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Investigation of the podiatric model of foot biomechanics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Nov 2, 2013.

  1. Eric:

    I think you may have hit on something here. I wouldn't say that my evaluations are "subconscious", but that, rather, I don't use the Root et al measurements the way I was taught to use them. I use a lot of subjective assessment that is based on simply having evaluated, casted and ordered over 15,000 pairs of orthoses over the past 30 years.

    When I train the Kaiser Podiatric Surgery residents that rotate through my office, I try to teach things objectively, versus subjectively, and try to put the ideas that I use in evaluating and treating my patients into a biomechanically coherent language that makes sense to me, and hopefully also makes sense to them. Actually, much of what I talk about with the residents is more about modelling the foot and lower extremity to understand how to alter internal forces and moments act on internal foot and lower extremity structures with very little on "forefoot to rearfoot", "rearfoot varus/valgus", etc.

    However, it is nice that the residents understand the terms and deformities that Root proposed so that when we do talk, I can describe a foot structure using these terms and they understand what I am talking about.

    By the way, everyone....great discussion!!:drinks
     
  2. bob

    bob Active Member

    I think this is an important point well made Jeff. Speaking from experience of performing thousands of operations on feet, I would say that I have relied heavily on static and radiographic examination of the foot and specifically aimed to alter structure of the foot with surgery in many cases - all the while hoping that this either maintains or improves function. I suppose my clinical assessment of the foot has partly been formed by my training in podiatric surgery and my clinical experience, cpd and reading. This is not to say this is the correct or most accurate way to assess the foot and I am keen to improve upon it in the hope that it will improve outcomes for my patients.

    Most reconstructive elective foot surgery seems to be designed to alter structure of the foot first and foremost. It seems that there are many assumptions made about the effect on function, and some of my assumptions based on static clinical exams are in question.
     
  3. Jeff Root

    Jeff Root Well-Known Member

    Bob,

    And I would add that evidence based medicine and research has improved both surgery and orthotic outcomes but treatment decision making in both of these arenas can't be based on science/evidence alone. In fact, innovative thinking and experimentation are required if we hope to find better treatment methods in the future. Over my career I have had many consultations with podiatrists who were attempting to treat post surgical complications with orthoses that resulted from their own or from surgery performed by another practitioner. A number of those cases involved post surgical transfer lesions, hallux limitus, contracted digits and other iatrogenic complications. Even in cases where surgery is clearly the best option, it is not without risk which is why informed consent is so important. Like foot orthotic therapy, it is a blend of art and science and requires practice. And just like foot orthotic therapy, individual rates of success can vary greatly depending on skills, philosophy and knowledge of the practitioner.

    Jeff
     
  4. Exactly! When I view frames from a video of a gait, I am performing a series of rudimentary quasi-static free-body analyses usually in my head, but often drawn out to explain to the patient the modelling of forces occurring at key points. Those that think that I am somehow not interested in structure are very much wrong. However, by looking at structural alignment during dynamic function, the dynamic function which is exacerbating the problem, I feel gives me a better handle on the potential internal forces than looking at alignment during non-weightbearing and relaxed standing (unless relaxed standing is the exacerbating factor).
     
  5. Franklin

    Franklin Active Member

    Hi Kevin, Daryl, Eric, Simon et al,

    “Let there be but one opinion and you have an end to research and knowledge” (Ludwig Aschoff)

    At the time of Mert’s emergence on to the academic stage in the middle-to-late1950s and early 1960s, the concepts and ideas he was developing were deemed by the profession in the States to be novel, fresh and exciting. Witness the words of Eads for example, written in 1959: “Little is known of the various types of feet, and of the development of the various types……..This is a project in which our colleges and our practitioners can contribute their part…..Merton Root has contributed much new thought on this subject” [Eads, W. F. (1959) Podiatry research. Journal of the American Podiatry Association. 49: 492-499.].

    However, the passing of time has, in a growing segment of the profession, dulled their lustre, with eminent practitioners and academicians such as Podiatry Arena’s own Dr Kevin Kirby recently asserting that “there is now sufficient evidence to conclude that many of Dr Root’s ideas and theories need to be either modified or discarded in order to more accurately reflect recent research findings and newer theories of foot and lower extremity biomechanics” [Kirby, K. A. (2009) Are Root biomechanics dying? Podiatry Today. 22(4): 58-65.]. So what of the Root model?

    I have recently re-reading a book which I read some years ago [MacMahon, B. (1992) The Master. Poolbeg Publishing, Dublin.], and I have again been struck by an observation he made:

    “I consider the greatest mistake any commentator can make…..is to pass judgement on “then” in the context of “now”. To do so is to ignore, either through ignorance or deceit, the prevailing atmosphere of a particular era and hold it up to unjust scrutiny or ridicule by applying to it standards that nowadays prevail in a completely altered set of circumstances.”

    Root’s ideas and theories were certainly innovative products of their time, but are they for all time? They were forged from a heady cocktail of already published research and the creativeness borne out of many years of clinical experience, along with the odd eureka moment thrown in such as that of Root’s subtalar joint neutral concept [Root M.L. (1989) Back to the Root (edited transcript of a telephone interview of Dr M.L. Root by Dr J.A. Rubenstein and Dr H. Rubenstein). Podiatry Today. 2: 23-32, 73-77.]. A lot of the research that Root cited to give underpinning to his corpus of work, along with the data generated by that research, was undertaken using equipment and technology that was considered to be cutting edge at that period in time. However, the armoury of technical hardware which the podiatric and non-podiatric clinical and research communities have at their disposal today, simply didn’t exist 40 (even 30) years ago. With the passage of time, the equipment and technology of the 1950s and 60s is now recognised as being extremely primitive, when compared to the all-singing, all-dancing hardware we have today, and this fact has been eloquently highlighted by Jarvis in her recent PhD dissertation. The constantly moving research juggernaut gains more and more momentum as time marches inexorably on, and in so doing, it creates new data in its wake, throws brighter and more intense light upon already recognised clinical relationships, informs the development of new clinical diagnostic methods, points out new correlations, helps in discarding previously recognised correlations/relationships, serves to refute and/or confirm past hypotheses, and also throws up new ones. As such, there is a temptation to look down upon the earlier work of pioneers within the field; labelling that work as being either too primitive, naively simplistic, or even more frankly, ‘plain wrong’. The above extract from MacMahon’s book has simply been cited as a check, to remind us that it is all too easy to be dismissive (from the vantage point of the 21st century) of a body of work that had its genesis in the early 1950s. I therefore think that, although MacMahon’s aforecited observation may be a little severe in this case (words such as ‘deceit’ are far too strong and have no place here), it does carry within it a grain of truth. Our criticisms, if they are valid, must be tempered with that historical context in mind – they must always be constructive and dispensed with humility. I admit that in the white heat of the moment amidst the rumble of debate, such a goal is sometimes not all that easy.

