Dairy fat may cut Type 2 diabetes risk: study

A natural fatty acid found in whole-fat dairy products may lower the risk of Type 2 diabetes, U.S. scientists have found.

Studies on populations show that diets rich in dairy foods such as milk, cheese, yogurt and butter are linked to lower risk of Type 2 diabetes. Animal studies also suggest naturally occurring palmitoleic acid helps protect against insulin resistance and diabetes.

The reasons for the effect are unknown. To find out more about the fatty acid and its potential health benefits, researchers at the Harvard School of Public Health analyzed data from more than 3,736 American seniors who have been followed for 20 years as part of a study on risk factors for cardiovascular diseases.

Unlike industrially produced trans fats found in partially hydrogenated vegetable oils, which have been linked to higher risk of heart disease, trans-palmitoleic acid is found mainly in naturally-occurring dairy and meat. Previous studies have not linked this type of trans fat to higher risk of heart disease.

In the study, participants who said they consumed more whole-fat dairy products had higher levels of trans-palmitoleate in their blood three years later, the study's lead investigator, Dariush Mozaffarian, an epidemiology professor at Harvard and his co-authors report in the December issue of the Annals of Internal Medicine.

People with the highest levels of the fatty acid circulating in their blood had about two-thirds the risk of developing Type 2 diabetes than those with the lowest levels, the researchers found.

How exercise grows a healthy heart

Everyone knows that exercise comes with metabolic and cardiovascular benefits, but scientists understand surprisingly little about how physical activity influences the heart itself. Now, a new study in the December 23rd issue of Cell, a Cell Press publication, offers some of the first molecular-level insights.

The studies in mice suggest that exercise turns on a genetic program that leads the heart to grow as heart muscle cells divide. It appears that shift in activity is driven in part by a single transcription factor (a gene that controls other genes). That gene, known as C/EBPb, was known to play important roles in other parts of the body, but this is the first evidence for its influence in the heart.

"We've identified a pathway involved in beneficial cardiac hypertrophy – the good kind of heart growth," said Bruce Spiegelman of Harvard Medical School.

The findings may have clinical implications, particularly for those with heart failure or other conditions that make exercise difficult to impossible, the researchers say.

"This is yet another reason to keep on exercising," said Anthony Rosenzweig of Harvard Medical School. "In the longer term, by understanding the pathways that benefit the heart with exercise, we may be able to exploit those for patients who aren't able to exercise. If there were a way to modulate the same pathway in a beneficial way, it would open up new avenues for treatment."

There may also be ways to optimize training regimens such that they tap into this natural mechanism more efficiently, Spiegelman added.

Researchers had known that heart muscle adapts to increased pressure and volume by increasing in size. That's true in the case of exercise as it is in pathological conditions including high blood pressure. In disease states as opposed to exercise, those changes to the heart can ultimately lead to heart failure and arrhythmias.

In the new study, the researchers sought to better understand those differences using methods developed in the Spiegelman lab that allowed them to quantify changes in the expression of transcription factors in the heart at the genome-wide level in both exercised mice and those who had their aortas surgically constricted, a treatment that leads to a pathological increase in heart size.

The researchers found changes in 175 transcription factors in exercised mice and 96 in mice whose aortas were constricted. Importantly, the changes showed little overlap between the two animal models. For instance, the researchers said, 13 percent of the genes with differential expression following exercise have known or suggested roles in cell proliferation compared to less than one percent of those that changed with the surgery.

The researchers then zeroed in on one transcription factor, C/EBPb, which goes down about two-fold with exercise and a second that rises in turn. Studies in animals and cell culture showed that the decline in C/EPBb leads to changes that appear to be consistent with those that follow endurance exercise, including an increase in heart muscle size and proliferation. Those mice with lower C/EPBb levels also were resistant to heart failure.

That finding is key given that there is little prior evidence showing that the increase in heart size with exercise has direct benefits, the researchers say. The new evidence also gives important biological insights into the heart's potential for regeneration of muscle.

Rosenzweig said it will be important in future studies to explore all of the players in the pathway and to provide even more definitive evidence that exercise leads to an increased rate of cell proliferation in heart muscle.

