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Functional foot typing

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Sep 27, 2008.

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  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

    Members do not see these Ads. Sign Up.
    Our alert system missed this orginally, but it was granted in July:

    Foot Typing Method
    Link to patent
     
  2. Is this related to these?
    http://www.strideorthotics.com/id49.html

    This seems very similar to the foot type matrix presented in chapter 2 or 3 of Valmassy, whereby a forefoot to rearfoot matrix is used. I find it difficult to believe that something like this is patentable. It appears to me as a retrograde step.

    I especially liked this:
    "Foot orthotics of the prior art generally are simple and non-patient specific in regards to postings and other modifications. They are only very slightly arched, are long, wide and the shell is poorly posted and modified. In summary, they lack centring. Functional Foot Type orthotics according to the present invention, on the other hand, are advanced foot orthotics that have a shell (body) that is fabricated from a negative plaster or fiberglass cast which is positive poured and to which custom postings and modifications are prescribed utilizing foot type specific techniques of the present invention."

    Those patent lawyers certainly earn their money, must have performed an exhaustive search of techniques already in the public domain.:bash:
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Indeed, that is the case. There were discussions between Paul Shearer (who wrote the chapter in Valmassy's book) and Dennis Shavelson (who owns the above patent) some time ago about this.

    I do cover this approach in some of the workshops I run; mainly in the context of it being another approach and part of the analysis I do is to look as what do all the different theoretical approachs have in common and what do they have that is different .... this is based on the assumption that what most of the different theories have in common must, in some way, be important for clinical practice.
     
    Last edited: Sep 27, 2008
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    No. Different, but I had not heard of this one, so dug out their patent for their foot classification system:

    System and method for foot classification
    Link to patent and images

    I have attached a pdf from the patent of the foot classifications. I have no idea how they ever expected to enforce this patent and why they spent the money obtaining it!
     

    Attached Files:

  6. Secret Squirrel

    Secret Squirrel Active Member

    Can we expect a letter from lawyers if we start using there classification systems?
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Just realised that the classification was two pages - here is the second page.
     

    Attached Files:

  8. Bruce Williams

    Bruce Williams Well-Known Member


    I KnowDr. Shavelson utilized his lab for several months several years ago.

    When he started to teach the above system I explained to him immediately about the chapter that was essentially identical in Dr. Valmassy's book. That was where our working relationship ended.

    As Craig said, there is some value in teaching this concept, but it is up to others as to how far to take it from there.

    Sincerely;
    Bruce
     
  9. Bruce and Colleagues:

    I personally don't see any value in teaching the concepts promoted by Dennis Shavelson. To me, they are old and worn-out theories that need to be discarded so I don't even mention them in my lectures. I also don't mention in my lectures the **** that Ed Glaser teaches in his infomercials since I think he is only interested in self-promotion, not promoting good science.

    Personally, I would rather teach Root biomechanics than either Dennis Shavelson's concepts or Ed Glaser's concepts since at least Mert Root did something original and did not simply promote a rehash of old concepts. That to me, is what I respect in a podiatrist. I greatly respect those podiatrists that can think originally and have invented therapeutic concepts/products that they have developed for the good of patients, with no concern regarding whether their idea or product will make them more wealthy.

    To me, I just don't see the point of all this patenting and trademarking. Neither Drs. Mert Root or Rich Blake found the need to either patent or trademark their orthosis designs....and they developed a much more original concept and useful clinical foot orthosis design than have other podiatrists have. I know that the both of them were only driven by their desire to improve the therapeutic outcomes for their own and their colleagues' patients. Do you all think that these other individuals are driven only by their desire to improve the therapeutic outcomes for their and their colleagues' patients?? I don't think so.
     
  10. drsha

    drsha Banned

    I appreciate your comments about my new paradigm, positive and negative. It is an upgrade of Root and using architectural engineering for language and comparison, it is built on the very shoulders of some of those commenting.
    Functional foot typing is built on Dr Scherer's chapter and included discussions with him and an opportunity for him to edit it before publishing. I have made the matrix 16 types (instead of nine) and that upgrade made the FFT's clinically relevant, reproducible, teachable and marketable. Unlike biomechanics, orthotics varus, rearfoot, etc most of my words are not misspellings on WORD spellcheck.
    I am a clinician, a healer and an educator. I am not a researcher and therefore would hope that your group would actually read my applications and articles and prove my ideas which are anecdotal (that's all they are) as valid, useful or the senseless trash as most of you have generally inferred. My opinion is no stronger or weaker than yours and yet, I seem to be being judged by assumption instead of inspection.
    I am 62 years old, have five children and two grandchildren and my reasons for patenting and trademarking as I am offering my work are my own and need no defense. However, that should not automatically blacklist it from your minds.
    Woodrow Wilson stated "If you want to make enemies, try to change something". I am not the enemy.
    Rob Lebow states that "New ideas stir from every corner. They show up disguised innocently as interruptions, contradictions and embarrassing dilemmas. Beware of those who shower you with comfortable sameness, and remain open to those who make you uneasy, for they are the true messengers of the future". I may not be the future but if I'm not, I cannot conceive why I make you so uneasy.
    Prepared for your reaction, come what may,
    Dennis Shavelson, D.P.M.
     
  11. admin

    admin Administrator Staff Member

    Dennis :welcome:

    Its allways good to have those whose work we discuss here!
     
  12. Scorpio622

    Scorpio622 Active Member

    Dennis,

    I don’t quite understand exactly what you are patenting? Is it the info in the two tables that Craig posted; or is that info explaining some sort of device you are patenting? If it is a unique device, I understand. But if it is just the information- why does that warrant a patent? Shouldn’t it be presented via a scientific journal?

    Nick
     
  13. efuller

    efuller MVP

    Dennis,

    Some questions and comments that I thought up when reading through the patent.

    Three arches? Is there any evidence of a transverse arch? How do you define arch. Pillars of an arch? I am not familar with the concept of pillars of arches. How do you define a pillar of an arch? I really don't see how you can incllude the talus in the lateral arch.

    Rigid lever mobile adapter. Old, not very useful idea.

    Wouldn't it be better to just look at the bones an ligaments rather than add a layer of confusing terminology like lateral arch and failure of rigid lever mobile adapter concepts.

    Why do you feel it is important to include the supination end range of motion of either the forefoot or the rearfoot? What effect does this have on prescription writing for orthotics or on foot function?

    There seems to be an unwarranted connection between rigidity and flexibilty and range of motion. There may be a weak correlation between range of motion and rigidity, but this seems to be a weak method of classifying feet. How do you justify this connection?

    "Each Functional Foot Type of present invention is associated with a certain profile of features that define that functional foot type. These include open and closed chain presentation, forefoot lesion pattern, x-ray presentation, shoe wear pattern, foot deformities, foot pain and fatigue syndromes and postural pain, deformity and fatigue syndromes. "

    This is straight out of John Weed's lecture sylabus. If 5 out of the 16 foot types exhibit a particular lesion pattern, is this system really that helpful in predicting the lesion pattern? This was a problem I had with John Weeds presentation of Neutral position theory.

    "[0039]Centring of the foot is typically accomplished through the use of felt and foam pre-orthotic pads, and orthotic inserts. Pre-orthotic pads used in accordance with the present invention are called Functional Foot Type pads, and orthotic inserts used according to the present invention are called Functional Foot Type orthotics."

    What is centering and why is it good? Is this any different than "supporting the deformity?

    "[0055]Since Functional Foot Type orthotics of the present invention improve longitudinal and transverse splay and spread, they are shorter and narrower than other known orthotics. Since they fill the Vault of the foot better than any other orthotics, Functional Foot Type orthotics are taller and have a higher arch. In addition, they correct for hammertoe influence. They are always posted in both the rearfoot and the forefoot and they contain foot type specific forefoot and rearfoot modifications." Wow, how does that work?

    "[0077]The prescribing techniques are as follows: [0078]1. Rearfoot Posting. The use of angulated or vertical materials and lifts that balance the rearfoot to the weightbearing surface. Rearfoot posts can be Varus, flat (Vertical) or Valgus. [0079]2. Forefoot Posting. The use of angulated or vertical materials that balance the forefoot to the weightbearing surface. Forefoot posts can be posts can be Varus, flat (Vertical) or Valgus. [0080]3. Forefoot Ray Cutouts. Material is removed from the Functional Foot Type orthotic shell to allow specific metatarsals to drop, thus enhancing the centring of the forefoot vault by leveraging the muscles, tendons, ligaments and soft tissue.Prescription guidelines are ordered foot type specific as follows: [0081]Rigid Rearfoot Types: Utilize a Varus rearfoot post. Add additional lift to the rearfoot post as tolerable to the inside of the shoe to accommodate functional equinus. [0082]Stable Rearfoot Types: Utilize a flat (Vertical) rearfoot post. [0083]Flexible Rearfoot Types: Utilize a flat (Vertical) rearfoot post. [0084]Flat Rearfoot Types: Utilize a Valgus rearfoot post. [0085]Rigid Forefoot Types: Utilize a 1-4 Valgus forefoot post with a first ray cutout. [0086]Stable Forefoot Types: Utilize a 2-5 Varus forefoot post with a first ray cutout. [0087]Flexible Forefoot Types: Utilize a 2-5 Varus forefoot post with a first ray cutout. [0088]Flat Forefoot Types: Utilize a 1-5 Varus forefoot post. "

    Now all you need to do is show that the measurements are repeatable and that the prescriptions from the measurements relieve pain better than random application of posts. Or better than applying posts based upon some other measurement like subtalar joint axis position or a measurement I call maximum eversion height. (More below)

    The major distinction I see between this "invention" and neutral position theory is that the classification is based upon end of range of motion instead of neutral position. So, if a patient is complaining of sinus tarsi pain, or first mpj pain, shoulnd't we be trying to explain the pathology by forces applied to those structures and then trying to reduce the stress on those structures.

