New Podiatry Terminology

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Hi all!

Since joining Podiatry Arena I have discovered a lot of new Podiatry terminology, and have as such, started thinking about other terms that podiatrists could be using that are misleading... I am trying to improve my use of Podiatry terminology, and have had to correct myself a number of times when using terms such as "1st Ray Hypermobility" oops

Some of the new and interesting terms I have learnt so far:
Decreased First ray Dorsiflexion Stiffness (vs Hypermobile First Ray)
Increased Ankle Joint Dorsiflexion Stiffness (vs Ankle Equinus)
Dorsal Midfoot Interosseus Compression Syndrome

And some misleading terminology, due to being poor/inadequate descriptors of movement:
Hyperpronation
Hypermobility
Calcaneocuboid locking/Midtarsal Joint Locking

Does anyone else have any suggestions of new/old terminology that could be added to this list?

Thanks for your help

Regards

Donna

 

High and low gear propulsion- nonsense

 

The terminology may be nonsense but I did not think there was any consensus on the concepts.

 

Good idea for a thread!!!

What about CP's use of the words "theoretically coherent and biologically plausible". I recall him saying that a few years ago that these words will probably be engraved on his tombstone.

 

Thanks for the replies so far

DaVinci, my motive for this thread is that I have been asked to do a brief update on Podiatry Terminology at the upcoming Queensland Sports Podiatry Conference on June 3/4 2006.

I think it would be useful to put some of the "newer" terms out there for others to have a think about, because I know that when I have seen new terminology mentioned on Podiatry Arena it makes me think differently.

Regards

Donna

 

New terms in past 20 years (please correct me if these terms were coined/defined earlier than 20 years ago):

Medial and or lateral deviation of the subtalar joint (STJ) axis
Spatial location of STJ axis
Rotational position of STJ
STJ supination-pronation moments
Anterior-posterior reference axis of midtarsal joint
Medial-lateral reference axis of midtarsal joint
Vertical reference axis of midtarsal joint
Rearfoot dorsiflexion-plantarflexion moments
Forefoot dorsiflexion-plantarflexion moments
Forefoot plantarflexion test
Midfoot compression test
Supination resistance test
Maximum pronation test
Orthosis deformation test
Barefoot standing orthosis test
Subtalar joint axis locator
Anterior-posterior exit points of STJ axis
Medial heel skive technique
Lateral heel skive technique
Anterior axial radiographic projection
Calcaneal balance point
Talar dome percentage
Heel height differential
Plantar foot-ground angle
First ray dorsiflexion stiffness
First ray plantarflexion stiffness
Forefoot dorsiflexion stiffness
Forefoot plantarflexion stiffness
Ankle joint dorsiflexion stiffness
Ankle joint plantarflexion stiffness
Dorsal midfoot interosseous compression syndrome (DMICS)
Lateral component plantar fasciitis
Plantar ligament stress syndrome
Plantar intrinsic fatigue syndrome
Orthosis reaction force
Plantar reaction force


Vocabulary that needs to be eliminated from the podiatric lexicon to remove ambiguous, imprecise and inaccurate terminology:

Midtarsal joint locking
Pronation force
Supination force
Hyperpronation
First ray hypermobility
Midtarsal joint hypermobility
Midtarsal joint pronation
Midtarsal joint supination
Longitudinal midtarsal joint axis
Oblique midtarsal joint axis

 

This is my second year out of uni and the terminology I was taught was hyperpronation which is apparently a no- no. Which term should be used? I could spend an hour typing up some others I ve heard/read

 

Or is the idea to be more specific- calcaneal eversion/MLA flattening etc?

 

I thought this thread was terminology.

 

Thanks Kevin for that massive list of terminology! That's awesome! Do you have abbreviations for all of these mega-long words?

Regards

Donna

 

I don't mind the terminology of low gear-high gear since it does describe a theoretical idea. However, I do think the idea is too simplistic to have any useful value for the clinician and/or biomechanics researcher. Maybe for this reason it shouldn't be used either??

 

Hi all,

Another you could discard is rigid lever/ mobile adapter theory.

Eric

 

I think Eric demonstrated in the Bojsen-Moller thread why the propulsive axes described by BM do not provide a geared sytem, thus the terms high and low gear seem inappropriate.

 

Netizens and bio-cryptologists

Must be something to do with the da Vinci Code all these terms with secret meaning are being aired.

I suppose there must be two sets of reference term or nomenclature:


Those which are accepted within the wider scientific community and recommended to use if you wish to avoid unecessary confusion. and

conceptual phrases which have (temporary) currency in describing hyptothetical models of three dimensional motion. These appear at first anyway to be discipline specific and like a good wine do not travel well across discilines. These are best avoided as "terms" for general use and reserved only for the "mind map".

