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Functional Foot Typing: The Hypothesis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by drsha, May 23, 2010.

  1. drsha

    drsha Banned

    Members do not see these Ads. Sign Up.
    For the past thirty years, Subtalar Neutral Evaluation of the forefoot and rearfoot to forefoot examination developed by Merton Root, D.P.M. has been the gold standard in lower extremity biomechanics pedal examination if biomechanics is to become more scientific.

    The evidence is growing that subtalar joint neutral examination of the rearfoot and rearfoot to forefoot relationship examination is being disproven as being valid for obtaining evidence and in developing advances in practice and therefore is in need of change or replacement.

    A substitute for the Rootian Examination has been developed using independent rearfoot and forefoot examination and taken in the supine position called functional foot typing.
    Two rearfoot tests (SERM and PERM) and two forefoot tests (SERM and PERM) profile every foot into one of sixteen functional foot types that can then be used as a replacement for the Root Pedal exam when working biomechanically. The new foot typing may be more reproducable and valid for obtaining evidence and in developing advances in practice and therefore may be worthy of consideration when comparing to STJ Neutral Theory.

    Please advise as to accuracy of The Hypothesis (correct, prn)
    and provide discussion or evidence for same.

  2. Jeff Root

    Jeff Root Well-Known Member

    Dennis, what specific evidence are you referring to? What references are you using to support the above claim?

  3. Admin2

    Admin2 Administrator Staff Member

  4. Jeff

    Whatever "evidence" Dennis has it will only satisfy himself. I've just spent the past three hours reading various exchanges on other forums, such as Barry Block's PM etc., and quite honestly I've come to the conclusion that Dennis is a complete fruitcake. Unfortunately for you guys Stateside - a rather unpleasant, embarrassing fruitcake that does the podiatric profession no favours whatsoever. The exchange between Dennis and Lloyd Steinberg is particularly illuminating as Dennis gives his version of his experience from the teachings of Marvin Steinberg - Lloyds father:
    As much as I enjoy reading the various opinions from colleagues worldwide and their professional and personal experiences, it does become boring and frustrating when contributors like Dennis decry and abuse others simply because they disagree with their views - even when they are clearly outrageous and unfounded. I echo the sentiments above - give us a rest, Dennis.

    Mark Russell
  5. drsha

    drsha Banned

    This is the list that I have compiled over time.

    Morrison SC, Durward BR, Watt GF. Prediction of Anthropometric Foot Characteristics in Children, JAPMA, Volume 99 Number 6 497-502 2009
    Chen Y, Yu G, Mei J, Zhou J. Assessment of subtalar joint neutral position: a cadaveric study; Chinese Medical Journal, 2008, Vol.121 No. 8
    Sobel E, Levitz, SJ. Reappraisal of the negative cast impression cast and subtalar neutral position. JAPMA:1997;87(1):30-34
    Elviru RA, Rothstein JM et al. Methods for taking subtalar joint measurements. A clinical report. Phys Ther1998; 68(5):678-673
    Payne, CB, Bird AR. Teaching clinical biomechanics in the context of uncertainty.
    JAPMA, 1999 Vol 89, Issue 10 525-530
    P.Cavanagh, E.Morag. The relationship of static foot structure to dynamic foot function
    Journal of Biomechanics, 1997 Volume 30, Issue 3, Pages 243-250
    Harradine P, Lawrence B, Nik C: An overview of podiatric biomechanics theory and its relation to selected gait dysfunction; Physiotherapy, Vol92,2, June 2006, pg 122-127
    Harradine P, Bevan L, Carter N Gait dysfunction and podiatric therapy – Part 1: Foot-based models and orthotic management: Brit Jour of Pod, Feb 2003, 6(1) 5-11
    Mcpoil T, Cornwall M:Relationship between neutral subtalar joint position and pattern of rearfoot motion during walking. Foot Ankle Int:March 1994, 15(3) 141-5
    Pierrinowski M, Smith B”Effect of patient position on the consistency of placing the rearfoot at subtalar neutral: JAPMA;Mar 1997vol87 (9)399-406
    Pierrinowski M, Smith B:Rear foot inversion/eversion during gait relative to the subtalar joint neutral position, Foot Ankle Int Jul 1996:17(7)406-12
    Journal of the American Podiatric Medical Association, Vol 86, Issue 5 217-223, Copyright © 1996 by American Podiatric Medical Association
    Pierrinowski M, Smith B:proficiency of foot care specialists to place the rearfoot at subtalar neutral:JAPMA;Feb 1996;86(5) 217-223
    Smith-Orrichio K, Harris B: Interrater reliability of calcaneal neutral, calcaneal inversion and eversion; J Orthop Phys Ther; April 1990 12(1),10-15
    Lee WE. Podiatric biomechanics: an historical appraisal and discussion of the Root model as a clinical system of approach in the present context of theoretical uncertainty. Clinics Pod Med Surg 18(4):555-684, 2001
    Chuter V, Payne C, Miller K. Variability of neutral-position casting of the foot. JAPMA, 93(1):1-5, 2003.
    LaPointe SJ, Peebles C, Nakra A, Hillstrom H. The reliability of clinical and caliper-based calcaneal bisection measurements. JAPMA;2001;91(3)121-126
    Mathieson I: Restructuring Root:An Argument for Objectivity. Clin Podiatr Med Surg 2001;18(4):691-702.

