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Pronation Protocol Overview - A Chiropractor's Perspective

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Dieter Fellner, Sep 15, 2016.

  1. Dieter Fellner

    Dieter Fellner Well-Known Member


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    In the quest to maintain an open and inquisitive mind, it can do no harm to know what other professions do and believe about foot function.

    I listened to a 5 minute video presentation of "Pronation Control" by Dr. Mark Charrette, Chiropractice Lecturer.

    Here's my transcript of the video:

    Dr. Mark Charrette, Chiropractic Lecturer

    The most common pattern that is developed in the foot is pronation. Foot pronation develops, we are not born that way. We are not born with pronated, or supinated feet ,but instead we develop these. We are born with the type of foot we have, flat or high arched or somewhere in between.

    It appears that pronation is a functional adaptation to help level the pelvis. Pronation or supination develops very slowly over a period of years. Micro and macro traumas during the years to skeletal maturation e.g. falling while learning how to walk leads to sacro-iliac joints torque and counter torque in response to that macro and micro trauma. The un-level pelvis results. The nature of pronation is bilateral and asymmetrical. In pronation, in essence the foot flattens and flattens more on the higher or more superior ilieum and this is the levelling effect on the pelvis.


    The soft tissue retaining mechanism is ligamentous and not muscular. We take 5,000 to 10,000 steps a day. 2.5 times body weight on heel strike and 3.5 times body weight in the running gait. The ligamentous integrity, made up of the plantar fascia and all the other bone-to-bone ligaments become plastically deformed over time. So you need to support the arches either with taping or an orthotic to support all three of the arches as all three of the arches do the same thing, meaning decreasing or increasing their height. An orthotic with a correction or stabilizer at the lowest end of normal range of motion you find that from heel strike to toe-off this orthotic device will allow for the normal range of motion and block the excessive. And that’s exactly what a Foot Leveler Orthotic does.

    The foot is distorted the most at midstance. That’s where both the heel and the forefoot are in contact with the floor. If you want to find the greatest degree of pronation or supination it can be viewed at that point in the gait cycle. The navicular will be inferior and medial compared to it’s neutral component. The cuboid , due to forced inversion, this rolling of the ankle, mechanically this causes it to go superior and lateral. Prior to forced inversion the cuboid tends to go inferior and lateral. The three cuneiforms at midstance literally drop straight inferior.

    The three arches in the foot, the medial and lateral longitudinal arch and the anterior transverse arch will all decrease their height. The anterior transverse arch, the 2/3/4 met heads will drop down and the first and fifth will go superior-lateral and superior medial. The talus, at midstance is actually mostly anterior and slightly lateral. The calcaneus will literally plantarflexand evert. The fibular head will always go posterior and lateral.


    It was necessary, for me to rewind a few times to be sure I heard Mark correctly. In the Chiropractic world of Dr. Charrette, foot pronation is primarily a means to level a pelvis damaged by micro and macro trauma caused during the developmental stage to skeletal maturation.

    There is a good deal of other material that might cause a raised eye brow. For now I need a strong cup of coffee.
     

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  2. RobinP

    RobinP Well-Known Member

    One would be hard pushed to find a statement in there with which one wouldn't take exception.
    Makes you wonder why we bother to try and educate. This is the very information that Joe Public can relate to, and understand which is why the myths are perpetuated
    Thanks for the transcription Dieter
     
  3. Dieter Fellner

    Dieter Fellner Well-Known Member

    Robin,

    Hard to disagree with your appraisal. Always looking for a silver lining, I guess (maybe) this can serve as a reminder that pelvic obliquity (for whatever reason) might contribute to LLD and manifest as asymmetrical STJ compensation. Other writers make a better job of the subject.

    I purposely did not comment on the other material as it will be too time consuming but welcome input from a Chiropractor. I have no way to know if all Chiropractors, as a profession, subscribe to this explanation.

    Secondly, when a patient visits another health professional, such as a Chiropractor, it can be useful to have some insight to know what kind of (mis)information might be dispersed.

    The same doctor goes on to deliver a series of six manipulations to address the problems with pronation. At the same time, candidly I thought, admitting the correction will last only 2-3 steps. I liked that honesty. I was less impressed with the follow-up: a patient will, of course, need to be sold his unique shoe insert to maintain the correction of the three foot arches. Right ....
     
