Functional foot typing

Dennis, I thought you'd say this. But first you need to demonstrate that your profiles are valid and reliable predictors of future pathology. Then you need to demonstrate that your interventions prevent pathology. Good luck with this research, I look forward to reading the publications.

 

Simon:
As promised before my goodbye>

Proposal to Theroretical Question #1

1. At the beginning of each school year, all children ages 10-15 will be given a brief examination that involves three tests of their feet that will profile them into one of ten Functional Foot Types and determine if they are compensating for a short leg.
2. Inexpensive Foot Centering Pads will then be applied to their school shoes, foot type-specific to begin a test drive of the benefits of Foot Centering. In addition, a heel lift will be applied to into the shoe of the side that is functioning short compensating for that problem if testing is positive.
3. An educational brochure will be dispensed to each child to be taken home that describes functional foot typing, the centering theory of biomechanics and the inherited nature of foot and postural problems. In addition, the brochure will discuss the common foot and postural problems associated with his/her foot type and other topics such as where corns and callus will appear and the telltale shoe wear pattern of the foot type.
4. Each child will be re-examined at midyear to determine the effects of the centering pads and if it is agreed that they are productive, these children will be offered a foot type-specific custom casted and prescribed semi rigid Foot Centring for more permanent and effective care.
5. Children will be re-examined annually using this same method.


Theoretical Question #2
Solution

Utilizing Neoteric Biomechanics,
The patient was found to have the following SERM-PERM testing:
Rearfoot SERM Inverted
Rearfoot PERM Everted
Forefoot SERM Plantarflexed
Forefoot PERM Dorsiflexed

The callus pattern, x-ray, shoe wear and postural changes seem to confirm the foot type until proven otherwise.

Subclinical Precursor Testing was positive for the following future foot problems:
1. Hyperpronation Syndrome
2. Functional Posterior Tibial Tendon Dysfunction
3. Functional Hallux Limitus

The biomechanical diagnosis for this patient is Flexible Rearfoot. Flexible Forefoot Functional Foot Type

The treatment plan for this patient is:
Visit #1: Education regarding this foot type and the applicationof foot type-specific Foot Centering Pads into existing shoe gear, existing insoles or current orthotics if they exist.
Visit #2: If there is an improvement in Precursor and Functional Stance Testing and/or if there is improvement in comfort, activity level or the way the child is walking or performing, Foot type-specific cast corrective negative plaster casts along with a foot-type and patient specific prescription are created and used to fabricate a pair of custom Foot Centrings.
Visit # 3 The Foot Centring is dispensed and tested for clinical effectiveness.
Visits # 4 and 5: The patient is followed at two week and eight week post dispense follow up at which time additional foot centering pads are applied to the Centrings and a decision is made as to the value of concomitant foot type-specific physical therapy.
The patient is followed annually and the Foot Centrings are re-casted and Rx’d if:
1. His feet grow out of the initiasl pair
2. The patients ability to Vault is improved internally allowing a new, even more corrective Centring to be casted and Rx’d.
If the patient has had enough correction to engage Centered Position and tests positive for healthy function, the Centrings are weaned away or eliminated, prn.

My prognosis based on clinical experience and the anecdotal finding of other professionals clinically is good.
My prognosis based on scientific, double blind study is unknown.

Theoretical Question #3

A forty two year old otherwise healthy femalel presents herself to the practice complaining of thick, dystrophic, discolored hallux toenails for many years that have not responded to topical or oral antifungal care. They are painful in stylish shoes and sometime have a foul odor.
Examination reveals normal neurovascular status.
There are grade 1 bunions and the patient tests positive for functional hallux limitus. B/L. She has early 2nd and 5th toe hammering, B/L.
In addition, the subject has a prominent IP hallux callus and less prominent 2nd Metatarsal callus plantarly, B/L. Her other toenails are normal in appearance.

What is your diagnosis?
What is your treatment plan?
What is your prognosis?

Dennis

 

At the risk of repeating myself: first you need to demonstrate that your profiles are valid and reliable predictors of future pathology. Has this research been undertaken? How do you "know" that someone with one of your foot types will develop pathology, or what that specific pathology will be? Then you need to demonstrate that your interventions prevent pathology. Have you performed any controlled trials of your devices? Personally, I would not let anyone near my child unless they could answer these basic questions. Like I said, good luck with this research; I look forward to reading the publications.

