Forefoot Varus Predicts Subtalar Hyperpronation

Kevin-Thanks for the reply. I contacted you personally some time ago, so you actually do know my name. It will remain anonymous for now, but suffice it to write that rdp1210 also knows who I am. As for peer review...my original 42 page program, complete with jpeg's, illustrations, video interviews with patients and animation was peer reviewed by Ron Valmassy and a local Vascular-Thoracic surgeon that became President/CEO of the largest hospital/trauma center in central California. It was on his advice to get this information out in the public domain as quickly as I could which compelled me to have it published sooner, rather than later. Thus, a condensed version will be published in a non-PubMed journal, and as I wrote, with more hopefully to follow later.

The original program was intended to be utilized as a 3 unit CME program targeting gate-keepers, (Pediatricians, Neurologists, Sleep Disorder and Pain Management Specialists, GPs etc.), as well as Podiatrists that see this problem in their offices. I was met with incredible push-back from the medical/podiatric community in acquiring the CME units, so I have decided to release this info quickly, as the pilot study was completed 2 years ago.

As far as extending the forefoot varus correction to the end of the toes, this is not a new concept, and one you wrote about, (and Subotnick), as well as others...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2383477/

I don't anticipate that I will reference the voluminous archives here in order to "come up to speed" on the plethora of debate on rear foot vs. forefoot schools of thought, but the fact that this 'issue' is still being discussed ad infinitum indicates that the discussion is hardly resolved. What I discuss in my program is simply MY way of treating these patients, the problems I encountered early on and how I resolved them through my own thought process. Is my way the only way? Nope. I am not a "biomechanics guru", nor have I ever professed to being one. I believe in our line of work, sometimes it's not the end point that is as instructive as the path taken to arrive at that point.

The video interviews illuminate that point. And FWIW, the last interview I conducted was with the owner of the Valley's largest Prosthetic/Orthotic design and manufacturing company. He had GP as a child and RLS as an adult before we got him "squared away". Patient interviews, while instructive, are typically wrought with subjective opinions. His is not, as he has to be considered an expert in this field and offers helpful objective opinions.

As far as Simon's rather condescending reference to my posts, had he read what I wrote in some of the posts I offered, he would've/should've known that I distinguished between flexible vs. structural deformities...a topic I discussed at length in my 42 page offering, but due to word constraints, did not address to the same degree in my revised article, and to the degree that, no doubt, has been discussed here. His question about my name, (Mike Hunt), is not only sophomoric, but not befitting of a professional forum.

Once I determined the root cause of growing pains in children, the connection to at least a sub-group of RLS patients was an easy one. While my patient numbers aren't large, they are certainly greater than those originally offered by Dr. Evans in 2003.

Evans AM (2003) Relationship between “growing pains” and foot posture in children: single-case experimental designs in clinical practice. J Am Podiatr Med Assoc 93: 111–117

My suggestion that perhaps only a subset of RLS patients are involved, is based on the low number of patient treatments and the work of Dr. Walters at Vanderbilt Univ.

http://www.sleep-journal.com/article/S1389-9457(13)01108-8/abstract?cc=y

Without "giving away the farm" on this topic prior to release of the pilot study, the hypothesis that myself and a Podiatrist in your area are making is that GP and RLS are a continuum of the same problem. While Walters, (and all other MD researchers for that matter), have suggested that GP is the adolescent version of RLS, we come to the unique position of conjecturing that RLS is the adult version of GP. I have read no articles in the medical record/literature that suggests that. Based upon my findings since the time I concluded my pilot "study" two years ago, my opinion about the source of the pains and connection between these two medical conditions has only strengthened. Had I paid more attention to Root's book when I was a student and early in my career, perhaps I would figured this all out sooner. Stay tuned, regards and Merry Christmas.

 

drhunt1:

If I know you, then why can't you let me, and the others following along, know who you really are? And you complained that Simon Spooner was somehow unprofessional?! At least Simon is professional enough to sign his real name to all of his posts here and not hide behind a pseudonym, as you currently are. I think it is pretty unprofessional of you to tell me "I contacted you personally some time ago, so you actually do know my name." That's pretty lame, if you ask me.

