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Occam's Razon or the Law of Parsimony

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Nov 3, 2021.

  1. Thanks for that and good luck with your future endeavours
     
  2. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Hi Hilary,

    I agree with your philosophy - fix the problem, don't just treat the symptoms.

    Also, I stopped using Orthotics for the very reason you mentioned:
    • Orthotics limit motion
    I am an advocate for the use of Proprioceptive Insoles because
    • Proprioceptive insoles do not limit motion

    What is your viewpoint on patients Dx with either the RFS or PCFD? My research suggests that these two abnormal congenital foot structures distort the proprioceptive signals sent to the cerebellum, which in turn results in global postural distortions. And it is these postural distortions that eventually lead the patient into chronic pain.

    If you don't normalize the proprioceptive signals generated in the foot, by using proprioceptive insoles, how would you go about doing this? If it could be done without using insoles (which is a life long commitment), that would be preferable.
     
  3. Heather P.

    Heather P. Welcome New Poster

    Hi, Hilary. I'm a patient of proprioreceptive insoles (via Brian Rothbart), orthodontia, and most recently a tongue-tie release. I have a great interest in this area and am happy to offer a patient's perspective. After my tongue-release, I began to theorize the tie was the biggest cause of my problems--it created the bad mouth and jaws and the bad feet. A tie develops in the womb, is the top of the fascial chain, and links all the way to the toes. The feet and the mouth can't be fully and properly treated if a motion-restricting tongue-tie exists. I am proof of that. I know some good myofunctional therapists and a research-oriented adult tongue-tie expert. It is all connected. I look forward to looking into your work and hopefully being of some help to those studying these issues.
     
  4. Brian

    Whether orthotics or proprioceptive insoles, you are creating something to resolve the problem that the foot is not making correct contact with the floor. If a client is relaxed, you could rotate the foot so a certain part was making contact/receiving proprioceptive feedback but once the client controls their movement/posture it is not longer in contact.

    This then becomes a problem of unconscious learned postural control - learned and habituated in infancy. There is of course an epigenetic predisposition but this can be altered with experience. To correct the problem we must get to the source - a movement pattern predicted by our eyes from the unconscious.
    If your client cant put the base of their hand flat on a table, they cant put their heal flat on the ground. How do you learn to put your hand flat on the table - change the eye movement / prediction/ neuroplasticity.
    That is what I am investigating in my research

    There is a lot to it, so I will be at it a while

    Thank you for the question

    Hilary
     
  5. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


    Hi Hilary,

    When I googled Epigenetics, I found the following explanation:

    Epigenetics , a relatively new branch of genetics, refuting the commonly held belief that you are stuck with the genes you were born with. Epigenetics asserts that your genes are turned on and off, expressed to a greater or lesser degree, depending on lifestyle choices (e.g., behavioural, environmental, etc).

    With that understanding, how would you epigenetically change the distorted proprioceptive signals being generated by RFS or PCFD? Both of these foot structures are subject to gravity drive pronation, which is unrelenting and debilitating. I am not sure this pronation pattern can be altered/attenuated with changes in habituation and learning during infancy.

    And how does this fit into the concept of turning genes on and off.

    Difficult questions, I realized. But Intellectually, this approach is engaging.
     
  6. Hello Brian

    That is what I am researching. The reason posture becomes fixed is because it is predicted into being by our unconscious. This becomes habituated in infancy and is directly related to habitual tongue position at that time. At any given point in time our eye generate three saccades per second - lightening fast possibilities of how we would react to the environment based on our experience. To consciously change from a reflexively generated response to a conscious response we must stop the generated response and then switch motor plans - or create a new motor plan by changing the eye movement. Problems in switching occur when the next motor plan is too similar to the inhibited one - which is more likely when the core if off center resulting in reduced range of movement.

    My current research as I said is with adults with a developmental stutter and other than that I have my personal experience - so I know that changing foot shape and dental alignment is possible even in my 40's. I had an underbite for 30 years. The process is under scientific investigation but it centers on changing tongue position by learning the unconscious processes that control its movements.

    It is rather complex and my research is in early stages

    Hilary
     
  7. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Good morning Hilary,

    Thank you for that explanation.

    The tongue – foot link was demonstrated to me in a patient who recently had a tongue release procedure.