    One of the major problems with this and the neutral position system is that the measurements are based on non weight bearing measurements for weight bearing problems. At least the neutral position system took into account tibial varum, which I did not see in the patented process. My attempt at using these range of motion concepts led me to develop a measuremnt that I call maximum eversion height. (I do have to give credit to John Weed for describing how he would place his fingers under the lateral forefoot as a definite precurser that would lead to the maximum eversion height measurement) A patient is standing in angle in base of gait and is asked to evert their forefoot without moving their leg. Some individuals can lift their lateral forefoot off of the ground and others cannot, because of the available range of motion of several joints of the foot. Placing a valgus wedge (with thickness higher than the person can lift their lateral forefoot off of the ground) will cause problems in those with little eversion height. You can predict where these problems may occur. (high pressure under lateral column or sinus tarsi pain.) Placing your fingers under the lateral forefoot of someone who has minimal eversion height will hurt your fingers.

    I thank John Weed for teaching me his intuitive understanding of this phenomenon. I would agree that this process is a step backward from the teachings of Root Orien and Weed.

    Regards,

    Eric Fuller
     

  14. Dennis:

    I am 51 years old, have two children and two grandchildren. However, how does all this family information have anything to do with your decision to patent and trademark ideas that, to me, as Eric said, is a step backwards from what Root and coworkers proposed?

    I'm glad Mert Root didn't patent and trademark all of his ideas. Maybe this is one of the reasons why Dr. Root is held in such high respect by the majority of the podiatry profession.:drinks
     
  15. drsha

    drsha Banned

    Re: Functional foot typing
    To the forum members:
    Thank you for this opportunity to defend my work in your arena.

    To Eric;
    Neoteric (new and fresh) Biomechanics is based on architectural engineering comparing architectural arches, vaults and centrings to those of the foot. It uses Root Theory as its starting point for the foot.
    In architecture, when two arches are joined by a curved roof, that is called a vault. This means that the med and lat longitudinal arch connected by the area that sits above and along side them form The Vault of the Foot.
    In architecture, an arch has one function: to support. It has two equal pillars and a central keystone and it stands forever. However, if that arch was to function (i.e. walk) its tendo achilles would have be four bulldozers.
    In nature the rear pillar has been shortened, the front pillar lengthened and the keystone off-centered proximally in order to leverage tendons for function.
    In summary, in order to function efficiently, in an engineering sense, our feet have given up a lifetime of support.
    In architecture, if you want to build an arch, you take a wooden structure called a Centring in the shape of the arch and lay bricks on it and set a keystone and cement them. When dry, the Centring is removed and the arch stands on its own.
    In nature, some feet are weak in the rear pillar, some in the fore pillar, some both, some rigid in both etc etc (functional foot typing) but each foot needs a Centring placed under it in order to leverage the musculotendonous units so that they can support the bones and allow them to work efficiently for a lifetime.
    In architecture, you build the Centring first and remove it from the arch and in Foot centering, you build the Centring afterward and place it under the foot to support the Vault.

    That is The Foot Centering (Centring) Theory.

    In Functional Foot Typing:
    Serm tests represent open chain evaluation and PERM tests represent closed chain evaluation in determining the foot types.
    If the rearfoot SERM is Inverted and the Rearfoot PERM is inverted then that rearfoot will hit the ground inverted and stay inverted (a Rigid rearfoot type) and it will need a varus post in order to balance it to the three body planes.
    If the rearfoot SERM is inverted and the Rearfoot PERM is Vertical then it will hit the ground inverted and then pronate to vertical (a Stable rearfoot type) and it will need a vertical (or zero) rearfoot post and so on with the other two rearfoot types and the four forefoot types.

    In this manner, functional foot typing profiles all feet into one of the FFT’s that will then be casted, posted and prescribed foot type-specific (in my example, a rigid rearfoot type gets a varus rearfoot post and a stable forefoot type gets a vertical rearfoot post).

    Foot Centrings are shorter, narrower, higher arched and more forefoot posted than the “general” subtalar neutral casted device (using the gifs on most lab websites as examples, including Jeff Root’s, Prolab, Ortho-rite, etc).

    Conceptually, I would not build an architectural arch using a Centring lower than the arch I am looking to build and that is why many Root and OTC devices fail equally in studies (ref. Dr. Paynes work). My Foot Centrings are vaulted enough to begin to get p. longus, f. hallucis longus and the core intrinsics to fire stronger and in phase (anecdotally “correcting” the foot type).

    Another flaw (in my opinion) of current accepted theory is that gait became the standard for researching and evaluating the effectiveness of theory and practice, when in fact, we move front to back, back to front, side to side, up and down and we spend time in stance as well. In gait, the rearfoot controls the forefoot but in eurythmy or when a american football safety backpedals or a ballerina goes en pointe, the forefoot is the primary contactor and so varus rearfoot posts, Kirby skives and blake inversions play no role. In stance, an elderly person needs much more forefoot control for balance than the majority of Root devices dispensed offer. This means that evaluating patients and devices “scientifically” in gait has no meaning during much of ones living day. Therefore the standards for discussion stating that “in gait” or " during stance phase” only has importance when one is going from point "A" to point "B".

    Whew!!

    To Dr. Kirby:
    As I am new to The Podiatry Arena, I am not sure why you are allowed to use this forum to personalize a dialogue between us. For instance on Dr. Block's Podman Online listserve, personal dialogues are removed from general view and held between parties.
    As I am visiting your house and your personal comments seemed to be allowed on group “threads”, I would like to move our personal dialogue in the arena to an academic one and away from your opinion on whether one is “allowed” to patent or trademark, so here goes!
    The Shavelson/Kirby Challenge:
    I challenge Dr. Kirby at a common location (I will be at the New York and Midwest DPM conferences) to be mutually determined to examine the same person (s) who has (have) never seen a DPM or had orthotics with or without a foot complaint to be evaluated and marketed by both of us using our personal paradigms and then for each of us to cast, Rx and fabricate a pair of foot orthotics for that patient .
    The patient will evaluate our work at every step as to understanding, perceived and actual value and benefits received from orthotic care and the results will be judged by neutral third parties.
    I am willing to make a $10 wager that I win.
    I will pay up and go back to my drawing board if I lose.
    Dennis Shavelson, D.P.M. (still not the enemy)
     
  16. Aside from the obvious flaws in the argument comparing architectual arches with the foot, why would you expect any benefit from a foot orthosis or indeed dispense one to a subject who has no foot complaint?
     
  17. Dennis:

    I certainly don't perceive you to be the enemy. In fact, I greatly appreciate your willingness to publicly promote the conservative management of foot and lower extremity disorders to our more surgically-oriented podiatric colleageus in the States on forums such as Barry Block's PMNews e-mail list.

    Podiatry Arena is an academic forum which does not limit, for the most part, anything related to podiatry. Therefore, we have personal comments, opinions, and even jokes sometimes floating around here mixed in with some very intense academic debates. I did not intend my comments on your patenting and trademarking of ideas to be taken personally. That was not my intention. I just commented that I simply don't understand it since I have always felt it was better to offer ideas and new theories to my profession without any expectations for financial reward. You are certainly not the first podiatrist to trademark or patent an idea. I have a US patent on an x-ray positioning device that is unique also. Enough on that idea, I won't bring it up again.

    We are quite far along, Dennis, in using engineering and biomechanics terminology to understand how the human foot works. I have spent the last quarter century and, with the help of many of my colleagues who also participate on this international podiatric medical forum, have endeavored to advance the sophistication of podiatric biomechanics away from the Root model and toward a model that is based on strict Newtonian principles using currently accepted biomechanics and engineering terminology. Unfortunately, I see your model as a throwback to the Root model that I have worked so hard to get the profession to move away from for the past quarter century. Therefore, I simply don't see much benefit taking podiatrists back a step or two in sophistication, when they should rather be keeping more in step with the mainstream international biomechanics community and their prolific research on foot and lower extremity function.

    Hope this explains my thoughts better and sorry if I offended you earlier with comments about your decision to patent and trademark your ideas. I tend to offend many people with my opinions...I guess that is just my nature.
     
    Last edited: Oct 8, 2008
  18. drsha

    drsha Banned

    To Mark Russell:

    Architectural engineers, architects and so many physicians and foot sufferers seem to “get” biomechanics using my “architectural model”.
    I have corrected any “obvious flaws” they have raised and that is how my theory has become stronger with time. For instance, the base of each pillar of an architectural arch can be canted (angled) with material and in architecture, that is known as an Impost (where did post come from?).
    I would appreciate you documenting the flaws that you mention as I would like an opportunity to correct them.

