Are Root Biomechanics Dying?

The spatial location of the STJ axis is like using an x-ray to confirm what you already expect to see. I'm not so sure it provides significantly more information on which to base your orthotic prescription once you know the STJ open chain ROM and once you do a visual gait analysis. I find it far more important to assess the spatial location of the MTJ axis. Those individuals with a significantly greater ratio of ad/abduction of the MTJ relative to plantar/dorsiflexion (ie a more vertically oriented MTJ axis) tend to have feet that are more difficult to control.

For example, if you see a child with a flatfoot condition but whose heel remains vertical or slightly inverted during stance, is he fully pronated at the STJ? If you look at the spatial location of his STJ axis and it is adducted or medially deviated, what does this tell us? There seems to be far greater variability in the MTJ than the STJ. The MTJ is a far more complex joint. This child might be subluxing at the MTJ during stance and may be standing with the STJ everted beyond is normal ROM when his heel is slightly inverted or vertical. That's why we need to look the open chain range of motion of the STJ and the angular relationship of the heel to leg. If I had to give up one piece of the above information about this child, it would be the spatial location of the STJ axis since it would be the least useful clinically for me when it comes to writing an orthotic prescription.

I would also want to know his open chain range of ankle joint dorsiflexion and his open chain range of dorseflexion of the hallux more than the spatial location of the STJ axis. I know Kevin is very keen on the technique since he is the one who developed it, but when I talk to doctors about their orthotic prescriptions they rarely mention the spatial location of the STJ axis to me. In comparison, functional hallux limitus is frequently discussed and has a direct influence or the orthotic Rx (reverse Morton’s extension, Cluffy wedge, etc.).

I would be interested in hearing from other lab techs and/or owners on this forum as to what criteria they discuss with their customers when conducting prescription consultations.

Respectfully,
Jeff
www.root-lab.com

 

Eric States:
Then how does an orthotic support the vault directly when there is an inch of soft tissue between the skin and the bones?
Dennis Replies:
This is the second time asked by you and I still do not understand the purpose of the question.
If you put a hard material under a foot that pathologically can collapse in closed chain shaped higher than the unsupported height of any area of the foot, the foot will be prevented from compensatorily collapsing.
Soft tissues will buffer these effects but whether it is the ground, a shoe surface, an OTC arch, a custom root orthotic or a custom vaulted orthotic the material resists collapse by its shape and hardness of the material.
Poron will not have as much vaulting ability as fiberglass of the same shape.
I quess that the selection of materials (your Rx) would partially be based on the amount of soft tissue between the material and the ossous and ligamentous structures it is looking to support as treatment.
:bang:
Dennis

 

Jeff Stated:
My question to Dennis is, why do you use the term vault rather than arch? Wouldn’t it be better to use standard nomenclature like medial arch, which consists of the sagittal and transverse arch of the foot?
Dennis reples:
My definition of The Vault of The Foot utilizies the architectural definition of one specific vault (as you mention there are many) that applies best to foot structure.
The Vault of the Foot, as in architecture. exists when there are two longitudinal arches connected by a curved roof.
The medial and lateral arches and the sum of all of the transverse arches that exist in the foot form The Vault.
STJ Neutral CASTING (Suspension or SWB) captures the medial longitudinsal arch and some level of the lateral longitudinal arch but fails to capture the roof for all but the extreme rigid and extreme flat foot types.
My clinical experience is that Vault fill increases the ability of foot orthotics to treat feet with orthotics kinematically.
:drinks
Dennis

 

Kevin Stated:
If I were to take the time and introduce a system that was to measure "foot deformities" to replace the STJ neutral theory proposed by Root and coworkers, then I would use the maximally pronated position of the STJ as my reference position since
1) it is highly repeatable from one examiner to another and
2) many more people stand in the STJ maximally pronated position than in the STJ neutral position.
Dennis States:
Following in Dr Roots footsteps in profiling all rearfeet in open chain in a manner that allows us to classify them into foot types and then confirming the findings with closed chain static and gait evaluation.
My initial rearfoot exam (Rearfoot SERM) envisions the closed chain position that the foot can compensate to in supination.
My second rearfoot exam (Rearfoot PERM) envisions the closed chain position that the foot can compensate to in pronation.
This is Kevins maximally pronated position of the STJ!!!
and I agree with him as to its value as a test in expanding Roots paradigm.
:drinks
Dennis

 

Jeff:

Subtalar joint (STJ) axis spatial location can give you a direct link to what the prevailing STJ pronation and supination moments acting on the foot are. STJ spatial location can also inform the clinician as to how the orthosis will need to be designed to specifically reduce the pathological internal forces which are causing the patient's symptoms, how the clinician may best optimize gait function, all without causing other symptoms or pathologies in the patient.

Recent research over the last decade has shown that the midtarsal joint (MTJ) does not have a fixed, immovable or highly constrained axis, as you suggest above (Nester CJ, Findlow A, Bowker P: Scientific approach to the axis of rotation of the midtarsal joint. JAPMA, 91(2):68-73, 2001;Nester C, Bowker P, Bowden P: Kinematics of the midtarsal joint during standing leg rotation. JAPMA, 92:77-89, 2002; Nester CJ, Findlow AH: Clinical and experimental models of the midtarsal joint. Proposed terms of reference and associated terminology. JAPMA, 96:24-31, 2006). Therefore, I don't see how you can say that somehow you can move the MTJ around to find a singular "MTJ axis" when the MTJ will move in any direction depending on the magnitude, direction and point of application of the external force being applied to it.

Motion of the midtarsal joint does not occur about a single axis or two axes as has been taught for the last 30+ years within podiatric biomechanics. The midtarsal joint, rather, has a constantly moving axis of motion that is dependent on the prevailing external forces acting across it and the prevailing internal forces acting within it from the muscles, ligaments and joint surfaces, at that instant in time. In the foot shown, the MTJ is clearly seen to be a relatively unconstrained joint; a joint that allows motion around an infinite number of moving axes, not around one or two joint axes.

 

Daniel:

These are all good observations and questions. First of all, we need to know that the group of examiners in any experiment can repeat the same measurements over and over again on the same feet with good accuracy both within themselves (intra-rater) and between each other (inter-rater). Obviously, if we have a group of experienced examiners that all have worked together for some time, have compared techniques with each other and are all careful in their measurements, then one would expect their results of measurements of the foot and lower extremity to be fairly close to each other. However, if we have a group of examiners that have never worked together, have never compared their examination techniques with each other, and are not particularly careful or experienced, then one would expect their measurement results to have larger intra-rater and inter-rater errors.

