Prescription advice - heavy supination.

Personally, I try to never judge a book by its cover http://en.wikipedia.org/wiki/Don't_judge_a_book_by_its_cover.

I spent many years working with undergraduates in the manufacture of foot orthoses, some of the devices they manufactured and dispensed looked terrible (I was often embarrassed for them, but allowed the process of learning to take place), yet this did not appear to influence their efficacy. Strangely enough, the way they "sold them" to their patients did. Make of that what you will.

Wouldn't Phil be violating your patent if he did that?

 

Dennis

Thanks for the offer of making a pair of Foot centering orthotics.
However I think the sample size etc wouldn't be large enough to allow me to make a fair comparison. Also a Rotational Equilibrium (RE) orthotic is not a fixed entity. As I am sure you are aware, RE is not just applied to the Stjt but any segment of the foot so it would be hard to compare one device against another.
As a clinician the issue I have with the your approach of foot typing is that it does not seem to make the link between cause and effect. The matrix you use is created using assumptions that do not take into consideration more proximal gait influences and alignments e.g. the effect of weak glutues medius on shank rotation during gait. If an orthotic applies a counter force to the internal rotation forces being driven by the leg, the potential for injury is quite high.
The idea of linking the MLA and LLa isn't that new. We often apply a Carlton saddle modification to orthoses that creates the Vault that you speak of. Nothing wrong with the but it just another part of the varied prescription armory that we have - 'horse for courses'.

Regards

Phil

 

Phil:

You are correct in ascertaining that I am less involved in cause and effect than most of The Arena Seniors.
I am more involved in effect and solution.
Medicine is an Art as well as a Science and where I am biased in Art, you seem biased in Science. As clinicians, I think the common ground is where the well rounded greats live.

I am not skilled in the gluteal effect of my orthotics but in 38 years no patient or consulting physician or therapist has accused my orthotics of “promoting a pain in the A_ _". Many patients proclaim postural performance and strength as well as symptom reduction in the superstructure as a benefit of my orthotics as they are attended by consulting specialists more knowledgable than I in gluteals.
I maintain that while you are focusing energy, funds and time finding cause, I am finding (unproven but some of which may prove valuable) cures that you won’t research or try until proven.
The Tenets of Neoteric Biomechanics are (currently):
1. The Vault of the Foot must be prevented from collapsing in closed chain
2. The rearfoot must be balanced to the three body planes
3. The forefoot must be balanced to the three body planes
4. The rearfoot must be balanced to the forefoot
5. The left foot must be balanced to the right
6. Extrinsic and Intrinsic musculotendonous units must be encouraged to work with power and in phase in closed chain.
What do you have against that?
Functional Foot Typing profiles all feet into one of ten FFT’s and then produces Foot Centrings (FFT-specific orthotics) that utilize foot type-specific orthotic casting and prescribing techniques (utilizing your “prescription armory” as well as some new ones that I have developed in an organised way). No one Foot Centring is the same as any other (not even a right/left for a given patient.
This reduces complications and failures as it increases positive outcomes and makes Foot Centirngs the most custom orthotics available.
What do you have against that?
Furthermore, Neoteric Terminology is more understandable, teachable, reproducible and even more defining then your difficult engineering and physics terminology.
For example, Maximally pronated rearfoot (the flexible rearfoot types) and less than maximally pronated rear foot (the rigid rearfoot and stable rearfoot types). Which is more understandable?
Furthermore to give an example of where Neoteric strategy would be of benefit, in reviewing Dr. Kirby’s recent important researched article, I believe the authors would have come up with much more impressive data if they profiled all of “the less thans” into rigid and stable types using Functional Foot Typing, dividing the "less thans" group.
I think the unfortunate difference between us as clinicians is that although I try to keep up on SARLES Literature, you pay no attention to mine or any others, yet ooze apparent knowledge on these foreign subjects with the same confidence that you do about STJ Axis Theory.
“The authority of those who teach is often an obstacle to those who want to learn”. Cicero

Dennis

 