    A large body of Root’s work has demonstrated sticking power in the academic field over many years, but the constant prosecution of research, certainly over the last ten to fifteen years, has started to gnaw away at the adhesive that has held the Root model in its prominent clinical ‘paradigmatic’ position. Anyway, regardless of that, here are my suggestions and my potted historical take on what were some of Mert’s contributions to the field. Kevin has pretty much hit the nail on the head already.


    1. A concerted all-out effort to systematically standardise the terminology used in foot biomechanics.

    The British poet Richard Church (1893-1972) referred to words as “….the radium of thought/The close-packed atoms of our human story.” Words are without doubt extremely important tools of communication, and so it comes as no surprise that they should be used with the utmost care. Root recognised the need for such care. As such, one of his prime concerns was to try to establish and lay down an unambiguous nomenclature in order to describe positions and motions in the foot and lower limb with clarity; furthermore a nomenclature that would provide a common ground of communication between members of the podiatric community, and also between the podiatric community and other professional communities who treated the foot and its disorders – if you like, a sort of a biomechanical Esperanto.

    Prior to Merton Root stepping on to the academic scene in podiatry, the clinical field was mish-mash, an olla podrida of differing approaches toward the functional treatment of the foot, each approach parading its own terminology [Lee, W. E. (2001) Podiatric Biomechanics: An historical appraisal and discussion of the Root model as a clinical system of approach in the present context of theoretical uncertainty. Clinics in Podiatric Medicine and Surgery. 18(4): 555-684.]. He recognised the tower of Babel that was podiatric terminology in the 1950s and early 1960s era, and he sought to rectify it. In his first paper published in 1964, Root set out his stall by stating: “It behooves the podiatry profession to first of all establish a common nomenclature which is specific in its meaning so that knowledge can be accurately transmitted” [Root, M.L. (1964) An approach to foot orthopedics. Journal of the American Podiatry Association. 54(2): 115-118.] Even as late as 1998, his enthusiasm for the cause of improving clarity in biomechanics terminology had not abated: “It is imperative that the podiatric profession standardize biomechanical terminology before any further progress can be made in the understanding of normal or abnormal foot function. Without a standard biomechanical language, no understandable verbal or written communication among podiatrists is possible” [Root, M.L.: (1998) The Levitz and Sobel controversy: Part II. Podiatry Management. 17(2): 73-78.].

    2. An appeal to the ‘normal’ as a point of reference.

    “You seem very sure of yourself. Who can say where the normal stops and the abnormal begins? Can you personally define these conceptions of normality and abnormality? Nobody has solved this problem yet, either medically or philosophically. You ought to know that.”
    [Ionesco, E. (1960) Rhinoceros. Grove Press, New York.]

    “Seeking for so-called ‘normality’ is like looking for gold at the end of the rainbow.”
    [Darrah, L. W. (1939) The difficulties of being normal. Journal of Nervous and Mental Disease. 90: 730-737.]

    My apologies, for the somewhat disparate nature of the above two quotations (an incongruous mix of a French playwright and an American psychologist), but they do highlight one thing; the concept of ‘normal’ is notoriously difficult to pin down, and Root was well aware of that complexity and the average/ideal binary view within the normality debate. His clinical ideas of the foot were very much underpinned by the axiomatically recognised reciprocity between anatomical structure and function, and as such, he laid great emphasis on the morphologies (types) of the foot, and the effect that their differing biomechanical properties might have on function (rearfoot varus/valgus, forefoot varus/valgus etc). As Jeff said earlier on in this thread, he defined these foot types (morphologies) based on the requirement that the foot must be placed in the subtalar joint neutral position in order to establish the presence of these conditions. (To a segment of the profession, the subtalar joint neutral position concept is still viewed as a foundational concept, to another fast-growing segment, though, it has with time come to be seen as nothing more than an idée fixe that has dominated the collective mind of the profession for far too long, and should therefore be respectfully jettisoned.)

    Despite that aside, in the context of Root’s theoretical system of approach to the clinical treatment of the foot, when assessing the morphology of the foot type being considered, he used the reference point of an ideal morphology, which was captured in an inventory of eight intuitively derived criteria delineating what was deemed to represent ‘biophysical normalcy’ in the foot/shank complex, one of which was the subtalar joint neutral position [Lee, W. E. (2003) Merton L. Root: An appreciation. The Podiatric Biomechanics Group Focus. 2(2): 32-68.]. These eight criteria were developed between the years 1959 and 1965.

    He still fervently believed this aproach to be the case when in 2002, the year of his passing, he had a letter published in the International Journal of Podiatric Biomechanics wherein he stated: “Each structural abnormality alters the direction and strength of forces acting upon various joints of the foot thereby altering the manner in which the foot can function. To ascertain the effect of any abnormality, a morphological basis must be established that provides for optimal functional efficiency that one can refer to as normal or ideal. Once an ideal morphology of the foot has been established, clinical measurements can determine the extent of any osseous abnormality. Furthermore, the size of any morphological abnormality dictates the extent of abnormal function that can be anticipated in the presence of that abnormality. Determining the type of structural abnormality present in the feet or lower extremities also enables the practitioner to determine the direction and site or sites of abnormal forces acting upon the foot. Treatment methods can be devised to exert counter forces that will resist the effect of those abnormal forces (for example, functional orthoses)” [Root, M.L. (2002) Re: Podiatric biomechanics: Future directions – teaching. International Journal of Podiatric Biomechanics. 1(1): 19-20.].

    Interestingly, although Root coined the term ‘forefoot varus’, the awareness of an inverted forefoot as a documented clinical presentation, and a recognition that such a foot presentation could signal the possibility of pathological consequences, was not new. Here are a few examples from the past, although they are portrayed under different labels: Lateral imbalance (Schreiber and Weinerman 1948); Varus deformity of the forefoot (Perkins 1948); Supinated fore-foot (England 1948, 1950); Supinating twist of the forefoot (Catterall 1952); Biplane imbalance (Turchin 1956); Supination of the forefoot (Neale 1960); Inverted forefoot (Fisk 1966).

    Schreiber, L. F., Weinerman, H. W. (1948) Researches in podophysiology and their application to podopathomechanics. Journal of the National Association of Chiropodists. 38(6): 11-37.
    Perkins, G. (1948) Pes planus or instability of the longitudinal arch. Proceedings of the Royal Society of Medicine. 41(1): 31-40.
    England, M. D. (1948) Valgus foot. The Chiropodist. 3(2): 28-31.
    England, M. D. (1950) Supinated fore-foot. The Chiropodist. 5(11): 317.
    Catterall, R. C. F. (1952) The syndrome of forefoot instability. Proceedings of the Royal Society of Medicine. 45(12): 891-894.
    Turchin, C. R. (1955) Theory, physiology and treatment of foot imbalance. Journal of the National Association of Chiropodists. 45(11): 17-30, 45-52.
    Neale, D. (1960) Aims and methods in the examination of children’s feet. The Chiropodist. 15(2): 43-46.
    Fisk, G. R. (1966) Etiology and treatment of pes planus. The Chiropodist. 21(3): 69-74.