    This particular patient was fitted with a reduced plantar proprioceptive signal (required as her descending skewed proprioceptive signal was reduced). When she stood on these insoles, her right foot became excruciatingly uncomfortable. The left insole was comfortable. The problem was finally isolated to tongue pathomechanics (tongue offset right - supinating right foot)

    A functional unilateral supinated foot is pathognomonic of a skewed descending proprioceptive signal. I have been aware of this in patients having occlusal or sacral cranial pathomechanics (Below, I have attached examples of sphenoid torsions impacting the foot, concurrent with a PreClinical Clubfoot Deformity) but this was my first experience dealing with tongue pathomechanics.​

    I would like to run an experiment, using you as the subject (if you are so amendable). I suggest running CPA algorithms on specific photos you send me (I will provide instructions on how to take these photos in a separate email). The results may add credence to your theory. Are you game?

    Left Sphenoid Torsion.jpg Right Sphenoid Torsion.jpg
     
  8. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Hilary’s challenging research using Epigenetic designed interventions to attenuate postural distortions (and the associated musculoskeletal and visceral dysfunctions) is laudable.

    One of the current interventions to attenuate postural distortions necessitates the use of an extrinsic aid (insoles). These require a lifelong commitment.

    If an epigenetic approach can be developed, which by its’ very nature is an intrinsic intervention, the need for orthotic/insole therapies would be substantially reduced. Such a method is without doubt preferable over insole therapy.
     
  9. Brian,

    While I am incredibly interested in this conversation and research my brain can not afford the time to concentrate on this topic at present. I have received funding to complete a Research PhD on developmental stuttering - because if my approach can be shown to improve neurological functioning, I can then move on to the links between the proprioceptive system and the tongue.

    I am not there yet, and I unfortunately am finding myself spending time I can not spare from my other commitments ( Job , my PhD and my family) dwelling on this enormous research area.

    For this reason - only, I need to disengage from this conversation at present and hope to return to it in the future, when time permits. I am more than game for your experiment, but I need to be able to be focused on this area to engage with it fully .As you are aware, a PhD is an enormous time commitment.

    Thank you for your interest and kind words of encouragement. I need to focus my attention elsewhere at present.

    All the best

    Hilary
     
  10. Good news,

    My supervisor has agreed to give me time to look into this but it will have to wait until next week.

    I will be back in contact then

    All the best

    Hilary
     
  11. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Fantastic!

    We should start a new thread of discussion with the appropriate name, maybe something like Epigenetics, the Postural Link
     
  12. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I have been asked, on more than one occasion, why I post on this Podiatry forum in light of the unprofessional comments I've endured over the years. My answer is two-fold:

    (1) I believe one of the main purposes of this forum is to present new ideas/novel research. And that is what I have done.
    (2) Over 4800 views on this discussion alone
     
  13. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Here is a photo of a heel bone showing calcaneal supinatus in A.sediba. Calcaneal supinatus is the hallmark of the PreClinical Clubfoot Deformity.

    Heel supinatus.jpg

    Photo of the foot fossil of A.sediba
    Courtesy of DeSilva JM et al 2013. The Lower Limb and Mechanics of Walking in Australopithecus sediba. Science 340, DOI: 10.1126/science. 1232999
     
  14. Rob Kidd

    Rob Kidd Well-Known Member

    Several issues here - one must separate issues. Jerry and I were two of the authors of the original description of A. sediba, first published in Science in September 2011. In fact, my essential contribution to the work was the number crunching of the calcaneus, talus and medial cuneiform and their subsequent description - the tibia was done by someone else. The crunching required multivariate statistics, both of Principal Components Analysis (PCA) and Canonical Variates Analysis (CVA). I probablly have the biggest data set in the world of hominoid tarsal dimensions, comprising perhaps 1000 specimens and about 55000 measured dimensions; much of this was used for comparison. The first author on this paper was a colleague, good friend and ex-PhD student of mine, Dr Bernhard Zipfel from The University of Witwatersrand (also a closet podiatrist). In the paper you quote, Jerry does not contradict anaything we all said there, but goes on to substantially develop it.