Clearly because they exist is evidence of intellectual enquiry which can only be positive for podiatry . However like technical terms such as "transistor", "drip dry", and "loons" (flared trousers), these can only be taken seriously if used within the time frame an situation they had currency.

So Donna I would say there is really no new nomenclature from the podiatry discipline but plenty of techo-gobbledegook which can only be understood if certain theories are known and accepted. That is not to decry podiatry we are getting there andthemore we think about it thesooner we should be able to communicate what we mean.

What say you?

Cameron
Hey, what do I know?

 

Hi Cameron

Within podiatry I think we need to be more specific with a lot of our terms, because a lot of us are still using non-specific terms like "first ray hypermobility", which describes motion but it isn't actually quantifiable. I think it would be useful for more pods to be aware of the newer terminology (or techo-gobbledegook in your words ) so then we would have more uniform descriptions between practitioners. I guess a lot of biomechanical examination is still quite subjective, with great variability between practitioners, but using terms like the medially/laterally deviated STJ axis surely must be more specific than using words like hyperpronated or supinated?

I am very interested to see what others consider "obsolete" terminology, so maybe we can evolve to use more appropriate terms in future... I myself feel like I've said a dirty word every time "hypermobility" slips out!

Regards

Donna

 

Eric:

I think that the ability of the foot to adapt to uneven terrain and also act as a propulsive lever is an important function of the foot. Is this considered a theory?? Am I missing your point, Eric?

 

I disagree that there is no new reference terms for the podiatry profession. The newer reference terms are used quite frequently in the communication of important concepts between podiatric professionals both nationally and internationally and are considered to be only "techno-gobbledegook" to those who do not understand their definitions and understand the meaning that these terms, therefore, convey. One does not have to accept or reject a theory to use many of these terms since the acceptance or rejection of a theory is independent of many of these reference terms.

I believe many of the comments on this thread seem to be more about which theories should be rejected rather than which terms need to be replaced with more accurate, less ambiguous and more definable terminology.

Cameron, which of the following terms do you consider to possess more "techno-gobbledegook": the long-standing, widely-used terminology of First Ray Hypermobility or the recently-proposed, seldom-used terminology of Decreased First Ray Dorsiflexion Stiffness??

 

'osis' vs. 'itis'...

Some of the diagnosis terms are worth considering as well...

The newer terms of plantar fasciosis (vs plantar fasciitis) , achilles tendinosis (vs. achilles tendinitis) and osteoarthrosis (vs. osteoarthritis) all acknowledge the degenerative & non-inflammatory nature of the more chronic presentations of these conditions that we may be more commonly treating.

For example, plantar fasciitis often isn't an inflammatory process, as indicated by the 'itis' suffix.

The term plantar fasciitis is only appropriate for the acute tear or strain presentation, that many of us see less commonly.

If you can't tell the difference easily clinically, try applying some ultrasound gel over the area you're palpating. It makes it a lot easier to feel the difference between:
- 'old stuff' (thickening & fibrosis or varying degrees of a knotty or bumpy feeling within the affected soft tissues) which is degenerative & deserves the 'osis' term
- 'acute stuff' (small or large tears may be palpated, and there is a firmer feeling in the areas closely surrounding the soft tissue injury you're palpating due to oedema in the vicinity) which should be badged with the 'itis' term

This obviously isn't as definitive as an ultrasound exam, but the addition of the gel when palpating is like putting goggles on when you're underwater - it opens up a lot better potential for you to 'see' clinically with your palpating thumb the extent of fibrosis present, or any small tears or areas of inflammation in the soft tissues you're palpating.

A good reference on the fasciosis subject was:

Lemont et al 2004 J Am Pod Med Assoc
'Plantar fasciitis - A Degenerative Process (Fasciosis) Without Inflammation'

Lemont reviewed 50 histologic results from heel spur surgeries and found no evidence of inflammatory processes, but degenerative histologic findings such as mixoid degeneration with fragmentation.

So many of us probably have clinics full of osis's rather than itis's!

 

Hi Rachael,

Have you seen this thread discussing plantar fasciitis and fasciosis? It's very interesting.

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=1405&highlight=plantar+fasciosis

I guess there will always be arguments about differential diagnoses... ie. plantar fasciitis v plantar fasciosis.. but it would be nice to have everyone speaking the same universal "descriptive" language with regard to their biomechanical assessments. So using "decreased stiffness" instead of "hypermobility" and "pronation/supination moment" instead of "pronation/supination force" could be something that all pods will adapt to in their everyday language. As I said it would be nice, but will it happen...