Dennis

Why the confrontational statements?
I was hoping that you may be able to stay away from personal assumptions about me and worded my comments as neutrally as possible.
FYI, I am not a SALRE 'disciple' but a Tissue Stress model advocate. SALRE, Root, Sagittal plane etc all have their place and I was hoping for a constructive conversation with you as your methodology may have had some merit.
Unfortunately your attitude has had the effect of closing my mind to your approach - nothing to do with your theories but everything to do with your attitude.
I will refrain from name calling and will keep things professional , something you seem incapable of doing.

regards

Phil

 

In any debate, there are challenges of discussion that when answered further the knowledge of all involved.
The dictionary defines confrontation as:
1. an act of confronting.
2. the state of being confronted.
3. a meeting of persons face to face.
4. an open conflict of opposing ideas, forces, etc.
5. a bringing together of ideas, themes, etc., for comparison.
6. Psychology. a technique used in group therapy, as in encounter groups, in which one is forced to recognize one's shortcomings and their possible consequences
Isn't that what we are doing?
Must I only agree with what you say?
What names did I call you (as you infer)?
When I said:
I think the unfortunate difference between us as clinicians is that although I try to keep up on SARLES Literature, you pay no attention to mine or any others, yet ooze apparent knowledge on these foreign subjects with the same confidence that you do about STJ Axis Theory.
I said I THINK!!! that calls for a reply from you so that I can know your fiber better. I did NOT name call.
Have you ever read any information on Neoteric Biomechanics is a fair question, I thought.

Please either answer one or more of the questions/points I raised or suggest an online course for "attitude repair while visiting The Arena" which I will subscribe to and then return softer and more user friendly.

Dennis

 

Sorry to bring back an old post. Was just wondering how to dorsiflex the medial column when casting?

 

Ben:

While holding the foot in the standard supine neutral suspension casting position with one hand, I will use the contralateral thumb to apply a variable magnitude (about 2-5 lbs) of load to the plantar aspect of the first metatarsal head while simultaneously applying a variable magnitude (about 2-5 lbs) of load to the plantar aspect of the head of the proximal phalanx of the hallux with my index finger. This negative casting modification produces an elongation of the arch of the foot, a pre-tensioning of the plantar fascia, and a minimal change in the forefoot to rearfoot relationship within the resultant negative cast. This is the first time I have ever described this procedure publicly, but have been using it for the past 20 years in my practice. It is one of the many negative casting modifications I use to optimize the orthosis morphology for my patients.

Hope this helps.

 

Hi Kevin,

So I guess this is similar to the function that plantar flexing the 1st ray has? Benefits would be possibly less forefoot manipulation when casting and possibly a more 'natural' capture of the dynamic MLA?
I try this out.
Thanks for sharing your knowledge, it’s very much appreciated.

Kind regards,
Ben

 

No. The technique I described dorsiflexes the first ray.

 

sorry misread that. Just wondering when applying force to the plantar 1st metatarsal head would you risk creating an artifical forefoot varus?

edit: just had read your previous post a couple of times again. Guessing the force applied to both the metatarsal head and the hallux comes to an equilibrium, leaving the hallux realtively straight and windlass primed. I will stop asking (stupid) questions and try it for myself.

thanks again

 

When I've used this technique, I've often wanted, and gotten, a fairly large change in the forefoot to rearfoot relationship in the cast.

I usually use the technique when there is very little eversion range of motion available when the patient is standing and there is a large amount of forefoot valgus in the foot. If you did not modify the cast, and balanced the cast vertical there would be a large amount of intrinsic forefoot valgus correction, which could lead to excessive forces on the lateal side of the foot. If you balance the unfodified cast severel degrees inverted to reduce the amount of intrinsic forefoot valgus post then you will tend to be inverting the heel cup of the device. Often these feet, with a large amount of forefoot valgus will often have a laterally deviated STJ axis. You don't want to invert the heel cup in these feet. This problem is solved by dorsiflexing the first ray to decrease the amount of forefoot valgus.

Kevin, when do you dorsiflex the first met when casting? When do you try not to alter forefoot to rearfoot relationship?


Cheers,

Eric Fuller