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. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Dr. Kirby Caught Typing Feet

Discussion in 'Biomechanics, Sports and Foot orthoses' started by drsha, Jan 6, 2011.

  1. Tkemp

    Tkemp Active Member

    my computer saved the reply before I'd finished typing it. Please see full reply below.
     
    Last edited: Jan 11, 2011
  2. Tkemp

    Tkemp Active Member

    1/ Basic mechanics - If the fulcrum is misaligned then no matter how hard you pull on the rope the pulley wont perform as required.
    Therefore, if the STJ or its axis is "misaligned" then the peroneus longus can work all it wants but the foot position will be deviated - not that the muscles' role in foot position and function in gait are not important.
    So the PL may be your sun, but even the sun has to obey the common laws of physics eg. gravity

    2/ When does bone growth stop? Ossification of the bone from cartilage is completed around age 25. However, osteoblasts and osteoclasts are continually functioning. Bones can continue to increase in thickness or diameter throughout life in response to stress from increased muscle activity, weight or fractures. Contrawise, bones can thin in response to stress from certain diseases.
    Some foot conditions we treat can be exacerbated by osteophtic growth around bones and joints.

    Each patient has a different combination of bone shapes and positions, muscle tone and function. To "type" a patient into one of only an extremely small number of foot options, is to ignore the uniqueness of each individual and the need for us as clinicians to treat each patient accordingly.
     
  3. drsha

    drsha Banned

    I wish to thank Dr. Kemp for his posting because it helped me discern a possible place where my work is being perverted on The Arena and elsewhere.

    Functional Foot Typing is a new paradigm that serves as a starting place for beginning the custom formulation of a biomechanical treatment plan and subsequent care.

    Like a Root Biomechanical STJ Neutral Exam (proven poorly reproducible, inaccurate and not useful clinically), a SALRE evaluation that begins with a subtalar joint axis determination (almost always imagined and not accurately measurable), a MASS Evaluation (oh wait, there isn't one), a Functional Foot Typing is the starting place for rendering Biomechanical care.

    You summate my work slanderously by intimating that I determine a patients FFT and then two minutes later, take a cast and write the same Rx for each patient sharing a foot type.
    That is my basis for stating that you have not examined or practiced my work.

    FFTing is a new and fresh starting point for practicing FLEB. It replaces ROOT or SALRE for those who wish to practice Wellness Biomechanics.

    It is not better or worse, it is just another paradigm that some may wish to utilize in practice.

    Nothing more or less.

    Next thing you know, you will come up with research (like we have for Root) stating that FFTing is poorly reproducible intra or inter practitioner and summate that, like Root, it is worthless.

    Anyone monitoring The Arena would realize that in harboring huge bias, you would not take time out of your busy lives to conduct similar experiments on the accuracy of locating the subtalar joint axis because whenever that is performed, I suspect (you know) that would have a similar unacceptable error rate.

    Maybe Ed is right.
    He has simply eliminated the starting evaluation.

    Dr Sha
     
  4. This is a bad habit of Ed's. Please don't slip into it! There is no such thing as a "SALRE evaluation". Its just an assessment tool, like Talo crural range or jacks test. Its not an assessment protocol.

    Dennis, you have constructed a model for assessment. Kevin's model (the one he uses and advocates that is) for assessment is tissue stress which originated with Tom McPoil (although Kevin and Eric have done much to refine it). Comparing FFT to SALRE in this way is a catagory error. Just because Kevin criticises your work does not mean his work is comparable or in direct competition.

    I hear too much on the arena about SALRE. It is, in my opinion, a useful measurement and the concept of applying rotational equilibrium to biomechanics is a brilliant one, the basis for FEA and the best way to consider tissue stress (In and around ALL joints). However because Kevin is one of the more vocal critics of other models it gets held up as "what all you people do" for no better reason than people want to have a pop back at the person who had a pop at them! It is work that most people here approve of. One of MANY pieces of work I approve of. I also find immense value in the sagittal plane facilitation model. So what am I? A SALRE clinician or a SPF clinician. I am both, and neither. It does no good to consider others two dimensionally.

