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More 'snake oil' as orthotics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Jun 14, 2006.

  1. BEN-HUR

    BEN-HUR Well-Known Member

  2. Dennis Kiper

    Dennis Kiper Well-Known Member

    orig posted by Ed Glaser

    Dear all,

    It is our own fault that this is happening. When many podiatrists make foot orthotics that are no more effective than prefabs (see the article posted on the home page), we deserve this. We need a major shift in paradigm.

    ed


    Absolutely correct
     
  3. But Dennis, you have no evidence that the foot orthoses you are attempting to sell are even effective at all, let alone as effective as prefabs- true or false? Can you point me to a randomised controlled trial in which your foot orthoses have been employed and have been shown to be more effective than nothing at all? No you can't, so shut the **** up and stop spamming these pages with your junk.

    https://www.youtube.com/watch?v=anwy2MPT5RE
     
  4. Dennis Kiper

    Dennis Kiper Well-Known Member

    Simon,

    If you had any understanding how fluid mechanics and biomechanics interact, you wouldn't even need a comparative test, but your science skills are lacking, thus your ignorance in this matter.

    If you'd like we could do a test between our technologies. We could each put up say $50,000. The loser donates that money to the school of their choice.
     
  5. I do understand fluid mechanics, Dennis. You have been unable to convince anyone here regarding your insoles efficacy despite numerous discussions. Whenever anyone engages in discussion with you, you are unable to answer their questions. I have no interest in going over old ground repeatedly in order that you may attempt to promote your product. I don't need to wager anything with you Dennis; you do need to show that the product you are selling is efficacious. Leave the betting for the fair ground, not the evidence based medicine arena, it just makes you look like the pikey you are. Better to spend the 50,000 dollars on some independent research- surely? The way that evidence based medicine works is this: you say you have an efficacious product, the funding bodies / clinicians say prove it, you provide independent evidence of your products efficacy, the funding bodies / clinicians decide whether or not to purchase it based on that evidence. Here is how it doesn't work: you write on a blog site that everyone else is wrong, you are the best thing since sliced bread, everyone buys your product- have you not twigged this yet?

    You are writing here for one reason and one reason alone Dennis, you are attempting to sell your product. Effectively you are a spammer: https://www.youtube.com/watch?v=anwy2MPT5RE Move along, move along.
     
  6. Dennis Kiper

    Dennis Kiper Well-Known Member

    Simon,

    You say you do understand fluid mechanics, you don't and certainly not how it blends with human functional biomechanics. If you did, you would see the opportunity to get away from a non scienced based technology that every physical therapist and shoe salesman can make at least as good or better than yourself.

    You're still using the same 70 year old old technology that has fared poorly against generic and pre-fab insoles in modern clinical trials. I'm not at a point in my life where I have the time to conduct some independent study (or have someone elso do it).

    As for not convincing you or your adoring followers, that's because you never really asked any intelligent questions—again, maybe due to your poor scientific skills. I really don't care if you're not buying what I'm selling. It's not even your loss, it is the loss of the public at large and the many many failures your sales of traditional technology that is the real loser.
     
  7. achilles

    achilles Active Member

    Dear Dr Kiper,
    Simple question! Do you have any evidence apart from anecdotal supporting the efficacy of your devices??
    Regards
     
  8. Ed_Norris

    Ed_Norris Member

    According to my Fluid Mechanics textbooks, by definition, a fluid is a substance that exhibits continuous deformation when subject to any shearing force.

    By that definition, here is a list of things that are not fluids:
    -Fat
    -Cartilage

    While fat and cartilage may be deform-able they do not continuously shear, and are therefore not governed under fluid mechanics. Some similarities to fluids may be demonstrated, but this does not mean that fluid mechanics is the relevant application for accurately modeling systems made of these substances.

    As I understand, the actual fluids in the foot, blood, and lymph while important, are not particularly central in any bio mechanical theory.
     
  9. Adipose and cartilage (as well as tendon, ligament, muscle, bone and skin) are all viscoelastic tissues and, as such, will exhibit both fluid and elastic characteristics under load.
     
