Snake Oil Promotions

The purpose of this page is not to discredit anyone in person but to inform the unenlightened public of so called 'orthotic' or insole type devices which are associated with outlandish and/or cure-all type claims as well as inappropriate assessment practices (e.g. no measurements, gait assessment etc...) to thus entice the unwary to purchase an unsuitable, inappropriate device... hence the title "Snake Oil Promotions". These type of devices can also be associated with the term "custom made", yet do not fit the true context of the term as they are generic in nature (i.e. mass produced according to foot size). I feel the incidence / prevalence of such practices / devices is growing, with more and more people becoming disillusioned towards appropriate Orthotic Therapy due to poor resolvement of their pain.

From time to time I come across devices that promote all sorts of dubious, wild and diverse claims in the field of Orthotic Therapy (e.g. improved fertility, rid cellulite etc...). They are usually associated with marketing hype; grandiloquent results and often claim to be supported by research (pseudo-scientific 'evidence') ... which is usually questionable to say the least (e.g. no independent research and results not published in peer reviewed journals). The prescribers of such devices usually have little to no training / understanding of biomechanics and subsequently the role Orthotic Therapy should play in the treatment regime.

As mentioned in the first paragraph some devices are prescribed with little in the form of a biomechanical assessment (i.e. measurements, gait analysis) as well as obtaining appropriate foot representation (i.e. a 3D model via casting / impression mold of the foot) for an intended custom device. An example of which is something like the following (figures 1 and 2), where only a static (stationary/standing) 2D foot impression scan is taken and used to assess the functional state of the foot / lower limb...

Fig. 1:

- The above method (endorsed by a chiropractic based company and subsequently used by some chiropractors) does not give adequate and reliable data in determining the state of structural alignment, motion and subsequent support needed. There is no reference to a dynamic (movement) analysis which reveals what the foot is doing whilst in motion (i.e. walking). The following example (figure 2) further clarifies this via categorizing the static (stationary / standing) 2D scans solely by the state of the stated arches of the foot... and then associating these to dynamic (movement) related factors i.e. "phases of excessive pronation instability" (i.e. act of foot rolling inwards either too much and/or too long in the gait cycle)...

Fig. 2:

- "Phases of excessive pronation instability" (as stated above) cannot be assessed via comparing the state of one's arch with a so called "normal arch". It is an unreliable and deceptive means of identifying potential adverse movement related problems. The following pictures (figures 3 and 4) and scan (figure 5) will reveal why this is the case...

Fig. 3:

- The above photo is the anterior view of a lower limb with obvious poor structural alignment (medial deviation of mid / rear foot and ankle region). However, note the arch contour and height in the above anterior view, as well as the following posterior view...

Fig. 4:

- Despite the degree of medial rotation (i.e. medial deviated Sub Talar Joint axis), an arch is present at weight-bearing. Now the following static scan (figure 5) is of the above individual... 

Fig. 5:

 

- The individual's arch height could either be 1mm, 10mm or 20mm off the surface of the pressure pad or scanning device and thus not register a response... thus can still produce a similar result in a static (standing) scan of the foot as someone with a so called 'normal' foot, high arch (supinated foot type) or a pronated foot type (as shown above).

- Now compare the above scans with the classifications outlined in figure 2. Where on the scale between "normal arches" (1) and "phase 3 - (severe)" (4) outlined in figure 2 would the above scans sit? Would they not resemble that of position 1 - "normal arches"? Here is evidence that an individual with obvious poor structural alignment with an excessive degree of pronation and subsequent adverse pronatory forces (i.e. exhibiting a high supination resistance force - force required to resupinate foot from its pronated position) can give a so-called 'normal' result based on the static / standing foot impression scan used by many practitioners using this method of assessment. A pronated foot type can provide a similar 2D scan result as a supinated foot type assessed via the same method... yet functionally, they are totally different.

