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Trouble getting patients to use custom orthotics

Discussion in 'General Issues and Discussion Forum' started by Thomas Johnson, Mar 5, 2008.

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  1. Thomas Johnson

    Thomas Johnson Welcome New Poster


    Members do not see these Ads. Sign Up.
    I find that I am having trouble getting patients to use custom orthotics. They feel that they are not comfortable. So they don’t wear them. Or they have had them in the past and didn’t wear them and are not willing to pay the cost for customs.
    As an alternative I find that they are happy with the <BRAND NAME REMOVED> arch supports. I find that when given a choice of something comfortable, they wear them. And as a result they get support that they need.

    My feeling is they are getting the correction, and that is what is important.
    I found a great source on them where I order them online, mark them up, for handling, and the patient is still ahead $$$ as they only pay about $50. <WEBSITE REMOVED> My cost is about $26.00

    What are your thoughts?
     
    Last edited by a moderator: Mar 5, 2008
  2. admin

    admin Administrator Staff Member

    Re: SPAM: trouble getting patients to use custom orthotics

    A new member joins up and immediately starts talking about a brand (that is not actually very good) and drops a link to a site that is only a few months old selling the brand (rather than the main company site), sets of all sorts of SPAM alerts around here.

    Normally we just delete it and ban the member, but I thought we would leave this one as a source of amusement, mainly because:
    lol ...does not say much about your clinical skills if that is what you are finding!
     
    Last edited: Mar 5, 2008
  3. Admin2

    Admin2 Administrator Staff Member

  4. Trent Baker

    Trent Baker Active Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Agreed Admin. I was reading through this post thinking 'geez, does this guy have some problems'. Some funny stuff indeed.

    "My feeling is they are getting the correction, and that is what is important". No they're not!!
     
  5. davidh

    davidh Podiatry Arena Veteran

    Re: SPAM: trouble getting patients to use custom orthotics

    I know the point has been made before, but don't these people read the forums before they post?

    On the originality front, for working out a way to mention your own company whilst pretending to be someone else - very poor. I only award two out of a possible ten:D.

    Cheers,
     
  6. admin

    admin Administrator Staff Member

    Re: SPAM: trouble getting patients to use custom orthotics

    The sad thing is that these people do not realise just how useful forums are for promotions of commercial products. All they have to do is become a member of the community and contribute to the greater good of the community. They don't have to promote the product ....they have to earn the respect of the community by the quality of the contributions they make ..... and just have a link to the product in their signature.

    Think about ....would you not want to know more about their product and even buy it if they had earn your respect first?
     
  7. admin

    admin Administrator Staff Member

    Re: SPAM: trouble getting patients to use custom orthotics

    For those who have not looked at the first two links above, here is the highlight:
     
  8. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Aside from the fact that the original poster may have a hidden adgenda, why do you feel that if the patient is getting correction, that, that is not important?
     
  9. Re: SPAM: trouble getting patients to use custom orthotics

    What is "correction"? Sounds like something you pay a lot of money for in certain houses of ill-repute.
     
  10. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    I must have misunderstood you, because we are talking about different things.
     
  11. Re: SPAM: trouble getting patients to use custom orthotics

    Dr Kiper welcome to podiatry arena. I suspect we are both talking about these insoles. Just wanted to know what you mean by correction? Just 'cause my mind wanders occasionally shouldn't dilute from the real issues here. Perhaps you should be so good as to elaborate.
     
  12. perrypod

    perrypod Active Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Who is Thomas Johnson?
     
  13. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    DR? Johnson, first made the comment that he is finding that he is “ having trouble getting patients to use custom orthotics. They feel that they are not comfortable.”

    He then follows up by saying (referring to some brand name OTC support) …..” And as a result they get support that they need. My feeling is they are getting the correction, and that is what is important.”

    Any support in my opinion, even stuffing cotton under the arch does produce some form of “correction” by minimizing total pronation for that step, even if it is adequately lacking a precise fit or even close to a precise fit. We’ve seen that with most OTC products. They help, but do not help enough or the beneficial effects wane rather quickly.

    What Dr Johnson fails to realize (again in my opinion) is that true correction (the “correction they need”) is a more precise position of the structure of the foot able to function in all three planes of motion.

    So, I presume it was just semantics as to your reply and mine.
     