This is not only a problem with the subtalar joint neutral system measurement system as proposed by Root et al, but is also a problem with any examination technique of the foot and lower extremity, including subtalar joint axis location measurement techniques which I have been lecturing on for the past two decades. We must ask ourselves, why am I doing these measurements and how important are each of these measurements in properly assessing the foot and lower extremity of the patient so that the optimum treatment decisions may be made in their mechanical treatment (i.e. shoes, foot orthoses, stretching, strengthening, etc).

It is very good of you, Daniel, to be reading the literature and becoming more aware of the many problems that face us as clinicians in trying to decide how best to treat our patients. I just wish that all podiatrists would be so diligent.

Hope this helps. Happy Easter.:drinks

 

Kevin, I watched your video of you moving the MTJ. Unfortunately the technique you are using does not enable you to isolate motion at the MTJ. In order to better isolate MTJ motion, you need to grasp the cuboid and the navicular together as a unit. By grasping the foot so far distally (sub 5th met head), you are not only getting motion at the MTJ, but also at every joint distal to the MTJ. This makes it difficult to draw meaningful conclusions about the axes of the MTJ.

In order to better isolate the motion of the MTJ, with the patient supine, grasp the left foot with your right by placing your thumb directly plantar to the cuboid and navicular and your 2nd and 3rd fingers over the cuboid and navicular dorsally. Move the MTJ in pure ad/abdution and then in pure plantar/dorsiflexion and in pure in/eversion. Next, vary the direction of motion with respect to these planes. You will find when you better isolate the motion of the MTJ, the average MTJ demonstrates the greatest range of motion in the direction of simultaneous adduction/plantarflexion and simultaneous abduction/dorsiflexion. There is far less motion in the direction of inversion/eversion. You will not be able to clinically appreciate these motions when holding the foot as far distally as you are in the video, because you are getting motion elsewhere.

In order to help prove my point, I doubt that you would place skin markers or pins in the foot at the point you are applying forces in order to measure the relative motion of the cuboid and navicular relative to the calcaneus and the talus. You would however, place skin markers or pins directly over the cuboid and navicular, which is where I suggest you apply external forces when evaluating the MTJ. This is far more logical than your method if the goal is to isolate MTJ motion in order to draw conclusions about its role in dynamic function.

Virtually every time I teach this technique to podiatrists in clinical workshop, they ask "Why was I never taught this technique in podiatry school?". For those who are interested enough to master this technique, it can provide extremely important visual and tactile feedback to the practitioner as to the nature of an individual patient's MTJ as compared to that of others.

In some feet, there is more freedom and range of ad/abduction as compared to plantar/dorsiflexion. These are typically the feet in which the forefoot has a greater tendency to abduct on the rearfoot in stance. These are the same people you would probably describe as having an adducted or medially deviated STJ axis. In other individuals, it is difficult to produce ad/abduction at the MTJ. This is typical in a rigid, cavus foot. I find the ratio of motion at the MTJ relative to the cardinal body planes to be a very meaningful, clinical assessment tool.

I mean no personal disrespect, but I honestly doubt that you will be receptive to my recommendation. However, it is my hope that others on this forum may consider my recommendation and try to learn this technique so they can draw their own conclusions. This method of MTJ evaluation has been extremely beneficial to me and for those clinicians I know who use it regularly during their open chain examination of the foot.

Respectfully,
Jeff
www.root-lab.com

 

Jeff:

John Weed personally taught me the same technique that you have described above. So not only did I learn the technique that you described above about a quarter century ago, but I taught this same technique for many years. However, after reading Chris Nester's papers which I mentioned in my last posting which says there are no simulataneously occurring oblique and longitudinal midtarsal joint axes, after researching all the previous scientific articles on midtarsal joint biomechanics, after writing four Precision Intricast Newsletters on the subject, and after lecturing both nationally and internationally on several occasions on midtarsal joint biomechanics, I would have to disagree that the midtarsal joint examination technique does anything other than reproduce the erroneous results that were also obtained by Hicks and Manter in regards to midtarsal joint kinematics. To paraphrase Chris Nester: "It is not the axis of the midtarsal joint that determines the motion of the midtarsal joint, rather it is the motion of the midtarsal joint that determines the axis of the midtarsal joint.

Hope you and your family all have a nice Easter.

 

I have to disagree with you about the finding the axis to confirm what you already know. I've been surprised when looking at a foot by how wrong my first guess was when compared to palpation of the axis. There are some very high arched "rigid" feet that will have medially deviated STJ axes and there the very rare low arched, very flexible feet with a medially positioned STJ axis.

Jeff, how do you alter your prescription once you find that a MTJ is more difficult to control?

Jeff, how would you alter a prescription if you find that a STJ is maximally pronated versus not maximally pronated in stance?

I often assess this anyway to assess where the stresses in the foot are more likely to be, but use a different technique. I find the maximum eversion height in stance more satisfying in that I don't have to draw lines and do math or worry about skin lines moving between the seated bisection and stance. (Yes, you can take that into account by redoing the bisection, but I don't want to worry about it.) My reasoning is that if you want to see if the STJ is maximally pronated, see if there is range of motion when motion is attempted.

As for the usefulness of the STJ axis position: I don't see a better measure you could use to decide whether or not to add a medial heel skive, no skive, or a lateral heel skive. Jeff, do you recommend heel skives to your customers?

People will not talk about what they do not know about. Jeff, if you asked them about STJ aixs position they might start using it more in their prescription writing decisions. I agree WB and NWB range of motion of the 1st MPJ can be used in prescription writing.

 

The purpose of the question was to see if you have thought beyond the architectural (centrings, vaults) to the engineering. Am I missing something? It seems that centring is another word for arch support. Dennis, do you think that centrings are different than arch supports? An engineering approach would try and figure out where the forces are applied to get the changes in symptoms.

The soft tissue part of the question is in relation to my own experience. My foot has a very medially deviated STJ axis and attempts to raise the arch of my foot with a high medial arch of an orthotic are painful. Putting something soft on the device helps a little, but it still hurts. I certainly have seen patients who cannot wear orthotics prescribed by other doctors because they hurt in the arch. I can only explain this pain as from compression of the soft tissue. There are people who can tolerate high arched devices. Maybe, those people have less medially deviated STJ axes?


Regards,

Eric

 

Apply your same logic to a simpler joint, for example the 1st MPJ. A trained examiner can appreciate the relative difference in the range and direction of open chain motion at the 1st mpj. In some people, the range of dorsiflexion and plantarflexion are considerably less than others. In some people there is far more transverse plane motion than in others. By applying forces in all directions, one can see the resulting motion or lack of motion available. That motion is what determines one’s clinical appreciation of the axis.