Highest-Paid U.S. Doctors Get Rich With Fusion Surgery Debunked by Studies

Mikel Hehn poses in St. Cloud, Minnesota, with the daily medications he takes to combat pain and depression as a result of his spinal surgery. Photographer: Andy King/Bloomberg

Suffering from an aching back, truck driver Mikel Hehn went to see surgeon Jeffrey Gerdes in 2008. The St. Cloud, Minnesota, doctor diagnosed spinal disc degeneration, commonly treated with physical therapy, and said surgery wasn’t called for.
Unhappy with the answer, Hehn turned to Ensor Transfeldt, a surgeon at Twin Cities Spine Center in Minneapolis. Transfeldt performed fusion surgery on Hehn, screwing together three vertebrae in his lower spine.

Fusion aims to limit painful spine movements. This one didn’t work out. Two years later, the pain in Hehn’s neck, lower back, buttocks and thighs is so bad that he can’t hold a job and seldom leaves home, he said in an interview.

“There’s days when I just can’t take it and the tears run,” said Hehn, 52, who lives in Sartell, Minnesota. He said he takes oxycodone for pain, Soma to sleep, Lexapro for depression and Imitrex for headaches.
Hehn’s surgery generated a $135,786 bill from Abbott Northwestern Hospital in Minneapolis, feeding a national boom in costly fusion surgeries. It also illustrates how spine surgeons have prospered from performing fusions, which studies have found to be no better for common back pain than physical therapy is -- and a lot more dangerous.

The number of fusions at U.S. hospitals doubled to 413,000 between 2002 and 2008, generating $34 billion in bills, data from the federal Healthcare Cost and Utilization Project show. The number of the surgeries will rise to 453,300 this year, according to Millennium Research Group of Toronto.

Unnecessary Surgeries

The possibility that many of these and other surgeries are needless has gotten little attention in the debate over U.S. health care costs, which rose 6 percent last year to $2.47 trillion. Unnecessary surgeries cost at least $150 billion a year, according to John Birkmeyer, director of the Center for Healthcare Outcomes & Policy at the University of Michigan.

“It’s amazing how much evidence there is that fusions don’t work, yet surgeons do them anyway,” said Sohail Mirza, a spine surgeon who chairs the Department of Orthopaedics at Dartmouth Medical School in Hanover, New Hampshire. “The only one who isn’t benefitting from the equation is the patient.”
The Twin Cities Spine bill for Hehn’s surgery was $19,292, his medical records show. The firm received $8,978 after an insurance discount, $7,742 of it for Transfeldt’s services. Hehn’s insurer paid after his bid for workers’ compensation coverage was denied on grounds he wasn’t injured on the job.

Royalties, Consulting Fees

Limit set on popular procedure on spines

Blue Cross is under fire for seeking to curb use of expensive spinal fusions.

By Alan M. Wolf
alan.wolf@newsobserver.com

Posted: Saturday, Dec. 25, 2010

More Information

• By the numbers
  3,593: number of spinal fusion surgeries Blue Cross and Blue Shield of North Carolina covered last year, up 22 percent from 2007.
  $105 million: amount the insurer paid in claims for the procedures last year, up 44 percent from 2007.
  Nine: number of medical associations that signed a Dec. 15 letter to Blue Cross, urging changes to its new policies, which take effect Jan. 1.
  3.7 million: Blue Cross members statewide.

The state's largest health insurer is coming under fire from surgeons across the country for implementing tougher restrictions on an increasingly common type of spinal surgery.
Blue Cross and Blue Shield of North Carolina's new rules, which take effect Jan. 1, are designed to reduce overuse of spinal-fusion surgery, a costly and controversial procedure to ease patients' lower back pain . The Chapel Hill-based insurer says it wants to ensure the surgeries are approved based on the latest medical evidence.

"We are not going to stop coverage, but we do want to make sure the ones being done are appropriate," said Dr. Don Bradley, Blue Cross' chief medical officer. "In some cases, we're seeing technology being used when more conservative measures might be more appropriate."
But some spine surgeons worry that the restrictions will limit care for thousands of patients and could set a new coverage standard among other insurers.

A coalition of surgeons representing nine medical associations, including the American Association of Neurological Surgeons and the North American Spine Society, wrote to Blue Cross this month, urging the company to reconsider.

As Spinal Fusion Volume Grows, So Do Profits for Surgeons & Device Makers

Report outlines controversies over device-heavy spine procedures and surgeon-manufacturer relationships.