  10. Dennis Kiper

    Dennis Kiper Well-Known Member

    ACHILLES:

    To answer your question directly, yes. There was a study done by a physical therapist many years ago. I don't believe it was ever published and so prefer not to show its results. There was a study done on the silicone orthotic by a PhD in biomechanics, I don't think it was well written, but you can see his reference on my article: http://www.podiatrytoday.com

    Quesada PM, Sawyer FD, Simon SR. Temporal and gel volume and effects on plantar pressure relief with use of silicone gel-filled insoles. Presented at the 21st Annual Meeting of the American Society of Biomechanics. Clemson University, South Carolina, September 24-27, 1997. - See more at: http://www.podiatrytoday.com/closer...y-relate-orthoses?page=4#sthash.Gb2vTBEO.dpuf

    That said, the issue is not efficacy and I've not professed it. The issue is, traditional orthotic technology is a non-scienced based platform based on scientific theory. The silicone orthotic is a science based technology predicated on known principles of physics, combined with functional biomechanics.

    If you look at the technology and interplay with functional biomechanics, it would be hard for me as a scientist to not be able to deduce the efficacy of this model.
     
  11. Griff

    Griff Moderator

    .....
     

    Attached Files:

  12. Well that's me convinced, not.
    Bore off Dennis. https://www.youtube.com/watch?v=qsvbYKr19ng
     
  13. Dennis Kiper

    Dennis Kiper Well-Known Member

    Ahh Griff, where have you been. You're ignorance of theory and science is always enlightening.

    And Simon, you're always so witty with your English. You're suck a yuk!
     
  14. Ed_Norris

    Ed_Norris Member

    Kevin,
    I fully agree and support your statement that:

    To clarify; the fact that these materials exhibit viscoelastic properties is the precise reason why a fluid mechanics based model is inappropriate. The governing equations of Fluid mechanics (navier-stokes, Differential momentum, and bernoulli) do not account for the elastic modulus of the material.

    To better describe viscoelastic materials Princeton university takes a more Rheological aproach. They host a very elegant .pdf which explains several different methods for modeling viscoelastic materials.

    http://press.princeton.edu/chapters/s9774.pdf

    from initial inspection, it seems the most applicable model for podiatry would be this one:

    Anyways,

    My main purpose of posting in the Snake oil thread is to let the average podiatrist know that applying a Fluid mechanics centered approach to bio-mechanics may be a bit overrated / inappropriate.

    Rheology is generally more applicable.

    Thanks and kind regards,

    Dean
     
  15. Dean:

    Here is the Powerpoint slide for the Maxwell model that I use in my lecture on "Modern Biomechanics and Engineering Terminology for Podiatrists".

    Unfortunately, the only reason some podiatrists post here on Podiatry Arena is to try to sell their product, even though they don't have a clue as to how the international biomechanics community discusses foot and lower extremity biomechanics topics. They all have nothing new or interesting to teach us and seem to think that their myopic view of "biomechanics" is the "only true biomechanics". It is very sad to see this, and especially sad for me to see this coming mostly from podiatrists from the USA.

    By the way, Dean, I appreciate your comments and hope you continue to contribute when time allows.
     
  16. Griff

    Griff Moderator

    .....
     

    Attached Files:

    • c77.jpg
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  17. RachWadd

    RachWadd Member

    Hi all,

    I recently had a 30YO male patient present for "Orthotic Assessment" as part of the medical portion of his application to join the Army Reserves in Australia.

    He gave me his history, which included podiatric assessment and custom FFO's since the age of 15 but had recently (in the last 12 months) bought a prefabricated pair which he was very happy with.

    When he took his current 'orthoses' out of his shoes, I found they were the Step Forward Foot Correctors, a kind of insole I hadn't encountered before.

    The patient went on to tell me that they help by putting his foot in the 'proper' position and build strength in his foot muscles and that since wearing them, he finds that he can spend time without his orthoses whereas before with his FFO's he had to wear them all the time.

    Alarm bells rang immediately and I proceeded to question him about where he got them from and how much he paid for them. You can imagine my surprise when he told me they cost $350!

