Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

AOL-Lab "Retainer"?

Posted by josh s on 8/16/01 at hrmin (056866)

Hello doctors and others.

I posted about this about six months ago and only received one response. I'm hoping there's more opinion available now.

On the site aol-lab.com there is described a style of orthotic called a retainer designed by company president and DPM surgeon Jack Glick. The device is described as a structural rather than functional device in contrast to the root style devices most pf sufferers wear. Similar to the Alzner device but custom-made, the site claims that wearing the retainer positions the bones of the foot in a 'correct' position that reduces continuing strain on the primary ligaments of medial and lateral longitudinal arches. It is claimed that this device is the only one capable of reversing hypermobility of the foot ligaments.

I've been wearing a pair for several months now after requesting my podiatrist prescribe some for me. Attracted initially by the site's emphasis on the importance of long and short plantar ligament integrity (an injury to which hastened my own foot troubles) and claims to protect these ligaments in a way other orthotics cannot do, I was excited by the prospect of a device designed to restore the structure of the foot rather than only influence the function. The designers contention seems to be that functional (Root type, etc.) devices are truly appropriate for rigid deformities of the foot, whereas his device is designed for flexible deformities.

My own experience has been mixed. Though the support provided feels appropriate, the nature of the device is to provide strong pressure under the midfoot preventing undue collapse. This pressure oftentimes feels too strong and I'm concerned that such forces could be stretching my plantar fascia out even more, thus further weakening the structure of my feet. Sure, the deeper ligaments are supported, but possibly at the cost of the more superficial.

I'm hoping professional or otherwise interested readers might check out the site and post their opinions.

Some questions I have:
-Is my concern above feasible? Could a strong pressure in the midfoot cause innapropriate stretching and deformation of the pf?

-Are the contentions and suppositions made on the site reasonable? Many of the opinions and methods are unorthodox in the orthotic world. Do they appear to have merit?

-The 'retainer' does not use posting, rather they use an 'orthofunctional castwork' method apparently derived from foot reconstuction research to position the foot in a 'correct' position. Could such a method control hyperpronation? Several of the devices advertised on the site are recommended for severe pronatory troubles where extreme posting are usually employed. It is claimed that the 'retainer' primarily controls hypermobility in the sagital plane, whereas the Root style device controls in the frontal plane.

Any other observations on the methods or theory expressed on the site would be great.

Thanks all!

Re: AFO-lab

josh s on 8/16/01 at 01:27 (056867)

Excuse me, the product and website referred to in above post is afo-lab.com not aol...

Re: AFO-lab

BG CPed on 8/16/01 at 06:40 (056877)

Well I think you have figured it out for yourself. IMHO a hypermobile pronated foot has a few causative factors one being weak/loose soft tissue structure. If you look at it as a system of pullies and ropes, if the ropes are slack they do not provide enough pull or tension.
Another concern I would have with that device is a person with tight gastoc and midfoot collapse would feel like the had a golfball under the arch due to lack of rearfoot control. That is one of the simple reasons many pt get a hard device that lacks rearfoot control or correction and just relies on a lump in the arch....and ends up in the junk drawer.

I am sure that device would function well for several folks. My detector goes off when I hear of any claim that it is the only one that corrects alignment permanatly. A variation of that would be Birkenstock. That shape is a similar principal (the fo makers would disagree) that design has been around for decades. Thousands have fot relief from wearing birks that said I dont believe anybody has reformed foot structure, grown an arch.

If that were true than there should be thousands of folks walking around with no need to wear birks after a few years, they would have formed the perfect foot structure. How can a company claim that they have a design that is 'perfect shape' and 'will correct feet'. If feet had the ability to be reshaped by whats under them then orthotics would only need to be utilized for a few years like orthodontic braces.

I realize there are certain modifications in an fo to pressure cuboid or attempt to reduce tone in neuro situation. I am talking about boney alignment. Orthotics can and do reduce symptoms. They also can and do hold the foot in proper functional position. You can right a load of paper to make a theory look sound. Or like the infomercials you can do some dog & pony act and make claims that are silly from a scientific standpoint.