    Also

    Since you are talking about slander, you may wish to be careful about statements like this. Dr Kemps comment was a general one about foot typing (of which yours is one of 4 models which I know of) and is clearly in the nature of an opinion of an entire concept. To say that Root examination has been PROVEN to be "not useful clinically" is rather a different matter. Unless you can produce said proof, and you can't because there is none, because it is an unsupportable statement, you may wish to consider that carefully. ;)
     
  5. Beer count on the rise.

    Dennis - How does SERM or PERM relate to pathology?

    What do you do if the person gets no improvement or even gets worse from your device, if the device prescription is from the persons foot type then how can you change prescription as the foot type has not changed?

    any research for this statement or is this the option of the inventor ?

    again any research for this statement or is this the option of the inventor ?

    Why do you think that using Tissue stress theory or even physical stress theoryis not a wellness biomechanical treatment philosophy ?

    if we identify the stressed tissue then reduce loads on stressed tissue what is wrong with that ?
     
  6. :D

    And here they are now!

    [​IMG]

    BEHOLD!! THE SUM OF ALL OUR BEERS!

    Sorry. Could'nt help myself. Back to serious biomechanics.!
     
  7. drsha

    drsha Banned

    Robert, why couldn;t you address some of the points I made instead of deflecting the thread further.

    Assessment Tool Starting Place
    Show me the evidence
    who's slandering whom
    what you approve of what I approve of
    SALRE clinican SPF clinician
    potato potato
    proof proven
    all oil
    FFT snake oil
    SALRE snake oil
    Root snake oil

    This is where the rhread turns ugly and ends up with Nazi's and Hitler so I'll monitor a while and leave you to your diversions.

    and are you saying that Kevin being such a vocal critique is problematic?
    a detriment to your work?
    just using him?
    playing him like a pawn?
    Wouldn't it have been better for Craig or Menz to have come up with SALRE?

    This is where the thread turns ugly and ends up with Boiling Feet, Nazi's and Hitler so I'll monitor a while and leave you to your diversions.

    Dr Sha
     
  8. neilmalc

    neilmalc Member

    Check out the heads on those beers!

    I'd like to see the Mrs Doubtfire lookalike try and get away with serving those up in Scotland:butcher:

    Neil.
     
  9. efuller

    efuller MVP

    Ok Dennis, so you take a through history and perform a physical examination of the foot, make a diagnosis and then "type" the foot. What exactly do you with the foot type information? What changes in the prescription or the finished orthotic? The paradigm is lacking if it doesn't alter what you do. We've examined your posts on the arena and you haven't told us what you do with the information that you gather on foot types. If you can't tell us what you do differently, then the logical conclusion is that you don't do anything different. If you do decide to tell us what you do differently, could you also tell us why you think that what you do will make the patient well.

    Eric
     
  10. Sorry. Not my intention to deflect. I Just think that the comparison between SALRE and FFT (which you made remember) is a catagory error.

    Sorry, you lost me completely here. What is this a list of? And what have potatoes got to do with it?


    Lost me again. What to WW2 German politics have to do with the debate?
    I'm saying It makes his work a target for criticism which it would otherwise not attract.
    Eh?
    Double eh?
    Yeah, you said that already. I didn't see it turn ugly myself, but If you feel uncomfortable then forebearance is the best policy.

    Peace out.
     
  11. David Wedemeyer

    David Wedemeyer Well-Known Member

    My entire point in presenting a theoretical case and a lay explanation to Dennis was to illustrate that the argument that:

    is inaccurate.

    (BTW is it really arrogance to effect studies and research that improve our knowledge of foot function and treatment with orthoses, or is it arrogance to attack Kevin on his success and make a sweeping generalization about who does not understand his teachings?)