    This becomes an experiment in EBM and its applications:
    Is the evidence valid, at what level and most important, is it applicable into an EBP?
    Last edited: May 24, 2010
  6. Oh jeez, not again!

    Well for openers it's not a hypothesis. Look up hypothesis. That paragraph is not a proposal to explain observed facts, it's an series of opinions. A hypothesis must be testable in the form of a null. What you wrote isn't.

    Secondly, the evidence is not evidence which supports the statement. It's all relevant, but none of it directly bears. Saying something "may be more repeatable" is perjorative, worse, vague, and not supported by any evidence offered. The quadristep system may be more reliable than neoteric fft. But saying it don't make it so!

    Lastly, if that was to be condensed into a hypothesis, the scientific method would demand it be examined in the form of a null hypothesis to reduce confirmation bias. That means actively trying to disprove it, a process which always ends in tears where fft is concerned.

    Seriously dennis, as eric asked, what are you trying to acheive here? Advertising? Validation? To gather a following? There are now tons of fft threads, all of a muchness, do you really think a new one will yeild a different result? The paragraph you offerred cannot be objectively analysed apart from to say it lies outwith the norms of scientific enquiry.

    Must we have the same debate eternally? Have we not done this to death?
  7. Jeff Root

    Jeff Root Well-Known Member

    Let's start with this one since Craig did it. Dennis, how have you eliminated variability in your casting technique? Where is the study that proves this doesn't apply to your casting method? Time to take that one off your list!

  8. Craig Payne

    Craig Payne Moderator

    All we showed was that non-weight bearing casting was variable. That does not prove or disprove any theory. We have another publication on the variability of semiweightbearing casting. Several other studies have also looked at casting --> my conclusion of all that is that casting/foam box when there is a reference plane (ie the floor) is less variable than casting (or scanning) when there is not a reference plane .... theory does not come into it.
  9. Jeff Root

    Jeff Root Well-Known Member

    Craig, I know you know this, so I'm writing it for the benefit of others (or perhaps for my own piece of mind!). With foam box casting you do not capture any reverse curves from the outside, vertical tangent of the foot since the foam is compressed (crushed) and does not fill the reverse curves. One study (don't remember which one) said that heel bisection was more consistent and reliable with foam box casting. Yes, only because foam doesn't reflect the complex contour of the posterior anatomy of the heel of the foot which is necessary for heel bisection. If the heel was a perfect U shape like that which results from foam box casting, then it would be easy to bisect every heel, including plaster casts. More consistent doesn't necessarily mean more anatomically accurate or better clinically.

    In addition, allowing the plantar plane of the forefoot to parallel the plane of the floor in foam box casting may produce more consistent casts, but it doesn't necessarily lead to better clinical results.

  10. I would say it is impossible / meaningless to bisect a rearfoot from a foam cast. All such a line tells you is what angle the foot was pushed down into the foam. A rearfoot fixed at 15 degrees eversion will still bisect at 90 degrees if it were pushed straight in.

    It's the old political trick of finding the flaws in the status quo in order to imply that things must be better when you're in charge. We've had a skinful of it in the last election. There was an economic crisis under party A so party B Claimed it must be better. Only the party in power is subject to such critique. Of course in science it is a little easier as one can still test the validity of the model without committing to it for 5 years.

    And claims of superiority require more than criticism of other methods.
  11. drsha

    drsha Banned

    Originally Posted by Dennis Shavelson
    Marvin Steinberg, DPM mentored me to treat patients from a perspective of totality and not by their chief complaint. I had a diabetic patient walking with a cane complaining about mycotic nails. My history elicited chronic low back pain and sciatica and a bunion deformity on the left side. My review of systems elicited a positive test for the unequal limb syndrome with the left side being long. In addition to a culture, debridement and an Rx for his mycotic nails, I placed a ¼" felt pad into the heel of his short limb right shoe.