    For example, what the last author in the above list, the English orthopaedic surgeon Fisk (1966) is saying below appears to be remarkably similar to Root’s conception of fully compensated forefoot varus and partially compensated forefoot varus:

    “In this condition (inverted forefoot) the plane of the metatarsals is not horizontal when the heel is vertical because the inner part of the forefoot is raised in relation to the hindfoot. In this state, two alternative deformities can be produced: if the foot is sufficiently mobile the forefoot is brought flat to the ground and the heel swings into eversion (“the pronated foot”). This causes the collapse of the longitudinal arch and a valgus drift of the forefoot. In the second type, where the foot is less mobile the “three-point landing” which would normally take place on the heel and the first and fifth metatarsal heads is replaced by weightbearing upon the flexed great toe.”

    And indeed, an earlier forerunner of Root’s forefoot valgus was Schreiber and Weinerman’s ‘medial forefoot imbalance’ [Schreiber, L. F., Weinerman, H. W. (1948) Researches in podophysiology and their application to podopathomechanics. Journal of the National Association of Chiropodists. 38(6): 11-37.].

    3. Establishing a Biomechanics Department at the California College of Chiropody.

    This was set up in 1966. Between 1957 and 1959, the California College of Chiropody offered 128 hours of foot orthopaedics (at the time, the equivalent of podiatric biomechanics) teaching tuition across its four year course [Dickman, M. (1960) The development of the curricula of the schools of chiropody-podiatry in the United States. PhD Thesis, New York University.]. In 1966, The California Coolege of Chiropody offered 512 hours of foot orthopedics teaching tuition across its four year course [Root, M.L. (1999) Personal communication], adding a further 344 hours to the prior established curriculum. Root was the architect of that change, and this would come to have a far-reaching effect on podiatric education in the United States.

    4. Aiding the spawning of an industry in the form of orthoses.

    Dr. Chris Smith was quoted by in an interview [Wakefield, D. M. (2002) Merton L. Root DPM: The final interview. APMA News. 23(10): 20-23] as stating:

    “Mert Root spawned an industry” said Chris Smith, DPM, vice-president and medical director of Northwest Podiatrics Laboratory in Seattle,a classmate of Drs Weed and Sgarlatto. “I bet there weren’t a thousand pairs of rigid orthotic devices a year being fabricated when he began to fabricate them, and now there are hundreds and thousands.”

    Root’s work, which had already been disseminated across the U.S.A. and Canada on numerous lecture tours, coincided with the U.S. athlete Frank Shorter winning the Olympic gold medal for the marathon in 1972 [Kirby, K.A. (1993) Podiatric biomechanics: An integral part of evaluating and treating the athlete. Medicine, Exercise, Nutrition and Health. 2(4): 196-202.]. That celebrated American sporting achievement coupled with the development of the Root functional orthosis, enabled the word ‘orthotic’ to gain a widespread currency, one that it had hitherto enjoyed among the amateur running community and the wider Joe Public at large. However, let it be said, it is ‘orthosis’ not ‘orthotic’ – ‘orthotic device’ yes, ‘orthotic’ no!

    ***************************

    Here is an extract from what Merton Root personally wrote in the short introduction to the 1977 text:

    “The practitioner must have the best possible basis upon which to make treatment decisions. He cannot wait until sufficient research has been conducted to conclusively prove how the foot functions.
    Using the facts recommended by that research which has been completed and adding the logical reasoning based upon requirements of each applicable basic science, a story of normal foot function develops which is coherent and exciting to those responsible for foot care. Sound methods for diagnosis and treatment of abnormalities can be developed once normal function and structure is understood.”

    My impression from this personal statement by Merton Root, is that he wanted to put something ‘on the table’ (so to speak) for the profession to examine and use, and if they found it wanting, to go away and ‘build a better mouse trap’ [a Whitmanesque phrase he once used in one of his few postings to Jiscmail Podiatry many moons ago]. The 1977 text was a culmination of a grand ‘here-is-what-we-think-on-the-basis-of-research-up-to-now,-coupled-with-some-of-our-own-concepts’ gesture for the profession to grapple with and use; a “story of foot function” which he saw as “coherent and exciting to those responsible for foot care”. True, he adjudged the body of his work to be ‘coherent’ as he stated in his introduction, but I don’t think that ever he expected his work would ossify or harden into a clinical system of approach that clinicians would dogmatically or unquestioningly adhere to. From reading Volume II, it seems plain to me that Root et al stood on the shoulders of people who had been there before them, both in the domains of podiatry and the orthopaedic biomechanics world, and he fully expected that over time, his shoulders and those of his immediate colleagues would also be bearing the weight of others who, inspired by his work, would follow on from him. Indeed, to quote Inge: “There is no greater disloyalty to the great pioneers of human progress than to refuse to budge an inch from where they stood” [Inge, W.R. (1926) Lay Thoughts of a Dean. G.P. Putnam’s Sons, New York and London.].

    The name of Merton Root deserves to be for ever held in respect for what he brought to the field of clinical foot and lower limb biomechanics, and parting company from some of his ideas in no way diminishes our respect for him and what he achieved. However, the number of validity and repeatability issues which have been highlighted with various aspects of the Root model, are challenging clinicians to look elsewhere. Consider the following by Nester:

    “Rather than continue to apply a poorly founded model of foot type whose basis is to make all feet meet criteria for the mechanical 'ideal' or 'normal' foot, we should embrace variation between feet and identify it as an opportunity to develop patient-specific clinical models of foot function. Clinicians should consider foot function in terms of the entire foot, and, given what we know about the variation between subjects, the general ranges of motion likely at specific joints, and what is observable clinically, rationalise the most likely kinematic solution for each patient. It is hoped that patient-specific conceptual models for foot biomechanics will lead to improved understanding of the role (if any) of foot biomechanics in causation of foot and lower limb problems, and improve our design of orthoses such that they have more precise and predictable biomechanical effects” [Nester, C.J. (2009) Lessons from dynamic cadaver and invasive bone pin studies: do we know how the foot really moves during gait? – http://www.jfootankleres.com/content/2/1/18]

    Food for thought?

    Marshall in 1918 stated that “the last word concerning common foot ailments has not been said” [Marshall, H. W. (1918) Revised ideas concerning foot defects and orthopaedic footwear. Boston Medical and Surgical Journal. 176(13): 428-432.], and that statement still carries resonance in the year 2013.

    My two-pennyworth.

    Best wishes,

    Eric Lee.

