Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Functional foot typing

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

Thread Status:
Not open for further replies.
  1. Just sitting in the airport in Vancouver waiting for my plane to return me back home from the PFOLA conference.....while I was there, Craig Payne told me that some new responses were directed toward me in this thread....I guess that I've said enough on this topic.....but the real question remains.....why do I have so much fun being downright mean???:D:butcher::pigs:
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Kevin...I down the other end of the airport ... the wireless connections work down here :bang:
     
  3. Sorry I missed you Craig.....Pam was in a rush to get to the terminal....hope you had a nice flight home. Good lecture/seminar.
     
  4. drsha

    drsha Banned

    It looks like just you and I, Eric, so I can respond sooner.
    Eric States:
    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?
    Dennis Replies:
    I practice in Manhattan, NYC, in a relatively high end community. When I use NYC as a base for making more orthotics and marketing biomechanics (I dispense Foot Centrings at $800 in NYC) I am always told, Dennis you can do that in NYC but I can’t do it in Painted Post, NY! Part of the marketing of Centrings is that I am giving the practitioner a compelling why to deliver to their patients as to need for Orthotics plus I am giving them a product that is new and fresh they can be proud to dispense. When that is the case, I suggest raising orthotic fees $150-200 as compensation to the increased time, energy and money they have to invest to learn to practice The Foot Centering Theory. That is why I used a small town reference but you can do this anywhere.
    Eric States: 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.
    Dennis Replies:
    Thank you for civilly discussing the Patent/Trademark part of our debate. I expect a ton of salt and skepticism when examining any new paradigm. But whether you want to believe my next statement or not, we (you) are all salespeople, we (you) are all profit oriented in some way, we (you) are all businesspeople in addition to being scientists and professionals. The thought that a profit motive refutes the validity of a theory is totally subjective and belongs away from a scientific arena along with other negative visceral emotions that people have for each other like greed, jealousy, insecurity, meanness and a thirst for power.
    Eric States:
    There is abstraction of the anatomy that occurs when you start talking about vaults. How does a centring help plantar fasciitis? I really don't understand the comment about filling up the roof connecting the medial and lateral plantar arches with material. 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.
    Dennis Replies:
    I am not sure if there is abstraction of the anatomy or the fact that I am doing a poor job of explaining all of this in an engineering sense. Remember, you are twenty years ahead of me.
    But here goes.
    Plantar facsitis is the end result of stress being put on the fascicles of the fascia, medial, central and lateral bands, in that order. Poststatic dyskinesia (the hallmark symptom for me) occurs when the open chain foot goes into closed chain and abnormal moments, rotations and axis changes occur.
    If we look at the foot architecturally, there is a medial longitudinal arch and a lateral longitudinal arch that parallel each other. Then from the distal shelf of the plantar calcaneus forward to the metatarsal head parabola, there are an infinite number of transverse arches that exist from the med to long arch in most feet (Charcot would be the obvious foot with few if any transverse arches). When combined, these transverse arches form a roof connecting the long arches and in architecture, that is known as a Vault.
    Not knowing the anatomy of the areas to such a micro degree, I continue theorizing by saying that each foot has a weightbearing foot type-specific position that maintains the bony segments using minimal muscular energy (Centered Position?). The rigid/rigid foot type would hold this position best of the foot types and the flexible/flexible foot type would hold this position poorest of the foot types.
    If the rear pillar, leading up to the midtarsal keystone and the fore pillar leading down to the met head parabola as the sides and the plantar fascia as a base, connecting the bony pillars to form a triangle with unequal sides then there is some position of the bones, for each foot, foot type-specific that if maintained, would allow muscular moments to be less present creating no pathological moments and applying only a small amount of tissue stress resulting in efficient, long term, healthy function with less deformity, pain and overuse syndromes.
    In the flexible rearfoot types and the stable rearfoot types, depending on weight, activity level, age and other factors, there is a progressive lowering of the rear pillar. This forces the keystone forward, changing all muscular moments pathologically. This also causes a lengthening of the plantar fascia increasing the tissue stress of its insertion into the heel and the metatarsal heads in addition to increasing the tissue stress within the body of the ligament.
    In the flexible forefoot types and the stable forefoot types, depending on weight, activity level, age and other factors, there is a progressive lowering and widening of the fore pillar, since the foot imitates an anglogothic architectural arch when weightbearing. This forces the keystone forward, changing all muscular moments pathologically. This also causes a lengthening of the plantar fascia increasing the tissue stress of its insertion into the heel and the metatarsal heads in addition to creating tissue stress within the body of the ligament.
    These subclinical, repetitive micro stresses when added, eventually produce symptomatic and anatomic changes to the heel insertion, met head insertion and the body of the plantar fascia (plantar fasciitis).
    I theorize that if every foot was held in Centered Position, elevating the rear pillar, prn and plantarflexing the fore pillar, prn and a Centring was then constructed that filled up the entire vault of the foot with material, foot type-specific so that it was held in that position when weightbearing, pathological moments of the muscles would be reduced to the point where symptoms never develop, performance would be enhanced and pain and overuse syndromes and deformity would be reversed or prevented.

    Neoteric Biomechanics states that in architecture the Centring produces the strongest and most efficient arch when the arch is built upon it and in the foot a Foot Centring is be placed under the foot, foot type-specific, in order to have the most efficient biomechanics and kinetics.

    I believe that Foot Centrings reduce the amount of work that the plantar fascia must perform reducing pathologic moments and tissue stress from becoming clinically significant.
    Specifically:
    1. They serve to support the medial and lateral longitudinal arch in a higher arched position (i.e. increases the dorsiflexion stiffness of the medial and lateral forefoot)
    2. They assist in resupination of subtalar joint (STJ) during propulsive phase of walking
    3. They assist the deep posterior compartment muscles by limiting STJ pronation
    4. They assist the plantar intrinsic muscles in preventing longitudinal arch flattening
    5. They reduce tensile forces in plantar ligaments
    6. They prevent excessive interosseous compression forces on dorsal aspects of midfoot joints
    7. They prevent excessive dorsiflexion bending moments on metatarsals
    8. They passively maintain digital purchase and stabilizes proximal phalanx of digits within the sagittal plane
    9. They reduce ground reaction force on metatarsal heads during late midstance and propulsion
    10.They help to absorb and release elastic strain energy during running and jumping activities
    Some of these functions (1,4,7) are supported by research while most of them are based only on my consideration of mechanical modeling of the foot.

    Eric States:
    Dennis, you appear to be changing the definition of SERM from what was in the patent at the beginning of this thread.
    Denis Replies:
    The definition of Rearfoor SERM remains: 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.
    It then should have stated it represents the heel contact position in closed chain. (It is not another definition. Oooops)
    Eric States:
    I don't see where SERM fits in. The prescription seems to be entirely based upon stance position.
    Dennis Replies:
    SERM PERM and the Casting and prescribing techniques utilized in Neoteric Biomechanics live in open chain. They have closed chain implications and impact. My claim is that Neoteric Biomechanics is built on Root and in that sense all of my upgrades start from Root STJ neutral, midtarsal joint locked imitating midstance blah, blah. Are you still taking off weightbearing suspension casts as per Root/CCPM for your orthotics to eliminate closed chain symptoms? If not, please give me an update as that may help to explain your SERM refrain.
    Eric States:
    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 position 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.
    Dennis Replies:
    I do not understand what your point is here. If the centring is the only change and symptoms improve, I know what caused the improvement and I think this is where The Arena and I remain separated. I am less capable of you to find out why but using my paradigm, I think I am more capable of what to do.
    I remain debating my theory to the point where an Arena member may question it to the point where they would be willing try a Centring on a patient and if it is an upgrade to the current model clinically, help me find out why.

    Eric Stated:
    A new theory will be accepted when it explains observations better than the old theories.
    Dennis Reply: New theories that stand the test of time after being tested by the best are the ones worth keeping. “New theories that are eliminated subjectively without scientific investigation even by the best dampen progess”. Dennis Shavelson, D.P.M.

    Dr. Kirby Stated: I guess that I've said enough on this topic

    Dennis Replies:
    a. ???????
    b. I bet you $10 that you will have more to say!! Hahahaha
    “You better start swimmin or you’ll sink like a stone, for the times they are a changin”. Bob Dylan

    Live. Love. Laugh and Be Happy.
    Dennis
     
  5. efuller

    efuller MVP

    I still maintain that you are abstracting the anatomy. Your statement about not knowing the anatomy to to the micro degree illustrates my point. We both know the anatomy well enough to describe which bones make up the arches and which ligaments exist to hold those bones into place. We know the attachment of the muscles. When you describe transverse arches you should be able to describe which bones are in an arch. Then we can look at the bones and ligaments and see if they are behaving as an arch. We can also look at external devices under the living foot and makes some educated guesses about how the forces from those devices change the forces in the bones of the foot.

    I still don't see how a centring can support the bony arch of the foot when there is as much as an inch of soft tissue between the skin of the foot (Where the orthotic contacts the foot) and the bones of the foot. To examine your theory further, I would need a better description of what the arches are in terms of the anatomy.

    Regards,
    Eric Fuller
     
  6. efuller

    efuller MVP

    Dennis, I'm still confused. Are you saying that the end of range of supination nob weight bearing is the same position that the STJ is in at heel contact in gait?


    My statement was in reply to...
    Quote:
    Originally Posted by drsha
    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.

    Original reply by Eric

    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.​

    My point was that you don't have to see a change in position to see a change in symptoms. Therefore, it is not the change in position that caused the change in symptoms. The theory is that the medial heel skive device change the pronation moment from ground reaction force. I have studied the placement of wedges under the foot and have unpublished data show that there is a shift in center of pressure under the heel with a varus wedge under the heel. So, the theory is the pathology is caused by a pronation moment from the ground. The treatment chagnes the pronation moment from the ground. The evidence that supports the theory is that a wedge changes the pronation moment from the ground and the pain goes away. It's not conclusive proof, but it is coherent.

