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Are Root Biomechanics Dying?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Apr 2, 2009.


  1. Members do not see these Ads. Sign Up.
    Colleagues:

    Just wanted to let you know that I just had an article published in the latest issue of Podiatry Today magazine titled "Are Root Biomechanics Dying?". Happy reading.
     
  2. Cameron

    Cameron Well-Known Member

    Kevin

    Very good.

    Taken you a bit of time come round. I have copies of our converstions on the Podiatry ListServe back in the early 90s with you, myself and Dr Bob Kidd. Bob was always respectful of Merton Root (et al) theories but both of us were skeptical of its foundation. Great piece of deduction though (Root).

    Through length of days comes understanding.
    toeslayer
     
  3. ANDY RYALS

    ANDY RYALS Member

    Certainly myself and several other student's on the MSc over here in England are moving away from Root for a more "Egineering" based system of Podiatric Biomechanics, but like Kevin says we are still respectful that Root laid the foundation stones.
     
  4. I'm going to disagree, just to be different!

    Let us, for the sake of the argument, define "Root biomechanics" as the overall model of deviations from the criteria of normalcy (setting aside the huge range of other things it added to the science).

    What criteria might we apply to "dying". Perhaps that the number of podiatrists using it is declining?

    I would have to disagree. Take a straw pole of podiatrists on this forum, or in post grad education, or at your average conference and I suspect we would see this trend. But is this group representative of the profession? I suggest not! This is, by definition, the group interested in biomechanics CPD.

    Certainly in the UK most schools of podiatry I am aware of are still teaching a modified root model. Even in other areas i suspect Root is taught as a baseline from which other models spring. The student who descend upon me from time to time are firmly imprinted with this mindset!

    So we have a good number of UK podiatrists entering the workplace with root firmly implanted (albeit with a lingering sense from their tutor that its not necessarily all there is).

    Then we have those who learn the new models, and then return to work the next day and revert to type. I have known many a podiatrist with wonderful theoretical knowledge, who undertake fabulous assessments with many disparate elements... and then cast in neutral, balance ff rf and wedge the rearfoot to however much. They THINK progressive biomechanics but they USE Root, even if they do not adopt the thought process. I embraced SALRE wholeheartedly but it was a while before I was brave enough to leave my comfort zone and use a Kirby skive or a lateral heel wedge.

    It would be interesting to hear from a commercial lab how many prescriptions they get for a "standard" STJN root device, compared to others.

    I rather suspect that although the model has fallen from favour amongst those of us who debate these things, if one looked at what the majority of Podiatrists at the coalface actually DO, we'd see far more root than anything else and no less Root than 5 years ago. For every Biomechanist who renounces the criteria for normalcy there may be two who graduate with the model in mind or backslide into ignoring their assessment and relaxing comfortably into their "cast neutral, balance, wedge" groove.

    Perhaps as a test we might conduct a survey. Present a cross section of working podiatrists with a patient with medial Knee OA and a foot with rearfoot varus. For all our claims how many will provide a lateral wedge and how many will cast the foot in STJN etc etc. That would give us an idea of how many, when push comes to shove, are willing to defy the root mindset and go with evidence and engineering. The test is not how many renounce it in public, but how many cling to it in private!

    Regards
    Robert
     
  5. Griff

    Griff Administrator

    Sadly I think Robert is bang on with this - I'd certainly agree thats the state of things in the UK at present.
     
  6. Atlas

    Atlas Well-Known Member

    I liked this bit ...









    There will always be valuable cherries on the root-tree IMO. It might have a few dead branches that have and will fall. To proclaim that root-biomechanics is an anachronism might encourage a too narrow focus by future students.

    We were told only years ago, that socialism/communism was dying? Look at the state of the neo-conservative free-market now.




    I will continue to cherry-pick from a plethora of theories. Each will have its own relevancies in its certain situations.








    If Root Biomechanics is dying, the question should be

    What is the phoenix, that will rise from its ashes?