    Yes the calcaneus is decidedly ape like and is inverted while weightbearing; this is not unlike a modern Pan troglodytes or paniscus. However, if you look at the embryology, one will find that in the pre-ape tarsus - eg an anphibian, (go to Freddie Wood Jones' book for detail (FWJ was Prof of anatomy first in Manchester, then in Adelaide) the calaneus and talus are broadly on the same plane AND the calcaneus is caudal to the talus (medial - lateral do not work in embryology). Then come back a few embryological weeks later, the calcaneus has rotated down and around the talus to be positioned marginally cranially, ie inverted. Of course, as I assume you know, in H. sapiens, the calcaneus then descends to be approaching vertical, but rarely completely vertical. Thus, an inverted calcaneus is what one sees in modern apes (and in humans but to lesser extent), and in our opinion what one sees on A. sediba. That is, it is ape like. As to ancestor - of H. sapiens, there no evidence that ANY of the hominoid fossil record are a direct ancestors or anticedents of any other.

    As to the term "Calcaneal supinatus", I cannot find any sensible use of the term, at least, if one still associates the terms "supinated" and "pronated" with triplane motion. To do that would require and axis of rotation of movement/torsion; to the best of my knowledge, no such study has been undertaken.
     
  15. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Hi Rob,

    Thank you for that clarification.

    The term Calcaneal supinatus is a structural relationship (e.g., a structurally inverted anatomical part), not a positional relationship. Embryologists use the term supinatus when describing the ontogenetic growth patterns (e.g., untwisting) transpiring during embryogenesis and fetalgenenesis. This growth pattern, in cartilaginous tissue (not ossified bone), develops along the long axis of the structure (Refer to Animation below). It is impossible for this to occur in ossified bone.

    Do you agree?

    Carnegie-16-18-21-Frames.gif

    In Carnegie Stage 18, note the terminology (rotated, not rotation).

    In the postnatal foot, a common usage of the term supinatus is in the description of the clubfoot deformity (do you disagree), or when I am describing the PCFD or RFS.
     
    Last edited: Dec 10, 2021
  16. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

  17. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    From Sept. 2016-Sept. 2018, 214 consecutive pats underwent a complete evaluation by both an MD and a Board Certified Myofascial Trigger point Therapist at one pain clinic. Of the 214, 133 pts (62%) had a medial foot column disorder ranging form Morton's Toe (short first metatarsal or primus metatarsus elevatus) to Rothbart's Foot (incomplete unwinding of talus).

    The most common complaints of the 133 pts were back pain in 37 and leg, knee, or hip pain in 29. Only 14 pts had foot pain, 5 of whom also had peripheral neuropathy. The mean age of pts was 52 yrs (13-81) and the female to male ratio was 3:1.

    The first metatarsal deficit (FMD) was measured using Rothbart's microwedges with the foot in subtalar neutral position. Ten pts had an FMD up to 14 mm and were considered to have mild Morton's Toe deformity. The other 123 pts (92%) had an FMD > 14 mm and were diagnosed with Rothbart's Foot Structure, all of whom also had a short first metatarsal.

    In the latter group 3 pts had an FMD > 20mm, consistent with pre-clinical clubfoot disorder. Pts were treated with antipronation posture congtrol insoles (PCIs 3.5, 6,or 9mm depending on FMD). Arch suppports and heel lifts were added if leg length discrepancy or pes planus was present.

    Medial foot column disorders are extremely common and lead to callouses, bunions, neuromas, hammer toes and even knee and hip arthritis. We are unaware of any commercial shoe or orthotic that can remedy hyperpronation at the forefoot as well as can inexpensive PCIs. No pain/posture evaluation is complete without a barefoot, standing evaluation of the feet.

    Earlier diagnosis and treatment of these disorders is mandatory, especially in children and athletes, in order to avoid complications requiring surgical intervention.

     
  18. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Just to provide an insight into the current interest in my work among other researchers - below is my current rating on ResearchGate:

    Research Score.jpg
     
  19. efuller

    efuller MVP

    Brian, it's too bad that the researchers used a technique of measurement that you feel is no longer valid. You did find that that 96% of subjects had a pathological foot using that test in your 2002 paper.
     
  20. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I agree.

    I wrote that paper 20 years ago. Diagnositic protocols have been updated. Currently I use CPA (CPT) and KBT to differentiate between Rothbarts Foot and PreClinical Clubfoot Deformity.

    Microwedge measurements (as I discussed in my 2002 paper) have the same potential inaccuracies as any measurement using palpation to evaluate joint position. That is why I now advocate using Computer postural assessments and Knee bend tests.
     
  21. efuller

    efuller MVP

    Brian, why did you post that paper? Why did you post the paper without a warning to the readers of podiatry arena about the use of the now discredited measurement technique?
     