  4. RobinP

    RobinP Well-Known Member

    I have a chiropractor near to my practice. As a result, I hear a lot about the (lack of) clinical reasoning and the (I'm struggling for another way to describe it) indoctrination.

    One of the impressions that I have had on my discussions with him are that business plays a big role in their teaching. Their goal is to sign people up to a years worth of regular adjustments. All under the banner of "wellness". This particular model involves involves standing radiographs AP and lateral. Diagnosis of subluxations. Prescription of 6-12 months of adjustments, traction, and traction/compression under exercise then re X ray at 6 months or 9 months to show improvement in alignment

    It is essentially a "normalist" approach to clinical management....for the spine at least. I know he prescribes some orthoses along the MASS line. As such, I reckon that what you have transcribed fits with his model of management. Does he do it knowing that the evidence available suggests that he is wrong? I doubt it. This is what he knows and believes(strongly) in but he is certainly not open to other thought processes as far as I can see and this worries me with any health professional

    That being said, some people do really well with what he does for them and I would be a hypocrite if I said that there wasn't some merit in what he was doing
     
  5. Craig Payne

    Craig Payne Moderator

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    I have read his stuff before. Very superficial with a poor understanding of how the foot actually functions. Dunning Kruger comes to mind.
    As for the claim re the anterior metatarsal arch --> nonsensical
     
  6. Dieter Fellner

    Dieter Fellner Well-Known Member

    Craig,

    I agree of course and would likely be less critical if the narrative was designed for the layman consumer - unfortunately it is aimed at the clinician. As a matter of curiosity - how do you tailor your explanation to the patient. We have to dumb down our explanations or loose the patient very quickly with 'jargonese'.
     
  7. Craig Payne

    Craig Payne Moderator

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    Of course, I often 'joke' about that. You have to dumb things down, even to the extent of "lieing" to make explanations understandable.
     
  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    Surgery is often described as ' deliberate wounding with a noble purpose' .... the 'dumbing down' process is likely the narrative equivalent
     
  9. David Wedemeyer

    David Wedemeyer Well-Known Member

    Dieter, Robin, Craig and fellow Arena readers,

    I am a practicing chiropractor as well as a CPed so I feel duly competent to comment on Dr. Charette's video, I have seen it prior btw.

    When assessing chiropractors one must be aware that there are many flavors: a smaller percentage (estimated at below 20%) are vitalists who claim not to diagnose or treat anything except claiming to remove spinal subluxations. They represent the old guard in chiropractic and claim to "defend the sacred trust" of the founder DD Palmer and wield considerable political influence amongst the colleges, state associations and one National association.

    An even smaller percentage are the polar opposite and are seeking rx drug dispensing inclusion within the profession, perform manipulation under anesthesia, perform and interpret needle EMG etc. The rest are somewhere in the middle and many are advancing the profession by integrating movement and rehabilitation alongside traditional manual manipulation.

    I am often quoted as describing the profession as a loaf of bread with two ends and a middle. There is considerable overlap in beliefs and practices amongst these subsets and I feel that understanding this helps to understand why so many of my colleagues fall into the trap of clever marketing rather than sound reasoning and evidence when it comes to the subject of foot orthoses.
     
  10. David Wedemeyer

    David Wedemeyer Well-Known Member

    Mark Charrette is employed by Foot Levelers, paid to market their product in continuing education seminars and write articles for them. To my knowledge he has no training in the subject and is not an authority in my humble opinion. He perpetuates myths like the transverse metatarsal arch existing or being a functional, anatomic arch of the foot. As Foot Levelers marketing claims to support "the 3 arches of the feet" in their marketing, this alone should alert anyone knowledgeable about the veracity of that claim and the literature that foot function is not their forte.

    I am often appalled at how incorrectly I see the subject of pedal biomechanics represented by shills for this company. They have stranglehold on the colleges as they indoctrinate students via marketing and supplying free insoles to them absent any real education in the subject. they donate large sums to the colleges and support national and state organizations as vendors and demand exclusivity at symposiums and conferences, eliminating the quality labs access to their potential clients en masse.

