Do you take measurements during orthopaedic examination?

Graham:

So glad to have your valued opinion on this matter about what I should and should not be doing for my patients. Instead of telling me and other podiatrists how we should practice, why don't you, more than once in your life, try publishing some of the valuable information that you think you possess about how you think all podiatrists should practice biomechanics since you seem to be quite judgemental about what we all do in our clinical practices? I won't hold my breath.

It is always amazing to me how those who live in glass houses are so fond of throwing stones.....

 

Kevin,

__________________

I'm not telling anyone what they should or should not be doing for their patients. However, there is ample research evidence on the lack or reproduceability of measurements between practitioners and beween our selves on diferent days.

Also evidence that indictes that certain structural measurments, that we thought were a predictor of dynamic function, and therefore influenced our prescriptions, are not and will not tell you with any confidence what an orthotic will achieve based on those measurments.

As a Podiatrist who I respect I am surprised you advocating the use of these measurments clinically when you have moved so far ahead theoretically.

And Kevin. We all are doing something right and have patients that travel long distances to see us. We all make foot orthoses Etc Etc Etc. This doesn't add much to the discussion!

 

What I really need is a job where someone pays you to sit and think.

 

There are many ways to gain information about the foot. When I had access to an EMED force platform there were times when I took the patient to the gait lab and had them walk over it. There was a time when I had the FScan and had a patient with a partial foot amputation that kept ulcerating. With the FSCAN printout I was able to modify the device so that ulceration healed. I did it faster with the FSCAN than I could have done it with patient coming back every week to see if it healed. So, there are times when its use is indicated.

I also do some of the tractograph measures but don't write them down. When I see an ankle joint that can dorsiflex to perpedicular I will add a heel lift. When I see a plantar flexed first metatarsal I will add a reverse morton's extension. If there is also a long 2nd metatarsal, and callus sub 2nd met I will change that reverse Morton's extension to a forefoot valgus wedge.

When you look at, and hold and manipulate the foot you are getting information about that foot. The hard part is putting what you see into a protocol that someone else could follow. Or even a protocol that you could repeat with the next patient or the same patient at a later time. If you are going to be scientific about it, you should be able to say when I see "A" I will do "B" It is much better to have your decision making process out in the open than to have it in your subconscious. That is you may have subconsciously learned that a particlular orthotic variable may work better when you see a plantarflexed first ray or a laterallized center of pressure path. The protocol needs to be written down so that variations in the protocol can be tested. Saying it's too complicated is no excuse.
Regards,
Eric

 

Seeing as it was brought up I thought I'd throw this is in.

As the owner of an F-SCAN it can be useful but its probably one of the least reliable, least repeatable things I can do with a patient. COM-nalysis software is in particular "interesting" but often absolutely all over the place. If anything is a piece of patient assessment "theatre" IMHO F-SCAN is it.

A lot of the time I find it far more reliable and valid to decide visually if a patient has a plantarflexed 1st ray or a forefoot valgus and prescribe a valgus wedge, standing eversion height permitting (Eric ). Took me £KK to learn that :wacko:
IMHO if anyone was thinking of putting the in-shoe presure at the heart of a consensus on foot orthotic precsribing protocol e.g.COP progression, then I would hold it in doubt.

Is my failure down to old theory:new lenses dyspraxia? No doubt.

 

The only measurements I take are those measurements in which I actually do something meaningful with the number.... ie not very often.

 

I wonder what many of us would think of a neurologist who did a electromyogram/nerve conduction study (EMG/NCS), but only tested the nerve that he thought were involved in causing the patient's symptoms, but wouldn't test the other nerves that are normally tested in a EMG/NCS since he thought it would be "wasted information" or didn't want to test the other nerves since he was worried that another neurologist would say he/she was doing "snake oil" since doing those tests could possibly be within normal limits or may have nothing to do with them getting better.

