No 1 Best seller

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netizens

The #1 on Amazon Best Sellers list for medical\allied health professions\podiatry on July 8, 2009 was for the 2nd time in six weeks Why You Really Hurt: It All Starts In The Foot which is the story of Morton's Toe. by Dr. Burton S. Schuler, a foot specialist of Panama City, Florida.

http://whyyoureallyhurt.com/

The book is published by the La Luz Press, Inc., and distributed national by the Cardinal Publishing Group of Indianapolis. It is available at all major book outlets, and on line at Amazon.com, Barnes and Noble.com and other bookstores.


Newt to do with the book but in the spirit of Da Vinci Code type conspiracy, the Lux bone was a mythical reference to a human bone which would be used to pick up the righteous on Judgement Day. I forget the actual criteria now but when I did some research a few years ago all the information suggested the talus. Maybe this is a sign and it could be the first metatarsal?

sinner toeslayer

 

It seems the fella wants to chew the cud right here on the Arena...

 

well I am that guy,
what exactly don't you guys understand about the Morton's Toe
I will be happy to explain
Dr. Burton S. Schuler,

 

Well you can start by answering some of the questions on this thread

Look forward to the discussion

Ian

 

Ian,
no problem but i would like to know the background of the people i am answering. are you a foot specialist in the U.K. ?

 

Yes I am a Podiatrist. For future reference this is a professional forum, so there are no lay people on here. And if my Union Jack flag and 'Location: London' on my profile didnt give it away then just to clarify for you, yes I am in the U.K.

(Robert Isaacs is also a U.K based podiatrist; to save you time asking him before answering his questions)

Ian

 

Most of the patient's who come to your office will have a short first metatarsal bone or a hypermobile 1st ray . (This was first written about by Dr. Morton in 1927 and 1928 in the Journal of Bone and Joint Surgery). You can confirm this by yourself by just reviewing the xrays of your patients.
These problems will cause the foot to over pronate. Before 1960 (when Dr. Morton died) this was widely accepted as a major reason for foot pathoilogy. Since then the work of Dr. Root has taken over as the standard. Dr. Morton wrote about 6 textbooks about the foot and anatomy.
Please submitt any other questions you may have.
Dr. Burton S. Schuler,

 

I don't remember asking any questions regarding your above response...but as you ask I do have some questions actually

QUESTION 1: What is over pronation? i.e. how much pronation is too much?
QUESTION 2: Do you honestly believe this is always pathological?

That maybe the case but that was nearly 50 years ago.
QUESTION 3: Have you read any literature that has been produced in the last 4 decades?

As I said before you have been asked alot of questions by Rober Issacs in the other thread - please feel free to answer these first, and then come back here to answer mine

Ian

 

QUESTION 2: Do you honestly believe this is always pathological?
Ian, nothing is always pathological. What i am saying these problems have been over looked and ignored by podiatry for years. And most of the patient's who will come see you with routine foot problems (heels, hav, c&c) will have some pathology at the first met. Start looking for it, you we find it

That maybe the case but that was nearly 50 years ago.
QUESTION 3: Have you read any literature that has been produced in the last 4 decades?
Great question !
Absolutely , dr janet travell Personal White House physcian to presidents kennedy and johnson, and professor emertius of medice at Geroge Washington Medical school, wrote extensively about the "Dudley Morton Foot" in her two textbooks (1993 and 1990). In 1989 she made a video tape for physcians to teach them about the the Morton's Toe . You can buy her books and tape on line from amazon

 

Ian

Just because you guys have never really been exposed to it doesn't mean the Morton's Toe
is not what I claim it is. I have nothing to defend. You can attack me all you want, but two of the most important physcians of the last 100 years stand behind it

If you are really interested in learning about the pathology of the 1st metatarsal bone, and how it effects your patients', as a fellow podiatrist i will aid you any way i can. i have spent the last 7 years researching my book, working with the morton family (his papers) , and with no less than 5 universities, and two presidential libraries.

Burt

.

 

From the good doctors' website:

Puh-leease. What the...?

Kind sir, this is an embarrassment to the reputation of podiatrists everywhere who try to provide evidence-based care. I think you need to sit a contemporary podiatric biomechanics refresher, stat.

Get ye to a Boot Camp in your nearest locale post haste, and stop living in the past.

LL

 

Why are you so threaten by a noted amercian orthopedic surgeon who taught at Yale and Columbia Medical Schools ? Who was this countries leading authority on the human foot for 40 years ??


Do you believed modern (root orthopedices) answers all of the question. ?

Of course not.
I can not comment about what goes on in the UK, or other countries but i will tell you that more and dpm's are publishing articles questioning "root"

Doctor you still have many things to learn

 

Please excuse me everyone. it is 7:00 a.m. here in florida and i must go to my office to treat all those patients who have Morton's Toe.

