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FFT Precursors

Discussion in 'Biomechanics, Sports and Foot orthoses' started by drsha, Mar 27, 2009.

  1. drsha

    drsha Banned

    Members do not see these Ads. Sign Up.
    Within each functional foot type, there are specific locations that when palpated or manipulated, produce discomfort or restrictions in motion, foot type-specific.

    These precursors in the feet and posture, when positive, point to eventual (or existing) pathology and by predicting future pathology (locations of tissue stress) yhey expose the need for preventive care via Manipulations, Physical Therapy, Foot Centrings or Foot Surgery.

    i.e. (partial lists)

    The Rigid Rearfoot Types
    Sinus tarsi precursor
    Cuboid precursor
    inferior medial calcaneal tubercle precursor
    insertional tendo achilles precursor

    The Flexible Rearfoot Types
    Navicular precursor
    Medial Knee precursor
    Low Back precursor

    The Flexible Forefoot Types
    MP Flexion precursor
    FHL precursor
    1st Met head Hyperostosis pecursor
    1st Met-Cuneiform precursor

  2. Twaddle.
  3. drsha

    drsha Banned

    not if I were treating your patients instead of you.
  4. Luckily for them, you are not.

    Lets take the first one on your list "sinus tarsi precursor", so according to this having a "rigid rearfoot type" is a precursor to having a sinus tarsi? Moving down the list, "rigid rearfoot type" = cuboid precursor???? So does this mean that if I don't have a rigid rearfoot type, I won't have a cuboid? etc.

    Lets assume that you mean a precursor to sinus tarsi syndrome, you make claims here of "predicting future pathology", please provide me with the details of the predictive model that you built: n=? r2=? etc. etc.

    In fact, show me one piece of peer reviewed published data which supports what you have written above. Bet you can't!
    Last edited: Mar 27, 2009
  5. Sammo

    Sammo Active Member

    It is my belief that there are too many variables in the foot to put a system together which is of any great use to clinicians. Every pathology has an aetiology which is completely unique to the person in which it forms. Clinicians should therefore know the inside-out of foot, lower limb and gait related functional anatomy, the gait cycle and should also have a clear understanding of bioengineering principles applied to the foot and lower extremity to be able to truely puzzle out exactly what is going on.

    In every foot, where there is tissue which has become, or is becoming, injured due to the fact it is under abnormally high and thus pathological levels of stress, if you press the tissue it will most likely hurt. This will tell you that this tissue hurts and is likely injured (unless you are a reflexologist, in which it tells you rather something else). Therefore you need to figure out the mechanism by which it is being excessively loaded and, if possible, reduce these pathological forces, through whatever means you have at your disposal, which should then in turn relieve the pain, if it was there, and thus the chance of further injury.

    I have always shied away from paradigms or boxes of information that tell you A + B = C, because when A is actually F in disguise, or the closest fit to F is A, even though they don't truely fit, you can get inappropriate treatments, because you have been unable to truely identify A as F because the list doesn't go up to F.

    The square peg goes into the round hole if you hit it hard enough...
  6. drsha

    drsha Banned

    Simon Says:
    Show me one piece of blah blah.

    Dennis States:
  7. drsha

    drsha Banned

    Sam States:
    Clinicians should therefore know the inside-out of foot, lower limb and gait related functional anatomy, the gait cycle and should also have a clear understanding of bioengineering principles applied to the foot and lower extremity to be able to truely puzzle out exactly what is going on.
    Dennis States:
    I agree in a perfect world and as a goal to strive for we all should.
    I Can't.
    Can You?
    Can Any of You?

    If not!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    "What do you suggest as an alternative Waddle"?
  8. Sammo

    Sammo Active Member

    Tissue stress...

    there are no boxes.
  9. drsha

    drsha Banned

    Sam Stated:

    Tissue stress...

    Dennis replies:

    So to use the common foot type, you have a rigid rearfoot, flexible forefoot foot type foot.

    On contact, the proximal insertion of the plantar fascia is under tension at the medial calcaneal tubercle.
    After midstance, the 1st ray pronates, dorsiflexes and lowers the vault of the foot distally, putting added tension into the plantar fascia via the windlass.
    The tissue stress proximally causes insertional plantar fascitis.
    The tension in the middle of the fascia causes micro and macro tears, ruptures and fibromatosis.
    The tension at the proximal insertion causes plantar plate injuries, tears and pathology and MPJ and hammertoe deformities.