    P.S.: Whatever happened to the Foot Orthotic Consensus Project? the thread that was continually hijacked by someone who is no longer part of this e-community – the individual who ended up being the ‘architect’ of his own banishment.
     
  6. Eric:

    Thanks for taking the time to provide a great discussion on the significance of Dr. Merton Root's life work. For anyone who has an interest in the history of "podiatric biomechanics", I consider Eric Lee's treatise on Mert Root and his contributions a must-read (Lee WE: Podiatric biomechanics: an historical appraisal and discussion of the Root model as a clinical system of approach in the present context of theoretical uncertainty. Clinics Pod Med Surg, 18 (4):555-684, 2001).

    Thanks Eric!
     
  7. wdd

    wdd Well-Known Member

    Simon,

    Could you expand a bit on this statement?

    Did it knock it back when measured against some imaginary ideal developmental pathway for podiatric biomechanics in the UK?

    I imagine it's possible that if Merton Root hadn't published when he did that sometime after that someone else might have come along and set things back fifty years or more?

    In some ways only setting things back thirty years might be seen as a success story?

    Bill
     
  8. Having been taught the Subtalar Joint Neutral Model of Foot Biomechanics (proposed by Root and colleagues) at the California College of Podiatric Medicine (CCPM) during my podiatry student years, and then having formulated other ideas on foot and lower extremity biomechanics during my CCPM Biomechanics Fellowship (1984-1985) and onward in later years, I believe I have, in some ways, had the best of both worlds of education on foot and lower extremity biomechanics. In other words, when I am evaluating the structure and function of the feet and lower extremities of my patients, I can use both the Subtalar Joint Neutral (STJN) Model and later models to best understand the biomechanics of my patients. I use the parts of the STJN Model which I like, discard the parts I don't like or don't make good mechanical sense, and then use other biomechanical concepts/tests/evaluation methods which are based on more recent research and my own years of writing, lecturing and thinking about this fascinating subject.

    Here are the parts of the STJN Model of Foot Biomechanics I like:

    1. Concept of STJ neutral position to establish a midrange reference position of function for the STJ.

    2. Casting for foot orthoses in the STJ neutral position with the lateral column loaded with manual dorsiflexion force on the 4th and 5th digits.

    3. Having a common set of terminologies and measurement techniques to describe segmental ranges of motions and structural deviations within the foot and lower extremity so that communication between clinicians/researchers is less ambiguous and more clear and a reference range of "normal" can be established and discussed.

    4. Understanding that certain structural deviations in rearfoot and forefoot structure can have significant impact on foot and lower extremity biomechanics.

    Here are the parts of the STJN Model of Foot Biomechanics I have thrown out and don't use any more since they do not hold up to clinical scrutiny and/or do not make good biomechanical sense:

    1. The STJ neutral position can be accurately defined as "neither pronated nor supinated". (Sorry, that is a tautological definition.)

    2. Casting for foot orthoses without the medial column having varying amounts of dorsiflexion load being applied during the casting procedure. (I prefer to add either dorsiflexion or plantarflexion loads to the medial column during casting in most patients.)

    3. The calcaneal bisection line is accurate and reproducible from one examiner to another and that each foot has only one "correct" heel bisection. (Heel bisections are not consistent from one examiner to another.)

    4. The STJ neutral position and "forefoot to rearfoot relationship" is reproducible from one examiner to another. (The STJ neutral position and forefoot to rearfoot relationship are not consistent from one examiner to another.)

    5. The degree of rearfoot varus/valgus, degree of forefoot varus/valgus helps predict frontal plane gait kinetics or kinematics. (The research evidence all suggest that these measures have no affect on gait kinetics or gait kinematics.)

    6. The calcaneus will pronate until the STJ maximally pronated position once the calcaneus is more than 2 degrees everted. (STJ pronation moments have nothing to do with a line drawn on the calcaneus, they are dependent more on STJ axis spatial location.)

    7. The calcaneal bisection in relaxed bipedal stance helps determine STJ pronation or supination moments or is predictive of pathologies. (See #6.)

    8. The calcaneus must be in a vertical position to function normally during gait. (Calcaneal bisections are unreliable and not reproducible.)

    9. An orthosis made with the STJ in neutral position will cause the foot standing or functioning on that orthosis to stand or function more in the STJ neutral position. (An orthosis must exert sufficient external STJ supination moments to place the STJ in neutral position, most neutral position orthoses don't have that ability.)

    10. Forefoot varus/valgus deformities are congenital deformities and do not change with time. (Forefoot to rearfoot relationship is a constantly changing structural relationship that depends on the viscoelastic properties of the structural components of the foot and lower extremity and the external and internal forces/moments that have acted on the foot over the past weeks, months or years.)

    11. A "Functional Foot Orthosis" does not have a forefoot extension or have accommodations for plantar metatarsal head lesions incorporated into it. (Forefoot extensions can often be used to make foot orthoses even more "functional" than foot orthoses that end at the metatarsal necks, contrary to the teachings of Root and colleagues.)

    12. Foot orthoses should be always be balanced with the calcaneus vertical unless the patient has: 1) a rearfoot varus where the calcaneus is inverted when the STJ is maximally pronated; 2) the patient has a "rearfoot valgus deformity", or 3) the patient has a tarsal coalition. (Foot orthoses should be balanced within the frontal plane to optimize the orthosis reaction forces to heal pathologies, improve gait function and prevent other pathologies from occurring.)

    13. The standard STJN biomechanical examination as proposed by Root et al yields sufficient information to predict gait kinetics, gait kinematics or foot and lower extremity pathologies. (Without measuring STJ axis spatial location and only measuring calcaneal bisections, the measurement system proposed by Root et al was doomed to be a failure at predicting STJ pronation and supination moments.)

    14. If a patients stands with their calcaneus inverted in relaxed bipedal stance then there must be some "deformity" causing that inverted calcaneal foot posture. (An inverted calcaneus can be due to examiner error in drawing a calcaneal bisection or simply to the fact that calcaneal bisections have nothing to do with foot function.)

    15. Equinus deformity always causes a STJ pronation moment. (Equinus deformities can also cause STJ supination moments.)

    16. Feet tend to pronate because the "center of gravity" of the body is medial to the STJ axis. (Feet tend to pronate when the STJ pronation moments are greater than the STJ supination moments for a given posture of the foot on the ground.)

    17. Genu valgum deformity always causes a STJ pronation moment. (Genu valgum deformity often causes a STJ supination moment.)

    18. Rearfoot varus deformity causes a STJ pronation moment since the calcaneus will tend to pronate toward the vertical position in relaxed bipedal stance and then stop pronating at the calcaneal vertical position since this position of the calcaneus is somehow more stable than other frontal plane positions of the calcaneus. (The calcaneus has a rounded plantar surface which does not correlate to the calcaneal bisection. The inverted forefoot to ground relationship is what causes the foot with a rearfoot varus deformity to pronate, not the inverted heel.)

