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Challenging the foundations of the clinical model of foot function

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jan 31, 2017.

  1. Stanley

    Stanley Well-Known Member

    I guess you also disagree with ascending vs. descending pathology. So what is the mechanism for an anterior ilium and what is the mechanism for a posterior ilium according to your theory?
     
  2. Dennis Kiper

    Dennis Kiper Well-Known Member

    For alignment issues, balance starts at the ground. That's my opinion. I've met DC who think func ll starts at the hip.
    There certainly may be some anomoly that I'm not aware of are you? Otherwise I believe the majority of every foot on the planet fits the profile of ascending bio-mechanical pathology.
    My theory to as/pi is that it's a neuromotor response to asymmetrical pronation. As I said earlier, I see this imbalance in postural alignment with children as early as 2 yo. For me, this was confirmed, that in every single case I also see contralateral shoulder positioning. I didn't keep records, this is anecdotal of thousands of exams given at major running events.
    In addition to my last post I have found that the mechanical function of pronation, remains the same, regardless of ll (variables-aside) I believe, that tissue efficiency and performance results from the alignment of mechanical function, starting at the MTJ. I've observed that mechanical eff starts and ends with the tri-plane motion of the POM. I knew Orien , I spoke with him months before he died. He said that Root was adament about the rearfoot. Weed saw it that way too. He says he did think about the MTJ and wanted to pursue it but went along to keep peace and move on. From that, you understand bio-mechanics as you do.
    I have found that for the supinator population of our society and some anomolies that exist, hydro-dynamic technology enhances the mechanical efficiency of functional bio-mechanics. I admit I haven't written all I've seen like you did, so when you talk about lifts and compensation, those have different definitions to me then what you and I have learned in the same classes.
    It is the principles of physics involved which are confirmed by scan tech, that tells me, the science tells me this! Why doesn't it tell you the same thing?--are you influenced by those that think this is snake oil? or are you afraid to learn something new? Is it just because you don't like me? If so, mankind will owe you a great debt.
    The only thing I'm expert in is what I've learned about bio-mechanics and bio-mechanical medicine from this technology. It's given me the opportunity to take out the guesswork of pt response, results and dx. I've been accused of doing this for $$. It's you that are losing $$$$. Because if podiatry started to teach the public the importance of bio-mechanical health (like dental health) prevention over a lifetime starting as yearly as 10 yo and the tool to accomplish this is scientifically established, bio-mechanics would become the largest part of your business. And you won't be discussing how many degrees you post to effect bio-mechanics, instead you can discuss how many grams or mg you need to pronate or supinate the TNJ to effect the POM. your business would be more about bio-mechanics than anything else, that information would spread. I think podiatry and foot specialists should take the lead instead of getting mired down in theory and conjecture.
     
  3. Stanley

    Stanley Well-Known Member

    What is POM? It appears that you don't believe in descending pathology nor a primary posterior ilium. Also you can't explain an anterior innominate. Can you distinguish between an anterior innominate vs an opposite side posterior innominate?
    You have no idea what I believe in as far as how the body functions.
    I really don't care if you make money. I just care about the truth of how the body really functions.
    Finally, yes there is a neuromotor response that causes a posterior innominate, but the cause is not what you think.
     
  4. Dennis Kiper

    Dennis Kiper Well-Known Member

     
  5. Stanley

    Stanley Well-Known Member

    No, you have no idea of how I think the body functions. The reason is that I haven't told you.
    I do know that you have no idea that there are primary ilio sacral dysfunctions, and you can't tell me the difference between a posterior or anterior innominate or how to distinguish it.
    You claim to have been involved in sports medicine. But that is suspect in my mind because if you have, then you would have seen the high school runner that during his first speed workout of the year felt a pop in his back and then developed a lateral knee problem (IT band syndrome) which is a primary iliosacral joint pathology. which requires the iliosacral joint to be mobilized/manipulated via one of many techniques.
    All I know is that you think that if you put a fluid filled sac under the foot, it will find its neutral position automatically and the pelvis will level. You have no explanation of the mechanism of how this occurs except some vague neuromotor response and you call it scientific technology.
     
  6. Gardener

    Gardener Welcome New Poster

     
  7. Gardener

    Gardener Welcome New Poster

    What is the significance of the First Ray in establishing a tripod effect in feet?
     