  22. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Already answered in Reply 220
     
  23. scotfoot

    scotfoot Well-Known Member

    Brian
    Are you aware of any other adult musculoskeletal conditions that are classified by developmental problems encountered before birth?

    As we discussed previously, classification of club foot is made after a baby is born since seeking to classify before birth makes no clinical sense .
    Classification of clubfoot

    A Diméglio 1, H Bensahel, P Souchet, P Mazeau, F Bonnet
    Affiliations expand
    Abstract

    Clubfeet must be classified according to severity to obtain reference points, assess the efficacy of orthopaedic treatment, and analyze the operative results objectively. A scale of 0-20 was established on the basis of four essential parameters: equinus in the sagittal plane, varus deviation in the frontal plane and derotation around the talus of the calcaneo-forefoot (CFF) block and adduction of forefoot on hindfoot in the horizontal plane. Four grades of clubfeet can be individualized: (a) Benign feet so-called "soft-soft feet," grade I, similar to postural feet, with a score of 5 to 1 (these mild feet must be excluded from any statistics as they tend to increase good results); (b) moderate feet, so-called "soft > stiff feet," grade II (reducible but partly resistant, with a score of 5-10); (c) severe feet, so-called "stiff > soft feet," grade III (resistant but partly reducible, with a score of 10-15); and (d) very severe, pseudoarthrogryposic feet, so-called "stiff-stiff feet," grade IV (score of 15-20 points). To avoid risks of errors, our method is based on a very complete checklist and on diagrams. Our training material inculdes an audiovisual package.
     
  24. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I believe I am the first researcher to make the connection between the prenatal clubfoot shape and the postnatal Clubfoot Deformity.

    You said: Classification of club foot is made after a baby is born since seeking to classify before birth makes no clinical sense .

    I agree. However, I am not classifying the severity of the Clubfoot deformity before birth.

    I am suggesting that the etiology of the Clubfoot Deformity is the arrested torsional growth during embryogenesis

    I suggest we continue this discussion in a separate thread. It would make a very interesting debate. I would suggest naming that new thread - Etiology of the Clubfoot Deformity
     
  25. scotfoot

    scotfoot Well-Known Member

    Re your use of capitals, you are drawing a distinction between "Clubfoot Deformity" , an entity you claim to have discovered and "Clubfoot deformity" a condition widely recognized in conventional medicine ?
     
  26. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I just created a new thread entitled -The Etiology of the Clubfoot Deformity?

    Let's resume our discussion there.
     
  27. scotfoot

    scotfoot Well-Known Member

    No thanks .What I am driving at is that classifying adult foot types by guessing that "undetectable at birth" developmental issues are the root cause, cannot be justified .

    I would be happier with you using your classification if you qualified it as "unsubstantiated" .
     
  28. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I would be happy to carry on this discussion on the new thread - The Etiology of the Clubfoot Deformity?
     
  29. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    It is in peer review as we speak.
     
  30. scotfoot

    scotfoot Well-Known Member

    .What I am driving at is that classifying adult foot types by guessing that "undetectable at birth" developmental issues are the root cause, cannot be justified .
    I would be happier with you using your classification if you qualified it as "unsubstantiated" .
     
  31. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Happy to continue this discussion on The Etiology of the Clubfoot Deformity?
     
  32. scotfoot

    scotfoot Well-Known Member

    Brian
    With your orthotic device ,is the wedge going under the met head or the distal aspect of the great toe ?
     
  33. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    The proprioceptive wedge (insole) used for Rothbarts Foot extends underneath the base of the first metatarsal and extends to the distal aspect of the hallux (great toe).

    No signal is placed underneath the 2nd metatarsal or adjacent phalanges.
     
  34. scotfoot

    scotfoot Well-Known Member

    I am interested in this . Re the military trial , did you get any results before the project was ended ?
     
  35. Greg Quinn

    Greg Quinn Active Member

    Hello Brian,

    I hope you've had an opportunity to read my paper. If you don't mind I'd like to better understand the basis of your foot-typing protocol by asking you some questions.

    Within your work, have you expected and/or detected identical or similar responses from all morphologically matched patients treated in a particular 'Rothbart' way? If not, what is your explanation for variable outcomes?