Are financial relationships with medical device companies and profitable reimbursement margins inducing spine surgeons to perform more fusions than necessary? A recent report in the Wall Street Journal explores several controversies associated with the growing market for these device-heavy spine surgeries. Medicare paid $343 million for spinal fusion procedures in 1997, compared to $2.24 billion in 2008 — a nearly 400% increase, according to the Journal's analysis of Medicare data. Within the medical community, doctors are divided between more conservative spine surgeons who believe fusion should be used sparingly to treat a small number of conditions, such as scoliosis, and surgeons who advocate using fusion to relieve chronic back pain or to treat degenerative disk disease, one of the most hotly debated uses of the procedure.  Blue Cross and Blue Shield of North Carolina announced earlier this year that it would stop paying for spinal fusions performed to treat aging disks beginning on Jan. 1, 2011. Nine medical associations, including the American Association of Orthopaedic Surgeons, recently sent a letter to the insurer to express concerns over the new policy and advocate for less restrictive language. One thing is certain: The increase in spinal fusions has been a boon for the companies that make and sell the hardware and implants used in spinal fusion surgery, which can cost tens of thousands of dollars for a single procedure.  Meanwhile, companies like Medtronic, the largest manufacturer of spinal implants, pay surgeons millions of dollars in royalties for their help in developing new technologies. Medtronic and the surgeons who collaborate with the company say the payments are a legitimate way for surgeons to give input on new devices and do not create a conflict of interest. Critics, including some members of Congress, argue that they are essentially kickbacks designed to boost medical device sales.  In response to this criticism, Medtronic began disclosing its payments to surgeons publicly on its website in June, and many doctors who partner with device makers say they disclose these relationships to their patients. A provision in the Affordable Care Act requires all companies to disclose such payments made to physicians by 2013. Read the full WSJ report here. Irene Tsikitas

Diet key to longer life, even when you're old

Adults ages 70-79 who ate healthy foods had lower risk of death over a 10-year period, study finds 

By Rachael Rettner 

Even in your elder years, eating healthy foods can help you live longer, a new study suggests.

In the study, older adults who ate mainly healthy foods — such as vegetables, fruit, poultry, low-fat dairy products and whole grains — had a lower risk of death over a 10-year period than those who ate less-healthy foods, including high-fat dairy products.

"Some people have suggested in the past that it doesn't maybe matter too much what people eat at an older age," said study researcher Amy Anderson, of the department of Nutrition and Food Science at the University of Maryland. "But our study, and previous studies, support the idea that that older adults can affect their health and longevity by following a dietary pattern that is high in healthy foods."
Anderson and her colleagues examined the eating habits and quality of life of about 2,500 adults, ages 70 to 79, from Pittsburgh and Memphis, Tenn. Participants answered a questionnaire designed to assess their typical diet. They also indicated whether their health was excellent, very good, good, fair or poor.
Story: Being 'chilled out' can increase risk of obesity The researchers grouped the participants based on their diets:

• Those who ate mainly healthy food
• Those who ate mainly high-fat dairy products, such as ice cream and cheese, and had a lower intake of poultry, low-fat dairy products, rice and pasta
• Those who ate mainly meat and fried foods and drank alcohol
• Those who ate mainly refined grains
• Those who ate mainly breakfast cereals
• Those who ate mainly sweets and desserts — such as doughnuts, cakes and candy — and had a lower intake of fruit, fish, other seafood and dark green vegetables

The researchers followed up with the participants for an average of 10 years, during which 739 died. Those in the high-fat dairy product group were 40 percent more likely to die during this time period than those in the healthy food group. Those in the sweets and desserts group had a 37 percent higher risk of death than those in the healthy food group.

Those in the healthy food group also reported more years of healthy life, when they rated their health as excellent, very good or good.

Interestingly, those who ate mostly meat and fried foods and drank alcohol did not have a higher risk of death than those who ate healthy food after the researchers took into account other factors that could affect the results, such as age, gender, race, education, physical activity and total calorie intake. It's possible that eating plant-based foods counteracted the deleterious effects of eating animal fat, the researchers said. Those who consumed meat, fried foods and alcohol also ate slightly more vegetables, fruits and whole grains than those in the high-fat dairy products group and those in the sweets and desserts group.

Low Vitamin D Levels Common in Breast Cancer

Dec. 14, 2010 (San Antonio) -- More than half of women with breast cancer have low vitamin D levels, British researchers report.

"Women with breast cancer should be tested for vitamin D levels and offered supplements, if necessary," says researcher Sonia Li, MD, of the Mount Vernon Cancer Centre in Middlesex, England. The findings were presented at the San Antonio Breast Cancer Symposium.