  8. Dennis Kiper

    Dennis Kiper Well-Known Member

    Stan,
    I've explained this before, when you're dealing with a scientifically calibrated orthosis, then your bio-mechanical results are predictable. This experience has taught me what I know. I know everything you know and think you know. I know what you don't know because you don't know what I know. Because I haven't told you.
     
  9. Dennis Kiper

    Dennis Kiper Well-Known Member

    the biomechanics of foot orthoses and the concepts of Tissue Stress Theory does not need to measure subtalar joint neutral, forefoot to rearfoot relationship, subtalar joint range of motion or neutral calcaneal stance position to prescribe excellent custom foot orthoses for their patients.
    This concept is the level of mechanical insuffieciency that makes the profession's orthotics only equally as effective as generic and orthotics for a fraction of the cost. One of the difficulties the podiatry profession has always faced in working out financial reconciliation for orthotic therapy with health insurance companies or Medi-Care is based on this evidence pointing to the efficacy of cheaper generic and pre-fab orthoses being equally effective to customized orthoses, for both short and long term results.
    In other words, nearly all of those measurements, which the people that dogmatically preached Subtalar Joint Neutral Theory to us for decades as the only way to make "correct" custom foot orthoses, don't really need to be done in order to make great custom foot orthoses.
    While your statement is fine for a generic orthotic, it does not meet the criteria or standards of what our profession should be able to do. and when you can calibrate mechanical efficiency for a stance phase you can do more than make a great custom orthotic, you can consistently make a bio-mechanical health support system that can be changed as tissue stress resolves and bio-mechanical health is restored and maintained over a lifetime. The ability to grow the accuracy and health benefit of a pt's lower extremity. This includes the use of lifts when appropriate. then you know what to expect. it's the measurements based on past and present theory that has resulted in the inability for precise bio-mechanical measurements and mechanical function, which matters like 20/20 vision. You just don't realize it. Present day orthotic technology does not do this.
    The Subtalar Joint Neutral dogma, full of errors and inconsistencies, which has been passed on from generation to generation of podiatrists, blinds many podiatrists to the truth of how the foot and lower extremity actually works.
    I don't agree, we know how it works, you don't know how accurately it should and could work.
    Better theory needs to be actively taught

    Better technology for the mechanics that fit needs to be learned. That's what would change the course of the entire profession and health benefit world wide. Any theory that is not scientifically supported is not a good theory.
    Those that continually want to refer to the past contributions of our ancestors of podiatric biomechanics, keep things as they were 35 years ago, and not keep an open mind to change and move on to better theory,

    Hydro-dynamics is a simple technology, there's no theory, it just works just like a bio-mechanical tool should for the right foot. You may in some cases even make something better than a generic o., especially for anomolous conditions--otherwise clinical results are still around 50%.
     
  10. efuller

    efuller MVP

    I'm not sure what you mean by tripod effect.
     
  11. Stanley

    Stanley Well-Known Member

    I am glad you do, so tell me how you would use a one point acupuncture technique vs. a two point acupuncture technique to affect the foot? How does the cervical righting reflex affect symmetry and how would you treat it? Tell me how the vagus nerve effects the foot and what techniques would use use that would mimic that of a vagus nerve stimulator?
    How does a first degree forefoot sprain affect the biomechanics of a foot?
    I remember my first experience with a silicone insole. It was in the fall of 1976. I was amazed at how it felt and for a few hours, I thought I was going to use this instead of real orthoses. Then my heels started to hurt. I immediately went back to my self made orthoses and my heel pain left.
    So please explain to me how a bag of slime constitutes a scientifically calibrated orthosis?
     
  12. Dennis Kiper

    Dennis Kiper Well-Known Member

    Here's an example of what you don't know that, because of the difference in wt and pronatory distribution, you're initial heel pain was perfectly normal and just temporary. If you were really medically and biomechanically informed you would have realized that and that it's not necessarily the orthotic that was at fault. You must give up easily on a lot of stuff?
     
  13. Dennis Kiper

    Dennis Kiper Well-Known Member

    This is the structure of an elephant foot.
     