    They are clever to tie the need for their insoles into the spine and focus exclusively on "over pronation" as clinical reasoning to support dispensing and that hey magically aid in "holding your patients adjustments" (spinal manipulation) and have never produced any relevant research whatsoever that this is true. They advocate adjusting (manipulating) the feet to improve biomechanics but there is no relevant research to support that either that I have seen. Their shills parrot $5 words and concepts, often nonsensically and weave a confusing but appealing story to bolster their marketing but at the end of the day it is all nonsense. You can put lipstick on a pig as the saying goes....

    This is why many chiropractors fall for marketing such as theirs and MASS type devices, mainly the simplicity and claims mislead them and they lack the foundation to objectively discern the truth. I also fault many for intellectual indolence and failing to look further than what they are being sold. Many of these companies offer a one material, one design, accomodative device with no options other than colors and most are very expensive compared to a quality lab.

    In all what they produce is an insole of EVA/Poron and a topcover with convex shapes at the calcaneus, MLA and LLA and a bizarre shaped metatarsal pad from a full weight bearing cast in most cases. I have pictures of their insoles vs molds of pop and foam and they do not appear to even contour to the plantar vault!

    I could go on but hopefully this gives some insight into the company and the man behind some of their education Dieter.

    Best regards,

    David
     
  11. Dieter Fellner

    Dieter Fellner Well-Known Member

    David,

    Thank you for this candid appraisal of certain elements within the Chiropractic profession. Every profession has some rotten apples. An open and candid discussion is certainly helpful.

    I would say that manipulation can have a useful ancillary role - I have had some exposure to some of the techniques.

    As an aside, the MASS orthotic can also have a useful role in the correctly indicated patient - but not every patient.

    If you have more to contribute I, for one, will be interested to learn more.

    Best,
     
    Last edited: Sep 22, 2016
  12. RobinP

    RobinP Well-Known Member

    Thanks David. I think it is safe to say that Chiropractic practitioners are far from the only profession lacking the depth of knowledge to understand why the simplified model of someone like foot levellers is flawed.
    I sat in a meeting yesterday with an experienced Orthotist talking about the types of things that we are criticising on the transcription. Not one person called him on it (obviously I did - can't have the "O" word being banded about and not say anything) which means I can only assume that everyone else was fine with it.
    I think most of our professions follow the loaf of bread analagy. As ever David, your views make you a great touchstone regarding anything in the Chiropractic world. Cheers
     
  13. kevin miller

    kevin miller Active Member

    If we are candid, foot and gait mechanics is poorly understood by MOST clinicians of any stripe. Medical training is shallow in the area of chronic musculoskeletal dysfunction. Consequently, a great many clinicians are not even aware of what can be done to treat chronic gait pathomechanics. They kick those cases to physical therapy or to O&P, and lets face it, the reimbursement for foot orthotics pales next to an AFO or TLSO. I have often wondered how long the CPed certification would continue to exist in the absence of the Diabetic Shoe Bill

    That said, the Chiropractic profession harbors a special breed of incompetent clinicians who use and support Foot Levelers knowing they are lacking, yet make no effort to find out why or evaluate other products. Why? Go to a Chiropractic conference or CEU course and you will see. Foot Levelers is one of the largest financial supporters of the profession. Sign up for a continuing education course with a foot or gait related title and you will likely find yourself in a 3-hour sales pitch from Foot Levelers. In the end, its all about the money. Of course this does not register as a problem for folks who "cure" all things with a C1 manipulation. Thankfully, that group is small and getting smaller, but until the Chiropractic profession chooses to accept as treatment anything but the adjustment, I fear we are stuck with Foot Levelers. (Of course, if every DC who prescribes those horrendous things had to wear a set of them every day, the problem would solve itself.)
     
  14. Dieter Fellner

    Dieter Fellner Well-Known Member

    Kevin,

    That foot & gait mechanics is poorly understood is a viewpoint hard to refute. The craft still lacks a solid / definitive scientifically researched knowledge base. That doesn't mean there is none. Often it's a rare find; trickier still to extrapolate really meaningful data onto the patient population.

    A simple example. Many now espouse the view that a foot functions in a much more pronated position than was once considered 'normal'. When a foot is analyzed this is performed on hard surfaces. I can't help but wonder if that is, in fact, a foot's (evolutionary) 'normal' habitat. Does a researcher then find evidence of normal or simply what is commonly found but not necessarily normal.