  14. Re: SPAM: trouble getting patients to use custom orthotics

    Doc. Kiper:

    I have been told by many that I need "correction". My 3rd grade teacher told me that I needed "correction", while I was passing notes to the cute girl sitting next to me in class. My German teacher in junior high school told me that I also needed "correction", while I was caught sneaking out the back door of German class to talk to one my friends in the room down the hall during "German dialogue drills".

    In fact, one of my friends, as soon as he became married to his former girlfriend, suddenly found that he was constantly being told he needed "correction" in order to be a better husband for his new wife. It is interesting that these "corrections" weren't necessary before they were married?!

    Is this the type of "correction" you are talking about??? I am confused....maybe I need to go out and get "corrected". Where do I have this service performed??:pigs::cool::eek:
     
  15. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    to your wife, you're honey
    to your kids, you're daddy

    they will correct you plenty
     
  16. markjohconley

    markjohconley Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Jeez Dennis you got off light
     
  17. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    how so?
     
  18. markjohconley

    markjohconley Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Dennis, if you don't know then you won't know, all the best, mark
     
  19. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    why aren't I allowed to know?
     
  20. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Is it your web site Dr K that promotes the orthoses described as dynamic and made of scientifically calibrated silicon? The ones that gently support and correct the feet, and align the spine while reducing pressure in the hip and knees, enhances sporting performace and reduces injury potential, cures all known foot pathologies and can all be done by mail order from the comfort of your own armchair in front of the computer in your own home. The one that say's "With proper foot care, your whole body can remain healthier throughout your life. Whether you are [a child] an athlete or a senior or somewhere in between, the SDO can get you feeling better - WHILE YOU WALK".
     
  21. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    is it the one that describes the pain butterfly flitting from place to place "If you are beginning to experience foot pain, don't ignore it. The pain may go away temporarily, but later settle elsewhere in your body"?

    so lightly DrK so Lightly!! like the touch of a butterfly
     
  22. Rob Kidd

    Rob Kidd Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Back in the 70'-mid 80's in Manchester, mechanical therapy was taught as providing protection, correction or rest. I suspect that is where this is coming from.
     
    Last edited: Feb 10, 2014
  23. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    What is your point?
     
  24. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    What's who's point?
     
  25. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    David Smith., is that the best comment you can make to mock isolated sentences so it sounds to look like what to you?

    To answer you directly, that is my web site you refer to and I sense an unfriendly attitude.

    "With proper foot care, your whole body can remain healthier throughout your life. “
    What's the problem you have with that statement? Are you not aware that a proper fitting orthotic is a health benefit. It improves biomechanical efficiency, it's easy and comfy to wear. It reverses injury and inflammation. So if it can do all that when you're hurting, how good do you think it would be to wear it when you're NOT HURTING.--especially if it's easy and comfy to wear.

    The orthotic Rx I make is scientifically calibrated in grams and millograms.
    It is easy and comfortable(in other words “gently supports). Keeping the body under longer biomechanical efficiency, while wt bearing. At the same time a proper fitting orthotic is a health benefit to wear, because “reducing pressure in the hip and knees, enhances sporting performace and reduces injury potential, cures all known foot pathologies and can all be done by mail order from the comfort of your own armchair in front of the computer in your own home.”

    I take exception to the statement that it “cures all foot pathologies”. That didn't come from my web site. I would never say that it cures. What it does do is EXACTLY WHAT AN ORTHOTIC IS SUPPOSED TO DO”

    It reverses and reduces biomechanical inflammation, while minimizing the biomechanical movement for normal and performance use.

    “can all be done by mail order from the comfort of your own armchair in front of the computer in your own home.”--yes, it can. Because I am able to evaluate the biomechanical expectations as the patient communicates to me about it, I can determine if I need to scientifically calibrate 3-5 grams more or less to pronate or supinate the planes of motion of the tarsus.

    Now I realize you don't know how to do this, but I do. I've been doing it a long time actually since '89 (on the web) I have patients in just about every state and half dozen of foreign countries, all done in the comfort of their armchair. And so, just because you can't do it, don't mock me.

    And what the heck is this??
    “is it the one that describes the pain butterfly flitting from place to place "If you are beginning to experience foot pain, don't ignore it. The pain may go away temporarily, but later settle elsewhere in your body"?

    so lightly DrK so Lightly!! like the touch of a butterfly

    Are you telling me you don't have the experience to know that to be true?
    Look if you've got something intelligent to say, I'd like to hear it.”
     