So long Dennis. Despite what you may think of me or the rest of the Arena it's been fun and I honestly do wish you well with your endeavours.

"so long and thanks for all the fish"

 

Realizing the increase in foot and postural problems over time and realizing that the Podiatrist, the Chiropractor and the Orthopedist cannot always offer cures for these chronic, disabling and progressive problems, the Secretary of Education of your country is asking for proposals and offering funding for a screening program that will examine all school children in your country from 10-15 years of age for potential foot pathology and postural problems.
Once uncovered those children with potential problems should be given education and on the spot conservative treatment.
In follow-up additional education can be offered and with the parents approval more advanced care for those children in need can be offered.

The purpose would be a longitudinal program to identify potential foot and compensatory postural problems early and if possible delay or eliminate them from occurring.

Proposals please:

========

TIC answer:

1. Government mandate weight loss for all children.
2. Decrease gravitational pull
3. Find a way for orthotics to work with Flip Flops (universal foot ware of choice)


Steve

 

Eleven days have gone by.

Not one response to a very clinical, theoretical question.
Theoretical Question #3

A forty two year old otherwise healthy female presents herself to the practice complaining of thick, dystrophic, discolored hallux toenails for many years that have not responded to topical or oral antifungal care. They are painful in stylish shoes and sometime have a foul odor.
Examination reveals normal neurovascular status.
There are grade 1 bunions and the patient tests positive for functional hallux limitus. B/L. She has early 2nd and 5th toe hammering, B/L.
In addition, the subject has a prominent IP hallux callus and less prominent 2nd Metatarsal callus plantarly, B/L. Her other toenails are normal in appearance.

What is your diagnosis?
What is your treatment plan?
What is your prognosis?

On The Arena, if the answers don’t read something like this one of Kevin’s:
“The mechanical effects of a dorsally directed force acting on the medial navicular, straight toward a medially deviated STJ axis that passed directly over this medial navicular, would be to cause:
1. an ankle joint dorsiflexion moment
2. a talo-navicular dorsiflexion moment
STJ supination moment could occur once internal forces changed in response to the medial navicular pushing force”

The Arena is tongue-tied?
How amazingly sad for your patients!!

Have any of you ever actually treated a dystrophic toenail?

Dystrophic Toenail: A toenail where the elevational moment of the vertical traumatic force meets the nail bed moment that has been deviated by a pronatory force produced by lateral pronation of the hallux sagital axis.

Did I get it right Kevin? Hahahahaha
Let’s leave the office and step down to the lab and ask a question that even a graduate of the lowly New York College of Podiatric Medicine might conger up an answer.
Theoretical Question #4:

Since the vertical pillars of the foot (in the windlast system) have flexible potential if not provided with additional support, in closed chain function they lower, collapse, become more flexible (pick one or more) when stressed, a horizontal system must exist underneath (the plantar fascia, spring ligament, etc) in order to provide stability and support to the system.

Is there an amount of material fill that can be placed under the vertical pillars in this system to prevent their collapse that would reduce the amount of work needed for the horizontal system to perform?

Dennis

 

Laugh! I nearly had to buy a new suit. Excellent!

Dave

 

DRSHA

I've only just come in on this thread today and I've read most of it. In another thread you cited your website and so I read thru it thoroughly. In the thread 'is symmetry an important theraputic goal' on the 15th Nov I asked you a whole raft of questions about the footlevers systems. You did not answer, perhaps you were to busy elswhere or perhaps you felt the questions were not asked in the correct manner. This is the problem with your qusetions 1 - 4 you don't really want or expect an anwer your just goading for the sake of it. What's the point in answering when the answer is of no interest to you and we would just be taking your poorly baited hook and reeled in for your gratification.

The questions you ask are in my opinion to vague and irrelevant to my way of thinking. This old fashioned approach of fitting symptoms to an intervention is well just that old fashioned and more importantly not very useful. This is the same for foot typing, what is the point of foot typing when they don't come in defined non ambiguous morphilogical and functional catergories. They are not made as a range on some production line, they are not types of cars or boats or egg cups fitted curtain rails or a variaty of architetural structures. How about this as a foot categorisation technique

Flat

Flat arches are either level or have a slightly curved arch. This arch has supportive voussoirs, which are wedge-shaped stones or bricks.

Gothic

Gothic arches, also called pointed arches, are narrow and pointed at the top. They were seen during the Gothic period in Europe from about middle 12th century to the 16th century. In the late 19th and early 20th centuries in America, a Gothic Revival style incorporated these pointed arches into homes and buildings.

