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Classification of forefoot pain based on plantar pressure measurements

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Feb 26, 2013.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Classification of forefoot pain based on plantar pressure measurements
    N.L.W. Keijsers, N.M. Stolwijk, J.W.K. Louwerens, J. Duysens
    Clinical Biomechanics Available online 20 February 2013
     
  2. drsha

    drsha Banned

    This study reinforces the thought that forefoot pain and deformity are preceded by foot typing information.

    The fact that no deformity pre-exists the pressure changes in the forefoot can be taken one step further back by stating that the functional foot type preceded the pain as well.

    This makes foot typing relevant in biomechanics as a predictor of underlying pathomechanics as discovered in this study.

    The flexible forefoot functional foot type reduced the pressure under the first MPJ and shifts it laterally to the II and II-III mets depending on the RF FFT. It also pushes it distally under the hallux IPJ of the 1st Ray.

    This would also be reflective of callus pattern shoe wear and eventual predictable deformity such as bunions, lesser toe hammertoes, neuromata, PF and great toenail distal subungual dystrophy.
     
  3. efuller

    efuller MVP

    This study does no such thing. Dennis, you are undermining your creditability by claiming this.


    Have you even read the full paper yet? You certainly can't make that claim from the abstract. Your bias is clouding your thinking.

    Are you going to explain how this happens or can just continue to assume that you are making this stuff up?

    Eric
     

  4. Agreed. You can't get there from here, Dennis... http://www.youtube.com/watch?v=gD3cYh5Pp1I

    "When the world is a monster
    Bad to swallow you whole
    Kick the clay that holds the teeth in
    Throw your trolls out the door

    If you're needing inspiration
    Philomath is where I go, I go
    Lawyer Jeff he knows the low-down
    He's mighty bad to visit home..."
     
  5. Delusional.....
     
  6. Rob Kidd

    Rob Kidd Well-Known Member

    Dear me: so much tautology........................ To look at a foot type and use it to predict, or perhaps even simply explain symtoms may be considered in the realm of scientific method. To look at symptoms and use them to explain what foot type caused them is decidedly tautological. What do they teach at science school these days?
     
  7. drsha

    drsha Banned



    I am sure that I deserve the comments that I am receiving here and in response, I would like to dissect my posting piecemeal.

    As to Eric's comment of not understanding the article findings.

    Does this study find that by pressure pattern and neural networks and without the existence of deformity, the authors could predict forefoot pain 70% of the time in their subjects?

    If I am wrong here, then the rest of my hypothesis becomes appropriately skewed and weak.

    Dennis
     
  8. drsha

    drsha Banned

    Dr Kidd:
    As there has been no response to my query as to the nature of the article that is the basis for this thread and discussion, I would like to respond to your honest and fair posting.

    In stating that looking at a foot type and using it to predict, or perhaps even simply explain symptoms may be in the realm of scientific method confirms the uses of typing and classification systems in medicine in general.

    I have, with anecdotes and low level evidence (case studies, etc) worked in both directions. A person with a bunion most often has a rigid RF, flexible FF FFT and the rigid RF, flexible FF FFT has the greatest propensity to develop a bunion in the future. That is the current level of my proof and I feel that this article adds to conforming my evidence.

    As far as teaching things in science school, that remains the biggest negative of The Arena that I have learned to accept is the acceptance of postings such as Dr. Kirby's on this thread that simply says "delusional.."

    I realize this genre of posts from Kevin reduce his overall reputation and importance as a scientist, mentor and biomechanist but they still reflect something that for me, is not being taught in science school these days that is accepted on these pages unnecessarily.

    Dennis
     
  9. drsha

    drsha Banned

    Dr Kidd:
    As there has been no response to my query as to the nature of the article that is the basis for this thread and discussion, I would like to respond to your honest and fair posting.

    In stating that looking at a foot type and using it to predict, or perhaps even simply explain symptoms may be in the realm of scientific method confirms the uses of typing and classification systems in medicine.

    I have, with anecdotes and low level evidence (case studies, etc) worked in both directions. A person with a bunion most often has a rigid RF, flexible FF FFT and the rigid RF, flexible FF FFT has the greatest propensity to develop a bunion in the future. That is the current level of my proof and I feel that this article adds to that evidence.

    As far as teaching things in science school, that remains the biggest negative of The Arena that I have learned to live with. The acceptance of postings such as Dr. Kirby's on this thread that simply says "delusional..". These are mean, angry, personal posts that have no place in the discussion.