    I don't understand how we could test a centring, because I don't know how it is supposed to work. I don't see how it changed abnormal moments acting on the foot. If you are going to say that it changes moments, or it changes muscle leverage, you have to explain how it does it.

    The root paradigm was not really testable because forefoot to rearfoot measurement was not repeatable and the whole theory was not coherent.

    Before a theory can be tested it needs to be thought through enough that hypotheses can be formed and measurements related to the hypothesis can be made. What bones make up a vault and how do we tell if a vault has been filled with a centring?

    The amazing thing about orthotics is that there are many different ways to create an orthotic that relieves pain. Explaining why several different methods of creating an orthotic that works is the real chalange.

    Cheers,

    Eric Fuller
     
  7. drsha

    drsha Banned

    Eric Stated:
    1. What abnormal STJ axis changes are you talking about? Are you talking about changing the position of the axis or motion about the axis?
    2. In changing from a non medial heel skive device to a medial heel skive device, I've seen symptoms reduce. My theory is that the medial heel skive device changes the pronation moment from ground reaction force….spaces… I have unpublished data show that there is a shift in center of pressure under the heel with a varus wedge under the heel.
    The theory is the pathology is caused by a pronation moment from the ground. It's not conclusive proof, but it is coherent.
    I don't understand how we could test a centring, because I don't know how it is supposed to work….spacing… If you are going to say that it changes moments, or it changes muscle leverage, you have to explain how it does it.
    Dennis Replies:
    1. I don’t know what STJ axis changes I am talking about!!!
    2. These words seem to put us on a more even plane. You have a theory as do I. Your theory is unproven as is mine. Your theory is incoherent to me and mine is incoherent to you (and I am sure, mutually incoherent to others).
    Where I lose you is why one cannot test something clinically (in this case a Centring) before explaining how it does it?
    I dispense medications all the time whose mode of action is not understood. Medicine is grandfathered with thousands of unproven diagnostic and treatment modalities that we all agree, should be proven, however, that does not eliminate them from consideration or use?
    I am too much of a caretaker and you are too much of an engineer. From my perspective, I took an oath that lives on a creed of “thou shall do no harm” not one that states “thou shall prove your theories using engineering before they can be reviewed and studied”.

    Eric Stated:
    Before a theory can be tested it needs to be thought through enough that hypotheses can be formed and measurements related to the hypothesis can be made. What bones make up a vault and how do we tell if a vault has been filled with a centring?
    Dennis replies:
    I have tested my theory for years clinically with great success (to be discussed later on this post). Would you have used the same argument against Fleming for Penicillin? Your premise smothers possible theoretical advances before they can get to the point of proof. Why haven’t you smothered yours using the same protocol since like mine, it is unproven.

    Eric Stated:
    The amazing thing about orthotics is that there are many different ways to create an orthotic that relieves pain. Explaining why several different methods of creating an orthotic that works is the real chalange (challenge).
    Dennis Replies:
    My theory and its dream go so far beyond pain and I must say that clinically, The Arena seems to be in diapers. This was confirmed to me by the posting on this thread questioning why I would dare make an orthotic for a pain free patient.
    I have unpublished data showing prevention of pain, deformity and overuse syndromes, reversal of underlying pathology, performance enhancement, shoe fit and style upgrades, reversal and prevention of postural sequelae and improved quality of life. It’s not conclusive proof but it is coherent.
    I proudly dispense my orthotics to patients who come to me with a complaint of warts or an ingrown toenail after I have explained their foot type, their precursor symptoms and discuss heredity and the progressive nature of underlying foot type-specific biomechanical pathology even though they have no closed chain complaint.
    And yes, in medicine, like all other professions, there are those practitioners who are better than others, more gifted, better bedside manner, better equipped and even those with advanced theories like Kevin that stand as role models for the others to work towards as they put in 100% doing the best they can (The Arena’s “competition” refrain).

    Eric Stated: Nothing about what I put so much time and energy into trying to explain in your terms:
    Please, please, comment on the following: (Repeated)
    Plantar facsitis is the end result of stress being put on the fascicles of the fascia, medial, central and lateral bands, in that order. Poststatic dyskinesia (the hallmark symptom for me) occurs when the open chain foot goes into closed chain and abnormal moments, rotations and axis changes occur.
    If we look at the foot architecturally, there is a medial longitudinal arch and a lateral longitudinal arch that parallel each other. Then from the distal shelf of the plantar calcaneus forward to the metatarsal head parabola, there are an infinite number of transverse arches that exist from the med to long arch in most feet (Charcot would be the obvious foot with few if any transverse arches). When combined, these transverse arches form a roof connecting the long arches and in architecture, that is known as a Vault.
    Not knowing the anatomy of the areas to such a micro degree, I continue theorizing by saying that each foot has a weightbearing foot type-specific position that maintains the bony segments using minimal muscular energy (Centered Position?). The rigid/rigid foot type would hold this position best of the foot types and the flexible/flexible foot type would hold this position poorest of the foot types.
    If the rear pillar, leading up to the midtarsal keystone and the fore pillar leading down to the met head parabola as the sides and the plantar fascia as a base, connecting the bony pillars to form a triangle with unequal sides then there is some position of the bones, for each foot, foot type-specific that if maintained, would allow muscular moments to be less present creating no pathological moments and applying only a small amount of tissue stress resulting in efficient, long term, healthy function with less deformity, pain and overuse syndromes.
    In the flexible rearfoot types and the stable rearfoot types, depending on weight, activity level, age and other factors, there is a progressive lowering of the rear pillar. This forces the keystone forward, changing all muscular moments pathologically. This also causes a lengthening of the plantar fascia increasing the tissue stress of its insertion into the heel and the metatarsal heads in addition to increasing the tissue stress within the body of the ligament.
    In the flexible forefoot types and the stable forefoot types, depending on weight, activity level, age and other factors, there is a progressive lowering and widening of the fore pillar, since the foot imitates an anglogothic architectural arch when weightbearing. This forces the keystone forward, changing all muscular moments pathologically. This also causes a lengthening of the plantar fascia increasing the tissue stress of its insertion into the heel and the metatarsal heads in addition to creating tissue stress within the body of the ligament.
    These subclinical, repetitive micro stresses when added, eventually produce symptomatic and anatomic changes to the heel insertion, met head insertion and the body of the plantar fascia (plantar fasciitis).
    I theorize that if every foot was held in Centered Position, elevating the rear pillar, prn and plantarflexing the fore pillar, prn and a Centring was then constructed that filled up the entire vault of the foot with material, foot type-specific so that it was held in that position when weightbearing, pathological moments of the muscles would be reduced to the point where symptoms never develop, performance would be enhanced and pain and overuse syndromes and deformity would be reversed or prevented.

    Neoteric Biomechanics states that in architecture the Centring produces the strongest and most efficient arch when the arch is built upon it and in the foot a Foot Centring is be placed under the foot, foot type-specific, in order to have the most efficient biomechanics and kinetics.

    I believe that Foot Centrings reduce the amount of work that the plantar fascia must perform reducing pathologic moments and tissue stress from becoming clinically significant.
    Specifically:
    1. They serve to support the medial and lateral longitudinal arch in a higher arched position (i.e. increases the dorsiflexion stiffness of the medial and lateral forefoot)
    2. They assist in resupination of subtalar joint (STJ) during propulsive phase of walking
    3. They assist the deep posterior compartment muscles by limiting STJ pronation
    4. They assist the plantar intrinsic muscles in preventing longitudinal arch flattening
    5. They reduce tensile forces in plantar ligaments
    6. They prevent excessive interosseous compression forces on dorsal aspects of midfoot joints
    7. They prevent excessive dorsiflexion bending moments on metatarsals
    8. They passively maintain digital purchase and stabilizes proximal phalanx of digits within the sagittal plane
    9. They reduce ground reaction force on metatarsal heads during late midstance and propulsion
    10.They help to absorb and release elastic strain energy during running and jumping activities
    Some of these functions (1,4,7) are supported by research while most of them are based only on my consideration of mechanical modeling of the foot.

    Additional Comments:

    I am frustrated by my inability to give The Arena a kindling level of thought that my paradigm has any merit and/or deserves to be studied even at the lowest level even though it has not convinced me differently so I contacted a Ph.D. Professor at a major US University who teaches and publishes on the kinematics and kinetics of the shoulder. He talks in engineering terms and he seems to parallel the important role that The Arena plays as a FLEB watchdog to unproven new theories when it comes to the shoulder.
    I sent him the following email:
    Dr. T:
    Thank you for your time if you decide to respond to this email or if you think it has any merit.

    I am a clinicially oriented podiatrist who has developed a new and fresh approach to pedal diagnosis and treatment involving profiling feet into one of ten functional foot types and then treating them, foot type-specific with a new and different foot orthotic called a Foot Centring.

    I am debating with some scientists (podiatrists included) who are asking ME to prove my theory in an engineering sense (why I contacted you) when my standard is the clinical effectiveness of my paradigm. The key word here is me, since I am not versed in engineering, moments, axis deviations, tissue strains, etc, I am frustrated because in weeks of trying, I cannot seem to initiate even one of the many who I am debating, to consider ground level study of my paradigm, which is what they do so effectively.

    I would like your sense of whether I should stop my clinical practice and research in order to learn engineering (a huge deviation from 38 years as a healer), ask those I am debating to answer their questions personally or try to get the clinicians in the group I am debating to try my paradigm clinically (i.e. have me fabricate a Centring for one of their patients to compare to their current devices.

    Dennis Shavelson, D.P.M.