    Until we are happy about the phoenix, we shouldn't totally abandon the carcus.




    Ron
    Physiotherapist (Masters) & Podiatrist
     
  7. ANDY RYALS

    ANDY RYALS Member

    What other paradigms are used to write prescriptions for functional foot orthotics? There are massive commercial factors involved here, the vast majority of pods will prescribe Root based orthotics based around Root based assessment protocols. We have other paradigms, but not enough evidence to justify a change in how we practice. I think it would be better to say that ROOT's paradigm is not dying (in fact it's firmly embedded), buts its validity is being challenged. This is as it should be, nothing is science stays in stasis!! I would be interested in seeing what other paradigms people are using in replacement of the Root model?????
     
  8. Griff

    Griff Administrator

    Andy,

    If you prescribe a medial heel skive it could be argued you are using the SALRE paradigm to write a prescription for a functional foot orthosis...

    If you prescribe bilateral heel raises and 1st Ray cut outs/kinetic wedges then it could be argued you are using the sagittal plane paradigm to write a prescription for a functional foot orthosis...

    If you prescribe a FF valgus post/wedge/extension in a patient with peroneal tendinopathy it could be argued you are using the tissue stress paradigm to write a prescription for a functional foot orthosis...

    Just a few examples

    Ian
     
  9. Five question marks! You really want to know don't you!;)

    How about tissue stress.
    Disagree. There is plenty of deductive evidence for changing how we work.

    For EG. With a patient who has fnHL would you consider some form of 1st MH cutout / reverse mortons extention? That, to my knowledge, is outside of "Root Protocol" and is therefore a change in how we practice!

    Regards
    Robert
     
  10. ANDY RYALS

    ANDY RYALS Member

    Yes, point taken, but I bet you still put some of these modifications on a Root based design orthotic, it was Root that designed the things in the first place. So will still use Root paradigm for orthotic design and other paradigms to design and
    add new extensions/extensions to our functional foot orthotic. So, what other paradigms do we use to design a functional foot orthotic? (Not add to it or modify it with other paradigms).
     
  11. ANDY RYALS

    ANDY RYALS Member

    Thanks, i use tissue stress already and funnily enough your example of fnHL prescription control is the same thing I've been using for many years now.
     
  12. Depends what you define as a functional foot orthotic. If a device is cast other than in STN, not cast corrected in the traditional way , moulded using material other than polyprop and wedged with no intention of returning the foot to SJN its not really a Root device to start with any more than a Pagani Zonda is a modified ford escort. It has some of the same characteristics and as nothing is designed in a vacuum it might be influenced by it, but one cannot say that the latter is a modified version of the former.

    Is an audi TT a modified Golf GTI? Shares a lot of the characteristics and even parts but it is clearly (and increasingly as it evolves down its own path) a different creature.

    Orthotics existed before root. Were Root devices modified arch support?

    I think the defining characteristic of a Root FFO is the modifications designed to return the foot to the "normal" position. If the FFO is cast / modified to do other than this, I don't think it can be called a Root device!

    Be interested to hear Jeff's view on this.

    Regards
    Robert
     
  13. Ian Linane

    Ian Linane Well-Known Member

    I enjoyed Kevin's article and grasp and understand the move towards more engineering concepts within Podiatric biomechanics. However:

    1. Is the idea of "Podiatric" biomechanics a misnomer and long been a complicator of the issues? That is, surely there is "Biomechanics" - just that in our case it is applied to the foot as opposed to the arm.

    2. Are not Podiatrists playing a sort of "catch up" with bioengineers who, from my experience of conversations with them, have long considered "Podiatric biomechanics" to miss the mark or complicate the matter further because of the belief like adoption and (possibly) misapplication of Root. As Kevin noted, Root anticipated his ideas to become surpassed, it may just be that podiatry has chosen to lag behind as to surpass takes courage and thinking and, perhaps more importantly, listening to those outside of a profession who have much to offer to our understanding.