    We had a good discussion about the different type of insoles and orthoses that exist and I hopefully made him think about buying insoles from salespeople rather than seeking help from trained medical professionals.

    As soon as he left I got straight onto the computer to see what these insoles were all about and was glad to see my suspicions were correct. I knew there had to be some sort of discussion about them on Podiatry Arena and I wasn't disappointed!

    Thanks Podiatry Arena for providing education and affirmation - and a good deal of amusement at times - for us clinical pods. Much appreciated!

    RachWadd
     
  18. Dennis Kiper

    Dennis Kiper Well-Known Member

    Originally Posted by Ed_Norris

    Ed, I just came across this, or I would have responded sooner. This statement:
    applying a Fluid mechanics centered approach to bio-mechanics may be a bit overrated / inappropriate.

    What basis do you have for saying this? What experience gives you the authority to say that?
     
  19. Dennis Kiper

    Dennis Kiper Well-Known Member

    Simon

    I do understand fluid mechanics, Dennis. You have been unable to convince anyone here regarding your insoles efficacy despite numerous discussions. Whenever anyone engages in discussion with you, you are unable to answer their questions.

    Typical of you. If you understood fluid mechanics, you wouldn't need to ask any questions
     
  20. BEN-HUR

    BEN-HUR Well-Known Member

    Good points RachWadd (Podiatrists need to educate the unenlightened public on such issues). Here is another thread on this forum which specifically dealt with "Step Forward Orthotics" (i.e. critique their brochure etc...): Thread - Salesmen selling orthotics at the show? (http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=64385)... it also has some "education" & "amusement" bits (with some BS in the mix).
     
  21. Ed_Norris

    Ed_Norris Member

    Dennis, the basis upon which I state that:

    "a Fluid mechanics centered approach to bio-mechanics may be a bit overrated / inappropriate"

    is that the soft tissues in the human body are not fluids, many of them are an-isotropic and only somewhat "fluid like" in that they have some viscoelastic properties.

    Fluids by definition do not have Elastic properties.

    The experience that gives me authority to say this is spending a few hours reading a fluid mechnanics textbook, in particular the part where they go over the definition of what is considered a fluid.

    As it turns out, "continuous shearing due to an applied force" is quite central to fluid Mechanics and the governing equations of fluid mechanics do not take into account for modulus of elasticity of a material.

    The body of science that deals with the flow of "fluid like" materials is Rheology not Fluid mechanics.

    Engineering models should be designed such that they best replicate the circumstances that they describe.

    so in conclusion:

    If somebody is going to invest a significant amount of effort into understanding bio-mechanics it will be more effective if they use a application of physics that is specifically designed to describe the behavior of tissues (Rheology) as opposed to an application of physics that is specifically designed to model a continuously shearing medium (Fluid Mechanics).

    Dean
     
  22. Rob Kidd

    Rob Kidd Well-Known Member

    Hi Dean, having studied geology many years ago, we came to the conclusion that essentially all structures were anisotropic. Isotropy seems to only exist at a larger than atomic level. At least, that is what we though in the early-mid '80's. One can demonstrate anisotropy in bone in a peco second, the same with obvious fibrous tissues (tendon, lig etc). It may or may not be true in common connective tissues such as fat, but may well be true when one considers the other structures that hold fat such as arreolar etc etc. Just thinking aloud. Rob (Ps beware of my spelling)
     
  23. Ed_Norris

    Ed_Norris Member

    Yup that is my point... fluid mechanics would be generally restricted to isotropic systems.
     
  24. Dennis Kiper

    Dennis Kiper Well-Known Member

    Ed

    I think your whole approach of mixing fluid mechanics with isotropy and viscoelastic properties is short sighted as opposed to thinking “hydraulic engineering”.

    Our skeletal framework can be supported with a fluid. Any weight in the world can be supported by a fluid, if the container doesn't break.

    The dynamics of our skeletal and viscoelastic tissues in a “fluid manner” (pun intended)--assisted and guided by a fluid orthotic makes perfect sense, is appropriate and underrated.
     
  25. Without spitting in the soup too much

    seems that for whatever the claims and BS but Step Forward Foot Correctors seemed to working very well for the Gentleman.