Kevin, are you saying that there is no difference in the range and direction of motion or in the anatomical structure of one mtj as compared to another? Are you saying that I can apply a force in any direction to the mtj and get the same range and freedom of motion? I think not. I agree with Chris Nester. So when I apply a force in one direction at the mtj and get much different motion than I did when applying that same force in the same direction to other individuals, it does tell me something about the quality, range, and direction of available motion. That resulting motion is exactly what helps me appreciate the axes (note plural!)clinically. It is the totality of the applied force in various directions that allows me to differentiate one mtj from the next. I’m not saying the MTJ has one, two or ten axes. I’m saying by examining all of the available motion at the mtj and by relating the motion to the cardinal planes of the body, one appreciate and compare one mtj to another. Even in your test, if you compared the excursion of the forefoot in space and compared it to the cardinal planes of the body, you would appreciate differences from one foot to the next due to fundamental differences in their joints (ie joint axes as determined by the motion).

We have had this same discussion many times before. As I'm sure Eric Fuller can verify, I have described my rather limited and constrained MTJ motion as compared to that of others. There is nothing that you or anyone else can say to change my opinion that this is a very useful clinical technique when conducted properly, because I have seen so much benefit come from using it. Although you may not find it clinically useful, that doesn't mean that others can’t or don't.

Respectfully,
Jeff
www.root-lab.com

 

Jeff, Eric, Drsha, Robert, Simon and Kevin,
Good discussion.
I think some of this can be studied by just looking at the bony geometry then adding ligaments that constrain motion in one direction or another. I think Nester is saying that there are an infinite array of possible axes, especially since the TN Joint is a slightly ovoid ball and socket. Saraffian called this the "Acetabulum Pedis" www.wheelessonline.com/ortho/biomechanics_of_the_subtalar_joint_complex

The restrictions to the ROM in various directions is also posturally dependant. More restriction in the sagittal plane in supination, for example. The ground and superstructure will also add certain constraints in the closed chain.

I agree with Kevin that Neutral theory is falling out of acceptance. It is still firmly rooted however in clinical practice and the transition will be slow, may take decades. Root was after all, quite influential. He gave us quite a gift and I stand in his debt. None of us would be here discussing biomechanics if it were not for his brilliance, hard work, creativity and efforts to disseminate his ideas. I certainly could not have enjoyed my career if it were not for Jeff's dad.

Jeff, I don't think that you have anything to worry about, Neutral is still alive and well and still the casting position of preference of most of the biomechanics world. Everywhere I go I ask, "Who casts in Neutral?" and almost every hand goes up (except for a few…..those MASS position guys). I feel that is the greatest tribute to Dr. Merton Root that every new technology has to be compared and contrasted to Neutral Position Theory.

I also agree with Kevin that the measurements taken both off weight bearing in both the static biomechanical exam and X-rays are sorely lacking in meaning, relevance, clinical significance, inter-rater reliability and especially relevance to manufacturing technique or results. Although, some relevance to the modifications ordered in Rootian technology does come from these measurements. So the solution of course is that Kevin has given us another static off weight bearing, measurement of the foot with, I suspect, poor inter-rater reliability: line of STJ axis on the plantar surface of the foot with the foot in this “plantar parallel” position with no frame of reference.

Better measurements are in order.

On the other hand, Jeff is right. It is important for the practitioner to have an appreciation for the relative ranges of motion of many of the joints of the foot in several directions. It tells us among other things, how much correction is possible, explains the etiology of certain symptoms and diagnoses and should correlate to our observations in gait.

Neither finding the exact location of neutral nor the exact location of the STJ axis’ shadow in the transverse plane when the foot is fully pronated, neutral or supinated has a whole lot of meaning. I guess, if you are struggling to eek some function out of a low, flat, smooth, invented, generic shaped, uncallibrated curve of some material with some bumps and tilts….I guess you’ve all done a pretty good job of that.

Then you allow excessive pronation to occur while worrying about the forces on either side of the STJ see-saw and tissue stresses become relevant. It still doesn’t tell a Doctor what position to put the foot in. I hear a lot of people knock down Neutral but then cast that way……hypocrites.

I agree with Eric that Vault = arch and with Dr. Shavelson that “pronated” = “medially deviated sub talar joint axis”. Pronated is far more elegant and descriptive. I also agree with Dr. Dennis Shavelson that the geometry of the orthotic is important and that vertical force should be applied by the orthotic in the MLA. Restoring the Vault or Arch will have a positive effect on foot posture and to the extent that such correction is possible, will also positively affect foot function. Comparing orthotics to architecture or engineering is almost the same thing.

I agree with Dr. Shavelson that Kevin is self serving in the article….choosing his theories as the new wave (as he did in his “Emerging Concepts….” Article).

I think that Tissue stress model is just a good observation. There is a threshold of damage before symptoms appear. A little over the line and ….pain. Kevin advocates easing people just below that line. To herd the tissues stresses around the bottom of the foot like cattle with a bag of tricks. Pads, lumps, bumps, tilts, skives, grooves, flanges. The Cluffy wedge, the reverse morton’s extension are just the latest tricks to go into the Bag.

I agree with Kevin that angular measurements are best because they take foot size out of the equation but disagree that any reference measurement should be taken in relation only to maximal pronation. I believe it would also be valuable to measure from the most corrected position or our postural goal for correction. Paul Scheerer wisely said at the last lecture of his I attended, to closely paraphrase; Unless you can measure something, you can not improve it.


Good discussion,
Ed Glaser, DPM
CEO Sole Supports, Inc.
www.solesupports.com

Allow me to appologize in advance. I have much going on this week and probably will not have the luxury of time to respond.

 

I have split off a new thread on Midtarsal Joint Kinematics: Motion vs. Stiffness from this thread.

 

Eric, it depends on a number of factors in addition to the MTJ. However, in the interest of answering your question, if the patient has increased motion in the transverse plane, or what was historically described as excessive verticality of the oblique axis of the mtj, I might recommend one or more of the following depending on the patients symptoms, stj axis, ankle joint rom, stj rom, etc.:
1. Pour the heel inverted (depends on STJ range and direction of motion, but probably 4 to 6 degrees inverted)
2. Use a medial heel skive
3. Use a deep medial heel cup of 20 to 25mm and a deep lateral cup of at least 18 to 20mm
4. Use reduce or minimal medial expansion (less or no arch filler)
5. Manufacture the orthotic shell with a wide arch profile to increase medial surface area
6. Use a flat (zero degree motion) rearfoot post
7. Apply a medial post flare
8. Add a lateral clip (lateral flange) to resist forefoot abduction (has to be done in conjunction with many of the above otherwise will likely cause irritation in the lateral forefoot

I can also tell you that many practitioners are likely to inadvertently cast this foot with the stj pronated because normal casting forces applied to the forefoot are apt to produce STJ pronation as well. Therefore, it may be necessary to grasp the medial and lateral sides of the heel with the opposite hand during casting to prevent inadvertent stj pronation. In severe cases, you might want to cast the foot with the stj slightly supinated. In addition, if the patient has significant calcaneal eversion in conjunction with this type of mtj, you need to use a more aggressive Rx than if they don’t have significant heel eversion. However, with severe equines, hallux rigidus, etc., it may be necessary to permit more pronation than this Rx might allow, because this Rx could produce tolerance issues if more compensatory pronation is required by the patient. It is necessary to look at all functional factors before deciding on the Rx.