  26. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Dennis

    The answer to all your questions are covered in details from a thread back in 2008 you can look it up if you like but i'm not putting the link here so as to avoid promoting your product for you - like Admin suspects the elusive Tommy Johnson is trying to do :rolleyes:


    If you do look back then you'll find we've been round this particular stump and I've spent a good deal of time explaining why you SDO is not all you crack it up to be, so I wont be doing it all again here

    many thanks Dave
     
  27. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    I don't have any questions. I received notice from PA that someone had responded to my thread from six years ago. When I asked why they said what they said I got an answer that sounded like a kid from the 6th grade “if you don't know then you won't know, “

    The thread started with an original poster (not me) who used the word “correction”--I responded to it, and Doc Kirby went off on a rant about being corrected for behavior “unbecoming”...then asked me to clarify it. I'm not sure what your site is about, but it's definitely not to expand the podiatric mind.
    Getting petty about the use of words and sentences is a waste of time,

    I don't recall your post or seeing a “good deal of time” about why “the SDO is not all I cracked it up to be”--You might not have a strong science background because you wouldn't have said that, if you understood what you were talking about. I'm willing to visit it again if you have the nerve. Why don't you just shoot me a quote so that so that there is no link otherwise, god forbid you might promote the product?
    So, there's nothing I need to look up. BTW, I'm not promoting my product on your site. I only promote my product on my web site, instead I tried to contribute and discuss a technology. The only remarks back I've had are personal (no intelligent professional questions or remarks regarding biomechanics). Maybe you don't get it? You must be unable to discuss the real scientific issues of fluid dynamics and biomechanics, you're equally unable to think outside the box. But then, you're limited by the information you have by outdated literature and an outdated technology.

    You're mired in your paradigms. Patients, and scientists alike have lambasted the traditional orthoses even after 70 years since Root started it all. You'd think a medical product that old would be able to work better for a larger number of people than the clinical tests have demonstrated.

    So if you want to run away, before you get in too deep...I understand.
     
  28. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Dr Kiper
    I really should run away but

    You say on your site

    And then you show an F scan showing g how the SDO is superior because it appears that it spreads the load under the foot more evenly.

    1st this is not a measurement of its biomechanical effect on distal joints or tissues but rather only indicates attenuation of pressure integrals applied to the F Scan insole.

    2nd it is not "normal" for he medial arch to be weight bearing and therefore it will have no pressure applied to it by the ground - this would seem contrary to your "natural arch support" theory and F scan demo.???

    3rd there fore the second F San video you show, using a (normal old fashioned) plastic shell type orthotic, actually indicates that it maintains the natural action of the arch, again contrary to what you suggest.

    4th if you had laid the F scan insole over the top of the plastic shell orthotic, instead of under it, so that it will actually be able to measure pressure under the medial arch as applied to the foot and not to the ground, then you would see a similar attenuation of the pressure integral as you SDO condition.

    but illusion is your game isn't it? :bang:

    Ps there's so much more but you can deal with this first!!!!

    Dave
     
    Last edited: Feb 12, 2014
  29. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    From your web site there is the following

    "The Complex Supinator"

    [​IMG]

    [​IMG]

    Regards Dave Smith
     
  30. davidh

    davidh Podiatry Arena Veteran

    Re: SPAM: trouble getting patients to use custom orthotics

    Hi Dave and all (haven't posted for a bit).

    Not wanting to be contentious, or protective of anyone or anything, but I actually think the medial arch does weightbear in some circumstances. I'm thinking particuylarly of the example of walking on sand or other soft surface.

    Think about it. We don't do that now much but we did, once upon a time. In fact a mix of soft and hard was our normal supporting surface, pavements not having been invented yet.
     