    So while the practices of the company and the cost maybe an issue, it doesn´t mean the device will not be really really good for some, so the opposite of same device for all being complete rubbish, there is a chance that they are the perfect device for some
     
  26. BEN-HUR

    BEN-HUR Well-Known Member

    True. I'm sure we have all heard of accounts/stories (or maybe it was numerous accounts of the one incident :rolleyes:) where a patient returns for a check-up reporting that the prescribed (custom) orthotics have been great with symptoms resolved... for the Podiatrist to then find that the patient has been wearing the orthotics in the opposite shoes. I'm sure rare (for various reasons i.e. fit)... but the (misplaced) devices (orthotics) worked in dampening those adverse (pathological) forces.

    Once worked in a clinic where one of the Podiatrists fitted another patient's orthotics into the footwear of the daughter of the clinic's major referral source - a sports G.P (of all the patients for this to happen to :eek:). A couple of days later when the patient (intended recipient) of the above fitted orthotics came for their fitting, the mishap was then discovered. The clinic manager had to make the (I presume awkward) call to explain the mishap & ask for the orthotics back so that the intended prescribed orthotics could be fitted to each client. The young lady wouldn't give them back - she loved them :eek:. I think the sports G.P then discovered the potential scope/margin of potential beneficial outcomes with orthotic therapy & subsequent role in addressing adverse (pathological) forces... we noticed he later started prescribing more prefabs himself (coincidence - not sure?).

    So sure, any device (within reason) placed in footwear has the potential to provide relief of adverse stress/force & subsequent relief of symptoms (i.e. arch support from chemist)... particularly if they are of the minor/acute variety. But there would be a far greater percentage of success over the scope of the general public suffering from a range of lower limb related problems if the orthotic prescription was done via an appropriate (biomechanical) assessment via a trained practitioner educated in lower limb biomechanics & associated orthotic therapy. That said, I have not conducted research on the comparative success rates of tradeshow insole salespeople & Podiatrists... nor am I aware of any research papers on the scenario (there could be reason for this).

    Also, it isn't just insole salespersons from tradeshows. I heard from a patient who went on a boat (or is it ship) cruise (on the sea)... there was an insole salesperson on the ship pushing their wonder insole (whilst bagging out Podiatrist prescribed orthotics). A couple of the patient's friends brought them (don't know the cost)... in short, back on dry land, they don't wear those insoles anymore (i.e. uncomfortable)... no chance getting the insoles adjusted (as if he/she could anyway) & no chance of a refund... salesperson beyond reach... likely out at sea somewhere :sinking: .
     
  27. Dennis Kiper

    Dennis Kiper Well-Known Member

    So Fellas,

    Why are you so surprised that a person (who overpaid) for a generic fitting got success?

    Any orthotic or material that minimizes pronation and still allow the foot to move within its own comfortable rom, is likely to be successful. Success is short term however. Custom orthotics try to be precise, but because of the same argument I present, is that your technology, does not allow you to "balance" the planes of motion--such that pronation is mimnimized and the rest of the structure can move within a comfortable rom.

    Because of that, the foot after a period of time in about 50% of the cases, don't move comfortably within its own rom.
     
  28. 78% of statistics are made up on the spot.
     
  29. Lab Guy

    Lab Guy Well-Known Member

    The other 22% of statistics are just false.

    Steven
     
  30. Dennis Kiper

    Dennis Kiper Well-Known Member

    Yeah, you guys have a great product there!

    Keep up the good work: :pigs:
     
  31. BEN-HUR

    BEN-HUR Well-Known Member

    I for one (& I'm sure others here also) are not surprised by the success of generic insoles ("orthotics")... for reasons outlined in my previous post... which has also been discussed before in other threads on this forum. There is also another issue (highlighted bold in following quote), which is in the best interest for the general public - who we are here to serve (not ourselves)...
    Yeah! It's pretty darn good... particularly in light of other medical/allied health forms of treatment/practice.
     