Donna

 

Hi Kevin

>Cameron, which of the following terms do you consider to possess more "techno-gobbledegook": the long-standing, widely-used terminology of First Ray Hypermobility or the recently-proposed, seldom-used terminology of Decreased First Ray Dorsiflexion Stiffness??

Sorry I had not been following this tread and only caught it this morning. My post grad background is in bioengineering and althought I have a qualification in biomechanics, it is really grounded in bioengineering so I am a traditionalist in that I will accept only international scientific nomenclature. The reference to "tg" is tongue in cheek and covers conceptual terms which have no scientific basis and therefore no currency beyond those who accept theories that are being postulated. Like many I can follow the thinking but remain sceptical until independent evidence is available.

As you know I believe podiatric biomechanics is a quasi-science based on tautology. Like the King's clothes to the faithful they see a fine suite of clothing, me I see, no clothes. I understand perfectly the attraction of podiatric biomechanics and have met many experts and quite a few adept tweekers, but still believe there is more to pedal mechanics that we are yet able to explained within the theorum. Good luck to all who try.

As to your terms neither is specific in a qualified way and therefore incomplete as stand alone terminology, quid pro quo - gobbledegook.

As always yours respectfully

Cameron

 

Best fit terminology

Hi Donna

No I hadn't read that thread yet - just starting to poke around here really. I'm sure I have a truckload to learn - so thanks to everyone who takes the time to generate helpful posts!

Thanks very much for the link to the plantar fasciosis topic - I enjoyed having a quick read thru it at lunch.

Certainly I agree with a lot of the thought on the plantar fasciosis thread - that it seems unreasonable to indicate that an inflammatory component is totally absent.

Clinically, I see what would appear to be a lot of overlap of degenerative soft tissue conditions with varying degrees of an inflammatory component. The findings from history taking seem to correlate well with the degree of overlap of inflammation and degeneration when palpating. Acute tears or strains also seem to regularly have a decent amount of degenerative change in the sorrounding tissue - I've always thought this indicated the same tissue stresses that accumulated the degenerative changes have now caused the tear.

So I found Lamont's article of use mainly to get me thinking about the degree of degeneration vs. inflammation present when examining patients - and the nomenclature involved.

For the past few years, we've given a customised printout to our patients, with some brief diagnosis information, as well as treatment details (so they remember correctly!). So with some patients I will have on their handouts 'plantar fasciosis' if I've palpated what feels more like a chronic degenerative process without a noticable inflammatory or turgid feel thru the localised areas.

The cases with any palpated inflammatory component get the 'plantar fasciitis' term on the diagnosis section of the handout. Similar with arthritis vs arthrosis and tendinitis vs tendinosis.

With good palpating skills shouldn't we be able to be a little more specific with the names of our diagnoses we're giving to our patients? I like the idea of using a term that's the best fit to how each patient presents.

Probably using an individualised handouts has made me a little more thoughtful about what diagnostic terms are being used. We've not added sections on eitiology on our handouts yet - so the biomechanical terms are ones I've not been forced to commit to writing for our patients just yet - but I'm enjoying this discussion of biomechanical terms as well.

 

Rachael and Donna:

I have a problem with Lemont's article as I pointed out in the thread http://www.podiatry-arena.com/podia...antar fasciosis that Donna pointed out to Rachael. If there is pain in the plantar fascia, then I assume there is inflammation. If there is a fasciosis without inflammation, then the patient would be asymptomatic, wouldn't they?

While I agree that the fascia may be damaged either microscopically or macroscopically in nearly all cases of plantar fasciitis/fasciosis, why change the name to plantar fasciosis if it is instead the inflammatory (i.e. fasciitis) component that they are seeking your expert treatment for??

 

Rigid lever/ mobile adapter theory. Observation: The range of motion of the midtarsal joint increases when the STJ moves from a more supinated position to a more pronated position. The theory postulates that the "function" of pronation is to allow the foot to become a "mobile adaptor" and then it "should" resupinate so that it can be a rigid lever in the propulsive phase of gait.

I am not saying that the foot cannot be a mobile adapter or a rigid lever. What I am saying is that we should discard the extension of this hypothesis and that is the foot becomes a "loose bag of bones" when the STJ is pronated. There are feet that are quite rigid when in the maximally pronated position of the STJ. Also, I don't think that the change of position of the STJ that occurs in gait will be enough to signiificantly effect the range of motion of the MTJ. (McPoil study on position of foot in stance and gait. The STJ never gets to neutral positoin.)