 

With respect I doubt there is an active member of the forum who believes Root et al's work is the modern podiatric biomechanics be all and end all.

The science of podiatric biomechanics is evolving with new ideas and challenges to old ideas coming along all the time.

Those at the top of our, and any medical profession are dealing in evidence based practice and if you want ideas to be taken seriously good quality scientific evidence based on biological and physical plausibility need to be presented. Robert as touched on a small snippet of the evidence we have in the [thread=33411]other tread[/thread], your comments on which we would be delighted if you would share.

Respectfully,
Euan

 

Burt

What do you consider more important in podiatric practice; having a unique selling point or adhering to the principles of best practice (including EBP) for the benefit of your patients? It's just that in recent years we've witnessed the emergence of many clinicians who appear to consider the former is paramount. Strangely enough, most have been DPMs. Perhaps the philosophy that is discussed in the Naked Chiropractor has infused into some US Podiatry Schools....

MR

 

Burt,

What my esteemed collegues are trying to say is that the past biomechanical assumptions, such as the morton's toe and "Root" no longer stand up against scientific scrutiny.

Your book may well be an extremely accurate historical document but when analysed under the current research evidence will not stand up as an evidence based model.

Morton's theories and clinical applications were based on observed assumptions not scientific reality. Take some time to read some of the discussions and you will see how Podiatry accademia around the world far out reaches the "standard" of what I am sad to say reflects many podiatrists general knowledge and practice.

Regards

 

Burt,

Firstly cut the patronising tone.

Secondly, don't just come on here and repeat yourself every post - we can all read your website for that kind of guff (I did read it - I must say it was a waste of 10 minutes of my life). You said you wanted to discuss this - well then get on the other thread and start discussing it you joker

In all seriousness if you could send me a copy of your book that would be great; theres a door in my clinic which has lost its wedge.

Ian

 

Dr. Schuler:

I actually very much like Dr. Morton's textbook. I have it in my library and used it quite extensively when I developed my lectures and wrote my papers on why I thought the term "first ray hypermobility" should be replaced with the term "decreased first ray dorsiflexion stiffness."

http://www.biomech.com/full_article/?ArticleID=674&month=7&year=2005 (Tom Roukis and I cowrote this article)

I would suggest you read the archives on "first ray hypermobility" here on Podiatry Arena before you get yourself too far along in your discussions here with the members of Podiatry Arena. Even though we can be a little bit testy at times here on Podiatry Arena, I think you will find we are all willing to learn, as long as the contributor has good scientific reasoning and evidence to back up their claims.

Welcome to Podiatry Arena!

 

Why Have you not moved on with the rest of us? That person may have been the leading foot expert for 40 years but that was 50 odd years ago! Galen was the leading medic for centuries but we've quit trepanning!

Of course not. And Root orthopaedics have not been modern for about 20 or 30 years :bang: But it was an advance on a single treatment cures all model published years earlier!

You don't say! Who do you think you are talking to exactly? This forum hosts some (or even most) of the top podiatrists in the world right now. What you say, we already know!

We all do. But the leading edge of biomechanical thery is NOT stuff written before the advent of Radar, television and the microwave oven!

But enough of this meaningless and unhelpful banter. Dr Schuler, you said you have come here to help us understand this condition. Accordingly I've asked you an array of questions on this condition. Rather than this rather petty to and fro of "no it isn't - yes it is" why not put your money where your mouth is and address a few of them. You found the other thread right? Go there. Answer some, one, any of those questions. Lets get to the nitty gritty.

Regards
Robert

 

netizens

Retired academic and general old fart.

I first read D J Mortons work thirty years ago and have dipped in from time to time ever since. I was a one time very interested in footprint morphology. On a technical note historically there were two Mortons; i.e. DJ and TG. As far as I am aware it was TG Morton who wrote about Morton's Toe and from memory this referred to oseteochondrosis of the second metatarsal. DJ Morton highlighted the potential significance of the metatarsal formulae to general foot pathology with particular reference to an incompetent (hypermobile) short first metatarsal. I think it was others who made association with the juxtaposition of the 4th and 5th metatarsals and digital formulae as a precurser to interdigital lesions.

toeslayer

 

netizens

Reading through the thread again I dont think Morton's observations circa 1920 are any less relevant. In the same way stj neutral may have been a reasonable working hypothesis for the 70s., but neither can explain the mysteries of the metatarsals in terms of scientific logic. I would think the observations are valid but flawed due to a limited set of subjects on which to base the theory.

This does not distract from interesting descriptive theories of historical interest and only goes to reinforce there are far more things in heaven and earth than podiatry theory.

off to twitter
toeslayer