    The patient asked why no other DPM had told him about his LLD or explained his foot and postural mechanics as I had. With additional care, he has given up his cane, claims to have reduced sciatica and a "new lease on life." I dictated a report to his MD including my biomechanical findings and care and now, the MD sends me cases regularly. We are impacted by a lifetime of hard, unyielding shoe boxes, hard, unyielding ground surfaces and the pull of gravity. We walk slower at 80 than at 40. As we age, we have reduced quality of life and face a future of degenerative complaints.

    The podiatrist is "The Foot Specialist" and the only medical professional capable of determining natal foot type, the inclined posture and the biomechanical predispositions that will harvest problematic during one's lifetime. I am dedicated to educate the foot suffering public about functional lower extremity biomechanics in order for them to make intelligent decisions about whether to institute preventive and compensatory care. If I am right, FLEB and semi-rigid prescription foot orthotics are fluoride for the foot and posture and if utilized, will improve the quality of life for our aging society.
    I set my goals high many years ago to include wellness, prevention and compensatory care. Many of my colleagues are waiting for pain, deformity and reduced quality of life to approach patients biomechanically. I believe Dr, Root felt that his theory, as it evolved, would benefit mankind beyond pain management.

    Dr. Steinberg was my mentor in podiatry and in life 40 years ago. He planted the seeds for podiatry to become a medical profession and to a great extent, because of him, we are justly demanding parity with the physician community.

    Lloyd is not completely accurate as to Dr. Steinberg's use of biomechanics. In addition to his medical care, almost every patient recieved one or more precut foam pads placed in what Dr. S called the LA and/or the AMA pads. These pads were as much a part of his care as was injection therapy.

    I maintained these pads in my EBP and in 1986, Ron Valmassy, the then chief of Podopediatrics at CCPM published an article in:
    J Am Podiatr Med Assoc, Vol. 76, Issue 12, 672-675, December 1, 1986
    The triplane wedge. An adjunctive treatment modality in pediatric biomechanics
    RL Valmassy and N Terrafranca
    It introduced a double skived heel pad for peds that improved gait and function.
    I added Steinbergs LA and AMA pads to it and upgraded that to what is today my foot centering pads that are precut into kits and dispensed on the first visit to begin positional and motor control of the patients mechanics.

    This test drive for the need for orthotics also serves as introducing the concept of breaking in new pessures and torques under the foot as well as allowing for muscle engine adjustments. These pads are modified until a decision is made as to cast for orthotics and continue to be modified until the actual orthoics arrive from fabrication making patients far more ready to enjoy the benefits of orthotics.

    Without this kind of preliminary orthotic, semi rigid materials are too often rejected even if they would make great shells that would be accepted if given time.

    This especially relates to vaulting.

    The Valmassey article provided evidence for me that a preorthotic system could be used to test for and break in semi rigid orthotics.

    I challenged Dr. Steinberg in practice and I think that as many times as I was on the border of release, I positively stimulated his drives at the end of his practice. I am not very proud of some of my personality traits but I have used them to advantage as I have matured. However, I am very proud of my podiatry career, my teaching and especially my steadfastness in fostering Wellness into Biomechanics as my personal addition.
  12. Funny how it's always everyone else who's in the wrong. We have a lovely yellow truck that collects the rubbish every Monday morning - and it's always full of crap.

    Attached Files:

  13. drsha

    drsha Banned

    As have no argument that I, like you and the rest of us have not eliminated variability in my casting technique thereby making our collective biomechanics difficult at best to develop positive evidence.

    So if its OK with you, I would rather leave this article on your list and add it to mine (and Kevin's and Craig's and Robert's etc).

  14. drsha

    drsha Banned

    The flaws I point out are a suggestion that there is room for change and alternative theory. I NEVER said (other than my clinical skills which will only be answered in live debate) that my work was better than anyones, only worth examining.

    What I don't see either politically or on this scientific Arena is the fact that the status quo is flawed and in need of new and fresh ideas.
  15. drsha

    drsha Banned

    Your CRAP Mark
  16. And around, and around and around...

    There is no "status quo", there never was. There is (presently) no consensus on the best or the right way to do things. I work differently to Simon, who works differently to Mark, who works differently to Michael.

    Which is why the community is always so interested in new ideas, new data and new information. Check out the foot driving the leg vs leg driving the foot thread for an example. Accepted wisdom (orthodoxy) challenged by evidence and scientific consideration.

    However being INTERESTED in new ideas does not mean that we must automatically ACCEPT new ideas, unless there is a reason to! And there, AGAIN, is the rub. It is no enough to simple expect people to accept something new just because it is new.

    And Neoteric FFT is not just a new concept to consider, it is a shake and bake, wholesale, This-is-how-it-should-all-be-done package. In some areas it may well ovelap what I already believe, but if one accepts it as a theraputic model one must accept ALL of it, the bits which make sense AND the bits which don't!