    PS: I will not mention your name when referring to your answers as they should only be interested in your thoughts and not who you are.

    Dr. T. graciously replied:

    Rather than learning engineering, you might try to fashion a clinically oriented research question whose answer will move forward your search.

    What clinical outcome would bolster your standard of clinical effectiveness? What patients are most likely to be helped by your approach? What comparison is relevant, in terms of a standard or competing treatment?

    D.T., Ph.D.

    So here goes!
    What is keeping you from testing my paradigm beyond proof?
    Is there a value in typing feet for the purpose of custom care?
    What is The Arena currently researching aside from her own theories and applications?
    Happy Halloween.
    Dennis
     
  8. efuller

    efuller MVP

    Hi Dennis,

    I'll have to reply in small chunks. I can't keep up with your volume.

    If you don't know what changes you are talking about then you should not talk about them. It might make people think you know more than you do. It's just a sales pitch if you say your device changes the STJ and you don't know how or what it's doing. Yes you can stick to clinical success, but don't try to explain the success with things you don't understand.

    Dennis, do not put words in my mouth.

    Dennis, I agree you can test something without an explanation of how it works. This is known of empirical research. Levels of testing: Putting a piece of plastic under the foot makes it feel better. Changing the design of the piece of plastic from some measurements taken is a more advanced research question. Now we have to decide on which measurements to test. Dennis, I'm asking you for the rationale for the use of your measurements. You have said that devices made from your measurements change things, but you don't say how they change things.

    Fleming had a plausible theory from observation. Bacteria did not grow near a fungus. He isolated the the compound from the fungus that inhibited bacterial growth. He thought that this compound might kill bacteria when in the human bloodstream. I don't know if he knew the chemistry of how it inhibited cell wall formation of bacteria, but that explanation was found to corroborate the reason for the clinical success.

    We know that putting pieces of plastic under feet will, some of the time, make them feel better. We are now at the stage of trying to figure out why. And if we know why we can improve the process and success rate.

    You have tested at the empirical level. Putting a piece of plastic under the foot makes it feel better. Have you not tested your theory against another?

    The arena is in diapers???? If you want people to accept your ideas you should not insult them. Do you give people with warts orthotics because they have warts or because you are trying to prevent something?


    If you do not know which moments are changed and how, then this is not a coherent explanation. You could just as well as said the orthotic removed the bad humors from the plantar fascia. This level is: well the pain went away so the forces in the plantar fascia must have reduced.


    What anatomical structures make up the transverse arches? How does a centring support (choose a better word if you like) a vault. Is the vault the bones or does it include the soft tissue.

    To what degree do you need to know the anatomy? There are bones, there are ligaments, muscles and tendons. With free body diagrams we can estimate the forces going through them. Why does the rigid/rigid foot type hold its position better? What makes the rigid/rigid foot type more rigid? The classic definition of the rigid is that there is less deformation with load than a more flexible structure.
    Your foot types are defined by position of the foot in various positions of the joints and I don't see the connection to rigidity.


    Yes, there is some position of the bones where stress is minimized, but why is that the centered position. You make the claim with no evidence. Again, you could insert there is a position of the foot where the bad humors are minimized. You can use the terminology, but that doesn't mean that you have used it correctly.


    I agree that lowering the arch will tend to increase the tension in the plantar fascia. What I don't see is how a centring reduces stress on the plantar fascia.

    What do you mean by elevating the rear pillar? What is the rear pillar? Which bones are in the fore pillar? How does a centring fill a vault? What anatomical structures make up a vault? I know what the calcaneus, talus and spring ligament are. I assume that you do to. If we talked in terms of anatomy it be much easier to communicate. This is what I meant by abstraction. A pillar, as used above, is an abstraction of the anatomy.


    PF flyer biomechanics states that you can run faster an jump higher when wearing PF flyer shoes, becuase it makes your arch stronger and more efficient.

    How do you make an arch stronger and more efficient? How does a centring make the bones and ligaments of the arch of the foot stronger and more efficient.

    Enough for now.

    Eric
     
  9. Dennis:

    When you copy my words verbatim without giving credit to me, or copy the words of any author without giving credit to them, then this is called plagiarism. Don't plagiarize my work again.

    From: http://www.podiatry-arena.com/podia...?t=1464&highlight=functions of plantar fascia

     
  10. efuller

    efuller MVP


    Dennis, after thinking a bit I can see it would be possible to do an empirical clinical trial on your paradigm with some pre requisites.

    As I understand your paradigm, you takes some measurements and then prescribe an orthotic device based on those measurements. We would have to verify that your measurements are repeatable or that the person who you learned the measurements from you could reliably put feet in the same category each time a specific foot was measured. Then you would have to describe how you the orthotic is made and prescription variables should be applied. What do you differently than a netural suspension cast?

    If you are going to do a study you have to have a protocol for treatment that someone else could follow to repeat the study. Since this is your lab, you probalbly would also have to fund the study, or at least provide the orthotics. You would also need an outcome measure. How much did the device improve the patients foot health? There are some that have been mentioned on the arena.


    As an aside, I don't understand the prescription writing variables versus the pathology. As I understand it, your orthotics are shorter and have a higher arch. Thinking clinically, what if you had a patient with a painful callus sub second metatarsal head and a short first metatarsal. In my experience these people do better in longer orthotics with extensions under the metatarsal heads to off weight the second. What you do for this patient?

    Regards,

    Eric Fuller
     
  11. drsha

    drsha Banned

    Originally Posted by drsha
    I believe that Foot Centrings reduce the amount of work that the plantar fascia must perform reducing pathologic moments and tissue stress from becoming clinically significant.
    Specifically:
    1. They serve to support the medial and lateral longitudinal arch in a higher arched position (i.e. increases the dorsiflexion stiffness of the medial and lateral forefoot)
    2. They assist in resupination of subtalar joint (STJ) during propulsive phase of walking
    3. They assist the deep posterior compartment muscles by limiting STJ pronation
    4. They assist the plantar intrinsic muscles in preventing longitudinal arch flattening
    5. They reduce tensile forces in plantar ligaments
    6. They prevent excessive interosseous compression forces on dorsal aspects of midfoot joints
    7. They prevent excessive dorsiflexion bending moments on metatarsals
    8. They passively maintain digital purchase and stabilizes proximal phalanx of digits within the sagittal plane
    9. They reduce ground reaction force on metatarsal heads during late midstance and propulsion
    10.They help to absorb and release elastic strain energy during running and jumping activities
    Some of these functions (1,4,7) are supported by research while most of them are based only on my consideration of mechanical modeling of the foot.
    Kevin Stated:
    When you copy my words verbatim without giving credit to me, or copy the words of any author without giving credit to them, then this is called plagiarism. Don't plagiarize my work again.
    Dennis Replies:
    Kevin:
    I was only playing one of the Arena “JOKES” although I guess you didn’t get it.
    Honest, other than my already theorizing that filling up the vault of the foot with material changes (to some extent) the biomechanics of the foot from a two pillared truss system (needing a plantar fascia) to a two pillared architectural arch system (needing less of a plantar fascia) when supported by a Centring . I would have no need to ever use your words regarding the plantar fascia ever again and meant nothing plageristic . In addition, I did add three numbers to the list as I converted the functions of the plantar fascia to the functions of a Foot Centring. I added (1,4 and 7) as those functions not backed up by research. This means that numbers 2,3,5,6,8,9,and 10 I MADE UP. You don’t even explain which ones YOU MADE UP! This means that at least some of the students and less capable of your followers. eventually, after ten years of your objective/subjective magic would believe all that you say to be supported by research.
    Hahahahahahahahaha….Do you get the joke now?
    In addition, the dictionary defines plagerism as “Plagiarize \'pla-je-,riz also j - -\ vb -rized; -riz•ing vt [plagiary] : to steal and pass off the ideas of another as one's own. I’m not sure if you have been reading my posts but I have no interest in STEALING or PASSING ON your ideas.
    I feel that SATIRE, defined as “trenchant wit, irony, or sarcasm used to expose and discredit vice or folly” fits what I did better.
    Secondly, reading additional Arena threads verify that you state your subjective opinions as objective. In fact I was very concerned about your statement that
    Kevin Stated:
    ..ethical podiatrists practice when treating plantar fasciitis…..whenWE will still first suggest icing, stretching, avoidance of barefoot walking and using strapping and prefab orthoses. If this does not work then cortisone injections, night splints and custom foot orthoses will be recommended.
    Dennis Stated:
    I have not dispensed an OTC orthotic for plantar fascitis in 38 years. My protocol is injection therapy, strapping and preorthotic pads on the initial office visit followed by a casting for custom orthotics on the second visit if the test drive care is successful. If the patient opts for no custom devices, I suggest an OTC orthotic and some brands but explain that I have no belief that they are professional or will work and that I will not stand behind them or work with them.
    What right have you got to call MY protocol unethical, mate.
    My subjective opinion is that YOUR protocol reflects the fact that your custom devices are not much better than OTC, have no corrective nature, have no preventive nature, have no postural benefit, have no effect on underlying biomechanical pathology and have no effect or posture other than the one involved in the complaint. No wonder why the research is showing them to be no more effective than high tech OTC (Especially now that ProLab has an OTC with a medial skive (BTW: did they give you the credit as they plagerized the KS? hahahaha).
    What gives you the right to call me unethical?
    Finally,
    Kevin Stated:
    I guess that I've SAID ENOUGH on this topic.....but the real question remains.....why do I have so much fun being downright mean???
    Dennis Replies: I knew you wouldn’t be able to control your desire to say more on this thread.
    Please send my $10 to
    Dennis Shavelson
    C/O The Foot Typing Center, 200 East 72nd St, N.Y.C. so I can paste it up on my wall like they do in Pizza Parlors in Brooklyn, hahahahaha
    I will not dignify any further posts to this thread (I allow my five children to make fun of me in a downright mean manner and I have no place in my life for a sixth) by you unless I receive
    a. an apology
    b. a promise you will not randomly leave the thread or be mean for fun or
    c. the $10
    Good Bye, Kevin.
    Dennis
     