    As to biomechanics and an asymptomatic patient, I am wondering whether or not you have posed a trick question or are playing one of the arena jokes Dr. Kirby mentioned.
    Assymptomatic pathological feet of all kinds need Centering for quality of life and prevention issues.
    Morbidly obese patients are so grateful for additional balancing and support.
    Diabetics that will develop wounds from biomechanical pathology (the IP Hallux wound of the flexible forefoot types, the first met ulcer of the rigid forefoot types,etc) may never ulcerate if centered.
    Charcot foot prevention in anesthetic feet with an active lifestyle and underlying foot type pathology (ref. The PreCharcot Foot, Poretsky, Shavelson, Practical Diabetology, Sept 2007)
    Children of parents and grandparents with “bad” feet, bunions, lower back complaints, (heredity?)etc
    Performance enhancement issues of sport and daily life.
    Injury prevention on the playing field and gymnasium.
    Treatment of unequal limbs (any unilateral complaint, deformity or performance issue)

    Has Dr. Scherer et al convinced you that “pathology specific” care is the best you can offer and that you need to wait for symptoms before caring?

    To Dr. Kirby:
    There is no need for any apology from you, as over the years, your chiding has has provided me education and desire to improve and that is reflected in Neoteric Biomechanics. You are a mentor to me and an important player and role model to us all. It took all my nerve to challenge you in your arena in my previous post.
    I can remember emailing you after you published a great posting on Dr. Block’s site. i told you that I felt it was great because it was down to earth and from the hip but didn’t contain the “scientific lexicon” that scares away so many of our weaker colleagues from being a part of your flock. I continue to echo that urge to the entire arena because in the trenches, you are such a reach for so many practitioners that they never take the first step.
    My theory, as personal, infantile, flawed and unproven as it is serves an important service to take the masses closer to the pedestal that they have you "guys" justifiably living on instead of just straining their collective necks in pain or not looking up.
    Your disregard of my challenge fuels me to sharpen my paradigm to a point where you may consider some fragment of it worthy of your time.

    To Dr. Payne:
    You are a shining star and advocate for biomechanics. You have accepted your relatively thankless position with dignity and have created the most respected research machine in the field. Thank you for mentioning my paradigm in your boot camps, etc. I remain hopeful that you will someday investigate Neoteric Biomechanics with a small study that will prove (or disprove) its value to the foot and postural suffering community.
    Dennis Shavelson, D.P.M.
    drsha@foothelpers.com
     
  19. admin

    admin Administrator Staff Member

    Dennis - we are well aware of these issues and its always a fine line, that does get crossed with increasing frequency. We do have guidelines on it in the rules (which may need strengthening). Sometimes the personal banter is fun (as long as it does not detract from the value of a thread) and other times it contributes nothing of value to the thread (in which case I leave it for people to see and maybe delete some messages after a week or so).

    When the line does get crossed, I get damned if I edit it and damned if I don't .... (there is currently a very valuable 3 page thread hidden from public view that needs a lot of editing before I put it back and hopefully bring people 'back to the table' to stick to the issues). I am busy enough dealing with the spam to keep the board clean - as well as everything else an Admin has to do and don't have the time or energy to deal with these issues (I am doing this at 1.30AM, as up with one of the Arena'ettes).

    Hopefully this thread becomes a valuable resource on Functional Foot Typing - we have the patent; links to articles; and some opposing views on it from some key people ..... it does not get any better than that! I had nothing like that when I was a student. Agree or disagree, the resource is here for people to make up there own mind.

    ....lets everyone stay on topic.
     
  20. drsha

    drsha Banned

    To The Administrator:
    I sent an article for publication to "Gait and Posture" some months ago entitled "The Inclined Posture". It involves my personal rant on the importance of LLD and the need to research, diagnose and treat it. The three blind reviewers gave me a huge wake-up as to the value and place of my type of clinical, anecdotal stuff in an incredibly mean and base manner. Their only unintended kind comment was that one of them called me a "kenisiologist with biomechanical skills". I can debate with the best of them in my own mind (hahaha).
    I am humbled to swim in your pool as a visitor who hopefully knows my place. I agree that the exposure that my paradigm is getting is elevating it in value and I am grateful.
    Groucho Marx once quipped "I would never become a member of any organization or club that considered me worthy enough to join".
    For me, your fraternity is worth fighting to get in to.
    Dennis
     
  21. Dennis:

    First of all, please call me Kevin...most everyone else does on this forum.

    From my perspective, I have never viewed my ideas of foot function and foot orthosis therapy as being more complicated than the Root model or as being more complicated than any other model of foot function in existence. On the contrary, most of the podiatrists who have taken the time to listen and read my articles, books and book chapters have commented to me that I have been able to simplify a difficult concept for them and explain difficult-to-understand mechanical concepts in such a fashion so that they can more readily understand foot and foot orthosis function.

    At the California School of Podiatric Medicine, the concepts of subtalar joint axis location and rotational equilibrium have been taught to the second and third podiatry students by myself, and Drs. Larry Huppin, Paul Scherer, Cheri Choate and Suzanne Ishii for the past 10+ years as the preferred theory of understanding foot function and foot orthosis function. From what I and the other members of the biomechanics faculty at CSPM hear from students, these concepts are certainly not viewed as difficult or "scary", but rather as basic physics concepts applied to the human foot.

    We don't see any students "scared away" by using concepts and terminology such as moment, moment arm, force, compression, tension, stiffness or compliance. The only ones that seem "scared away" by these standard biomechanics terms are those podiatrists that never learned these concepts in their podiatric medical education or are those podiatrists that are older, already set in their ways and don't want to put much effort in learning "new" concepts that are over twenty years old.

    I hope I never am perceived as being on a pedestal, out of reach and unable to teach clinicians about how the foot and lower extremity works and about how foot orthoses function for our patients. If I am forced to teach these same subjects in an inaccurate manner, using ambiguous or imprecise terminology, just for the sake of trying to educate the podiatrists who have little interest in the subject in the first place, then I will cease teaching and go about my life pursuing one of my many other interests. However, at this time, there does not seem to be any lack of interest in my ideas since every year I am getting more and more requests to do lectures at international seminars. It seems to only be the more established and surgically oriented US podiatrists that are "scared away" by my ideas and who find my ideas too difficult to grasp. I have accepted this and have found my national and international colleagues who I have published with and lectured with to be of great inspiration to me while I continue to do something I truly love....exploring the mechanical secrets of the human foot and lower extremity.

    It is great having you on board here on Podiatry Arena, Dennis. Your comments and perspectives will greatly add to the wealth of information and ideas that this forum offers to the international podiatric medical community.
     
  22. efuller

    efuller MVP

    So, if you pile bricks on a center which brick is a pillar? Why do pillars have to be equal in length?

    An arch is a structure that is entirely under compression. You could pile pricks and add a keystone and it should stand alone even without the cement. A arched bridge over a stream needs to have the banks of the stream pushing inward to compress the stones of the arch together. You can also have a structure pulling the ends of an arch together and this is called a tied arch. The Windlass mechanism is a tied arch. the lateral column is not an arch but a series of beams. But, this part is irrelevant. If you want to understand the foot you should look at the individual bones and ligaments and not add confusing layers of terminology like arch and vault. You can do mechanical analysis of the structures of the foot without defining the parts of the foot as an arch or a beam. If you do try and clasify an arch or a beam you are losing information on what you are trying to study.

    "In nature, some feet are weak in the rear pillar, some in the fore pillar, some both, some rigid in both etc etc (functional foot typing) but each foot needs a Centring placed under it in order to leverage the musculotendonous units so that they can support the bones and allow them to work efficiently for a lifetime. "

    Every foot needs a centring???? Could you explain further what you mean by "leverage the musculotendonous units so that they can support the bones and allow them to work efficiently"?

    If I understand you correctly, you are saying that every foot needs a "scaffold" to help hold up the arch. Am I understanding you correctly?


    How often do you see an everted or perpendicular Supination end of range of motion when have an inverted pronation end of range of motion? Why not just look at Pronation end of range of motion? Why do you feel that Supination end of range of motion is important in typing the foot?



    I would agree that a short high arched device will make the muscles fire more, but more in a pain avoidance response. I don't see how this "leverages" the muscles.

    Your criticism of Root devices is that they don't work when the heel is off of the ground. This criticism is even more valad the shorter the device is. You have said that your device is shorter.

    There were other comments in my first post that you did not address.

    I'm looking forward to your responses,

    Eric
     
    Last edited: Oct 10, 2008
  23. drsha

    drsha Banned

    Dr. Fuller:
    In architecture, the bricks are called voissoirs. They are equal or proportional and voissoirs on each side of the keystone combine to form a pillar.
    In feet, the bones are the voissoirs and they are all of different size and shape.
    In architecture, pillars of equal length are used for constructing arches for maximal and long term support.
    In our feet, the physics of leveraging the tendons require the rear pillar to be shorter than the fore pillar in order to provide stability to the forefoot and they are inherently weak as supporters.
    The comparison that I would make would be a surgically planned osteotomy to a ballistic fracture (like a ski-slope fall) as to which is preferrable.
    Collapse of the Vault in the rearfoot or forefoot produces predictable problems in foot type-specific locations. Flexible rearfoot types (PTTD). Flexible forefoot types, FHL, FHE. When the Vault is supported by a Centring, tendons leverage (gain advantage), reducing their slack position improving the ability of the foot to support, morph and function.

