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Claims of Foot Orthosis Superiority

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Nov 3, 2008.

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  1. drsha

    drsha Banned

    My fellow resident in 1970 at Jewish Memorial Hospital, Dr. Marvin Steinberg’s Program, David Mullens , D.P.M. sent me an email yesterday.
    More than a year ago the Podiatric Medical Education Advisory Committee (PMEAC) at the California School of Podiatric Medicine (CSPM) at Samuel Merritt College (SMC) committed itself to work towards reestablishing CSPM as THE national center of excellence in Biomechanics. The PMEAC asked one of its own members, Dr. Don Green, to form a committee to work with Dr. Paul Scherer, the Chair of the Department of Applied Biomechanics at CSPM, to make this goal a reality. Dr. Green asked three other nationally recognized experts in biomechanics (Dr. Tom Sgarlato, Dr. Kevin Kirby, and Dr. Doug Ritchie) to join this PMEAC committee and all enthusiastically said yes.

    As a result, a wonderful collaborative effort ensued. The distinguished members of the PMEAC Biomechanics Committee and the CSPM Biomechanics Department, led by Dr. Scherer, all agree the time has come to integrate biomechanics and technology as applied to foot and ankle surgery. With the full support of the PMEAC, the first meeting on the “Biomechanical Implications of Foot Surgery” will be held on Saturday, February 28, 2009 at the Hilton Oakland Airport Hotel in Oakland, CA.

    I wondered how long it would take to get Kevin to self promote it to you Pavlovian yes men and promote more paid lectures as I have to sell orthotics and patent to make money!
    So I peeked at Darth VADERS Arena and and and and and

    Great Job Tip………… It took one day….. for you to be Kevins stooge and post…….
    Remember Kevin--that was one of my biggist gripes at CCPM when I tried to get the school to require a full biomechanical evaluation for every surgery patient and I think it still occers in podiatry-the gap between biomechanics and surgery. we need to get someone like Kevin (a scientifically minded biomagical guru) hooked up with Al Burns or Steve Palladino (scientifically minded surgeons) and apply the "principle of biomechanics theory" to the practicality of surgery. Developing a long term prospective study that intercalates biomechanic principle with some of the more simple or even the complex surgical cases is sorely needed and could be undertaken on a multisite basis using our schools and/or residency training for the data.
    Tip

    Won’t see you at the conference, I have to spout my b___ls___t to those lost souls who will listen to me. You handle the Arena Darth, hahahahaha
    Dennis
     
  2. Tip:

    As Dennis Shavelson, DPM, (Drsha) mentioned, we are organizing a conference in Oakland in February where we are bringing in both surgeons and biomechanists to lecture on the biomechanics of surgery. Should be a very good one day seminar and I don't think this type of seminar has been tried before.

    Jeff Christensen, Tom Sgarlato, Doug Richie, and many others will all be lecturing. I have attached the flyer to the seminar.

    Tip, you should attend!!
     
  3. EdGlaser

    EdGlaser Active Member

    In the open chain, but certainly not in the closed chain. And why is the navicular tuberosity the exception to the rule. If you look at Kevin's diagram of the medially deviated STJ axis, it is also lateral to the axis. What you are saying grossly contradicts what Kevin says in the very next post.

    Your observation on your "outlier" foot seems to contradict the supination resistance tests by Craig. His strap was placed in the arch and caused supination. Also Kevin's two finger supination resistance test is also contradicted by your observation. What is more, I have never pushed up on the arch in the closed chain and had it drop as you seem to observe. Are you standing upside down on the ceiling? Even then it would not work. Gravity is not just a good idea....its the law. What you have done here is highlighted the first major flaw in SALRE theoretical assumptions. I will clarify in the next post.

    Eric.... my theories are not on trial here, Kevin's are. The majority of your post which is the quote above is a criticism of my orthoses. Attacking me is not defending SALRE nor the point of this discussion. I would love, at the end of this thread to defend my theories as long as the same ground rules apply to me that I have embraced in this discussion. That would be a refreshing change indeed.