    This is my clinical discussion of the tissue stress theory because when the sum of subclinical stresses go beyond a certain level, injury, pain and other symptomatology ensues.

    FFT's allow me to profile all patients so that I can apply foot type-specific diagnosis and treatment that is further custom as I evaluate each patient and case.

    Now you get a 32 year old runner who comes in with an ingrown toenail.

    In addition to the nail care, vascular and neurological workup the patient is foot typed a rigid rearfoot, flexible forefoot functional foot type.

    Further examination reveals pain on palpation of the medial tuberosity of the calcaneus as well as pain when palpating the plantar plate insertion into the second ray. They have no complaint related to these symptoms. His/her mother had bunions and sister, plantar fascitis.

    I relate the mechanics of the foot type to the precursor symptoms and the future problems that will ensure progressively if left untreated and offer preventive biomechanical care in the form of Foot Centrings.

    I casnnot tell you how many patients tell me that they were so happy they had the ingrown toenail or wart once given preventive biomechanical care.

    What do you do with this same patient and his/her ingrown toenail?
  10. While you may think that your pathetic responses divert attention away from the fact that you haven't answered the question and in so doing "got you off the hook", they don't. Like I said bet you can't provide any scientific evidence to support the utter nonsense written in your first post in this thread. Bet you can't.
  11. David Smith

    David Smith Well-Known Member

    Sam the Man!! :welcome: to the A team. My heart quickens in delight as the biomechanical revolution progresses from master to student > Caine (Sam) has snatched the pebble from the hand of the Po collective (KK, SS, EF, et al.) It is now time for him to go out in the world and spread the knowledge.

    Go in peace young Sam from the old country :D

    Luv Dave
  12. Yeah
    Well you can bump and grind
    It is good for your mind
    Well you can twist and shout let it all hang out
    But you won't fool the children of the revolution
    No you won't fool the children of the revolution, no no no

    Well you can tear a plane in the falling rain
    I drive a rolls royce 'cos it's good for my voice
    But you won't fool the children of the revolution
    No you won't fool the children of the revolution, no no no - yeah!

    But you won't fool the children of the revolution
    No you won't fool the children of the revolution
    No you won't fool the children of the revolution
    No you won't fool the children of the revolution
    No way, yeah, wow!

    T.REX: children of the revolution
  13. drsarbes

    drsarbes Well-Known Member

    I didn't get through all of these posts / replies or even all of your initial post...........but I can tell you that trying to pigeon hole symptoms and foot types is a tricky proposition.

    If it were only that easy I could have saved a few years studying!!!!!

    Take sinus tarsi (I assume you mean sinus tarsi syndrome) - the most common historical finding in sinus tarsi syndrome is inversion ankle injury. Period.

    Inferior medial calcaneal precursor!!!!!!!!!!! If you mean medial plantar tubercle pain........well.....I can tell you right now that the most common underlying cause of medial plantar tubercle pain is living on a planet with gravity!

    If you're looking to find shortcuts for making meaningful diagnoses you're going to be disappointed.

  14. drsha

    drsha Banned

    I have followed Dr. Spooners advice and researched the articles of his I could locate as well as those he invited all of us to review on foot typing.

    Dr Spooner’s work includes:
    The Subtalar Joint Axis Locator
    Simon K. Spooner, PhD * and Kevin A. Kirby, DPM
    In this preliminary study of two adults. It is possible, then, that the subtalar joint axis locator can reliably track the spatial location of the subtalar joint axis during weightbearing movements of the foot. (J Am Podiatr Med Assoc 96(3): 212–219, 2006)
    Effect of Extrinsic Rearfoot Post Design on the Lateral-to-Medial Position and Velocity of the Center of Pressure
    Joanne S. Paton, MSc * and Simon K. Spooner, PhD
    This study was undertaken to examine the effects of rearfoot post design on the lateral-to-medial position and velocity of the center-of-pressure path.
    Although the effect of the post designs seemed to provide reasonably predictable changes in center-of-pressure position, the effect on center-of-pressure velocity was variable and inconsistent. The effect of the orthotic post was dependent on design and phase of gait. The addition of a rearfoot post and, specifically, the design of the post can probably be used to alter the center-of-pressure position and velocity.
    STOP THE PRESSES!! Shavelson adds nothing new but this is EARTH SHAKING NEWS!!