  31. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    “1st this is not a measurement of its biomechanical effect on distal joints or tissues but rather only indicates attenuation of pressure integrals applied to the F Scan insole. “ I disagree with you, I see the scans do give you a good look at basic balance and the high and low pressures during stance phase. I think it's a very good effect of biomechanical wt bearing and pronatory forces under dynamic load. In order for GRF to reduce and spread out, the peak forces of each met has to be peaking closer together at the same time in stance (evidenced in another scan).What biomecanical principle tells you otherwise? If you're not aware of this, then I understand why you don't understand. When you see the scan, what do you see as positive or negative about both orthotic scans? (In a general way) 2. “it is not "normal" for he medial arch to be weight bearing and therefore it will have no pressure applied to it by the ground - this would seem contrary to your "natural arch support" theory and F scan demo.???”-- 3. CONTRARY TO NATURAL ARCH SUPPORT”--An increase in pressure in an enclosed envelope is transmitted uniformly and instantaneously to all portions of that envelope (Pascal’s Principle)--therefore, the ground reactive pressure is transmitted up to the arch of the foot. And the pressure within the envelope is equal throughout, thereby hydro dynamically supporting the foot in its NATURAL ALIGNMENT POSITION (provided the volume of fluid is correct) 3.How do you know it's a “plastic shell type orthotic”--what in the scan told you that? How can you tell it wasn't carbon fiber or another material?
    Saying that the foot on a trad orthotic “maintains the natural action of the arch” . Look again at the side by side scans of the barefoot and traditional orthotic scan. The individual is a supinator with high arch. The two scans look almost the same (with and without the trad orthoses). Where do you see a “natural action of the arch”? If anything, there is no real effect on the load of the forefoot. This would indicate to me, that the load under the arch, tarsus is not well distributed, otherwise you'd have a better distribution under the forefoot. You are of the mind to “build” an orthotic for the symptoms and various conditions. I don't agree with that either. Instead I'm of the mind that a proper fitting orthotic must always accommodate the normal and anomalous structure. And each structure has its own ROM and best parameters it works most efficiently in. Looking at the big picture, a scan can show the pronatory execution of the biomechanical cycle. If you can't see those differences in that scan you're referring too, I don't know what to say. BTW, David, please stop pulling sentences and phrases that were meant for the lay public. I've spent a lot of time and money to develop my site over the last two decades. Those words and phrases are for marketing purposes to a lay public. Designed to be as succinct and effective as possible. What my site says is not for professional information or use. If you want to see the entire scientific context instead of piecemeal: http://www.podiatrytoday.com/closer-look-principles-fluid-dynamics-they-relate-orthoses
     
  32. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Appreciate that, of course it does, and I had anticipated that DrK might come up with that retort but the thing is we are, or at least he is, using a baseline of bare foot on flat hard ground and proposes that normal orthoses don't change forces under the arch when in fact they do but he chooses not to measure pressure under the arch to make his point, which is either deceptive or stupid.
    If the second pressure map is the same foot as the first then its pretty obvious that, since there is no pressure reading, there must be something holding the lateral arch off the ground that was not there in the barefoot example - so how does it do that without pushing up on the lateral arch??

    to finish the point here's an F Scan correctly measuring the pressure between the foot and orthosis

    [​IMG]

    you'll note how the pressure is distributed over a larger area of the plantar foot when using a foot orthosis, just like contrary to DrK claims that it does not!?

    If on the other hand DrK comes back to say that he wasn't using F Scan but rather a Tekscan pressure mat, which is what he appears to indicate on other pages of his site, well then one would have to say he's just wasting the readers time.

    Dave
     
  33. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    So what you're saying is that the pronatory motion of an individual foot is different, walking/running e.g on the grass, is different than the same foot's pronatory motion in a shoe? Is that what you're saying?
     
  34. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Dr Kiper, while I agree that you have to tailor your writing to suit the audience you are addressing, many of your statements are nonsensical whoever reads them. E.G. something cant be common and uncommon at the same time and a foot can only work well within it physiological range of motion however you word it.

    Dave
     
  35. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    I don't believe I said that anywhere (perhaps you could point out where if you think I did) but, if I can decipher your question with it's terrible grammar, then I would agree that the pronatory motion (but more importantly and specifically the pronation moments about the STJ) of an individual foot is different when walking compared to running and when on grass compared to a hard surface or shod compared to unshod.

    What's your point?

    Dave
     
  36. davidh

    davidh Podiatry Arena Veteran

    Re: SPAM: trouble getting patients to use custom orthotics

    May I contribute?