You would gain much more respect here on Podiatry Arena if you:

1) Let us know your real name, and,

2) Publish your research first to let us see, first hand, how good it is, before you comment multiple times about how good it is before anyone has had a chance to read it.

In the past, when others have come on Podiatry Arena to tell us how great their research is before it is supposed to be published, invariably, we never see the research because it seems to never get published, for some reason.

I hope you are different.

 

In addition to Simon's and Kevin's points. I also do many things that Root never taught. If I feel that I want to increase load on the lateral forefoot, I will add a forefoot valgus intrinsic post even when I don't see a forefoot valgus in the cast. I can then add a medial heel skive so that the "everted" heel is no longer everted. Yes, I'm using a cast modification described by Mert Root, but I'm certainly not using it in a way described by him. I'm certainly not using the same rationale for that modification. I'm not supporting a deformity that I saw when I measured forefoot to rearfoot relationship.

Daryl, you obviously have thought a lot about the biomechanics of Hallux valgus. I don't know if we agree about the mechanics. I'm a big believer in the role of the windlass mechanism in the development of hallux valgus and the increase in the intermetatarsal angle. If you decrease the load in the windlass, you will decrease the forces that will make the bunion develop. You can design an orthotic to reduce forces in the windlass.

I remember not liking the explanation of bunion formation in Normal and Abnormal Function of the Foot. I don't recall how Root et al. thought an orthotic was supposed to be designed to prevent bunions. I think I am recalling their protocol correctly when I say they would make the same orthotic for a patient with lateral ankle instability and a bunion and any other pathology.

Daryl, I liked your comment about why would anyone want to bisect anything. We certainly should answer that before we examine what would be a good heel bisection.

Daryl, I have some questions on your criteria for the heel bisection. Why should it overly the center of mass of the calcaneus. Why is the center of mass of the calcaneus important?

Why should the bisection be over the center of the weight bearing surface? Isn't the center of pressure under the heel more important than the geometric center of the fat pad. Doesn't Kevin's paper on the anterior axial projection call into question whether the geometric center is important. I've seen a lot of EMED measurements where there is more pressure on the medial heel than there is on the lateral heel.

Why should the inversion and eversion moments be equal when the bisection is vertical? Inversion and eversion moments from what source. The forefoot will be applying moments to the rearfoot. You cannot analyze the moments acting on the heel independent of the forefoot.


Eric

 

Eric,

As you may recall, I have written in the past about John Weed's valgus onlay modification that I helped him develop back in the late 70's or very early 80's. John theorized that if the foot still pronated with an orthosis in the shoe, the mtj range of pronation would increase. He wanted to support all of the forefoot valgus. Via trial and error, we developed a korex extrinsic valgus wedge that was placed on the orthotic shell to produce valgus post on the shell. To the best of my knowledge, your instructor John Weed was the first to use a valgus post on a foot even when there may not have been any forefoot valgus demonstrated in the cast of the foot. I know John spoke about this modification at the Root Lab seminars and I would assume he spoke about it to his students.

As far as what my father did with his patients, it is important to remember that he retired from practice around 1977 or so while he was mid fifties due to severe rheumatoid arthritis. He also was disabled and was out of practice for about two years in his early forties when he was incorrectly diagnosed with a terminal illness. Since he spent time in the army during and after WWII, he had a relatively short career when you think about it. Logically orthotic therapy would and should continue to evolve during and certainly after his career. As I said to Kevin, Root knew that his work was a work in progress. In fact, after he retired he was frustrated that prescription foot orthotic therapy and biomechanics wasn't progressing much more rapidly. Clearly Root's work was not intended as the be all, end all in biomechanics and orthotic therapy.

As the owner of a prescription foot orthotic lab, what concerns me is the lack of consistency in how podiatrists practice. The is no standard biomechanical examination or evaluation, no standard theory of function and no standard treatment approach. So how are the podiatry schools going to teach the students of today and what text books do they have to use for educating them?