  12. drsha

    drsha Banned

    Eric Stated:
    If you don't know what changes you are talking about then you should not talk about them. It might make people think you know more than you do. It's just a sales pitch if you say your device changes the STJ and you don't know how or what it's doing. Yes you can stick to clinical success, but don't try to explain the success with things you don't understand.
    Dennis Replies:
    It’s not a sales pitch (alone) that I am making. I am talking about anecdotal, clinical evidence which need to be proven (or disproved) by research. I repeat that much in medicine’s acumen has never been proven and yet is used with great success clinically. It is important to prove clinical theories right or wrong (the Arena is so needed) but to practice medicine utilizing nothing but the proven would deny the artistic, experimental and subjective pieces of medicine from patient care. I would not consult such practitioners; I would ask them only to research all theories, including their own because their protocol assumes that all care in medicine is scientifically proven before it can be used clinically.
    Eric States:
    Dennis, I agree you can test something without an explanation of HOW it works. This is known of (as?) empirical research. Levels of testing: Putting a piece of plastic under the foot makes it feel better. Changing the design of the piece of plastic from some measurements taken is a more advanced research question. Now we have to decide on which measurements to test. Dennis, I'm asking you for the rationale for the use of your measurements. You have said that devices made from your measurements change things, but you don't say HOW they change things.
    Dennis Replies:
    My plastic (and its posts and its manual and motion control care) not only makes feet feel better (as your seems to do), they improve the closed chain function of p.longus, FHL, P.tibial, A.tibial and the core intrinsics to work with more power and in phase. They improve shoe fit and style when purchasing. They reverse underlying biomechanical pathology (like casting out met adductus) in children, foot type-specific.
    I understand your desire to have me say HOW things change in engineering terms (as I have obviously unsuccessfully tried) which at this age and stage, I am unwilling to divert my work in order to do.
    Eric Stated:
    I don't know if he (Fleming) knew the chemistry of HOW it inhibited cell wall formation of bacteria, but that explanation was found to corroborate the reason for the clinical success.
    Dennis Replies:
    Glad to see that you can see how you would have allowed Fleming to market his antibiotic for profit without knowing HOW or why it worked. It sounds like you would have tried Penicillin in practice before it was proven. Why won’t you try mine clinically?
    Eric Stated:
    Have you not tested your theory against another?
    Dennis Stated:
    I have developed and tested my foot typing method and Foot Centrings against the bag of failed orthotics (including Root developed, a la Kirby developed and Glaser developed orthotics) in the bags of failed devices that patient have brought to me over time with major success. Have you ever seen a Centring in one of your bags?
    Eric Stated:
    The arena is in diapers???? If you want people to accept your ideas you should not insult them. Do you give people with warts orthotics because they have warts or because you are trying to prevent something?
    Dennis States:
    I have absorbed three weeks of subjective and personal assaults from The Arena and you would get upset by me saying that it is my opinion that clinically, the Arena is in diapers as insulting. I guess calling someone (or his work) throwback, old and outworn, a step backwards, obvious flaws (not documented when challenged), don’t see much benefit and admitting to being mean to me for fun is the way to get me to conform to your protocol? C’mon.
    Actually, as opposed to finding it insulting, I would hope that it would make one or more of the members to look to acculturate or allow other than incestuous thought to enter The Arena.
    Some of the most exciting testimonials I get from patients reflect the same refrain. “I am so happy I came to you for my wart (ingrown toenail or fungus toenail) because it enabled you to educate me about foot typing and Foot Centrings that no other podiatrist has ever explained to me”.
    Eric Stated:
    If you do not know which moments are changed and HOW, then this is not a coherent explanation. You could just as well as said the orthotic removed the bad humors from the plantar fascia. This level is: well the pain went away so the forces in the plantar fascia must have reduced.
    Dennis Replies:
    You have certainly unmasked the fact that I do not know HOW the moments, stresses, etc. that you have taken years to learn once again.
    But what if Kevin stated that the eleventh function of the plantar fascia is:
    11. The plantar fascia removes the bad humors from the foot.
    Does that make his other postulates less believable or less deserving of research.
    Eric Stated:
    What anatomical structures make up the transverse arches? How does a centring support (choose a better word if you like) a vault. Is the vault the bones or does it include the soft tissue.
    Denis States: A lateral CAT scan taken from the distal calcaneal shelf forward to the transmetatarsal heads sliced microns thin when added together would answer your question as the shape of the undersurface of the bones would measure the Vault.
    Eric Stated:
    To what degree do you need to know the anatomy? There are bones, there are ligaments, muscles and tendons. With free body diagrams we can estimate the forces going through them. Why does the rigid/rigid foot type hold its position better? What makes the rigid/rigid foot type more rigid? The classic definition of the rigid is that there is less deformation with load than a more flexible structure.
    Dennis Replies:
    I am once again not familiar with free body diagrams, deformation of load and the other engineering models that you live with day to day.
    If the Rearfoot SERM is grossly inverted and the Rearfoot PERM is equally inverted, there is little to no deformation available making that Rearfoot Type Rigid. If that same inverted Rearfoot SERM becomes a Rearfoot PERM that is grossly everted then that foot will deform dramatically in closed chain and is a Rearfoot Type Flexible. I honestly cannot understand how whether you agree with my paradigm or not, you do not understand this simple thought as most podiatrists do.
    Eric Stated:
    Yes, there is some position of the bones where stress is minimized, but why is that the centered position. You make the claim with no evidence. Again, you could insert there is a position of the foot where the bad humors are minimized. You can use the terminology, but that doesn't mean that you have used it correctly.
    Dennis Replies:
    I know (I think we all know) that STJ neutral is not that position. My paradigm proposes, with clinical and anecdotal evidence as early proof, that there is a position for each and every foot, foot type-specific, which when maintained by a semi rigid, fully posted, limb length corrected cast or lab corrected, foot type-specific Centring that will minimize stress better than any current model. I stand by that statement until proven otherwise and your subjective rejections and your resistance to even look at my paradigm clinically have fueled my belief that you cannot prove it otherwise.
    Eric Stated:
    I agree that lowering the arch will tend to increase the tension in the plantar fascia. What I don't see is how a centring reduces stress on the plantar fascia.
    Dennis Replies:
    If you foot type a patient, take a cast corrected cast, foot type-specific and supply a foot type-specific prescription and I will deliver a Foot Centring that you can inspect, test and evaluate clinically. I would be more than pleased to fund this clinical experiment. I believe that the device will answer many of your questions about my paradigm that our debate of words will never.
    Eric Stated:
    What do you mean by elevating the rear pillar? What is the rear pillar? Which bones are in the fore pillar? How does a centring fill a vault? What anatomical structures make up a vault? I know what the calcaneus, talus and spring ligament are. I assume that you do to. If we talked in terms of anatomy it be much easier to communicate. This is what I meant by abstraction. A pillar, as used above, is an abstraction of the anatomy.
    Dennis Replies:
    I do not include the Spring Ligament in The Vault. It (in addition to other soft tissue structures) stabilize (or cannot stabilize) the bony pillars.
    Eric States:
    PF flyer biomechanics states that you can run faster an jump higher when wearing PF flyer shoes, becuase it makes your arch stronger and more efficient.
    HOW do you make an arch stronger and more efficient? HOW does a centring make the bones and ligaments of the arch of the foot stronger and more efficient.
    Enough for now.
    Dennis States:
    I continue to admit that my work is clinical and has only been reinforced by its reproducibility, the success of others who are using the paradigm in practice and anecdotal evidence and testimonials.
    Enough for HOW!
    "A successful man is one who can lay a firm foundation with the bricks others have thrown at him." David Brinkley
    I will answer your other post later.
    Dennis
     