    Ian
     
  14. Ian:

    Very insightful remark. I totally agree.
     
  15. ANDY RYALS

    ANDY RYALS Member

    Ian,

    You have hit the nail bang on the head. Podiatrists are like magpies in that we steal other professions. Podiatric Biomechanics, Podiatric Accupuncture, Podiatroc homoeapathy, even Podiatric orthopaedics, are we seeing a pattern here. We rely on other professions to develop our own profession.
     
  16. ,

    Indeed. Sometimes we pick up some little gems (like biomechanics). Then there's those things on that list which are (IMVHO) shiny and gaudy but worthless pieces of C**p we would be best leaving on the junk pile of medical castoffs and dark age thinking where they belong :mad:.*

    There is a dissonance between Podiatry and other professions such as physio and orthopaedics. Physio, for eg, is defined by the therapy type. Physical therapy. Podiatry, Podiatry, however, is defined by the body part. A podiatrist will use physio techniques, surgery techniques, dermatology techniques etc on a specific body part / function. A physio will use a single therapy type on many areas, feet, legs, hips, spine, etc.

    Other professions tend to specialise by demographic or body part. We tend to specialise by treatment type within podiatry.

    Regards
    Robert

    *Sorry. Bad day.
     
  17. Ian Linane

    Ian Linane Well-Known Member

    Hi Robert

    Sorry to hear about the bad day.

    I believe a sniff of certain aromatherapy oils or imbibing of certain homeopathic brews can do wonders for bad days. Failing that, a course of reflexology can help balance the energy zones! :boxing:
    :D
    Ian
     
  18. [​IMG]
     
  19. Jeff Root

    Jeff Root Well-Known Member

    Root theory has many components. Some components have or will become obsolete while others will continue to be part of the basis of "podiatric biomechanics". The application of Root theory is found in biomechanical examination, surgery, and foot orthotic therapy. Until you can completely extract it, Root theory will live on.

    One interesting issue we face is how to define and differentiate the following: a functional foot orthtotic, a Root type functional foot orthotic, and other types of foot orthotics. While a Root functional orthotic was usually made from a neutral position cast, it was sometimes made using a supinated or pronated cast of the foot. Therefore, it is the nature of the cast modifications, the orthotic shell configuration, the use of a suspension casting technique that helps to differentiate a Root type orthosis from other types of devices.

    Root's STJ neutral position and heel bisection technique are the basis for defining inverted and everted conditions of the forefoot and rearfoot. Until we are willing to stop using the terms ff varus, ff valgus, ff supinatus, rf varus, rf valgus, inverted heel position, everted heel position, supinated foot, pronated foot, etc. we will continue to be practicing Root theory. All of these concepts are dependent on the Root theory of foot classification and Root's biophysical criteria for normalcy. What other paradigm allows us to replace these methods of categorization?

    Jeff Root
    www.root-lab.com
     
  20. Jeff:

    Thanks for coming into this discussion.

    While I would agree that Merton Root may have been the first to coin and define the terms "subtalar joint neutral", "forefoot varus", "forefoot valgus", "forefoot supinatus", "rearfoot varus" and "rearfoot valgus", the terms "everted heel position", "inverted heel position", "pronated foot", "supinated foot", I believe, were coined and used well before Dr. Root began to popularize them.
     
  21. Thanks for coming back Jeff. :drinks

    This is a fair question and a good point! This terminology does work from the Criteria for normalcy as a baseline. Personally I rarely if ever use any of those with the possible exception of FF supinatus (which i tend to describe as inverted forefoot) and Forefoot Valgus. These I only refer to if the abberation is huge. For example, there is literature which shows that in a healthy population the forefoot sits an average of 8 degrees inverted to the rearfoot. I would be reluctant to describe this as a forefoot varus / supinatus.