Jeff

 

Very erudite observation and the real elephant in the room as far as the profession is concerned. I'm reminded of a quote by Hunter S Thompson in Fear and Loathing in Las Vegas

That high-water mark in podiatric biomechanics may have already been made.

 

Nope. There is plenty more to learn...now with our eyes and ears open.

 

Yes, I know, but you remember the other thread when I remarked that you aren't representative of the profession as a whole? Same applies here.

 

Is "podiatric biomechanics" represented by the leaders of the profession, or by those who care little about it? I hope the former.

I guess it all comes down to how one views their profession. Do they look toward the leaders of their profession and strive to attain the knowledge they provide and say the leaders represents the profession? Or do they look at the mediocrity within their own profession and complain how bad the profession looks?

I tend to look toward the leaders since these are the ones I can learn the most from. This is why I think "podiatric biomechanics" has an exciting future that is, already, far ahead of anything I was taught in podiatry school three decades ago.

Has the high-water mark in "podiatric biomechanics" already been made. Not a chance!

 

Regrettably, it is by both - at least as far as the public are concerned. There may be a few enlightened patients out there who do some research before consulting a clinician of choice, but usually a pin, blindfold and the yellow pages does the trick. If only there was a way of measuring quality, huh? I guess that is what Jeff may be alluding to.

 

Actually, here in Northern California, as in most large communities in the USA, almost no one uses the "yellow pages" any more. That's old school. Now it's web searches, smart phones and, the old stand by, word of mouth. I think I got only one patient in 2014 from the yellow pages. Do people in the UK still use the yellow pages??

 

Not really sure where you're coming from, Kevin. When I called you and identified not only myself, but the Podiatrist in your area that had contributed to the material I'm presenting, I directly told you what I had discovered and achieved. Did you blow me off after that conversation? Did you forget about it completely? You asked if I had the material peer reviewed, and I told you that Ron Valmassy had, as well as a prominent MD. Have you not disseminated newsletters that were not peer reviewed? Were we supposed to take your information with a grain of salt, or as gospel? Is Valmassy not a good peer reviewer?

Considering that I now am at the "mercy" of the publisher, (he has had the revised article for 4 months now), I can't speed the process of publication any more than I have tried. It is, what it is. I will wait.

Next, you call ME unprofessional for not stating my name on this board, and calling me lame. Really, Kevin? Please be sure to tell that to rdp1210, as he has done the same, and "newbies" here have no idea who he is. I remember somewhere in the Podiatry Arena archives that you stated growing pains are an overuse syndrome. Not so, Kevin...and I'll give you a quotable quote: "Life is an overuse syndrome". It's original but you can use it. For every example of overuse syndrome that I have treated as a practitioner, I have discovered an underlying structural reason why, with only a few exceptions.

It appears that I have stumbled across a "good ole boys" club of Podiatric soft-tissue advocates that also aren't Dr. Root fans. So be it. I didn't intentionally mean to disrupt that line of reasoning, even though I have...but let me ask you this: I see that you attended UC Davis right after I did. Did you take Comparative Morphology from Milton Hildebrand Jr.? If so...did you learn anything in his class? It was quite instructional for me, for among other things it taught me, (along with Irwin Segal's Biochemistry 101 and several other profs), HOW to think...not what. For me, focusing on soft tissue is a waste of my time. For almost 200 years, medical and podiatric researchers/students have not known the answer, and for the last 100 years have been taught/lectured to that growing pains were caused by the long bones growing faster than the soft tissue can adapt. They totally ignore the fact that seldom, if ever, do children experience pain in the long bones of the upper extremity, (that's a slight problem...isn't it?). Although some researchers have steered away from that definition, there are still those that believe it...mostly old school docs that pass this misinformation along to their patients and families. We're doing a great disservice to our patients. When you read how simple the answer is, it will blow you away. The fact that I believe a correlation to RLS has been achieved as well...a malady that dates back to the 1600's, is icing on the cake. They are not caused by an overuse syndrome, nor has it much to do with soft tissue. In the case of RLS, my study indicates a direct link to GP, with patient testimonies, and it doesn't have anything to do with heavy metal levels in the body. Stay tuned.