That depends on where the maximally pronated position of the STJ is. If the heel is everted with maximum pronation, I generally pour the cast vertical. If it occurs when the heel is five degrees inverted, I would pour and correct the heel at leave five degrees inverted. If the patient's maximally pronated position is being caused by a peroneal spasm, then I would stretch out the spasm and cast the foot less everted than the maximally pronated position, but possibly less than vertical. Conversely, if the patient's maximally pronated heel position was 6 degrees inverted and they had a history of inversion ankle sprains, I would pour and correct to the maximally pronated position (6 degrees inverted, and use a lateral heel skive). There are many answers to your question that are patient specific.

[/QUOTE]Jeff, do you recommend heel skives to your customers?[/QUOTE]

Regularly. It's a good modification.

Respectfully,
Jeff
www.root-lab.com

 

Eric States:
It seems that centring is another word for arch support. Dennis, do you think that centrings are different than arch supports?
Dennis Replies:
Eric, What is your definition of arch support.
The vast majority of the orthotics that I see clinically and as displayed by labs on their printed material and websites are well conformed to the medial longitudinal arch and offer little to no “support” of the roof of The Vault (the curved roof between the medial and lateral longitudinal arch). A Centring has as its goal maximal support of The Vault.

Eric States:
My foot has a very medially deviated STJ axis and attempts to raise the arch of my foot with a high medial arch of an orthotic are painful. Putting something soft on the device helps a little, but it still hurts. I certainly have seen patients who cannot wear orthotics prescribed by other doctors because they hurt in the arch. I can only explain this pain as from compression of the soft tissue.
Dennis Replies:
Couldn't you go further in proving your pain is a result of compression of soft tissue using engineerng and physics since you refer to it so often? Do you have any studies? Any proof?

We all see our devices and those of others rejected or not tolerated by patients. Does that justify dispensing inferior devices laden with flaws to the foot suffering public?
If it did, one of my options would be to lower my standards, look for comfort and pain relief as my gold standard for care and, argue against Root STJ Neutral casting even as it remains my accepyed casting technique for creating shells or monitoring the effectiveness of scans. I choose to upgrade Root STJ Casting.
Functional Foot Typing goes far in eliminating intolerable devices by targeting care, foot type-specific.
Eric, Do you believe that the high medial arched orthotic would be more therapeutic than the lower arches device that you eventually ended up with in your personal scenario? If you do, then you should be fighting to find a way to get that device accepted by your feet and those of your patients.
If you don't, why were you trying so hard to break them in?

Clinical rejection of what is a great device gives reason to find techniques to improve acceptance rather than accepting poorer outcomes and blame your defensless soft tissues.
I accept that task as a doctor dispensing orthotics.
If your definition of “the best” orthotic is the one that helps a patient the most without causing any pain before acceptance then you are the root reason why Payne has shown OTC orthotics and custom Orthotics to be equatable.
As doctors, we professionally can monitor the breakin and maximize the benefits of our orthotics before stepping backwards to a device that is no better than OTC.

This is why I developed Foot Centering Pads as part of Neoteric Biomechanics They are applied to the patients shoes, existing insoles or existing orthotics, foot type-specific previewing the effect of Vaulting and biomechanical control and balancing on the initial office visit by introducing the process at a low level.
Patients preview the foam and felt pads prior to a semi rigid orthotic asking for more correction than their tissues can tolerate. Additional pads are applied into the shoes as treatment of the patients complaints, casting for orthotics and lab fabrication time passes. This gives 4-6 weeks time to get soft tissues to strengthen and better tolerate more rigid and better formed materials. They are a test drive for biomechanical balancing and control and great orthotics are accepted when dispensed more often.
If Centering pads are not tolerated, my great orthotic will certainly not be tolerated. In your case (and I see so many) I would have gotten you more prepared to accept my FFT orthotic or if you are the rare case strongly rejecting the pads, I never would have casted you!
After dispensing, I continue to apply Centering Pads to the initial Centring to exert even more correction and additional healthy kinetics. When I believe that the orthotic is performing as best as it can, I have the lab permanently add the upgrades under the topcover or by raising or lowing the angles and thickness of my rearfoot and forefoot posts and then redispense the final Centring.
At this time, I offer patients a course of aggressive physical therapy and gait training to further improve kinetics and kinematics as I believe that further upgrading of the Centring to provide more support and care would prove fruitless.

I reevaluate patients annually and continue to upgrade their care as I refurbish their Centrings.
:drinks
Dennis

 

Hi colleagues!

Pemanently yes.Root biomechanics are standing in for new concepts.

For two or three years, in some Spanish schools of Podiatry, has existed an open discussion ( I suppose that debate in US started many years ago)about the delegates in favour of Root´s paradigm and people who advocates new aspects of modern podiatry(STJA equilibrium, tissue stress, force models,...)In my school, there was Kirby´s paradigm supporters and Root´s theories partisans.It supposed a confused standing for many students because of the conflicting among these theories.

Personally, I think some Root´s concepts cannot be explained by the laws of the physics, and this is one of the reasons why I don´t like so much the vast majority of Root´s affirmations.
I agree with Howard when he states tha “Root’s major contributions was the invention of a language for podiatric biomechanics”.Of course. There is no doubt that Merton was one of drivings of podiatry.

Since I Know Kevin´s theories and other recent paradigms, I have understand very good podiatric biomechanics.Putting them into a daily practice, are contributing to resolute a lot of patients´problems, as long as treating the people from Root´s viewpoint wasn´t such satisfactory.

Regards

 

Thanks for your reply Jeff. In general, are your recomendations based on theory or by what your customers have asked for again in a specific situation. I realize it is not scientific, but it is still very good information. I'm interested in why things work.

It is very difficult to control transverse plane motion with an orthotic that does not curl up around the sides of the foot. It's hard to apply forces in the transverse plane. Some of the modifications that you listed can work that way. Others are related to STJ pronation and I agree that rapid STJ pronation can be associated with transverse plane motion at the midtarsal joint. Both inverted pours, and medial heel skives will increase STJ supination moment from the orthotic.

I can see how a high heel cup can apply transverse plane forces. As you suggest below a lateral clip will help create a transverse plane force couple that can apply transeverse plane moments.

A higher and wider medial arch can help resist adduction of the rearfoot on the forefoot.

A post that makes the arch of the orthosis more rigid will add to 4 and 5 above.

