Every single orthesis has its individual specification and
characteristics. Insoles can be applied as an alternative to a
surgical correction, but only when a realistic improvement of
pain can be expected and when the patient is not obliged to
- conservative treatment in foot and ankle problems
decrease his activity level.
It is important to point out one statement clearly: An orthesis can definitely not correct an existing foot form, it can only improve the gait patterns and in some cases achieve a pain free situation!! It is therefore in the hands of a responsible orthopaedic surgeon to explain to his patient what he can realistically expect from a conservative treatment with insoles and to inform him about further treatment options.
The use of insoles during post surgical rehabilitation can support a faster recovery with pain free weight bearing during movement. In athletic sports, but also in recreational sports, the advantage of correct insoles is clearly confirmed, especially
Dr Petr Spurek
A very important patient group is the one that suffer from Diabetes Mellitus. These patients can profit very much from correct orthesis as they have to face the danger of skin ulcers, problems with terminal blood circulation (microangiopathy) and nerve disorders (microneuropathy). Especially in these patients, we can avoid complications with the use of correct materials in the insoles, but this always has to be applied in combination with correct footwear with the advances in materials used in shoe manufacturing.
The optimal insole goes through a long process of
manufacturing, but the base of everything is the correct
measurement. Orthesis have an enormous influence on the
whole static and motoric function of the body. A thorough
clinical examination of the patient has to detect every possible
Orthopaedic insoles are the most frequently applied and most
finding of the locomotor system. Differences in length of the lower extremities, shortening of tendons, the position of the
versatile devices in conservative treatment and prevention of
pelvis, spinal pathologies, and imbalances of various muscle
foot and ankle problems. However, their importance in scientific
groups have to be kept in mind when deciding how the insole should be working.
discussions is stil rated low. Yet with the correct insoles a high
The effect of an orthesis is not limited inside the shoe!!
amount of painful pathologies in the lower extremities can be
Computerized static and dynamic gait analysis offers very good information and helps in the process of decision making,
but must never be the only criteria to decide the definite form of the insole! It always remains a one - dimensional description of numbers and graphics on a piece of paper.
During our process of manufacturing, we make a three - dimensional model of the foot , made of plaster, and on that model we apply the combination of materials.
Non surgical management of foot and ankle problems requires
Basics of treatment with insoles:
an understanding of the interaction of the foot and ankle and
Due to the complexity of foot and ankle pathologies it is very
Every mistake during measurement leads consequently to
the shoe or device applied. The biomechanics of normal foot
difficult to establish categories of insoles. They differ in the
an insufficient product at the end. The process of clinical
function and the effect of the disease entity being treated
goals they have to achieve, their function, the procedure in
examination, measurement, assessment and definition of
should be analyzed. The anatomy of the specific shoe type, the
which they are manufactured and in the material that is being
goals, manufacturing and correct choice of materials has to be
function of each component, and the effect of modifying each
of these components must be understood. The responsible specialist should have a thorough knowledge of the available
Traditionally insoles should correct, support or take away load,
It requires a very good communication between patient and
orthoses and appliances and the effects of these devices on
which means they are applied for static compensation and
treating doctor during the process of treatment. A perfect
prevention of further evolution of an existing malformation.
cooperation and coordination between orthopaedic surgeon,
The indication for a correcting insole can be made exclusively
podiatrist and orthopaedic technician is extremely important
Orthoses are devices that can be placed inside a shoe to help
in the growing skeleton. In children with a clear tendency for
and offers the possibility to adapt the insoles with minor
accommodate anatomic abnormalities or to relieve pressure or
developing an infant flatfoot we apply neurologic insoles with
changes to the evolution of the patient until the perfect insole
stress at a specific site on the foot and ankle. They function by
encouraging results. Specific stimulation of proprioceptive
applying a force on the body in a controlled manner to achieve
structures in the sole of the foot can have a positive effect on
a desired result, that is, transfer of pressure or restriction of
the general posture and during gait.
motion. Orthotic devices range from simple shoe inserts to
Dr Petr Spurek
A huge variety of organic and synthetic material can be used
Dr Spurek is a wel respected specialist in Orthopaedic surgery
In order to achieve a successful result with insoles, it has to
during the process of manufacturing. Materials like leather,
and Traumatology, a Certified Foot and Ankle Surgeon and
be clearly stated that only custom made orthesis can have the
cork, wood and rubber are soft but wear out quite fast.
specialist for Sports Medicine. He is the head of department for
Synthetic materials on the other hand have good durability, but
foot and ankle surgery at Xanit Hospital in Benalmadena and
they are lacking isolation towards changes in temperature and
the Medical Director of the Marbel a Foot and Sports Clinic.
‘Over the counter insoles’ are manufactured in high numbers
His clinic offers a total medical service for his patients, from a
and it is obvious that their effect is very limited. Every individual
thorough initial diagnosis, to surgery if necessary, and complete
has his specific foot form and a different distribution of forces
A combination of organic and synthetic material is the best
during the various phases of gait patterns and therefore
option, so the advantages of both can be included.
Journal of Antimicrobial Chemotherapy (2003) 52 , 303–305 DOI: 10.1093/jac/dkg318 Advance Access publication 1 July 2003 Susceptibility to rifaximin of Vibrio cholerae strains from different geographical areas Maria Scrascia1, Maria Forcillo1, Francesco Maimone1,2 and Carlo Pazzani1,2* 1Dipartimento di Anatomia Patologica e di Genetica, Sezione di Genetica, Università di Ba
_______________________________________________________________________This service is provided by Atlantic Swine Research Partnership Inc. To subscribe or unsubscribe, contact our Editor at [email protected] "A sailor without a destination cannot hope for a favorable wind."-- Leon Tec______________________________________________________________________1) Russia raises pork quota, b