 

drhunt1, I suppose you don't realize how many podiatrists call me or e-mail me every month to ask me to give them advice about their "latest great product" or "latest great research". Sorry I don't remember you out of the other hundred or so podiatrists I have talked to over the past few years about their pet projects that they need to talk to me about and want my advice on.....all for free, of course.

I suppose that you think your idea is so important that I should somehow remember you from all the others. Honestly, I have no clue who you are, don't ever remember talking to you about restless leg syndrome or growing pains and, at this point, could really care less considering the way you have conducted yourself here on Podiatry Arena. And you call Dr. Spooner unprofessional? What a joke.

drhunt 1, I'll give you a quotable quote, that you can also use, and suggest you remember the next time that you elbow yourself into an academic discussion with proclamations about your own pet project that has nothing to do with the ongoing discussion:

"If you want some respect in an academic forum for medical professionals, provide your real name and don't brag about how good your unfinished ideas are or your unpublished papers are until they have been published."

 

Kevin-how many millions of patients are currently effected by the two maladies? What's the percentage of kids that present with GP? How many articles have been written on the subject that are referenced on Google Scholar...ever looked? And when have I EVER bragged about the research I did? I simply used it to deliver a hard, and deserved response to Simon's incredibly ignorant address to me, and here you are defending him. Tsk, tsk, Kevin. And you have the gall to call me unprofessional. What's really humorous is that I predicted your response well over two years ago...yours as well as those that have yet to read my pilot study, but consider themselves biomechanics "gurus".

Have you contacted rdp1210 to tell him to post his name and info...or are you being a hypocrite with me? Let me tell you, Dr. Kirby...I've simply had enough of the dogmatic Podiatrists among us that have made a living making biomechanics so incredibly difficult, complicated and useless to the practitioner without regard to furthering the profession that I have decided to raise my hand in opposition. My program is the antithesis of the garbage I have read here...

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=97997

Taking pot shots at Dr. Root is NOT professional, nor is it helpful, appropriate or truly instructive.

My program is simple, prudent and will potentially help millions of patients. And the animation is killer stuff. Is that bragging? Sorry.

 

Coming from this maybe a bit rich - all involved take a chill pill, as my grandkids say to me. Yes there are a load of egos about - maybe mine is one of them though I have tried to steer clear of this bit.

I think we would all do well to remember that opinions are worth essentially nothing - its what is in the refereed press that is worth anything. And actually there in lies the rub; there is refereed press and then there is refereed press. To really gain credibility, one should be published in journals in addition to one's own profession journal, The Australian Podiatrist (now defunct), JAFAR, JAPMA, The now defunct UK journal etc.. To really gain the respect of one's peer group, one needs to be published in the discipline area under discussion - Journal of Biomechanics for instance; Journal of anatomy; Journal of Comparative Human Biology; American Journal of Physical Anthropology, to name but a few (lousy English, I know).

The point is, quite simply, that we may sit here and pontificate about the biomechanics of this, that or the other, but not read about it in a biomechanics journal. If that was to occur, then I think the pod world would stand up and take more attention of what was being said, rather than hiding under the wing of one's own professional journal.

Rob

 

Daryl Phillips has stated his name in the past and us good ole boys know who he is.

Is your mentioning of "soft tissue advocates" referring to what we call the tissue stress approach to biomechanics? Us tissue stress advocates consider bone a tissue.

Eric

 

Jeff, do you know if Mert agreed with John Weed's use of the valgus onlay? Lack of consistency in podiatric practice is not a new problem.

It sure would be nice if our teachers all new the truth and had the perfect paradigm to teach us. However, all we can do is think critically and question what we were taught and develop our own view of the biomechanics world. We can teach our students what we think and to remind them to think critically and develop their own world view.

