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PEEL and STICK Posts and Balances

PEEL and STICK Varus Posts

The PEEL and STICK Forefoot and Rearfoot Varus Posts attach directly to the bottom of an insole and have been proven to improve alignment and alter motion in the foot, ankle, knee, and hip. Great for managing plantar fasciitis, Achilles tendinitis, and reducing valgus collapse of the knee.

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PEEL and STICK Valgus Posts

Most custom and over-the-counter orthotics are designed for people with low arches who pronate excessively. Valgus posts are designed to treat and prevent injuries in people with high arches. These full length posts are placed directly beneath your insoles.

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The PEEL and STICK Interdigital Neuroma Balance

Interdigital neuromas are common, poorly studied, and notoriously difficult to treat. By offloading the third and fourth metatarsal heads throughout propulsion, the PEEL and STICK Interdigital Neuroma Balance allows you to effectively treat interdigital neuromas, usually without the need for surgery and/or expensive orthotics.

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The PEEL and STICK Sesamoid Balance

Sesamoid injuries are extremely common, especially in high-arched individuals. The new PEEL and STICK Sesamoid Balance is thicker than most sesamoid balances, and is made of a blend of urethane rubber, PPT, and synthetic suede designed to significantly reduce pressure beneath the first metatarsal head.

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FOUR ARTICLES FOR AUGUST

DR. MICHAUD CHOOSES FOUR CLINICALLY RELEVANT ARTICLES AND SUMMARIZES THEM BELOW.

Successful 10- second one-legged stance performance predicts survival in middle-aged and older individuals. Araujo C, et al. Br J Sports Med  2021.

In this study, 1702 individuals between the ages of 51 and 75 were followed for 12 years. At the start of the study, subjects were asked to stand on one leg and balance with their eyes open for 10 seconds. To ensure consistency, subjects were told to keep their arms at their sides with their elbows straight and to fix their gaze on an eye-level point that was 6 feet away. To reduce compensatory movements, they were told to place the top of the non-support foot on the back of the opposite lower leg “as naturally as possible” (Fig. 1). Once they assumed this position, they were given three chances to complete a 10-second single-leg balance test. They were classified as either "Yes" or "No" depending upon their ability to complete the test. 

Overall, 20% of individuals were classified as No, and the survival curves for these individuals was significantly worse. During a mean follow-up of seven years, 7.2% of the subjects died with 4.6% of them being in the yes group, and 17.5% being in the no group. The authors note that the hazard ratio of all-cause mortality was higher for the No individuals even after adjusting for age, sex, body mass index, and other comorbidities. The authors state that "unlike aerobic fitness, muscle strength, flexibility, balance tends to be reasonably preserved until the sixth decade of life, when comparatively, it starts to diminish quickly.” This is consistent with prior research showing that toe strength is a better predictor of longevity then grip strength, and strength training enhances balance more than balance exercises. This simple test should be a standard component of a biomechanical examination and interventions to improve balance, including proprioceptive and strengthening exercises, should be incorporated immediately, and the importance of improving balance should be conveyed to the patient. 

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Effects of two types of 9-month adapted physical activity program on muscle mass, muscle strength, and balance in moderate sarcopenic older women. Piastra G, et al. BioMed Research International Volume 2018 (Open Access).

In this study, 72 older adults were randomly assigned to a strength training program or a postural training program. Both the strength training and postural programs were performed twice per week for 36 weeks with each session lasting 60 minutes. The strengths training program consisted of a brief warm-up, followed by low/moderate intensity exercises for both the upper and lower extremities. Postural exercises consisted of a wide range of stretches and mobilizations, including “spine stretching, hamstring and psoas muscle reinforcement, and self-stretching.” Six months later, the authors evaluated body composition, muscle mass, grip strength, along with balance measures including sway path, sway area, and sway time, and determined there were significant increases in muscle mass, strength and balance only in the strength training group. No significant differences appeared in any parameter for the postural group. The important lesson from this study is that strength training is important not just for building muscle, but also for controlling the proprioceptive response to center of mass perturbations. The findings of the study are consistent with prior research showing that strength training effectively reduces fall risks in the elderly. In a pilot study of balance using the ToePro, researchers from Temple University showed that six weeks of foot strengthening using the ToePro by itself produce significant increases in not just toe strength, but balance assessed with the anterior reach test. 

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The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players. McHugh M, et al. Am J Sports Med 2007, 35;8:1289.

This is one of my all-time favorite ways to improve balance and/or prevent ankle injuries. In this study, researchers followed 125 high school football players for anywhere from 1 to 4 seasons. Players were classified as low-, moderate-, or high-risk for reinjury, depending upon their body mass index and/or their prior history of ankle sprain. The authors note that at the start of the study, the overweight, previously injured football players were 19 times more likely to be injured than the low-risk athletes. What makes this such a great paper is that the treatment protocol is so simple: The athletes were instructed to stand on a conventional foam stability pad for five minutes on each leg, five days per week for four weeks preseason, then twice per week for nine weeks during the season. The pads were placed in the weight training room, and the subjects were told to just stand on the pad with their sneakers on and their eyes open for five consecutive minutes before switching to the contralateral leg. At the end of the study, the authors noted that 77% reduction in ankle sprain frequency, which is unheard of in high-risk athletes. In fact, the authors state “the increased risk of a noncontact inversion ankle sprain associated with high body mass index and previous ankle sprain was eliminated by the balance training intervention.” I’ve used this protocol for the past 10 years and I’m always surprised by how effective it is. It’s easy, inexpensive, and surprisingly enjoyable to do, as it is a significant challenge, especially for previously injured individuals. If the patient is unwilling to spend 10 minutes performing this protocol, I have them do the proprioceptive training on the injured side, as prior research shows that there is a significant crossover effect, and that balance improves bilaterally when performed unilaterally. The simplicity of this exercise protocol explains why compliance in the study was so high: 91% for anywhere from one to four seasons.

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Differences in foot muscle morphology and foot kinematics between symptomatic and asymptomatic pronated feet. Zhang et al. Scand J Med Sci Sports. 2019;00:1–8.

This was an interesting study in that researchers took 30 young physically active adults with pronated feet and divided them into two groups: one group with a history of prior injury, and another group that had not been injured. The authors analyzed three-dimensional motion during the gait cycle, and used ultrasonography to measure cross-sectional area of the peroneal muscles, flexor digitorum longus and brevis, and the abductor hallucis muscles. The authors concluded the symptomatic pronators demonstrated significantly smaller cross-sectional areas of the flexor digitorum longus and abductor hallucis, and thinner peroneal muscles compared to the asymptomatic group. The symptomatic pronators also had excessive abduction of the forefoot during stance phase, possibly from weakness of the abductor hallucis. This was an interesting paper because there has been a long-standing argument as to whether or not excessive pronation is a contributing factor to injury. This research shows that it might be possible to prevent people with low-arches from getting injured by strengthening their foot and ankle muscles. This is significant because until recently, excessive pronators were primarily treated with orthotics, which new research shows that orthotics can actually weaken the intrinsic muscles of the arch, producing anywhere from 11 to 17% muscle atrophy in as little as 12 weeks. The take away from this paper is that you can’t go wrong by prescribing strengthening exercises for people with low arches. This is consistent with research showing that foot strengthening exercises can improve horizontal jump distance, vertical jump height, and agility. 

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