    In fact, in Kevins next post he states:

    "MLA raising effect since, by applying a compression force to the soft tissues of the medial arch, there will be both a rearfoot dorsiflexion moment and medial forefoot plantarflexion moment."

    What you seem to be asking Kevin here is why is there a medial forefoot plantarflexion moment.

    Furthermore, you did not even attempt to answer the actual question. It is a physics question and should be answered as such. I understand that you have taken the side of defending Kevin's work but lets stay on task here.

    Perhaps I failed to qualify the question adequately. I am talking about the closed chain. Not any measurements taken in the open chain, even the "plantar parallel" position. I believe Kevin's own work, among others, have done an adequate job invalidating static measurements taken in the open chain even when done by an "expert" clinician. I understand the STJ axis location is not static.

    I am writing a much longer involved answer to Kevin's response which will follow.
    Please be patient as I am choosing my words carefully.

    Cheers,
    Ed
     

  4. If the navicular tuberosity is medial to the STJ axis, then pushing up on it will cause a STJ supination moment. If there is a severely medially deviated STJ axis so the the STJ axis passes directly superiorly to the navicular tuberosity, then pushing up on the navicular tuberosity will not cause a STJ supination or a STJ pronation moment but will simply cause a compression force on the STJ axis (i.e. compression of plantar soft tissues on the navicular tuberosity). Also please understand, Ed, that the term "medially deviated STJ axis" simply means that the axis is medial from its more normal position overlying the lateral first metatarsal head area. The STJ is widely variable from one individual to another and within the same foot depending on the rotational position of the STJ axis during weightbearing activities (Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987. Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992. Kirby KA: Biomechanics of the normal and abnormal foot. JAPMA, 90:30-34, 2000. Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001). Therefore, before you can know the mechanical effects of any plantarly applied force to the foot on the kinetics of the STJ axis, you must first know where the STJ axis is located relative to that force.

    And Ed, making comments like "Even then it would not work. Gravity is not just a good idea....its the law." to someone as knowledgable of physics as Eric Fuller will not help your cause in any way with any of us. What do you expect to gain from such comments when you are trying to have an academic discussion?
     
  5. If we pushed hard enough, could we also achieve dorsal displacement of the navicular relative to the medial cuneiform and talar head and a resultant supination moment from the navicular via the spring ligament to the calcaneus, shifting the STJ axis laterally in the process and creating a "snowball" of increasing STJ supination moment?

    Or, would the dorsal displacement of the navicular, effectively mean that the talar head is more plantarflexed relative to the navicular (at least until the "slack" in the spring ligament is taken up), increasing the medial shift of the STJ axis, in relation to the forefoot? Perhaps this would negate the moment via the spring ligament? Just thinking out loud.
     
  6. efuller

    efuller MVP

    No, it does not contradict what it says in Kevin's post. The "L" in SALRE is the key issue here. The location of the axis is variable. In my foot just the medial edge of the navicular lies medial to the axis. My example is of an outlier foot. Kevin explained in his post the physics of arch raising in a foot with a less medially deviated STJ axis. The question of whether or not pressure in the arch will cause supination of the STJ is dependent upon how far medial the center of pressure is shifted relative to the STJ axis. Kevin's explanation is the one that I wanted you to see and understand. Do you agree with his explanation? With his explanation, it is possible to have an axis far enough medially deviated that you would not get supination with pressure in the arch.


    Again they don't contradict the supination resistance test. Craig mentioned that there were some feet that broke the strap. Some feet are harder to supinate than others and if I remember correctly Craig mentioned that the feet that were really hard to supinate tended to have medially deviated STJ axes. The point here is that there are some feet that will take a really high amount of force in the medial arch before they supinate. My experience is that this high amount of force is painful and additional muscular activity is need to create supination.