    The Effect of 5-Degree Valgus and Varus Rearfoot Wedging on Peak Hallux Dorsiflexion During Gait
    Catherine Smith, BSc (Hons) *, Simon K. Spooner, PhD * and John Alan Fletton, MSc *
    The dynamic effects of 5° varus and valgus rearfoot wedging on peak hallux dorsiflexion were investigated. The reduction in peak hallux dorsiflexion occurring with rearfoot varus wedging was statistically significant compared with that associated with rearfoot valgus wedging. These findings have implications for the orthotic management of a variety of lower-limb pathologies. (J Am Podiatr Med Assoc 94(6): 558–564, 2004)
    This one reflects some amazing expantion and updating of thirty year old stuff.

    Simon: please supply us with titles to your research that adds anything more to the literature than mine offers to theory.

    Foot Typing Aricles from Spooner:

    The articFoot Type and Overuse Injury in Triathletes
    Joshua Burns, BAppSc(Pod)Hons *, Anne-Maree Keenan, BAppSc(Pod), MAppSc and Anthony Redmond, PhD, MSc, DPodM
    Corresponding author: Joshua Burns, BAppSc(Pod)Hons, PO Box 799, Neutral Bay, New South Wales 2089, Australia.
    Abnormal foot morphology has been suggested to contribute to overuse injuries in athletes. This study investigated the relationship between foot type and injury incidence in a large sample of competitive triathletes not wearing foot orthoses during a 6-month retrospective analysis and a 10-week prospective cohort study. Foot alignment was measured using the Foot Posture Index and the Valgus Index, and participants were assigned to supinated, pronated, and normal foot-type groups. Overall, 131 triathletes sustained 155 injuries during the study. Generally, foot type was not a major risk factor for injury; however, there was a fourfold increased risk of overuse injury during the competition season in athletes with a supinated foot typeFoot Types: pronated, normal, supinated....not interesting or new but
    Perhaps this supinated type is my rigid rearfoot functional foot type that I say is common?
    Foot type classification: a critical review of current methods
    Mohsen Razeghi, Mark Edward Batt
    Received 14 September 2000; received in revised form 24 May 2001; accepted 8 June 2001.
    Investigation into the effects of foot structure on foot function, and the risks of injury, has been at the core of many studies, sometimes with conflicting results. Often different methods of foot type classification have been used, making comparison of the results and drawing sound conclusions impossible. This article aims to critically review current methods of foot type classification. It is concluded that if a classification method combines data on structure with information on foot function in dynamic loading situations, it should relate more closely to the functional behaviour of the foot during locomotion.
    This fits well with functional foot typing

    Eric S. Rohr1, William R. Ledoux1,2,3, Jane B. Shofer1, Randal P. Ching1,2,3,
    The article states that “the cross
    validated misclassification error was 20%,
    reflecting some degree of instability in our classification tree !!!!!!!!
    and then summarizes by stating:
    Accurate classification of foot types can assist and
    improve in orthotic prescription and surgical correction.

    I suggest Functional Foot Typing is one such accurate classification system.


    Thirty Five subjects.Thirty had pronated feet and five had a normal foot type. Statistical analysis using Fisher’s exact testshowed no relationship between level or frequency of pain and foot type.
    Limitations in sampling and weaknesses in the questionnaire precluded any
    other method of hypothesis testing. The conclusion was that there is no
    relationship between foot type and foot injuries in recreational walkers.

    The two foot types in this study were pronated foot types and normal feet!!!!!!
    Is this the best you can do Simon?

    Relationship of Foot Type to Callus Location
    in Healthy Subjects
    Do-young Jung, M.Sc., P.T.
    Dept. of Prosthetics and Orthotics, Suncheon First College
    Moon-hwan Kim, B.H.Sc., P.T.
    Dept. of Rehabilitation Medicine, Wonju Christian Hospital, Wonju College of Medicine, Yonsei University
    In-su Chang, M.Sc., P.T., C.P.O.
    Dept. of Prosthetics and Orthotics, Suncheon First College
    The purpose of this study was to determine whether a relationship existed between foot type and the
    location of plantar callus in healthy subjects. Twenty-five healthy subjects with plantar callus were recruited
    for this study. Foot deformities were classified according to the operational definitions as 1) a
    compensated forefoot varus, 2) an uncompensated forefoot varus or forefoot valgus, or 3) a compensated
    rearfoot varus. The location of plantar callus was divided into two regions. Fourteen of the 19 feet with
    compensated forefoot varus and six of the 9 feet showed plantar callus at the second, third or fourth
    metatarsal head. Five of the 6 feet with uncompensated forefoot varus and twenty of the 16 feet with
    forefoot valgus showed plantar callus at the first or fifth metatarsal head. A significant relationship was
    found between foot type and location of callus (p<.01). The results support the hypothesis that certain
    foot types are associated with characteristic patterns of pressure distribution and callus formation. We
    believe diabetic patients with insensitive feet and with the types of foot deformity should be fit with foot
    orthoses and footwears that accommodate their respective deformity in a position as near to the subtalar
    joint as possible with the goal of preventing plantar ulceration.