  32. Dennis Kiper

    Dennis Kiper Well-Known Member

    Yeah! It's pretty darn good... particularly in light of other medical/allied health forms of treatment/practice. :confused::pigs:
     
  33. BEN-HUR

    BEN-HUR Well-Known Member

    Regurgitating my last sentence Dennis then placing ":confused::pigs:" at the end isn't productive nor enlightening. In fact it just alludes to your level of ignorance/competence on the topic.

    Now, I am not too familiar with your background & history on this forum (don't have time to look into it at the moment)... yet I am aware of some element of controversy with your input.

    Hence it leads me to suspect that you are either (&/or):
    - ignorant of the methods/principles of Podiatry based orthotic therapy (which I doubt).
    - ignorant of the success of Podiatry based orthotic therapy... or is it really a case of your lack of success with it (which may be indicative of you level of competence in the area).
    - biased towards an alternative method/principle to Podiatry based orthotic therapy (which rings a bell... & may be related to the previous point).

    Like I've said before, there are various ways to adequately address potential adverse (pathological) forces. The fact is I have success with orthotic (Podiatric) therapy (& so do many others). Level of success (with most things) would depend on the adequate data you get via i.e. observation & feedback... & subsequent conversion of the data/method/principles to an adequate functional device for the individual. If you have found an alternative means of obtaining an adequate functional device for the individual then good for you (PM me if you wish)... but don't rubbish something that is evidently working very well for other Podiatrists (is it any wonder that other medical fields have delved into orthotic therapy as well... due to the level of success that has come from it).

    Sound reasonable?
     
  34. Iain Johnston

    Iain Johnston Active Member

    I was just laundering though old stuff....what has happened about this Big Company Craig, did they materialise>
     
  35. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    It was Bristol-Myers Squibb that were backing it and they did throw a lot of R & D $ at it .... not sure what happened to it, but it obviously did not get of the ground.
     
  36. Dennis Kiper

    Dennis Kiper Well-Known Member

    Sound reasonable?

    No, not at all. I've stated that my biomechanical ed. Began under Root/Weed/Sgarloto & Orien. Chris Smith (Superfeet) was the clinical instructor. I was as good as anyone (it's not that hard).

    I also stated I wasn't happy with my own results and after wearing a traditional orthotic myself, thought this can't possibly be good.

    You may have what you consider good results. Any orthotic that minimizes pronation should work to some degree. When you talk about “ignorance” , either you haven't read my article or are oblivious to the inherent technological flaws in a traditional orthotic. It allows pronatory “instability” moments that
    over a lifetime, continues to produce biomechanical problems.

    Often uncomfortable, unable to reproduce “precise” same position casts. Unable to explain how your technology works. No science basis for your technology. The unlimited number of orthotic failures in our society, evidenced by the thousands of blogs and forums, complaining about individuals who've tried several pairs from one or more “specialists”.

    No, the ignorance lies with you.
     
  37. Dennis Kiper

    Dennis Kiper Well-Known Member

    BenHur and the rest of the soldiers for traditional technology orthotics:

    It's too bad you can't get over yourselves. Instead of recognizing how important a find it is to work with a technology that works “EXACTLY” the way it's supposed. A technology that requires a trained specialist to understand and make work. A technology you can be proud of that explains more of the biomechanics of the foot and lower extremity. A technology for the 21st century.

    Instead you choose to compete with shoe salesman and technicians with a technology that you're not that much better at—if at all. A technology that does work some of the time. The percentage while poor (I'm guessing around 50%), is not 100% of the times successful—THAT'S A BIG DIFFERENCE!

    If the world knew about it, there would be such a run on people able to use this technology, your incomes would accelerate upwards for years to come.

    Too bad.
     
  38. Dennis Kiper

    Dennis Kiper Well-Known Member

    Norris


    Fluids by definition do not have Elastic properties.

    What you fail to recognize is that different viscosity fluids in designed containers, can very much react as if it did have viscoelastic properties. Beyond that what other properties did you have in mind that
    fluids all have that doesn't meet your criteria?

    The experience that gives me authority to say this is spending a few hours reading a fluid mechnanics textbook, in particular the part where they go over the definition of what is considered a fluid.

    Well, I didn't realize I was talking to an expert. I haven't read anything about it since high school science.