    19. The midtarsal joint has two simultaneously occurring midtarsal joint axes: the longitudinal and oblique midtarsal joint axes. (See the research of Chris Nester and coworkers.)

    20. The normally functioning foot reaches the STJ neutral position while barefoot when the foot is in the middle of midstance. (While barefoot, the normally functioning feet don't reach the STJ neutral position until the end of midstance, while in heeled shoes, the STJ reaches the neutral position at the middle of midstance).

    I hope Eric Fuller, who graduated 4 years after me at CCPM, can check over my list of things to throw away from the "STJN Model" to see if he thinks he was also taught these things while a podiatry student at CCPM by the members of the CCPM Biomechanics Faculty, all of who taught the STJN Model exclusively to their students.

    Further reference: Kirby KA: "Inaccuracies in Podiatric Biomechanics Dogma - Volumes I-III", August 1990 - October 1990 Precision Intricast Newsletters, in Kirby KA: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997, pp. 7-12).
     
  9. Jeff Root

    Jeff Root Well-Known Member

    I thought I would post the foreward and the introduction to terminology in Biomechanical Examination of the Foot (Root, Orien, Weed and Hughes) as I think it sheds light on a number of the issues being discussed in this thread.
    Jeff
     

    Attached Files:

  10. efuller

    efuller MVP

    Eric L, That was described brilliantly. I've heard others say Mert did not expect others to dogmatically adhere to his teachingss. However, when I heard them say it they were often dogmatically adhering to his teachings. Today, I can see the body of work as here are our thoughts on how the foot works.
    Thanks,

    Eric F.
     
  11. Jeff Root

    Jeff Root Well-Known Member

    One of the coauthors of Biomechanical Examination of the Foot was Robert (Bob) Hughes, DPM. Dr. Hughes was a gifted artist who had to choose between a career in art (as I recall, he had an opportunity to work for Disney, as in Walt Disney Productions) and podiatry. He chose Podiatry but he even wrote a cartoon book called Dr. Pod. Here is a picture he drew in the year 1972 inside the front cover of a copy of the book that he gave to Dr. Root. I hope you will enjoy it as much as I have!
    Jeff
     

    Attached Files:

  12. efuller

    efuller MVP

    In post # 49 in this thread I added one other thing that I liked and that was the intrinsic forefoot valgus post. An orthotic made without this modification can have results dramatically different than an orthotic with this modification. It is something that we can use to change the basic arch support.




    I call this choosing the amount of forefoot to rearfoot correction that you want in your finished orthotic. You can use the Root communication tools of saying that I want a 5 degree intrisic forefoot valgus post. I also like to choose what the forefoot to rearfoot relationship should be when I make my orthotics. You shouldn't have to be limited by the shape of the foot on the day that you cast it.


    a lot of stuff I agree with was cut.


    This is an interesting one. If you look at the index in Normal and abnormal under equinus you will see an entry for equinus causing supination and a different entry, on a different page, on equinus causing pronation. The two entries are never reconciled. There are a lot of inconsistencies in the writing and this is just one example. I like Eric Lee's point about how their writings were a "compendium" of thoughts on the subject. At different times they made the observation that an equinus causes supination and it causes pronation and didn't have the tools to explain why both things could happen. Subtalar joint axis location is a tool that can explain why in some feet an equinus causes pronation and in other feet it causes supination.


    At the PFOLA meeting in San Francisco, that Mert attended, there was a side meeting with the biomechanics faculty of CCPM to discuss the future of the biomechanics curriculum at CCPM. Mert attended that meeting too. I remember him talking about how all the basic sciences should be incorporated into the teachings of biomechanics. He listed anatomy, physiology pathology etc. However, he left out physics. I'm sure that if you asked him he would have said that it should have been included. I did find it interesting that physics was left out. As Daryl has pointed out a few times, the physics guy (M Willie?) they got to write part of Normal and Abnormal said to Mert "your biomechanics is all bio and no mechanics." A lot of the later stuff Kevin listed was incorrect use of mechanics and physics.


    Eric
     
  13. I was there at that meeting, I believe. In addition, I believe Craig Payne was there also, from what I remember.
     
  14. Jeff Root

    Jeff Root Well-Known Member

    Here are a few more Robert Hughes creations just to show the lighter side and sense of humor of Dr. Root. He loved Bob like a brother and Bob captured some great moments with humor (like my father yelling when he lectured and the "simplicity" of biomechanics!).
    Jeff
     

    Attached Files:

  15. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I was. I was an interested observer of proceedings. I recall Mert turning up with a lot of of notes to read from and the Chair cutting him off....
     
  16. I remember that Mert did get cut off rather abruptly since he was starting to get into lecture mode, from what I remember. That was a rather tense moment.:butcher:

    This meeting occurred just before CCPM was sold and then moved to Touro Universtity in Vallejo, California, where biomechanics was practically eliminated from the podiatry students' curriculum. That was a very sad time for me and many other CCPM alumni.

    However, a few years later, the California College of Podiatric Medicine became the California School of Podiatric Medicine (CSPM) when it moved to Samuel Merritt University, in Oakland, California, where the California school is still located. When that move occurred, I became the "biomechanics representative" for the four member Podiatric Medical Education Advisory Committee (PMEAC) for the next four years which was chaired by Don Green, DPM. With the PMEAC, we began to reestablish the biomechanics curriculum at CSPM along with Paul Scherer, DPM, who organized the biomechanics faculty for CSPM to provide the lectures. I have been teaching biomechanics and sports medicine courses at CCPM and CSPM for the past 28 years, except for the few years the school was at Touro University.

    Now, after 8 years of pushing for it, CSPM has built a new Motion Analysis Research Center (MARC) with two force plates, a 8 camera video analysis system, a pressure mat, accelerometers, a skin mounted electromyogram unit and a newly hired biomechanist, Drew Smith, PhD, to run the lab and teach the students. Looks like biomechanics is starting to play a much bigger role at the California School than it has in many years. In addition, Tissue Stress Theory is being taught front and center at CSPM and is being gobbled up by the students...almost as if these physics/engineering ideas have always been present within podiatry.

    If they only knew what Eric Fuller and I went through to get there.....what a journey....:wacko::drinks
     
  17. Jeff Root

    Jeff Root Well-Known Member

    In honor of my father and in the interest of future biomechanical research, Root Laboratory was asked to become a major sponsor of the new Motion Analysis Research Center by Samuel Merritt University. I'm proud to say that we were able to support the school in their effort to improve the body of scientific evidence related to lower extremity biomechanics.