    It is. The foot is designed to be used unshod. It is designed to conform to the supporting surface. The supporting surface is unlikely to have been concrete when the foot was designed. It matters not whether we believe in Evolution (the foot evolved over millions of years), or the Garden of Eden (the foot was designed as part of a perfect entity). Pavements and Shopping Malls were not high on the immediately needed list in either case.

    Data from a gait lab are relevant today only because we spend so much time in shoes, on hard, flat surfaces, but it wasn't always so. Healthy feet are capable of so much more than clumping around in shoes on concrete all day long (powered castors would be a much more effective mode of locomotion for that particular activity).
     
  37. David Smith

    David Smith Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    David H

    I agree but the thing is we DO walk on hard flat ground a lot and so we need to design interventions to deal with that fact. That requires us to make assumption about how a foot works on hard flat ground, while shod.
    We then get into the consideration of defining hard flat ground since most of our roads and pathways are not flat as a general topographical overview but locally, beneath our feet, they may be more so i.e. the ground tends toward being flat. Of course shops, offices, work places and shopping centre's / malls and warehouses all present a very flat surface even over large areas and we spend more and more time on them.

    regards Dave Smith
     
  38. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    Dr Smith
    “Yes they do characterise high and low pressure areas but i don't know what you mean by basic balance, perhaps you could elaborate.”--To quote markjoconley “if you don't know, then you won't know”

    This sentence is nonsensical (i.e. - having no intelligible meaning)
    just because you apparently don't understand it, doesn't make it nonsensical .

    First - a force is a force it can't spread out like butter on bread but I can imagine what you mean if you were writing this sentence for the lay public—You are a lay person when it comes to this technology, so when you state you understand it “that” way, good. You don't understand as a professional. It's OK .--I shouldn't have to explain the principle of “PEAK FORCES”as they “spread” out (i.e. attenuate)—

    What is your interpretation (ur scans) of the lateral column pressure readings with & w/o?
    How would you interpret the improvement in function”?--

    The positive changes would be the ones that I predict would achieve the effect I designed the orthotic to do. In general a reduction in saggital plane progression perturbation is a desirable effect, which is indicated by the change in CoPP and changes in the total and masked force time integrals—------------How would you explain this to the patient?

    the peak forces of each met has to be peaking closer together at the same time in stance (evidenced in another scan).What biomecanical principle tells you otherwise? If you're not aware of this, then I understand why you don't understand.-----

    DrK I don't really know what you are saying in the first sentence but are you suggesting that all the met heads should reach peak force at the same time for optimum biomechanical performance.. I've never read that research, could you site that for me.

    No I didn't say what you said, read it again, ( each met has to be peaking closer together at the same time in stance) it says closer together , depending on an individuals biomechanics and the type of foot and degree of pronation, all met heads do not always peak at the same time (like in the scan which you must have seen but didn't fully comprehend), but they should peak closer together and a reduction in peak force will and should be seen (this is what I refer to as increased biomechanical efficiency and better balance.., I'm sure you disagree!). If that's accomplished throughout mets 1-5 on a scan I would call that good “balance” and optimal position for STJ, MTJ etc.and best balance for daily walking use and high performance
    Now you're reading that in the literature.. That's because I've assessed thousands of scans I've seen since around 1991 (starting with the Pedobarograph). I gave you a link to a scan that shows “peak pressures” during stance and what “appears” to be optimal biomechanical efficiency (for that foot) and attainable with a different technology than yours. The scan represents the peak forces of each met head under time and pressure (is that better for you rather than “biomechanical wt bearing and pronatory forces under dynamic load”?) I don't need someone else's research to think for myself and to recognize what I understand. Intrinsically is where you have to go Dr Smith. Look at what's happening inside the foot, what structures are moving, what part of the biomechanical cycle is loading and UNloading and when, during the gait cycle, then we can measure orthotic efficacy. AND assess, the biomechanical expectations, because I know how the fluid is moving (aside from scientic understanding) based on the pt's response.--I know your technology. I studied under the Big 4. You on the other hand do not know my technology.


    Again, you didn't measure the pressure under the medial arch so you cant see a characterisation of it on the scans. That does not mean there was no pressure applied to the plantar surface of the foot and this scan shows clearly what I mean----------No, I clearly do not see what you mean.



