EBM Terrorism

Jeff and David:
:good:
Thank you for your recent very accurate and realistic critique of my time on The Arena.

I am in total agreement with your discussion of why my theory is meeting resistance since I apply the same methods when evaluating other systems (hence my lack of understanding of SALRE where I understand sagital plane and advocate its incorporation into orthotic prescribing).
I am moving in a direction (as I am educated) of attempting providing the spark necessary to get practitioners to test foot centering in practice and I am miles away from that time and would be shocked if you gave up your inherited and developed dogmas to listen to me

However, I am also pointing out practical places where whether using my theory or not, biomechanical treatment is falling short and podiatry has become complacent even at the level of The Arena.
Like the orthotics we make for our patients and those patients themselves, we all differ. We all are ignorant about some things even in our brilliance.
My biggest stumbling block is the ignorance that The Arena displays when I say that there are practitioners who are better diagnosticians and orthotic fabricators than others (I mistakenly used myself as one example) and the ignorant refrain was that we all practice at the same level.
Another is The Arena ignorance that pain and comfort are our goals in care when we all realize that well placed tissue paper will reduce pain and improve comfort above placebo.

Another is that although a belief in STJ Neutral as the best examing tool is being proven unfounded, the use of that very same STJ Neutral for casting remains your gold stamdard for casting in ignorance.

Kevin Stated (after quoting Dennis):
The rigid rearfoot type should have a STJ Axis that is laterally deviated.
The flexible rearfoot type should have a STJ Axis that is medially deviated.
The stable rearfoot type should have a STJ Axis that is STJ Neutral or not deviated.
The flat rearfoot type should have a STJ Axis that is maximally medially deviated.

Dennis:

none of what you say above is true and is a total misrepresentation of the subtalar joint axis location/rotational equilibrium theory of foot function

Dennis Replies:
Why? or in what way would any one of my statements such as
The flexible rearfoot type should have a STJ Axis that is medially deviated
be false or reflect a total misrepresentation of STJ Axis Location Theory?

Dennis

 

Then you should not attempt to use it. Either learn what the rest of us mean when we talk axis and moments or don't use it. You can't just "have a stab"

Interesting question. Begs 2 more.

1. What makes you think our current paradigms are built on a neutral shell? Leave alone that you don't tend to base a mode of thought on a type of insole. Speaking for myself neutral shells represent about 10% of the devices I issue.

2. To come to the OP, what evidence is there that a different shaped shell is superior? If i designed a shell which was longer, higher or otherwise different would you beleive it was superior to yours? Because that is what you are asking us to do .

Regards
Robert

 

Robert Stated:
Then you should not attempt to use it. Either learn what the rest of us mean when we talk axis and moments or don't use it. You can't just "have a stab".

Dennis Replies:
I will stop using my language as best as I can and plug in where I can. If not, I am silently monitoring to continue learning.
Dennis

 

As Wittgenstein puts it :-

"That whereof we cannot speak, thereof must we remain silent".

Which is not, of course, to say that you or anyone should not communicate your ideas! It is simply that inappropriate use of terminology is worse than lack of information because it leads people off on tangents!

For example. Dennis Said

This is Kevin's pitch to field, I'm merely a student and not a fast one, but I'll have a go...

The STJ, as we know (by experimental EVIDENCE ), has no single axis. Rather it has a bundle of instantaneous axis depending on the position of the STJ. Generally we refer to the position of the axis we are referring to the one position within this bundle. I do the palpation in STN but so long as you are comparing within your own data set any repeatable position besides fully pronated or supinated would do.

If an axis is deviated one presumes that the whole bundle is deviated.

So when you refer to an axis which is sub talar neutral you are mixing concepts. Sub talar neutral defines a position of the STJ and, by inference, the position of the axis within its bundle. When you refer to a deviated axis you are referring to the position of the whole bundle. So you are mixing metaphors!

My advice would be that if you wish to challenge the accepted paradigms you should first be very, very familiar with them. Read those papers Kevin referenced. He's been known to e mail them to people who ask nicely if they don't have Japma access. Better yet, do the thought experiments on the arena, you'll find them in the hall of fame*. I found those much more stimulating than reading the papers "cold" and after doing them the Japma publications made a LOT more sense. Do these, read Kevins work, learn the terminology and then should you wish to argue these things you will be in a far far stronger position to do so!

Regards
Robert

*Skip no 1 and come back to it would be my advice

 

I have listed the file-sharing link to all my published papers, and one of my book chapters, at a new thread for all of those of you who would like better access to them.

 

Roberty Stated:
Speaking for myself neutral shells represent about 10% of the devices I issue.


Dennis Asks:
Could you possibly list, by percentage, what casting tachniques you use for the other 90%.

I give thanks, in advance, for you taking the time to do so.
:drinks
Dennis

 

Ye gods! I didn't expect the Spanish inquisition! (cue bel...) ;-)

Don't know how it bears on the debate but since you ask...

As a very vague estimate, and I emphasize that this is just me!

About 30% are "simples". These are NOT the monstrosities which some surgical appliance labs churn out btw. I don't know if there is an analogue for these on your side of the puddle.

Of the rest, like I say about 10% are neutral polyprop or co polymer shells cast in stj neutral.

Perhaps 15% are shank dependent EVA devices in low, high or mixed density.

Another 15% or so are partially shank dependent in EVA or therrox.

About 10% are plasterzote 6mm over hi density EVA


Another 10% or so are poly devices cast other than neutral.

That leaves about 10% "other" for those oddities one sees in a state funded health service;-).

Of the non poly shell casts I don't particularly aim to cast in neutral. The position depends on the material I'll be making the device from, the capabilities of the foot, the supination resistance, the activities of the individual, the planal dominance and the prescription and a few other details. Some are neutral, some more supinated, some less.

That help?

Regards
Robert

 

Prefabs?

So, 10 percent are casted neutral

What stj position? Neural, supinated pronated?

What stj position? Neural, supinated pronated?

What stj position? Neural, supinated pronated?

Regardless of your aim, the foot is either supinated, neutral, or pronated at the STJ if you are making the device from a cast or foam impression. From the information you provided, it seems that 10 percent of your devices are intentionally cast in neutral, 10 percent are intentionally not cast in neutral, and the remainder are randomly positioned, which means that the percentage of neutral casts could actually be much higher than you estimated if you don't determine the STJ position in casting. Or am I missing something?

Respectfully,
Jeff
www.root-lab.com

 

Perhaps I did not make myself as clear as I may have. Of the poly shells about 10 % are intentionally cast in neutral as you say. Of the rest they are cast at points between pronated and supinated and also as you say some of these will be neutral. I distinguished the 10 % of poly shells because Dennis asked how many were Neutral SHELLS. I do not consider a plasterzote over eva laminate partially shank dependant device to be a shell.

I would not say that any of my casts are "randomly" positioned. BTW. They are very carefully positioned, just not necessarily in neutral. Neutral is great but I don't see it as inherently better than neutral plus 10 degrees, minus 10 degrees or ten degrees from maximully pronated.

Is that clearer?

Perhaps this subject deserves its own thread?

Regards
Robert