    So I consider Neoteric FFT.

    I see no evidence to say it works better than anything else.

    I see it based on premises and concepts which evidence in hand shows to be fallacious (like the transverse arch).

    I see that it is based on personnal opinion and anecdote rather than first principles, thus the process of WHY X foot might respond to Y orthotic is not accessable, I am asked to simply take your word for it.

    I see treatments based on foot type rather than actual diagnosis so that a lateral ankle sprain will receive exactly the same prescription as a medial ankle sprain... which makes no sense to me.

    And I wonder, why should I change from my present way of working to this? It does not rest on any principles I can examine, it rests entirely on the argument "it is thus because I say it is thus."

    As I have observed before, Brian Rothbart tells us HIS paradigm is new and superior. You, Dennis, obviously do not think "by giminie he's right" and switch to his way of thinking (which makes no sense to you). So why do you expect me to do the same for your model?

    Round and round it goes... The next post will doubtless be on the lines of "yeah but root / kirby / newton is no better / has no evidence / smells funny. What you fail to realise dennis is that to change from one treatment paradigm to another it is not enough to denigrate the existing paradigm. You must show the new paradigm to be better. And you fail to show that NFFT is better than Quadristep FFT, classic root, SNA, or any other model. The last few threads have all been about the models and concepts you would DE-value rather than the one you would promote. Its all negative.
  17. drsha

    drsha Banned

    Great Posting :good:


    You have always taken the time to try to help me see the light.

    I have asked that my work be considered fairly and I do not get that sense.

    As an illustration, I have always had my EBP for testing for equinus.

    I read about The Lunge Test on The Arena and I tried it on 8-10 patients and now I have added it to my EBP and have suggested that others have a look at it as well. I never looked for evidence or prejudged the test I just examined it.


    Have you looked (in addition to your usual workup) at as many as 4-5 foot typings
    which for most DPM's would be after or in concert with STJ Neutral and rearfoot to forefoot relationship as part of diagnosis (orthodox diagnosis).
    If you verify that you have and have come to your same conclusions, I'm done until I can (and I'm currently moving on slowly funding or performing the research) until I can present evidence.

    Most foot typers find a higher incidence of the rigid rearfoot type (most common type) which for those feet preclude the need for frontal plane rearfoot treatment, producing a void in treatment that needs to be filled with something else.

    For your ankle sprain example, the extreme rigid rearfoot types have a predisposition to lateral ankle sprains. The flexible rearfoot types that engage in lateral sports or activities such as basketball, tennis are more prone to lateral ankle sprains. That is not to say that other foot types cannot have ankle sprains.
    Isolated deltoid sprains are rare in my EBP and so I have no foot type precursor or tagged types for medial ankle sprains. I would be interested to know if you have any?

    Simon, Mark, Michael and you are not my attack audience as you are skiled and dedicated to working biomechanically and with you, I would only hope to share some possible pearls as you examine my work. Kevin and I agree that the vast majority of the DPM's (that means America I have been told) and our labs believe they are STJ Neutral Theory biomechanists when they are practicing sham Rootian biomechanics (not Jeff's) and they need an alternative that is not called Root.

    Until my work was published on a thread called functional foot typing on The Arena, I monitored The Arena and was waiting for the needed evidence before being proactive to introduce my work.

    A patent is an upgrade of some part of the existing art in the eyes of a patent examiner. It is no more. I never claimed superiority or demanded acceptance of my work from the Arena, only a desire for it to be examined with an open mind.


    My name and work was already poisened when I posted on the FFT thread that Admin started.

    I think we can end the round and round Robert describes if for once, one or more of you try to respond to this posting as a colleague (I hope you consider me that) and not with poison or garbage trucks or personal attacks and report on examining my work.

  18. I can't resist it. Bel I owe you £5.

    Ok. Dennis, please see this as a critique of ALL FFT systems, not just yours.

    I don't type feet for several reasons.

    1. It moves the treatment model away from the simple paradigm which almost all medicine uses but which podiatry sometimes loses sight of. That is

    Symptoms (what the patient complains of)
    Diagnosis (what is wrong in what structure)
    Aetiology (what I think has CAUSED the pathology / diagnosis)
    Prescription (what I think will abrogate the force which caused the pathology / is preventing it from healing)

    Biomechanics is, IMO, a tool for working out steps 3 and 4. It cannot help us with 1 or 2. I believe that one must discover the pathology before one can try to dispense the cure. FFT, along with many of the traditional forms of biomechanics, jumps ahead to step 3, seeking the cause of the pathology without first establishing what the pathology IS.

    This can be sold on the basis of creating the "ideal functional situation" but we are largely ignorant of what that situation actually IS. As such I think the logical way to PRACTICE biomechanics is to seek to move away from a pathological situation rather than toward our best guess at ideal.