    (Fuller: All feet need a scaffold)
    The whole idea of functional foot typing is to profile feet into types so that they can be treated foot type specific. Smaller failure rate, less complication, focused care that would be harmful if used on all feet. ALL FEET does not live in my vocabulary as it does in yours. In addition, I’m not sure why you converted Centring to Scaffold?
    The rigid rearfoot and forefoot types do not need Centering correction, the Centring shell provides shock absorption and houses the foot type specific posts and modifications mentioned in my patent.
    The Flat rearfoot and forefoot types won’t accept Centering correction and so a Root neutral shell will house their foot type specific posts and modifications as per Root.
    The flexible rearfoot and forefoot types need rearfoot vaulting correction and forefoot vaulting correction respectively as described in my patent.

    No perpendicular SERMS have been measured and the Everted SERM is rare (a failed Dwyer would be one example).
    The SERM/PERM relationship as reference points enable the paradigm work. They allow for custom care within each foot type (in the rigid rearfoot, the subtalar joint may be frozen, have three degrees of motion towards vertical ot ten dgrees of motion towards vertical Without the SERM reference, you could not classify all feet when profiled. You could not apply any treatment protocols to all feet and there would be no reproducibility and much too much variability when retesting or reexamining.
    These are the very problems with the Valmassy (Scherer) matrix that my paradigm has upgraded and made practical (a 16 foot type matrix instead of nine). When I asked Dr. Scherer why he didn’t follow up on his foot typing, he told me that he had other priorities to focus on. I asked his permission to take his baby and make it more clinically relevant.
    I maintain that in the flexible foot types, the muscles are not responding due to vault collapse. This prevents muscles from firing with power and in phase depending on the momentary “job” of the foot at any given moment. “Pain avoidance” doesn’t come into play from my perspective proven by the fact that the diabetic feet with LOPS respond to foot type-specific care and have absolutely no pain sense. My paradigm has anecdotally reversed Charcot feet and returned them to an arch shape (previously referenced).

    My criticism is not of Root but the focused way his followers live in gait (and the phases of gate) as they research and verify results. It is my take when reading Root that he selected gait as the most obvious function to describe his thoughts as an example because in going from point A to point B his subtalar neutral casting and rearfoot control have great effect on the forefoot. However, this same posting fails when applied to other tasks we perform in life.
    I maintain that there is a set of rules for every other function of the foot. Stance, side to side, front to back, etc. In these “jobs” the rearfoot plays a less important role (especially in front to back when the heel is not even on the ground). At these times, forefoot control and a locked and supportive forefoot (leveraging muscles) would have an effect on the rearfoot. In architecture, you must balance and support the base of each pillar equally. Root is weighted heavily on rearfoot control. Root devices are for walking or running. Foot Centrings are for living life.

    My pulse of the arena is that you are very advanced biomechanically (using my dialogue with Dr. Kirby as your standard) in your ability to understand, explain and teach biomechanical laws and how the foot operates in gait. On the other hand, I have spent my career advancing my ability to diagnose, treat and prevent biomechanical pathology from negatively affecting quality of life and performance.
    In practice, I am removing orthotics from underneath children with flexible foot types after about two years (three castings) because p.longus, f.hallucis longus and abductor hallucis are able to plantarflex the 1st ray without the devices. I am improving the gait, stride length and velocity of senior citizens, reversing Charcot feet and curing thick and deformed toenails from microtraumatic dystrophy (Bakotic, Shavelson, “The Pathogenesis of Toenail Dystrophy”, Podiatry Management, August 2006). I have taught others to provide these services and they testify that Neoteric Biomechanics has given them a better understanding of biomecanics and an ability to explain biomechanics to their patients.
    Until convinced otherwise I believe passionately that I can help those who are obese, those who have inherited faulty foot mechanics, children, athletes, etc. better than you can. My challenge (which Dr. Kirby has totally avoided comment on) remains on the table for someone to accept and I strongly believe that we have work that differs, work in common and work that we can share and that someday, our positions will be more melded.
    I thank you all for welcoming me to this forum (especially the moderator and Dr. Williams) and am available to dialogue personally with any or all of you privately.
    Dennis Shavelson, D.P.M.
    drsha@foothelpers.com
     
  24. Griff

    Griff Moderator

    Dennis,

    I wasn't aware any of us did this job in competition with each other - surely we all do it with the patients interests in mind ahead of our own egos? If yourself and another clinician are both applying different paradigms to patients, yet both managing to get patients symptom free and back to their own individual qualities of life/goals how can you claim one clinician is 'better' than the other?

    Your persistance in mentioning 'the challenge' with Kevin is getting embarrassing mate - but thanks for the trip down memory lane for all of us, never could beat a bit of playground banter.

    Ian
     

  25. Ian:

    Good one, mate! I never knew that trying to give the best treatment to patients was a competition either. The last person that offered an "orthotic challenge" to me was Ed Glaser.....and look where that got him.;)
     
  26. efuller

    efuller MVP

    Dr. Shalveson,

    Please call me Eric. Even though we may be taking part in a debate, we usually don't get so formal on this forum. I am impressed with your knowledge of architecture. However, biomechanics is more about engineering than architecture. Engineering is used to analyze the named architectural structures. We can use engineering to explain why one structure may resist loads better than another structure. For example an arch with equal pillars may be stronger than an arch with unequal pillars, but that does not meat that the arch with unequal pillars cannot stand up to a particular load. A mechanical analysis (engineering aproach) can tell us if a particular architectual structure can withstand a certain load.


    Could you explain what you mean by leveraging the tendons? I don't understand the last sentence above. Are you saying that a centring changes the leverage of a tendon. If that is what you are saying, could you provide an example? What is a reduction in slack position?


    I'm still trying to understand your concept of centring. Is a centring a support placed under a structure? From you earlier description, it seemed as if a centring was a structure upon which you placed your bricks and keystone to build an arch. Afer the arch is built, is the centring removed. Perhaps I should have used support instead of scaffold.

    Here is the original quote and my response regarding all feet. My questioning of "all feet" comes from your sentence "each foot". What did you mean in your original statement?

    ""In nature, some feet are weak in the rear pillar, some in the fore pillar, some both, some rigid in both etc etc (functional foot typing) but each foot needs a Centring placed under it in order to leverage the musculotendonous units so that they can support the bones and allow them to work efficiently for a lifetime. "

    Every foot needs a centring???? Could you explain further what you mean by "leverage the musculotendonous units so that they can support the bones and allow them to work efficiently"?"​


    Could you explain what vault collapse is and how it prevents muscles from functioning?




    I believe passionately that both you and I can help people with foot problems. I believe that the Root paradigm has helped a lot of people with foot problems. I have been helped by orthotics made using Root's methods. I passionately believe that there are dramatic flaws in the logic of the Root paradigm, even though the orthotics made under that pardigm have helped my feet. We have observed that pieces of plastic under the foot can make people feel better. We have many explanations of why those pieces of plastic work. Just because your piece of plastic works, does not mean that your, or my, explanation of why that piece of plastic works is valid.

    I like having a coherent explanation of why orthotics work. I believe that the tissues stress approach is a coherent explanation. Things (even biological things) break when they are placed under more stress than they can handle. Orthotics should be designed to reduce stress on injured structures. My need for coherence is satisfied, if I theorize that an anatomical structure is placed under higher stress when there is a high prontation moment from the ground and the structure feels better if I do something that reduces the pronation moment from the ground. I don't understand how faulty vaults effect the plantar fascia or the posterior tibial tendon. It would help me to meld our theories if you could explain some of the questions that I have asked above.

    Regards,

    Eric Fuller
     
  27. drsha

    drsha Banned

    Thank you for allowing me to call you Eric.

