Role of Biomechanics, Orthotics

July 21, 2017

Breakfast Symposium 2: Biomechanics
Thursday, July 27
6:30–8 a.m.
Presidential B

Two Breakfast Symposium presentations on Thursday will stimulate discussion as they explore the importance of following biomechanics during diagnosis and studies showing that using custom orthotics and corticosteroid injections may not be the best treatments for heel pain.

The Foundation of Biomechanics

In “Standards of Care in Biomechanics,” Mark J. Mendeszoon, DPM, will examine how the mechanics of the foot and ankle can affect the lower extremities, including the back. He will also evaluate their impact on overuse injuries. Dr. Mendeszoon specializes in sports medicine, biomechanics, and surgery, and is a senior partner at Precision Orthopaedics Specialties, Chardon, OH. He will focus on boot mechanics and two newer theories—Kirby tissue stress and Dannenberg’s sagittal plane.

“I will tell people what I try to utilize and how I visualize people when I do my workups,” Dr. Mendeszoon said. “We want to give people an understanding of how biomechanics is integrated with overuse injuries, and then start to talk about injuries you will see with athletics.”

Having a solid background in biomechanics and sports medicine can help you grow your practice and integrate yourself into the medical and sports medicine community, Dr. Mendeszoon said.

Best Therapies for Heel Pain

The primary treatments for patients with heel pain have long been to use custom orthotics and corticosteroid injections, but recent studies show those may not be the best options.

During the second breakfast presentation, James B. McGuire, DPM, PT, will review the 2014 Journal of Orthopedics and Sports Physical Therapy guidelines regarding heel pain and how they differ from the 2008 guidelines. 

“This review of the literature has specific implications for podiatric medicine and how we treat heel pain,” he said. “Corticosteroid injections do not have the evidence we think they do. Manual therapies and orthotic interventions are much more important, but the data supporting the use of custom foot orthoses as opposed to prefabricated orthoses just isn’t there.”

The data supporting the use of medial longitudinal arch support and heel cushioning for a short period of time—several weeks—to reduce pain and improve function is strong, but the effectiveness of long-term use of these interventions has yet to be demonstrated.

“The data supporting the use of a one- to three-month program of night splinting had pretty good evidence for heel pain with symptoms of pain on rising and post-static dyskinesia,” Dr. McGuire said.

The use of physical agents, such as phonopheresis and lasers, had little evidence to show they were effective, he said. Also receiving low scores were special footwear, rocker soles, cushioned soles, and shoe rotations.

“The recommendation for heel pain is to use manual therapies, night splints, and some form of short-term orthotic management,” Dr. McGuire said. “If the patient responds positively to those interventions, then there is no need to move on to a corticosteroid injection, which has limited evidence and may actually be harmful, or a custom orthotic, which is only indicated when the patient exhibits other signs of structural instability and additional types of foot pain.”

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