    That is an over-riding schism in biomechanics, between those who seek to move toward "normal", "ideal" or "wellness" and those who dispute our ability to identify these states (or even the existence of such a state for everybody).

    Take Afrocarribean feet for example. Almost exclusively flatter and lower arch than european feet. By a system which attempts to restore feet to a baseline they are ALL pathological, or functioning in an inefficient way. And yet afro-carribeans represent the bulk of elite runners.

    I mistrust any model which bases treatments on rearfoot and forefoot measurements which have been shown to be grossly inaccurate. If there are 3 situations for a rearfoot, inverted, vertical or everted, and assuming I am no better at bisecting rearfeet than the people who have studied this measurement, my 6 degrees of variability might mean a patient gets one of 3 foot types and three types of insole based on pure, dumb luck.

    As such I mistrust the whole basis for typing feet, or issuing insoles based on foot type. The individual points I've picked out of your system are just examples of what I see as indicators of these over-riding flaws in the entire concept.

  19. Robert

    Try this - it's more satisfying and saves you a fiver. And it has pulleys, levers and rods and reproducable results.......

    Last edited by a moderator: Sep 22, 2016
  20. Jeff Root

    Jeff Root Well-Known Member

    Robert Isaacs solves the formula for the rigid-flexible foot type!

    Attached Files:

  21. LOL!

    Sorry Jeff. That board looks all a bit clever for me. When I teach biomechanics it almost always has "for the terrified" appended to the lecture title. I try to make my slides a little more basic and a bit less scary.

    Found this one looking through an old presentation trying to make the point that even "routine" stuff is "biomechanical" and thus biomechanics need not be scary.

  22. Foot Lady

    Foot Lady Member

    Hi There,

    As a coalface practitioner i am really stuggling to understand the principles of foot typing, when all my patients are so different and have varying conditions etc. and it's not always the foot type i am treating. As Robert has previously said, what is the patient complaining of, not usually their foot type!

    I have always been of the opinion that in the first instance you do/add as little as possible to a simple/moudable orthotic to get the greatest effect for the patient.

    By only being able to chose from 16? models, does that not limit my treatment of the patient? Also I like to have a range of products in my clinic so I can send them away with a medium term device to see what effect I get. Patients hate waiting for a device when it hurts now! what I am trying to say is that it seems to be an expensive option 16? types how many sizes? So just for that reason it wouldn't appeal to me.

    Also do your products take into consideration the STJ axis? As for me this determines the angle at which I place my RF post.

    From a hypothesis point of view the question for me is do they work? How do they compare against other FFO with specific conditions etc, the science of measuring is so full of error and variability, that for me it is not as important, i want to know they work for the patient. Root had very little evidence based research early on, however there is enough anecdotal evidence to say that what he outlined has been effective, we have been using the principles for over 40 years (not me personally!) and had good results.

    A recent study by K Landorf, looking at the treatment of plantar fasciitis has shown that a casted device is as effective as an off the shelf mouldable device, this was a double blind controlled clinical trial (correct me if i'm wrong). This is the type of research that makes me consider using an alternative form of orthotic device.

    So do your products work? Have you compared them in controlled clinical trials? What % of the time do they not work? How often do you have to prescribe a differnt type of foot orthoses? If you say they work 100% of the time then I would be a little dubious!

    I know many of you are not keen on talking on the forum about the products specifically but for me as a practioner if the product stands well in controlled clinical trials against what is currently considered the benchmark. Then i would consider that the idea has merit. I understand that as researchers you are looking for a greater amount of evidence but as practitioner I feel that this would be sufficient.

    If it weren't for the number of stock items required to have one of each!

    i hope i am not to far off track with my post, i really enjoy reading through the forum and thought i would post as there has been a lot talked about this subject over varing threads.


  23. Jeff Root

    Jeff Root Well-Known Member

    Well, I had to pick somebody. Perhaps I should have chosen Kevin or Simon.

    You made an excellent point about the African foot type. Some of the most gifted professional athletes posses this same foot type. It is a highly functional flatfoot. It just goes to show you, there is much we don't know. My father lectured about this foot and suggested that his criteria for normalcy was based on a subset of the population and did not necessarily apply to all groups. He acknowledged that certain populations had genetic traits that we did not yet appreciate or fully understand.

    As I have mentioned before, the concept of "normal" has bias associated with it. That's why I believe we should try to avoid the term deformity and substitute the word condition, whenever possible. For example, instead of saying a forefoot varus deformity or a forefoot valgus deformity, we should say a forefoot varus condition or a forefoot valgus condition. These conditions are variances. It drives me crazy when the weather person on television says things like normal rainfall or normal temperature rather than average rainfall or average temperature. Our average high temperature for this day is 84 degrees but today it happens to be in the high 60's or low 70’s. It's "normal" for our temperature to range somewhere between 60 and 100 on this day, but it averages 84. Today it just happens to be well below the average!