    This study totally agrees with functional foot typing as it uses the older, poorly understood and fallable “Root” terminology.
    1/5 callus the rigid forefoot types
    2-3-4 callus the flexible forefoot types.
    I am going to be contacting these authors to see if I can fund further research.

    The point that I am trying to make Simon is that your work, like mine, the work of other investigators and the foam caster via email Smith who boasts that he is the witchdog over theorists and most of the rest of us (myself included) use our experiences and our knowledge bases in biased ways and even on ones home forum, the heavy hitters, when examined, are probably adding a lot to their weight by being repetitive, angry and abusive to the opposition’s point of view.

    "I'll let you be in my dream if I can be in yours".
    Bob Dylan

    "Waddle is in the eyes of the beholder"
  15. Sammo

    Sammo Active Member

    "Everyday I love you less and less" - Kaiser chiefs
  16. drsha

    drsha Banned

    Sam Stated:
    "Everyday I love you less and less" - Kaiser chiefs

    Dennis Replies:
    "Sometimes your the windshield wiper and sometimes your the bug, sometimes your the baseball bat and sometimes your the ball". Dire Straits
  17. Sammo

    Sammo Active Member

    We're not gonna take it
    Never did and never will
    We're not gonna take it
    Gonna break it, gonna shake it,
    let's forget it better still

    - The Who
  18. Lovin the game

    Team drama, The Automatic (I am like well down wif da youf init)

    What can I say
    I've got no room to complain
    Every mistake I made was out ok
    But you're asking me questions, making suggestions
    Telling me how to do what I do best

    Considering we don't play requests it's nice to see you're taking some interest

    Back to reality.

    Dennis I think you are missing the point of Simons continued reference to... well references.

    Its not a question of whoever has published most is best or even whoever knows more is right. Simon could be the most published podiatrist in the world with a string of pivotal and lauded studies to his name or indeed the lowliest undergraduate. As could you.

    The significance is not in the person posting but in what they are saying. Your OP on this thread was a flat statement of what is. You offered no evidence, either direct inductive published evidence nor even solid deductive evidence in the form of a reasoned rationale. On what basis therefore, do you expect us to accept it? With respect while you may be highly respected and well known in your own microcosm you are a relative unknown here.

    Once again, I mean this sincerly and without sarcasm or predjudice. Please examine your post on this thread. You made a bald and far reaching series of statements. Simon asked for evidence to support what you claimed. Not an unreasonable request. This is not him being vindictive (as if:rolleyes:) not an academic snob. You just can't roll up on a forum like this, make statements like that and expect people to accept them without question!

    If we (as a community) had accepted the validity of FFT as a tool then we might examine these claims, one at a time, for logical coherance. But we have not! So we can't.

    It would be akin to me saying "My cartm can fly". Everyone says "you're full of S**t, Show us a video if its true" (evidence). I then post another thread saying "it can go at Mach 2, do barrel rolls and has a range of 2000 km". We never accepted your initial proposition (FFT/the car can fly) so further claims based on it (barrel rolls/precursors) are meaningless UNLESS you can show us film of your car flying at mach 2 (inductive evidence again).

    Thats what has people so worked up!

    Keep it real housey!
  19. :drinks:good:

    Strealing that one too.

    It IS a thing of beauty is it not. I like to think as well that Sam represents a pebble snatched from the sludge of woolly thinking, bad science, lazy theory and
    academic turpitude, polished in the freezing waters of uncertainty and shattered illusion and brought forth to the crystaline bright and often sharp and painful world of a genuinely inquiring and penetrating mind!

    Which is, of course, only the START of the journey :eek:.

    One day, and it may not be far away, I expect to derive considerable kudos from telling people that I once worked with him.;)

    Well done M8


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