    If this hard surface is not a natural habitat for a foot, is it surprising that a lot of feet are found to 'pronate' more. The naysayer will be quick to point out such feet are found in 'healthy' young individuals. I would add they are healthy now but what about later in their lives. And so on and so forth....

    I speculate this uncertainty has a large role to play in the movement away from discussions about normal and optimal functional position towards moments and torque to explain how forces create pathology and how therapeutic mechanical devices are designed to dampen the effects of pathological stress on tissue - i.e. the tissue stress paradigm. Separating kinematics from kinetics can certainly help with the conundrum that research has failed to show that a foot orthotic can alter much the foot alignment (although much of the research espousing those views is hardly bullet proof).

    Interestingly when an internal 'orthotic' is used to alter directly kinematics -and consequently kinetics- a therapeutic benefit is very evident. Which makes me wonder if the kinetic therapeutic explanation is simply evidence of an incomplete solution for a mechanical 'pronation' related issue with a foot orthosis. Yet it cannot be denied this approach can offer a patient a very effective solution.

    Many questions and few good answers ... in the meantime, for a foot orthosis, the tissue stress explanation would seem to offer the best scientific model.
     
  15. kevin miller

    kevin miller Active Member

    Dieter,

    Our thinking on this subject is similar, and while much of the Tissue Stress Model borders on self-evident, I think there is subtle neuromechanics at work here that goes largely unrecognized.

    Consider a individual with "ideal" feet, running across a grassy field. (To interject a little evolution systematics, make our individual a primitive being pursued something hungry.) If our primitive quickly cuts left, he will supinate the (L) forefoot and maximally pronate the (R) forefoot. ("Maximally" meaning sufficient pronation to maintain contact and allow the generation of sufficient force to overcome momentum and make the change in direction.) If he looks over his shoulder to see how closer he is to being dinner, at the same time stepping in a depression, he may sprain an ankle or he may stumble and recover without injury. Both outcomes are interesting to consider. I think we can agree that there is some degree of "sprain" that our man can sustain without having to stop for dinner. It that merely a function of the degree of perturbation of the joint system, or are there factors that mitigate the severity of injury? The second outcome is more interesting. What mechanism provides injury prevention in the presence of significant perturbing forces? It certainly isn't "feed forward", he is running in grass and looking over his shoulder. I submit that it isn't spinal reflex either. [F-wave latency for the tibial nerve is roughly 50msec for an average height male. Max velocity of a world class sprinter is around 12m/s, or .012 m/msec. The distance travelled 0ver 50msec is roughly .6m or just under 2 ft.] The values used here are disputable, but the point is not how far our man travels, simply that nerve conduction velocity is finite. The mechanism we are looking for has to have essentially an instantaneous response. In short, it can't be reflexive, it has to already be in effect. We do have such a mechanism, internal tension.

    Just to be upfront, I could be described as one of those "biotensegrity" freaks, but that's not totally accurate either. And so, for this discussion, I'll try to keep to the self-evident and/or observable phenomena.

    That the kinetic chain is a tension system is hard to deny. Cut into tissue, living or not, and the tissue separates....because it is in tension. Hit the guy next to you over the head with a hammer, how long does he stand up? Loose tension, loose stability. To fully appreciate the importance of tension, we have to view a joint and joint systems is a slightly different way. Rather than as a lever or pulley system that moves about an axis, consider a joint is the special interface between two rigid elements held in proximity by tissues under tension. Each tension element contributes a fraction of the total tension required to maintain joint congruency. If the joint is stable an not moving, it is in its lowest energy state. (Because it exists in the gravitational field.) Consider the characteristics of this system. There are multiple force moments acting on it at all times, including gravity . If it is stable, it is in a state of equilibrium, harnessing gravity to produce stability rather than fighting it. Two produce movement, simply alter the ratio of contribution from the tension elements, and the joint instantly seeks to reestablish equilibrium and its lowest energy state. Thus, gait is synergistic change in tension to produce coordinated motion. Rather than fighting gravity, gravity is harnessed to contribute to both motion and the search for stability. Since nature abhors inefficiency, it should be no surprise that a system that harnesses gravity might be selected for over a system that fights gravity.