I also wonder what many of us would think of a rheumatologist whose standard of practice was to do a full panel of blood and serological studies to try and diagnose a patient's joint pain. What if, in this physician's attempt to be thorough and trying to rule out problems that could be causing the joint pain, all of these expensive tests came back as being "within normal limits". Would we say that he/she was doing "snake oil" even though each and every one of these many expensive tests may be normal and we thought that he/she "couldn't do anything useful with the number".

I pride myself in being something more than just an "orthotic technician" for my patients when they present with unknown causes of mechanically-related foot and lower extremity pathologies. My goal is not just to be a technician that will do the absolute minimum amount of tests or measurements that will produce a workable orthosis for the patient.

I pride myself in being a podiatric physician. I choose to do all these tests and measurements not just so that I can possibly use or not use the information, as I see fit, to make the patient more therapeutic orthoses, but also to rule out restrictions in subtalar joint range of motion (e.g. asymmetrical tarsal coalition), rule out torsional abnormalities (e.g. internal hip or malleolar position), rule out ankle joint dorsiflexion restriction (e.g. equinus deformity/ankle joint dorsiflexion stiffness), determine first ray position (e.g. metatarsus primus elevatus deformity), determine amount of hallux dorsiflexion with and without first metatarsal loading (e.g. functional hallux limitus), rule out abnormal frontal plane forefoot positions (e.g. excessive inverted or everted forefoot deformities), rule out abnormal STJ spatial location (e.g. medially deviated STJ axis), determine STJ rotational position while in RCSP (e.g. STJ maximally pronated or not), and rule out abnormal gait function.

In my quarter century of doing these measurements, I have never, even once, had a patient complain that I performed too thorough of an examination on them, or complained that I performed more measurements than than the other podiatrists they had seen for foot orthoses. Take note.....this is the case even though many of my measurements simply told me that their foot and lower extremities were "within normal limits".

If that means that I am practicing more like my medical colleagues, the neurologist and the rheumatologist, that routinely do tests and measurements that they know will probably be "within normal limits" in their desire to get to the bottom of their patient's diagnosis, then that doesn't bother me in the slightest. Also, if in doing all these measurements, even though many of them turn out to be normal and have absolutely no bearing on how I design foot orthoses for them, I am distancing myself from many of my podiatric colleagues, then I have absolutely no problem with that either. I'm not here to impress or be friends with anyone, I'm here to teach other podiatrists what I have learned from my professors and from my years of practice experience, and also to learn something in return. I will sleep very comfortably every night in doing the things I do for my patients, even though it may take a little extra time out of my day and it may not be the "popular" thing to do within the international podiatric biomechanics community.

 

I've been hidden under wraps by Uncle Sam for most of my professional life so Kev's post just seems common sense to me. But now that I have an additional clinic on the outside and am getting to know the medical community better, I'm finding many more Physicians and Therapists do not take measurements and rather rely on their visual memory and recall days later to write scripts or build devices. Outrageous! I can't believe the result of the poll so far. What are you referring to when you review your notes? Don't your patient's ask you HOW you derive at your conclusions? Aren't your notes audited? Don't insurance companies request your notes to justify rationales and conclusions?
Which would you trust more, your eyes or a goniometer? (or don't ya'll have one at your desk?) Which one do you think has greater intrarater reliability? Do you care?
Look, if you want to be the best, be able to prove it through documentation. Even if it's only for your own piece of mind. I charge a crap-load for my thorough evals and wild orthotics but you know what? My patients respect me because I show them everything and bring them along for the ride. Then on delivery day, they understand the science and fully believe in my product and direction. Compliance is high, success rate is high, and I just rebuilt my 3rd vintage Harley:Fingerwag:

(Admin: can we get a finger-wag emoticon pls?)

 

Hi Lawrence

Mmm, I'm coming to a similar conclusion, since doing somewhat of a literature review recently. I have used it a little - just on family and friends at this stage.