    I realize that in return, this genre of posts from Kevin reduce his overall reputation and importance as a scientist, mentor and biomechanist but they still reflect something that for me, is not being "taught in science school these days" that is accepted on these pages unnecessarily diverting them.

    Dennis
     
  10. Dennis, the main findings of the study were: "The pressure–time integral and mean pressure were significantly larger under the metatarsals II and III for subjects with forefoot pain. A neural network with 14 input parameters correctly classified forefoot pain in 70.4% of the test feet."

    So, did the observed pressures cause the pain or were the observed pressure patterns occurring as a response to the pain?

    Notwithstanding, did this study employ the foot-typing system (that you hold a patent on) in building their predictive model? I'm guessing they didn't; hence the 14 input parameters in their model did not include your foot-typing assessment and as such your foot-typing system cannot be considered as a predictor within their model- right? You have no data to suggest that your foot-typing system predicts either the pressure-time integral nor the mean pressure beneath the forefoot, so you cannot even extrapolate to that- right? Viz. your statements that:


    are simply not supported by this study. End of story. However, once again you have managed to crow-bar another plug for your system onto Podiatry Arena. I'll bet your bosom is now swollen with pride. Well done. Can you list the 14 input parameters in the model, Dennis; which of these variables has your foot typing system been shown to predict? None of them- hence my esteemed colleague calls your claims above: "delusional", with good reason.

    When another esteemed colleague asked:
    That went over your head because you skipped that class and went straight to "marketing 101" instead of taking the time to do the science and to provide evidence for the product you constantly try to plug here.
     
  11. drsha

    drsha Banned

    Thank you Simon. Once again you enable me to grow. I'm sure the next article that I feel may be evidentiary for Foot Centering will be better presented thanks to you.

    Very interesting thought. I think it depends on longevity, weight, activity level, shoe gear, etc. but
    my guess is that the inherited 1st met pathology of increased plantarflectory stiffness is causing a secondary dorsiflectory stiffness of 2-3 laterally as compensation. That would hold true for metatarsalgia and IPK's, etc. Different scenario for neuromatous pain which we can debate another time.



    My logic is as follows:
    The parameters seem to come from the scans that were taken for each subject so that was my focus. If their scans took them to their conclusions and the same scan has me foot typing the same scan as Flexible Forefoot, then Flexible forefoot would be the type of foot that tested often for pain (see Illustration).

    Here is a scan of a mean flexible forefoot functional foot type and the one from the article showing the mean foot that they scanned. I attributed my claim since they are quite similar.

    In addition: here are the callus patterns of the common foot types with old and new terminology (old as best as I could):

    Rootian Foot Centering Dominant Callus Pattern

    Uncompensated FF Varus Rigid FF FFT 1st met and/or 5th met

    Partially Compensated FF valgus Stable FF FFT no callus or mild 2nd met

    Compensated FF Varus Flexible FF FFT 2nd met or 2nd, 3rd met

    Uncompensated FF Varus Flat FF FFT 5th met

    The only FF FFT that has a dominant 2-3 met callus is the flexible FF FFT and this also seemed to be connected.

    In terms of application of foot typing in research, I believe that if the authors repeated their study using 100% flexible forefoot FFT's, they would end up with higher results. They could also foot type the pain group subjects of the study and prove me delusional if there was not a dominance of the flexible forefoot FFT (hypothetically).

    Dennis

    I'm hoping you will be able to apply the three attachments to their correct locations.
     
  12. drsha

    drsha Banned

    The attachments didn;t attach, I'm trying again.

    grey flexible forefoot FFT

    multicolor scan mean scan from article

    table the data scheme from the article

    Dennis
     

    Attached Files:

  13. Yep... Come back when you've actually done the science, Dennis. As oppose to speculating on what you "guess" and making it up as you go along. What did Henenfeld say about forefoot callus patterns; what about Demp? I'm not sure why Root should be considered the expert on callus patterns? Moreover, what about Hughes et al.: Foot and Ankle 1993: 14(9): 514-9, etc.? What might Bojsen-Moller say? Read Huson's chapter here: http://alexandria.tue.nl/repository/freearticles/604113.pdf, why might pressure be higher under the central rays?

    Please go away and read these works before you prematurely ejaculate more of your guesses here.
     
  14. drsha

    drsha Banned

    Straw Man....

