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Functional Foot Type Closed Chain Characteristics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by drsha, Feb 28, 2012.

  1. drsha

    drsha Banned


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    Functional Foot Type Closed Chain Characteristics

    By Dennis Shavelson, DPM
    Biomechanics Editor, PRESENT Podiatry
    as published, 2010, The Foot In Closed Chain, see original article for all illustrations

    As discussed foundationally, each Functional Foot Type(FFT) has a set of characteristics associated with that foot type1-2-3.
    Although some of the characteristics may be shared by more than one foot type, there are some (or a group of some), for each of the FFT’s, that characterize that foot type. The more characteristics of a foot type present in a given patient, the closer that patient is to being a “pure” example of that foot type3. (See figure 1)

    Figure 1. The Rigid Rearfoot, Rigid Forefoot FFT Characteristics

    This means that beyond the SERM-PERM testing4 for a patient’s FFT, overlaps can be determined which impact the clinical care decisions of patients by analyzing the presenting characteristics of each patient as a starting point to developing a plan for foot type-specific care.
    In addition, as previously discussed, there are concomitant factors, such as weight, activity level, health state, etc. that impact the extent and progression of hallmark characteristics.
    Although many patients share the same foot type, variations in closed chain characteristics and concomitant factors make each patient a case of one and well trained and practiced Functional Foot Typers dispensing Foot Centrings are once again finding themselves atop the biomechanical pyramid that Dr. Root placed us on thirty + years ago.

    Hallmark Foot Typing Characteristics

    X-Ray Presentation
    FFT X-ray Characteristics
    Rigid/Rigid High CIA++++, Bullet Hole Sinus Tarsi ++++, Intact CYMA Line ++++, Low Talo Calc Angle ++++, Lateral STJ Axis ++++, Plantarflexed 1st Ray ++++, Low HAV++++, Low IM++++, Low PASA++++


    Rigid/Stable High CIA+++, Bullet Hole Sinus Tarsi +++, Intact CYMA Line ++++, Low Talo Calc Angle +++, Lateral STJ Axis +++, Plantarflexed 1st Ray +++, Low HAV+++, Low IM+++, Low PASA+++
    Rigid/Flexible High CIA+++, Bullet Hole Sinus Tarsi +++, Intact CYMA Line ++++, Low Talo Calc Angle +++, Lateral STJ Axis +++, Plantarflexed 1st Ray +++, Low HAV+++, Low IM+++, Low PASA+++

    Rigid/Flat High CIA++, Bullet Hole Sinus Tarsi ++, Intact CYMA Line ++, Low Talo Calc Angle ++, Lateral STJ Axis ++, Plantarflexed+ or Dorsiflexed+-++++ 1st Ray, HAV +-++++, IM +-++++, PASA, +-++++,
    Stable/Stable Normal CIA, Sinus Tarsi, CYMA Line, Talo Calc Angle, Neutral STJ Axis, Neutral 1st Ray, Normal HAV, IM and PASA

    Stable/Flexible Low CIA+, Closed Sinus Tarsi+, Broken CYMA Line+, High Talo Calc Angle+, Medial STJ Axis+, Dorsiflexed 1st Ray+, High HAV+, High IM+ and High PASA+
    Stable/Flat Low CIA++, Closed Sinus Tarsi++, Broken CYMA Line++, High Talo Calc Angle++, Medial STJ Axis++, Dorsiflexed 1st Ray++, High HAV++, High IM++, High PASA++
    Flexible/Flexible Low CIA+++, Closed Sinus Tarsi+++, Broken CYMA Line+++, High Talo Calc Angle+++, Medial STJ Axis++++, Dorsiflexed 1st Ray+++, High HAV+++, High IM+++, High PASA+++

    Flexible/Flat Low CIA++++, Closed Sinus Tarsi++++, Broken CYMA Line++++, High Talo Calc Angle++++, Medial STJ Axis++++, Dorsiflexed 1st Ray++++, High HAV++++, High IM++++, High PASA++++
    Flat/Flexible Vertical CIA, Obliterated Sinus Tarsi, Broken CYMA Line++++, High Talo Calc Angle++++, Medial STJ Axis++++, Dorsiflexed 1st Ray++++, High HAV++++, High IM++++, High PASA++++, Arthritic Changes Rearfoot and Forefoot++
    Flat/Flat Vertical-Negative CIA, Obliterated Sinus Tarsi, Fixed and Broken CYMA Line++++, High Talo Calc Angle++++, Medial STJ Axis++++, Dorsiflexed 1st Ray++++, High HAV++++, High IM++++, High PASA++++, Advanced Arthritic Changes Rearfoot and Forefoot++