I feel that COP is really of no use. There may be something useful in the force/time curves but its interesting that although these are mentioned often by Tekscan FScan proponents, they are not used at all in any research - there is not any quantitative information gained from them, even from instructions from Tekscan. And there is next to no helpful information about peak pressures and what they mean for biomechanical anomalies. Leg length inequality is often mentioned as being able to be diagnosed with FScan, but it doesn't give you definitive info on which leg is shorter (see Bruce Williams knee case study from Tekscan), just like you cat rely on which foot pronates / supinates more. The other biomechanical anomaly that is supposedly able to be diagnosed with in-shoe pressure analysis is functional hallux limitus - but you should see the list of findings that are meant to depict FnHL. The Tekscan case studies confuse more than inform.

From what I have read about CoM, it is a measure of overall gait efficiency that doesn't have the inaccuracies that CO2 output and pulse rate have. I think this must be a great measure but pelvic, hip and knee function figure heavily in this measure, not just foot function.

So although on the face of it FScan can give very useful information because we are measuring in a dynamic situation and in the shoe, Inshoe pressure parameters have not been proven to be reliable or valid either. As only vertical pressures are measured, using FScan to evaluate orthosis successs is a bit dubious. This would be less of an issue just in the shoe (no device). But I'm yet to decide if or how to use FScan in-shoe in my practice.

Rebecca

 

Do your patients ask you? More pertinently, how do the measurements you take dictate your prescription?

On occassion. But rationales/conclusions can be justified without quantitative measurements in my opinion.

Well done on all your success. I'd be interested to know some of the 'science' that your patients understand. As it was my belief the whole point of discussions like this one, (and also one of my favourite ever threads on the arena: see here) is that most of us don't entirely understand the science. When you measure a RCSP of 6 degrees everted in standing are you telling them a rearfoot varus post of 6 degrees will return them to 'normal'???

Ian

 

Well Ian I too am still practicing after 21 yrs, the matter of measurements is to ensure the patient is able to achieve the position you wish the foot to be in. It allows us to evaluate the axis of motion of the subtalar joint and this allows us to determine how much frontal plane motion we have in the device.
Yes there are many Podiatrists who like to argue how accurate these measurements are but that does not alter the fact that we need to know and not just guess.
I have been carrying out measurements for the last 21yrs and I have found that the technique that I use does not alter and after checking the same patient 5, 10 and even 15yrs down the track the method holds up.
Hope this helps
Regards
Alex Adam

 

Hey alex.

You mentioned measurement to ensure the patient is able to acheive the position you want them in.

How do go about "putting the foot" in a particular position?

Leave alone the dynamic element of gait and that there is no single "position" how do you position the foot? For eg let's say you want to invert the calc, based on measurement, by 5 degrees. Let's further say for the sake of argument that this is the maximum degree of inversion the calc can acheive.

How much inversion will a 5 degree post cause?

What will happen if we use a 10 degree wedge?

 

And are you saying that your patients biometrics don't change in 15 years? Things like joint ranges? Because I known mine vary depending on time of day and what I've been doing much less year on year! What kind of accuracy do you reckon on?

Regards
Robert

 

How similar do two or more orthoses need to be in terms of their morphological characteristics to be classed as "similar"? Better, how dissimilar do these orthoses need to be before one or more of them become ineffective at producing the desired goal? Isn't this Hylton's point? (sounds like a surf beach ;-))

If we consider the zone of optimal stress (ZOOS), we realise that as long as the foot orthoses prescriptions shift the loading of the target tissue to within this range, we should see some improvement in the patients symptoms (providing we don't place another tissue outside of the ZOOS in the process). What we don't know is how big a range the ZOOS for each tissue is in each individual, or where within that range the tissue is functioning with each of the orthoses prescriptions, in each of the patients activities of daily living, in each of the patients multiple pairs of shoes, in each of the environments these tasks are performed in! Ultimately this may be achievable, but it won't be through eye-balling, it will be through quantitative measurement. Not necessarily any of the traditional Root measurements, but some form of measure.

What is required now is the identification of clinical tests that impact upon prescription variables and their relationships with the kinetic changes they produce. Easy to say, not so easy to do.