    Ed, I'm not sure what you are alluding to in your second sentence. I never said that pushing up on the arch causes it to drop. Yes, you can still get pronation, in some feet, when you push up on the arch, but the arch does not drop.

    Ed, you asked the question:

    Originally Posted by EdGlaser View Post

    According to the SALRE theory.....In the medially deviated STJ axis, the majority of the MLA is lateral to the axis. If a vertical upward force is applied to the plantar surface of the foot with its COP in the MLA, then according to the SALRE theory, being lateral to the axis, it will have a pronation moment. However this force will raise the MLA and therefore supinate the foot.

    How can a force directed upward in the MLA which in the SALRE theoretical model causes a pronation moment, result in supination? or more simply: How can an upward force with COP in the arch result in a pronation moment?

    Please clarify,
    Ed​

    Ed, you did not even state what your theory was, how could I be criticizing it? Is it that pushing up on the arch causes supination? I agree with Kevin's post on the description of the physics of how pushing up on the medial arch will cause a medial shift in the location of center of pressure under the foot. Do you agree with that analysis?

    What exactly is your problem with SALRE? All you did is ask a question and we have attempted to answer it.


    Actually I disagree slightly with what Kevin wrote. There is not an increase in plantar flexion moment on the forefoot. There is a decrease in dorsiflexion moment on the forefoot because the center of pressure of ground reaction force is moved more posterior with pressure in the arch. As long as there is upward force on the forefoot, the forefoot will stay dorsiflexed. Yes the net dorsiflexion moment can be reduced by shifting the force more posteriorly, but it is still a dorsiflexion moment.

    As I said above, I think Kevin answered the question.

    Ed, are you saying that because you cannot accurately determine the location of the STJ axis, you cannot use it theoretically. I maintain that there is a hinge like axis to the STJ and that when you apply a force from plantarly medial to the axis the STJ will supinate and when you apply a force lateral to the axis the STJ will pronate. I also maintain, that there is variation of the location of the axis across people. Regardless, of the exact location of the axis, a medial shift in the location of the center of pressure under the foot will decrease pronation moment or increase supination moment about the STJ.

    I'm waiting for your criticism of the above theory.

    I also disagree with the notion that open kinetic chain forces are qualitatively different from closed kinetic chain forces. We should be able to analyze all the forces that are acting in both situations. An upward force medial to the STJ axis will cause a supination moment regardless if it is open chain or closed chain.

    Cheers,

    Eric Fuller
     
  7. Eric:

    I stand corrected with your improved terminology. The net mechanical effect is the same. A medial arch plantar force will cause a net decrease in medial forefoot dorsiflexion moment.
     
  8. EdGlaser

    EdGlaser Active Member

    Kevin,
    Thank you for the physics analysis of SALRE. It was quite thought provoking and well stated as usual. I had a lecture today which kept me busy so I am just getting to reading the responses. I will prepare a rather lengthy discussion of your ideas. I had a full day today and still have to work out, so I will probably post it tomorrow.

    In consideration of my schedule, I will try to give one combined answer to everyone that responds. I will put quotes around the posts I quote and identify the author whenever necessary. I think that my last visit to the Arena was overwhelming to me time wise because I tried to answer each person separately. Maybe there are more shortcuts that I have not yet realized.

    Well Done,
    Ed
     
  9. Ed:

    Please take your time with your responses since I know, with my busy life, how difficult it is to try to respond to multiple people when you already have too much to do in a day. I believe we can all accomplish a lot for the podiatry profession and for our patients in pain if we can try to understand each others' viewpoints by engaging in rational, level-headed academic discussion. After all, I hope you can agree with me that the large amount of time and effort we are all making in contributing to this discussion is only worthwhile if it ensures that our patients are receiving the best possible foot orthosis therapy available.