  24. drsha

    drsha Banned

    Foot Lady:

    The Intro to Dr. Root’s 1977 text reads:
    “The practitioner needs a basis for making treatment decisions. Patients cannot wait until difficult research conclusively proves how the foot functions. Using the facts revealed by completed research and adding logical reasoning based on clinical study and applicable basic science, a story of normal foot function develops which is coherent and exciting to those responsible for foot care” still has merit 30 years later.

    EBM Facts:
    Subtalar Joint Axis measurement, STJ Neutral measurement and Functional Foot Type measurement are all inaccurate poorly reproducible and serve as generalities in practice.

    The variability within feet and the people that exist above them obscures the accuracy of evidence and so:
    There is no Level I Evidence of any theory that is worthy of incorporating into an evidence based practice (EBP). The best the BioNewtonians came up with was medial knee pain of which I have had a handful referred for care as a singular complaint.

    The Evidence in an EBP includes:
    1. Medical research
    2. Society’s values
    3. Particulars of patient situations such as course and severity of illness, concurrent mental and physical disease, diagnostic, therapeutic and/or education, beliefs, social resources, monitoring strategies
    4. Patients’ readiness to accept and adherence to recommended diagnostic, therapeutic and monitoring strategies
    5. Medical providers’ experiences, beliefs, and skills
    6. Health care systems’ rules, resources, and financing

    Clinically, Medical Research is Biased on The Arena to outweigh all the others.

    Biophysics, Biomechanics, BioArchitecture and Bioengineering are not as exacting as their ineximate namesakes Physics, Mechanics, Architecture and Engineering. Foot function can be described (interchangeably) in many languages (tissue stress, foot centering sagital block, MASS) and it can be described as positional (Root’s pronation) or as forces (Kirby’s pronatory moments)but their clinical applications are the key to patient care in EBP and are universal. You can examine, diagnose and deliver care in any language. For me, physics is the language of research and architecture is the language for practice.

    I wonder if Dr. Kirby charts notes in dorsiflectory stiffness for physician or insurance ecompany review? or if a flexible forefoot type would not ne more explicative.

    In practice, I take a vascular exam, a neurological exam and a functional foot typing before addressing the patient’s chief complaint.

    Functional foot typing separates the colors of the pedal rainbow into subgroups that have similar characteristics but contain a bell curve of subjects within each type.
    As Robert doesn’t foot type, I don’t Subtalar Axis Locate but I believe that the rigid rearfoot types contain the laterally displaced axes and the flexible and flat foot types contain the medially displaced axes.

    The orthodox theories are skewed to the rearfoot (take a look at Jeff Root’s sample orthotics on his lab url). There is a de-emphasis on the forefoot when most pedal pathology and corrective surgery is forefoot focused.

    FFTing examines the forefoot as an independent entity, in supine position, not needing a rearfoot exam first. The orthodox forefoot exams are totally subjective and based on a subjective rearfoot exam first.

    The foot types define planar pathology and positional collapse either rearfoot, forefoot or both and prepare the practitioner to treat the many variations in each subgroup foot type-specific with patient specific care without focus on the rearfoot.

    There are suggested casting and prescribing for each foot type based on rearfoot posts and modifications (frontal, sagital and transverse plane) and forefoot posts and modifications (sagital and frontal plane) but any treatment can be substituted at any time by the practitioner from his/her armamentarium.

    The use of foot centering pads for immediate treatment on the first visit begins treatment and can be modified, patient-specific.

    Added goals of motor control, the phasic activity of muscles, prevention and performance enhancement can be considered by foot typing and treating assymptomatic (or pained) patients knowing the characteristics and eventual pathology that will arise predictably within foot types (the rigid/flexible=bunion, the flexible/flexible = PTTD, etc).

    I believe that the perfect casting position for feet rather than STJ Neutral (collapsed position) is the day that bone growth stops (age 17-20). FFT Casting technique, as an art practiced by skilled practitioners, can best determine that casting. In general, the casts are shorter, narrower and vaulted when compared to STJ Neutral and they create a position where Wolf’s and Davis’s Laws are working regeneratively instead of degeneratively.

    This does not interfere with proximal evaluation or influence and certainly does not interfere with research using Newton’s Laws (or any others) which if researched in FFT subgroups (my hypothesis) would reduce the variables in test groups producing more applicable studies.