Eric

 

William Sayle-Creer (1937) was discussing contra-lateral wedging long before John Weed: “By wedging the inner border of the heel and thus inverting it, the tibials are relieved. By wedging the outer side of the sole, the foot is everted and the strain on the peroneus longus is removed. Clinical practice shows that the degree of wedging must be determined for each individual case.”

 

I think I like the title "Angry Podiatrist" more than I like the title "Good Ole Boy". Oh well, consider the sources.

I find it fascinating that some podiatrists, especially here in the USA, think that podiatric biomechanics began and peaked with Mert Root at the helm. If you criticize Dr. Root's ideas, they get pushed out of shape and take it personally, as if you were calling their own father a horse thief.

What Eric Fuller, Simon Spooner, Craig Payne, Simon Bartold, myself and many others have tried to do over the years is to bring some common sense physics ideas back into "podiatric biomechanics". We have tried to get away from some of the "voodoo biomechanics" that we were taught in podiatry school, where we were taught things like heel vertical was normal, that an orthosis that extends past the metatarsal necks was not a true "functional orthosis", that the midtarsal joint has two axes of motion and once a calcaneus everts past 2 degrees, it will continue to evert until maximally pronated.

Foot and lower extremity biomechanics is not just about what one man dreamed up and what he, and he alone thought and taught. Rather, foot and lower extremity biomechanics is about taking all ideas coming from all directions, sorting them out into which ones make the most sense mechanically and physiologically, and applying these principles in a coherent fashion to make our patients better.

I find it so refreshing to lecture outside of the USA in the UK, Spain, Australia and Canada where podiatrists are eager to learn new ideas and are unburdened by all the dogmatic biomechanics teaching I was subjected to that did not make sense mechanically. These podiatrists soak up the information I teach, use it in their practices, buy and read my books and have great success with the concepts I have tried to teach over the past three decades. In addition, I have been extremely honored over the years to lecture internationally with the likes of Simon Spooner, Eric Fuller, Craig Payne, Simon Bartold, all of whom have also taught me. I have learned an enormous amount from all of these fine men.

However, there is a big problem. Here, in the US, we have many older podiatrists that are convinced that everything Dr. Root said is gospel, couldn't possibly be wrong, and that if you disagree with what Dr. Root said then you are a blasphemer. Then, on the other hand, we also now have a generation of younger podiatrists, as Jeff mentioned, who barely know who Mert Root was and who could care less about prescription foot orthosis therapy because they are "Foot and Ankle Surgeons" and making custom foot orthoses for their patients is somehow below their elevated station of being a "Foot and Ankle Surgeon".

Considering all of this, I'm rather happy I'm approaching the end of my teaching career since the BS I have had to endure over my last 30 years of teaching gets older every year. I'll be happy when the younger teachers can take over. I'll then be happy to watch from the sidelines to see what direction "podiatric biomechanics" takes next.

 

Eric,

I think John's modification seemed logical to Mert but he never used it himself because he was no longer practicing.

I remember the days when the practitioner could bill the patient's insurance for a biomechanical examination and orthoses because the technique and devices were somewhat standardized. I think the lack of consistency in the practice of biomechanics and orthotic therapy is one of the primary reasons why most insurers don't cover these services any more. Are you aware of any individual or association that is actively trying to get insurers to recognize the value of prescription foot orthotic therapy and to pay for it? I agree that critical thinking is important when prescribing orthoses. However, the practice of foot orthotic therapy must have a some consistency if we ever expect insurers to recognize it.

Jeff

 

Kevin,

Can you think of one younger podiatrist in this country who is likely to become a future leader in teaching biomechanics and foot orthotic therapy? The future of "podiatric biomechanics" in this country is very uncertain.

Jeff

 

No, because there is no longer a CCPM Biomechanics Fellowship program where Dr. Fuller, Richard Blake, Ronald Valmassy and myself were all trained.

Solution? Reinstitute the Biomechanics Fellowship program before all of us who previously did the Biomechanics Fellowship program are dead. Honestly, I think the future leaders of podiatric biomechanics will come from the UK, Spain and Australia....not from the USA.