    If you get a chance in the next few days, please have a read of the attached review paper by Steve Piazza, PhD, who is a mechanical engineer with his PhD in biomechanics from Penn State University Biomechanics Lab and who I am collaborating with (along with Greg Lewis-a mechanical engineer at Penn State that just got his PhD in biomechanics) on finding an improved method to determine the 3D location of the subtalar joint axis. Steve, I believe, does a nice job here of objectively reviewing the functional importance of identifying the STJ axis location from a clinical aspect and, since he is a mechanical engineer, is very precise in what STJ axis location can tell us mechanically. Since Steve and Greg are both mechanical engineers, I often struggle to understand what they are talking about, but I am always learning from them which I have found very rewarding and intellectually stimulating. It has been very nice to have them helping me out with this problem of trying to determine STJ axis location.

    In addition, another very well-known biomechanics researcher from Massachusetts, and his biomechanics PhD student, are soon going to be utilizing the STJ axis locator that Simon Spooner and I designed and researched (Spooner SK, Kirby KA: The subtalar joint axis locator: A preliminary report. JAPMA, 96:212-219, 2006) to try and research the kinetics of the STJ during weightbearing activities in their biomechanics lab. All of these research projects should give us a much better understanding of the relative importance of the spatial location of the STJ axis in both foot and foot orthosis function.
     
  10. Simon:

    The mechanical effects of a dorsally directed force acting on the medial navicular, straight toward a medially deviated STJ axis that passed directly over this medial navicular, would be to cause:

    1. an ankle joint dorsiflexion moment

    2. a talo-navicular dorsiflexion moment

    STJ supination moment could occur once internal forces changed in response to the medial navicular pushing force (e.g. posterior tibial or anterior tibial muscle had increased contractile activity).
     
  11. EdGlaser

    EdGlaser Active Member

    Kevin,
    Thanks for the references. I will read them before I respond. I stayed up late last night writing a three page post, had a doctor's appointment myself with blood tests and EKG this morning, had a one hour meeting with my engineers, Don and Stu and went over my assessment of the physics in your answer, among other business issues, and then spent the rest of the day at the local high school giving a guest lecture and forming an entrepreneurial scholarship program for seniors, returned to work to answer emails, worked out and just got home from a 16 hour day. Then Don sent me an email with two more pages of discussion on this topic which I also have to review. As I said, I am very busy. I have another lecture at 8 am tomorrow followed by work on my own research project. There is just not enough time in the day. I will try to post this weekend.
    Sorry for the delay,
    Ed
     
  12. Ed:

    If Don, Stu and yourself want to do a joint posting with all of your comments together, then that seems like a good idea to me. As far as I'm concerned, the more educated people we have discussing this important subject and adding in positive and constructive criticism, the better.

    Hope the doctor's visit went well.:drinks
     
  13. Steve The Footman

    Steve The Footman Active Member

    The really weird thing about this debate is that Kevin Kirby has been accused of representing the status quo. If any podiatrist could be accused of rocking the establishment it would have to be Kevin. From a perspective of someone outside of the US podiatry community Kevin appeared to be instrumental in bringing about the downfall of the Rootian paradigm. I would even go so far to say that he is still viewed by many Podiatrists to be undermining their closely held beliefs on biomechanics and orthotic therapy.

    Now that the Kirby paradigm shift is in the ascendency the rebel has become the establishment. This fact must in itself carry a greater risk that Kevin's new ideas may not be scrutinised to an adequate level. Because of who he is - rather than what he says. This is the fallacy of authority and every person with a reputation has increased risk of falling into this trap. One apect of this risk is that the science becomes incomprehensible to most who rely on this change in perspective. Many will continue to be in denial and cling to the old paradigm while others will accept it on face value because they will be unable to prove it themselves. I believe that e=mc2 but can not do the maths to prove it.