Moorish

Moorish arches, also called Horseshoe Arches, have an exotic shape. They're most likely to be seen on commercial buildings such as theaters. A Moorish Revival style of the early 20th century in America reintroduced this arch style into the architecture scene.

Roman

Roman arches are semi-circular and were first used widely by Roman engineers. Using arches and concrete, the Romans were able to build on a previously unseen scale. This rounded arch style is seen today in the Spanish Colonial architectural style and the Richardsonian Romanesque style, as well as others based on Classical Roman architecture.

Segmental

Segmental arches have a partial curve, like an eyebrow. One of the earliest examples of a segmental arch in the West is the Ponte Vecchio Bridge in Florence, Italy, which was built in the 14th century.

Tudor

Tudor arches have a low point and are seen mostly on Tudor Revival and Gothic Revival styles of architecture, both popular in the late 19th and early 20th centuries in America. These arches are based on the architecture of the English Tudor period of the 16th century.

Just about as relevant as any other foot typing in my opinion.

The whole point about using engineering methods to evaluate the foot in terms of its pathology and what forces are causing that pathology and how to construct an intervention is just so that you do not categorise, but rather build a prescription based on what is relevant for the resolution of the pathology ie reducing tissue stress.

If you don't get that then it is pointless trying to discuss why your system / systems are constrained by their boundaries of categorisation.

I can see the advantage of categorisation from your point of view because then one can categorise people into convenient boxes that fit well into bureaucracy and computer files. Then you can sell a categorised system to large organisations and government departments and fit school children into convenient pre determined and categorised foot products for their categorised feet.

Why would I want a pre determined shape of orthosis when I can make any shape I wish that will best suit the needs of my customer.

This is another reason why it is difficult to answer your questions because for you in you pre determined symptoms equal intervention world ie by convention symptom A = intervention B then it is difficult for you to understand why we require and even abhor such conventionalism. (Especially the bit about heel lifts and TIP)

Perhaps you can tell me why with good reasons I should want to categorise feet.

All the best Dave Smith

PS I don't agree with your theories but I enjoy your style of writing, no really I do.

 

So many people think that what they do is unique and special. The reality is that they just have not read enough current literature. When others question their assumptions it gets a defensive response. If you can not defend your theories with research and evidence and rely on anecdote and belief then you are talking about a religious and not scientific debate. As with evolution/creationism you can not use science to prove faith.

The real problem with anecdotal evidence is that many people get better despite what we do to them. Dennis you do not even have evidence to support your orthotics are better than a placebo.

As I am not a gladiator/master of ceromonies for podiatry arena but just a new poster like you with no academic standing perhaps you will be happier with my comment on your orthotics.

I can see a significant problem with your orthotics for people with ankle equinus and any sagittal plane block. The high Arch will cause discomfort and potentially debilitating compensations. What do you do with this sort of patient?

Frankly the waffle that has gone on in this thread in the guise of academic discussion makes me think your orthotic system should be renamed neurotic biomechanics.

 

The last three posts had absolutely nothing to do with mine. That is what I meant by deviating from the topic (I was never calling any of YOU deviants, as you called me). These posts deserve editing, Craig!!

Why can't even one of you guys answer one of my theoretical questions. They are clinically pertinent questions that should stimulate some reply beyond "eliminate gravity" in an academic forum such as yours.

My stuff is anecdotal, I have patents, I am neurotic, balh blah blah!! Get past it, get a new refrain or bow down to Kevins work even lower but don't waste your time or mine on the FFT thread.

If any of you had even the smallest crack in your mind that could go beyond whatever Kevin says took the time to examine my ideas and respond civilly to them, oh well pavlov has done such a good job, why don't you go get your breakfast bones. hahahaha

If not!!

A forty two year old otherwise healthy female presents herself to the practice complaining of thick, dystrophic, discolored hallux toenails for many years that have not responded to topical or oral antifungal care. They are painful in stylish shoes and sometime have a foul odor.
Examination reveals normal neurovascular status.
There are grade 1 bunions and the patient tests positive for functional hallux limitus. B/L. She has early 2nd and 5th toe hammering, B/L.
In addition, the subject has a prominent IP hallux callus and less prominent 2nd Metatarsal callus plantarly, B/L. Her other toenails are normal in appearance.

What is your diagnosis?
What is your treatment plan?
What is your prognosis?