    I am comparing architectural engineering construction (designed of arches and vaults from scratch) to the engineering about the feet that we see clinically (preformed by nature and evolution).
    An arch with equal pillars (MAY BE stronger, eric writes). On the contrary it IS stronger than an arch with unequal pillars.
    (Eric; that does not mean that the arch with unequal pillars cannot stand up to a particular load) In fact, an arch with unequal pillars does not distribute force as well as a symmetrical one. That is why arches are built symmetrically in architecture.
    The foot needs capsules, ligaments and musculotendonous units to help resist deformation, fatigue and the ability to perform during a lifetime.
    (Eric: Could you explain what you mean by leveraging the tendons and What is a reduction in slack position?). I must admit (and it took the arena’s knowledge base and sophistication to take me to this moment) that my explanation of what occurs in the foot kenesiolologically has never been challenged to be further defined. Like a slack closeline that is then tightened, tendons must have a certain position and tension in order to perform. I anecdotally know that if I can elevate the calcaneus enough medially and plantarflex the first metatarsal foot type-specific and support the keystone of the vault of the foot higher than in Root theory (see patent), the posterior tibial tendon starts working with the keystone of the vault of the foot more stable in the flexible rearfoot foot types, the peroneus longus starts locking the long axis the midtarsal joint and weight the first met head earlier so that the hallux performs as a functional unit (eliminating FHL) in the flexible forefoot types. The flexor hallucis longus can plantarflex the great toe and allow for distal contact and function (eliminating functional hallux extensus and its sequelae in the flexible forefoot types.
    I have not been taught a language to explain these facts, nor have I proven my clinical findings by study and I am using the best language in my vocabulary. At this point, I know that clinically, reproducibly and with consistency, when I apply this method of profiling, foot typing and providing foot type specific casting, posting and modifications (i.e. ray cutouts) to my patient population, feet function better and with less pathological sequelae and with alevel of correction, kenesiologically . In summary, I am not armed with evidence beyond clinical and anecdotal (confirming anecdotal testimonials from patients, DPM’s and therapists exist) that keep me using and teaching my paradigm until either someone proves it right or wrong by research or provides me with a better plan.
    (Eric: Is a centring a support placed under a structure {or a} structure upon which you placed your bricks and keystone to build an arch {that is then}removed).
    In architecture a Centring has the form of an arch to be built and once voissoirs and a keystone is placed on top of it (with or without cement) it is then removed and the arch stands forever.
    In the foot, I believe that the Vault needs a Centring placed under it that fills it up (foot type-specific) enough to allow capsules, ligaments and musculotendonous units it to support, perform work and morph between tasks more efficiently.
    (Eric:what do you mean by "leverage the musculotendonous units so that they can support the bones and allow them to work efficiently?) As stated above, I do not have better language to explain what I am seeing clinically.
    (Eric: Could you explain what vault collapse is and how it prevents muscles from functioning?). In the flexable and stable rearfoot and forefoot types, one or both pillars and the adjoining roof that form the vault of the foot lowers (collapses) and the MT units must first repair that collapse before accomplishing “work”. This means that there is a time end energy drain when performing the tasks of support, performing and morphing. Physical laws (wolfs and davis’ for two) have these feet eventually permanently as the soft tissues fail and pain, deformity, poor performance, overuse and compensatory pathology progressively unfold.
    (Eric: I believe passionately that both you and I can help people with foot problems. I passionately believe that there are dramatic flaws in the logic of the Root paradigm, even though the orthotics made under that paradigm have helped my feet. Just because your piece of plastic works, does not mean that your, or my, explanation of why that piece of plastic works is valid. I believe that the tissues stress approach is a coherent explanation. Orthotics should be designed to reduce stress on injured structures. It would help me to meld our theories if you could explain some of the questions that I have asked above).
    I agree that Root Theory takes biomechanics to a certain level beyond the “arch supports theory of Roots predecessors; he exposed flaws and gave upgrades to the paradigm. Since 1977, personally (and I am not California trained and do not follow the International Biomechanics Community), I do not understand your theory enough to even ask questions to you about it and I have not seen any major upgrades to help feet to any great extent more than Root with clinically.
    I have developed upgrades to Root that allow me and others open to change or willing to give it a chance to offer foot type-specific custom care of the feet and posture. I will continue to attempt to answer your questions as openly as I can in order to allow you to disprove mine, explain yours well enough to me or meld our theories.
    One thought to the arena. I have no doubt that your train is going down the right track and I do have the energy to research and explore your biomechanical thoughts. But what are you doing to reconnect to the large portion of the podiatry profession (both young and old) to reach out to them so that they can get back on the train?
    Rudyard Kipling stated that “Its an ill wind that blows no evil”. Exposing Functional Foot Typing will have some positive effects, no matter what.
    Dennis
     
  28. efuller

    efuller MVP


    Hi Dennis,
    I would agree with you if you used the same sized materials and the same sized pillars in the uneven pillar arch versus the even pillar arch. However, the premise of your theory is that an uneven pillar arch is inherently flawed. This I have to disagree with. If the proper materials, in proper amounts, are used then the arch may withstand a given load. In engineering you have to examine the materials as well as the architectural geometry.

    Agreed. That is why it is important to describe or model the forces on those structures so that you can attempt to reduce stress on those structures so that they can heel.

    Kinesiology is the study of motion. Kinetics is the study of the forces that cause the motion. To improve your description of your theory you should understand the forces that cause the change in position. In order to explain your anecdotal example you would have show what forces cause the calcaneus to be elevated medially.


    The language can be found in any basic engineering (statics) text. These all start with Newton's laws for motion. For some examples of application of these principles see
    Fuller, E.A. The Windlass Mechanism Of The Foot: A Mechanical Model To Explain Pathology J Am Podiatr Med Assoc 2000 Jan; 90(1) p 35-46

    Fuller, E.A. Center of pressure and its theoretical relationship to foot pathology.
    J Am Podiatr Med Assoc. 1999 Jun;89(6):278-91.



    I don't really follow your logic here. How does arch lowering prevent muscles from performing their normal function?


    Tissue stretch approach in brief: Things break when placed under more stress than they can handle. Mechanical pain in the foot occurs when anatomical structures are placed under more stress than they can handle. Mechanical treatment of mechanically induced pain is directed at reducing the stress on the injured structures. Structures can be modeled using free body diagrams. These diagrams can be used to estimate which forces need to be reduced to decrease pain in the foot. Forces, on the foot can be altered by putting an orthotic under the foot. So, an orthotic should be designed to reduce stress on specific anatomical structures. A foot type based prescription orthotic may not reduce stress on the anatomical structure. That is why I asked the question of how does a faulty vault cause plantar fasciitis.

    A classic example of this is lateral ankle instability udner the Root paradigm. A foot was supposedly more stable in neutral position, but most feet stand more pronated from neutral position. So, the goal of the therapy would be to try to supinate an over supinated foot. Under tissue stress, you would try to identify the cause of the instability. If the cause of the instability was a laterally deviated STJ axis then the goal of therapy would be to increase pronation. Would you ever do this with centrings?

    regards,

    Eric
     
  29. Dennis:

    If you look at the top of the box where you write your messages on Podiatry Arena, you will see a little "quotation box" that if you click on it
    That will make it easier for all of us to read your postings.

    Eric Fuller and I share very similar thoughts in regards to foot function and foot orthosis therapy so I can't add much to what he has said in regards to your ideas of "foot pillars" and "centrings". I suppose if the foot wasn't a dynamic structure, and was only static, more like a bridge or building, then using your approach would make more sense. However, as we all know, the dynamics of the foot require us to be able to analyze the function of the foot both in a static and dynamic mode. Modeling the foot as discrete segments that will move on each other depending on the external forces acting on them and the internal forces/moments acting between them, I believe, is the proper path for the future for podiatric biomechanics since this approach allows both dynamic and static analysis. I simply can't see that your model or the Root model will ever be able to accomplish this necessary function to allow both static and dynamic analyses to occur with the robust disciplines of mathematics and physics as it's basis.

    You also seem, Dennis, to be very worried about the podiatric profession, as I am, and how they will get the point that they need to start understanding the mechanics of the foot better in order to better serve their patients. My philosophy has been to try and understand exactly what the world's leading researchers in foot and lower extremity biomechanics are discovering in their research and how they are discovering it, and then bring this information back to the clinical podiatrist with papers, books, newsletters and book chapters (that I have listed at the end of this posting) that, if they only took the time to read them, could have a much more accurate and clear picture of how the foot and foot orthoses work. You know, that you can lead a horse to water, but you can't make them drink. I know very many podiatrists that act just like horses.

    You may also want to check out my Thought Experiments here on Podiatry Arena as a few examples of the way that I view the foot and lower extremity and how this method of analysis allows a precise mathematical approach to the way the foot works. I do agree that your approach of foot biomechanics may suit many podiatrists very well and may allow them to progress to a better understanding of foot and foot orthosis function, that they may not have been able to achieve otherwise. However, I believe, that if a podiatrist simply knew some basic physics, that they can start to appreciate how the foot and lower extremity really works by using the approach that Eric, myself and many others on Podiatry Arena also advocate.

    Kirby KA: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997.

    Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002.

    Kirby KA, Valmassy RL: The runner-patient history: What to ask and why. JAPA, 73: 39-43, 1983.

    Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987.

    Kirby KA, Loendorf AJ, Gregorio R: Anterior axial projection of the foot. JAPMA, 78: 159-170, 1988.

    Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989.

    Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992.

    Kirby KA: The medial heel skive technique: improving pronation control in foot orthoses. JAPMA, 82: 177-188, 1992.

    Ruby, Patricia, Maury L. Hull, Kevin A. Kirby, and David W. Jenkins: "The Effect of Lower-Limb Anatomy on Knee Loads During Seated Cycling", Journal of Biomechanics, 25 (10): 1195-1207, October 1992.

    Johnson, E. Ralph, Kevin A. Kirby, and James S. Lieberman: "Lateral Plantar Nerve Entrapment: Foot Pain in a Power Lifter", The American Journal of Sports Medicine, 20 (5):619-620, 1992.

    Kirby KA.: Podiatric biomechanics: An integral part of evaluating and treating the athlete. Med. Exerc.Nutr. Health, 2(4):196-202, 1993.

    Kirby, Kevin A.: "Modifying Orthoses", Podiatry Today, Vol VII, No. 6, pp.42-46, October 1994.