    This has nothing to do with the article...... or foot typing. What anyone said about the FF Patterns and my knowledge thereof has nothing to do with this thread. Not this article or my claim. Nor does your ability to quote references with light speed make your argument any stronger.

    and

    The key word here is notwithstanding for this other Straw Man. What caused the pain was not a part of the article or my belief that it evidenced foot typing.

    You've taught me well and thanks.

    Please respond to my pertinent postings or explain why they are not worth answering, or...

    Dennis
     

    Attached Files:

  15. Whatever, Dennis. My ability to quote references is because I have actually gone to the trouble to read and understand the scientific literature. You'd do well to emulate this.

    Your premature ejaculation notwithstanding, the study in the original post has absolutely nothing to do with your patented foot-typing system and never will. Viz. your postings are not pertinent in this thread. End of story. Whether they are pertinent at all is highly debatable, I should say that they are not. Several have suggested that your original posting in this thread was completely out of context, yet you choose to ignore this. Thus, I'll refrain from answering anything else you write, until I feel that you have added anything pertinent; so far this has not been the case. You're argument appears to consist of "because I said so", if you went to the trouble of reading the references I listed, you'd soon realise that others have already suggested your position to be at best questionable, if not erroneous. Nothing to do with "straw-men", Dennis. Perhaps if you could reference your guesses? Meanwhile, keep flogging your dead horse. :deadhorse:

    You'd do well to read more and spout-off less. You complain that I did not address your question, when all the while you have not addressed the questions I asked of you prior to this. Moreover, if you'd have followed my direction to read the references I listed, you should have realised that I was leading you to answer your own questions via Socratic teaching. Never mind.

    Now, whether the pain caused the pressure pattern or whether the pressure pattern caused the pain is interesting and is related to the article- do you understand predictive model building?

    You've attached an image of a print from a Harris-Beath mat that you made and one from a pressure mat from the paper and a flow chart from the paper; this is your idea of evidence to support your conjecture? This person had a whatever foot-type, look see the pressure is similar to the one in the picture, therefore functional foot typing is related to the paper.... if only it were that simple. How do you measure pressure-time integral or mean pressure from your Harris-Beath print, Dennis? Answer: you can't. At best, it records peak pressure from a single step.

    How many years have you been plugging your functional foot-typing system here on Podiatry Arena, Dennis? Nothing you have ever written has ever made me think: this guy knows what he's talking about; this guy could be on to something; etc, etc. I really do not foresee you being able to change my opinion of you or your ideas because I do not believe you have the scientific understanding of foot and lower limb biomechanics nor of the research methods to achieve this within me. In short, I do not think you are "well-read" enough in the subject to achieve any change in my opinions.
     
  16. Rob Kidd

    Rob Kidd Well-Known Member

    Your flow chart may look impressive to the unititiated, but it leaves significant methodological issues unexplained.
    1) What normalization methods, and perhaps more importantly, why, and upon what biological and stastical basis?
    2) Exactly what data and data type is to be fed into the Principal Component(sic) Analysis ("Components")?
    3) Do you use the correlation or the covariance matrix? It makes a difference to interpretation due to the standard deviations being treated differently.
    4) are the data (AKA dimensions) fed into the PCA correlated? If not forget it and go home - all you will do is to lay out the components in order of their statistical significance - ie no biology)
    5)How do you interpret the eigenvalues? That is, since PCA has no statistical power (you knew that?) how many components are biologically significant?
    6) How do you interpret the eigenvectors? That is, how big is big enough?

    Looks good to the unitiated, not to those who have used PCA extensively for 30 years.

    As I have said until sick of saying, stats do not answer questions, their correct use and interpretation provides answers.
     
  17. drsha

    drsha Banned

    Dr. Kidd:
    Thank you once again for your honest and accurate posting. I realize that I am swimming in a fish tank of whales as a goldfish and have never offered rebuttal to that.

    The flowchart I illustrated was cut and paste from the article in question and was not mine. I am simply looking at the fact that they were all derived from the scans that were taken and then I compared them to scans of flexible forefoot FFT's

    1. Instead of going home, can I stick around and continue learning?

    2. I am not looking to impress anyone (certainly not the likes of you) but in spite of the fact that "there are significant methodology issues unexplained, can I infer that the similarities in the pressure scans of the article for those with forefoot pain and the scans we get for flexible forefoot foot types may lend credence to the theory that the flexible forefoot functional foot type may be a predictor of forefoot pain and that this deserves further research with better methodology?
    Dennis
     
  18. What a thought for a Saturday afternoon.
     
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