    There is a question of degree. One problem I have always had with Pure Root theory is the idea of measuring and altering by a couple of degrees. I don't think this can be done with any meaningful degree of accuracy. Noticing a 30 degree inverted forefoot or desiring to increase supination moments by adding a rearfoot post however has little to do with moving to normal and much to do with moving away from the position / end range where residual moments are are causing tissue stress.

    In other words, if I place my hand on a hot hob I withdraw my hand, but i'm not seeking to move it toward the minimum distance from the hob in which i can hold my hand without burning, just away from the point where it IS.

    Regards
    Robert
     
  22. efuller

    efuller MVP

    Kevin and I had a bit more to overcome to "unlearn" what we had been taught. Both Kevin and I were in the Biomechanics fellowship at CCPM where part of our fellowship was teaching. If you really want to make someone believe something youi should make them teach it. Not only that, but the curriculum at that time had four semesters of classroom biomechanics. Spending that much tmie on something will make you think that your instructors think it is worthwhile and important.


    I think it is important to examine what we should take away from Root theory. One of the biggest contributions is that not every foot is the same. This is important for research as well as treatment. Certain treatments (e.g. forefoot valgus wedge) will work well for some patients and not for others. Defining the deformities was a pretty good attempt at trying to figure out who should and should not get certain treatments. For the longest time I was completely down on forefoot to rearfoot as a useful concept because it is impossible to measure. However, Jeff posted to the arena a long while back about how if you look at the extremes there is something to forefoot to rearfoot. There is such a thing as a rigid forefoot valgus foot that will tend to oversupinate. There is a forefoot or rearfoot varus foot that will not have enough range of motion to get significant weight on the medial forfoot in static stance. I feel that biomechanics would lose a lot if we discarded these concepts. We just can't measure these things precisely.

    Anonther important advancement from Root biomechanics is the use of forefoot and rearfoot wedges in treatment. I think that the effectiveness of these treatments can be better explained in the tissue stress approach when compared to using Root et al explanations. That does not dimiinish the observation that the use of wedging can improve patient symptoms.

    Root biomechanics will not die out. However, some of the ideas will drift. For example the definition of rearfoot varus should drift from neurtral position is inverted to the leg to a more practical definition of the rearfoot cannot evert far enough to significantly load the medial column.

    However, there are some parts that do need to be discarded. So, why do you cast the foot in neutral STJ again? I have to admit that I still do, but only because that is where I have the most experience in modifying the device/prescription.

    Regards,

    Eric Fuller
     
  23. Dananberg

    Dananberg Active Member

    I always felt that one of Root’s major contributions was the invention of a language for podiatric biomechanics so practitioners could communicate with one another. As a blend of mechanical and clinical, it forged a new way to think (and more importantly, discuss) ideas and thoughts on foot function. That ability has become quite refined as evidenced by this website, but it had to start somewhere.

    One of my favorite life concepts is known as “The Theory of the Coach”. Basically, it states that the hardest part of any job is getting off the couch to get started. Starting, like creating something from nothing, takes special ability, talent, and often a touch of genius . As it was the original paradigm shift, Root theory can never die.

    Howard
     
  24. Cameron

    Cameron Well-Known Member

    netizens

    Must say have deja vu reading through this thread.

    The criteria for normalicy is a hypothetical model which has no scientific basis whatsoever. It was a very clever model (credit to the authors) and the basis for foot orthoses but the concept of sub talar neutral is a tautology which results in an oversimplification of kinetic movement into a single plane analysis.

    Since the complete nomenclature of podiatric biomechanics is based on the sub talar neutral definition (which does not exist) then the lexicon of podiatric biomechanics is nonsense. Trying as that may be.

    toeslayer
     
  25. drsha

    drsha Banned

    Kevin starts this thread with the word Colleagues and asks
    Is Root Biomechanics Dying?
    col•league:
    n.
    A fellow member of a profession, staff, or academic faculty; an associate
    .

    Its derivation is
    Fr collègue < L collega, one chosen along with another
    And
    leg•ate (leg′it)
    noun
    1. an envoy or ambassador
    2. the governor of a province, or his deputy


    The Arena represents a profession that I am not a part of and evangelically, dares me and the rest of MY COLLEAGUES to join or die!