  13. drsha

    drsha Banned

    Eric Stated:
    As I understand your paradigm, you take some measurements and then prescribe an orthotic device based on those measurements. We would have to verify that your measurements are repeatable or that the person who you learned the measurements from you could reliably put feet in the same category each time a specific foot was measured.
    Dennis Replies:
    That is exactly what I have done. Dr. Scherer’s Valmassy Chapter had a grid of nine foot types that did not profile all feet into a type. It had virtually no clinical applications and proven by the fact that Dr. Scherer has never upgraded his own work, there was room for upgrading.
    My profiling system has a grid of sixteen. All feet are profiled into one of the types. There are huge clinical applications when working with the system that improve outcomes and reduce failures as they expand our ability to diagnose and treat foot and postural problems.
    The one who knows best what I have accomplished is Dr. Scherer and he remains deafeningly silent on the subject.
    Craig Payne suggested to me personally that he was considering profiling a bunch of feet using my system to see if it was reproducible in 2006 after he saw me deliver lectures at The New York Conference. There has never been any follow-up to my knowledge.
    Eric Stated:
    Then you would have to describe how you the orthotic is made and prescription variables should be applied. What do you differently than a netural suspension cast?
    Dennis replies:
    The original posting on this thread or the articles that I have published to date are a great foundation for answering those questions and they exist in open domain.
    However, there is one more question that needs answering. If I have given you some iota of substance in Shavelson’s paradigm, wouldn’t you first want to see if it work in your hands before wasting time on studying it?
    Eric Stated:
    If you are going to do a study you have to have a protocol for treatment that someone else could follow to repeat the study. Since this is your lab, you probably would also have to fund the study, or at least provide the orthotics. You would also need an outcome measure. How much did the device improve the patients foot health? There are some that have been mentioned on the arena.
    Dennis Replies:
    To quote Dr. Kirby on another Arena thread, “however, there is only so much time in the day for me and someone with more time and a less busy life will need to take up this project for us in the future”.
    I would like studies performed but currently, all lab profits are going to advance Neoteric Biomechanics clinically.
    I agree that I must take some of those funds and divert them into purer research such as you suggest and
    Finally, we get to the point where you are asking me to FUND something. It takes a lot of capital to take a paradigm to market. Maybe in this changing world, patents ARE a necessary evil.
    Two years ago, the deadline came and went for me to apply for international patents of my paradigm. Without hesitation, I passed. This means that the international members of The Arena are totally free to utilize my paradigm any way they see fit. As a matter of fact, I am hereby granting all outside of the US permission to plagiarize my work if you wish to do so for profit or otherwise, personally. I would consider that an honor. In the US, I have no plan to protect my patents from practitioners who wish to work with Neoteric Biomechanics but I have retained attorneys to aggressively confront institutions and laboratories that violate my patents without permission profitably.
    As to diverting funds,
    I am accepting proposals on this thread from Arena members leading to $2000 in funding for a low level study involving Neoteric Biomechanics.
    I am offering $2000 to Craig Payne to fund a proposed student research project involving Neoteric Biomechanics at LaTrobe and
    I am offering $2000 to Eric Fuller to fund a proposed student research project involving Neoteric Biomechanics at CCPM.
    Eric Stated:
    Thinking clinically, what if you had a patient with a painful callus sub second metatarsal head and a short first metatarsal. In my experience these people do better in longer orthotics with extensions under the metatarsal heads to off weight the second. What you do for this patient?
    Theoretically, this patient would be a rigid rearfoot, flexible forefoot functional foot type. He/she would be casted root STJ neutral in the rearfoot and posted with a 0-1 or at most 2 degree varus rearfoot post and a 27mm deep heel cup. A 2mm heel raise may be incorporated to compensate for equinus influence The forefoot would be cast corrected with forefoot vaulting technique and hammertoe correction technique and posted with a 3-4 mm 2-5 forefoot varus posting and a fairly aggressive first ray cutout, B/L, (assuming no Inclined Posture influence).
    During the course of the next 6-8 weeks the Centrings would be dispensed and modified utilizing additional centering pads to further vault the foot and get peroneus longus, flexor hallucis longus and abductor hallucis to become more efficient at forcibly plantarflexing the first ray into the weightbearing surface and if needed, at that time, a course of closed chain physical therapy would be instituted to further re-educate the musculature to perform with power and in phase.
    I would expect reduction of pain and a longer interphase between callus debridement but I would also expect improved gait, cadence, step and velocity and a longer stride length. In addition, I would expect improved postural balance and performance and a reduction of tired and fatiguing feet and posture.
    If unsuccessful, this would open up consultation or surgical criteria for shortening two or plantarflexing or elongating one as conservative care has failed.

    In summary, I asked my family to allow me the indulgence to spend one month seriously debating The Arena members with regards to my paradigm. That month is coming to an end.
    On November 8, 2008, at the one month anniversary of my Arena membership, I will post an article from my website that has yet been submitted for publication entitled “The Kinesiology and Kinematics of Neoteric Biomechanics” that sums up the essence of my paradigm and its value as a clinical and marketable entity.
    I have gained a great deal of insight and my respect of the potential for The Arena remains very high. You questions, prodding and yes even your mean posts were educational and of great value to me. Thank you all (even Kevin).
    I will keep involved at a lower level, as my priorities allow and I hope these next words are absorbed in the tone they are meant, constructively.
    The Arena is self limiting for two reasons. You subjectively shoot down new ideas from external sources. There are things to be learned from the Rothbarts, the Glasers and the Shavelson’s. The second is that your lack of clinical advancement from within combined with your commitment to research come what may is eliminating your practice protocols from viability and insurance acceptance. Today plantar fasciitis, tomorrow flat feet, etc..
    I am not the enemy, I am a fresh and new paradigm change looking to survive in your midst hoping that it is proven viable. If not, we will all go to a totally new place, together.
    We have to go somewhere, Biomechanically because here is not the place to be! Dennis Shavelson, D.P.M.
    "Only the extremely ignorant or the extremely intelligent can resist change." Socrates
    Proud to still be standing on this thread after one month.
    Dennis
     
  14. Yes.

    Really?

    I debated with them and wasn't convinced by their arguments; I've re-read all of your posts in this thread and I am yet to be convinced by any of yours. I'm willing to change my mind as they and you provide high quality scientific evidence for these ideas.

    Yeah, thanks for that. Lets forget about research and the scientific method and follow anyone who says "I'm am the way and I am the light". As I say to the doorstep salesmen, religious or vacuum cleaner: not today, thanks. Now, back to where I came in on this:

    Dennis, please provide evidence for this statement.

    And modest too. If it walks like a duck and quacks...
     
    Last edited: Nov 2, 2008
  15. Hi,
    Howard Dinowitz DPM here. Nice to be here and look forward in participating in meaningful dialogue. I have been viewing the ongoing back and forth with Dr's. Shavelson,Kirby etc. I am truly impressed and proud to be part of this mix. For 25years, biomechanics has been my passion embedded with knowledge taught to me by Dr's D'amico,Shuster and many others from NYCPM back in the early 80's
    My reliance on their teachings gave me the knowledge and confidence to persue many meanigful years of the clinical application of Poditric biomechanics. I salute them all!!
    In short, I have been using Dr. Dennis Shavelson' Centrings for several months. Having been trained in the the traditional Root Biomechanics, my orthotics have relyed primarily in rearfoot control and not truly encompassing the "architectural arch" and the dynamics thereof, involved with Dr. Shavelsons Neoteric approach. His Functional foot typing offered me a simple and concise way to assess rearfoot and forefoot pathology with special reference to cross-referencing foot type specific pathologies. I've never looked back. Dr. Shavelsons Foot Centings simply work better. These orthotics fit and function with greater specificity then any other orthotic I have ever casted.fabricated and dispensed to any patient.
    I sometimes think, that as practitioners, we tend to get "lost in the sauce" of didactics and forget to put into action what changes are necessary to improve upon current theory and application. My bottom line is what my patient needs and what my patient is ultimately comfortable and happy with. I employ Dr. Shavelsons Neoteric Biomechanics and prescribe his Foot Centrings with great success!
    Howard Dinowitz, DPM
     
  16. Thanks Howard, that's me convinced and converted then. If they are good enough for you (whoever you are) they must be good enough for me. As a PhD podiatrist, I love anecdote and just can't help but buy into it without any scientific support. Like I said: "not today, thank you."

    Could you now sell me a god please, I feel the need...
     
  17. Good Morning Simon,

    Many thanks for the kind reply. My feelings, I believe, are shared with the majority of our great profession. Podiatry has offered us the chance to approach the perfect balance of science and practicality with reference to patient care. If ones interest is purely research that's a different story. But perfecting that delicate balance between art and science can't possibly exist without having years of science and practicality ingrained in you. So, prescribing anything with success, whether an orthotic, a shoe or for that matter an Rx cream, requires years of understanding science and years of the art of managing whats best for a particular patient. I wholly subscribe to your need of scientific backing, but at our level of expertise, I believe that it's the science we learned, and for that matter continue to learn, that directs our course of action for a successful reslove. A "hit or miss" approach never survives over time.