  14. Stanley

    Stanley Well-Known Member

    What are your patient responses when you tell him that the new pain he developed which he never had before by wearing his new "scientifically calibrated orthosis" is because of the difference in wt and pronatory distribution and is perfectly normal and just temporary? How is this better than when I dispense a pair of orthoses and the patient is now able to go out and run without any pain?
     
  15. drhunt1

    drhunt1 Well-Known Member

    Kevin Kirby and Eric Fuller both state that Dennis sells "snake-oil" and wonder if he knows what he's talking about. I'm LOL...because the irony is too rich. Perhaps Kevin and Eric need to take a few steps back and perform some serious soul searching. Kevin states that all one needs to do is Google Dennis Kiper's name. Like you did with mine, Kevin? Both Kevin and Eric have locked into the TST and the theory that lateral wedges will "cure" medial knee arthrosis. There's NOWHERE to go...is there, chumps? Lock and load...you're committed...you are all in. Is that why you solved the Myth of Growing Pains? Is it because of your insight and training? Pfffffft! I break wind in honor of your insight and training...
     
  16. Dennis Kiper

    Dennis Kiper Well-Known Member

    It's crazy to see your discussions are still about muscles having so much influence over function. How do you do it Kirby?
    If you do enough strengthening exercises and then step down barefoot you may achieve physiological improvement, not maximal functional alignment, not even good alignment-just normal overpronation and instability. Muscles can only help support or assist- they function to the point of overpronation, unless restricted by support-- you've recognized this concept in an earlier post (and in many articles).
    "The foot core system": Hmmm... I think the terminology is overemphasizing the nature of the muscles-Kirby
    Add so many discussions about the benefits etc of barefoot running and what was said there.. Muscles cannot achieve optimal mechanical efficiency of alignment for maximal bio-mechanical function of the human locomotion system. Plain and simple. Unless you have an argument for it? dpm to dpm, I'd like to hear it.
    If Root had at least started with the MLA instead of the rearfoot he'd have been closer to a better understanding of the mechanical function of arch motion instead of midstance and pronation/overpronation--the "core" of our profession. It would have been seen differently and recognized by someone who thought like an engineer. Instead, after looking at everything, he felt he could justify the rearfoot controlling the motion of the arch (in an
    un-ubstructed way). He was wrong.
    He did recognize neutral at midstance as a congruent structure, this he had right! now, he thought how do we get there? Clinical trials and the lack of science has shown--It's too bad the technology that evolved never worked as well as it should have. Traditional technology for a non-subluxed foot doesn't demonstrate the mechanical efficiency proficiency required for scientific, medical needs or maximal bio-mechanical function.
    It is the precision and dynamic functionality of the tri-plane axis that clarifies "core stability". I never see any discussion of any biomechanist or foot specialist that says that. Why? Is it because there is no scientific evidence to support all the conjecture of traditional technology and Bio-Mechanics? Hmmmmm
    In the last 70 yrs--every medical field has technologically advanced. Robotics and AI has moved forward into these fields.
    Podiatry and it's affiliated foot specialists are mired in traditional theory and conjecture unsupported by an accurate scientific Rx. The rate of failures and in-adequate Tx is way too high for the number of feet that a more modern hydro-dynamic technology can fit.
    Reducing and minimizing Tissue Stress (with or w/o symptoms) through increased mechanical efficiency is what makes it a health benefit to wear-- Mechanical efficiency yields tissue efficiency. Tissue efficiency reverses tissue stress.
    Instead you're dealing with unknown variables with a technology that functionally interferes with "core stability" A scientifically precise calibration is the difference in most all the failures of orthotic treatment and the awareness of bio-mechanical function.
    If you need to see research on my claims as if I was curing cancer--then I challenge Kirby to a clinical trial of our technologies at the school in SF. Consider bringing in other orthotic concepts into the trial. Make it nationally known that the most extensive foot trial on plantar fasciits in the world is being conducted. Open the doors to mankind. The profession will benefit, more importantly, mankind will benefit.
     
  17. scotfoot

    scotfoot Well-Known Member

    "It's crazy to see your discussions are still about muscles having so much influence over function. "

    Muscles may be viewed as fluid filled bags . If fluid filled bags between the foot and the shoe can influence function then why can't fluid filled bags within the foot ?
     
