Ptosis

[rothbart]

For the past several years I have been investigating the link between piede proprioceptive signals and tonus changes in the levator (eye) muscle.

I have documented cases (photos pre vs post signals) demonstrating the following:

(1) Reversal of Ptosis with correct piede signals - see rothbartsfoot.info/Testimonialsgen.html

Note - no flash attachment is used for any of the photos, camera is mounted on a tripod, distance between the camera lens and testa is constant (although the head moves more over the spine post stim).

(2) Reversal of hypertonicity of the levator muscle (postural buldging eyes) with correct piede signals

(3) Increase Ptosis (hypotonicity) and Increased Buldging Eye Syndrome (hypertonicity) when the piede signals are incorrect.

Comments?

Prof Brian A Rothbart

[ronm]

www.podiatry-arena.com/podiatry-forum/showthread.php?t=4436&highlight=rothbart

[Admin]

This is blatant self-promotion by Prof Rothbart, and would normally be removed, but I'm inclined to let it run for a while for discussion by the forum.

For anyone who hasn't read the thread above - link posted by Ronm (cheers ;D), my whimsical contribution was:

"Dear Dr Rothbart,

I have suffered with droopy eyelids for years, and on the advice of a friend decided to try your proprioceptive insoles.

Unfortunately although they work well in holding my eyelids up I cannot see past them.

Can I have a refund?

Yours sincerely,

A. Punter (Mrs)"

So you get an idea of how I personally feel about some of this "research".

[rothbart]

David,

I am very surprised and disappointed by your reply. The impact proprioceptive insoles have tonus patterns, globally, is well known by Posturologist throughout Europe (undoubtably you are familiar with Dr Marie Pierre Gagey Research). My research has helped clarify the mechanics behind this relationship, similar to my recently published paper in the JAPMA, which help clarified the link between abnormal pronation and pelvic rotation.

Instead of writing diatribes, why not have a PROFESSIONAL discussion on this very interesting subject.

best regards,
Prof B Rothbart

[robertisaacs]

Congrats David. No pod forum is complete without a Rothbart thread. You've arrived!

Hey Brian

First off i should apologise for not getting back to you on the research thing. I've been crazy busy since getting back off hols and undertaking a new project was not uppermost on my list. I've got a few things i'd like to talk to you about the PMS measurement, i'll start a thread here when i get chance, we might as well discuss on open forum as by e mail.

On the ptosis thing, lets see if we can have a civil discussion.

My view.

I don't fully understand the mechanism behind ptosis. However i find it hard to beleive that changing the muscle tone in the lower limb can alter the muscle tone in the eye without a clear rational, which i've not seen. I find your "evidence" to be unconvincing. With respect the internet abounds with Before/after photos of the effects of anyything from sugar water to reiki and the effects you show could easily be explained by a psychosomatic reaction. Or indeed the patients opening their eyes a bit. I also find it faintly troubling that the biggest photo, the coloured guy on the front, shows ptosis reversed by surgery. This could be considered misleading given that the title of the page is the effects of your insoles. It leaves a bad taste.

As somebody or other the plural, of anecdote is not Data. We have still not seen any quality evidence of the effect of your insoles. Which is a shame.

I can see the principle behind proprioception and i have heard of a study suggesting a FF varus extention caused increased inversion at the rearfoot at heel strike (before ff load) which would be consistant with the whole proprioception thing. Whilst i would not go so far as to say i DO beleive it works i could beleive that proprioception could affect somebodies foot posture or gait if i had a kinematic / kinetic study to look at.

What i struggle with is the huge list of things you claim your insoles cure. This for me damages the creditability of the whole package and makes it hard to take the otherwise plausible bits harder to swallow.

I do not wish to be rude, however there are many proffessionals out there who make claims of their products which are simply untrue. Otherwise we would be rubbing marigold into our patients bunions and watching thier IM angles shrink. It is for the rest of the community to decide which claims to beleive. Obviously RCTs are the gold standard and a good solid rational comes a good second. Unlikly sounding claims tend to make people suspicious and increase the burden of evidence needed. I have yet to see either an RCT or a solid rational for either the local or global effect of your insoles.

Regards
RObert







I

[ianl]

Hi Brian and all

Coming from a quite eclectic background (plenty of varied complementary training as well as orthodox stuff) I could be described as a sucker for having a go at anything and (as David is aware) will even blend some of these techniques together with some patients. In that context I wholly advocate the use of foot orthosis intervention as part of a treatment modality than can encourage musculoskeletal changes. It is something I do, frequently in response to physio requests and, yes, have even provided them for a depressed person at the request of their psychotherapist - the postural control gained helping their self esteem.