    Pedal Conditions

    FFT Foot Conditions
    Rigid/Rigid Hallux Rigidus +++, Hallux Malleus, 1=5 Hammertoes, Haglund’s Deformity++++
    Rigid/Stable Bunions+, FHL ++, FHE +, 2-5 Hammertoes +
    Rigid/Flexible Bunions+-++++, FHL +-++++, FHE, +-++++, 2-5 Hammertoes +-++++, Plantar Fascitis +++, Morton’s Neuroma +++, Met Cuneiform Exostosis +++, Bunionette +++
    Rigid/Flat Bunions++++, FHL ++++, 2-5 Hammertoes ++++
    Stable/Stable Problems only if patient is overweight, overactive, bunions + late, Plantar Fasciitis +, Bunionette ++
    Stable/Flexible Bunions ++, FHL ++, FHE ++, 2-5 Hammertoes, Morton’s Neuroma ++, Met Cuneiform Exostosis ++
    Stable/Flat Extremely Rare Foot Type, Surgical Failure, i.e. met primus elevatus postop
    Flexible/Flexible PTTD +++, Bunions Late+-++++, Extensor Substitution +-++++
    Flexible/Flat PTTD ++++
    Flat/Flexible Extremely Rare Foot Type, Surgical failure i.e. valgus producing dwyer postop, PTTD +
    Flat/Flat Non Functional, Non Correctable Foot Type, Surgical Salvage Considerations, Low Level Lifestyle
    Flat/Flat Non Functional, Non Correctable Foot Type, Surgical Salvage Considerations, Low Level Lifestyle

    General Guidlines Rearfoot Alone Forefoot Alone
    Rigid Poor Shock Absorption, Poor Morpher, Excellent Rigid Lever Hallux Rigidus, 1-5 Hammertoes,
    Stable Good Shock Absorber, Good Morpher, Good Rigid Lever Bunion, 2-5 Hammertoe, Plantar Fascial and Neuroma Problems Late and Low Level
    Flexible Excellent Shock Absorber, Excellent Morpher, Poor Rigid Lever Bunions, 2-5 Hammertoes, Neuromata, Bunionette, Plantar Fascitis, 2nd Met Capsulitis, Freibergs, 2nd Met Stress Fracture
    Flat Poor Shock Absorber, Poor Morpher, Poor Rigid lever NON Functional, Osteoarthritis +++

    Postural Sequellae

    FFT Postural Information
    Rigid/Rigid Equinus +++, Shock problems, degenerative knee, hip, lower back problems, tight musculature
    Rigid/Stable Equinus ++, Shock problems
    Rigid/Flexible Equinus ++, Knee, Lower back Problems Early, Runners Knee, Shin Splints
    Rigid/Flat Equinus +, Severe Postural Sequelae, Low Back, Knees, Hips
    Stable/Stable No Postural Sequelae Unless Stressed or Overused
    Stable/Flexible Collapsed Posture, Knee Hip, Low Back Sequelae
    Stable/Flat Severe Postrual Sequelae, Late
    Flexible/Flexible Genu Valgum, Coxa Vara, Lumbar Lordosis, Shin Splints, Runner’s Knee, Collapsed Posture Early, Poor Function
    Flexible/Flat Genu Valgum, Coxa Vara, Lumbar Lordosis, Shin Splints, Runner’s Knee
    Flat/Flexible Poor Performance
    Flat/Flat Very Poor Performance, Major Postural Sequelae included, Gait

    FFT Rearfoot Alone Forefoot Alone
    Rigid Postural Shock Problems, Equinus, Degenerative Joint Disease Shock Problems, Degenerative Joint Disease
    Stable Stable Posture Unless Stressed Depends on Rearfoot
    Flexible Flexible Posture, Collapse +++ Depends on Rearfoot
    Flat Tight, Non Functional Posture

    Characteristic Lesion Patterns


    FFT Lesion Patterns
    Rigid/Rigid First Met Callus
    Rigid/Stable Mild First Met or Second Met Callus
    Rigid/Flexible Medial Heel Callus ++, IP Hallux Callus +++, 2nd Met callus
    Rigid/Flat 5th Met Callus ++
    Stable/Stable Callus Hallux IP Joint, 2nd Met If Stressed or Late
    Stable/Flexible Medial Heel Callus +
    Stable/Flat Medial Heel Callus +
    Flexible/Flexible Medial Heel Callus+++, Medial First Met Callus ++, IP Hallux Callus ++, 2nd met callus+++, 5th Met callus++
    Flexible/Flat Medial Heel Callus, Medial First Met Callus +++, IP Hallux Callus ++, 2nd met callus++++, 5th Met callus+++
    Flat/Flexible Fifth Met Callus +++=
    Flat/Flat Fifth met Callus ++++