  18. Dennis Kiper

    Dennis Kiper Well-Known Member

    Didn't your mother ever teach you not to smear poop on your head--now look at your brains
     
  19. scotfoot

    scotfoot Well-Known Member

    In actual fact I was not criticizing you or your fluid filled orthotics . I have no idea if they work and frankly don't care . I was merely pointing out that water filled bladders (condoms ) have recently been used to help model the in-compressible nature of fluid in skeletal muscle . In the foot a large number of muscles can be found between the bony arch of the foot and the plantar fascia .

    You are not being criticized by me and I see no need for your offensive comment .
     
  20. Dennis Kiper

    Dennis Kiper Well-Known Member

    You have no idea if they work?? Have you ever had a course in basic science? How could you develop the concept of the in-compressable nature of fluid in skeletal muscle?
    What concept are you thinking about that would allow for the function of hydro-dynamics versus fluid in skeletal muscle? For your edification--that's called "edema"
    And you don't care if they do work? Too bad for you and the population you deal with.

    In the foot a large number of muscles can be found between the bony arch of the foot and the plantar fascia .
    This is your professional response? This must be why you have "no idea"
     
  21. Dennis Kiper

    Dennis Kiper Well-Known Member

    Maybe I've judged you too harshly. When you have "no idea" how a couple of scientific principles effects the functional mechanics of a foot, then I can see why you don't care.
    If you have the same license I do, then your remarks are offensive. The fact you don't care is also offensive. Do you care about the latest antibiotics for your patients? or are you only aware of the latest fungal treatments?
    The information you're getting from where, comic books?? about condoms infused in the foot is also offensive. Then again, it might make sense to you, I might be judging too harshly again ("if the condom fits, you must not a quit")
    You're inability to address any established scientific information and mechanically established principles is also offensive (if you're a dpm), if you're a technician, then you get a pass. Most importantly, you don't recognize the importance of the precise modification of pronation/overpronation that makes it work (actually, neither does anyone else), you don't know how it works, you don't know how to make it work--
    Podiatry schools are having trouble to fill their classes and Good Feet, Scholl's and others are growing because, their technology is as good as yours. The profession is behind chiropractors in medical status (according to insurance standards), and in other parts of the world your accreditation is "Mr". The leaders in the field have stagnated in the advancement of biomechanics and bio-mechanical medicine, while you continue to ask the same questions about the intrinsics/extrinsics and spring ligament etc etc for the next 70 years plus.
    Traditional technology and science based on Newton's Law premise, makes it impossible to achieve accurate biomechanical function and get consistant, reliable and accurate data.
     
  22. scotfoot

    scotfoot Well-Known Member

    Dr Kiper ,
    Do you ever recommend foot strengthening exercises to your patients and if so what exercises do you recommend ?

    Re fluid filled condoms being used in muscle modelling , this from one of your Universities -

    Incompressible fluid plays a mechanical role in the ...

    https://www.researchgate.net/publication/312926475_Incompressible_fluid_plays_a...
    Sleboda and Roberts (2017) observed that the interaction between collagen network and the incompressible fluid within the muscle influences the mechanical behavior of the muscle, i.e. during ...
     