    “Using the facts revealed by completed research and adding logical reasoning based on clinical study and applicable basic science, a story of normal foot function develops which is coherent and exciting to those responsible for foot care”.

    At a Midwest Podiatry Conference, I met with Jeff Root and functionally foot typed him. He had a pair of his labs STJ Neutral casted orthotics in his shoes. I did hallux elevation tests for FHL and muscle engine power and function which showed hallux dorsiflexion restriction and little muscle function. I then added a set of my foot centering pads, foot type specific to his devices. His hallux dorsiflexion dramatically improved from my sagital plane care and his motor power for peroneus longus, posterior tibial, flexor hallucis longus and abductor hallucis were noticeably improved from the vaulting that his device did not address.

    In the universe, there are billions of colors but within the color yellow (or red, or blue) there are millions of hues. In the univers, there are billions of feet and within each FFT, there are millions of feet. Once I know a color is yellow or a foot is rigid/flexible, I can work with the hues in yellow or the feet in that foot type more accurately and focused.

    Functional Foot Typing enables practitioners to organize their EBP’s (or research) by subgrouping their patients before addressing chief complaints (or studies).

    Finally, please ask Craig to restate his feelings on the validity and usefulness of the Landorf study which has almost no reason to be applied to my (or I hope your) EBP, so don;t believe everything that is Level I Evidence.

    Dr Sha
  25. That's a long list of things you consider to be evidence. Is that IYO or is that from an independant source?

    There are a few there I would question. Working in the nhs I am acutly aware of treatments dictated by resources. I'm not sure I would descibe the compromises I'm forced to make "evidence".

    As a pure by the by, a funny thought just occurred to me. I have two very different feet. Do I have two foot types?
  26. The problem arises when you have two overlapping distributions lets say green and red, which population do the individuals that fall within the overlap belong to?

    Attached Files:

  27. Not facts at all.
  28. drsha

    drsha Banned

    Independent source.

    Watch out, this is where Spooner might tell you that you have to do some research on your own.

  29. drsha

    drsha Banned

    Virtually all subjects have two different feet in length, width and arch height, two different calf muscle girths, two different thigh muscle girths and dare I say it, two different leg lengths. Why do you think most presenting complaints at least begin unilaterally?

    Virtually all subjects present with two different variants of the same foot type. I have rarely found cusped feet that type rearfoot rigid on the left and rearfoot stable on the right. This means the typing would diagnose both feet the same FFT and then the clinician would have to go beyond the basic typing when treating such as using different forefoot or rearfoot degrees of posting or different heel lifts or different PT for each foot. (This of course does not include post traumatic or post op one sided where the foot types are more often different).

  30. drsha

    drsha Banned


    I'll preface my answer by asking you if this makes a great deal of difference clinically?

    The skills and experience of a foot typer comes into play when cusp (like signs of the zodiac) overlap come into play. The same thiing happens when dealing with different variants within a Foot Type. There will be similarities in different types and within types as well as different characteristics and in some cases the differences would be very small so as to prevent exact typing.

    In those cases both types needed virtually the same treatment prescription and the argument over their differences becomes moot clinically.

    90% of all patients have no major typical overlap and can be handled by the "average" skilled foot typer. The other 10% require additional skills and experience to diagnose and treat just like within all the medical fields and specialities in practice.

  31. Using your system it might because the orthosis design is linked to the foot-type and as you do not know the probability that that foot is either one type or another...
    Does it?
    76% of all statistics are made up on the spot. With all those grey areas between your foot-types Dennis, it hardly seems worth trying to artificially delineate them.
  32. drsha

    drsha Banned

    I would to introduce a new form of evidence:
    Common Sense Evidence: Evidence derived from the experiences of skilled researchers and clinicians that is not yet or cannot be "proven".

    Simon, are you actually trying to say that if I take ten practitioners and have them examine the same feet for STAxis, STNeutral and FFT, there would not be a dramatic difference in findings?

    If I take the same practitioner and on different occasions have them STAxis, STNeutral and FFT the same foot that there would be noticable variation?

    If I sent the same cast to ten different labs, I would not come away with many different products when devices are fabricated?

    If I sent the same patient with the same complaints to ten biomechanists the difference in diagnosis, casting, prescription and ancillary care would not vary enormously.

    Do these not fall under the heading of Common Sense Evidence as Facts?


  33. I happen to know what my intra-observer between-day error is for measuring a number of variables and the ICC's don't fall into the poor category. I don't know what it is for FFT because I've not measured it. What are your Kappa values for FFT? The point is that intra-observer error is specific to the individual and will vary between practitioners, my between-day error in examining STJ axial position might yield ICC's in the region of 0.8, while yours may be in the region of 0.1. Inter-observer error will be larger than intra-observer error for all measures. But that doesn't allow the sweeping generalisation that you made above.