 

We will get going soon: Foot Orthotic Consensus Project

 

(Primarily by identifying the type of sub talar joint neutral position I reflect in the posterior medial process of the cuboid, anterior inferior aspect of the sustentaculum tali. This point is achieved on the case at a position calculated from the cast that has been done with subtalar joint neutral.)

( Havlac's work would indicated the ideal and only point of gait that any device can control the calcaneous is that of 'foot flat'.
If we control this point of gait and due to the cyclic nature of gait we can provide a stable structure through to propulsion. It is therefore essential for the forefoot to rearfoot alignment to reflect neutral and this is achieved at the time of cast correction.)

( A 5 degree post in what?? rearfoot or forefoot. If I require that the rearfoot is to be held at 5 degress inverted I simply pour and balance the cast at 5 degrees at the point previously indicated. If I was to use the common method of control via the medial cuneform/navicular then you would need to determine the range of motion of the midtarsal joint long and oblique axis and the this would be added to the 5 degrees to achieve the same results except for the dorsal impaction of the talar navicular joint.
For ten degrees using the latter method one would have the range of motion allowed for and then for each degree of control we would invert 1 degree, however as Blake indicated in the 90's this will lead to overload as well as impingment of the medial colateral ligament of the knee.)

10 dregree wedge would lead to 10 degrees minus MTJ ROM to put the calcanous into an undetermine inverted state.

Cheers
Alex Adam

 

Every single static and dynamic study that has looked at this show that this does not happen. Some people even pronate/evert more with medial posting or wedging (and the evidence is that they still get better)

 

My point. Casting a foot in a certain position does not mean that's the position the orthotic "holds" the foot in. As craig says this is consistant within the lit.

Off to church. More on your post later!

Robert

 

The Casting technique is crucial to a corrective device, to be taken according to Havlac's parameters and while allowing the subtalar joint to position itself into the correct position while loading the mid tarsal joint and compensation for the suspension technique.
Gentlemen, we discuss the lit and all the studies but we have not addressed the problem.
The literature is flawed in one significant way, there is no standardization in the nomenclature of the word 'orthotic' a rolled up piece of newspaper could be considered an orthotic if we look ate the root of the word. I have seen over the last 21 year Universities handing over the manufacture of devices to laboratories that do not know the differnce between a Root device and a Modified Root device and in fact when I lectured I struggled to find anyone that could identify the differnce in function, control and compensatory mechanisms associated with such devices.
We are not 'holding the foot' we are bringing it to rest at it's unique optimal position. If we try and push the foot somewhere Closed Kinetic Chain motion will see the foot rejest the device. If we put a triplanar structure on a concave surface we should expect the foot to pronate off it. If the met heads are dorsiflexed with met domes and the like, we increase pronation at the MTJ oblique axis, is that control??
The reason why orthotics come from laboratories covered in ppt, so they don't irritate the foot, soft and fluffy...
We as a profession must teach our students every detail of manufacture and the reasons behind every step, that way the podiatrist can troulble shoot the device and this will improve the quality of the devices we receive from the laboratories.

 

Sorry to seem pedantic but there are some fundamental presumptions you are making which I cannot accept. You speak "bringing the stj to rest in it's optimal position". I have no problem with that save for two details. Bringing the foot to rest and the concept that it has an "optimal position".

Whilst I don't see how it bears on this discussion I do however agree with your last point.

Regards
Robert

 

Alex,

Thanks for joining the discussion with respect to those of us that take quantitative measurements and those of us that do not (and our individual rationales for doing so). However in my opinion your posts do not 'fight the corner' for taking these measurements very well at all. As some of the replies to you have already mentioned -> your understanding of how foot othoses exert their effects is a smidge out of date (and therefore undermines how you 'use' your measurements)

What is the foots 'unique optimal position' in your opinion, and am I correct in suspecting you think this is the same for everyone?

You are a bit behind on the current theory regarding the MTJ as well, but we'll leave this for another thread.

Like Robert, I don't disagree with this point.

Do you mind me asking where you teach? As (in my opinion) teaching undergrad students the sort of things you have posted on here is not going to help the profession progress one iota.