I have to agree with you Jeff, that I can see how each of these modifications can "control" transverse plane motion. So, if you feel that your gait examination tells you that you need more transverse plane control, does the midtarsal joint examination tell you more than what you saw in gait?

I remember John Weed talking about missing the fact that a patient had an equinous and that the orthotics hurt and John was worried about the patient throwing the orthotics at him. I don't know who made the observation first, but it is a good one.

I saw why you chose the modifications that you did for the MTJ. I don't necessarily see why you make the modifications based on the position of the heel in maximal pronation.

Regards,

Eric

 

Dennis you can use your definition of arch supports to explain the differences between centrings and arch supports.

Now you are making a claim that other labs don't supporrt the "roof of the vault" and from the inference that your centrings do support the roof of the vault.

Let's put some names to these things. So the lateral arch consists of the calcaneus cuboid and metatarsals 4 and 5. The medial arch consists of the calcaneus, talus, navicular, 3 cuneiforms and metatarsals 1-3. Do you agree so far Dennis? So the roof of the vault is navicular cuboid? and talus? I don't see how what you make supports these bones any differently than what everyone else makes. Could you explain that?

Dennis do you have a better explanation of these facts. Orthotic with high arches make the arches of my feet hurt. Orthotics with lower arches make my feet feel better than walking barefoot. Sometimes, you got to go with empirical data.

How many of your patients tell you they don't want comfort and pain relief? If they come to you asking for the best orthotic, do you think the best orthotic is of a certain shape regardless of whether it hurts or not?

Dennis, I'm going to have to disagree with you. I've heard peole say that you just have to get used to them. I wanted to prove to myself that I could get used to them. There are some patients who will not get used to them even after a month long break in.

Dennis what is your criteria of best orthotic and why do you think that this criteria is correct?

Dennis, how do you vary your centring pads for the different foot types? How does an orthotic vary for one foot type when compared to another?

Regards,

Eric

 

I asked of Eric:
What is your definition of arch support.
Eric States:
Dennis you can use your definition of arch supports to explain the differences between centrings and arch supports.
Dennis Replies:
Was my question too hard or would it leave you in an uncomfortable position on the chessboard?
Eric:
What is YOUR definition of arch support?

Eric States:
(Dennus infers that) other labs don't support the "roof of the vault" and from the inference that your centrings do support the roof of the vault.
I don't see how what you make supports these bones any differently than what everyone else makes. Could you explain that?
Dennis States:
I chose a heel relief orthotic from the precision intracast website as an example:

By medial arch, I mean the medial rim of the foot.
This device doesn’t support one of the bones you mention as making up the roof of The Vault!

It allows for collapse of the roof of The Vault, not support.

Eric States:
Dennis do you have a better explanation of these facts?
Dennis replies: I asked you for proof, scientific evidence, studies as you have asked me to supply regarding Neoteric Biomechanics.
Since your explanation of these facts has no evidence basis (as does mine), why does yours merit attention and mine merit derision?
Do you have a better explanation of my facts?
How do you like the podiatric shoe on the other foot Eric?

Eric Stated:
I disagree with you. I wanted to prove to myself that I could get used to them.
Dennis States:
Your medially displaced axis needs to be more centered to the gound on the three body planes in order to have comfortable function, excellent lever arms of your musculotendonous units and overall efficient function. It wants to be in a position that eliminates the tissue stress flowing through all of your bones, ligaments and joints and musculotendonous units. If Vaulting gets you there (and it does) isn’t that worth getting used to or would you like to be progressively more deformed and deviated throughout your life?
I asked of Eric:
What is your definition of arch support.
Eric States:
Dennis you can use your definition of arch supports to explain the differences between centrings and arch supports.
Dennis Replies:
Was my question too hard or would it leave you in an uncomfortable position?
Eric:
What is your definition of arch support?

Eric States:
other labs don't support the "roof of the vault" and from the inference that your centrings do support the roof of the vault.
I don't see how what you make supports these bones any differently than what everyone else makes. Could you explain that?
Dennis States:
I chose a heel relief orthotic from the precision intracast website as an example:
Attachment: A precision intracast orthotic
By medial arch, I mean the medial rim of the foot.
This device doesn’t support one of the bones you mention as making up the roof of The Vault!

It allows for collapse of the roof, not support.

Eric States:
Dennis do you have a better explanation of these facts?
Denis replies: I asked you for proof, scientific evidence, studies as you have asked of neoteric Biomechanics.
Since your explanation of these facts has no evidence basis (as does mine), why does your merit attention and mine merit derision?
Do you have a better explanation of my facts?
How do you like the podiatric shoe to be on the other foot Eric?

Eric Stated:
I disagree with you. I wanted to prove to myself that I could get used to them.
Dennis States:
Your medially displaced axis needs to be more centered to the gound and the posture in order to have comfortable function, excellent lever arms of your musculotendonous units and overall efficient function. It wants to be in a position that eliminates the tissue stress flowing through all of your bones, ligaments and joints and musculotendonous units. If Vaulting gets you there (and it does) isn’t that worth getting used to or would you like to be progressively more deformed and deviated for the rest of your life?

Eric States:
Dennis what is your criteria of best orthotic and why do you think that this criteria is correct?
The Tenets for a Foot Centring Are:
1. Optimally Supports The vault of the Foot, foot type-specific
2. Balances the rear pillar to the three body planes (or foundation)
3. Balances the fore pillar to the three body planes
4. Balances the rear pillar to the fore pillar
5. Balances one foot to the other
6. Promotes musculotendonous leverage, performance and efficiency

Eric Finally States:
Dennis, how do you vary your centring pads for the different foot types? How does an orthotic vary for one foot type when compared to another?

Dennis States:
Eric, you will either have to wait for my latest advance to patent (where I inject information and education into a subject so they don’t have to investigate it on their own) or investigate some of my stuff as I have done yours.

Eric States:
Dennis what is your criteria of best orthotic and why do you think that this criteria is correct?
The Tenets for a Foot Centring Are:
1. Optimally Supports The Vault of the Foot, foot type-specific
2. Balances the rear pillar to the three body planes (or foundation)
3. Balances the fore pillar to the three body planes
4. Balances the rear pillar to the fore pillar
5. Balances one foot to the other
6. Promotes musculotendonous leverage, performance and efficiency

Eric Finally States:
Dennis, how do you vary your centring (spellcheck - Centering) pads for the different foot types? How does an orthotic vary for one foot type when compared to another?

Dennis States:
Eric, you will either have to wait for my latest advance to harvest (where I inject information and education into a subject so they don’t have to investigate it on their own) or investigate some of my stuff as I have done yours.
:drinks
Dennis

 

Both. After you do this long enough it almost seems intuitive. However, that intuition comes from studying theory, science (especially the practical application of physics), and history (past experiences with a similar set of conditions). We learn from our past failures and successes. I always think of functional control as a relative concept. I know what prescription options will increase the relative control of an orthosis and I look at feet in terms of their relative difficulty to control based on the specific patient information that I have available to me. I also look at where we need to exert functional control to get the best result.