    I am not an engineer, I am not a physicist, I am not a researcher. I am a Podiatrist.

    My profession uses the literature, in addition to other input, after weighing its substance and strength to enable us to improve how we evaluate, diagnose and treat mankind, individually, when it comes to the foot and lower extremity in preventive, performance and quality of life issues including the management of deformity, pain and overuse issues, metabolic disease and suffering.

    I weigh the body of your weak, poorly substantiated, 2 patient, self funded and unbelievably biased work that you prostelatize as the literature and research of the International Biomechanics Community in the same light MY COLLEAGUES hold my theories.

    I guesstimate that you have about 300 colleagues vs the thousands of us who as antagonists find you arrogant, close minded, totally self serving and downright mean.

    Kevin, I already have 14,000 colleagues in America alone, one of which is YOU!

    I can tolerate your abuse and selectively swim in your cesspool but now in your article and this thread, you reveal that you believe you have gathered enough steam to bury your bloodline, education, roots, forebearers, your fellow colleges of podiatry and your fellow podiatrists until and unless we all conform to your angry postulates and mean governance in your new profession.

    Kevin, we read through the kind words that you close your article with after putting a knife in Dr. Roots back as lacking remorse and totally self serving.

    Furthermore, if you bury your history, trash its language and base the future solely on things that you have (and have yet) developed, your work will be easier for practitioners of clinical biomechanics to make vestigial in the future.

    I predict that someday you will read an article by a Podiatrist entitled, Is Kirby Biomechanics Dying? Only then will you feel like I am sure Jeff Root does after reading your article.

    I value you and your work as my podiatry colleague but like mine, I realize is polarized and biased and flawed. I take it with a grain of salt and end with “Kevin will be Kevin”.

    On The Arena, I have been told that my parents are siblings, that I am a twat and been asked to get a refund of my DPM, Cum Laude NYCPM degree investments. Behaving like that, why would I want to be in your profession and under your governmental rules and laws?

    I visit The Arena to learn about biomechanics and to gain experience navigating through the cesspools of life and thank you all for that but please do not delude yourself that it is different for me than visiting any other infomercial that I will never but into.

    When will you be quoting longitudinal studies funded by outside sources, with serious numbers of subjects, backed by practical clinical confirmation that goes beyond a root neutral shell or a foam box, clinically based on actual, standardized methods of analysis and conclusion?
    You are so far from that time and so detached from Podiatry.
    Dennis
     

  26. Dennis:

    I was expecting a reaction like this from you. Since you obviously didn't like the article, then this should bode well for how my article is received by the remainder of the international podiatry profession.

    Good luck with the marketing of your trademarked "The Foot Centering Theory of Biomechanics" .
     
  27. drsha

    drsha Banned

    Kevin:
    On the contrary, I think your article and your passion for the good of mankind provides great insight to pointing out the growth of biomechanics since Root and the need for continued change.
    However, threre is evolution, upgrading, expanding and so many other words and ways to present your point as opposed to DEATH!!
    That is my insult and the reason why I reduce the value of the things you say and promote.

    Dennis
     
  28. Dennis:

    For your information, I did not choose the title for the article. It was chosen by Podiatry Today. I guess they thought a title such as that would generate a little more controversy and commentary....which, it seems, to already have accomplished quite a bit of controversy and commentary, at least on Podiatry Arena.

    I am anxious to see how the podiatrists in the US respond to the opinions I expressed within the article. Certainly, if you feel so strongly about what I wrote, you should write a letter to the editor to let them know how you feel. Commentary and debate is the purpose of such articles...to promote open discussion...hopefully all for the good of the international podiatry profession.
     