    Ed I see you make the claim for a paradigm shift on your website regarding your MASS system and Bruce Rothbart makes the same claim for his posture control insoles. But while Paradigm shifts require a certain amount of charisma and persistance to occur the most important ingredient is truth. The very nature of a scientific paradigm shift is that the new perspective must make more logical sense than the previous paradigm and enough people must be able to independently validate it experimentally. It needs to be obvious to most who try to grasp the new perspective and then be impervious to those who try to undermine it with false logic. That is the criticisms must be weaker than the new perspective.

    I believe that there is some merit in the idea of casting in a semi weightbearing position and making the corrections at the time of the casting rather than to the cast. While I have not seen your orthotics I am sure that you have many satisfied patients. However this does not in itself make your claims for a paradigm shift valid.

    You should use Kevin Kirby's example of how to make a paradigm shift occur. It is not by making unsubstantiated and exaggerated claims such as "He offers the first credible challenge to the standard, industry techniques originated by Root, Orien and Weed in 1977." and "His course, MASS Position Theory & Application, has strengthened the foundation of foot biomechanics." It is also not by creating a product that is a panacea except for "traumatically deranged feet" as your website states.

    Your position is also undermined by taking such a financial interest in your theories. Kevin in contrast offers his ideas to all practitioners without proprietary control. The "medial heel skive" is called the "Kirby Skive" not by himself but by the many practitioners who recognise his contribution to podiatric biomechanics.

    I wish you luck on creating the paradigm shift you crave. But I would counsel you on taking a different approach if you are to succeed.
     
  14. Steve:

    I love this Einstein quote:

     
  15. David Wedemeyer

    David Wedemeyer Well-Known Member

    Steve,

    :good:
     
  16. David Wedemeyer

    David Wedemeyer Well-Known Member

    Graham,

    Sorry for the delay in responding to your post.

    That is precisely why I spend time here Graham, I have a keen desire to improve my knowledge and skill and not be a dilettante like so many we have encountered. I also would like to get my own profession to think about WHY they are providing these services and to elevate the level at which they practice (or to discontinue “selling” inserts and refer). I feel that somewhere along the way Podiatry has allowed other professions to offer a service that was distinct to Podiatry at one time and the door has been opened whereby virtually anyone can dole them out (and make any claims that they want to). It is a problem and you are correct that some level of standardization would benefit those of us who take it seriously. If F-Scan is one method by which we could verify the biomechanical effects that would prove a measured outcome then I am all ears.

    The posts by Mac and Tip have added an infusion of intelligence and restraint that was sorely needed. This thread was getting out of control, off point and very personal. Of course passion is something to be admired and respected and no one seems to lack that quality here; that’s what keeps me coming back to this forum.

    From the perspective of an allied practitioner whose primary didactic education was not specifically focused on the foot or on orthoses, there is zero continuing education available of this level for my profession regarding the foot and orthoses. I really only have all of you as colleagues and mentors. When I graduated from Chiropractic College I was afforded a gratis pair of Foot Levelers’ dandy little inserts, handed a foam box with postage paid return envelope and told “this is the company to use for foot orthotics”.

    My odyssey in orthoses began when I questioned that company’s profligate marketing and unsubstantiated claims upon which their sales are built, to being duped into buying a Quasar system, then an optical scanner (which actually is good but with zero lab support) and pestering a local DPM to teach me appropriate plaster casting and about Root Theory, to eventually becoming a Pedorthist. All of this was just to try to become better than the next Chiropractor at dispenses a quality custom orthosis. Hopefully no one will ever say that I don’t think for myself, question falsehoods and try to advance my practice.

    I am only relating this because I feel that although I am not a podiatrist colleague, I have an overwhelming interest in conservative foot treatment and biomechanics and a unique and unbiased insight into your industry that at times that may hopefully be of value. My ultimate goal is in benefiting my patients, many of whom are referrals from DPM’s and MD’s.

    I have therefore had to learn to discard anything that simply was not based on science, not achieving results and to question, learn and implement new theories and ideas and keep revising my own methods.