That is why I write so much. Because after I've breathed my last breath, I will still be able to pass on what I've learned over the years to future generations of podiatrists.

 

Simon,

What I meant to write was: John Weed was the first to use a valgus post on a foot orthosis even when there may not have been any forefoot valgus demonstrated in the cast of the foot.

I did not intend to imply that John Weed was the first to use valgus wedging.

Jeff

 

Yep, and that's exactly what Sayle-Creer was doing in the 1930's- cool guy, he understood tissue stress. He also had about 10 wives, the last one when he was in his 70's or 80"s.

 

You can re-instate it, but you've got to have full-time mentors employed there to look after these people.

 

Jeff-I believe that it will be technology that overcomes some of the limitations in our ability to teach foot function. By that I mean animation. Doctors, for the most part are binary thinkers and have difficulty visualizing in 3D. Animation can bridge that gap. While one can conjecture that animation has the problem of "artists' conceptualization", and therefore potentially error ridden, I believe that much of that can be reduced or eliminated by the melding of professional input, skin marks overlying known osseous structures and someone who has the ability and software to create 3D animation. Thus, the person(s) most likely to forward our deepening understanding of foot function may be some software nerd with no real experience in anatomy but is real good at rigging producing animation. Hopefully, we can further that cause.

http://3d.about.com/od/Creating-3D-The-CG-Pipeline/a/What-Is-Rigging.htm

Further, instead of thinking like engineers, perhaps we should look at biomechanics from the perspective of an architect. Any architect worth their weight will tell you that it's the foundation that's more important than the quality of the materials superior to that. In other words...it all starts with the foot. From athletic demands down to chronic LE pain in older, more sedentary patients our approach should be similar from a biomechanical perspective...find the root cause of the structural problem first. IMHO, it has little to do with what layer of muscle in the foot is "traumatized".

Your father's book has given me MUCH more realistic and useful information than anyone since his time. While not perfect, it was an epic accumulation of concepts still important in any discussion today. I just wish I had listened more intently to Dr. Weed when I had the chance. He, like Milton Hildebrand/Comparative Morphology, Irwin Segal/Biochemistry, Victor Vacquier/Embryology, Bill Hamilton/Human Ecology at UC Davis, tried to teach me HOW to think, not what. Just imagine if John Weed had 3D animation to demonstrate his concepts instead of using his fists and arms to represent metatarsals? Happy New Year!

 

Utter twaddle. You don't want to be talking about animation, you are infering modelling- boy is there a difference.

Man, you talk a lot of crap. You aren't any kin to Dennis are you, Michael? Unprofessional? I'd rather be labelled by you as being unprofessional than labelled by me as being ignorant. You come across as ignorant to me, Michael. Prove me wrong. Did I mention that it's a comedy special for Christmas?

Rewind, let's talk about "structural deformity": what is your definition of this?

 

As I recall, I called you both. No matter. As far as the definition of structural deformity, I suggest you contact rdp1210 and ask him. Nothing I write to you will make a difference, I'm sure, based on your prior posts to me, as well as the one above. Please be sure to send me your epic contributions to biomechanics when you arrive at that point. Happy New Year.

 

Clueless. Next? Give me your e-mail address, I'll send you my CV, you can send me yours and we'll see who can piss the highest. Alternatively, you can wind your neck in, introduce yourself properly and we can discuss podiatric biomechanics... back to the plot: can you define "structural deformity:?

 

More interesting: I appreciate that you said "excessive" moments, but assuming that the loading is not so high as to induce plastic set, surely the elevated forces acting on the tissues will result in an increase in tensile strength due to remodelling within the restraining tissues, which over time should result in less deformation/ unit load? Similarly, if we used a device which increased the loading on an uninjured tissue (though not so much as to induce plastic set) then over time this tissue should become stronger; this is the principle of "training"- right?

