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Failed orthotic therapy

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Oct 20, 2014.

  1. Dennis Kiper

    Dennis Kiper Well-Known Member

    Another interesting thread poisoned. Sigh

    Just doing my job
     
  2. Dennis Kiper

    Dennis Kiper Well-Known Member

    Ahhh the pronation is the Root of all evil in Gait and science discussion, round and round we go.

    BTW—medical technology should be driven by science, not theory.
     
  3. At what position is the subtalar joint most congruent, Dennis?
     
  4. Dennis Kiper

    Dennis Kiper Well-Known Member

    neither pronated, nor supinated
     
  5. Interesting theory. You said:
    I agree, medical technology should be driven by science; yet science and theory are not mutually exclusive: one has to develop a theory before science can be applied to test the validity of such a theory. So what does the science actually tell us about the position in which the subtalar joint demonstrates maximal congruency? What the science tells us is that the subtalar joint appears to be most congruent in the foot position of 10 degrees of abduction, 20 degrees of dorsiflexion and 10 degrees of eversion. http://www.ncbi.nlm.nih.gov/pubmed/18701029 To quote Thomas Huxley: "science is organized common sense where many a beautiful theory was killed by an ugly fact." This science does not agree with your theory, so how will this scientific information change your orthotic practise, Dennis?

    Now that we've established what science tells us about the position in which the subtalar joint is most congruent, let us explore your contention further:

    Why should a congruent joint be more mechanically efficient? Efficient at what?
     
  6. Dennis Kiper

    Dennis Kiper Well-Known Member

    Science does not say anything about the maximal congruency of the STJ. Research has assessed “The results demonstrate that the most approximate (science—really??) STJ neutral position was in the foot position of 10 degrees of abduction, 20 degrees of dorsiflexion and 10 degrees of eversion. “

    Your answer is incorrect for any STJ with < or > ROM. And that's not science, that's a conclusion of STJ neutral ROM. That's what you call “theory”

    My answer is the better one.

    Why should a congruent joint be more mechanically efficient?



    www.mccc.edu/.../BiomechanicsKine...
    Mercer County Community College
    Joint Congruency. ✓ Definition: the best fit! ✓ The relationship between two surfaces:

    www.dailybandha.com/2011/.../joint-reaction-forces-padmasana-and.ht...
    Feb 2, 2011 - There is a concept in orthopedics known as joint congruency. This refers to joint surfaces maintaining their natural curvature when in contact*...

    www.ncbi.nlm.nih.gov/...
    National Center for Biotechnology Information
    by KD Connolly - ‎2009 - ‎Cited by 13 - ‎Related articles
    Quantifying joint congruence may help to understand the relationship between joint function and health.


    Therefore
    less lateral subluxation
    less heat buildup
    less tissue strain



    Efficient at what? What another asinine question
     
  7. Not my answer Dennis, it was a paper published in a scientific journal- that's how science works- we start with a theory, test it scientifically, then publish the results for peer review. Your answer demonstrates that you don't understand the scientific method. This paper is probably the best that science has to offer regarding the relationship between position and congruency of the subtalar joint- unless you can provide other references which support your conjecture? You don't like it because it doesn't fit your theory and you are a poor/ non-scientist. Rather than taking on board what the evidence base tells you or even providing critical appraisal, you'd rather throw your toys out of your pram and start screaming like an infant.

    Your second paragraph above does not make sense.
    How scientific of you. I think you'll find that I can piss much higher than you too, Dennis.
    Link does not work
    Link points to: "Sorry, the page you were looking for in this blog does not exist.."
    Link points to a home page which does not support your conjecture.

    Viz? Ergo? Thus? None of which really answers the questions.

    Dennis, you just talk non-science then act like a child when someone questions you. End of story.

    Grow up, little man. Go away, read the literature; take on-board what the science tells you; then come back and debate it with your peers.

    BTW, when you write in big letters and bold font, we still only read it; it just makes you look like even more of a twat.
     
  8. Rob Kidd

    Rob Kidd Well-Known Member

    I am staggered that anyone, in this day, age and state of knowledge, would produce a comment that suggests that subtalar joint congruency is at its greatest while neither pronated nor supinated. While not actually using the term "neutral" with respect to this position, it has been invoked in the past and taken as gospel. Since the movements of pronation and supination at the s/t jt are defined and movements away from neutral, it has to invoked here also.