    One more element must be considered before we can apply this to our running man. How does a tension system deal with perturbation? There are two characteristics that are predominant here. 1) Any force that is applied to the system affects the entire system - instantly. Donald Ingber has written extensively on the subject of mechanotransduction, messaging via the tension system. 2) The viscoelastic nature of both individual tissues and the system provide the ability to "tune" the response to perturbation. Combine the two characteristics and a body can alter tension to maintain function even as an applied force propagates through the system. Variation in tension and viscoelastic characteristics produces a dampening effect....not simply to dissipate potentially damaging forces, but to direct and use them enhance function. Stress on the system alters function. For instance, the total tension in the system is less during walking than running, as is the muscle firing sequence. The shift from heel-toe walk or jog to an all-out sprint requires a change in muscle firing sequence and total internal tension. Sprinting, literally bouncing from one foot to the other, becomes more efficient as internal tension and increases the viscoelastic effect, improving the ability to handle high-force perturbation.

    So, when our primitive steps in the depression, increased internal tension activated to allow efficient sprinting, also increases the dampening/viscoelastic effect of the muscles and connective tissues, allowing him to mitigate the damaging forces produced by the transient instability.

    This is germane to your comments in that it provides explanation for variations in foot posture. All other things being equal, how might two "clones" present with differing foot posture? Perhaps the one more pronated has less than optimal stabilizing tension. Perhaps there is not enough muscle volume to stretch the fascia and connective tissue. Perhaps one registers load differently and maintains lower muscle tone and thus, internal tension. More interestingly, is the variation in tone and posture a function of conditioning? Might it be possible to develop rehab or conditioning programs to restore or maximize both foot posture and its response to perturbation? I think the topic is worth exploring.
     
  16. Dieter Fellner

    Dieter Fellner Well-Known Member

    Kevin,

    The overall impression I have from this line of thought, about muscle tone, is that we might rehabilitate a patient to assume a 'better' foot posture. I can neither confirm nor deny the possibility.

    But this does seem reminiscent of the days when the solution to the problem was thought to be found in physical therapy. Unless you have a different version of conditioning in mind, that concept (i.e. PT as a primary therapeutic modality to reverse flat foot, for example) was put to rest many years ago. Seems like a chicken & egg problem. How can a healthy, active young adult with signs of 'pronation' develop a muscle volume deficit. This is not to marginalize the benefits of adjunctive PT / rehabilitation in its' entirety.

    What if there is a common (possibly inherited) structural component e.g. in the talo-calcaneal complex, that disposes a foot to slip more easily into a pronated position. In such a situation there may be moments and torques generated to create a demand from the soft tissue that can lead to injury. When a foot is exposed to, and expected to habitually operate in an 'unnatural' habitat (hard, flat walking surfaces) we can add an environmental factor. When tissue is, in this way, required to function out of its' zone of optimal function, and it does so repeatedly, many thousands of times a day and over many years, the tissue may reasonably be expected to eventually fail.

    Injury, from the effects of repetitive chronic insults in such a situation, is not inevitable. Activity level, footwear, body mass, ligamentous laxity, injury, disease and other factors may play a part in the expression of pathology.
     