 

Clearly both Dennis and I (and especially Dennis!) need to figure out how to use the quote function on this website. Any suggestion would be greatly appreciated!

 

I would like to know how I place attachments to a post more than the quotes.
Dennis

 

Jeff:

There is a quote icon above the box where you write your posts that will put in the correct beginning and ending to your quoted material. In one of your last posts, you left out the left bracket symbol, [ , before the /QUOTE] at the end of your quote which prevented the software from recognizing it as a quote.

 

Thank you for bring this article to my attention and I must admit I tend to agree with one exception, Dr Root and his team started the change that few academics had the vision to continue.
Although the initial work had its assumptions and conclusions we often find the answers hidden in the text and all we need to do is understand the simplest of physics and anatomy to conclude that the foot is a simple yet complex structure.
All too often ideas are thrown out because of variation factors in both individual anatomy and very poor teaching techniques by academics that don't let their minds explore.
I am totally aware of the investigation carried out in Australia regards the variation in one patient but I put this forward: the clinicians we trained by academics that were trying to disprove orthotic therapy and so the research was of the worse bias and should be discounted.
Root etal explored the possibility that there was a subtalar neutral where neither supination nor pronation was present and this was calculated in an open kinetic chain motion. If we take this further reading C. Oxnard's work we understand that while the talus is superior to the calcaneus the integral shape of the joint would dictate a position where force travels vertically with no supination nor pronation, osseous restraining mechanism, Root etal.
Dr Root's work indicated the use of support of the sustentaculum tali to control the calcaneus and our research, primarily dissection and histology of the region, indicates this is the same area that the cuboid supports the spring ligament as well and the talar dome. . The canter lever of the medial process of the cuboid produced by the action of peroneus longus allows for the resupination of the foot at propulsion and the angle of the medial process will determine the degree of midtarsal joint motion in both its axis’s during midstance to heel off.

Our laboratory only makes this style of device (fully balanced Root device), not based on theories rather scientific and anatomical fact. This is the dilemma, Laboratories are not thorough enough in the riggers of correct manufacture and so the profession is led by a force they have no control over and so standards fall and confusion compromises our univerities.
So I agree with your conclusion in the article,
I do feel however, Dr Root's thought will always challenge our profession to achieve a better clinical understanding of the biomechanics of the skeletal system.

Regards
Alex Adam

 

At the bottom right of each post there is a button labeled quote. Click on that button and the entire message will have "[xxx quote]" around it. To break it up you can copy the [] and paste the top at the beginning of a new quote and then paste the last one at the end. You can also cut text that you don't want to quote.

Eric

 

That device would support those bones in a very flat foot. Don't you see different people who have the same foot type, but different arch heights?

What is the medial rim of the foot?

Dennis, how do you know when the rear pillar is balanced to the three body planes?

Dennis, I got that spelling of centring / centering from your posts. As I saw the centring spelling more often I assumed it was a patened or trademarked thing that you did.

Dennis, How come you repeated my questions and answered them twice? Were you not having enough fun not answering the questions just once?

Dennis, I guess I'll just have to wait, because I'm not going to try them unless you can explain why they are different from what I already do.

In anticipation,

Eric

 

One last time:
Eric:
What is YOUR definition of arch support?
Dennis

Please stop asking questions of me until you answer mine.

 

For what its worth, I think its well nigh impossible to define something as nebulous as an "arch support". Its poor terminology. To call it the "arch" oversimplifies a complex three dimensional structure into a two dimensional one.

And what exactly is, to "support"? I think this harks back to the rather unhelpful and inaccurate mindset that the foot will configure to the shape of the dorsal surface of the orthotic. Which is not needfully the case.

"arch support", to me, comes from the school of thought which refers to "collapsed arches". Whatever we might think of the Root model in light of more recent ideas, it is clearly a quantum leap above this rather crude and vague terminology.

How would I define an "arch support"? I wouldn't!

I know I'm not Eric but perhaps since I answered that question you would enlarge on something you said? Cos it makes no sense to me!:bash: I've numbered my questions for your convenience and so you don't miss any!

1. What do you mean by "centering" an axis to the ground.2. How does one center an axis? What is the correct position for an axis? 3. How do your insoles modify the position of the axis?

4. What is an "excellent lever arm"?!

5. How on earth can an axis "WANT" to be anywhere!? Is it unhappy where it is now? How does one assess the emotional state of an axis?

Hmmm. Eliminate tissue stress you say. 6. How do we do that outside of the international space station?

Nice to know it cheers the axis up. Nobody wants a depressed axis! Out of interest are we just to take your word for the fact that your insoles do these things?

I've never had the pleasure of meeting Eric. Until I do i will forever more now imagine him as an Igor type figure with a hunch and a lithp. Progressively deformed. You poor soul :boohoo:.

Sorry if I seem facetious, but its impossible to understand what you mean when you post of centered axis, excellent lever arms and eliminating the tissue stress flowing through the body!

At the risk of incurring your resentment one might almost imagine the you don't actually understand what these things actually are!


Regards
Robert

 

An arch support is a vague and general term that can be used to describe a wide variety of custom made or non-custom made shoe inserts. These devices may be manufactured to the foot directly, to a model of the foot, to a tracing of the foot, to an ink imprint or other two dimensional representation of the foot, or they may be prefabricated and manufactured by using a last, model, injection mold, etc. and can be made from a variety of different materials. The theory behind an arch support is to promote an increase in the height of the arch or to resist lowering of the arch of the foot through the use of an in shoe support.

As with custom, functional orthoses, the issue becomes "which" arch support, since they are not all the same.

Respectfully,
Jeff
www.root-lab.com

p.s. Thanks Kevin and Eric for the tip on how to use the quote functions.

 

Should have got some foot centerings :empathy:

 

Why?





I withdraw my question on whether or not you think centerings are different than arch supports. From reading your descriptions it is obvious that they are arch supports in that they hold the vault ( arch up) An arch support holds the arch up.


I just have this sinking feeling that even with that answer you won't answer the more important questions from the earlier post.

Cheers,

Eric

 

I'm not so sure. From my very limited understanding the "vault" as Dennis calls it is in the frontal plane, much like the Mysterious and possibly mythical "metatarsal arch" but at the base of the mets rather than the met heads and therefore inverted. The "blocks" being the 1st met base , the cuneiforms across to the 5th met base and cuboid.

I beleive most people, when they speak of the "arch" are speaking of the saggital plane, the 1st met, medial cuniform, navicular and the calc.