Some studies have suggested a link between low vitamin levels and breast cancer risk and progression, but others have not, she says. No studies have proven cause and effect.

Previous research suggests a biologic rationale for vitamin D putting the brakes on breast cancer development and spread, Li says.

Breast cancer cells have vitamin D receptors, and when these receptors are activated by vitamin D, it triggers a series of molecular changes that can slow cell growth and cause cells to die, she says.

Even if it does not have a direct effect on the tumor, vitamin D is needed to maintain the bone health of women with breast cancer, Li says. That's especially important given the increasing use of aromatase inhibitors, which carry an increased risk of bone fractures, she says.

Vitamin D is found in some foods, especially milk and fortified cereals, and is made by the body after exposure to sunlight. It is necessary for bone health.

Consumer Reports Warns Pregnant Women Against Canned Tuna

Pregnant women and children have long been warned that they should be wary of eating certain kinds of seafood because of the risk of mercury contamination. It's a real threat — mercury is a neurotoxin, and exposure in-utero at high levels can damage an infant's developing cognitive skills.

Seafood can pose a danger because mercury — usually from the emissions of coal-fired power plants and other industrial sources — can accumulate in the tissue of fish, especially in predators high on the food chain. That includes tuna, and white (albacore) tuna is known to be especially high in mercury. The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) both recommend that women of childbearing age and young children should eat no more than 12 ounces a week of light tuna, including 6 ounces of white tuna. (More on Time.com: 5 Pregnancy Taboos Explained (or Debunked))

But that may not be safe enough. Consumer Reports tested 42 samples of tuna from cans bought in and around New York and found that white tuna usually contains far more mercury than light tuna — and that women and children should be even more cautious about eating the fish.

After analyzing the tests, the magazine's fish-safety experts concluded that pregnant women should avoid eating all tuna as a precaution. Children over 45 lbs. should stick to no more than 12.5 ounces of light tuna or 4 ounces of white tuna a week, while lighter children should have no more than have 4 ounces or less of light tuna or 1.5 ounces or less of white tuna, dependent on their weight. (Download a copy of the report here.)

Why the stricter warnings? Every sample that Consumer Reports tested had measurable levels of mercury, ranging from 0.018 to 0.774 parts per million (ppm). Samples of white tuna ranged from 0.217 ppm to 0.774 ppm and averaged 0.427 ppm — enough that by eating 2.5 ounces of any of the tested samples, a woman would exceed the daily mercury intake considered safe by the EPA. (More on Time.com: Study: Restless Leg Syndrome During Pregnancy May Recur)

Samples of light tuna ranged from 0.018 ppm to 0.176 ppm. That's low on average, but about half the tested samples contained enough mercury that eating a single can would exceed the EPA's limit for women of child-bearing age.

Indeed, it's the outliers that pose a particular danger, not so much the average. While light tuna especially on average doesn't contain that much mercury, there's the danger of spikes in certain samples — and there's no way for pregnant women to know if the canned tuna they're eating contains unusually high levels of mercury. But the Consumer Reports study shows that it is a real threat that cautious women should take seriously.

Of course, limiting your seafood intake has its own risks. Omega-3 fatty acids — found in fish — are thought to help in developing fetal nervous systems, and they're well-known to reduce the risk of heart attack and stroke. The National Fisheries Institute, a trade group, noted that none of the canned tuna it tested — even the outliers — exceeded the FDA's allowable limit of 1 ppm or more. (That's the point at which the FDA is allowed to pull products from the shelves, though that's never been done.) The group also noted — cheekily — that Consumer Reports had apparently served tuna tartare at its recent holiday party, so it can't be that dangerous. (More on Time.com: Photos: Pregnant Belly Art)

Of course, the FDA's safety limits on mercury have long been considered too lax — and compared to the rest of the world, they are. It will be a long time before we have definitive science on just how much mercury pregnant women can be exposed to without ill effect, but most people would agree that this is a time for the precautionary principle.

Top Spine Surgeons Reap Royalties, Medicare Bounty

Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.

The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.

Medtronic and the surgeons say the payments are mostly royalties they earned for helping the company design one of its best-selling spine products.

Corporate whistleblowers and congressional critics contend such arrangements—which are common in orthopedic surgery—amount to kickbacks to stoke sales of medical devices. They argue that the overuse of surgical hardware ranging from heart stents to artificial hips is a big factor behind the soaring costs of Medicare, the government medical-insurance system for the elderly and disabled.