  23. Dennis Kiper

    Dennis Kiper Well-Known Member

    Don't take this the wrong way, but is it because you do not understand the significance of alignment in functional mechanics that you came out of left field to point out the incompressibility of fluid in muscle function ? Or is it that like the rest of your colleagues, that you're stuck in theory that doesn't deliver the ansers you want and need?) Chiropractors temporarily re-align our structure by the release of intra articular pressure. As soon as the pt steps off the table they are walking out of alignment and rebuilding intra articular pressure (from distorted joint axial congruency), so while the normal incompressibility of fluid "might" reduce the force in the long direction of skeletal muscle, why deal with maybe--when there is an answer? Present day theories are good for anomalous, rearfoot and flatfoot deformity. They are born from 70 year old theories and conjecture by Root and others. It doesn't work as well as it should? (primarily for the supinator classification)
    Last year, in this very thread I tried to point out the incompressibility of fluid that allows for midstance to reach an equilibrium state of stability (hydro-dynamic technology). This
    principle of physics optimizes our ability to scientifically measure reduction of forces, balance of med/lat columns, loading time and shorter foot contact to the ground. This presents a much better assessment of bio-mechanical function in my opinion) and the significance of this is major to bio-mechanical medicine as in the treatment of plantar pressure ulcers. None of you had anything to say about that. Is that not the science that is lacking from your technology? It certainly appears often in the journals. Eric Fuller argued this point and was unfortunately unable to grasp that fact of physics, nor was he able or willing to recognize the benefit of congruency in alignment for functional mechanics. I thought we had similar basic science backgrounds, maybe not I hope you get it.
    Anything that is comfy and minimizes overpronation will reduce tissue stress, but without optimal mechanical efficiency, tissue aside from ageing will ultimately degrade faster --physiologically and mechanically, instead of maintaining decades of bio-mechanical health.
    Strengthening exercises will only help, somewhere down the line, tissue stress will increase again. Then as Kirby has written about several times, it will be difficult if not impossible for you or another practitioner to reproduce a new functional fit. The reason is that the travel distance of pronation/overpron (of the full stance phase) is very small (if you think like an engineer and can conceptualize it). When all you can do is unscientifically calculate how many degrees you want to post the rf/ff you don't realize that in degrees of the tri-plane axis, that's huge (not to mention not effective in all 3 planes). You should recognize this error in Rx results in inadequate mechanical performance secondary to minor alteration in ROM)and often including bio-mechanically discomforting to wear by the pt (this results in--tissue in-efficiency/tissue stress-aka bio-mechanical inflammation). or if you've made a good fit- pt does ok until next time. I have found, modifying pron/over-p (of stance) should take about 6-10 years. That's what pts tell me that it took to reverse 10-30yrs of the way they felt at that age.
    There can be 2-4 changes in tissue stress during that time that requires a new calibration. Measurement of mechanical efficiency allows you to grow a new accurate Rx and improvement in tissue efficiency (another difficult term for Fuller --do you know what I mean?)
    If a pt wants to perform strengthening exercises for pf, I'll help him. I'll suggest a couple of things. I prefer a therapeutic approach of intrinsic massage (self-applied accupressure)-I tell them to see the video instructions on my website), followed up by maximal functional mechanics.
    Alignment efficiency is my final answer to lower extremity patho-mechanics. I just use a different technology to get there.
     
  24. Dennis Kiper

    Dennis Kiper Well-Known Member

    This statement is 30 yrs behind the times. The reason to study any asymptomatic pt is because any supinator and some pronators can be fit with this technology and bio-mechanically more efficient in daily life--over a lifetime.
     
  25. Dennis Kiper

    Dennis Kiper Well-Known Member

    I disagree, complex and average are two very different things.
     
  26. scotfoot

    scotfoot Well-Known Member

    I am a Dentist , Dennis ,and have have very specific interests when it comes to the foot .

    With regard to fluid mechanics and the use of condoms in muscle models , I wrote about this before Brown and Sleboda submitted their manuscript , although I spoke of water filled "long thin balloons" and not condoms . I suspect Mr Sleboda has more fun than me . I have provided a link at the end of this e-mail .

    With regard to your product have you considered that a fluid filled medial arch support may reduce work partitioning in the intrinsics ?

    Hydraulically discrete fascicles in skeletal muscle [Archive ...


    https://biomch-l.isbweb.org/archive/index.php/t-28655.html
    13 Feb 2016 - 2 posts - ‎1 authorIf the perimysium is sufficiently impermeable then might it be possible that each fascicle is able to function as a hydraulically discrete unit with ...
     