    FFT Rearfoot Alone Forefoot Alone
    Rigid Callus Depends on Forefoot First met Callus
    Stable Callus Depends on Forefoot
    Mild or Late 2nd met callus, Mild 5th met Callus, Mild IP Hallux Callus
    Flexible Navicular Callus 2nd met Callus, IP Hallus Callus, 5th met Callus
    Flat Lateral heel callus, Fifth Met Callus 5th Met Callus

    Shoe Wear Characteristic
    FFT Lesion Patterns
    Rigid/Rigid Medial Heel Wear ++++, 1st met Wear+++, 5th met Wear+
    Rigid/Stable Medial Heel Wear ++++ 1-2 Met Wear, 5th Met Wear++
    Rigid/Flexible Medial Heel Wear ++++, Lateral Forefoot Wear, 2nd met Wear ++, IP Hallux Wear +++
    Rigid/Flat Medial Heel Wear ++++, 5th Met ++++
    Stable/Stable Medial Heel Wear ++, Normal Forefoot Wear Unless Stressed
    Stable/Flexible Medial Heel Wear ++
    Stable/Flat Medial Heel Wear ++, 5th met Wear ++
    Flexible/Flexible Medial Heel Wear +, Expanded Medial Counter +++
    Flexible/Flat Medial Heel Wear +, Expanded Medial Counter ++++
    Flat/Flexible Lateral Heel Wear ++, Lateral Forefoot Wear ++++
    Flat/Flat Lateral Heel Wear +++, Lateral Forefoot Wear ++

    FFT Rearfoot Alone Forefoot Alone
    Rigid Narrow Forefooted Shoe, Medial Heel Wear ++++, Needs High Throat First Met Wear, Fifth Met Wear
    Stable Medial Heel Wear ++
    2-3 Met Wear
    Flexible Wide Forefooted ShoeMedial Heel Wear +, Medial Midsole Wear, Medial Counter Expanded 2nd Met,Wear, Fifth Met Wear, IP Hallux Wear
    Flat Wide Forefooted Shoe, Lateral Heel Wear, Needs Low Counter Lateral Forefoot Wear

    FFT Precursors

    FFT Precursors
    Rigid/Rigid Sinus Tarsi, MP Flexion ++++, Medial Calcaneal ++, Cuboid
    Rigid/Stable Sinus Tarsi ++, MP Flexion ++, Medial calcaneal ++
    Rigid/Flexible Sinus Tarsi ++MP Flexion +++, 2nd Met +++, Medial Calcaneal +++
    Rigid/Flat Sinus Tarsi ++++MP Flexion ++, Medial Calcaneal +++
    Stable/Stable Precursors When Stressed or Late
    Stable/Flexible MP Flexion +++, 2nd Met ++
    Stable/Flat Sinus Tarsi +, 2nd met +
    Flexible/Flexible PTTD, 2nd met ++, Medial Calcaneal
    Flexible/Flat PTTD,
    Flat/Flexible PTTD,
    Flat/Flat Sinus Tarsi, Navicular, Cuboid

    FFT Rearfoot Alone Forefoot Alone
    Rigid Sinus Tarsi MP Flexion, 1st Met, 1st Met Cuneiform
    Stable Precursors When Stressed or Late None Unless Stressed or Overused
    Flexible PTTD, Cuboid, 5th Met Base MP Flexion, 2nd met, 5th Met head
    Flat PTTD, Cuboid, 5th Met Base 2nd met, 5th Met, Navicular, Cuboid

    Legend Depending on Confirmatories and Purity of FFT
    + Mild and/or Late Development
    ++ Moderate and/or Earlier Development
    +++ Major and Early Development
    ++++ Major and Late Development

    ###
    References:
    1. Shavelson, Dennis: The Pedal Snowflakes, The Foot in Closed Chain, Present Podiatry Ezine 09/14/09: http://www.podiatry.com/ezines/?pub_year=2009§ion_id=51#ezine509
    2. Shavelon, Dennis: A Closer Look at Neoteric Biomechanics; Podiatry Today, September 2007, pp 147-153
    3. Shavelson, D. Steinberg,J, Bakotic, B: Chapter 25, The Diabetic Foot;Principles of Diabetes Mellitus, 2nd Edition, Elisiver Publishing, Switzerland; February, 2010 pp 528-551
    4. Shavelson, Dennis: The Functional Foot Typing Forefoot Examination; The Foot In Closed Chain, Present Podiatry; Ezine 03/29/10:
    http://www.podiatry.com/ezines/?pub_year=2010§ion_id=51#ezine584

    Dennis
     

    Attached Files:

  2. What a waste of electrons!!:deadhorse:
     
  3. David Wedemeyer

    David Wedemeyer Well-Known Member

    So what?