The infomercial orthotics that are talked about irritate me. And from what I have read about the stores they imply a satisfaction garantee, but make you sign things and only will replace with more merchandise. It is similar to all the 'herbal' stuff out now. Some of it works and has been used for years. There is also a lot of it that is crap and you have no idea whats really in it or how much. They get around it with the phrase 'supports good health' 'supports strong hairgowth' etc. then is followed by the old 'these statments have not been tested or proved by FDA'

You could put tap water in a medicine bottle and make the claim that it 'could save your life' We all know you need water to live. I know that was a bit off track but when I see scams or claims that are not proven it frosts me big time.

DISCLAIMER: Any reference to any device and or herbal supplement real or imagined is strictly used in an imaginary context. Any similarity to anything seen after 1:00 am on cable, at a flea market, or expo is strictly coincidental. This statement has not been evaluated by the FDA or anybody else.

Re: AFO-lab

bg cped on 8/16/01 at 20:54 (056948)

P>S> I was not refering to the device from the aol lab . That portion of the rant was directed at the infomercial insert. I just think that they need to be countered. They are diseminating lots of bogus info to a large number of people, many of which are suffering from pain and have already been scammed by other products.

Re: AFO-lab

josh s on 8/17/01 at hrmin (056959)

BGCped,

Thanks for your comments,

I certainly understand your strong feelings regarding the infomercial foot panacea products. Unless someone is desperate, uninformed, etc. the charlatinism of these products is pretty obvious from what I've seen.

You've mentioned several times that never have you seen a case where a person with a hypermobile flatfoot has 'grown' an arch after orthotic therapy, is'nt that because that type of orthotic was not designed to rehabilitate or form an arch? It seems that the developer of the mentioned 'retainer' from afo-lab is adressing this reality with his product. The contention of the afo-lab.com site is that functional orthotics are appropriate for rigid flatfoot types whereas his product is designed for the flexible flatfoot or hyperpronating foot that has an arch nonweightbearing but loses it upon weightbearing. The 'retainer' is supposed to reverse the hypermobility of this type of foot and restore structural integrity. A rather bold claim.

It is my understanding that the podiatry profession has long held the view that just as eye doctors improve function with eyeglasses, but leave the cause(s) (mostly structural) alone, the foot doctor has been advised to treat or improve the function of the foot but not attempt to alter, rectify or restore structure.

Recently, the eye guys have adressed the structural angle with various high-tech microsurgeries which apparently restore the function by intervening closer to the cause - improving structure. I know nothing about foot surgery, but it seems that this has been the only attempt by the podiatric profession that I'm aware of to adress structure; unfortunately they have not developed radically succesful procedures as have the eye guys.

I seems the rational for this aversion to attempting to alter structure and thus improve function is the logical conclusion that once plastic deformation has taken place, due to the incredible and constant forces placed on the foot, positive alteration is not possible conservatively. Recently, some friends have been experimenting with self-help techniques to improve their vision. These methods have been around since the fifties and involve eye exercises and gradual weaning off of glasses. Anecdotally I am aware of some success among those who practice the techniques religiously. I believe that to the entrenched medical establishment, these attempts have been looked upon as foolish and wishful thinking. However, with time and improved technology, they have themselves achieved the same goal: put away the glasses and see.

Eyeglasses and orthotics have another similarity, they both seem to be habit forming; downright addictive even. A structural bodyworker once told me that it was his opinion that orthotics and birks, etc. were actually not so good for the foot, as with this dependency came a laziness or complacency on the part of the arch maintaing muscles and ligaments which, when the support was removed, would tend to remain lazy and inadequate-and the arch would collapse.

What interests me about the 'retainer' orthotic is that this is the first serious attempt by podiatry that I'm aware of to conservatively improve structure and 'restore' the healthy shape of the arches of the foot. It is imperfect for the reasons conjectured in the first post of this thread and also for the one expressed above. But to me it does represent a move towards more restorative and less paliative measures. To me, being a young man, the thought of a continually spreading and collapsing arch, albeit propped up and supported by an orthotic is nightmarish. Why do not more in the podiatry profession try to step outside the box of preconceptions formed 20, 30, 40 or more years ago, and reevaluate the model - theory and treatment of the hyperpronating foot? Whoops, now I'm ranting.