 

Clueless, Simon? How very generous of you. Are all Brit chiropodists of the same mindset as you? There is a huge difference between modeling and animation. Both can be used for instructional purposes. The following is a link to the early renderings from my first animator. I progressed way past this with my second animator, but this should give everyone an idea of what I'm discussing. Crude, yes...but still noteworthy, and I believe to be the direction we need to go in educational concepts...and it's cost effective.

http://youtu.be/UL0UaP2ePVg

Hope this helps.

 

Naive to say the least- the voice over being as much dated as anything. A quick skip around YouTube reveals lots of such animations. I sat in a lecture earlier this year when Dr Glass Youtubes were used, they've been up there for some years now. A female podiatrist from the US gave me similar animation videos on a disc about 10 years ago at a PFOLA meeting. Nothing new, Michael.

I doubt that all British chiropodists (was that word supposed to hurt me or somehow lesser me, Michael? For the record, I actually prefer the term chiropodist to podiatrist) are of the mindset of me, just as I am thankfull that not all US chiropodists are of the mindset of you. Shall we talk about talo-tibial coupling? After you've defined "structural deformity" of course. Or, shall we carry on trying to see who is academically more credible and who can piss the highest? Your PhD was in...?

Kevin, the problem isn't that there is no fellowship any more, it's that the podiatric biomechanics that the majority of American podiatrists employ is 40 years out of date and lacking in scientific basis. Perpetuating crap, outdated theory with modern animation is not the way forward.

Michael, what was it that you were selling, again?

Anyway, there's far more interesting things to be discussed here, like the influence of foot orthoses on tissue remodelling. Shush a bit Michael, so that the adults can talk.

 

As close the the higher end of the zones of stress or physiological window the greater the training, but I assume you would need to be micro adjustments as the high point will be forever changing due to the remodeling process being an on going one

 

Lets say we had a tissue who's role it was to resist pronation moment. We introduce an orthosis which relieves the stress on that tissue and reduces pronation moment. In so doing, we have increased the supination moment acting upon a tissue which resists supination moment. Which tissue is being "trained" to increase it's strength and which tissue is being "weakened"?

It's interesting, I got to this problem about 20 years ago after reading Daryl's and Kevin's papers on STJ axis location, I never did get a solution that I believed in.

 

Depends

The increased supination moment from the device will, increase force on the pronatory muscles and if this does not cause plastic deformation, there will be an increase in strength.

The supination muscles should get weaker, unless the supinator muscles were damaged, we may then have them working in their physiological window, they too may get stronger

 

Simon-are you past the point of discussing modeling vs. animation? Good...it's not your forte. I've seen Dr. Glass' renditions as well as others. I like mine, (the newest versions), better. Notice that Dr. Glass did not show STJ motion that well...notice that the talus doesn't plantarflex/adduct to any extent. Before I had my animation created, I had not witnessed any other animation that re-created STJ motion. Please direct me to a source of that if you might. Needless to write, Valmassy was "blown away" with what I had created...on my own, with out-of-pocket expenses. What am I selling? To you nothing. Once my article is published, you will have the information for free. I have no doubt you and others will pick it apart. I predicted that, too. Again...let me know when you publish anything that has such widespread repercussions. Happy New Year.

 

Let's assume they were not damaged. You're right, the supinators should get weaker and the pronators should get stronger. Given that the equilibrium about a joint axis is going to be, in part, dependent upon the forces acting about it- shouldn't the now relatively stronger pronators to supinator muscle balance result in a more pronated position?

 

it should without the device being warn all things being equal

ie the foot was not maximally pronated and the Ground was stopping any pronation, but yes there should be an increase in pronation moments, from the training effect of the supinatory device and then going barefoot.


Hmmmmm

 

You must be the best. Shush now though, the adults are talking.

 

So, if we took a juvenile with asymptomatic pes planus, gave them orthoses and then they stopped wearing them...

 

Now, let's throw in a little plastic deformation along the medial column induced by an overly zealous "podiatrist' who is about to show the world how clever s/he is with some outdated animations and an increased dorsiflexion moment coming from an extended forefoot varus wedge acting on said asymtomatic pes planus.... remove the orthoses, and what have you got?

First, do no harm.