    This is Dennis’ working explanation of how his mortally flawed methodology purports to effect clinical changes and written in characteristic hillbilly biomechanics lexicon:

    http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=243851&postcount=33

    And you STILL cannot explain how these FINDINGS alter your clinical decision making process nor how they effect the design of the orthosis. You've discovered "fire" but you cannot describe how it "cooks the meat" amigo, does that about sum it up Dennis?. Posting this effluent drivel is meaningless yet again; you're pathological Shavelson.

    Eric has pointed out the flaws in your method ad nauseum and you have never provided a cogent explanation of how you get from "fire" to "dinner". Mike Weber summed you up best here:

    http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=244104&postcount=38

    I swear to God if we ever enter another cold war we should subject our enemy to reading Dennis' bull****...
     
  4. drsha

    drsha Banned

    Kevin:

    Electrons are negative, just like you.

    Dennis
     
  5. Admin2

    Admin2 Administrator Staff Member

  6. RobinP

    RobinP Well-Known Member

    Am I alone in having read over everything in the OP and being absolutely none the wiser as to what is trying to be explained?

    For a practitioner whose knowledge is perhaps not so biomechanically sound, a foot typing system makes sense. The Talar Made Quadrastep system is a good example of this. However, the reason it works is because it accepts that the offering of the system is limiting and cannot cover all bases. It provided a system that might cover 75% of a given population and the choices within that system are limited.

    the system above would seem to have an almost infinite number of possibilities as the variables are many. So it begs the question:

    Is this really a foot typing system?

    It looks to me like a series of patterns that have been spotted, based on experience, that are variable. It has then been shoehorned into some "system" but essentially says that there might be exceptions/crossover.

    At the risk of looking a bit silly myself here.....is this not competely obselete? If you are going to go to the trouble of identifying a foot type from a list of....I'm not really sure how many there are based on the above description......why not just assess the foot without pigeon holing it in the end( which effectively restricts your prescriptive options.)

    And for the love of God, can we not just call it an orthosis/orthotic/insole.....you know....a word we all understand instead of a Centring
     
  7. Robin,

    With the quadrastep system you have a finite number of foot orthoses with specific design features; the manufacturers recommend the application of one of these devices based on a gross assessment of foot shape and pictures there of. Clinicians who have experience and knowledge of foot and lower limb biomechanics could look at the design features of these prefabricated devices which are reasonably well described and determine which, if any, of these devices might provide the prescription variables required to lower the stresses upon a given pathological tissue, in a given patient. I'm not convinced by the "look at the pictures of the foot" approach to prescription, but an experienced clinician can look at the devices and base their choice on that; pick the device as a closest starting point and modify as required. To me, they are just another range in the library of prefabricated devices and as such they provide a useful adjunct. Will I prescribe devices based on their foot-typing system? No. Will I use their devices? Yes, if they provide the design features that I believe would be beneficial to a patient.

    On the other hand with Dr Shavelson's system, we appear to have a method which is half completed, that is we have a proposed assessment technique to classify foot types, again the validity of this is questionable, and is one which I am unlikely to use. Yet unlike the quadrastep system, we have no range of prefabricated foot orthoses to choose from, nor any rationale regarding the prescription design features of prefabricated nor custom made foot orthoses. So, even for a relatively inexperienced clinician looking to build their knowledge of foot orthoses therapy, this system does not appear to provide a complete simplified system.

    I think the key point is that simplified systems need to be simple; they also need to be complete systems; efficacious goes without saying. At present, Dr Shavelsons system doesn't appear to tick these boxes and despite being given multiple opportunities, over several years now, he has been unable to describe the different design features of the foot orthoses for the different foot types and there is no range of prefabricated devices to choose from. Contrast this with other foot-typing systems.

    I don't recall how many foot types are possible within Dr Shavelson's system. As I recall there were 9 within Paul Scherer's original version, which if we followed to the letter, should have required a range of 8 prefabricated devices/ distinct prescription variations.
     
  8. Simon:

    You forgot to mention the original classification system that is far superior to either Scherer's or Shavelson's classification system:
    The simplicity of this system is remarkable.;)
     
  9. RobinP

    RobinP Well-Known Member

    Ah...the meat pie system *wistfully staring into space with fond memories passing thorough the brain*

    The funniest thing about this system is that it would be very interesting to provide orthoses based on the meat pie system and audit the results. I bet they would be not too bad!
     
  10. Yes. Morgan also defined the orthoses design, which is key to its superiority. It had a 4 degree post with 4 degree motion. Thus, he provided a complete, albeit simplified system. Moreover, he did also note that you could have meat pie with chips, a meat pie with gravy, a meat pie with mushy peas or even a meat pie with curry sauce etc and in so doing listed several orthoses variations.
     
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