Of course these are both flawed concepts because while we can take a "slice" with an mri or cadaver and see something which looks like a 2d structure these structures are actually in 3 d. :bang:

Regards
Robert

 

Been there, gave up on him.

 

Robert States
I've never had the pleasure of meeting Eric. Until I do I will forever more now imagine him as an Igor type figure with a hunch and a lithp. Progressively deformed. You poor soul.

Dennis Replies:
I have never met Eric either and I don’t know his age, weight, activity level, but I do know from FFTing him online as a flexible rearfoot, flexible forefoot that in closed chain, he has a navicular sag, an FHL, a bowed t. Achilles, functional equinus, functional hallux extensus, a mild bunion deformity and some level of PTTD and a dorsal met/cuneiform exostosis. He has callus sub IP hallux and 2nd or 2nd-3rd mets as well as some medial heel callus. He has functional genu valgum and lumbar lordosis and he has closed chain weakness and lack of leverage of posterior tibial, peroneus longus, flexor hallucis longus and abductor hallucis.
A picture of this professors feet rather than one of Igor would be sad enough.

Robert States:
Sorry if I seem facetious, but its impossible to understand what you mean when you post of centered axis, excellent lever arms and eliminating the tissue stress flowing through the body!
At the risk of incurring your resentment one might almost imagine the you don't actually understand what these things actually are!

Dennis Replies:
I HAVE ADMITTED SO MNY TIMES THAT I DO NOT UNDERSTAND YOUR LANGUAGE!!!
Its kind of like having a debate over a subject passionate to both sides in two languages, lets say in English and Hindi. I don’t understand you and you don’t understand me and since we are both natally English speaking, our debate degenerates into one in which we are trying to prove which of us is talking English.
I am trying to find a way to speak your language but as you point out…. I cannot express to you at a debating level what things are when I’m speaking Hindi (or is it English)?

I see compassion from The Arena when a posting comes from a member where it is obvious that English is not their primary tongue. You appreciate that he/she is trying and in addition, is exposing their challenge for you to make fun of. What makes me different?

ARE THERE ANY INTERPETERS OUT THERE!!!

Robert States:
would you like to be progressively more deformed and deviated for the rest of your life?
Should have got some foot centerings

Dennis replies:
Are you making light of the fact that the closed chain pathology that we all diagnosis in whatever manner we do is progressive and leads to pain and overuse syndromes, deformity and dysfunction as we age.
Can a man at eighty walk as he did when he was forty? What do you tell a patient who states “I used to dance, now I collect stamps but my feet don’t hurt”? I want to dance again.
If you see a family for foot care and the grandmother has a grade 4 bunion with overlapping second toes and the mother has a grade 2 bunion with evidence of FHL, how strongly are you forcing her children to get your orthotics, physical therapy, postural balancing, etc?
If you wish to debate these types of questions, they can be debated in all of our tongues simultaneously.

If not, I think we all have more important things to do, like Simon.
:drinks
Dennis

 

Robert States:
From my very limited understanding the "vault" as Dennis calls it is in the frontal plane. The "blocks" being the 1st met base , the cuneiforms across to the 5th met base and cuboid.

Dennis States:

There is a story of how Dr. Root discovered STJ neutral in an epiphany in the shower. I have just had one supplied by Robert.

The Vault lives on all three body planes but I have never really looked at it from a frontal plane perspective. I have always looked at it as the sum of all the longitudinal plane slices like a CAT scan and monitored it as a proximal to distal entity (lengthening the foot and lowering the arch) and although I teach that the vault widens, his words opened up an additional plane for me to examine and treat, The Frontal Plane!
In architecture, there is an entity called a gothic fan and its similarities to the foot have been investigated by the swiss orthopedic community.
Picture: The gothic fan in architecture and the foot

This architectural entity, supported for a lifetime by musculotendonous, ligamentous and capsular cement rather than brick and mortar, creates the MTJ problems of expansion, changing axes, etc. and the mystery of the transverse arches as Robert calls it.
The Centering Theory supports the vault of the foot with struts (Centring) preventing the expansion and collapse of the gothic fan better than natures cement as an upgrade to Root, Sagital Plane, STJ Axis, etc. Dr. Glasers MASS struts the vault of the foot and like Centering it changes the architectural nature of the foot from a Tie-Beam to an architectural arch that is much more stable, efficient enhancing the ability of the musculotendonous units to perform with power and in phase. Unfortunately, Dr. Glaser denies the need for posts, angles, modifications, etc burying Root.
Neoteric Biomechanics incorporates them all, functional foot type specific eliminating the ability of a practitioner to treat all feet alike and develop simplistic rules for care.

I’m going to try to give an updated first draft definition of The Vault of The Foot incorporating Roberts brilliant observation.

The Vault of The Foot is the space that lives beneath the bony surfaces of the foot . It is bounded proximally by the distal surface of the calcaneal tuberosity. Distally by the proximal surfaces of the metatarsal heads. Laterally by the medial surfaces of the cuboid and fifth metatarsal. It has no medial boundary.

Picture: The Vault (AP)

Picture: The Vault (Lat)

I continue to learn from the amazing minds of The Arena. Thank you.
:drinks
Dennis

PS: still don't know how to manage attachments. Sorrrrrry.

 

Interesting in the laws of engineering for a lateral wedge to be effective the line of force need to be in reverse considering the neutrality of simple stuctural alignment.
I thing Rose's work would have totally discounted the use of Lateral wedging.
Medial knee pain is associated with holding the rearfoot in an inverted position while the femur is in it's internal rotation mode.
Perry's and Roots work would surely indicate this.
Control is what its about and control on a flat playing field, how can we stabilise a rolling ball on the side of a hill?? Root's work is inspirational, 10,000 patients prove it gentlemen, stabilizing the calcanous by mimicing the action of the cuboid is the brain child of Dr Root and first thought of by Dr Royal Whitman.
Our difficulty is having an orthotic laboratory that supplies the device that we Podiatrists demand but alas they do what they want and not what functional anatomy demands.
Can someone tell me what a modified Root orthotic is?? Has Dr Root sanctioned the devise?? The only modified Root device I have see is one that is easier to make and does little to control the triplanar motion of the foot and therefore the internal rotation generated by the lower limb.
Ask a Laboratory, I think not, we are the perscribers but alas I have not found a laboratory that can actually manufacture a well constructed Root device, the reason why I have my own and have my own staff.

I pray for the well being of the public that Dr's Root's work is not dying, rather I pray the academics see the reason for he's work and that is, to inspire and challenge the thought of biomechanics of the skeletal system and how, we, as a profession Can make a difference.