Ian

 

Well I fear the presumption is the fact that Podiatrists understands biomechanic. We seem to discuss at great length the pros and cons of orthotics yet the true understanding of the Physics associated with foot function and it association with pathology goes back more than 100 years.
Whitman found than supporting the rear foot at a certain point of the calcaneous allows the foot, not just the STJ to be in a position that allows for a strong propulsion phase of gait. I, by no means am saying I understand better than others the physics of gait, however I do appreciate the action of gravity on the skeletal system and that the forces present must be supported at the point where they enter the foot. Grays anatomy describes the function of the broad lig of the tarsal region and when this is compared with the fuction of the peroneous on the cuboid, at a microscopic level we understand that the peroneous longus pushes the cuboid, providing the first ray is stabilised.
The cell structure of the chondrocytes/lucuni show that the tendon and cuboid facet joint is that of a force producing a posterior medial pressure on the sustentaculum tali.
This have been investigated at Melbourne Uni over the past 10 year in the dept of Anatomy.

I am not saying I totally understand the optimal position however I do understand that through proprioceptive responce the ST joint does have one and we need to idetify that there is one. Supporting the foot some 1 to 1.5 cm anterior to the point of force entry will not cotrol or hold anything without compensatory mechanisms occuring. If we allow the STJ to come to rest at a point where the oblique and long axis of the MTJ are stable we will allow the tricept surae to act at its appropriate time instigation propulsive phase.
The truth is we only have a millisec to control the entire gait cycle, but the body and it's proprioceptive system allows us to do this providing we can support the foot in it's desired neutral/locked position at mid stance.

To return to the original question I do and will continue to take a series of measurements to allow the determination of the skeletal alignment and the ability or inability for the skeleton to tolerate the support that we do with an orthotic device. There is no point in controlling the pronation of the foot if that pronation is needed to compensate for a scoliosis in the thorasic or lumbar regions. Why replace one pathology with another..

 

I see the concern is that I am behind on my theories. Gentlemen my Hypothesis is based on my own exhaustive investigations at Melbourne Universtity Anatomy department. It is the understanding of anatomy/neurolgy/myology and histology that we can start to understand biomechanics. Pressure plate and gross biomechanical theories are bias in the fact that they consider the means and standard diviations and seldom consider the eitiological facts of pathological forces. Orthotic devises used in these investigations are not standarized nor is the corrective process discussed in the Methodology nor nomenclature and so compromises the discussion.
The disappointment as a clinial practioner and past lecturer, Curtin University, is that we have lost the true direction of understanding biomechanics and that is, to improve the skeletal heath of the public. Whitman, Hicks, Wood Jones and Root all asked the question and anatomists as Rose, Lewis and Oxnard describe the function it is up to the present time investigators to 'connect the dots'
I seldom visit this site as I run a busy practice as well as spent several hours a week at the microscope and it saddens me to see very little has changed. If we wish to improve the health of the public it is necessary that we look at every aspect of pathology from systemic to biomechanics of the entiere skeletal system not just the feet. The questions being posted by new graduated indicates the the Univeristies are failing in preparing the young professional and we as a Profession really are stumbling in the dark and so we see other allied health practioners filling the voids that we are leaving behind.
Should we just resign ourselves to cut toenails or should we seriously organise ourselfs into the great profession we are.
Kindest regards
Alex Adam

 

Wow. There is so much there I don't know where to start! I'm also suffering a cruel flashback to somebody else who thought that we should turn the clock back 70 odd years to what was leading edge then (The Dudley morton Appreciation society).

Kinda depends on the theories would'nt you say?! I can think of one which is almost entirely based on "eitiological [sic] facts of pathological forces".

Damn. Thats where we've been going wrong. All this time those of us on this site have been looking at just the feet.

But enough of this muturally patronizing abuse. Fun though it is it does not move us forward. Here is the fundamental question which you have avoided answering.

I contend that the STJ no more has an optiomal position than the knee or the talo crural joint, that no single position has particular merit and that with or without an orthotic (or indeed a rolled up newspaper) in the shoe, a sub talar joint will travel through a range of movement during gait.