    Engineering models should be designed such that they best replicate the circumstances that they describe.

    Excellent, I couldn't agree more

    so in conclusion:

    If somebody is going to invest a significant amount of effort into understanding bio-mechanics it will be more effective if they use a application of physics that is specifically designed to describe the behavior of tissues (Rheology) as opposed to an application of physics that is specifically designed to model a continuously shearing medium (Fluid Mechanics).


    So, why don't you or anyone discuss why bio-fluid mechanics can't work. You gave your best scientific spiel as to why this is not an approved system. You haven't shown much else why it's a bad system, especially compared to yours.
     
  39. BEN-HUR

    BEN-HUR Well-Known Member

    Dennis, I've tried to be reasonable with you. You have not outlined your position (even gave you the option to PM me)... so yes, I was ignorant of your background... thus did a search myself & found your website here, where you sell a device over the internet (here)... a device that apparently looks like this...

    [​IMG]

    ... yet apparently works via the principle of this (i.e. "Hydrodynamic pressure, lifts and holds the arch up in the foot’s own natural alignment position")...

    [​IMG]

    Hmmm, OK then... the images alone (from your website) seem to have a (functional) compatibility issue; but to be fair, when I have time I'll look into it deeper.

    Anyway, your responding post to me (post 76) didn't reveal much at all... only what I suspected of you (part of which coincides with the above cited website i.e. selling an alternative product & evident associated bias to it)... that being your lack of success (competence) with "traditional orthotic therapy"... & the lack of success/competence of others & subsequent failures with their patients...
    No, I'm not ignorant of the above... I suspected it with you... & I am aware of & have personally experienced the poor orthotic results of others (Podiatrists, Osteopaths, Chiropractors, Physios) i.e. patients coming to me with rigid (non-flexible) devices which don't correspond to the (i.e. morphology) patient's foot... & subsequent forces it exhibits. Yes, such a device can cause problems (let alone comfort issues). Yet it would seem, based on your failures & that of others, you are now intent on rubbishing "traditional orthotic therapy"... & those who use it (based on the sentiments of your recent posts).

    It would evidently appear that I have/had more success than you with "traditional orthotic therapy"... it appears that your evaluation of "traditional orthotic therapy" is based around your poor success & that of your alternative device, which reeks with biasness (& probably wilful ignorance). For want of a better analogy, cars rarely cause crashes - people do i.e. the competence level of individuals prescribing orthotics is more the issue here... otherwise, everyone using principles/methods (which is varied mind you) pertaining to the realm of "traditional orthotic therapy" would have a similar poor success rate to you (the fact is - they don't). By all means use whatever works for you within the realm of lower limb control (there may be some validity to its use... with some patients)... but don't expect to be professionally regarded with the attitude you have... a condescending attitude which is based around your personal competence (i.e. incompetence) & biased generalisations to that of "traditional orthotic therapy" (& those who effectively use it).

    In the mean time, I'll keep an open mind to your position/product... & when I get some time I'll look deeper into the content of your website (I might even buy your product to test for myself). This now appears to be a more reasonable solution to my inquiry... as the attitude of your recent posts alludes to an unreasonable (biased) individual & subsequent future dialogue.

    [PS... using the "Quote" option via the "Quote" button associated with the material/post your want to reference is a handy tool to use]
     
  40. Dennis Kiper

    Dennis Kiper Well-Known Member

    Ben

    ... yet apparently works via the principle of this (i.e. "Hydrodynamic pressure, lifts and holds the arch up in the foot’s own natural alignment position")...


    Did you have an opportunity to read the bio-fluid mechanics of how that hydrodynamic pressure does what it does?


    your alternative device, which reeks with biasness (& probably wilful ignorance)

    Am I biased? Of course I'm biased. I'm utilizing a scientific technology over a theoretical technology.
    You seem to think you have the answers of how to make every orthotic you make a satisfactory outcome, well maybe you should run some bootcamps and show everyone else how to do it??

    For want of a better analogy, cars rarely cause crashes


    My analogy refers to the “mechanics” of a car—not driving it or causing crashes???
     
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