    Kirby, Kevin A.: "Functional Design in Running, Court and Fitness Shoes", Podiatry Today, Vol VII, No. 9, pp. 37-44, February 1995.

    Kirby, Kevin A.: "How Much Are Orthotics Really Worth?", Podiatry Management, Vol 14, No. 6, pp. 73-77, September 1995.

    Kirby, Kevin A.: "Troubleshooting Functional Foot Orthoses", pp. 327-348, in Valmassy, R.L.(editor), Clinical Biomechanics of the Lower Extremities, Mosby-Year Book, St. Louis, 1996.

    Kirby KA.: Biomechanics and the treatment of flexible flatfoot deformity in children. PBG Focus, J. Podiatric Biomechanics Group, 7:10-11, 1999.

    Kirby KA: Biomechanics of the normal and abnormal foot. JAPMA, 90:30-34, 2000.

    Kirby KA: Conservative treatment of posterior tibial dysfunction. Podiatry Management, 19:73-82, 2000.

    Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001.

    Kirby, Kevin A.: What future direction should podiatric biomechanics take? Clinics in Podiatric Medicine and Surgery, 18 (4):719-723, October 2001.

    Van Gheluwe, B., Kirby, K.A., Roosen, P., and R.D. Phillips: Reliability and accuracy of biomechanical measurements of the lower extremities. JAPMA, 92:317-326, June 2002.

    Roukis TS, Kirby KA: A simple intraoperative technique to accurately align the rearfoot complex. JAPMA, 95:505-507, 2005.

    Kirby KA, Roukis TS: Precise naming aids dorsiflexion stiffness diagnosis. Biomechanics, 12 (7): 55-62, 2005.

    Van Gheluwe B, Kirby KA, Hagman F: Effects of simulated genu valgum and genu varum on ground reaction forces and subtalar joint function during gait. JAPMA, 95: 531-541, 2005.

    Spooner SK, Kirby KA: The subtalar joint axis locator: A preliminary report. JAPMA, 96:212-219, 2006.

    Kirby KA: Foot orthoses: therapeutic efficacy, theory and research evidence for their biomechanical effect. Foot Ankle Quarterly, 18(2):49-57, 2006.

    Kirby KA: Emerging concepts in podiatric biomechanics. Podiatry Today. 19:(12)36-48, 2006.

    Lewis GS, Kirby KA, Piazza SJ: Determination of subtalar joint axis location by restriction of talocrural joint motion. Gait and Posture. 25:63-69, 2007.
     
  30. drsha

    drsha Banned

    Eric, Kevin and The Arena Membership::
    I will change kinesiology to kinetics wherever appropriate to kinetics and thanks.
    I am learning this language when dealing with physical therapists but it is late to my vocabulary. I am so busy clinically perfecting my paradigm of diagnosis, treatment and prevention of foot and postural problems that I don’t have the time or priority to slow down my train in order to better understand WHY it works so well.
    When confronted with a patient with weak and tired feet, a lesion sub 2nd met and 5th met, bunions and thick hallux toenails, lateral shoe wear and a varus heel wear and deep wear sub 2nd in their shoes, with a genu valgum and lower back problems when very active in addition to a difficulty in purchasing shoes because their heel is narrower than their forefoot and they wish to be diagnosed and treated both for their clinical problems and their underlying biomechanical pathology, for that moment of our encounter, neither they nor I are very interested in WHY I can help them, only HOW I can help them.
    This imaginary patient has a rigid rearfoot, flexible forefoot functional foot type which I would further confirm by foot type-specific x-ray changes.
    This means that I will cast the patient utilizing rearfoot position technique (reducing the need for a rearfoot varus post), forefoot vault technique and hammertoe correction technique as I recommend. I would prescribe the proper amount (if any) of rearfoot varus posting, an aggressive first ray cutout, a 2-5 aggressive forefoot varus posting and some amount of additional heel lift, B/L to compensate for any concomitant equinus (not yet discussed). I would dispense foot type-specific centering pads into the patients shoes (in this foot type = rearfoot varus wedges, a vault raise pad and a 2-5 forefoot varus pad into the patients shoe, on an insole or over their existing orthotics as well as a heel lift applied to the short side if testing positive (not yet discussed). I would dispense their foot type specific brochure which gives them further education and markets the centering theory into the community and I would treat their complaints as always.
    I would not treat any other foot type similarly and in that sense, I offer targeted care of biomechnical pathology, have better outcomes, fewer complications and much more acceptance and many more referrals because using Foot Centering.
    If you understand what I am saying, I can have a discussion with a DPM in England (especially with casts in hand) and I can make the same recommendations not ever having met the patient. That produces a clinical dialogue potential that I think Dr. Root dreamed of. In reverse, I can get lesion pattern, shoe wear, fracy without ever having met the patient. I could go on and on with the clinical advantages, educational opportunity and marketing capabilities of functional foot typing since it is my scientific life.
    WHEW!
    That said, as a clinician and educator, I can teach all of this information, discuss my findings to patients, other podiatrists, the foot suffering public and the medical community with great success.
    As researchers and pure scientists (as well as clinicians) your work is invaluable in order to present and promote FLEB in the academic and scientific community and if I can serve a purpose to this arena, perhaps it is that pure clinicians like me play a part in the total equation and represent a parallel thread to your important work and can actually make advances, clinically.
    My question to the arena is a simple one. What if any upgrades has your work accomplished to the casting, prescribing and fabrication of Foot Orthotics or the treatment of the foot and postural suffering public? It seems like your devices remain rather Root Looking.
    This is taken from The Precision Intracast Lab site.

    This is taken from The Prolab site precisionintra.jpg

    prolab.JPG

    centring11.jpg

    NeoRootcast.jpg

    This is taken from The Orthotech site in Australia and England precisionintra.jpg

    prolab.JPG

    centring11.jpg

    NeoRootcast.jpg

    OrthotechOrthotics.gif
    This is taken from The FootHelpers Lab Site
    This is a Subtalar Neutral Cast Compared to a Foot Centring Cast of the same patient with a flexible rearfoot, flexible forefoot foot type from The FootHelpers Lab site.
    It has been very rewarding for me to divert from my routine and participate on a daily basis as part of The Podiatry Arena these weeks. I will continue to monitor the site and try my best to send a weekly posting reacting to the functional foot typing thread. I will continue to carry on one-on-one dialogues via email and welcome you all to contact me personally away from The Arena as it is less time consuming.
    I am not the enemy, I stand firm in the value of Neoteric Biomechanics until proven otherwise and I am NOT Ed Glaser!! (hahahaha)
    Thanks once again to Dr. Payne for keeping an open mind and for giving me this opportunity to debate the future of FLEB within The Arena.
    Score: Lions 29, Christians 0 (hahaha).
    Dennis
    drsha@foothelpers.com
     
  31. efuller

    efuller MVP

    Uh, Dennis, you are too busy perfecting it to figure out how it works? Wouldn't be easier to figure out how it works so that you could perfect it. Or are you too busy selling it to figure out how it works?

    It's less time consuming to respond to several people individually than all at once to a group of them??? Perhaps, individually you get less questioning of your paradigm? I love debating FLEB. That is why I was disappointed in your last post where you just restated what you do, with little discussion of why you do what you do.

    I could go on,....

    Eric
     
    Last edited: Oct 14, 2008
  32. drsha

    drsha Banned

    Eric:
    I counted 38 lines on my post including pictures. You have reacted to 6 of the least important. I have tried to address your complete postings.

    Can't we stop this patent, trademark, making money stuff.

    Would Dannenberg, Ritchie and Langer get the same immature rhetoric?

    I realize that any Arena needs sideshow entertainment and playground fun and that there should be a trial by fire for new members; But I am starting to think that Groucho is right.

    Eric, I would not dignify this last posting with an answer if it was delivered privately.

    I'll update next week.

    Score Lions 30, Christians 0 (you win again)

    dennis
     
  33. Dennis:

    I tend to agree with Eric on this one. I just can't see, for the life of me, how your "centring" trademarked approach or "foot typing" copyrighted approach is any better than the approach offered by Root et al with their subtalar joint neutral position theory or to Morton's theory that pronation is caused by a short first ray. Why exactly is your approach better than theirs?:confused: They all got good results with their orthoses also. Does your approach give us any new information that advances our knowledge of foot orthoses that hasn't already been written about before? To me, it seems to be taking a few steps backward to the approach that Whitman and Schaefer had with their foot plates from a century ago.

    Certainly many of us get great results with foot orthoses. The question is, considering the current scientific research on foot orthoses, hopefully that you are aware of, how does your orthotic approach blend in with this scientific research? How will we be able to mathematically quantify your approach to see if it can be modelled biomechanically?

    Here are some quotes from DJ Morton on first ray hypermobility from 1935 (i.e. 73 years ago) that sounds just about as advanced as your "centrings" and "foot typing" approach:

    Certainly, I would hope that any new approach to foot orthosis therapy wouldn't be using the same language that was used over 70 years ago and therefore would not be considered just a rehash from the original thoughts of other published authors from decades ago. I think we need to moving forward as a profession in understanding the biomechanics of the foot and lower extremity....not moving backwards.
     