Medtronic says it can't develop new medical products that improve patients' lives without the help of surgeons. It says the royalties it pays them are legitimate but it doesn't give detailed information about what intellectual property each recipient contributes. It says it doesn't pay its collaborating surgeons royalties on the devices they personally use in their patients, removing any financial incentive for them to do more surgeries than necessary.

Norton's Dr. Glassman cited this policy as a safeguard against any conflict of interest and said the royalties he and his colleagues receive are "legitimate." He added that they inform their patients of their financial ties with Medtronic. Norton Hospital said it has policies "to prevent direct conflicts of interest." The other Norton surgeons didn't respond to requests for comment put to them through Norton and Dr. Glassman.

Using a Medicare database that tracks hospitals' billing, The Wall Street Journal was able to ascertain that Norton is among the most aggressive practitioners of spinal fusion in the country.

Spinal fusion has become one of medicine's most controversial procedures. It involves fusing together two or more vertebrae to alleviate back pain, usually with the help of metal plates, rods and screws implanted in the patient's back. Tens of thousands of dollars of hardware can go into a single surgery.

Medtronic is the biggest maker of spinal implants. Last year, its spine business generated world-wide sales of $3.5 billion, accounting for half of the roughly $7 billion spinal-implant market.

Conservative spine surgeons argue that a spinal fusion is appropriate only for a small number of conditions, such as spinal instability, spinal fracture or a severe curvature of the spine known as scoliosis, and that financial incentives have caused the procedure to become overused. Others say it's a useful tool to treat patients who have debilitating back pain and have tried other options like physical therapy to no avail.

The Journal consulted several experts to determine which back conditions are commonly thought to require a fusion and which are subject to the most debate. The most hotly debated use of spinal fusion surgery centers on patients who merely suffer from aging disks, a condition known as degenerative disk disease.

One health insurer, the nonprofit Blue Cross and Blue Shield of North Carolina, announced in September that it would stop paying for spine fusions performed on such patients beginning on Jan. 1. The insurer said that the procedures are "considered not medically necessary."

The Journal mined hospitals' Medicare claims to see what proportion of fusions performed fall in this category. Due to a three-decade-old court ruling guarding the confidentiality of physician information, the paper is barred from disclosing what it found regarding the five Norton surgeons.

Critics of the court ruling and of the privacy policies of the federal Medicare program argue that making such information public would help taxpayers understand where their money is going, and potentially deter abusive or wasteful practices.

But the Journal is permitted to disclose its findings for Norton Hospital as a whole, where 27 surgeons performed one or more spine fusions in 2008.

At Norton, spinal fusions on patients who only suffered from aging disks accounted for 24% of the 2,475 fusions the hospital performed for Medicare between 2004 and 2008, compared with 17% nationally. This placed it 11th in percentage terms out of 60 hospitals that performed 1,000 or more spine fusions in those years, and fourth in raw count. Norton ranked third nationally in the overall numbers of spine-fusion surgeries.

In emailed responses to questions, Dr. Glassman said he and his four colleagues "do not overuse spine fusion procedures," and argued that the diagnostic codes the Journal based its analysis on "do not convey indication for spinal fusion with the specificity that you are attributing to this data."

When to Consider Orthotics: Research-Based Recommendations

Sometimes a patient's need for custom-made foot orthotics becomes apparent only after an inadequate response to chiropractic care. Some patients, however, reveal an obvious need, and orthotics should be provided early in their care.

This will allow a good response to adjustments and prevent frustration all around. What follows are some commonly seen patient characteristics that indicate the need for foot orthotics.

History

Back problems worse with standing, walking, running. When a patient reports a link between locomotor activities and their spinal symptoms, this clearly calls for orthotics to minimize the stress being transmitted from the lower extremities to the spine.1

Recurrent ankle sprains. A history of previous sprain injuries to one or both ankles indicates biomechanical instability and probable permanent ligament damage. Custom-made stabilizing orthotics provide the support needed to help prevent re-injury.2-3

Family history of foot problems or surgery. A patient who has family members with foot problems and/or surgery has a much higher probability of the same. Fitting for orthotics may prevent these problems from developing and could help the patient avoid surgery.