  29. Petcu Daniel

    Petcu Daniel Active Member

    Hello,

    Sorry if I ask a stupid question ! I have read the book „The Manufacture and Use of the Functional Foot Orthosis” by Raymond Anthony, published by Karger (1991) . For me, this book it’s a very good reflection of Root paradigm in practical manufacturing protocols, even if it is made sometimes in a “purist manner” as it’s the author statement. Mr. Kevin Kirby’s books and articles, like the work of the other great researchers from this field, represent to me an invaluable challenge to the way of thinking the use of foot outhosis in the treatment of mechanically induced foot pathology. I want to ask your opinion about the capacity of a paradigm to generate practical manufacturing protocols like those from Mr. Anthony’s book. I have to tell you that I’m from a country where the podiatry profession and foot biomechanics literature doesn’t exist so, in a way, I have to rebuild each paradigm from many parts without any guidance provided by an education system like those from California School of Podiatric Medicine or LaTrobe University, for example.
    Sorry for mistakes!
    Sincerely yours,
    Daniel
    :empathy:
     
  30. Jeff Root

    Jeff Root Well-Known Member

    Kevin, sorry for the delayed responses but I have been away at the Midwest Podiatry Conference. I think you may have missed the essence of my point. Without using a standarized method of bisecting the distal third of the leg and without bisecting the posterior aspect of the heel, how do you know if the foot is supinated or pronated or if the heel is inverted or everted? What is your frame of reference? If you reject Root's biophysical criteria for normalcy and do not subscribe to his methods of biomechanical evaluation of the foot, then what non-Root method do you use to determine if the foot is supianted or pronated?

    Jeff Root
    www.root-lab.com
     

  31. Jeff:

    Hope you had fun at the Midwest Podiatry Conference.

    In my article, I pointed out that the subtalar joint (STJ) neutral is a poorly defined position of the subtalar joint, it is tautological, can't be reproduced from one examiner to another and thus makes scientific investigation of the foot using STJ neutral or of "deformities" that are based on STJ neutral measurements, as advocated by Mert Root, DPM, lacking in reliability.

    We simply don't need STJ neutral position since it does not need to be used to evaluate feet. We could eliminate neutral calcaneal stance position and just measure relaxed calcaneal stance position relative to how far from the STJ maximally pronated the STJ is resting in while standing. This is what the Maximal Pronation Test does that I invented and first described back in 1992 (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). We used this Maximum Pronation Test as a more reliable indicator of STJ position in our latest foot orthosis study (Javier Pascual Huerta, Juan Manuel Ropa Moreno, and Kevin A. Kirby:Static Response of Maximally Pronated and Nonmaximally Pronated Feet to Frontal Plane Wedging of Foot Orthoses. J Am Podiatr Med Assoc 2009 99: 13-19).

    We could also use Tony Redmond's Foot Posture Index which does not use criteria that use STJ neutral position to determine how pronated or supinated a foot is. We could map out the STJ axis which doesn't rely on STJ neutral postion. We could use the Supination Resistance Test which is another test I invented and also first desribed in the chapter that Don Green and I wrote from the 1992 DeValentine book. We could use Eric Fuller's maximum lateral column eversion height test and/or the Hubscher maneuver to evaluate the forces and motion of the foot. None of the above tests need STJ neutral position in order to evaluate the foot.

    By the way, Jeff, what is the definition for subtalar joint neutral position that you are currently using? This would be a great way to discuss the many problems with the STJ neutral position.
     
    Last edited: Apr 7, 2009
  32. Jeff Root

    Jeff Root Well-Known Member

    Kevin,

    Can I assume that you are no longer using subtalar joint equilibrium theory since there is no evidence that it can be reproduced from one examiner to the next? How much variability is there in the placement of the line drawn on the plantar surface of the foot from one examiner to the next? Is there any difference between experienced and inexperienced examiners? Craig, where's the study on that one?

    What definition are you using to objectively differentiate (quantify) a medially, average (or is it normal?), or laterally deviated STJ axis? I will give you my definition of STJ neutral once again, after you answer that question for me.