  34. drsha

    drsha Banned

    It is my weekend and I have time to reply to recent posts.

    Eric and Kevin have many valid platforms which I totally agree upon. The need for scientific explanations to justify FLEB and the fact that Root Theory needs upgrading being the major two. Where we differ is who is going to do the experimentation and what can we currently offer to the foot suffering public as a replacement paradigm for Root in terms of language and product
    Kevin wants me to follow his philosophy that simply I have no passion for. He has taken me to his water over the years and I don’t still don’t want to drink!
    My passion rests in discovering that when the Vault of the foot is supported and the rearfoot and forefoot is foot type corrected, in most cases, the rearfoot doesn’t need any treatment (eliminating Root’s first commandment of thy shall post thy rearfeet in varus) and clinical outcomes are the best ever when dispensing Centrings.
    If Kevin’s statement about functional foot typing and foot centrings is quotable, he says “your approach of foot biomechanics may suit many podiatrists very well and may allow them to progress to a better understanding of foot and foot orthosis function, that they may not have been able to achieve otherwise” why wouldn’t someone in the Arena (especially Dr. Payne who has been obviously absent in this debate) simply utilize your knowledge of physics and your availability of research tools, technology and funding to examine my paradigm from your perspective? (Kevin, can I use your quote in my adverts mate).
    Eric asks “are (you) too busy perfecting it to figure out how it works?” Eric, that’s it in a nutshell! I am waiting for you to do that and when you do, my paradigm will be more perfected during the time it takes you to do that work.
    He talks about getting “good results and “great” results with foot orthoses” and combines it with his sound, scientific comments as if to make the former scientific. That sounds like Ed Glaser talk to me. Is “good” that the patient paid for the devices and never complained. Is “great” that you can bully your students into converts and get them to use your labs?
    The pictures I posted reveal your devices as flat, wide, long and NOT forefoot posted (FROM YOUR WEBSITES!!) and mine to be Vaulted (I will use rounder as poetic license in the rest of this posting), narrow, short and fully forefoot posted (FROM MY WEBSITE!!). If put in a bag along with your devices and high tech OTC devices, only the Centrings would STAND OUT AS DIFFERENT). I have made an actual clinical advance as did Root in his time.
    My summary is that you have not made any clinical advancments to Root as your passion is to find out why and I have made clinical advances using my passion and cannot prove why they work. Doesn’t this sound like the start of a great relationship (my “I am not the enemy” refrain)?
    Finally, Kevin talks about great men remembered after more than 100 years for their theories and unscientific clinical outcomes that fell short of scientific perfection. I am one of them. We are necessary to scientific advancement and will always be remembered as paving the road (fighting against The Arenas of their times) for better care of their generation of foot sufferers and even better care of foot sufferers in the future delivered by their clinical bloodline (those that wish to follow).
    If someday, my name is even mentioned in the same breath as Whitman, Schaeffer, Morton, Root, Ritchie and Dananberg, my heirs will be smiling.
    If The Podiatry Arena existed in the time of Root and they represented the arch supports of that time when this quiet, soft spoken genius delivered his paradigm for change, (amongst a pool of others), I think he would have responded in like kind to me at this moment.
    I would like to start a new thread entitled Flat Orthotics vs. Round Orthotics and then I could have some playground fun too but I am not allowed to start new threads (hahahaha).
    Score: Lions 30, Christians 1?
    Still standing,
    Dennis
     
  35. Sell me a God, it's love time... AGAIN.
     
  36. What drives your passion, Dennis? Is it solely trying to develop better foot orthoses for patients?

    You may use that quote as long as you use it along with my other quote, "Unfortunately, I see your model as a throwback to the Root model that I have worked so hard to get the profession to move away from for the past quarter century. Therefore, I simply don't see much benefit taking podiatrists back a step or two in sophistication, when they should rather be keeping more in step with the mainstream international biomechanics community and their prolific research on foot and lower extremity function."

    So good of you, Dennis, to objectively analyze that only you have made clinical advancements for the podiatry profession. In order to qualify as a clinical advancement, in your opinion, does the new theory or new orthosis technique need to also be patented and trademarked?:confused:

    Glad to see that your modesty remains intact, Dennis.;)
     
  37. drsarbes

    drsarbes Well-Known Member

    I can't wait.
    I read this thread when I can't sleep.
    Steve
     
  38. efuller

    efuller MVP

    Dennis, I'm not clear as to what part of Kevin's philosophy that you have no passion for. Are you referring to thinking about the foot like an engineer? You have used many architectural terms in your philosophy. I maintain that even architects have to obey the laws of physics.

    Dennis, In one paragraph you address me and in the next paragraph you write "he talks about". I did not author the sentiment that followed.

    Dennis, before I can figure out your paradigm I would need you to explain it better. I still don't understand how centrings effect the leverage of the muscles. I still don't understand why you think supination end of range of motion is important for the foot classification system. I don't see the theory on how a high arched centring will relieve the pain from plantar fasciitis. Sure, you can say the vault is supported, but to support the bony vault you have to push through all of the soft tissue that includes the painful structure.


    Dennis, Kevin has made a great clinical advancement with the medial heel skive.


    Scientists 666?, True believers ??

    Cheers,

    Eric Fuller
     
  39. drsha

    drsha Banned

    To Dr. Kirby:
    Kevin states: What drives your passion, Dennis? Is it solely trying to develop better foot orthoses for patients? And does the new theory or new orthosis technique need to also be patented and trademarked?

    Reply to Kevin: When you are finished objectively debating my paradigm scientifically, your subjective refrains of how I direct my passion or referencing patents and trademarks make you ,as a scientist and a debater less convincing. I have tried to keep my discussion focused on our theories as objectively as possible. (I guess you don’t respect your editor when he (she) says to keep to the thread).

    Kevin states: You may use that quote as long as you use it along with my other quote, "I see your model as a throwback to the Root model that I have worked so hard to get the profession to move away from for the past quarter century. Podiatrists should rather be keeping more in step with the mainstream international biomechanics community and their prolific research on foot and lower extremity function."
    Reply to Kevin: I will follow your wishes and precede the first quote with an edited version of this quote "I see your model as a throwback to the Root model that I have worked so hard to get the profession to move away from for the past quarter century. Podiatrists should rather be keeping more in step with the mainstream international biomechanics community and their prolific research on foot and lower extremity function." That said…”first quote”….And thanks.

    Kevin States: So good of you, Dennis, to objectively analyze that only you have made clinical advancements for the podiatry profession.
    Reply to Kevin: I realized that the above statement would push your buttons and force a scientific reply as to how much The Arena has done clinically for FLEB. Please note, once again, your incorrect use of objectively (my statement was subjective) and how comfortably you slip from what is real to what is your opinion). In one week the only advance The Arena proclaimed was The Kirby Skive!
    I liken The Kirby Skive (KS) to the varus rearfoot post of Root. When taken as a given (I used the term commandment for the varus post) further discussion and research can get skewed away from looking outside of the KS box. You begin to use valgus posting (reducing peroneal advantage) for peroneal problems instead of maintaining or improving peroneal function as you reduce symptoms. You begin to need more and more difficult terminology and concepts instead of something easier to understand and develop a passion for. I always had a hard time believing in and marketing a diagnosis of partially compensated rearfoot varus, fully compensated forefoot varus and moments and rotations are even more difficult for me to digest and repeat.
    Although, like Root, you have made great advances to FLEB and Podiatry (previously acknowledged), your close-minded, my way or no way manner has buried memory of how hard it was to convince the mainstream international biomechanics community and their prolific research of your theory and skive.
    I take comfort in Dr’s Payne and Williams’ thoughts that things developing a following clinically should be kept on the table as they may have some value. Interestingly, it produced a reply from you to remove my theory conveniently from sight. Bottom Block and Centering theories have a common thread that Vaulting may have some redeeming qualities when it comes to closed chain care of biomechanical problems.
    Kevin States: Glad to see that your modesty remains intact, Dennis.
    Reply to Kevin: One must have confidence and positive self worth about oneself in order to withstand your never-ending subjective comments like throwback, lacking benefit, taking steps backward in sophistication instead of debating the thread when in your Arena. If my ego and personal promotional rating is a 4.5, Kevin, you are a 9.5 so why call my kettle black
    I must apologize to Dr. Fuller for crediting him with the following quote which actually didn’t fit hid persona in that he is objective when debating. It was you who wrote: “I tend to agree with Eric on this one. I just can't see, for the life of me, how your "centring" trademarked approach or "foot typing" copyrighted approach is any better than the approach offered by Root et al with their subtalar joint neutral position theory…. They all got good results with their orthoses also…..Certainly many of us get great results with foot orthoses.
    So I redirect my comments on these certainly subjective statements purposefully intertwined with subjective evidence: Is “good” that the patient paid for the devices and never complained. Is “great” that you can use subjective “Kirbyisms” to get your students into converts and others to use your lab?
    In summary, The Arena seems to be very disciplined in its methodology and until you published my patents, I had no reason to disturb what seems to be a very fraternal and accomplished society accomplishing many good things for its members and their patients.
    Before I entered the debate, the postings were very comfortable and sarcastic believing that I would never see them (you know who you are who exaggerated the facts and even lied!). After joining the debate, the tone changed to me, personally as Kevin and Eric and the lions (ian, spooner et al.) joined in to poke and prod me to retreat as that posture has probably worked many time before (i.e. Glaser).
    I have accepted your gauntlet and have measured my statements so as not to incite as I am a guest in your Arena but why must I answer questions directed at one sentence of a fifty sentence post and The Arena is allowed to simply dismiss the majority of many of my questions?
    I have waited a week to reply to postings and only Kevin and Eric are still standing. I have controlled my subjective comments as I have absorbed yours.
    Can’t we call off the dogs and keep to the thread?