Strenuous athletic activities. Those who engage in upright, weight-bearing sports need both shock absorption and foot/ankle stability. Orthotic support can increase performance and prevent injuries in many individual and team sports.4

History of lower extremity stress fractures, recurring shin splints, hamstring strains. Whenever an athlete, whether recreational or competitive, reports symptoms of overuse injury (microtrauma) in the lower extremities, orthotics should be provided. These conditions are closely correlated with biomechanical asymmetries, and require better support and shock absorption.5-6

Chronic knee pain, patellofemoral arthralgia, ACL injury. The knee joint is a sensitive indicator of abnormal biomechanical stress, and these conditions have all been shown to indicate the need for orthotics. Controlling pronation decreases the rotational forces, improving patellar tracking and protecting the anterior cruciate ligament.7

Exam Findings

Postural imbalances (e.g., pelvic tilt, scoliosis, forward head). When a standing structural evaluation discloses any pelvic tilt, a lower extremity asymmetry requiring orthotics for proper correction is likely. Both functional and idiopathic types of spinal curvatures can benefit from the foot stabilization and neurological stimulus provided by orthotics.8 Many postural complexes (forward head is one of the most common) are secondary to poor standing balance and proprioception from the feet.

Gait asymmetry (e.g., calcaneal eversion, excessive pronation, foot flare). Looking for indicators of biomechanical asymmetry while a patient walks will often demonstrate the need for orthotics.9 If the foot and ankle complex is not functioning correctly during the stance phase of gait, this stress is transmitted to the pelvis and spine with every step.

Foot calluses, bunions, hallux valgus. Heavy callousing, bunion development and abnormal alignment all reveal evidence of abnormal or poorly tolerated forces during walking and indicate the need for improved biomechanics and orthotics.10

Lack of an arch (especially unilateral). This is seen during the weight-bearing portion of the exam, when a foot collapses under the weight of the body. A foot without an arch will not function properly and thus requires support.11

Knee instability, high Q-angle, poor patellar tracking. When the knee does not align properly or track correctly, degenerative wear-and-tear and other chronic symptoms will follow. Orthotic alignment is required to reduce the abnormal forces on this complex joint, which must be able to sustain frequent high forces during walking and running.12-13

X-Ray Findings

Scoliosis (functional or idiopathic), widespread disc degeneration. The spine will demonstrate poor support from one of the lower extremities by developing a lateral curvature. Gait disturbances may be one of the causative factors for idiopathic scoliosis. Significant intervertebral disc degeneration is proof of poor spinal shock absorption, and orthotics with viscoelastic properties often reduce symptoms dramatically.9

Unlevel sacral base, sacroiliac joint degeneration. The pelvis shows evidence of inadequate support by the appearance of a tilted sacral base when standing. This is often due to a functional short leg requiring orthotic support.14 Sacroiliac degeneration is unusual; when found, it indicates significant abnormal stresses.

Low femur head, coxafemoral DJD. These conditions are due to either an anatomical or a functional short leg. Degenerative changes in the hip joint have been correlated with the stress of a longer leg. Both will benefit from the improved balance and support provided by orthotics.14

Heel spur, DJD in knees, metatarsals. X-rays of the feet and knees may reveal evidence of long-standing regional stress, such as degenerative changes in weight-bearing joints and connective tissue calcification. Calcium deposited in the calcaneal attachment of the plantar fascia specifically indicates the need for support of the arches of the foot to help reduce shock and symptoms in degenerated joints, and provide arch stabilization.11

Treatment Response

Recurrent subluxations. Making the same adjustment to a patient's spine again and again suggests poor structural support for the region. Orthotics have been used for decades by chiropractors who don't want to continue adjusting the same area and who want to see the adjustment "hold" better.

Unresolving muscle strain, myalgia. Myofascial symptoms not responding to treatment often are a clue to an underlying biomechanical imbalance. Many chronic muscle spasms and strains can be corrected by providing orthotics to support and stabilize.15

Flare-ups, exacerbations. A patient who is feeling better, returns to daily activities, and then suffers a return of symptoms probably needs orthotics. Without proper biomechanical support, these patients find that every attempt to establish normal routines causes a recurrence of their symptoms.

Foot symptoms are only one of the many reasons for supplying orthotics. In fact, the feet are seldom painful in most of the conditions that are clear indicators of an need for orthotic support. All chiropractors must be alert for signs of lower extremity involvement in spinal conditions. The good news is that these conditions can all be helped. Investigation and correction of foot biomechanics can help most patients, especially the recreationally active and the elderly.