    Here is what you originally said:
    They are not all "inaccurate and poorly reproducible", at least not in my hands, nor in the hands of some of the participants of the some of the error trials that have been published for some of these measures, although they may well be in the hands of some less well skilled practitioners.

    By calculating your errors in measurement Dennis you will be able to rely upon scientific evidence, rather than what you presume is common sense. "The thing about common sense, is that it's not all that common." Now if I was promoting a new technique, such as FFT, the first thing I would do was plan and undertake a reliability study to assess the performance of that technique. What kappa values have you found for FFT, Dennis?
  34. Because there is no reason to expect a functional injury to occur at exactly the same time in each limb. If i jumped off a cliff I suspect I would damage one leg more than the other, (they would not be exactly equal fractures) that does not say anything about which leg was longer. As chaos theory states, "sometimes **** just happens" (I'm paraphrasing obviously).

    Thats not to say that it CAN be because a structure in the foot or leg suffers more trauma because its longer, or indeed shorter, but its ain't neccessarily so.

    Bloody hell at this rate we'll be defining "something some bloke in a pub told me once" as evidence!:sinking:

    As one of the Arena posters has on their signature, the problem with common sense is that its not very common. What if I think something is common sense and you don't?!

    OK. Trepanning to treat headaches.


    Its Common sense (it lets out evils spirits)

    It was consistent with the medical providers beliefs experiences and skills

    It was within the Health care systems’ rules, resources, and financing

    It was within Patients’ readiness to accept and adherence to recommended diagnostic, therapeutic and monitoring strategies

    It was within Society’s values

    And so far as they were concerned it was consistent with the particulars of patient situations such as course and severity of illness, concurrent mental and physical disease, diagnostic, therapeutic and/or education, beliefs, social resources, monitoring strategies

    By your definition of evidence (and yes I did find the source and I'm not at all impressed) Trepanning was evidence based and satisfies 6 out of the 7 criteria for being an evidence based intervention. Hurrah, lets get a drill out.

    The same could be said of the claims of Matthias Rath and his campaign to make people in Africa believe that HIV is a myth put about to allow westerners to poison Africans with antiretroviral drugs. By those criteria THAT was evidence based as well! As is the use of marigold paste to reduce IM angles in HAV.

    I see now why you keep referring to your EBP. By those criteria it is hard to see how anyone is NOT doing EBM!
  35. That would be me.
  36. drsha

    drsha Banned

    I see now why you keep referring to your EBP. By those criteria it is hard to see how anyone is NOT doing EBM! (Your Mother)

    I see now why you keep referring to your EBM. By your criteria, you would have a dirth of treatment protocols to choose from in your EBP so that you could spend more time trying to find, produce and justify evidence (No Your Mother).

    Can we get back to the thread and Foot Lady's posting.

  37. drsha

    drsha Banned

    Simon Says:
    I happen to know what my intra-observer between-day error is for measuring a number of variables and the ICC's don't fall into the poor category.
    So you're so much better than all of us I know but what if we can't meet your standard? What should we do?

    Simon Says:
    What are your Kappa values for FFT? (Your Mother)
    Inter-observer error will be larger than intra-observer error for all measures. But that doesn't allow the sweeping generalisation that you made above.

    Mr, Hyde replies:
    Do you know the kappa values for inter-observer error that you discuss? How much larger? How can you say it is not enough to make common sence evidentuary conclusions (No Your Mother).

    Can we get back to the thread and Lady Foot's posting?
  38. I didn't say I was better than anyone else, I did say that I know what my repeatability coefficients are for a number of the clinical measurements that I perform. If you are not very good at something the best thing to do is work on your technique to improve it, Dennis. Measure the reliability without training and re-measure once you feel more competent.
    Depends on who the other observers are. Do you even know what a kappa value is? The problem is Dennis, common "sence evidentuary"[sic] conclusions, are by definition, based on evidence. The complete vacuum of evidence for the validity and reliability of the foot-typing technique that you are promoting, makes it impossible to draw evidentiary conclusions.

    We never left the topic of the thread and my postings here are directly related to Lady Foot's posting and to your subsequent postings. If you really want to get back to the thread, you could try actually formulating a hypothesis.
  39. drsha

    drsha Banned

    Do you know the kappa values for inter-observer error that you discuss? How much larger?
  40. Do you know what a kappa value is and for what kind of data it is employed? I'm guessing you don't or wouldn't have asked that question. Because if you did you would realise that I said I don't know what my kappa value is for foot-typing because I don't use foot-typing, as I don't use categorical non-parametric data in my work up, I don't need to know kappa values. Now ask the right question, Dennis.

    As I said, it depends on the measurement and on the specific observers!

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