  27. Dennis Kiper

    Dennis Kiper Well-Known Member

    My understanding of the scientific principles: that would interfere as any force might with the max displacement of fluid in the bag.
    In terms of a Rx this would also alter the tri-plane axis. As an aside to the significance of precision, once the MTJ passes thru its optimal position (you may know it as neutral), partial instability and overpron are unavoidable. Unless it's restricted-Kirby
    That said, I have played with displacement (for a barely subluxed MTJ type foot) using foam pads specifically placed to give slight lift to the MTJ-comfortably. I think this allows the (displaced?) hydro-static pressure to give more lift to midstance. I've had some success with 2 pts
    I'm curious if your interest in the foot is because you can't find an orthotic thats helping enough?
    I've added some comments to parts of the article I found interesting:
    The weight will bear down on the eels ,squeezing away the water around them and pinning the eels flat
    What if the weight above were flexible? Same outcome?
    The” hydraulically discrete fascicle system “ proposed can only function if the fascicles are completely surrounded by fascicles at similar pressures .
    This is interesting info, but the hydro-dynamics under the foot is the technology to achieve functional effects. The article is concerned with local effects on tissue--what does it do for lever arm efficiency?
    If a long modelling type party balloon is filled with water and sealed then the pressure of the water will be the same at all points inside the balloon . However ,examination of the balloon will reveal the ends are under far less tension than than the midsection since the ends have a reduced radius . This is explained by Laplace’s law .
    This might apply to bio-mechanics as wt bearing and pronatory forces bearing on the MTJ--at MS. In a scan analyses however pressure under the MTJ is less as wt bearing and functional forces are at the forefoot.
    orthoses with a medial arch support cause the plantar muscular to be compressed and so I believe the functioning of medial arch supports and the volume and contractile state of the plantar intrinsics are highly inter related .
    Well, of course, -with fluid underfoot the hydro-static pressure is the same, at the same time scans confirm it functionally improves joint axial congruity (just an intersting fact)
    So, I wonder how this paper will help traditional orthotic technology? and the growth of bio-mechanics in the profession? Have they tried using this on a plantar ulcer?
    BTW--what was your concept for the water balloons and function? what were you tring to accomplish?
     
  28. scotfoot

    scotfoot Well-Known Member

    The” hydraulically discrete fascicle system “ proposed can only function if the fascicles are completely surrounded by fascicles at similar pressures .

    Yes , you have picked out the sentence which is most relevant to your orthotics and their possible ability to avoid work partitioning in the intrinsics . Work partitioning occurs when a muscle is subject to a transverse compressive force somewhere along its length which means that it must work harder to apply the same force at its point of insertion . It is well covered in a paper by T Siebert .

    J Biomech. 2014 Jun 3;47(8):1822-8. doi: 10.1016/j.jbiomech.2014.03.029. Epub 2014 Mar 27.
    Muscle force depends on the amount of transversal muscle loading.


    Siebert T1, Till O2, Stutzig N3, Günther M3, Blickhan R2.
    Author information

    Abstract


    Skeletal muscles are embedded in an environment of other muscles, connective tissue, and bones, which may transfer transversal forces to the muscle tissue, thereby compressing it. In a recent study we demonstrated thattransversal loading of a muscle with 1.3Ncm(-2) reduces maximum isometric force (Fim) and rate of forcedevelopment by approximately 5% and 25%, respectively. The aim of the present study was to examine the influence of increasing transversal muscle loading on contraction dynamics. Therefore, we performed isometric experiments on rat M. gastrocnemius medialis (n=9) without and with five different transversal loads corresponding to increasing pressures of 1.3Ncm(-2) to 5.3Ncm(-2) at the contact area between muscle and load. Muscle loadingwas induced by a custom-made plunger which was able to move in transversal direction. Increasing transversalmuscle loading resulted in an almost linear decrease in muscle force from 4.8±1.8% to 12.8±2% Fim. Compared to an unloaded isometric contraction, rate of force development decreased from 20.2±4.0% at 1.3Ncm(-2) muscleloading to 34.6±5.7% at 5.3Ncm(-2). Experimental observation of the impact of transversal muscle loading on contraction dynamics may help to better understand muscle tissue properties. Moreover, applying transversal loads to muscles opens a window to analyze three-dimensional muscle force generation. Data presented in this study may be important to develop and validate muscle models which enable simulation of muscle contractions under compression and enlighten the mechanisms behind.
    -------------------------------------------------------------

    You asked "BTW--what was your concept for the water balloons and function? what were you trying to accomplish? "

    I asked myself the question "can the intrinsics act as pressure distributing core within the foot whist still retaining their ability to contract and produce force at their insertions " . The theory of " hydraulically discrete fascicles " came from this and may have moved our understanding of muscle physiology on a bit .

    Further to compressive forces within the foot and the contribution these forces make to the functioning of the plantar venous plexus , you might be interested in this thread . Link

    Plantar venous plexus and the intrinsic foot muscles - Biomch-L


    https://biomch-l.isbweb.org/.../28468-Plantar-venous-plexus-and-the-intrinsic-foot-m...