    You contend that we don't need STJ neutral to evaluate feet yet you continue to use the concept of forefoot varus, valgus, forefoot supinatus, etc. That seems hypocritical. For example, if you have a forefoot supinatus and you pronate the foot, the inverted forefoot to rearfoot is reduced or gone. Unless you use STJ neutral to determine the presence and quantity of forefoot supinatus, how can you determine if the patient has a forefoot supinatus? There are many clinical benefits to using STJ neutral as a basis for comparing feet. While you may advocate discarding them, many practitioners do not. Regardless of your preference, you will continue to need the concept to communicate with others until you can develop or adopt a foot classification system that replaces it. As an example, how many surgical procedures require an neutral position x-ray as a basis for calculating osseous surgical intervention? Since the angular relationship of the osseous structure of the foot changes with positional changers of the foot, which of the alternative systems that you mentioned above will allow x-rays to be taken that are clinically more useful than the neutral position files used today? Random position surgical intervention? Not on my foot!

    Some people might advocate getting rid of speed limits because 1) there is variability between speedometers, 2) no one actually follows the speed limit, and 3) no one can agree on the best speed. So the solution is to remove all speedometers from cars. But what is a better system? :bang:
     
  33. Jeff:

    You asked me a few questions which I believe I answered. I only asked one question of you.

    To which you replied:

    I would appreciate an answer to the only question I asked of you, Jeff, (i.e. what is the definition for subtalar joint neutral position that you are currently using?) if you want me to continue this discussion with you.
     
  34. Jeff Root

    Jeff Root Well-Known Member

    This conversation is not worth continuing since you are unwilling to acknowledge the weaknesses of your own theories and since you are attempting to dismiss the limitations of your theories but are more than willing to discredit the theories of others. This horse was dead years ago! :deadhorse:
     
  35. Jeff Root

    Jeff Root Well-Known Member

    Kevin, what was your answer?
     
  36. drsha

    drsha Banned

    Kevin Stated:
    The Maximal Pronation Test does that I invented and first described back in 1992 (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). We used this Maximum Pronation Test as a more reliable indicator of STJ position in our latest foot orthosis study (Javier Pascual Huerta, Juan Manuel Ropa Moreno, and Kevin A. Kirby:Static Response of Maximally Pronated and Nonmaximally Pronated Feet to Frontal Plane Wedging of Foot Orthoses. J Am Podiatr Med Assoc 2009 99: 13-19).

    We could also use Tony Redmond's Foot Posture Index which does not use criteria that use STJ neutral position to determine how pronated or supinated a foot is. We could map out the STJ axis which doesn't rely on STJ neutral postion. We could use the Supination Resistance Test which is another test I invented and also first desribed in the chapter that Don Green and I wrote from the 1992 DeValentine book. We could use Eric Fuller's maximum lateral column eversion height test and/or the Hubscher maneuver to evaluate the forces and motion of the foot. None of the above tests need STJ neutral position in order to evaluate the foot.

    This is a great and timely debate. I predict that it will turn personal and ugly as Kirby's arguments and skills are shown to have many of the same flaws as he denounces others with. At some point, The Administrator will close the thread as he does with all opposing threads whether meritorious or not. I am calling this symptom complex "Arenaitis".

    Dennis Debates
    I have no argument that these evaluaton and diagnostic techniques you and your colleagues have invented represent one possible direction for consideration as uogrades and expansions on diagnosis and evaluating feet biomechanically but have they led to any advances in treatment?
    Have they expanded, upgraded or changed your casting technique for creating an orthtoic shell?

    Your lab pictures and those that I have seen you post on The Arena of your orthotic shells seem to be generated from a Root Suspension technique which you then Rx with your inventions?
    If so, what difference does it make cinically if you use Dr. Roots fallable strategy or your fallable strategy? I think that is Jeffs point and it deserves an answer, not a dodge.
    If not, please describe the advances in casting a foot orthotic negative cast that your inventions, terminology and research have fostered as I will be glad to incorporate them into my treatment plans.
    Dennis
     
  37. Can I play?

    I think that there is an error in considering a foot to be pronated or supinated in terms of describing "a foot". Depending on where one defines neutral the more recent Mc poil and Cornwall data (1994?) suggests that

    A: the foot is never in a static position, passing through most degrees from a bit pronated to maximally pronated twice in each stance

    B: the foot never actuall passes through neutral while WB!