And here is an area I think you are just plain wrong.

Because an orthotic poured and balanced at 5 degrees inverted will NOT "hold the rearfoot at 5 degrees inverted". Evidence abounds as you are well aware.

Regards
Robert

 

Lets recap...

I think our concerns are valid here Alex. And the biggest irony of all is you (as a university lecturer) then stating:

Perhaps you should read some research which is a little more 'up to date' than the ones you currently refer to and cite?

Ian

 

HavlRobert, Sorry but I am not trying to be smart just here to gather more information and to fill my appitite for knowledge. I am sorry if I offend.
Havlac theories seem to have a very good basis in Physics and science. Theories are just that aren't they? Unless the investigator takes his theory to the public and practices it and documents it for a number of years then it just remains a theory for discussion.
I can pour and correct to 5 degrees inv and the foot is held in that position, why, because to support a triplanar axis one needs to position the fulcrum at a point medial to the axis and by supporting the calcaneous with a lateral cup of 20 mm and a medial cup of 16 mm. The forefoot needs to be stabilized otherwise the oblique axis unlocks and allow forefoot pronation thus unlocking the STJ.
Rose's work in yes the old days, explains it well in his Paediatric work. The clue is have control of the entire manufacturing process through to dispensing.
The point is why would you want to hold the STJ in a 5 degree position unless the STJ is in a coalition or uncompensated position.
The standard orthotic out there has no chance of stabilizing at 5 degrees unless we invert the cast at a position that is too agressive on the lower limb, if I remember my articles, Blake's theory is 5 degrees for every 1 degree of control but that is up to the MTJ being locked and then it's one for one.
The axis also has a major influence, if the axis is high then the transverse plane motion would be excessive and the foot would pronate off the device anyway and would cause lateral column overload.
But back to the original question, that's why we take measurements.
I really don't do the one upmanship well sorry buddy.
I know Craig doesn't see passion as a good trait in research but it helps ;-)
Cheers
Alex

 

Sometimes, when I am not communicating well enough with them in a way that bolsters their confidence that they are being held, touched, viewed, positioned, graded, drawn on or any other of the infinite intimate ways in which we evaluate, for a reason. I find that if i bring the patient into my world, they become more critical thinkers and therefore better patients.

An example of measurements influencing the product:

Considering tissue stress theory, STJN reveals an 11deg FF Varus, while the patient also tests positive for FHR to the tune of 6deg extension. What's the minimal amount the rearfoot post should be in order to effect relief using a 30% arch backfill? 60%?
(Hint: There's a measurement missing and it's not deg HF valgus)

As long as it is THEIR opinion too, you're doing just fine. It's just not mine.

You know, what they understand is that by quantifying the parameters that may be contributing to their dysfunction, we can define their disability and this gives them hope.

I agree but we should all strive to understand all of our lives. Of course, The only true science is the science of freaky, funky, hip-hop beats.

Nope, I'm telling them that I have a point at which to start. I also have a number to weigh against my other numbers to make an educated decision. Sharing them with my patient gives them a more tangible role in their recovery. If the device fails to be effective, I have documentation to refer to to justify the changes I make and they have retained their hope that an orthotic is still a helpful treatment option.

Chris

 

Hey alex

I'm nor offended. A little frustrated but that's my problem. I'm not trying for one upmanship, just trying to bridge the gap. And you keepsaying tantalizing things I don't understand. Like for instance

"to support a triplanar axis one must position the fulcrum at a point medial to a sub talar axis"

This was an explanation but i'm left more confused. If a fulcrum is a fixed point around which a lever turns how can an orthotic have a fulcrum? Do you mean that the orthotic must exert force medial to the Stj axis? And what do you mean by "supporting the axis"?

To return to the nub though, you say if you post and pour at 5 degrees the foot is held at 5 degrees. It's just not. The evidence is overwhelming. How many references would you like? And can you show me a single study or even a case study which supports this claim?