    But what did we have before all this technology? In addition to conducting a visual gait analysis, one of the other important tools Dr. Root used/taught to evaluate function was the patient's shoe. He taught that the normal wear pattern in the shoe at heel strike should be posterior and slightly lateral of center. If the wear pattern was too medial (increased pronation) or too lateral (increased supination), that was significant and could be addressed in the orthotic prescription. The wear pattern should be observed to remain lateral of center in the heel area and should then transition medially and be slightly greater under the 1st met head and hallux. If the wear pattern was observed to be too medial or too lateral (central forefoot to sub 5th), then this also could be used to indicate dynamic function (forces) and might influence the orthotic Rx. Does the shoe have a spiral wear pattern under the ball of the foot (often due to an abductory twist at heel lift) and could this be associated with excessive shear forces and possibly callous under the ball of the foot? The wear pattern provides significant evidence of dynamic forces and suggests how we might want to attempt to alter those forces. Post orthotic wear patterns can be evaluated to see if the orthoses have successfully altered those forces.

    My point being, there are simple and inexpensive techniques the clinician can use to evaluate foot function. It is the totality of all the tools in the tool chest that enables the carpenter to build an elegant piece of furniture. The problem is not with the hammer, the saw or the screwdriver. The problem is when you ignore them or place too much emphasis on any single tool.

    Jeff
     
  18. Fifteen or so years ago, I manually went through every copy of the Society of Chiropodists Journal and read all of the papers which had any relation to biomechanics. It was quite obvious from my reading of these journal articles, together with other British publications pertaining to foot biomechanics of this period that biomechanics in the UK was travelling along a fairly specific lineage- that of a tissue stress approach in which the focus was turning to kinetics and biomechanical modelling. Many were building on the earlier work of the US author Arthur Steindler- http://books.google.co.uk/books?id=TSUEAQAAIAAJ&source=gbs_similarbooks_r&redir_esc=y and http://www.amazon.com/Kinesiology-Human-Normal-Pathological-Conditions/dp/0398064423 (one of my favourite books back then)

    In reading the literature, this approach to the study of foot biomechanics in the UK reaches its pinnacle in the late 1970's with Ian Stokes's work: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1233023/pdf/janat00239-0128.pdf Stokes approach here is about as close to modern biomechanics as you can get. Stokes and his work was certanly known within chiropodial circles back then. Unfortunately, after this date there is a hiatus within the British literature in which people are chasing the shadows of Root. It's not until more recent times that we have returned back to the biomechanical modelling of the foot of the sort of quality that Stokes was doing in the late 70's. Now things have really started moving forward again, in my opinion. Hence the 20-30 years lost chasing Root which was more about bio than it ever was about mechanics, should have been better employed following the lead of the likes of Stokes et al.
     
  19. Jeff Root

    Jeff Root Well-Known Member

    Simon,

    From the section Material and Methods: “Six normal subjects were studied and measurements were made on both feet”. And in the conclusion: “In most of the normal feet studied, the forces in the rays of the forefoot were ranked in sequence so that the first ray carried the highest loads and the fifth carried the smallest loads” and “Disorders of the foot which reduce the load-bearing function of the toes result in less load in the m.t.p. joints”.

    After a very quick review of the article, I have to ask what criteria were used to determine what a “normal subject” was and how “disorders of the foot” would have been determined. Again, I think this illustrates why Dr. Root felt that we could not communicate effectively unless we had a clear understanding of normal (or ideal) structure and could use it as a basis to define and differentiate structural and functional “disorders” of the foot.

    Jeff
     
  20. As I've previosuly stated, there are other definitions of the "normal" foot which predate Root and were clearly employed to enable practitioners to talk effectively with one another- I'm still awaiting my copy of Staffords book in which he lists twelve criteria. Usually from this era they define "normal" as being free from pain and obvious pathology- a definition employed to this day. Show me the data which validates your father's definition of "normal", Jeff... Regardless, this work is significantly more sophisticated.
     
  21. Jeff Root

    Jeff Root Well-Known Member

    Simon,

    It just seems ironic to me that we are expected to accept someone's totally undefined concept of normalcy and yet there is so much criticism of Root's effort to create a standardized set of criteria, although not perfect, which attempts to reduce some of the subjectivity associated with the definition and concept of normalcy (ideal). Until some of these issues are resolved, ideally through both research and consensus, we will never change the communication barrier and the status quo of which we are all victims. It is this environment which contributes to our periodic mutual frustration.

    Jeff
     
  22. But you don't know that it was undefined, Jeff. By your own admission your father did not invent the terminology that he employed. When it comes to his criteria for normalcy he certainly did not validate nor test its reliability. The question is: did the extra layer your father added, which seems to amount to "when the subtalar joint is in neutral" add clarity or further obfuscation? The problem as I see it, is that the person hung up on defining "normal" was your father and this is the fundamental failing of this paradigm since it failed to recognise that "normal" is variable, moreover, that variability is normal. End of story.

    Anyway, Bill- here's another great paper from 70's blighty which included a chiropodist as one of the authors. http://www.bjj.boneandjoint.org.uk/content/57-B/1/98.full.pdf If nothing else, I'm sure Eric Fuller will appreciate the two papers I have selected here from the 1970's, forces acting upon the metatarsal with free body analysis and CoP...hmmm, what's not to like.
     
  23. wdd

    wdd Well-Known Member

    Hi Simon,

    Thanks for your reply.

    So things were "set back" in comparison to an imagined ideal line of development for podiatric biomechanics in the UK?

    Root's contribution to podiatric biomechanics positive and/or negative has to be considered against the background of professional development within the UK podiatry profession at that time, ie it was not possible to impose the ideas of Root upon UK podiatrists in the 70s and 80s, UK podiatrists were receptive to his ideas. Why?

    I'd love to hear your views and anyone elses on the features of the UK profession, during the 70s and 80s and decreasingly since, that made it fertile ground for the publications of Root and infertile ground for the publications of Steindler, Stokes, etc.?


    Bill
     
  24. Jeff Root

    Jeff Root Well-Known Member

    Simon,

    It appears to me that it was not defined in the article. Since the article is all I have to go by, it is therefore undefined and it forces me to make assumptions about and blindly accept the author's concept or definition of normalcy. That requires a huge leap of faith.

    You said
    Prior to my mother's death from pancreatic cancer, she had an asymptomatic period of the disease. She was both free from pain and obvious pathology. She was not without disease nor would I classify her condition as normal (ideal). Using asymptomatic as a primary definition for normalcy would enable a lot of diseases to go undiagnosed or detected. In some cases, the first evidence of symptoms is unfortunately much too late.

    Jeff
     
  25. OK, Jeff. Yet we are supposed to accept you father's definition with equal blindness, since it has never been validated. Moreover, it has been found to be erroneous. It is pretty obvious to anyone that normal is variable and that variability is normal. There is no one ideal foot posture, there is no single criteria for normalcy. So lets say we apply your fathers criteria for normalcy, we can then label them as having normal alignemnt despite the fact that we've screwed and bolted their foot into that alignment and they are free from pain.
     