    Surely, everyone now recognises the tautological basis for this definition - and therefore that it is a scientific nonsense?
     
  9. Agreed.

    Actually, I'm more interested in the notion that:

    How does joint congruency relate to mechanical efficiency?
     
  10. Dennis Kiper

    Dennis Kiper Well-Known Member

    we start with a theory, test it scientifically—so how's that been working for you for the last 70 years or so? What's the technological science outcome for your theories. What's the science that worked to support those theories. SHOW ME THE SCIENCE.


    Just because the paper is listed in a scientific journal, that does not make the the theories functionally scientific. There is no functional science with traditional orthotic technology and its mechanism of working with known biomechanical function.

    You don't like because it doesn't fit your theory and you are a poor scientist
    —there's an expression that states something like “it's better to not say something stupid so that people don't know that you are”--I don't profess ANY THEORY, I'm discussing science based technology and facts.
    If you can't recognize that, it's you who are the poor scientist. Scientists discover and create based on scientific principles. I'm not like you. I don't always need to wait for some scientific journal to print something, that I couldn’t think for myself. You need to sit in the audience, because you're a follower, not a leader.

    You ask tangential questions and then throw out more BS. No one, including you has responded to the scientific technology of fluid mechanics and biomechanics. You're just too intimidated to deal with the truth.



    Therefore
    less lateral subluxation
    less heat buildup
    less tissue strain


    Because you needed to know the answer to “Why should a congruent joint be more mechanically efficient? “
    I listed some answers that you may or may not have been familiar with (you didn't respond to any of them), but I thought I should add one more-- greater and more efficient MA (do you need help with this one?), com'on man get out of your chiropody mentality and “think like an engineer”--Kirby
     

  11. Ladies and gentlemen, I give you: Dennis Kiper.:dizzy:
     
  12. Dennis Kiper

    Dennis Kiper Well-Known Member

    I am staggered that anyone, in this day, age and state of knowledge, would produce a comment that suggests that subtalar joint congruency is at its greatest while neither pronated nor supinated. While not actually using the term "neutral" with respect to this position, it has been invoked in the past and taken as gospel. Since the movements of pronation and supination at the s/t jt are defined and movements away from neutral, it has to invoked here also.

    I am staggered that you are staggered. To invoke your little speech when you said it all “ While not actually using the term "neutral" with respect to this position”

    I made a direct response in as simple a manner as possible to Simon. If you feel the necessity to argue the semantics of what it meant, so be it.


    it has to invoked here also.--what was your point?--do you mean movement away from neutral (for lack of a better term) is also gospel?
    --

    And I would argue--that subtalar joint congruency is at its greatest while neither pronated nor supinated is correct in this day and age.
     
  13. And this study demonstrates that it is not: http://www.ncbi.nlm.nih.gov/pubmed/18701029

    Can you provide a scientific study which supports your conjecture, Dennis? Since wishful thinking doesn't make it so.
     
  14. Dennis Kiper

    Dennis Kiper Well-Known Member

    Well there you go, Simon, you're unable to respond to science based technologies in the orthopedic field with possible advancements in our profession. Your status and income are dependent on keeping the status quo. You think you've pointed me out?
    You have everyone else fooled, you don't have me fooled.
     
  15. Dennis Kiper

    Dennis Kiper Well-Known Member

    And this study demonstrates that it is not: http://www.ncbi.nlm.nih.gov/pubmed/18701029

    so you say po tah to and I say potato

    Can you provide a scientific study which supports your conjecture, Dennis? Since wishful thinking doesn't make it so.

    Scientific study that supports my conjecture??? Hmmmmmmmmm
    --let's start with the Archimedes principle.
     
  16. Blarney

    Blarney Active Member

    We must be seeing different patient groups then - as certainly my patients with HAV and associated alignment issues are looking for measurable improvements.

    Griff when I get back to work next week I'll send over relevant papers. In the meantime check out the manipulation for ankle sprain papers a few threads back.

    Justin

    podiatry.ie
     
  17. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Dennis; your comprehension of what science is is very different to everyone else's. Therein is the problem.
     
  18. Griff

    Griff Moderator

    Whatever the patient group, the data tells us that foot orthoses intervention results in unpredictable and subject specific kinematic responses and almost certainly do not appear to exert their beneficial effects via solely 're-aligning' anything. Hence it is not my focus if I am prescribing them.