    17 Dec 2015 - 1 post - ‎1 authorPlantar venous plexus and the intrinsic foot muscles. Some time ago I placed a few posts on a site run by a shoe company . The posts have ...
     
    Last edited: Aug 4, 2019
  29. Dennis Kiper

    Dennis Kiper Well-Known Member

     
  30. scotfoot

    scotfoot Well-Known Member

    " do you use a Tek Scan? " No , but was at a related course recently .

    With regard to fluid filled orthotics have you considered their use in cases of repeated ,same site , ulceration ?
     
  31. Dennis Kiper

    Dennis Kiper Well-Known Member

    That was the original concept of the silicone dynamic orthotic, by the inventor Dr Krinsky.

    I know of one case where it was used by a colleague in Calif in the treatment of a diabetic ulcer--treatment took a year to close the ulceration.
     
  32. scotfoot

    scotfoot Well-Known Member

    Did it prevent recurrence ?
     
  33. Dennis Kiper

    Dennis Kiper Well-Known Member

    I don't know, I was not intouch with the doc after that.
     
  34. scotfoot

    scotfoot Well-Known Member

    So to go back to where I came in you had written " It's crazy to see your discussions are still about muscles having so much influence over function. How do you do it Kirby? "

    Could I ask in what way you think KK has over stated the influence of muscles in the way the foot functions . I have to say that I regard some of his recent writings on the subject as good summaries of what is know and of very recent research .

    I have to say that I am also quite enthusiastic about the initial windlass phase of gait , a very recent grounded theory referred to in this thread (below ) . Criticism welcome .

    Plantar fasciitis and footwear | Podiatry Arena


    https://podiatryarena.com › Forums › General › Biomechanics, Sports and Foot orthoses

    9 Jun 2018 - If footwear that restricts the" initial windlass phase " of gait is a major cause of plantar fasciitis then how can this condition be treated without...


    Also with regard to the body and fluid mechanics you might be interested in the following thread .It's a real jaw dropper (centripetal not pedal of course ) .

    Centripedal forces and the calf muscle pump - Biomch-L


    https://biomch-l.isbweb.org/.../31986-Centripedal-forces-and-the-calf-muscle-pump

    7 Feb 2019 - 10 posts - ‎3 authorsHowever what about the centripedal forces and centrifugal effect generated ... I have never ,in years of looking ,found a paper on venous return ...
     
    Last edited: Aug 6, 2019
  35. Dennis Kiper

    Dennis Kiper Well-Known Member

    Let me start by stating, I'm only speaking of the supinator classification foot type. Flatfoot and rearfoot anomolies are not part of my discussion.
    It is the function of the soft tissues in response to the mechanical efficiency (or lack of) that produces pathology (some other variables aside). Have you seen the two scans I posted on this thread? If you can pull them up I'd like to see your analysis.(This might be a good starting point for you to open your mind.)
    Almost any description of muscle function(incl the windless mech) is secondary. This in my opinion is because no scan ever produced utilizing traditional technology allows the true essence of bio-mechanical function. The mechanical in-efficiency interferes with the transference of motion,forces and momentum--a direct influence over tissue function.
    I have issues with most everything described e.g footwear that restricts the" initial windlass phase " of gait-- How do you see a shoe that resticts...?
    You mention the two phases--the first being "the preparation" of the foot landing. In swing phase at the moment of heel off--the foot begins its natural phase of supination. There is no locking in, any stability to the midfoot or forefoot. Any remaining wt bearing at the forefoot--"unlocks" This is actually evident on scan analysis when 1/32 of a frame is viewed. I don't think you or anyone has seen this because, trad tech doesn't support the forefoot or midfoot at heel off. Hydro-dynamic tech does! I believe my article in Podiatry Today explains it (unfortunately the magazine altered the images for the article)--but it wouldn't be seen there anyway, I'm referring to the frames (32) of stance.
    In my opinion it is very likely that a properly functioning and unimpeded initial windlass phase will substantially reduce the stresses to which all of the plantar tissues are subjected--
    I agree with this wholeheartedly, except in a forefoot strike. But, that's a different matter. This would apply to HD tech in a midfoot or rearfoot strike. Before you bring in the variables I would rather discuss the most common type of strike, because it's complicated enough.
    In cases where footwear induced suppression of the initial windlass phase is the cause of plantar fasciitis then it stands to reason that resolution of the condition can never be achieved so long as the same footwear continues to be worn . Further to the above , and in my opinion , it seems quite possible that certain types of footwear may cause musculo skeletal problems if worn for long periods .
    Here I disagree, a properly functioning orthosis balances the tissues as you would hope, regardless of the shoe. (excepting some styles of course)
    that shoes which require that the toes be pressed down against the sole of the shoe to hold the heel in place during the swing phase of gait ,
    I'd like to know which shoes are you referring too? I don't know of any shoe that can hold the heel in place--starting at HO thru swing phase.
    The actual act of keeping the heel in place over the course of a long working day may also lead to muscle fatigue in the plantar intrinsics and in the shank of the lower leg.
    Not in my playbook.
    1 switching from clogs to a training shoe type of footwear with a wide and deep toe box
    2 re-establishment of the initial phase of gait via prescribed exercises