    A part of that process was questioning the rationale for many of the proprietary designs and branded orthoses that I have encountered along the way and I admit it does offend me when a company comes along and professes to make the “best” orthoses and I find what I perceive as flaws in their design, a lack of clinical data to support these claims, fatuous marketing, etc. What disturbs me the most though is that these companies universally market aggressively to professions such as my own where the level of their education in orthoses as a group renders them very easily influenced and abjectly without the clinical and educational framework to sift through the hype and smoke and mirrors.

    I don’t want Ed to take that last statement personally, I will bet that you really do believe what you are offering, it is just the manner in which you market by detracting from your own professions fathers of the process that I find difficulty with. I don’t believe that anyone here would disparage the contributions and brilliance of Merton Root who (among others) laid the foundation and framework from which we all have learned, many here have expanded on and progressed and we ALL have profited from.

    Make no mistake though, the new ‘ideas’ that I have learned from Kevin (and many others here and through continuing ed) are not Rootian. They diverge from Root Theory in their biomechanical approach and have been tested and quantified utilizing physics and science. They are based on clinical outcomes over a number of years (and I’ll take that any day over simply data from peer-reviewed studies and research trials, many of which have an inherent flaw or bias). They are observable in a clinical practice and accepted (as I understand it) within the larger community of standardized labs and practitioners throughout the world. They are repeatable and often predictable as outcomes. I know this because I have adopted many of these ‘ideas’ into my own practice with much greater success and confidence than I could ever have hoped for.

    Ed I don’t know you personally but I have to admit that you are passionate about what you are teaching and have cut a path of your own. I do not agree with much of the MASS theory but I will keep an open mind as you debate with the better minds on here about your product. Also because we have never met I am going to apologize for giving you a hard time and hope that someday we will meet and can discuss your ideas and if we still disagree shake hands and leave with a degree of mutual respect. The same goes for Stu Curry, who I am sure you may have heard I had a brief debate with over MASS technology.

    I am stepping off my soapbox and into the shadows to observe and learn. Sorry for the long post.
     
  17. :D

    That is what society does! You change the world against all the objections of the established order, which is meet and proper. Then some upstart comes along and wants to change your new established order!!

    And so proceeds ad infinitum.

    Robert
    Rebel without a clue.
     
  18. Mac

    Mac Member

    David, you would be welcomed :welcome::welcome:at the PFOLA conference (www.pfola.org).

    Cheers, Christopher MacLean
     
  19. David:

    This was an excellent posting. Nice to have an intelligent chiropractor on board here on Podiatry Arena that can critically analyze the theories of orthosis therapy and hopefully better inform the less educated members of their own profession.

    When I first started this quarter-century journey of trying to gain a better insight into the biomechanics of the foot and lower extremity, I was fortunate to have professors, such as Drs. Mert Root, John Weed, Ron Valmassy, Rich Blake, Chris Smith, Jack Morris, Bill Sanner and John Marzalec, at the California College of Podiatric Medicine educating me as to their view of how the foot worked. I was taught Root theory (i.e. subtalar joint neutral theory) and I, in turn, taught Root theory to podiatry students during my Biomechanics Fellowship from July 1984 to July 1985. I owe these individuals all a great debt since their clinical skills were all excellent and I learned something from all of them, even though I have moved away from their biomechanics theories in the last 24 years.

    When I started exploring the concept of subtalar joint (STJ) axis location, after Dr. John Weed told me, in late 1984, about he pushed on the bottom of the calcaneus to help determine which patients needed anti-pronation features on their orthoses and which patients didn't need these features, I started to question what I had been taught by these learned individuals. The great intellectual breakthrough for me came when I realized that the weightbearing surface of the calcaneus was medial to the STJ axis and the weightbearing surface of the majority of the forefoot was lateral to the STJ axis and that the location of the STJ axis would determine the supination and pronation moment arms for ground reaction force acting on the plantar rearfoot and forefoot, respectively. I can still remember where I was on my drive home to San Francisco in the evening, after my all-day orthosis clinic at the Kaiser hospital in Vallejo, when this epiphany came to me.