    keep well,

    Howard
     
  18. drsha

    drsha Banned

    Originally Posted by drsha
    my ideas which are anecdotal (that's all they are)
    Dr. Spooner Replies:
    Yes.
    Dennis Replies:
    You give no credit to the fact that I am not trying to imply that my paradigm scientifically based (which I have pointed out exists in some of your threads). I simply believe that based on my clinical experience that the bulk of it will hold up to scientific investigation.
    Simon, we both agree that:
    “If you have an anecdote from one source, you file it away. If you hear it again, it may be true. Then the more times you hear it (unproven) the less likely it is to be true.” Anthony Holden.
    Dr. Spooner Stated:
    I debated with them and wasn't convinced by their arguments; I've re-read all of your posts in this thread and I am yet to be convinced by any of yours. I'm willing to change my mind as they and you provide high quality scientific evidence for these ideas.
    Dennis Replies:
    You are not debating on this thread, sir. You are simply spouting dictums and diatribes that obviously you are passionate about. However, your scientific level of skepticism, in my opinion, is preventing you from practicing a better brand of medicine, clinically..
    Dr. Spooner Stated:
    Yeah, thanks for that. Lets forget about research and the scientific method and follow anyone who says "I'm am the way and I am the light".
    Dennis Replies:
    I practice medicine with a level of healthy skepticism by using the first rule of medicine which is “Thou shalt not cause harm. I have practiced K.S., Blake inverted, Rothbart, Glaser et al and they all fall short of my tenets of care. That keeps me searching.
    My problem with your pole of The Arena is that the Ph.D. part of you is asking me to prove my anecdotal theories which you refuse to examine until proven (by me). I hope all members can see that this plan of action reflects a philosophy that stifles growth and experimentation, two necessities for the survival of medicine.
    For me, medicine must advance theories and investigate them, until proven scientifically unworthy for our patients benefit or until they prove harmful..
    Dr. Spooner, if your sister had a bacterial infection that no proven antibiotic killed, using your illogic, you would not try Manuka Honey because it is unproven. I am healing wounds in my office daily with UMF 15+ Manuka.
    Dr. Spooner Stated: Come back with personal evidence.
    I have repeatedly admitted that I am not capable of producing this evidence personally.
    Dr. Shavelson debate with the Skinners of the Arena) and the world.
    My subjective opinion is that although you are fundamentally and totally necessary in a medical system, you are a drag to the progress and growth of that very system if your viewpoint is taken too seriously.
    Medicine is a science but it is also an art. Bedside manner, cutting edge medicine, off label uses, etc. are common terms in the medical vernacular yet they hold little scientific water. We call what we do in our clinics and treatment rooms “Practice”, you, on the other hand are in your version of a “Perfect”.
    “So many come to the sickroom thinking of themselves as men of science fighting disease and not as healers with a little knowledge helping nature to get a sick man well”. ~Auckland Geddes.
    “Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic”. ~Thomas Szasz.
    Once again, if your 12 year old sister has inherited the flexible rearfoot, flexible forefoot family functional foot type guaranteeing that your every family gathering was putting people with PTTD, poor posture, poor athletic performance, herniated discs, and lifetimes of suffering together and you as a DPM knew about a safe and possibly effective upgrade to your biomechanical protocol that might prevent her suffering and you denied her that care, I believe that your Ph.D. half needed anger management because it was clouding your DPM decision at that moment (If you hold true to other comments that I have made of this nature on this thread, you will completely avoid addressing this sentence).
    The future of medicine, its cutting edge, its upgrades and improvements come from dreamers who forsake science to some extent in order to dream. I am currently involved in unproven biomechanical theories that are working for me and others to clinically care for our patients (nice job of accepting a new DPM dreamer who had the nerve to make a posting in favor of my theory).
    I offer alpha lipoic acid, evening primrose oil, l-arginine, B-12 and therapeutic nerve blocks for diabetic neuropathy. What do you offer your patients with LOPS since there is nothing proven?
    I taught ETOH injection therapy a la Marvin Steinberg, DPM, my mentor, at NYCPM for eight years when it was experimental and now it is the gold standard. When did this become a part of your acumen?
    I speak to my patients, podiatrists and the medical community using the same, simple and understandable language that educates them, enlightens them and unites them in diagnosing and treating the foot and posture in greater numbers than subjectively you ever can.
    When confronted by a young DPM Arena member who posted that he felt “weird” using engineering terms to explain his care Dr. Kirby admitted that he doesn’t use his engineering terminology to discuss his care with insurance companies and in charting??? That means that he has to convert the rest of the world to his protocol (something all of you will I am sure will continue to try to do to me un successfully).
    Finally, Dr. S. none of this has anything to do with g-d, ducks, etc. (I wonder how many times you relate Dr. Kirby to ducks and g-ds)?
    I believe you consider yourself the self proclaimed watchdog of The Arena and it remains my opinion that your close minded, narrow, focused and godless conduct will foster The Arena to become vestigial if you get your way.
    If I were theorizing personality types, you would be a rigid, rigid and not the type I would choose as a role model for my Arena.
    Dennis
     
  19. Dennis,
    Time will tell.

    No, what you do is apply science and test the hypotheses, write up the results and send it for publication in a peer reviewed journal.

    Please re-read my post, I didn't say I was debating with you in this thread. It's impossible, because when I asked you to provide evidence for your claim that "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.", you response to this was:

    BTW I asked for evidence, not personal evidence. Anyway, no evidence = no argument = no debate. If you have no evidence for this claim and are not capable of producing this evidence why did you state it in your patent application?

    I have no problems with growth and especially no problem with experimentation, that's what scientists do. I just want to see the results of your experimentation presented in a peer reviewed scientific journal and for you to stop making claims that you patently cannot support at this time and place.

    Yeah, thanks for that, but not today thank you. Dennis you're talking a lot, but not saying anything here. The watchdogs of the arena are the admin team, the spam busters etc. I just participate here when I find the time. You got my personality to a T though, Dennis: very rigid :pigs:. I relate Kevin to pigs by the way- he's aware of this. Although again, you should re-read my postings, where did I relate you to a g-d (whatever that is?) or a duck? Theorising on personality types? Clearly egocentric. Luckily, this isn't your arena; feel free to start one up and see if you can gather a flock. "still looking for to fill that god shaped hole" MOFO- U2

    Good luck in your future Dennis.
     
    Last edited: Nov 3, 2008
  20. efuller

    efuller MVP

    Dennis, you are making a claim about improved muscle function. Yet, later in your post you parry the HOW question. Are you making a claim of improved muscle function with absolutely no reason to convince us that it is true, other than you say so. I'm not going to ask how on these claims. I'm just going to ask why you think these claims are true.


    Dennis, you left out the part about how the bacteria died in the presence of penicillin. That would be the reason that I would expect it to work in a clinical trial. You haven't given me any reason, that I have accepted, that your devices would work. I don't accept that a piece of plastic placed under the foot directly supports the bones of the arch.

    I don't know. How would I be able to tell the difference between yours and other orthotics?


    So, how does a centring support the vault? Have you thought about the how the individual bones of the foot create a vault?

    Dennis, there is a phenomenon where a person who appears knowledgeable makes a statement and people who don't want to appear stupid say that they understand it. It's like the story about the king who had no clothes. Is there anyone out there who can explain Dennis' statement above?

    Dennis, I cannot prove or disprove your paradigm because I really don't understand what your paradigm is. How does an orthotic for one foot type vary compared to an orthotic for another foot type?


    Do you have a more detailed description of your method? I couldn't figure out how to take a cast corrected, foot type-specific cast from the patent.


    Dennis there was more than one question. What is the rear pillar? Which bones make up the rear pillar? Which bones make up the fore pillar? How does a centring fill a vault when there is soft tissue filling the vault?

    Cheers,

    Eric
     
  21. drsha

    drsha Banned

    Eric Stated:
    Dennis, you are making a claim about improved muscle function. Yet, later in your post you parry the HOW question. Are you making a claim of improved muscle function with absolutely no reason to convince us that it is true, other than you say so. I'm not going to ask how on these claims. I'm just going to ask why you think these claims are true.
    Dennis Replies: I am go back to common podiatry language and pursue my education in kinetic engineering elsewhere, hopefully to become better equipped. I would suggest you do the same when it comes to architectural engineering. In that way, we will both be more well rounded.
    Patients having weakness in either the rear pillar, the fore pillar or both have the bony structure of the vault collapse, foot type-specific with every weightbearing action (notice I did not say step) all of their lives.
    The extrinsic and intrinsic musculotendonous prevent collapse by tendon pull and muscular power in order to stabilize the pillars so that they may support or act as levers. This means that in feet with collapse of the vault, there is a muscular fatigue and tiredness created by the extra work needed to get the foot into (and maintain) centered position from which to perform. (compare this to roots STJ neutral or Kevin’s perfect STJ axis position).
    Clinically, there is evidence that once feet are in Centrings, testing of PL, FHL TA, PT by physical therapists pre and post dispense reveal increased scores and less need for strengthening and re-education of these muscles.
    Patients state they are stronger, less fatigued and performing better beyond the relief of their pain complaints, very consistently both in my hands and others, pre and post dispense.
    Eric Stated:
    Dennis, you haven't given me any reason, that I have accepted, that your devices would work.
    Dennis Reples:
    I don’t think that I can come up with reasons that are acceptable to you on your terms.
    I am using that as fuel to drive me towards researching my paradigm from the bottom floor up as a new priority.
    Eric Stated:
    How would I be able to tell the difference between yours and other orthotics?
    Dennis replies:
    Please revisit the pictures I posted to one of my early posts showing devices from Kevin’s lab, Dr. Sherers Lab, a british lab and an Australian lab from THEIR WEBSITES along with pictures of Foot Centrings. Print, cut up and put all these pictures into a grab bag and see which ones look different.
    Please surprise me and look at those pictures and COMMENT instead of continuing this refrain.
    Eric Stated:
    So, how does a centring support the vault? Have you thought about the how the individual bones of the foot create a vault?
    Dennis Replies:
    In a kinetic engineering sense, as stated previously, I don’t know. I am using architectural engineering and so we are speaking foreign languages. Do you know a good interpreter>
    The Arena has given me the incentive to amass enough money to fund studies (but then that leaves the door open for scientists to say that I paid for positive results if that be the case).
    Eric, can’t we admit that not everyone wants to be you or me but in the big picture, we both have something to offer to others?
    Eric Stated:
    Dennis, there is a phenomenon where a person who appears knowledgeable makes a statement and people who don't want to appear stupid say that they understand it. It's like the story about the king (It’s called “The Emperors New Clothes”)) who had no clothes.
    Dennis Replies:
    I think this is a critical statement that needs inspection on BOTH SIDES since threads on the Arena ( i.e. Kevin;s #’s 1-6) are doing exactly that. Kevin rewards those people who got it right (someone recently got 100 and huge congrats from the emperor).
    How dare you pick and choose the unproven work of your incestuous clan and prejudge those of outsiders as setbacks and worthless without even beginning to examine them.
    Dr. Dinowitz, a nice guy, seasoned practitioner who had a biomechanical fellowship at NYCPM, has had biomechanics as the core of his practice. He is one of those that can explain my paradigm to MD’s, DPM’s (other than you) and patients to a point where they see (or don’t see) some value in working with the paradigm. What kind of fraternity jibes and bully’s newcomers just because they support an unpopular theory?
    I have tolerated your bias for a month with two purposes.
    1. To make comments, from the point of view of a new member to The Arena as to how it can improve.
    2. To see if I could locate, using your fairy tale, a young man/woman in the Arena with the fortitude to suggest acculturation and force the emperors to wear clothes?
    Time will tell if I had an impact on either.
    Eric Stated:
    Dennis, I cannot prove or disprove your paradigm because I really don't understand what your paradigm is. How does an orthotic for one foot type vary compared to an orthotic for another foot type?
    Scientifically, I can only give introductory information about my paradigm which if it initiates curiosity or has some piece of merit would lead scientists to personal examination to verify or vilify that curiosity or merit. My feeling is that the members of The Arena would prefer having their collective heads cut off before investing time or energy into examining my paradigm while hypocritically saying posting that they are open minded and accepting of change.
    Eric States:
    Do you have a more detailed description of your method? I couldn't figure out how to take a cast corrected, foot type-specific cast from the patent.
    Dennis Replies:
    The same refrain as above. It usually takes about 2 months before becoming proficient but since I contact my clients with every cast in hand and talk them through each case, the learning curve is both painless and profitable. I am assuming that you are “figuring out” how to take a cast corrected, foot type-specific cast from a patient “in your mind”.
    I think two things at this point:
    1. If you examine my paradigm in real time instead of in your mind I would be even more responsive by your comments, corrections and rejections.
    2. Refusal to examine a paradigm objectively while rejecting it subjectively is a scientific paradox.
    Eric Stated:
    What is the rear pillar? Which bones make up the rear pillar? Which bones make up the fore pillar? How does a centring fill a vault when there is soft tissue filling the vault?
    Dennis Replies:
    As you did to me with regards to kinetic engineering, I refer you that any basic text on Architecture, especially one with an emphasis on the architectural arch and its construction using Centring technique.
    Dennis’ Summary:
    I have met members of The Arena throughout my 38 year career in a very casual way and I have had a brief business relationship with one member who at our last encounter seemed friendly and professional. I wish your society well and your members success as I believe we are symbiotic. I am not sure what I represent or have said or done that makes the members so adversarial and mean towards me?
    Maybe time will see an upgrade in my grade in this relationship from The Arena but for whatever reason, you have made me feel very unwanted and my father taught me not to hang my hat where I am not wanted.
    I’ll answer future posts if they are civil and show some evidence of an interest to be fair and repair, like Dr. Fuller’s, who is the one person that I have renewed respect for.