The following pictures (figures 6 and 7) and scan (figure 8) reveal a similar looking structural alignment but with different scan results due to past inappropriate treatment (i.e. past treatment not appropriately addressing supination resistance force thus excess stress (i.e. eccentric loading forces) directed to Posterior Tibial tendon → leading to a debilitating condition known as Posterior Tibial Dysfunction)...

Fig. 6:

 

Fig. 7:

 

- The above patient produced the following foot scan results which is to be expected for this foot type. Note the collapse of the arch region - particularly that of the right foot, where there is excessive Navicular / Cunieform pressure (an area of the foot which should not be weight bearing and subsequently having this degree of pressure directed to it).

Fig. 8:

 

HENCE... IF THE ASSESSMENT CRITERIA / METHODS ARE INADEQUATE, THE UNDERSTANDING AND DIAGNOSIS ARE LIKELY TO BE INADEQUATE, THUS THE ORTHOTIC / INSOLE IS ALSO LIKELY TO BE INADEQUATE. 

What can make matters more confusing is that there is sometimes an element of truth associated with these types of devices / methods which lures the unsuspecting person in; however... the ultimate form of deception is to mix truth with error and associate the claims with what people want to hear... particularly when pain relief is on offer.

 

The following products are listed because I believe they fit the above criteria. I have some of these devices (i.e. brought them and tested them out for myself) and have even written to the promoters of such devices. In some cases patients have come to me with such a device that has not helped resolve their problem / pain (i.e. due to not addressing the appropriate forces in an appropriate way).

 

♦ The following is a brief summary of the description of such devices... (list in progress):

[albeit, carefully worded due to past legal pursuits to have this page taken down] 

 

A/ Promoted 'orthotic' (insole) with foot / pelvis stabilizer type claims: usually dispensed by chiropractors. These are insoles with padded regions (i.e. generic arch pads / cookies - thus not custom to the individual) to 'support' the foot / body via 'supporting' the supposed marketed “three arches” of the feet.

They may look something like the following...

Fig. 9:

 

Fig. 10:

Fig. 11:

 

B/ Posture Control Insoles (PCI): usually dispensed by osteopaths... even dentists and masseurs. These are basically a rubber shoe inlay with either a 3.5, 6 or 9mm (depending on the supposed 'support' needed) raised rubber strip following the planter (underneath) and medial (inside edge) border of inlay located to 'support' the 1st Metatarsal/big toe region (medial column - see picture #14 below) which will apparently (as claimed) not only 'support' a large percentage of feet but apparently cure other adverse postural related conditions of the body.

• There has been a couple of individuals with an obvious vested interest in this product send me anonymous emails regarding this product (word of note: hiding behind the anonymity of the internet is unprofessional and cowardly). Hence, emails with legitimate email addresses will now only be accepted.

In answering the more sensible statements: I frankly don't care if a legitimate form of therapy takes business away from me. The key word here is "legitimate" (i.e. one that is backed up by research and clinical trials). My objective is to help people. As stated in the opening paragraph... the purpose of this website and subsequently this page is to educate, advise and help the unenlightened public on what can be a confusing and expensive form of treatment.

When this product provides evidence to the various claims being made by its promoters in peer reviewed scientific (i.e. medical / biomechanical) journals via appropriate research i.e. individual, double blind clinical trials etc., then the product will attract some credibility. Otherwise it is just an expensive rubber insole (around $250) with a raised medial column / post (which would be quite easy to make yourself). The concept of the PCI is not new – I have made similar devices for patients well before PCI’s hit the market. However, they are the type of device that is required for a specific purpose and for a specific condition – not as a cure-all for the masses as is what they are marketed as.

They may look something like the following...

Fig. 12:

 

Fig. 13:

Fig. 14:

 

C/ Healthxxrque PZ Prescriptive Orthotics: These are a rubber / leather shoe inlay with pouches apparently positioned in strategic locations (which actually does not match the intended anatomical sites of the foot) which are then filled with rubber (poron) pieces depending on the results obtained from an applied kinesiology test. These are also used (marketed) to treat adverse postural related conditions of the body.

They may look something like the following...

Fig.15:

 

Fig. 16:

 

Fig. 17:

 

D/ ...