Up until recently, the conventional wisdom has been that once a ligament of tendon is overstretched, it is deformed permanently, thus leading to hypermobile joints which in the foot has been seen as irreversible. Recent research in biomechanics has revealed that the tissue remodeling laws are more liberal than believed. Apparently under the correct conditions, tears in connective tissue do not always heal as contracted, gristly scar tissue, elongated and deformed ligaments can and will heal at the correct length and chronically lax structures might be capable of regaining proper tone.

For these reasons I hold on to the hope that this 'retainer' or some other soon to be developed product, orthosis, procedure, or process will more holistically and effectively adress the causes and effects of hyperpronation.

For now, I'm just trying to figure out if the new 'retainer' is more fair than foul - whether it represents an advance or dead end in my treatment. Since it is new and seemingly inheriting many of the flaws of the model it attempts to improve upon, I'm looking for opinion - expert and otherwise.

Ideally it seems what we want as a replacement to orthotics is a method or device to support the arches of the foot and thereby protect injured structures and allow them to heal, while allowing some stresses to pass through the structues to keep them strong and proprioceptively alert. Perhaps a means to gradually increase or decrease support as the foot became less acutely injured and stronger would work. Ideally also, for the reason mentioned in my first post, the sole of the foot would not be subject to any unnatural vertical forces irritating the plantar fascia. To this point it sounds like taping is the ticket, but that has serious disadvantages as well, although it does allow the foot it's original orientation to the ground and relies less upon tricking the proprioceptive mechanisms.

I don't know what the hell I'm talking about. Call in the inventors!

Re: AFO-lab

BG CPed on 8/17/01 at 19:38 (057038)

You have touched on many good points. Many of the hypermobile feet have similar characteristics, mainly hypermobility. I just have not seen any proof anecdotal, real world or theory on how it would happen. the foot is supported by boney alignment, which is maintained by ligament and tendon tension or lack of. If you think of the foot as a skeleton puppet that has a bunch of joints. if you pull up and put tension on the strings it becomes erect and stable. Take tension away and it will collapse.

There are other factors that will increase pronation. weight, leg alignment. and tight gastroc/heel cords can make it worse.

A typical pt would be a middle aged female that was 30 lb overweight, wide hips, valgus (knocked) knees, tight heel cords, and pronated flat feet. I can not see how any type of arch support would re-grow an arch. Help eliminate symptoms, yes. Control foot function yes.

There are 2 arguments. If they claim that a certain shape will promote tone and tighten soft tissue then some orthotic shape over the years would have to have contained a portion of these special shapes.

If you use the theory that you can exercise intrinsic and extrinsic muscle while wearing it to make it stronger and less pronated than a Birk would be a good example. The toe gripping, loose fit, and negative heel should make foot stronger therefore making them needless after a year or 2 of this therapy.

This may sound bad from a person that makes a living from orthotics but I believe they can actually make your foot more unstable. That said if they deal with the symptoms then it is worth it. Also the tight gastroc is many times not given enough blame for pronated feet and or pf pain. Yes it is easy to id flat foot, but the h-cords will not change with the shape of a foot orthotic. Heel lift has an influence but I would like to see some real evidence that they can re-grow foot structure

How are your friends doing with the eye exercises, i wondered if that works at all and if it is long term

Re: AFO-lab

josh s on 8/16/01 at 01:27 (056867)

Excuse me, the product and website referred to in above post is afo-lab.com not aol...

Re: AFO-lab

BG CPed on 8/16/01 at 06:40 (056877)

Well I think you have figured it out for yourself. IMHO a hypermobile pronated foot has a few causative factors one being weak/loose soft tissue structure. If you look at it as a system of pullies and ropes, if the ropes are slack they do not provide enough pull or tension.
Another concern I would have with that device is a person with tight gastoc and midfoot collapse would feel like the had a golfball under the arch due to lack of rearfoot control. That is one of the simple reasons many pt get a hard device that lacks rearfoot control or correction and just relies on a lump in the arch....and ends up in the junk drawer.