  17. kevin miller

    kevin miller Active Member

    Dieter,

    I agree with your assessment that traditional PT for foot conditions has proven largely ineffective for the reasons you state. To expand on this theme, what if the adaptive mechanisms that produce the training effect in athletes also attempts produce maximal performance, but not necessarily maximal efficiency, in the face of damaging forces? Returning to our primitive, if he breaks a tibia, resulting in a significant LLD, his kinetic chain will attempt to restore maximal function via altering global mechanics. We might see anterior ilium rotation on the short side, pronation and rear foot plantar flexion on the long side, pelvic obliquity shifting short leg plant close to the midline, long leg plant away from the midline, one arm swinging wider than the other, or some combination of adaptive mechanics. If these adaptations produce symptoms, we call it pathomechanics. No amount of general physical therapy is going to substantially alter this kind of adaptive mechanics, and may produce additional muscle imbalance. That aside, we should be able to harness the same neuromotor adaptive mechanisms to "steer" the adaptive mechanics.
    I have as patients, several world class jumpers and sprinters over the age of 25, the oldest is 34yoa. Years of hard training has resulted in general hypermobility in their feet. I am not trying to quantify “hypermobility” here, only acknowledge that there a great deal of segmental mobility in these feet. Standing barefoot, their feet collapse into “flat foot” posture with forefoot abduction. Watch them walk or run and they adopt a lilting gait, the synergy of intrinsic and extrinsic musculature shifting the COM anterior, producing forefoot loading with foot plant under the COM. They make initial contact with the foot slightly plantarflexed and shortened, quickly achieving stability before the foot pronates. In essence, they adopt the motor firing sequence of sprinting in order to walk without the pathomechanics expected from flexible flat feet. Of course, when they get very fatigued, their mechanics begins to falter and they display the expected flat-foot posture.
    The key element here is the motor firing pattern or sequence – the primitive focal motor pattern that generates basic limb coordination. A pronator who heavily heel strikes produces a different gait pattern and muscle firing sequence than the forefoot loading sprinter. On heel strike, the forefoot is not “stable”. There is enough mobility to allow the foot to fully contact the ground, after which muscle tension increases to stability. For a fraction of a second the COP acts on a less than maximally stable midfoot, providing the opportunity for pathomechanics/pronation to occur. On the flip side, the forefoot loader actively engages both intrinsic and extrinsic musculature to plantarflex the foot prior to contact. Consequently, that foot reaches stabilizing tension much faster than the heel strike foot, preventing pronation. The problem with this scenario is that changing a focal motor pattern requires repetitive activation of the new pattern. This brings us full circle to the original issue; if the gait pattern is adaptive, how can physical therapy do anything other than enhance the pattern we desire to supplant?
    There are only two ways that I can see. 1) Create an orthotic that changes foot posture, allowing the desired range of motion while limiting aberrant joint positioning. Of course, that resurrects the ugly debate over how to define and acquire “normal” foot posture. 2) prescribe a gait training exercise that produces the desired motor firing pattern as a matter of course. For instance, walking backwards, toe-first contact, as if on a balance beam, produces lower kinetic chain synergy very similar to forefoot loading walking forward. In the case of severe weakness or hypermobility, perhaps taping for stability or to limits joint excursion while walking backwards is necessary for the training effect. The key is to focus on motor firing pattern and muscle synergy rather than attempt to address strength deficits or muscle imbalance with standard physical therapy.
     
  18. David Wedemeyer

    David Wedemeyer Well-Known Member

  19. David Wedemeyer

    David Wedemeyer Well-Known Member

  20. Dieter Fellner

    Dieter Fellner Well-Known Member

    David,

    Thank you for that link. Since I saw the video I did a little search and found the FL marketing material. They make a damn good job of this promotional material. That perhaps can explain their financial success. I look forward to know what else you have.
     
  21. Craig Payne

    Craig Payne Moderator

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    This:
    is of concern.
     
  22. Craig Payne

    Craig Payne Moderator

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    As an side and in fairness, this: "Pronation Protocol Overview - A Chiropractor's Perspective" .... is really only one chiropractors approach.

    Just like a lot of podiatrists were upset at the recent Huff Post article that podiatrists do not like crocs .... when in reality they only interviewed one podiatrist, so it was not "podiatrys" view.
     
  23. Craig Payne

    Craig Payne Moderator

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    I stopped watching at the "3 arches":


    ....Dunning–Kruger
     
  24. Dieter Fellner

    Dieter Fellner Well-Known Member

    Craig,

    That was my first thought too but seemingly Charrette plays a lead role in education. But I quite like the three arches ... a little like The Three Stooges. And y'know what? The Foot Levelers even have a page dedicated to the foot 'vault'! Now it's getting really scientific ....
     
  25. David Wedemeyer

    David Wedemeyer Well-Known Member

    Dieter & Craig it is only one chiropractor's opinion as Craig states but both work for Foot Levelers as "experts" who teach CEU courses as well as market for them. They are obviously completely bereft of any legitimate didactic training in pedal biomechanics or foot orthoses to my knowledge, this is obvious when you read what Mark wrote or watch Tim's video.

    I engaged one off their other "experts" in a Facebook forum not long ago and simply asked him to defend the 3 arch myth and describe how a foot orthoses mediates simple "over pronation" because these are two of their main focal points in their marketing. He immediately blocked me and send me a pm stating "if I wanted to call him, we could discuss it".