    To Dr. Fuller:
    Eric States: Dennis, I'm not clear as to what part of Kevin's philosophy that you have no passion for.
    Dennis Reply: My passion is clinical. I dabble in research but that is a diversion from my joy which comes in having patients forget to take their canes when they leave my treatment room. In seeing children’s feet improve to the point where they no longer need orthotics. To offer foot type-specific diagnosis and treatment that reduces failures and improves performance and outcomes in my hands. My passion is in developing reproducible language and marketing skills that allow Podiatry to explain what we offer using FLEB in a more clear and appreciated manner than ever before. My passion is to work with podiatrists from small towns like Painted Post, N.Y. and have them memorialize that they are dispensing more orthotics at higher fees and with greater confidence and patient appreciation than ever before.
    Eric Stated: Kevin has made a great clinical advancement with the medial heel skive.
    Dennis Reply: So did Morton’s short first, Root’s varus wedge, etc. Why is it that if my personal opinion is that I have made a great clinical advance, The Arena passes on examining it?
    Eric Stated: Before I can figure out your paradigm I would need you to explain it better.
    Dennis Reply: My thought is that you would like me to explain my paradigm in your terms. I have done my best until now including admitting that I do not have the ability to explain certain questions nor a working knowledge of your theories or language.
    This week, I read a few other threads in The Arena and am willing to share my thoughts utilizing your language. I will concentrate on the rearfoot since if I am not heading right, no reason to describe other thoughts.
    Rearfoot SERM defines the position of the rearfoot in open chain the moment that the heel hits the ground (first in gait, simultaneous in stance, last in backward movement). Rearfoot PERM defines the amount of movement upon the ground that the heel would make as it weights (pronatory change in the STJ axis) in closed chain, defining where it moves to as weightbearing continues.
    So, if SERM is inverted and PERM is less inverted (I hope that is a pronatory moment, then the axis of the STJ would be pronating, but to a defined, foot type-specific place (I.e.,not all the way to vertical) in closed chain. In addition, the plantar fat pad will tend to collapse medially in this rigid rearfoot type further pronating the STJ axis and finally, since the posterior tubercle of the calcaneus is inverted to its body, a 1-2 or even 3 degree position of eversion may not need a varus heel post when prescribing. A deep heel seat (we default at 25 degrees at FootHelpers) will preventplantar fat pad pronatory moments to some extent BUT in addition there is the value of Foot Centering that is new and fresh (Neoteric).
    My Centrings support the medial calcaneus in a higher CIA (x-rays confirm) and the first ray in plantarflexion in addition to filling up the roof connecting the medial and lateral plantar arches with material. This act of Centering reduces the STJ pronatory moment (or axis?) obviating the need for varus wedges, skives, inverted casts, etc in many cases. Furthermore the Kinetics of posterior tibial, anterior tibial and peroneus brevis and longus as well as the core intrinsic muscles are working better and more efficiently to perform during closed chain (leveraged??)
    I theorize that if muscles start from a position of strength instead of having to work to get into that position, Wolfs and Davis’s Laws would tighten and strengthen their physical lever (what I am calling leverage) making them more efficient and productive (maybe enough to hold that foot in position without a Centring.
    I think we all agree that neutral STJ position is not that position. Nor do Kirby skives, etc (in my hands) get me to that position
    The advances suggested in my theory take the foot to a new Centered position utilizing the principles of architectural engineering which is only concerned with the job of support. My clinical, anecdotal findings are that Foot Centrings prevent abnormal STJ axis changes and reduce the frequency and intensity of abnormal moments that otherwise might develop.
    Theoretically, in Foot Centering, the tissues are prevented from developing abnormal moments and the STJ axis has fewer and less intense pathological compensations. If these suspicions can be proven then we will understand why the tissues will be less prone to develop pain, deformity and poor function (The Tissue Stress Theory?).
    Eric Stated: Kevin has made a great clinical advancement with the medial heel skive.
    Dennis Reply: So did Morton’s short first, Root’s varus wedge, etc. Why is it that if my personal opinion is that I have made a great clinical advance, The Arena passes on examining it?
    Historically, great scientists resist change from current gold standards subjectively and posture together to prevent it from happening. 98% of the time, they are resisting change that would divert them from their work. Resisting theories that would be proven setbacks to current trends.
    “Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof”. ~John Kenneth Galbraith

    I look forward to your replies and will react next weekend.
    I wish to stop keeping score, if that’s OK with The Arena
    Dennis
     
  40. efuller

    efuller MVP

    Hi Dennis,
    I see two passions. Not that there is anything wrong with having more than one passion. As an aside, what about the big cities? Don't podiatrists all over the world need to dispense orthoses with confidence in the theories that they use to make orthoses for their patients. This will enable the podiatrists, and the labs that make the orthoses, to get more reimbursement than ever before.

    I usually add a few more grains of salt when someone makes a profit off of their new theory. I think this is healthy skepticism.

    I am examining it. I want to know why you think it works. As I asked in earlier posts, how do centrings cure plantar fasciitis?

    I agree that I do want you to put your paradigm into words that are more familiar to me. However, they are not just my words. You can go into any college book store, where they sell books on basic engineering, and buy a book that uses this terminology. It is a language that is generally accepted to describe certain phenomenon. So, you can use the engineering terminology and principles to examine anatomical structures. It's not just the engineering that I want you to discuss, it is the anatomy as well. There is abstraction of the anatomy that occurs when you start talking about vaults. How does a centring help plantar fasciitis? How does a centring help posterior tibial tendonitis? I can explain how an orthosis can do these things using mechanical principles.

    Dennis, you appear to be changing the definition from what was in the patent at the beginning of this thread.
    [0029]The Rearfoot SERM position refers to the position the Rearfoot Joint assumes in open chain, i.e., when not weighted on the ground, with reference to a bisection of the lower one third of the leg after applying a strong inversion force upon the Calcaneus until it can no longer move. This is performed by inverting the foot so that it can no longer move, followed by determining whether the position is inverted or everted. If the Rearfoot Joint is tilted toward the medial arch, the Rearfoot SERM position is inverted. If the Rearfoot Joint is tilted toward the lateral arch, the Rearfoot SERM position is everted
    We cannot examine the paradigm if definitions keep changing. Why is SERM important for typing the foot? Can you give an example.

    A couple of points about the above. I don't see where SERM fits in. The prescription seems to be entirely based upon stance position.

    When describing moments you should talk about the object that applies the moment to another moment. For example, the pronation moment from the ground would distinguish that source of moment from a different moment like the pronation moment from the peroneus brevis muscle.

    I really don't understand the comment about filling up the roof connecting the medial and lateral plantar arches with material. Here is where I see an abstraction of anatomy that confuses the issue. This is where I would like to see a engineering language used. For example the orthosis applies a force to the anterior or middle or plantar part of the calcaneus that attempts to raise the arch.

    So, without an orthotic you see a lower arch. When you stand on a centring you see a higher arch. What forces from centring/orthosis cause the arch to be higher? How do centrings work?


    Muscles apply a force that is determined by the cross sectional area of the muscle and by the amount of activation by the nervous system. A given force's effect about a joint can be increased by changing the lever arm of that force relative to the joint axis. The effect at a joint of a muscle is the moment created by the muscle. Moment = force x lever arm. So, to correctly use the term leverage you would need to show, for example, how the centring changed the lever arm of the muscle. That is how you could prove your theory.

    I don't see how a centring changes the leverage of the muscle. Your argument, at this point, is that you have seen a change in the foot, so the leverage (or something else) must have changed. You are applying the term leverage to that change without explaining how the leverage changed.


    What abnormal STJ axis changes are you talking about? Are you talking about changing the position of the axis or motion about the axis?

    In changing from a non medial heel skive device to a medial heel skive device, I've seen symptoms reduce. There was no change in STJ postion on the medial heel skive device, yet symptoms resolved. I don't think that putting the foot in neutral position or a centered position is necessarily why symptoms improve.

    Again, we need to get back to anatomy. What pathological compensations are you talking about? What are pathological compensations? The tissue stress approach, as I use it, looks at the amount of force on anatomical structures. The forces become pathological when the forces become higher than the anatomical structure can withstand and then there is tissue breakdown.

    deja vu? I am examining it.

    Newtonian physics works very well. There were problems when Newtonian mechanics was applied to very small objects moving very fast. Einstein came along and showed that you can state a new theory that incorporated all of the observations and explained the newer observations. Just because a theory is new, does not mean that it is better than the old one. A new theory will be accepted when it explains observations better than the old theories.

    Very good idea, we should not keep score.

    Cheers,

    Eric Fuller
     
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