The issues in this incidence of Brian's for me is that musculoskeletal response to foot orthosis intervention are not accurately predictable (AFO's may be a different issue):

1. At a distal aspect, let alone at the mid body and even less so at, say, the eye level

2. Peoples response to attempts midfoot control varies for a large variety of reasons yet it is one of the easiest things to attempt.

3. Whatever device type you make its affects upon forces through the foot and possible consequential affect upon higher body issues
differ from the original purpose once it is in the shoe; once the heel pitch changes; if the durometer of the cushioning of the shoes
differ; once they are walking on a inclined/declined pavement or ascending / descending stairs; once they move from hard to soft
ground etc etc.

4. The anatomical architecture of the foot and even individual bones can vary from individual to individual, e.g., take a whole bunch of
calcanei (is there such a word!!!?), stand them side by side and you immediately notice that some are more rounded than others,
some have a more oblique angle to them than others, some are flatter than others. In other words, we have no control over the
anatomical architecture of the foot that presents and at best (surgery possibly excluded - Bill this is your bag) can only hope to gain
a global physiological reaction and not a specific reaction to intervention. Equally, the rom between joints of the foot so frequently
differ from one individual to another.

5. Now lets add in some soft tissue concerns, e.g. myofascial issues such as trigger points. I have certainly encountered moments
when the intervention I wanted only occurred after these were ironed out post orthosis intervention and that again was only
working at the distal level. Now if I apply an orthosis to effect a more inferior distal change but that change is limited due to
myofascial aspect how can I be sure that a more superior distal change can be affected?

Within the orthosis intervention world I am constantly impressed with the benefits patients get through orthosis provision, be that actual physiological benefit or benefit coming via placebo (perfectly legitimate to me). So I keep doing it but the rational behind becomes increasingly elusive in spite of any gold standard trials or description of the role of forces. Many of which immediately fall down when you look at it from the above view.

I do hold the view, based admittedly on my own experience, that actual biomechanical function of the human system is remarkably complex but intervention is relatively simple in most cases and can be simply taught and grasped. I believe that the effects Brian describes may well be in response to any orthosis intervention but is not a direct result of it nor, in light of the above, do I find any reasonable (or eclectic complementary medicine rationale) to make the claims Brian does.

From whichever camp I come it is this claim to possible predicability, implication of repeated predicability between patients with a specific foot type (BTW- there really is no specific foot type as the architecture of feet can be so different from one person to another even though they look similar) or direct response to orthosis intervention that is unacceptable.

Ian

[billliggins]

Hello again Ian et al

Recent (validated) research has shown that elephants are frightened of bees. This is because a bee sting inside the trunk can cause great damage.

This must be true because I have lots of bees in my garden but no elephants.

Do you think if I inserted one of the good prof's orthoses in elephants trunks, thereby preventing ingress of the pesky insects, I would get elephants in my garden?

All the best

Bill

[dtt]

Hi Bill

You might get a Good show of roses if you did ;D ;D
cheers
Derek

[ronm]

www.rothbartsfoot.info/RFS.html

my wife is expecting our 2nd child, had 12 week scan today, all good and absulutely no mention by the midwife that junior is suffering from the embiological foot type "primus metatarsal supinatus foot". Big sigh of relieve all round

www.podiatry-arena.com/podiatry-forum/showthread.php?t=2058&highlight=rothbart

what was mentioned was that my wife has a retroverted uterus, amazing then that somehow we managed to conceive 2 children dispite neither of us wearing proprioceptive insoles (although possibly the 2 courses of fertility drugs may have helped )

on a serious note, having gone through the trials of fertility problems (especially with 1st child which took over 3 years to happen) i know how you can cling to even the most far-fetched ideas in the hope that they might be of benefit.

[rothbart]

The concept of how proprioceptive insoles function is Not a mechanical model. It is based on the work of Gagey et al, who describe the model in terms of mechanical receptors in the foot generating signals to the CNS, which in turn, makes changes in the posture of the body.

Currently, I wear two hats: one as a researcher, the other as a clinician - as a researcher I live in the world of randomized trials and double blind studies (presently the gold standard). We tend to dismiss subjective outcomes as being unscientific and therefore not worthy of consideration. However, as a clinician I hold an entirely different point of view - subjective outcomes are very important. That is, the primary concern I have is to help my patient overcome their concerns, symptoms, problems, pathology. If many patients are continuously having positive reactions to a specific therapy (e.g., do no harm), I will continue to use that therapy, even if the research pundits disagree with the approach.

The information I am presenting on Ptosis is from a clinician's point of view. The comments you have made, are well taken from a research point of view.

Prof B