Alex Adam

 

A "Root device" is an orthosis balanced, for nearly all pathologies and "foot types", with the heel vertical, with an intrinsic forefoot post, with a 4/4 degree rearfoot post and without a forefoot extension. This was the type of orthosis I was trained to use by the disciples of Dr. Root. We we were not trained, in most pathologies, to alter the orthosis prescription depending on the location of the patient's pathology, such as would be currently used in the Tissue Stress Theory. If the patient had a posterior tibial tendinitis/dysfunction, they got a vertically balanced foot orthosis with an intrinsic forefoot post, with a 4/4 degree rearfoot post and without a forefoot extension. If they had plantar fasciitis, they got a vertically balanced foot orthosis with an intrinsic forefoot post, with a 4/4 degree rearfoot post and without a forefoot extension. If they peroneal tendinitis, they got a vertically balanced foot orthosis with an intrinsic forefoot post and a 4/4 degree rearfoot post. If they had a 2nd MPJ capsulitis they got a vertically balanced foot orthosis with an intrinsic forefoot post, with a 4/4 degree rearfoot post and without a forefoot extension. The "meat pie method" of orthosis prescribing, is what some have described this approach to orthosis therapy.

If the orthosis didn't work, then the Root disciples who were teaching us told us that we had obviously casted the patient incorrectly and a new vertically balanced foot orthosis with an intrinsic forefoot post, with a 4/4 degree rearfoot post and without a forefoot extension was made for the patient. Varus forefoot or valgus forefoot extensions or forefoot accommodations with soft materials were viewed as "non-Root", non-functional, accommodative modifications and we were told they may even limit dorsiflexion of the digits!! When asked how foot orthoses worked, we were instructed by the Root disciples that they work by "preventing compensation for forefoot deformities" or "holding the subtalar joint in the neutral position" or "locking the midtarsal joint".

Many of us have, thankfully for the well-being of our patients, have progressed well past this insistence that Dr. Root and his disciples taught for years and years on balancing nearly all orthoses with heel vertical to a more mechanically-sound approach of altering the orthosis for the location of the pathology, rather than on what our interpretation of the "heel bisection line" is. Many of us now understand better that foot orthoses don't work by ""preventing compensation for forefoot deformities" or "holding the subtalar joint in the neutral position" or "locking the midtarsal joint", but rather work by altering the kinetics and kinematics and reducing the pathological stresses on the injured structural components of the foot and lower extremity. Many of us now use forefoot extensions on our orthoses very skillfully to alter the kinetics and kinematics and reduce the pathological stresses on the injured structural components of the foot and lower extremity. Many of us now use inverted or everted orthosis balancing and medial and/or lateral heel skives on a majority of our orthoses to alter the kinetics and kinematics and reduce the pathological stresses on the injured structural components of the foot and lower extremity.

While I give Dr. Root a lot of credit for what he did for our profession, one would simply be foolish to keep their blinders on to new theories and orthosis techniques that are clearly "non-Root", that contradict Dr. Root's teaching, get better therapeutic results than his vertically balanced orthoses, and clearly represent a more biomechanically-sound method of evaluating and treating patients. All one needs to do is to actually read some non-podiatric biomechanics research done in the many other very fine biomechanics research journals to understand that many very bright researchers and clinicians around the world don't all think that all ideas regarding foot biomechanics and foot orthoses came from Dr. Merton Root.

 

Kevin, you make it sound like we are living in the 1970's. A lot has changed since then. I'm not sure where you get your impression of how other prescribe, so let me give you a small look at what we do at Root Lab.

Approximately 20 percent of our devices are made to something other than heel vertical. Our Rx form is 8.5 by 14 inches for good reason, it is packed with options. We have product defaults but the vast majority of our customer make changes to the defaults, including deeper heel cups, heel skives, fascia accommodations, sweet spot accommodations, changes to the arch height, changes to the shell configuration or shape, inverting or everting the cast, extrinsic forefoot posting, altering rearfoot post motion, and a multitude of top cover options like met pads, Morton's extensions, reverse Morton's extensions, Cluffy wedges, varus and valgus extensions, forefoot accommodations, etc., etc., etc. These options add a considerable amount of labor and cost to process since they are often very complex and are used in multiple combinations. We have 22 default devices. When you consider the possible options, the variation in our orthoses is staggering.

Our customers are influenced by a variety of factors, including competing paradigms. Some take bits and pieces from Root, Kirby, Blake, and others who have influenced modern custom foot orthotic therapy. I don't know of anyone who full accepts or adheres to the principles of one teacher or theorist.

This customization of orthoses is one reason why most orthotic studies don't reflect the reality of practice. Practitioner's don't all use the same methods and apply the same theories in their practice. The really funny thing is, that two practitioners who appear to subscribe to two "conflicting" theories, might come up with the exact same orthotic Rx for the same patient. What you seem to be failing to appreciate is the fact that there has been significant evolution in the use of Root type functional orthoses and the implementation of "Root" theory since you were a student. This evolution is natural and healthy but it doesn't take away from the origin and history basis of the device or the theory.

Respectfully,
Jeff
www.root-lab.com

 

Kevin, the following is the first paragraph in your Biomechanics III notes from John Weed's class. Where did you get the false impression that John Weed or Merton Root believed that you should "hold the subtalar joint in th eneutral postion"?


The functional orthosis is an orthoses which is designed to promote normal structural integrity by resisting all stance phase forces that would cause abnormal skeletal motion or position, while allowing normal motion during the stance phase of gait. The orthosis must:
1) Support any forefoot deformity that would exert an abnormal retrograde force on the rearfoot
2) Resist abnormal extrinsic or intrinsic forces that would cause excessive medial or lateral distribution of weight into the rearfoot, causing abnormal subtalar joint or midtarsal joint pronation or supination during the time of gait that the heel is bearing weight
3) Promote normal rearfoot pronation during the contact period of the stance phase of gait for shock absorption
4) It can be used to immobilize the rearfoot during the stance phase of gait

Respectfully,
Jeff
www.root-lab.com

 

Jeff:

In my posting in response to Alex's comments, I was talking about how I was trained, in strict Root biomechanics, at CCPM a quarter of a century ago. You and I have obviously learned a lot since those days and we are no longer now practicing and teaching strict Root biomechanics like your father taught, but rather practicing and teaching a blend of many ideas.

It is always important to know, as a profession, three things:

1. We we came from.
2. Where we are.
3. Where we are headed.

In order for the vast majority of the profession to learn about the history of STJ neutral theory, who never actually met or learned from your father, Drs. Weed, Orien or CCPM biomechanics faculty from my era, they must be taught the truth regarding our past successes and past mistakes. In other words, we must all know #1 very well. That is all I am trying to provide.

I believe that you are, Jeff, one of the most knowledgable individuals that I have ever had the pleasure to know, certainly much more knowledgeable than most podiatrists that I know. I greatly appreciate you taking the time to present your side of the argument, since this is an invaluable lesson for the many following along regarding the legacy of your father and your foot orthosis lab.:drinks