Since the vertical pillars of the foot (in the windlast system) have flexible potential if not provided with additional support, in closed chain function they lower, collapse, become more flexible (pick one or more) when stressed, a horizontal system must exist underneath (the plantar fascia, spring ligament, etc) in order to provide stability and support to the system.

Is there an amount of material fill that can be placed under the vertical pillars in this system to prevent their collapse that would reduce the amount of work needed for the horizontal system to perform?

Surprise me, Simon, Eric, David, Stev, Ian, Craig or dare I say it even Darth.

"Collective fear stimulates herd instinct, and tends to produce ferocity toward those who are not regarded as members of the herd". Bertrand Russell.

"I am not afraid of you" Dennis Shavelson, D.P.M.

 

More than two weeks have gone by and not one reply although there have been more than 200 visits to this thread.

Kirby got your tongue?

If your interest isn't being captivated then please stop visiting and I will go away.

If not, can't one of you find the open-minded, self-expressive thought that lets alternative expression exist without being ridiculed or abused in a (theoretical)free and open forum.

I will add another theoretical question to the mix:
Any Takers?

Theoretical question 5:

1) If an orthotic could be dispensed that reduced functional hallux limitus in those foot types that predictably have it so that it allowed peroneus longus to leverage and power to the point that it produced renewed stabilizing power upon the first ray, locking it more securely in closed chain with every step, would the IM, HAA and Met primus elevatus of that patient's pathological medial column improve?

2) Could manual therapy, motor control, and additional vaulting of the dynamic arches of the foot then leverage and power the flexor hallucis longus and abductor hallucis, further reducing the development or advancement of biomechanical pathology?

"The smart way to keep people passive and obedient is to strictly limit the spectrum of acceptable opinion, but allow very lively debate within that spectrum".
Noam Chomsky

Dennis Shavelson, D.P.M.

 

I don't subscribe to the concept of putting one person down to make myself feel better. He might have my ear, but no one has my tongue. If you haven't been here in 2 weeks, odds are, the thread is exactly where you left it. For any idea to be expressed, and although it sometimes means taking a little heat, a person has to be here and be a part of it. I'll give you my uneducated opinion about it after I'm done repairing my machine.

I believe I've already designed something like that:

* Wed Aug 29 2001 Joe Jared <joejared@oretek.com>
Improvements for first met cutouts

I draw the forefoot posting proximal to the first metatarsal in a curve fit fashion on the bottom surface of the orthotic such that there is support proximal to the first met cutout, reinforcing the arch.

http://www.oretek.com/programmersreference/variables/#pl5ratioy

Generally, the above referenced support behind the first metatarsal combined with a more aggressive arch has an immobilizing effect on the mid-tarsal joints while allowing fluid motion in the push off stage of gait. Freeing up the big toe while providing proper support of the arch was the objective at the time. I'll leave it to the experts whether or not they think this is good or bad.

Afterthoughts on this:

 

Dennis,

It isn't...

Jog on mate

 

On another thread, The Administrator announced some editing prompted by another Arena Member (whom he thanked?) when he posted:

I have locked this thread as it has ceased being productive. When I get a chance, some comments will be edited out.

These threads have also been locked:
MASS Position Orthoses = Modified Whitman Braces??
Challenging SALRE
Challenging MASS
Claims of Foot Orthosis Superiority

When I commented on the need for better editing on another site, his personal and arrogant reply to me was that The Arena was the most looked at sight in podiatry. I guess that means there is no need for improved editing!!! (hahahahaha).

To allow five of your most popular threads to degenerate into a giant pissing contest causing them to "cease being productive" reveals a lack of editing skills from my perspective. Administrator, I await your personal reply or do I have to patent or have a monetary reason for making this reply for you to comment?

Why can't you guys and gals admit that you have ONE COMMON AGENDA (Darth's) and that The Arena is poised to either diss anyone with alternative viewpoints or act as if you are above debate on any other terms (witness the simple theoretical questions that a first year podiatry student could muster up answers to that you refuse to reply to even though hundreds of you will continue to look at this and my other postings on this thread.

I guess you (The Administrator) have another alternative, you can lock this thread as well (hahahahaha).

“Immaturity is the incapacity to use one's intelligence without the guidance of another.” Emanuel Kant

"Long Live Free Thought in the Biomechanics Community" Dennis Shavelson, D.P.M.

Proud to have zero "Thanks" on The Arena
Dennis