    Any thoughts ?

    Exercises cannot re-establish sufficient mechanical efficiency. Functional over-pronation only results in instability or even partial instability and tissue in-efficiency.
    BTW--HD tech does not work well in a clog too.
     
  36. Dennis Kiper

    Dennis Kiper Well-Known Member

    This has nothing to do with the influence of hydro-dynamic technology on the body.

    Bigger toe boxes-swing phase-intrinsics etc ect

    Until you can consistently and reliably measure the distribution of wt bearing and pronatory forces,
    loading time, proportionate peak pressure and measure the foot contact to the ground--those discussions and any research associated with the influence of muscles over function are not valid in my opinion. You cannot assess mechanical function accurately.
     
  37. scotfoot

    scotfoot Well-Known Member

    " I have issues with most everything described e.g footwear that restricts the" initial windlass phase " of gait-- How do you see a shoe that resticts...? "

    This thread explains the initial windlass phase of gait .

    Windlass mechanism | Podiatry Arena

    https://podiatryarena.com/index.php?threads/windlass-mechanism.109913
    14/04/2018 · Welcome to the Podiatry Arena forums. You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features

    -------------

    Re the intrinsics ,any medial arch support is reliant on the tissue between the plantar fascia and bony arch of the foot for force transmission ie the intrinsics . I think Nester and Mickle produce a paper on this subject a few years ago .
     
  38. Dennis Kiper

    Dennis Kiper Well-Known Member

    any medial arch support is reliant on the tissue between the plantar fascia and bony arch of the foot for force transmission ie the intrinsics

    Muscles power the structure, hmmm--do you think they can prevent overpronation in the foot?

    You apparently have missed the scientific principles that modifies pronation/over-p--precisely. You can stuff cotton under an arch and restict pronation and help stressed tissue. The medical benefit to me remains a lifetime with the ability to grow a bio-mechanical Rx.
    Assess function accurately. A technology that works the way it's supposed to.
     
  39. Dennis Kiper

    Dennis Kiper Well-Known Member

     
  40. Dennis Kiper

    Dennis Kiper Well-Known Member

    I'm not sure which of KK comments you refer to as good summaries about the bio-mechanics he discusses, I disagree with his conjecture on muscle function in the face of unknown variables and in-efficient mechanical function.
    I think I've given you all the information you need to begin using this technology after I'm gone. You'll just need to grow through the learning process as I did.
    In the beginning, not one of you thought out of the box.
    Not one recognized the hydrodynamic principles at play (and when you finally did--you rejected it for all the wrong reasons). Your paradigms of the evolution and mechanics of the foot are founded on Root's Principles. He got almost everything right about muscle function, mechanical function and engineering principles, but he got it wrong thinking through the rearfoot for control . the idea was good. for that period in time, he was possibly brilliant. His recognition of the axis of motion-and ROM and congruency as the ideal at midstance. Was all good and correct. But, theory and conjecture grew from there, regarding the influence of muscles over function in order to support mal-function.
    Now you're stuck in a technology that doesn't work as well as it should (nor does it grow) for any patho-mechanical problem--that can be fit for HD technology. If Root had hired an engineer to design his foot orthotic he couldn't have come up with anything better than fluid for the human locomotion system. That would have changed a few things of the theories and conjecture that has grown to what it is today.
    I prefer accurate, consistent and reliable data to assess, works for me.
     
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