    Do you believe that the form & function of the foot as an outcome of development is entirely predictable by inherited genetic determination? If so, are the feet of identical twins always the same? If there are differences between the feet of identical twins, how does this happen?

    In essence, what I am asking is, does the physical interaction of a (supposedly predetermined) foot type with the environment always produce identical or similar outcomes or is this variable?

    If outcomes are variable in any way, is this attributable to genetics (or epigenetics) or the physics of the internal and external environment?

    Finally, how does your foot typing protocol rationalize these two elements?

    Many thanks

    Greg
     
  36. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Hi Greg,

    I have not had the opportunity to read your paper. That is on my short list of things to do.

    To answer your questions above:

    The clinical outcomes, resulting from my therapy, vary because they are can be impacted by more than just the foot deformation. For example, the postural deformations can come from the teeth, the tongue and vision, as well as the foot. If the skew in posture comes solely from the foot, the response to therapy is very predictable.

    I do not believe that the form and function of the foot is solely due to inherited deformations. However, I do believe the genetic deformations are a major determinant in the distorting of the posture and resulting musculoskeletal pain.

    To date, I have done no research in epigenetics and have only considered the genetics and postnatal physics in researching the pathodynamics of gravity drive pronation. However, Hilary and I have discussed a future research project looking at the epigenetic role in gravity drive pronation.

    Once I have read your paper, let’s talk more.

    Brian
     
  37. efuller

    efuller MVP

    Yes, look at the start of this thread to see how seriously, and how recently, you have considered "postnatal physics".

    At the start of this thread you attacked the use of physics and said it made your head hurt. Brian, I guess the upside here is you can change your tune in response to criticism. Now, if you would only actually consider the physics.
     
  38. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    The miliary trial was started during the Iraq war. The MDs involved in the study were sent to Iraq and the study was interrupted midstream before any results were obtained.
     
  39. scotfoot

    scotfoot Well-Known Member

    Are there any randomized trials to show your orthotic works ?
     
  40. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Hi Gerrard,

    Below are a couple of studies done on my research:

    In 1997 Cummings and Higbie publish a study on the novel approach I invented to measure forefoot posting in Rothbarts Foot (paper attached)

    In 2012 Safaeepour Z and Gholamreza A ran a study on the plantar pressure distribution in subjects with a flexible flatfoot using prefabricated insoles vs proprioceptive foot orthoses (my design). You will find their abstract at https://pubmed.ncbi.nlm.nih.gov/23085538/

    In 2019 Renee Hartz Md and Mary Biancalana published a paper in The Journal of Pain (Vol 20, Issue4) on Rothbarts Foot, in a clinical study using the insoles I developed. Below are their findings:

    From Sept. 2016-Sept. 2018, 214 consecutive pats underwent a complete evaluation by both an MD and a Board Certified Myofascial Trigger point Therapist at one pain clinic. Of the 214, 133 pts (62%) had a medial foot column disorder ranging form Morton's Toe (short first metatarsal or primus metatarsus elevatus) to Rothbart's Foot (incomplete unwinding of talus). The most common complaints of the 133 pts were back pain in 37 and leg, knee, or hip pain in 29. Only 14 pts had foot pain, 5 of whom also had peripheral neuropathy. The mean age of pts was 52 yrs (13-81) and the female to male ratio was 3:1. The first metatarsal deficit (FMD) was measured using Rothbart's microwedges with the foot in subtalar neutral position. Ten pts had an FMD up to 14 mm and were considered to have mild Morton's Toe deformity. The other 123 pts (92%) had an FMD > 14 mm and were diagnosed with Rothbart's Foot Structure, all of whom also had a short first metatarsal. In the latter group 3 pts had an FMD > 20mm, consistent with pre-clinical clubfoot disorder. Pts were treated with antipronation posture congtrol insoles (PCIs 3.5, 6,or 9mm depending on FMD). Arch suppports and heel lifts were added if leg length discrepancy or pes planus was present. Medial foot column disorders are extremely common and lead to callouses, bunions, neuromas, hammer toes and even knee and hip arthritis. We are unaware of any commercial shoe or orthotic that can remedy hyperpronation at the forefoot as well as can inexpensive PCIs. No pain/posture evaluation is complete without a barefoot, standing evaluation of the feet. Earlier diagnosis and treatment of these disorders is mandatory, especially in children and athletes, in order to avoid complications requiring surgical intervention.
     

    Attached Files:

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