    I've read that thread in the last few days and the most recent studies posted all referred to manual therapy and its potential role in treatment; i.e. pain reduction and joint range changes (which last how long?) I didn't see anything referring to hands on work improving joint alignment as you suggest? Look forward to the other references next week.

    Cheers

    G
     
  19. Dennis Kiper

    Dennis Kiper Well-Known Member

    Dennis; your comprehension of what science is is very different to everyone else's. Therein is the problem.

    You mean you're not familiar with the Archimedes principle and how that may apply to biomechanical function? Or are you referring to another comprehension of science?
     
  20. Dennis Kiper

    Dennis Kiper Well-Known Member

    Whatever the patient group, the data tells us that foot orthoses intervention results in unpredictable and subject specific kinematic responses and almost certainly do not appear to exert their beneficial effects via solely 're-aligning' anything

    And herein lies the difference in congruity. Poor congruity results in the above.
     
  21. I love the "ignore list" function of Podiatry Arena!

     
  22. Tkemp

    Tkemp Active Member

    Returning to the start of the thread. I had a client with multiple pairs of orthotics, all of which caused increasing pain.
    After a long consult and examination I could still see no reason for this to occur.
    So I chose the newest pair and asked the client to humour me one more time and walk with them again please....... this time I asked them to put the orthotics in their shoes........ and immediately noticed the problem!!

    The right orthotic was in the left shoe, and vice versa!
    Upon pointing this out, the client replied, "that's how I've always worn them" :rolleyes:

    Wrote a big R & L on the bottom of the orthotics and asked the client to try them for another week.

    Problem solved! :drinks
     
  23. Archimedes principle has nothing to do with the moot point which is: at what position is the subtalar joint most congruent?

    To refresh your memory:

    You stated:
    I asked
    You replied:
    I do not believe this to be correct and in support of my position I provided a reference study in which the congruence of the subtalar joint had been examined in various foot positions. This study had determined that the subtalar joint appears to be most congruent in the foot position of 10 degrees of abduction, 20 degrees of dorsiflexion and 10 degrees of eversion, not when it is "neither pronated, nor supinated" as you asserted. http://www.ncbi.nlm.nih.gov/pubmed/18701029

    Now, since you claim that Archimedes principle supports your conjecture, please use Archimedes principle to explain your answer that the position at which the subtalar joint is most congruent is "neither pronated, nor supinated".

    Don't worry Dennis, I know you are getting frustrated because all you want to do is talk about your insoles, but if you are patient we'll get on to these. First we need to examine your management philosophy.
     
  24. mefc

    mefc Member

    Ditto Simon!
     
  25. Tariff Hogan Jinn

    Tariff Hogan Jinn Welcome New Poster

    Sorry if I've missed something here but Kevin, you say you see 30 patients a day! Are these 15 minute fit appointments and joint appointments? Does anyone else see this many?
     
  26. mefc

    mefc Member

    If patients don't give the information when they book about what they want to see you for, it is difficult to allow suitable time. I have half hour and 15 minute appointments and make it quite clear when booking the shorter that it is a limited appointment. Any orthoses adjustments are made outside of the appointment time and left at reception for collection.
    Sometimes though, those "crazy's" slip through the cracks, and if you lose them as clients because you can't accomodate them instantly, good job :)
     
  27. On my full days (Monday, Wednesday and Fridays), I arrive at the office at 8:00 AM, start seeing patients at 8:30 AM then go to 12 noon (3.5 hours), then do my charts and eat lunch from 12 noon to 1:30 PM. I then see patients again from 1:30-5 PM after which time I again do my charts. I generally leave the office around 6:15 PM.

    Therefore, on my full days, I am treating about 30 patients for a total of 7.0 hours which works out to about 14 minutes per patient, on average. In addition, on those full days, I am doing (i.e. writing and dictating) charts for about 2.0 hours. The number of patients I see on a full day ranges from anywhere from 25 to about 35, but I prefer seeing less than 30, if possible.

    When I was first starting out, I thought seeing 15 patients per day was a lot. I guess, practice makes perfect. I am fast and efficient with my appointments. I suppose I should be pretty good at what I do now since I have been doing it for over 29 years. However, there are many podiatrists here in the USA who see more patients per day than I do. However, I doubt many of them do as many foot orthoses per month as I do.
     
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