  26. Jeff Root

    Jeff Root Well-Known Member

    Finally something we agree on! If I were to revise his work, I would toss out the use of the words normal and abnormal. It is simply a system of comparison that is based on standardized positioning and measuring techniques of the foot and leg. It is not unlike how we use the standard anatomical position of the body and the cardinal body planes, to help describe anatomy, structural relationships and anatomical variation.

    Jeff
     
  27. Root took us on a detour up a dead end which wasted time. We picked up from where we left off after going on a magical mystery tour- if we'd have carried on without this detour, I believe our knowledge base would be further forward now. Just think of the resources and time which have been wasted on projects testing the reliability of Root's measurements alone.

    I suspect this is mainly because chiropodists generally did not have a good grounding in mechanics and the formulaic approach of Root seemed appealing because it negated the need for cognitive engagement to the point of if x then y. In talking to my senior colleagues such as John Fletton and Lew Russell back in the day, this is certainly the impression I was given. Couple this with the lack of wider reading, knowledge of research methods and critical thinking and you end up with "it seemed so plausible". Then you have the increased earning potential of "orthotics" being marketed heavilly via the likes of Langer and all of a sudden you can see the obvious gravitational pull of a formulaic system that requires little knowledge of biomechanics, little thought and yet provides an increased revenue in a time of recession and civil unrest in Great Britain. Since no-one will meet the criteria for normalcy, you can sell "orthotics" to anyone willing to buy into the ideas. Certainly, when I trained in the late 80's orthotics offered the greatest profit margin for treatments provided by the private practitioner, as such everyone wanted to "do orthotics"; few wanted to learn physics.
     
  28. Eric Lee:

    I loved this quote from your posting a few days ago:

     
  29. Personally, I felt that was the poorest quote that Eric provided. Let us acknowledge that the world might be flat because that is what people thought back then.:bash:
     
  30. Jeff Root

    Jeff Root Well-Known Member

    I happen to look at it from a totally different perspective. Let us acknowledge why some people were reluctant to sail across the ocean in spite of evidence that the world appeared to be round for fear that it might actually be flat and they could potentially fall off of it!
     
  31. efuller

    efuller MVP

    I didn't think the quote applied to what we are talking about. There are/were flaws in the paradigm that people at that time should have seen. And did see. There was a 1981 article by Don Green that looked at "bowstringing" of the EHL tendon in HAV. Don Green saw that the tendon did not really bowstring as was hypothesised by Root et al. In Normal and Abnormal. In 1986 I was taught what was in Normal and abnormal even though there was evidence to the contrary. This is an example of the dead end that Simon speaks of.

    There are many examples of internal inconsistacies that were not addressed and could have been addressed at the time. One example. Forefoot varus causes pronation and forefoot valgus sometimes causes pronation and other times causes supination. Some may have come up with explanations, but those explanations often brought further problems. (This is very similar to the early astronomers who wanted to keep the earth at the center of the universe. This paradigm in crisis phenomenon is described well in Thomas Kuhn's on the nature of scientific revolutions.)

    Another internal inconsistancy. Forefoot to rearfoot relationship is measured in neutral position. When the STJ is moved into a more pronated position the angle of the forefoot to rearfoot becomes more valgus than it was in neutral position. Most feet function pronated from neutral position. Why would you support the deformity measured in neutral position when the foot is not in that position?

    If I picked up my copy of normal and abnormal I'm sure I could point out many more internal inconsistancies. However, the writers of the book did think that it was a work in progress. The problem comes when the readers/followers accept it as a finished product. It is partly the fault of the followers, but partly the fault of the writers who don't say there are areas where we don't have an answer and they are here, here and here. I can see why a lot of practitioners of podiatric biomechanics just didn't care when the academics debated internal inconsistancies. The practioners were happy enough with the amount of success that they were having selling orthotics.

    The problems with neutral position biomechanics have not been exposed by new tech. They could have been exposed at the time that they were proposed with information available at that time. It probably wasn't exposed because it worked well enough. I'm happy that it worked well enough. The orthotics made for me under that paradigm made my feet feel better. (Although an orthotic with a medial heel skive over the same cast is better.) I think the most interesting quote from Eric Lee's post is the Chris Smith quote. They spawned and industry. An industry that can help people. It may not help people for the reasons that they thought, but it has helped people.

    Eric
     
  32. Jeff Root

    Jeff Root Well-Known Member

    Eric,

    I consider that comment to be a very negative and cynical view of your profession! Did it ever occur to you that some of those practitioners might have been happy enough with the clinical success (treatment outcomes) that they were achieving with their orthotics, especially as compared to past results? I'm not a podiatrist but I have had the pleasure of working with so many conscientious ones over the past 35 plus years, I can't help but be offended by your remark. Just think how it might make some of your (older) colleagues feel?

    Jeff
     
  33. On the contary, I think Eric has absoltely hit the nail upon it's head here. I alluded to this yesterday. In the UK, prior to off the shelf orthoses, the easiest way to sell and make a profit for chiropodists was via foot orthoses, foot orthoses prescribed using Rootian protocols. I guess if we look at the 70's and to US podiatry this was probably also true there at this time. Now in the US podiatrists are turning away from biomechanics (remember in US podiatry, more often than not, biomechanics pretty much = orthotics), now in the US surgery is prevelant because more money can be made from surgery than orthotics. There is a driving force at play within Western, capitalist nations.
     
  34. Another problem as to why people did not challenge the ideas of Mert Root during that era was because it was assumed that ideas of Root and colleagues were gospel. Subtalar joint neutral theory, as you know, was taught as dogma, not as a current theory. Therefore, those that questioned it's validity, at least in the company of the "purists", were summarily shot down.

    I know you missed the meeting, Eric, where I told Dr. Root (who was lecturing at the time and I was in the audience) that I thought that heel bisections were highly variable from one practitioner to another since I had seen how far the heel bisections were different from one Biomechanics Professor to another while I was the Biomechanics Fellow at CCPM (this meeting was in about 1985, when I was 28 years old, and was finishing up my Fellowship). Basically, Dr. Root told me and the audience that a monkey could be trained to bisect the calcaneus accurately and he didn't know how the teaching curriculum at CCPM had gotten so bad since he had left the school. Certainly this type of professional attitude does not promote intellectual discussion and it seemed I was the only one of the approximately 40 podiatrists at the meeting that was directly challenging Dr. Root's ideas. Dr. Don Green liked sitting next to me at these meeting just so he could see the "fireworks" up close when I questioned Dr. Root on many of his statements. Basically, unless someone had extreme confidence in their biomechanical knowledge and didn't mind being subjected to ridicule, they would never question Dr. Root's authority on these subjects, in a meeting. I guess I was one of those few that did.