    The best analogy I can give for such a unusual and exciting experience is to imagine you have been wandering around for months in a room with multiple doors. In this room, there is a constant dark fog that frustratingly shrouds your clear view of objects around you and every time you open a door to try to gain a clearer view, more dark fog is present past the opened door so that your view is still obscured. Then one day, you open a new, previously unopened door that, instead of a dark fog, reveals a bright light past its boundaries that has no fog and where all the objects around you are seen to be crystal clear. This is exactly the feeling that I experienced when I realized the important mechanical signficance of STJ axis location on my drive home from Kaiser Vallejo almost exactly 24 years ago.

    I wrote my first paper on STJ axis location in 1986, a year after I graduated from the Biomechanics Fellowship and started my practice. I have attached this paper for those who want to read my first published thoughts on the subject. Since then, I have been very fortunate to have inviduals such as Eric Fuller, Simon Spooner, Craig Payne, Chris Nester, Bart VanGheluwe and Howard Dananberg who have greatly helped me with my thought processes in trying to gain a more logical and complete understanding of foot and lower extremity biomechanics and foot orthosis therapy. More recently, I have been very fortunate to be affiliated with research from a few of the major foot and lower extremity biomechanics labs here in the States that has challenged me to learn new ideas so that I can effectively communicate with these learned individuals.

    Overall, in retrospect, I don't regret any of the countless hours of work and effort I have made over the past quarter-century in trying to improve the biomechanical theories, improve the orthosis techniques and improve the clinical tests that we all use daily in our practices. I naively thought initially that this process of getting my theories to be accepted more widely would have taken only 5-10 years rather than over 20 years, but I am still satisfied that we have made very good progress in elevating our biomechanical understanding of foot and lower extremity function to the point that we can now communicate and work well with the PhD biomechanists of this world. It is my firm belief that by building a better bridge between the research world and the clinical world, we will establish better and more effective avenues of communication between the clinician and researcher so that, ultimately, our patients will benefit from our better understanding of foot and lower extremity biomechanics and the biomechanics of foot orthosis therapy. After all, this is what it is all about.....making our co-inhabitants of this small planet less painful, more active, more productive and more happy with the practical application of the science of biomechanics.
     
  20. David Wedemeyer

    David Wedemeyer Well-Known Member

    Chris,

    Thank you for the warm welcome. I did in fact attend the 07' PFOLA conference in San Diego. I intend on attending again as I found the experience invaluable and an excellent learning experience.

    Regards,
     
  21. David Wedemeyer

    David Wedemeyer Well-Known Member

    Kevin despite the common theme of skepticism I encounter regarding some antiquated philosophical beliefs in my profession, you might be surprised at the level of our education and the intelligence and dedication of my colleagues. Chiropractic has progressed, at least in the US and is no longer considered a fringe practice. There is also a great degree of current scientific data to support manipulation as a first line therapy for spinal complaints.

    It is when my colleagues try to extend their practice and claims beyond that valid scope that we encounter scrutiny and resistance. We are full body practitioners not limited to the spine and autonomous of the allopathic profession, which is what apparently they have historically seen as a threat. That is slowly changing and for the betterment of our patients.

    I wish I could have recorded the facial expressions of the first orthopedic surgeon that I approached asking for referrals for orthoses a few years back. We seemed to hit it off personally but I could tell that he was skeptical and cautious. We are friends today and I owe him a great debt of gratitude for giving me the opportunity to help his patients. That event seems like it was a long time ago and since then he is my most consistent referral source.

    That fog you describe would be the content of your papers Kevin! That is a great description though and I have felt that way numerous times. I do have the occasional epiphany and mostly they occur when I begin the process of putting these theories to paper in the process of writing out the prescription for that patient (which I was not taught prior). I adhere to your principle of establishing the goal for orthoses and patient and work from there.