    There can be varying areas of pressure applied to the SDO by the foot. I concede that the pressure peaks may be attenuated but that is a property of its ability to deform locally under point load but this would be the same with a foam orthotic ----What do you mean “ ability to deform locally “?? I question this because with point load, fluid will displace (called hydrodynamics). The foam cushions, in addition that foam by itself will not fully or prescriptively align the planes of motion at the tarsus—in a precise manner i.e “optimal biomechanical efficiency”----After some displacement of the fluid under point load, I can further quantify that value in “the scientific calibration” of grams and milligrams. Therefore, I can be precise with my biomechanical Rx.

    This is the difference in our technologies and results.

    If we take it down to basics, it boils down to STJ theory vs MTJ theory.
    I can see that because of the interpretation of your scans. You're missing
    biomechanical signs, that's evidenced by either system F-scan OR matscan. If you want to make that your issue and argument go ahead, but you got it wrong about my technology.

    Practicing biomechanics using fluid technology has been a real eye opener, and you have no idea. Like I said, I was trained in traditional methods and I don't see a big enough difference in improvement in results and satisfaction.

    I just need to fit a proper orthotic (proper means SDO) that accommodates the normal and anomalous foot. one solution for all problems eh? ------CORRECT! FOR MOST FEET , all one has to do is fit the proper volume. Now, I can tell you didn't read the article, or you would have read (but not understood) that the hydro-dynamic pressure loads and self-posts*the midfoot and forefoot*to an equilibrium state of*stability , concurrent with the STJ optimal position. –(at midstance for your edification)

    I don't know about you, but this is what I want in every orthotic fitting I make REGARDLESS of the pathology (with the exception of neurogenic disorders—for your edification). Furthermore, I expect to see in any scan an improvement in foot function (with the correct volume of fluid). Other than just seeing a reduction in pressure, and calling that the “correct measurement” I expect to see a wider surface area bearing wt., I expect to see a decrease in pressure at heel contact, due to impacting with the silicone. I expect to see a reduction in the velocity in the transference of motion, etc, etc, etc.
    Lastly I expect to see that at heel off, there is still sufficient stability at the forefoot until toe off. I know this should happen, because, pressure at the forefoot is displacing fluid back, exerting a decreasing amount of silicone under the forefoot, tarso-metatarsus and tarsus, prolonging momentarily the equilibrium state of stability.
    YES, I want that in every orthotic I “build”.-


    The picture is in your imagination. The scan only shows what it shows, the change in distribution of forces applied to the cell matrix and the intuitive characterisation of that e.g. pressure, CoP, integrals etc. What you deduce from that information is entirely based on assumptions made about initial conditions, known variables and generally accepted precepts and axioms.----

    Wait a minute, you mean I'm not supposed to interpret the scans based on my medical and scientific understandings? What is wrong with you? My imagination is playing out that information into an understanding of my biomechanical expectations.---so you don't think like that? Why does it make what I've said a pile of c**p? Unless it's because you're right and I'm wrong!
     
  39. Dennis Kiper

    Dennis Kiper Well-Known Member

    Re: SPAM: trouble getting patients to use custom orthotics

    David H.--I don't disagree with your reasoning, I do disagree with your conclusion. Shod or unshod in the real world allows the foot to pronate the same way. Walking in sand or hard surface the motion is the same , the difference is the ROM in my opinion.

    Let me ask you this, if you could micrisize yourself and you could sit inside the STJ--what differences do you think you'd see in differences you would expect?
     
  40. davidh

    davidh Podiatry Arena Veteran

    Re: SPAM: trouble getting patients to use custom orthotics

    In the healthy AJC (STJ and TC joint combined) I would expect to see a greater ROM in the unshod foot on an undulating surface, depending on the inclination angle of the ground and what the foot had to conform to. Part of our survival mechanism (I hypothesise) is that we like our eyes horizontal because they function better as a unit that way, and we need to be able to take off, at speed if needs be, in order to eat/not be eaten. This depends to a large degree on the body/ground interface. Our feet are well-adapted for converting from a shock absorber to a rigid (I use the word loosely in it's non-mechanical sense) lever for push-off on most surfaces.
    The basic foot design hasn't changed.

    We have, most of us, a far greater range of motion in pronation/supination than is needed for flat and hard. and shod. I recognise of course that all this motion does not just come from the AJC, but in normal walking gait that's where it all starts.

    I did some research in this area some years ago. Thanks for the interest.
     
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