foot and the forces needed to supinate it.
The test is associated with several different pathologies. It tends to be much harder to supinate a foot in those with posterior tibial tendon dysfunction and much easier to supinate the foot in those with peroneal tendonitis. Other pathologies and conditions are not related to the test.
There has been plenty of discussion on Podiatry Arena about the test. Probably the best summary and review of the evidence is this blog post by Craig Payne. This encyclopedic entry on PodiaPaedia is also worth checking out.
This video from PodChatLive talks with all those who have published research on the supination resistance test.
“Overpronation” is a commonly used and misused term by runners and health professionals in the context of running injuries and the use of running shoes. Pronation is a normal motion of the rearfoot in which the ankle rolls inwards and the arch of the foot collapses. This is what the foot is supposed to do as it is how the foot adapts to uneven surfaces and absorbs shock. It is healthy and nothing wrong with it. The way some runners talk about what they have read about it, you would think that they have some sort of disease.
Where the problem arises is that overpronation is widely considered a risk factor for getting an injury when running. For that reason, there are design features in running shoes that are claimed to help runners with this overpronation. These are what are known as the motion control running shoes. In contrast, the neutral running shoes do not have these design features aimed at helping the so-called overpronation.
The problem with the concept of overpronation is that there is no consensus on what is ‘normal’ and what is ‘over’. Some runners with severe overpronation get no problems and other runners with only small amount get lots of problems. The actual evidence linking overpronation to injury is also very weak. The consensus of the systematic reviews of the evidence is that it is only a very small risk factor, so it is not really a big issue due to so many other factors that go into runners getting an injury.
So should overpronation be treated? Yes, if it is contributing to the problem. No, if it is not contributing to the problem. This can be difficult to determine. A key in determining if it is contributing to the problem is to determine if the forces in the tissues that it is causing are high enough to damage the tissues. The supination resistance test can be helpful here in helping decide this. If that test is high, then the forces are high, so the overpronation probably should be treated. if the forces are low, then it may not be necessary to treat it. For example posterior tibial tendinitis could be due to overpronation if the forces are high.
If it does need to be treated, then the cause of the problem has to be addressed. There is not a one-size-fits-all when it comes to overpronation. If a muscle weakness is the cause of the problem, then exercises like the short foot exercise will help (it won’t help other causes). If tight calf muscles are the problem, then stretching is what is needed (muscles strengthening or foot orthotics will fail in these); if a bony alignment, such as forefoot varus, problem is the cause, then only foot orthotics will help (strengthening muscles and calf muscle stretching will fail); and so it goes on. The cause must be addressed.
There are so many myths and nonsense being perpetuated about overpronation. A key warning sign is that whoever is talking or writing about it is, if they advocate a one-site-fits-all when it comes to it, then they probably do not know what they are talking about.
