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Have Biomechanics Become An Afterthought In Podiatry?

Discussion in 'USA' started by NewsBot, Oct 20, 2019.

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  1. Dennis Kiper

    Dennis Kiper Well-Known Member

    Rich,
    I'm glad you're open to examining this orthotic technology, but maybe you haven't gone back in the threads to realize that the biggest advantage of the fluid volume is that it's a Rx (predicated on principles of physics that supports the technology). Sending you a pair of a Rx orthoses is like asking you to send me a Rx pair of what you make.
    Does your stance take 30 Gm--40--50--60? Or 61--62 maybe 62.5Gm? Each mg affects the POM (precisely) in all 3 planes. Adding fluid supinates the POM, in cases of overcorrection, I can remove fluid to pronate optimal positional stance.
    That's the hydro-dynamic Rx that has to be determined if your foot type can even fit this techmnology.
    Are you flat footed or are you a supinator? I need more information, just like if I called you. I'm willing to make a pair for you, but you also need a little more information as to what to expect--because it's not the traditional biomechanical response you're familiar with.
    You asked if it's for a specific group--I thought I was clear in previous posts, that it's specif for a supinator/non-subluxed MTJ. This mechanical structure allows for the hydro-dynamic principles that performs as an orthitc exactly the way it should.
    Once you recognize that fluid mechanics blends with bio-mechanics, you wouldn't even have to see or try it. I'd be happy to speak with you. I can send you a couple of scans that confirm the physics behind the biomechancs registered. actually I think those scans were posted in another thread. Dennis
     
  2. Dennis Kiper

    Dennis Kiper Well-Known Member

    Jeff,

    I don't know what you've ever followed that I've posted, but be aware I have stated several times that hydro-dynamic technology is not for a flexible flat foot. Otherwise your thoughts about lateral displacement of fluid is correct.

    Because the supinator structure is bordered by the template (med), proximal to the met heads rearfoot and the lateral column. In this structure, the lat col GRF is higher and hergher enough to contain pronatory and wt bearing forces from the medial. I see this in thousands of scans. In this way, equal hydrostatic pressure is developed under the tarsus.

    BTW--it's taken me years to recognize the genius of your father. I was in his classes. Most everything he's stated is mostly correct in my opinion. I spoke with Bill Orien several times before he passed. Bill told me he argued/discussed with him to look at the midfoot--your dad was adament. For me RF theory is for the minority of foot types esp flexible flatfeet. Dennis
     
  3. scotfoot

    scotfoot Well-Known Member

    Dennis ,
    Some time ago a group of researchers thought it would be worthwhile looking at the effects of fluid filled insoles on balance .
    They found that the insoles they tested were not detrimental to balance (see below ) .

    Do your orthotics incorporate a greater volume of fluid than those used in the study ?

    Also in what way do your insoles differ from the ones used in the study ? Could you provided a comprehensive annotated diagram to show how your insoles work with regard to fluid flow within the orthotic during use ? Diagrams are easier to follow than text and I am genuinely interested in what you are saying .

    Conclusions (from study )

    Single-leg standing balance, star excursion balance test performance, and level-ground walking patterns in asymptomatic adults do not appear to differ when wearing glycerine-filled insoles, contoured prefabricated orthoses, or flat insoles. Perceived comfort may be related to the biomechanical or clinical effectiveness of novel footwear interventions, and requires further investigation. Importantly, these findings are specific to a healthy population and further research is needed to determine the long-term effects of glycerine-filled insoles in patients with known balance impairments.

    Study

    A study of the immediate effects of glycerine-filled insoles ...


    https://www.ncbi.nlm.nih.gov › pmc › articles › PMC4561414

    by AL Hatton - ‎2015 - ‎Cited by 7 - ‎Related articles7 Sep 2015 - The insoles contain 100 % fluid glycerine which flows from areas of high ... in previous studies to explore the effects of foot orthoses on balance ...
     
  4. Dennis Kiper

    Dennis Kiper Well-Known Member

    Rich,
    tks for sending that to me, I wasn't aware of this study. There are several differences between mine and theirs
    1st--the viscosity of glycerine is not sufficient. It's more than H2o, but not comparable to silicone. With silicone at HC, impact is dampened. It decelerates (seen on scans) the motion of pronation starting at the STJ--it then accelerates and decelerates the motion as if it were part of the foot. This alone is one key to comfort--don't you think?
    2nd--the glycerine orth is generic, it's a cushion. the efficacy in reducing peak plantar pressure of a cushion, does not demonstrate the difference and importance in mechanical efficiency of the reduction of those pressures through functional mechanical alignment for prescription purposes. With the mechanical efficiency of alignment, the proper proportionate amount of reduction and balance is attained. With a cushion there is still a disproportionate amount of peak pressure, which still contributes to the imbalance and pathology.
    So, you mentioned you're a size 14, but your Rx could vary by 15 mg of fluid (more or less) than someone else with the same foot size. With HD technology that's already 25 different Rxs possible (actually more if we break it down to hundreths of mg)
    3rd--because the glyc orth is channeled it doesn't allow for equal hydrstatic pressure under the tarsus and proportionate GRF-(those channels might also have contributed to the lesser comfort between orthoses?)--my tech has no channels.
    This would also have impact on loading time and shorter foot contact to the ground.
    This would also have an impact on proprioceptive response. This is how I'm able to fit anyone outside of my space (after I qualify their foot type)
    The fit must meet 3 criteria
    comfort
    fullness
    stability (based on motion)
    this is what I use to know when my Rx is correct and determine whether to pronate or supinate their stance phase if I need to adjust.
    Over all, it's probably a decent product for an initial phase of PF etc.
    With silicone tech--you can grow the Rx over several years as the pt's Rx changes as you know.
    I've found that as bio-mech inflammion (aka--tisue stress) reduces, ROM increases and eventually requires add'l fluid to improve mechanical alignment and function.
    You might be able to post or add a little cushioning to a generic orth, but it's not the same.
    If you go to my web site: drkiper.com on the front page you can see a gait analysis comparison between a barefoot--same pt with SDO and their own custom ortosis. If you click on it, you'll be able to follow it in slow motion.
     
  5. Dennis Kiper

    Dennis Kiper Well-Known Member

    I disagree that pods are lacking in biomechanics knowledge. I think it's because in most (if not at least 1/2) the traditional technology for supinators are inconsistent and unreliable.
     
  6. Dennis Kiper

    Dennis Kiper Well-Known Member

    This is the biggest mistake I see. Most all generic orth help, because they minimize pronation motion. For some that may be 100% resolution. Usually only for the short term though.
    For most, it's not enough nor for the long term.

    A Rx that modifies the POM accurately is as important as Rx for vision. Especially for the long term and the ability to grow the Rx. Accuracy of a Rx is a health benefit to the life term of one's biomechganical health.
     
  7. Dennis Kiper

    Dennis Kiper Well-Known Member

    Allow me to clarify: I believe it is the ROM that speaks to overpronation. The axis of the joint is what changes. The greater the degree deviates from dynamic congruety, the greater the reduction in lever arm efficiency.
     
  8. Dr Rich Blake

    Dr Rich Blake Active Member

    Great, I will
     
  9. Dr Rich Blake

    Dr Rich Blake Active Member

    Great, I will look into it deeper
     
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