    As Craig knows my long term goal is to introduce lower extremity biomechanics and foot orthoses to my colleagues in a manner I have never seen offered prior. Until they are actually given an alternative to this and other companies that I feel prey on their lack of understanding of the subject, this sort of tripe is widely accepted as truth amongst my colleagues.

    and btw for my colleagues reading this, that insole is not something any trained professional would dispense, it is essentially a pancake made of bits of filler and top Cover materials and expensive compared to quality labs devices. Caveat emptor.
     
  26. Dieter Fellner

    Dieter Fellner Well-Known Member

    Well David, their insole design incorporates a medial arch component (to block excessive pronation) and a lateral arch component. That makes for what we used to call a tarsal cradle. Not bad for limiting the arthritic STJ. What else do you need or want? Oh, the transverse arch. OK. So there isn't one, blah. Curiously patients often find this oddly comforting. Perhaps this allows the 1st and 5th ray to go about their business. Can't be a bad thing? Last, but not least, they all seem to have a heel lift. One of those cures pretty much all that ails the foot. So FL have got all their base covered. FL offer a wide range of specialist custom foot orthoses. When you take a closer look the design seems mostly identical. But there are variations in color and cover material. So, what's wrong with that. ;-) I am going to open a store and call it FellnerLevelers - to support the static and dynamic foot vault.
     
  27. Craig Payne

    Craig Payne Moderator

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    Don't forget to patent it before you say too much more.
     
    Last edited: Sep 26, 2016
  28. Dieter Fellner

    Dieter Fellner Well-Known Member

    DANG .... thanks (patented)
     
  29. Dieter Fellner

    Dieter Fellner Well-Known Member

    Kevin,

    Your emphasis is on the athlete. Do you hold the same tenets to be true for the 'average' individual?

    I don't know if we can say that an athlete has acquired hypermobility or was born with it. At this time my thoughts align more closely with internal derangement / variation of joint architecture as a primary culprit. In a similar way that Dr. Kirby thinks of the medially deviated STJ axis. In part that's because it's really difficult to change foot posture with an external orthosis. Or when you can manage this feat, the wearer is so uncomfortable the orthosis gets tossed.

    So how to change internal architecture? Conventional surgery is by osteotomy, tendon work and fusions. Too messy. Modern options can include STJ arthroereisis. That can certainly alter kinematics in a way that is radiographically self evident. Are athletes a good patient group for such an intervention? Not sure ....
     
  30. Craig Payne

    Craig Payne Moderator

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    Thats why I keep saying 'Dunning-Kruger'. You ask these "experts" making public statements what then would they do for a foot with stage 2 PTTD, with a very medial STJ axis and high supination resistance ... and you get a blank stare back with a "WTF are you talking about?" look.
     
  31. Dieter Fellner

    Dieter Fellner Well-Known Member

    Why Craig ... easy peasy: have I told you about the FellnerLevelers?
     
  32. David Wedemeyer

    David Wedemeyer Well-Known Member

    Funny you should mention the MLA Dieter, I have a picture here of one of their insoles juxtaposed with a pop cast of the same foot for comparison, in fact I have several pictures that may be of interest but cannot upload directly from my computer? Any way to accomplish this without a URL Craig?
     
  33. Dieter Fellner

    Dieter Fellner Well-Known Member

    :D:D:D:D:D:D:D:D:D:D:D:D:D:D:D (Craig will get this .....)
     
  34. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    In new post, there is an 'upload a file' at bottom right
     
  35. David Wedemeyer

    David Wedemeyer Well-Known Member

    I hate to make an entirely new thread unless it were something very important?
     
  36. Dieter Fellner

    Dieter Fellner Well-Known Member

    lol .... no it's right here (to the bottom right where you reply)
     

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  37. David Wedemeyer

    David Wedemeyer Well-Known Member

    Laugh at my expsense Dieter, I truly have no feelings left haha:cool:
     
  38. Dieter Fellner

    Dieter Fellner Well-Known Member

    Wouldn't dream of it .... only your picture doesn't show :D
     
  39. Dieter Fellner

    Dieter Fellner Well-Known Member

    Is it invisible?
     
  40. David Wedemeyer

    David Wedemeyer Well-Known Member

    This is one of their insoles vs a pop cast of the same foot..
     

    Attached Files:

    Last edited: Sep 27, 2016
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