There are two dramatically different values for stiffness of the midtarsal joint depending on position of the joint. If you start with the forefoot maximally plantar flexed on the forefoot and apply a load that would dorsiflex the forefoot, initially the stiffness is vary low. Now, as the forefoot dorsiflexes it will reach a point where the plantar ligaments become taught and resistance to dorsiflexion increases. I question whether the stiffness of the MTJ that comes from tension in the plantar ligaments is going to be significantly effected by the amount of motion of the STJ that occurs in gait.


That is why we should discard the rigid lever/ mobilie adapter theory and its extension to the "loose bag of bones" line of thought.
Cheers,

Eric Fuller

 

Eric:

I agree with your above thoughts. However, I think that the theory needs to be better explained rather than discarded since nearly all feet that I have examined have increased forefoot dorsiflexion stiffness when moved from a maximally pronated to a supinated position.

As you and I have discussed before, Eric, this is likely mostly due to the increased dorsal-to-plantar thickness of the rearfoot/midfoot when the foot is supinated so that the plantarly-located tensile load-bearing structures (e.g. plantar fascia) are a greater vertical distance from the dorsally-located compression load-bearing structures (talo-navicular joint). This concept is commonly used in engineering to design beams with greater bending stiffness (i.e. orienting a 2" x 6" beam on edge gives greater resistance to supporting loads and greater bending stiffness than by resting the same beam on its wider surface).

 

We are pretty much in agreement here. The question is whether we can get the foot to supinate enough, in gait, to make it significantly more rigid. My major problem with the theory is how people extend the line of thinking. There are some who would use the theory to take a laterally unstable foot and attempt to supinate it further to make it more "stable". The theory is that since the MTJ is more rigid the foot will be more stable. The problem with lateral instability is with STJ and not the MTJ.

Eric

 

Much like each species of wood has a different modulus of elasticity Mechanical Properties of Wood, each foot will also have a characteristic forefoot dorsiflexion stiffness (i.e. plantar metatarsal head loading force relative to forefoot dorsiflexion motion) that is dependent on many factors, two of those being subtalar joint (STJ) rotational position and STJ axis spatial location.

The more supinated the STJ, the more "stacked" the talar head is on top of the anterior calcaneus. This midtarsal joint "stacking" increases the vertical thickness of the midtarsal joint (MTJ) and will cause increased forefoot dorsiflexion stiffness. When the talar head has plantarflexed and adducted toward a position that is close to being medial to the anterior calcaneus, then the MTJ is "unstacked" and has a relatively narrow vertical thickness which will, in turn, cause decreased forefoot dorsiflexion stiffness. This is also true in any other structural material where increased cross-sectional thickness of the material will increase its bending stiffness and a decreased cross-sectional thickness of the material will decrease its bending stiffness.

Feet with medially deviated STJ axes will have a relatively "unstacked" MTJ since the talar head is more medial to the anterior calcaneus than in a foot with normal STJ axis location. Therefore, in these feet with medially deviated STJ axes, there will tend to be decreased forefoot dorsiflexion stiffness. Feet with laterally deviated STJ axes will have a relatively "stacked" midtarsal joint since the talar head is more laterally located and close to being directly on top of the anterior calcaneus when compared to a foot with normal STJ axis location. Therefore, in these feet with laterally deviated STJ axes, there will tend to be increased forefoot dorsiflexion stiffness. I have made these observations of interdependence of STJ rotational position and STJ spatial location with MTJ mechanical characteristics over the past two decades of examining thousands of feet with varying STJ axis spatial locations. I believe that this theory that links STJ rotational position, STJ spatial location and MTJ function into a nice, neat package is a much more mechanically coherent way of explaining the mechanical interdependence of STJ and MTJ function than the parallel/perpendicular axis theory of MTJ motion that was first proposed by Elftman over 45 years ago (Elftman, H.: The transverse tarsal joint and its control. Clin. Orthop., 16:41-44, 1960). I'm sure that Eric agrees that it is a shame that Elftman's theory of criss-crossing imaginary axes of motion within the MTJ is still being taught in podiatric medical institutions around the world, even to this day, as the way the midtarsal joint "locks and unlocks" during gait.

 

Thanks again everyone for posting such interesting information in this thread! You've been a great source of info! Thank you!

Regards

Donna

 

Dona - I just wrote a word in another thread and immediately thought of this thread:

Subject specific is a word that has crept into the vernacular in the last few years. ie we now know about the subject specific response to foot orthoses; the subject specific range of motion at the ankle joint (ie its not 10 degrees, its specific to each individual)

 

Hi Craig

That's a very nice term...I like it

Another term to add to our vocabularies!

Regards

Donna