I am sure that device would function well for several folks. My detector goes off when I hear of any claim that it is the only one that corrects alignment permanatly. A variation of that would be Birkenstock. That shape is a similar principal (the fo makers would disagree) that design has been around for decades. Thousands have fot relief from wearing birks that said I dont believe anybody has reformed foot structure, grown an arch.

If that were true than there should be thousands of folks walking around with no need to wear birks after a few years, they would have formed the perfect foot structure. How can a company claim that they have a design that is 'perfect shape' and 'will correct feet'. If feet had the ability to be reshaped by whats under them then orthotics would only need to be utilized for a few years like orthodontic braces.

I realize there are certain modifications in an fo to pressure cuboid or attempt to reduce tone in neuro situation. I am talking about boney alignment. Orthotics can and do reduce symptoms. They also can and do hold the foot in proper functional position. You can right a load of paper to make a theory look sound. Or like the infomercials you can do some dog & pony act and make claims that are silly from a scientific standpoint.

The infomercial orthotics that are talked about irritate me. And from what I have read about the stores they imply a satisfaction garantee, but make you sign things and only will replace with more merchandise. It is similar to all the 'herbal' stuff out now. Some of it works and has been used for years. There is also a lot of it that is crap and you have no idea whats really in it or how much. They get around it with the phrase 'supports good health' 'supports strong hairgowth' etc. then is followed by the old 'these statments have not been tested or proved by FDA'

You could put tap water in a medicine bottle and make the claim that it 'could save your life' We all know you need water to live. I know that was a bit off track but when I see scams or claims that are not proven it frosts me big time.

DISCLAIMER: Any reference to any device and or herbal supplement real or imagined is strictly used in an imaginary context. Any similarity to anything seen after 1:00 am on cable, at a flea market, or expo is strictly coincidental. This statement has not been evaluated by the FDA or anybody else.

Re: AFO-lab

bg cped on 8/16/01 at 20:54 (056948)

P>S> I was not refering to the device from the aol lab . That portion of the rant was directed at the infomercial insert. I just think that they need to be countered. They are diseminating lots of bogus info to a large number of people, many of which are suffering from pain and have already been scammed by other products.

Re: AFO-lab

josh s on 8/17/01 at hrmin (056959)

BGCped,

Thanks for your comments,

I certainly understand your strong feelings regarding the infomercial foot panacea products. Unless someone is desperate, uninformed, etc. the charlatinism of these products is pretty obvious from what I've seen.

You've mentioned several times that never have you seen a case where a person with a hypermobile flatfoot has 'grown' an arch after orthotic therapy, is'nt that because that type of orthotic was not designed to rehabilitate or form an arch? It seems that the developer of the mentioned 'retainer' from afo-lab is adressing this reality with his product. The contention of the afo-lab.com site is that functional orthotics are appropriate for rigid flatfoot types whereas his product is designed for the flexible flatfoot or hyperpronating foot that has an arch nonweightbearing but loses it upon weightbearing. The 'retainer' is supposed to reverse the hypermobility of this type of foot and restore structural integrity. A rather bold claim.

It is my understanding that the podiatry profession has long held the view that just as eye doctors improve function with eyeglasses, but leave the cause(s) (mostly structural) alone, the foot doctor has been advised to treat or improve the function of the foot but not attempt to alter, rectify or restore structure.

Recently, the eye guys have adressed the structural angle with various high-tech microsurgeries which apparently restore the function by intervening closer to the cause - improving structure. I know nothing about foot surgery, but it seems that this has been the only attempt by the podiatric profession that I'm aware of to adress structure; unfortunately they have not developed radically succesful procedures as have the eye guys.

I seems the rational for this aversion to attempting to alter structure and thus improve function is the logical conclusion that once plastic deformation has taken place, due to the incredible and constant forces placed on the foot, positive alteration is not possible conservatively. Recently, some friends have been experimenting with self-help techniques to improve their vision. These methods have been around since the fifties and involve eye exercises and gradual weaning off of glasses. Anecdotally I am aware of some success among those who practice the techniques religiously. I believe that to the entrenched medical establishment, these attempts have been looked upon as foolish and wishful thinking. However, with time and improved technology, they have themselves achieved the same goal: put away the glasses and see.