    I think to describe a foot as pronated or supinated is like describing a person as seated or standing. It describes what they are doing this second not what they are.

    One can see what a foot is doing. One can derive what is creating excessive tissue stress. One can attempt to push the foot in such a direction as to attenuate same. Whether that foot in static WB is described as pronated, supinated, rigid or flexible or 23.6675 degrees for the rotation of the planet does not change what it IS. Its all just how we describe it! Semantics if you will.

     
  38. drsha

    drsha Banned

    Robert:
    I hope I am misjudging but I wrote it to reduce the slimy comments from surfacing by harvesting the energy of some of the members in delighting in proving me wrong.
    Dennis
     
  39. DTT

    DTT Well-Known Member

    Hi Dennis

    Nope don't think your wrong ,that is that they have proved you wrong,because you are wrong ,and being wronged as you feel you have been wronged, you are very wrong and carrying on your wailing about being wrong is spoiling what is a great discussion.

    DENNIS DO YOU SEE A PATTERN EVOLVING HERE????? :wacko:

    Two ears one mouth, listen twice as much as you speak.:empathy:

    Just a piece of friendly advice :rolleyes:
    Cheers
    Derek;)
     
  40. Jeff Root

    Jeff Root Well-Known Member

    I agree! When you manufacture an orthosis using a POP cast or a digital, 3-D model of the foot, the frontal plane orientation of the model must be determined during the manufacturing process. We have no choice in this matter. Whether this is determined by the practitioner using heel bisection, forefoot to rearfoot angle, or randomly (post to cast, correct as is, etc), or in the lab by a technician, the frontal plane position of the cast or image must be determined to make a device. Therefore, like it or not, someone is determining the position of the heel in the frontal plane. I find it interesting that the one plane we must actually determine to manufacture an orthosis is the one plane that gives some on this forum so much trouble. It doesn’t matter if the cast is ad/abducted during manufacturing and we do not alter the sagittal plane orientation of the cast.

    Questioning the reliability of heel bisections and the value of forefoot to rearfoot relationships within the foot does not absolve us of our obligation to somehow govern the position of the cast in the frontal plane during the manufacturing of orthoses. When we determine the frontal plane orientation of the cast, we are establishing the frontal plane relationship of the forefoot to the rearfoot and the relationship of the plantar plane of forefoot and the rearfoot to the ground. Whether you choose to measure it or not is irrelevant. In my opinion, anyone who suggests that this is not significant has no business prescribing or making prescription orthoses and is living a state of denial.

    I doubt that many of those who question the reliability of forefoot to rearfoot measurements actually use the forefoot measuring device that Dr. Root helped develop. Unfortunately they no longer seem to be available. Much to my surprise, I noticed that even Kevin Kirby wasn’t using one in his recent article about Root theory. It’s no wonder there are issues of reliability when we don’t even use proper and consistent measuring tools and techniques.

    I also noticed that Kevin Kirby’s heel bisection did not appear to use the same technique as that described by Dr Root and which I describe on our website. Note a solid heel bisection line (Kirby in Podiatry Today) versus a segmented line as per Root (if interested, see http://www.root-lab.com/takingagoodcast_p2.htm).

    The posterior, superior aspect of the calcaneus has a parabolic shape which can be palpated and bisected with reasonable clinical reliability. The fact that many people don’t actually bisect the heel as described by Root is the primary reason that there is such wide variability between practitioners. You can lead a horse to water but you can’t make him drink. But when he doesn’t drink, I’m left to beating another dead horse.

    Regards,
    Jeff Root
    www.root-lab.com
     
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