    I think, at the time, that a number of podiatrists liked "doing orthotics" because they made more money when doing them. Then there were also a number of podiatrists who were "doing orthotics" because they saw fantastic results for many injuries that, otherwise, may be considered only surgical problems, for example. Probably, though, the majority of podiatrists made orthoses for their patients both because they were therapeutically effective and they were paid well for their specialized services. Do surgeons expect to be paid high dollars for their surgeries? Why shouldn't biomechanically oriented podiatrists also expect to be paid well for their particular expertise when evaluating, casting, adjusting and fitting orthoses for their patients?

    I believe to go back to that era where Root first started and objectively look at what information he had to work with, he did a remarkable job at assimilating the information and producing four textbooks for our profession to help give them a better background in biomechanical thought. I do agree with Simon and Eric Fuller that, however, it is too bad that someone (or some people) of authority hadn't stepped forward to question the internal consistencies of subtalar joint neutral theory earlier on here in the US, and in other countries. Many seemed to follow subtalar joint neutral theory as if they were the only theories of foot function and foot orthosis therapy.

    However, when all is said and done, this is the way that history of podiatric biomechanics and foot orthosis therapy happened within the worldwide podiatric profession and has also happened numerous times within the history of science in the past. For those of you who have read Eric and my chapter on "Subtalar joint Equilibrium and Tissue Stress Approach to Biomechanical Therapy of the Foot and Lower Extremity", we cover this subject quite a bit on the development of podiatric biomechanics theory with the background of Kuhn's work on scientific revolution.

    Great discussion.:drinks
     
  35. Probably the most succinct summary of the podiatry profession I've read; ergo. follow the money, not the evidence. Well said, Simon.
     
  36. Jeff Root

    Jeff Root Well-Known Member

    Shows what you know about the economics of podiatry in the U.S. Doctors often comment/complain that they can make more money from orthoses than from doing surgery and without the increased liability. They make more off an orthosis than doing a bunion procedure. The economic climate and regulation in medicine in the states is making it almost impossible for individual practices to survive. Many podiatrists are now employed by hospitals where the focus is on foot and ankle surgery because podiatrists get paid less than orthopedic surgeons. Once economic parity is achieved, there will be no financial advantage to employing podiatrists to do the same work. What then?
     
  37. efuller

    efuller MVP

    Re reading my quote I can see how it can be interpreted as negative and cynical. However, I intended to refer to the portion of the profession that is more in it for the money. I am one of those practitioners who thoroughly enjoys seeing a patient feel better with just a piece of plastic, or cork, or adhesive felt in their shoe. Biomechanics is a wonderful puzzle. I know that there are more practitioners out there who also experience that joy. I did not intend to paint the whole profession with the same brush. Jeff, you did take the most negative part of my comment. I also said in that post that orthotics have helped people. I don't think that post, as a whole, would make my colleagues feel bad unless they had a lot of emotional investment in neutral position theory. Do you disagree with the inconsistencies that I pointed out?

    Eric
     
    Last edited: Nov 15, 2013
  38. Rob Kidd

    Rob Kidd Well-Known Member


    I note Kevin's comments above with interest, and acknowledge the boldness of the action of "questioning Root". In the late 80's and early 90's I did exactly that in a series of (with hind sight poor quality) publications. Now, I know that diplomacy is not my trump card, and I know that I could have handled it better, but the result was fascinating. The pod world in Australia - and also some in the UK, polarised into 1) wanting me put down, and 2) saying thank goodness someone has the balls to challenge this stuff. I was Ostracised by much of The Western Australian podiatric world, including one that wanted me sacked from my position at Curtin University (1991). I was dismissed as a "total wanker" by one ex-member of the Curtin staff, who by then was working in private practice - but then, he was taught by Root. Another person, then a member of the staff, referring to "The Root Orthosis" said to me, and I quote: "you do not understand, we have got very good as making that device". Maybe lessons in English would have been appropriate. My reply was something along the lines of: "You are pushing as state of the art, a device that was first described before you were born"? [I note the comments in previous posts vis biomechanics = orthotics].
    Time is a funny thing, it has a nasty habit fo bringing out the truth. Not that I was necessarily right though, but I do know that it needed saying, much like Kevin is saying above. I am sure that Kevin did it with more tact than I did, Rob
     
  39. Well, Rob, tact was not my best subject either...at least according to some of my friends who were at the meetings with me where I questioned Dr. Root's assertions.

    In one meeting in about 1987, when I was 30 years old, Dr. Root had invited about 25 podiatrists to a meeting to discuss another book he was planning on writing where, the goal of the meeting was to go through his book notes to develop a consensus. I was included in this small group which was actually quite an honor for me since I was the youngest of the bunch.

    Again, Don Green was sitting next to me and he would elbow me every now and then to make sure I raised my hand to question Dr. Root when we both didn't agree with what he was saying. He knew, from his prior experiences with me at Root Meetings that I had no problem questioning some of the principles that Dr. Root was trying to put forth.

    In one particular instance, Dr. Root, while at the head of the tables in the conference room, made the statement that in order for the subtalar joint (STJ) to pronate, the knee must also flex since the two actions were integrally linked. I raised my hand and stated that the knee and STJ were independent of each other so that the STJ can pronate or supinate without the knee flexing.

    Since I wanted to demonstrate this to the audience, and to Dr. Root, I walked up to the table where he was standing, and right in front of Dr. Root, took off my shoes and socks, climbed up on the table and showed how I could easily pronate and supinate my STJ with my knees extended.

    Needless to say, Dr. Root was silent throughout my table top barefoot demonstration, but I did get a few nervous chuckles from some of those in attendance. Looking around to the others in the audience, I got frowns of disapproval from most of those in attendance. I quietly gathered up my shoes and socks after this "tactful" display and took my seat next to Dr. Green. "Good one, Kirby", Don said, with a smirk on his face.

    I don't think Dr. Root appreciated my "standing on the table in front of him" demonstration. But, this was a time where I thought tact wasn't as important as making certain the biomechanical principles of the foot and lower extremity were being accurately portrayed.

    After that, I was pretty much branded as"the young troublemaker" by many of those who were the ardent advocates of Dr. Root's teachings, even though, in private, a few of those in attendance told me I should keep questioning Dr. Root since they thought it was a healthy thing for podiatry.

    Even though this was over 26 years ago, it still seems like yesterday.

    True story.:drinks
     
  40. Rob Kidd

    Rob Kidd Well-Known Member

    I am fascinated by your story - and glad to hear it. There is so much to say about Root theory, and so much has already been said. At the time my biggest beef about it was that, under so much ras-ma-tas (eg the 1/2-2/3 measurement for neutral - such a joke) there was a seriously good clinical paradigm trying to get out. If only it had not been dressed in the other stuff.

    You know as well as I do that medicine is not always scientific; one of the biggest mistakes of the Root paradigm to me was to try and pretend that it was scientifically based - it wasn't. But that does not make it bad clinical practice.................
     
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