    I have learned a great deal from your work Kevin and appreciate your efforts (and those of the many other researchers and contributors to this site). Thank you for all that you do and for welcoming an allied professional along. I sometimes wonder if I should have considered Podiatry as a career instead ;). Family members have commented "when did you become a foot doctor"?. :eek:

    One never knows what strange path life will lead you down...

    Regards,
     
  22. I just wish that more podiatrists in the States had the same level of interest in producing the best foot orthoses for their patients as you do, David.
     
  23. DanthePod

    DanthePod Member

    I have experienced the Bottom Block course run by Ed twice now. The course is very simplistic on theory. Ed never encourages any kind of questions during his course and most of it is aimed at educating Podiatrists about what you can use orthotics for. On talking directly with Ed it would be over eight years since he actually treated patients with his devices himself. However he professes to be an expert clinician!!! please correct me if I am wrong.
    On the other hand Kevin Kirby and many others are continually treating patients directly with orthotics they prescribe and are continuing to refine their ideas based on recent research,group discussions and their own direct clinical interventions.
    People who only pontificate with little continuing clinical experience must leave themselves open to the assumption that their focus is on selling the idea of clinical success as opposed to actually acheiving it.
    Ed how much true direct clincal work have you done....let me guess maybe you are just to busy...:sinking:
     
  24. Dan:

    I have never been to one of Ed's lectures, even though I understand he offers to pay his way to lecture at many state podiatry seminars here in the States. Of the 10 or so podiatrists who have attended his lectures that I have to spoken to about Ed's lectures, every single one of them told me that they thought, instead of attending a scientific lecture on foot biomechanics and foot orthosis therapy, that they were attending an "infomercial" for Ed's orthosis lab.

    Even though most podiatrists are not experts in foot biomechanics, most podiatrists are intelligent enough to see right through the slick promotional presentation made by an owner of a foot orthosis lab as being nothing more than a self-serving advertisement with the sole intent to sell more foot orthoses and make his company bigger, not to educate podiatrists in the science of foot biomechanics and science of foot orthosis therapy.
     
  25. joejared

    joejared Active Member

    Part of it is technology, part of it is technical and management competency within the company, and absolutely none of it has to do with marketing, except by word of mouth. Of course, giving one's opinion on one matter or another can involve lower life forms (lawyers) from time to time because sometimes, the truth 'hurts'. I've recently seen well made videos about a product I wouldn't use to weigh my cat, and yet it claims to be a true 3D scanner. From a technological perspective, it's a no brainer. Pressure does not equate to altitude, and yet it is marketed as such. (Note that at no time have I attacked any company, but rather the well marketed technology that means almost nothing to the patient) Conversely, and in spite of the best possible technology, the technician at he helm can either make or break the product. :bang::bang: From a purely biomechanical perspective, I believe a technician should be taught about the foot and biomechanics of various conditions before he is to even touch a computer or file on a positive, and most importantly, before he or she is allowed to even talk to a doctor unless it is to say, 'hold on, I'll hand you over to someone who can help you."

    We could argue at length about casting methods, technology, ad nausium and waste a lot of bandwidth and time, but the real question has to do with just what level of understanding does a given laboratory have of the foot, and are they able to communicate with a doctor properly about the problems, even if the problem is the doctor and how bad a casting job they did? Did I mention that some doctors have a little bit of an ego problem and never cast a patient wrong? Some labs avoid this issue all together, simply by quietly finding a prefab that 'looks close', leaving it as an educated guess as to whether the device will actually help the patient. I'm not a fan of this technique, but it happens all of the time, because of ego, either on the part of the doctor, or fear on the part of the lab of losing their 'good' customer. so in advance, how many :deadhorse: got killed in this post?
     
  26. admin

    admin Administrator Staff Member

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