Eyeglasses and orthotics have another similarity, they both seem to be habit forming; downright addictive even. A structural bodyworker once told me that it was his opinion that orthotics and birks, etc. were actually not so good for the foot, as with this dependency came a laziness or complacency on the part of the arch maintaing muscles and ligaments which, when the support was removed, would tend to remain lazy and inadequate-and the arch would collapse.

What interests me about the 'retainer' orthotic is that this is the first serious attempt by podiatry that I'm aware of to conservatively improve structure and 'restore' the healthy shape of the arches of the foot. It is imperfect for the reasons conjectured in the first post of this thread and also for the one expressed above. But to me it does represent a move towards more restorative and less paliative measures. To me, being a young man, the thought of a continually spreading and collapsing arch, albeit propped up and supported by an orthotic is nightmarish. Why do not more in the podiatry profession try to step outside the box of preconceptions formed 20, 30, 40 or more years ago, and reevaluate the model - theory and treatment of the hyperpronating foot? Whoops, now I'm ranting.

Up until recently, the conventional wisdom has been that once a ligament of tendon is overstretched, it is deformed permanently, thus leading to hypermobile joints which in the foot has been seen as irreversible. Recent research in biomechanics has revealed that the tissue remodeling laws are more liberal than believed. Apparently under the correct conditions, tears in connective tissue do not always heal as contracted, gristly scar tissue, elongated and deformed ligaments can and will heal at the correct length and chronically lax structures might be capable of regaining proper tone.

For these reasons I hold on to the hope that this 'retainer' or some other soon to be developed product, orthosis, procedure, or process will more holistically and effectively adress the causes and effects of hyperpronation.

For now, I'm just trying to figure out if the new 'retainer' is more fair than foul - whether it represents an advance or dead end in my treatment. Since it is new and seemingly inheriting many of the flaws of the model it attempts to improve upon, I'm looking for opinion - expert and otherwise.

Ideally it seems what we want as a replacement to orthotics is a method or device to support the arches of the foot and thereby protect injured structures and allow them to heal, while allowing some stresses to pass through the structues to keep them strong and proprioceptively alert. Perhaps a means to gradually increase or decrease support as the foot became less acutely injured and stronger would work. Ideally also, for the reason mentioned in my first post, the sole of the foot would not be subject to any unnatural vertical forces irritating the plantar fascia. To this point it sounds like taping is the ticket, but that has serious disadvantages as well, although it does allow the foot it's original orientation to the ground and relies less upon tricking the proprioceptive mechanisms.

I don't know what the hell I'm talking about. Call in the inventors!

Re: AFO-lab

BG CPed on 8/17/01 at 19:38 (057038)

You have touched on many good points. Many of the hypermobile feet have similar characteristics, mainly hypermobility. I just have not seen any proof anecdotal, real world or theory on how it would happen. the foot is supported by boney alignment, which is maintained by ligament and tendon tension or lack of. If you think of the foot as a skeleton puppet that has a bunch of joints. if you pull up and put tension on the strings it becomes erect and stable. Take tension away and it will collapse.

There are other factors that will increase pronation. weight, leg alignment. and tight gastroc/heel cords can make it worse.

A typical pt would be a middle aged female that was 30 lb overweight, wide hips, valgus (knocked) knees, tight heel cords, and pronated flat feet. I can not see how any type of arch support would re-grow an arch. Help eliminate symptoms, yes. Control foot function yes.

There are 2 arguments. If they claim that a certain shape will promote tone and tighten soft tissue then some orthotic shape over the years would have to have contained a portion of these special shapes.

If you use the theory that you can exercise intrinsic and extrinsic muscle while wearing it to make it stronger and less pronated than a Birk would be a good example. The toe gripping, loose fit, and negative heel should make foot stronger therefore making them needless after a year or 2 of this therapy.

This may sound bad from a person that makes a living from orthotics but I believe they can actually make your foot more unstable. That said if they deal with the symptoms then it is worth it. Also the tight gastroc is many times not given enough blame for pronated feet and or pf pain. Yes it is easy to id flat foot, but the h-cords will not change with the shape of a foot orthotic. Heel lift has an influence but I would like to see some real evidence that they can re-grow foot structure

How are your friends doing with the eye exercises, i wondered if that works at all and if it is long term