    The fact that a chiropractor (and pedorthist) can understand and implement SALRE as a clinical tool for evaluation of the patient is important. It helps to explain kinetics, the motion and forces acting on the foot that are causing the patients complaints through kinematic observation. The same can be said for Root Biomechanics or the Sagittal Plane Theory (as Robert pointed out), or any other theory that is built on a plausible kinematic platform.

    Patient’s don’t typically want or need to know in scientific terms what we are doing; they want to know if the prescribed treatment will afford them relief and in plain language. My point was I often afford a patient a reasonable description of the forces causing their symptoms and how I intend to effect a change in those forces with the orthotic device in language they understand. They often thank me for taking the time to explain their treatment. I don't feel that this is a difficult concept to grasp.

    Patients do not care how much you know until they know how much you care is a mantra I try to stay mindful of. Patients can smell arrogance and smugness and prefer compassion to condescension. I do as well when I am a patient and I don't require a pedantic explanation of how the medicine will work at the cellular level. I care more that the doctor cares about me as their patient. That includes communicating a simple explanation of the rationale for their treatment and the treatment itself.

    If I were to use the word cavus to describe a patient’s foot shape, is that is a type of foot? Yes and no, it is a category that is descriptive and subjective. Is it Foot Typing, no! For one I am probably describing an off weightbearing foot and we don’t walk on air, I also must describe the changes that occur when weight, gravity and GRF are involved in gait. It does not describe the flexibility of the foot, the function of the first ray, the valgus accommodation/heel varus we often find in a more flexible cavus foot etc. As I stated there are too many variables to say that every cavus foot supinates and that all cavus feet have the same function. FFT appears to be very limited in assessing these myriad variables is all that I am saying Dennis. That is much more”cookbook and reductionist” than the approach(es) that I and many others here utilize.

    Do you believe that oncologists describe the mechanism by which interferon kills cancer cells to every patient and utilizing the same lexicon that they would discuss a case with their colleagues? No, they do not and you are well aware of it. This whole thread is a semantic argument and designed to provoke another round of highly unproductive and angry banter. That is why I responded in such a flip manner to your post.

    I try to argue constructively but for some reason with you and Ed it always ends up a cage fighting match (how's your ground game amigo?). For that reason I will try not to engage either of you again unless it is mutually agreed upon and some ground rules are agreed to. I do feel that you have a modicum of proof of the reasonableness of your methods to establish. You argue quite a bit without ever really gaining any ground empirically. Good luck and try to answer Eric’s questions please.

    Regards,
     
    Last edited: Jan 12, 2011
  12. Tkemp

    Tkemp Active Member

    DrSha, thank you for your kind reply. It warms my heart that you take time out of your busy schedule to respond to my comments with such force and passion.

    Just a couple of small points:
    I am not a Dr, just a Podiatrist.
    Iam not a Mr, but a female - Ms, Your Supreme Excellency, and Head of Coffee and Chocolate Tasting are all acceptable.
    I have read - in some depth- your "work" on the internet. I may say there are a few small points you seem to skim around or completely ignore.

    It's great that you wish to push the boundaries of Podiatry with new ideas, but when they are questioned please don't retaliate in such a harsh manner. It really does you no favours and only serves to add more doubts on your theories.

    There. I have responded in a nice manner. It wasn't hard and certainly doesn't detract from my viewpoint..... and since I know you love them so much :D
     
  13. Sorry Miss. DAMN. I Mean your supreme Excellency. (Funny, my wife goes by the same title!) I done that too. :eek:

    How easily we assume. But always nicer to have someone think you a Dr when you are not than vice versa.
     
  14. David Wedemeyer

    David Wedemeyer Well-Known Member

    Thank you MS. Your Supreme Excellency, really got quite a laugh out of this!