This really is the heart of the op because if a 5 degree pour and post did hold a foot 5 degrees inverted then measurements are vital. If not, they're not.

Robert

 

And not wishing to enter debate with chris as well but what is fhr?

I'm ignorint.

Robert

 

Chris,

I have absolutely no idea what you are going on about. Remember it is not I who uses measurements it is you. I asked you how the measurements you took dictated your prescriptions. Why not just answer the question?

Ian

 

Kevin,

Kevin. You are starting to sound like Dennis! Medical specialists utilize testes with proven normal ranges and proven therapeutic options based on abnormal results. We don't.

I hope we all pride ourselves in our work as podiatrists. But taking measurements which have been shown to be both inaccurate and telling us little that should influence our orthotic design is deceptive.

How do your numerical measurements allow you to do the above Kevin? How do numerical measurements rule out abnormal gait function?

Here we go again. Well Kevin, In my quarter of a century I have never had a patient with a degree in podiatric biomechanics who would even know if you were taking enough or too many measurements.

We are not medical specialists with known proven test values. Your numerical measurements do not tell you what is normal because we haven't determined what exactly is normal. Your measurements, when extrapolated to the orthotics, can not be shown to do what you think they do. Neither can mine!

Back to Hylton's Idea and Craig's forum. We need these areas to be thoroughly thought out by the brains of this arena, And no Kevin, that doesn't incude me.

 

Graham:

Do you also often use your testes that have "proven normal ranges and proven therapeutic options?" This seems like a very interesting method, using your testes, to perform an orthopedic examination of a patient. Could you please explain these very unusual methods to the rest of us??

 

Thanks for asking! Functional Hallucis Rigidus.
http://www.ptjournal.org/cgi/content/abstract/83/9/831

I made the all the devices for the woman in the study. Unfortunately, the climate at the time of the study in the government was not conducive to contractors being included as investigators. Sigh.

 

Then perhaps you should re-read the study since it refers to functional halllux limitus, not functional hallux rigidus which I suspect is a term you have just made up erroneously.

 

Sorry Alex- Havlac theroy? I am not familiar with this... could you give some reference? Do you mean Harry Hlavac?

 

Ah. Thats Ok. I was worried someone had snuck functional hallux rigidus into the lexicon when I wasn't looking. FnHL It is. HRigidus only comes in the structural flavour.

Curse of the technician Chris. All the work, none of the glory. . Are you a pod who manufactures or a tech who learned biomech? Either way look both ways crossing the street because you might be a dying breed!

Regards
Robert

 

Chris

 

Weeding out the punks and the Pros, Spoon-man. That question is deep and I wouldn't want to be on the other end of it. Although, I'd have thought your response would have been different given your background, but you're still a Pro. Hallux Rigidus exists and you know it.

 

Yes we all know this exists... but does a functional hallux rigidus?
My experience is that many physios use the terms hallux limitus and hallux rigidus interchangeably.

 

I didn't question the existence of hallux rigidus, I was questioning the use of the term functional hallux rigidus, which is not commonly employed in the literature, although if we read some of the definitions of functional hallux limitus, such as a temporary blockage of movement etc. then the term functional hallux rigidus may be more apt. That's a discussion for another day.

Back to your measurements, rather than being esoteric and evasive, why not just tell Ian, and the rest of us the answer to his question? When people fail to reply to a direct question with a direct answer, the majority here will assume it is because you cannot answer the question or at least do not want to loose face by answering it. Ultimately it's your choice if you want to play games go ahead, but people will get tired of asking pretty rapidly.

Perhaps it would be useful if you could reference and outline the theory of Hlavac for those unfamiliar with his work, and why you believe it is significant and superior to other theories of biomechanical foot function and orthoses prescription. This is an international community so don't assume everyone has read the same books as you. Also, it would serve you well to remember that there are many very very bright people who contribute here, who may have read even more books than you.

BTW, welcome to Podiatry Arena. Those that know me well, also know that I've played with a number of punk bands, but I've never been a prostitute.