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EBM and Foot Orthoses

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Apr 30, 2010.

  1. Members do not see these Ads. Sign Up.
    For those of you who do not get Present Podiatry Newsletters, I thought you might be interested reading Dennis Shavelson's opinions on his foot typing system, his "Neoteric Biomechanics" and Evidence Based Medicine (EBM).

  2. [​IMG]

    Just because nobody CALLED it EBM before 1990 doesn't mean it is only 15 years. old. There's a controlled clinical trial described in the Old testament for crying out loud (although it does have methodological flaws I will admit)
    Thanks Nostradamus. Where does the prediction that there WOULD be Level one evidence fall in the hierarchy?

    Yeah. Because all Podiatrists use is sub talar joint neutral custom casted insoles. For everyone. Regardless of what's wrong with the patient, their physiology, they're lifestyle, their age, their biometrics, their tissue viability, their age, they're activity etc etc. Nobody deviates from the precise protocol used in the study and therefore every Podiatrist in the world has to stop using customised orthoses.

    There is SO MUCH here which is BS you just don't know where to start. So I'll leave off there because I can feel my BP rising alarmingly. If I stroke out today I'm sending YOU the medical bill Kevin!
  3. Ding Ding Ding Ladies and Gentlemen Round 8 of the Podiatry Arena Heavy weight title fight Dr Dennis " the Shovel" Shavelson V´s "Rampaging" Robert Isaacs is about to start take your seats.

    Attached Files:

  4. Can't! He's buggered off again. He does that every time it becomes excessively obvious that he's being evasive.

    Probably for the best.
  5. All lies and jests
    Still the man hears what he wants to hear
    And disregards the rest ......

    Paul Simon - The Boxer
  6. Mike:

    Do you have version of this card holder for business cards?:cool::rolleyes::D

    Attached Files:

  7. Jeff Root

    Jeff Root Well-Known Member

    Yeah Kevin, like me I'm sure your eyes were instantly drawn to her boots and you were thinking, "Wow, what an excellent way to improve coupling between the foot and leg!". Oh sorry Kevin, you didn’t notice she had shoe gear on!!???
  8. See I was thinking she has a clear LLD. Those hips are never square.

    Question is, where did mike get a picture of twirly?
  9. Alison said that I'm not allowed to look at this thread anymore. I said that was doing some research so I could narrate the story of little red riding hood to Grace. She said: "you're sleeping outside then, and BTW you won't be telling bed-time stories to Grace."

    I'll get me cloak (and sleeping bag).:sinking:
  10. Oops. Got a comfy sofa if you need it.

    We've drifted off topic a gnats and I see through my eyes that dennis is still viewing.

    Ebm only 15 years old. Care to offer a justification or retraction?

    Over extrapolating research? Fancy going into that in more detail?

    Or feel free to pop back to the old thread if you prefer.
  11. Tell me Uncle Simon.......about little red riding hood......and her healing energy.:rolleyes:
  12. Jeff Root

    Jeff Root Well-Known Member

    Sam The Sham And The Pharaohs

    What's that I see walkin' in these woods?
    Why, it's Little Red Riding Hood.
    Hey there, Little Red Riding Hood,
    You sure are lookin' good,
    You're everything a big, bad wolf could want...
  13. Kevin, I've felt your healing energy and it ain't that good, unlike little red riding hoods...
  14. David Wedemeyer

    David Wedemeyer Well-Known Member

    The Redmond Study appears to be completely bereft of important data such as a solid diagnosis and description of symptoms (labeling them all lower extremity overuse injuries), basic patient data, the type physical therapy received and frequency, specific modifications... I could go on but it leaves a lot of important data out that should be a part of any quality RCT I feel. Does anyone else have that same impression? Not to mention the fact that they appear to have used the same type and grade of material, which is not common to a prefab in my experience (usually the ones that make their way into my office are best described as very flexible, not at all semi-rigid as we would expect of typical CFO's used to mediate pathology.

    One problem that I have with every proprietary insole or theory (and their proponents) is that they cherry pick studies of often low value and compare their device based on these studies, fund their own studies which may influence the outcome and attack Root theory and other competing theories rather than proving their own assertions. They do it not to advance the science of lower extremity biomechanics but to advance their agenda (and profit). This last part is so obvious it is appaling.

    Calling this EBM is a stretch at best.

    MTJ Locked positioning < what?

    Shoddy work Dennis. Sorry but it need be said. :empathy:
  15. I think that the Redmond study provides useful information, as do the other studies of its type. The problem is that it is often interpreted as something it is not.

    This, for me, is bench data. Nobody (without an agenda as David stated) is suggesting that biomechanics is a toss up between whether we should issue everybody a particular pre fab or a standard protocol Root FFO.

    Its NOT a clinical trial as such.

    Lets face it, it limits the whole processes of biomechanics to one which could be carried out by a plaster technician or a trained chimp with a box of insoles. If it was an either or scenario no diagnosis is NEEDED. You only have two treatment options. Why bother? Try one, if it doesn't work, try the other. Simples.

    As I say its useful bench data. But it proves nothing in terms of what is the best treatment... unless you are a clinician with only those two tools in your toolbox and no diagnostic ability or training whatsoever.

    It would be akin to randomising everyone who entered a GP surgery on a given day to receive either antibiotics or painkillers to see what was best. No diagnosis as david says. On such basis the two might have comparable success rates. Doesn't make Co Codamol better than penicillin.

    I'd like to think that there are not many of those types of clinician around (although I'm not naive enough to suggest that there are none), but they make a convenient straw man to compare oneself to.

    In the land of the blind, the one eyed man is king. So it makes right good sense for a one eyed man with ambitions to royalty to suggest, or even believe, that he lives in the land of the blind.
  16. From the Menz Paper: "The Redmond et al [16] study is not without its limitations. First, the sample was relatively small, so the lack of differences between the devices may have been due to type II error (i.e.: failing to observe a difference when in truth there is one). Secondly, the study was designed to examine biomechanical differences between the devices, rather than patient-oriented, clinical outcomes. Thirdly, the prefabricated orthoses were manufactured from the same materials as the customised devices (4 mm polypropylene shell with 450 kg/m2 ethyl vinyl acetate heel posts), so the key differences being examined were the contour and frontal plane "correction" of the two orthoses."

    How might the contour and frontal plane "correction" (angulation) of the devices influenced the data collected using in-shoe pressure measuring technology which employs sensors that are only capable of quantifying the loading forces which are normal to each discreet sensor?
  17. By failing to take into account the vector of the force based on the angulation of the surface and the friction co efficient which would nonetheless be altered by having a force sensor insole in the schrodingers cat stylee?

    By failing to take into account exteroceptive effects (a la spikeothotic tm)?

    By failing to take into account enhanced supination moment derived from other than grf?

    Or am I on the wrong track altogether?
  18. I´m thinking that the angulation of the device will affect loading rates, which may cause data collection issues that you mention about - but I´m just thinking and may have missed the boat?

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