    2011 Quote of the year pick thus far!

    Warm regards,
     
  15. Tkemp

    Tkemp Active Member

    I have many clients address me with the phrase "Oh my god" ...............
    but I am quick to deny any rumours of deity ;)

    and my respects to your wife - my fellow Supreme Excellency :D
     
  16. stevewells

    stevewells Active Member


    There is just one thing I would like to say about this thread - its REALLY BORING!! and Dr Sha your english is appalling!
     
  17. drsha

    drsha Banned

    Dr. Wells, or is it Ms. Wells or Podiatrist Wells or coffee preparing Wells:

    First, that was two things. So I have appalling English and you, my friend, can't count (comment off the year?)

    I am saddened to opine that Robert has explained to me why whenever Dr. Kirby is confronted or challenged as to the value of his work (or opposing paradigms) or the value of his ability to confront opposing positions The Arena Police comes to his rescue stating that he is being picked on (witness this thread).

    I know Kevin is capable of defending himself to his last cell in any debate and so, he needs no support. That fact has puzzzzled (purposeful misspelling that I will use form (again) now on to hide my actual english illiteracy for Dr or Ms Wells and others, haha) me

    But.

    Kevin, if allowed to engage opposing positions to his version of Biomechanicsp, will call for removal, banning, exorcising and lacing (another) under a bus, the opposition.

    Kevin is your scientific leader and at times Darth Vader!

    This thread, for me, is anything but boring.

    Dr Sha
     
  18. That's because you're a class 1 prick. Agree completely with Steve - your repetitive monologue has ceased to entertain, Dennis. Please take it elsewhere.
     
  19. efuller

    efuller MVP

    The "arena police" are people who happen to think there is value/truth to what Kevin has said. He doesn't pay us to defend his work. I just happen to agree with it. It appears many others also see value in his work.

    Dennis, I might defend foot typing if you could explain why you think it has value and I agreed that the explanation is valid. I don't know why you think foot typing should change the shape of an orthotic or any other part of the treatment plan.

    Eric
     
  20. Sammo

    Sammo Active Member

    Never mind a separate thread, can we start WWW.shalveson-arena.com for this discussion to continue.

    Seriously, its been going close to 2 years now and I feel we havent gotten very far in a very long time. It's made me use pod arena less.

    Dennis starts reasonable, over-reacts to criticism, then when "the Target" is irate he becomes reasonable again to make "the Target" look bad...

    I'll even pay for the web domain myself...

    S

    Xx
     
  21. David Wedemeyer

    David Wedemeyer Well-Known Member

    Um, no.

    You have this incorrect as well Dennis. In my case I am defending Kevin's ideas because they stand up to clinical scrutiny. I do not know Kevin personally, although I hope that will change. I read his work and I have to inform you that it changed my thinking profoundly on the subject. The same can be said for several contributors here. You attack him for the same reason I propose, which is myopic and selfish.

    Better to be included in the Arena Police than the Militia for Abject Fools wouldn't you say?

    Publish something please and for God's sake, hire an editor!


    Do you have any proof of this because it defies logic, you and Ed are still here aren't you? I feel this is an egregious and regrettable comment. It is also loathsome and childish.
     
  22. Did I say that?! Where!? I said I think people attack Kevins work because he attacks theirs rather than because they have a problem with his work. Thats not the same at all!

    That, to be fair, was a LOL comeback! Sorry, but credit where its due.

    And here is the very crux of this particular argument. I'm not defending Kevin. I'm defending a theoretical construct of which he approves (tissue stress) or which he described (SALRE). In common with everyone here, you included Dennis, I defend what I beleive to be true because I believe it to be true, not because of who else does.
     
  23. I´m a guility as the next or even more so, I tried and now Robert gets beer. But if we all did not respond Dennis might just get the idea or even start to act more well grown up.

    But now I will make my pledge public .

    I will not reply ..... which will make lots happy not just Dennis I suspect.
     
  24. Sure you will ;)

    And I shall have beer.
     
Loading...

Share This Page