    “People say New Yorkers can't get along. Not true. I saw two New Yorkers, complete strangers, sharing a cab. One guy took the tires and the radio; the other guy took the engine”. David Letterman
    Dennis
     
  22. What a disappointment. Dennis, your approach is something akin to a petulant child who has not got his own way. Making a statement such as
    should make you consider why that may be the case. Like four or five other clinicians who have announced a "breakthrough" in podiatric care with their new orthotic invention (see http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=19929), you seem to follow suit in that your answers are evasive and characterised by obsfuscation. Ok, so engineering terminology may not be your forte, but you have tried to explain similar terms in architectual terms, which may be fine for inanimate, stationary objects, but for a complex structure which is subjected to any number of dynamic forces, it may not be the most appropriate language. Besides that, even when asked simple, pertinent questions such as
    you answer
    At this stage I am inclined to agree with other colleagues that you are trying to patent and market a niche product without even the most basic understanding of how that product is interacting with the foot and lower limb and that your primary motive, above all else, is making a profit.
     
  23. efuller

    efuller MVP

    I did look at the pictures. They were not labeled well and in the pictures that were labeled well, the one from one lab looked exactly like the picture from the other lab. Were the ones from your lab the ones with the white top covers?


    Dennis Architectural engineering is "kinetic" engineering. Architecture describes the structures. Engineering analyzes how the structures work.

    I will agree that not everyone wants to be you or me. There are some people who do not want to think about how something works, they just want it to work. But here, on an academic forum, we do care how things work. And, at least I care, what is told to the podiatry community at large is told. I want medicine to be practiced at more than a technician level.


    So, since you did not defend the statement, that I referred to, should I assume that you cannot defend it? I'm getting the sense that you feel the best defense of the statement is a good offense.


    At least the sole supports lab describes its casting method. By the way, the devices, in the pictures that I think are yours, look very much like the sole support devices. What do you different from sole supports? Which one of you came first?

    Basic texts on architecture don't describe the bones of the foot. Basic texts describe concepts. I'm asking you to apply the concepts of architecture to the foot. Which bones make up the pillars?

    Regards,

    Eric Fuller
     
  24. Eric,

    I think one of the differences here is the use of extrinsic rearfoot posting, if I remember correctly Ed frowns upon this, the devices in the pictures look like they've been taken from a cast in which the first ray may have been plantarflexed (giving increased MLA profile) and/ or the positive may have been inverted and/ or received minimal arch fill (giving increased MLA profile); and or first ray segment may have been sectioned and plantarflexed etc etc. And then there is a first ray cut out in the shell. I can really only make a guess from the photo's. Dennis, since you speak the language of architecture, could you provide architectural drawings of your casts + devices, highlighting the unique features; third angle orthographic projections please?

    From the pictures already provided alone though, it's like wow! I'm buzzing! I've never seen such a device before, it's incredible, must have been dreamt up by a genius, it a whole new concept in podiatric biomechanics etc etc :rolleyes: I've been waiting for the whole of my career for someone to teach me something other than a neutral suspension cast and a 4 degree/ 4 degree Root shell. I've never dared to put the foot into any other position than that described by Root, I don't know about anyone else here? I especially ignored the debate you (Eric) were involved in titled something like "no-one stays neutral on casting" in podiatry today, or biomechanics or somewhere?????( I ignored it so much I can't even remember where it was published :bash: :D). Guess we all got stuck in the '70's with Mert as I've certainly never manipulated the negative or positive cast in any way shape or form. No sir, never inverted it or everted it, pushed rays up or down, never sectioned one or skived one or played around with additions/ subtractions in any way shape or form. BTW never ever should one attempt to pronate the foot, if you do thou' shall burn eternally :butcher:. As for experimenting with shell design, I certainly never got involved with any of that crazy stuff and no-way would I start using 3D modelling and FEA to explore how foot orthoses design characteristics influence the mechanics of foot orthoses. I would never start using multi thickness shells in an attempt to manipulate orthoses surface stiffness or play around with variations in extrinsic post geometry - no way, no siree, never, ever. Because me, I'm a rigid just happy sitting in my 1970's box:D

    But since Dennis won't tell us how he casts the foot, I'm only guessing upon the magic he has performed to produce such an oddly shaped device that looks like no other foot orthosis I've ever seen before. Perhaps his reluctance to telling us his secret casting technique is that this may be information that costs $$$? Again, just guessing. Not sure how anyone independent could carry out meaningful research on this methodology if Dennis won't tell us though. BTW Dennis, I'll take your $2000, pay you some of it back to learn "the secret" if that's what we need to do to find it out and then I'll carry out some meaningful research on the "centring" devices for you. Surely it's better to have someone with a PhD working on this than the undergrad projects you offered to Craig and Eric?
     
  25. 3. "There is no such thing as bad publicity except your own obituary."
    Brendan Behan Irish author & dramatist (1923 - 1964)

    Of course it is, for you.

    "I can't see through the tear-gas or the dollar signs in my eyes": Angels of deception- The the

    Tried to show interest throughout, if we weren't interested we wouldn't take the time out of our busy schedules to give this topic the time of day- yet we have and you've got some free publicity out of it Dennis, as well you know. By being "fair and repair " do you mean don't ask any questions you can't/ won't answer?

    "Don't hold your breath, expectorate": I've had it with blondes- The Cud Band
     
    Last edited: Nov 5, 2008
  26. drsha

    drsha Banned

    Eric Stated:
    I did look at the pictures. They were not labeled well and in the pictures that were labeled well, the one from one lab looked exactly like the picture from the other lab. Were the ones from your lab the ones with the white top covers?
    Dennis Replies:
    Yes
    Eric Stated:
    I want medicine to be practiced at more than a technician level.
    Dennis Replies:
    I assume the technician is me?
    Back to being complimentary.
    Eric Stated:
    Since you did not defend the statement, that I referred to, should I assume that you cannot defend it? I'm getting the sense that you feel the best defense of the statement is a good offense.
    Dennis Replies:
    Since I hold no economic, academic or power position to my “subjects”, there is no reason for them to act stupid or lie about my nakedness. Therefore, your fairy tale does not apply to me and needs no defense.
    On the other hand, I think Kevins “subjects” fearing bullying, retaliation, persecution and mean fun, seeing what he does to “subjects” like me, would be more than enough reason not to voice dissent so why don’t you defend the fairy tale on another thread Kevin?
    Eric Stated:
    At least the sole supports lab describes its casting method. By the way, the devices, in the pictures that I think are yours, look very much like the sole support devices. What do you different from sole supports? Which one of you came first?
    I just read my casting technique for free through this very thread, either on the thread itself or in one of the referenced articles. I’ll pay $10 to the first Ph.D. who can find it!!
    Hahahahaha.
    Eric, you have found me out!
    My real name is Ted Glaser and I am the fraternal twin of Ed.
    There is no difference between sole supports and Foot Centrings (not The Beatles), they are actually an amazing copy (Beatlemania). My work has been ongoing with the sole (haha) purpose of fooling the podiatry community and you with a different twist on spikethotics and Ed and I are splitting the money that we are making and running off to Tangiers together.
    As to who came first, I think it was the chicken.
    No, the egg, you jerk.
    Eric Stated:
    What bones make up the pillars?
    I just read which bones comprise the pillars of the foot for free through this very thread, either on the thread itself or in one of the referenced articles. I’ll pay $10 to the first Ph.D. who can find it!! Hahahahahaha.

    Eric, I am going to try a different tact al La Dr. Kirby. Later today, I will post Neoteric Biomechanics theoretical question #1 for the lynch ponder and reply to. I will be interested to see how much entertainment it provides you with.
    Still Standing
    Dennis
     
  27. To Dr. Sha..
    The essence of function is many fold. Foward gait , is just that, forward. There is side to side, perhaps even back steps, and so many other facets of ambulation to consider.
    Don't they get it?

    Howard
     
  28. efuller

    efuller MVP

    Howard, since you get it, could you explain the following?

    Originally Posted by drsha
    If the Rearfoot SERM is grossly inverted and the Rearfoot PERM is equally inverted, there is little to no deformation available making that Rearfoot Type Rigid. If that same inverted Rearfoot SERM becomes a Rearfoot PERM that is grossly everted then that foot will deform dramatically in closed chain and is a Rearfoot Type Flexible. I honestly cannot understand how whether you agree with my paradigm or not, you do not understand this simple thought as most podiatrists do. ​
     
  29. Hi Eric,
    Thanks for the opportunity. My previous comments on the thread only meant to bring forth the concept that to appreciate the pathomechanics of the entire stride, whether forward,backward,side to side etc., one should consider the forefoot/rearfoot as a dynamic unit working co-dependent. It is not that I don't understand inversion/eversion etc, It's just that, at least in my hands, utilizing Dr. Shavelsons foot typing techniques, the foot centrings incorporate more forefoot/rearfoot relationships. Orthotic Labs I've used in the past, seemed to have steered clear of forefoot posting , rearfoot cast corrections.These, and other modifications prescribed specific to common foot types simply work better. To that end,covering a greater range of rearfoot and forefoot motions give a greater range of specificity to a wider range of activites. ex., lateral motion-tennis player,or skier(sp?),a bowler, who often walks up and back on an alley.I don't dear cross the line of representing myself with anything more than an appreciation of engineering dialogue. So, I don't think I could really explain perhaps in engineering terms why the dynamics are more favorable utilizing the serm/perm foot typing, but in practical terms utilizing a sound biomechanical and gait exam, plug in the foot type-cross reference with an orthotic with specific modifications so far is getting greater patient satisfaction. Perhaps anechdotal,
    but my bottom line is patient satisfaction.
    your thoughts?

    keep well,

    Howard
     
  30. drsha

    drsha Banned

    Theoretical Question #1:

    Realizing the increase in foot and postural problems over time and realizing that the Podiatrist, the Chiropractor and the Orthopedist cannot always offer cures for these chronic, disabling and progressive problems, the Secretary of Education of your country is asking for proposals and offering funding for a screening program that will examine all school children in your country from 10-15 years of age for potential foot pathology and postural problems.
    Once uncovered those children with potential problems should be given education and on the spot conservative treatment.
    In follow-up additional education can be offered and with the parents approval more advanced care for those children in need can be offered.

    The purpose would be a longitudinal program to identify potential foot and compensatory postural problems early and if possible delay or eliminate them from occurring.

    Proposals please:
     
  31. drsha

    drsha Banned

    The last post on this thread was October 6th and it was mine.
    That posting was a theoretical, clinical application dealing with the subject of FLEB.
    Over 150 of you have visited the thread so the internet is working.

    Scientifically, I feel I can draw the following conclusions.

    1. The Arena is allowing me to have the last say on this thread. (please send my last man standing award to blah blah, hahahahahahaha).

    2. My button pushing comment to Eric that clinically, your paradigm is in diapers when debated against Neoteric Biomechanics may have some merit.

    3. The Arena seems very skilled on asking questions of visitors.

    4. The Arena seems very skilled in answering theoretical questions posed by its members.

    5. When confronted with simple a language question requesting a straightforward simple response from a visitor. The Arena becomes deafeningly silent (please drop a pin, hahahahahaha).

    Seriously, I expected replies to my theoretical question # 1, some other reply to a different part of the thread or an absence of Arena members from visiting the thread either showing continued interest or getting to the point where my paradigm just is not worth any of your time. I never expected what has occurred.
    Can anyone explain?

    I have a number of theoretical questions that I thought we were going to discuss and so until I understand the current dynamics better, I will post #2 for you to view.

    “Doesn’t The Arena have a Gladiator to go up against me? I said egotistically.” Dennis Shavelson, DPM

    Hahahahahaha
    Dennis
     
  32. drsha

    drsha Banned

    Theoretical Question #2:

    A 16 year old male is referred by his physician for consultation and treatment.
    He is Pain free. He has flat feet and his mother states that he is tired and lazy and would rather play on his computer than a ball field. He is normal height and weight for his age and has no concomitant health issues. The mother also relates a history of lower back problems in the family.

    He has slight callus sub hallux IP joint and the second and third metatarsals are a bit redder than the rest of the forefoot, B/L. He has pain on palpation of the sinus tarsi, an area below the navicular at the insertion of the fan of the posterior tibial tendon and on MP Joint forced flexion, B/L.

    Weightbearing x-rays reveal a low CIA, high T-C angle, slightly hyperperiostotic 2nd and 3rd metatarsal shafts and the first metatarsal is dorsiflexed to its proximal ray, B/L.

    There is excess lateral heel and 2nd and 3rd metatarsal surface wear of both shoes.

    Gait exam reveals a genu valgum, a slightly elevated “Q” angle B/L and lumbar lordosis in the posture.

    What is your biomechanical diagnosis for this patient?
    What is your treatment plan?
    What is your prognosis?
     
  33. Ian Linane

    Ian Linane Well-Known Member

    Hi Dr Sha

    To be perfectly honest I'm really quite bored with the way this whole thread seems to have gone and then to be presented with a case study where there is a raft of issues that is beyond a single biomechanical diagnosis ( if indeed there is any such thing as a "biomechanical diagnosis") is bordering on the ludicrous.

    I'm all for case studies and try to take the view that the intention behind this last post is positive, albeit a reasonable response is wholly unrealistic. I don't mind the big boys getting a bashing, they are masochistic enough to enjoy the fray, but I suspect they are bored as well - which is probably the reason why they are not replying.

    Please present your case studies and please continue to contribute and contradict mainstream or cutting edge thinking but cut out the attempts to prove a point, it actually undermines what you say for many of us lesser intelligent one.

    Cheers
    Ian
     
  34. Dennis,

    There are probably a number of reasons that you have received no replies to this. That there are few validated predictive models that we can employ to "manipulate time" and "look into the future" being but one of them. The model described in my PhD thesis could be employed to predict those individuals who are likely to develop hallux valgus within your school populations, within the statistical limits of the model (Spooner S.K.: Predictors of Hallux Valgus: A study of heritabiity. PhD Thesis University of Leicester, 1997). However, the number of independents within the model may make school sceening impracticable due to the time required to take the measures from all of the children and plug them into the model.

    Kilmartin (Kilmartin TE, Wallace WA. Predicting hallux abducto valgus. J.Am. Podiatric Medical Assoc. 1990;9:509-510) looked at using 1st ray position in isolation as a screening tool for hallux valgus. Indeed, this was employed in school screening by him. While the accuracy of this variable in isolation is unlikely to be as accurate as the model that I described, first ray position was high up in the list of predictors of hallux valgus within my model. Obviously, taking only one measure, should be quicker and cheaper than multiple measures, so if time was an issue (as it's likely to be in school screening) perhaps the best way should be to take the best predictor from mine, or any other predictive model and employ them in isolation in school screening for hallux valgus, or any other pathology, but the accuracy will surely be lost and resources wasted. Obviously there are inter-observer reliability issues here too if a number of screeners were to be used.

    Once individuals at risk of developing hallux valgus are identified the problem then becomes preventing the deformity. Current best evidence suggests that within a juvenile group, night splints should be the first line of therapy. But the real long term solution appears unknown.

    Obviously this approach is for one specific pathology, to screen for all pathologies should likely be impracticable. Perhaps if you name the pathology you wish to screen for, we may be better placed to help you.

    What is your answer to the question?
     
    Last edited: Nov 8, 2008
  35. Thought you said he was pain free?
     
  36. drsha

    drsha Banned

    Simon:
    The patient has no pain in life or function, just pain on examination.
    Like if I poked a finger in your eye, however, that would not be a tip to future problems, I don;t think?
    Dennis
     
  37. Dennis, thanks for that. What is your answer to question No. 1?
     
  38. drsha

    drsha Banned

    Simon:

    Do you expect my answer to come so easy now that you have been elected (or self appointed) Gladiator?

    Hint!!

    If you profile the candidates into types. that may lead to the development of type-specific protocols for treatment and prevention.

    If I have no other respondants to my challenge..in two days...

    I will give my answer and I will list #3 and expect The Arena to pick a winner to #1.
    Still Bored Ian?
    If you are, its the weekend (at least here in America), get LAID! or find something else worth doing, and go away!!
    hahahahahah
    dennis
     
  39. drsha

    drsha Banned

    In my years of practicing Dr. Root’s paradigm, I watched it get diluted, waste away and become unappreciated.
    I watched the universal 3 degree rearfoot skive become a commandment.
    I watched the forefoot post disappear.
    I watched his work on the phasic activity of muscles being avoided.
    I watched his bloodline lose focus on what he was thinking and where he wanted FLEB to go.
    I watched his work become OTC, shoe store, ski shop snake oil.

    In a desire not to see this happen ever again (as I see the sharks continue to swim in the Biomechanics ocean), I asked my self, what could Dr. Root have done to prevent him from seeing his name spoken when referring to unproven, old fashioned, stale and worn paradigms instead of being appreciated as The Father of it all.

    “He Should have PATENTED!!!!” Dennis Shavelson, DPM

    Ian Linane Stated:

    I don't mind the big boys getting a bashing, they are masochistic enough to enjoy the fray, but I suspect they are bored as well - which is probably the reason why they are not replying.

    Dennis Replies:

    I am not sure what role you play in The Arena. Perhaps the Master of Ceromonies?
    As The Arena has assumed and prejudged so much about me, as The Arena can subjectively read the minds of its members and even those far away and unconnected.

    I have to say you have read my mind Ian.

    I AM SO BORED after one month visiting The Arena and reading about robots and moments, blah blah blah blah blah blah blah blah blah!.
    I leave you all with my final quote:
    “Goodbye and Good Luck” Dennis Shavelson, D.P.M. (plagiarized from David Brinkley)
     
Loading...
Thread Status:
Not open for further replies.

Share This Page