How Far Have We Come in Podiatric Biomechanics?

Dave:

Welcome to the world of getting papers published in peer-reviewed journals. The author is at the mercy of the reviewers and to the standards of the journal.

As Simon noted, Basmajian's paper is quite typical for this period within the scientific medical literature. All you need to do is read Manter's, Hicks', and Elftman's papers on the midtarsal joint to realize how poorly the methods are reported in these "classic" papers from a similar era. However, like Basmajian's paper, these shortcomings do not make these papers any less important to the history of medical literature regarding foot and lower extremity biomechanics.

I think what is even more impressive about Basmajian's 1963 paper on plantar intrinsic muscle function is how few papers have ever been done on the electromyographic activity of these muscles of the foot. You will probably find that Basmajian's paper is the only paper ever done that has investigated the electromyographic activity of the plantar intrinsics under varying loading circumstances. I would certainly think that we should give Basmajian a lot of credit for his pioneering work in this field, especially in consideration of the near total lack of similar research done in the 45 years since this paper was published.

 

Hi Simon

Don't know if this is of any benefit for folks on the muscles alive. For those who don't know what the book is. Hope the link works.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1897321

Ian

 

Kevin, Simon

I agree that the style of that time is very different to today and indicates how we have changed our standards over that time. Is this a good or bad development in your opinions?

Hicks- Mechanics of the foot - SUMMARY
1. The plantar aponeurosis at its distal end is attached through the plantar pads
of the metatarso-phalangeal joints to the proximal phalanges. The attachment is
mechanically very strong.
2. When the toes are extended they pull the plantar pads and hence the aponeurosis
forward around the heads of the metatarsals, like a cable being wound on to
a windlass. The arch is caused to rise because the distance between the metatarsal
heads and the calcaneum is thereby shortened.
3. The toes are forced into an extended position in toe-standing and walking by
the action of body weight, and the arch is caused to rise by this ligamentous
mechanism without the direct action of any muscle.

This paper had a simple format but its conclusions were reasonably extrapolated from the experimental data, unambiguous and difficult to refute.


Basmajian - Role of muscles in foot architecture. - Summary
Simultaneous electromyography of six muscles in the leg and foot in twenty subjects reveals that only heavy loading elicits muscle activity. Loads of 100 to 200 pounds on one foot are borne easily by passive structures (ligaments and bones) that support the arches. With 400 pounds, the muscles do come into play, but even then many remain inactive. The first line of defense of the arches is ligamentous. The muscles form a dynamic reserve, called upon reflexly by excessive loads, including the take-off phase in walking.

The format is similar to Hicks but the nature of the experiment is quite different in that relies on collection and analysis of electronic data of bio-feedback. This requires precise reliable protocols. Although in general terms the conclusion is probably correct the experimental data does not, in my opinion at least, reasonably enable these conclusions to be extrapolated.

Would we allow a paper like this nowadays? Does not allowing such a format restrict our ability to progress? Should we be allowed to make leaps of logic in our experimental conclusions? Do these leaps allow faster progress or confound the scientific method and cloud our understanding?
Just because this paper turns out to have conclusions that represent what we see as correct today does that make it better in retrospect than it was in 1963?
How would you have critiqued this paper in 1963 without the knowledge of today?

Although limited by techology 45 years ago thay were not limited in scientific methodolgy, were they? Has writing methodology (by this I mean the way we format, write and present a paper) evolved into a 'higher' state over that time. Do we innately demand more of a scientist now than then?

Cheers Dave

 

In my 15 years of reviewing papers for scientific journals, I would easily accept such a paper for publication. Why? Because no one has ever done such an experiment before, to my knowledge. And such experiments may stimulate others to do more refined research in the future. There is no doubt in my mind that this paper should have been published in 1963 and I still think it is valuable for us in 2008.

 

I know this is an old thread but I Just wanted to add...I'm not what you would call a 'mature' podiatrist, in fact, I wasn't even born in 1983! But unfortunately a lot of the concepts you outlined are the exact same ones that I was taught. I graduated 2011.

Thank God for this forum!!

 

Nice bump Miss B

Reading that list depresses me. Not because we have not moved on, we have. But as MissB points out a lot of this stuff is still being taught.

I fear that those of us who have suffered the epiphany which Kevin alludes to have done our colleagues a diservice. The gulf between the "get its" and the "don't get its" in biomechanics is huge. People like Kevin, Eric, Simon and Craig have moved out ahead... but the pack is still limping along in the 70s as MissBs post indicates.

I don't know the solution.

Oh and MissB? You've made some good posts on some good threads. Time to start posting under your own name I think...

 

Ask yourself this: if it is perceived that Kevin, Eric, Craig and I (I think you do a disservice to yourself and others here in their omission, btw) have moved out ahead, how have we done this?

I'll give you a clue, it didn't happen overnight, it certainly didn't happen without hours and hours of study and a dedication to the subject that would make Roy Castle proud.
http://www.youtube.com/watch?v=GilqqHC0SQ8

"You can have it all, but how much do you want it?" - Oasis- supersonic :drinks

 

Had a huge crush on Roy when I was 7. Frequently wrote to him to ask if I had beaten the world record on many things, including keeping the largest collection of stick insects...Still have the signed photo.

 

So now we have a good list of the historical podiatry biomechanics dogma.

How about creating a list of current dogma?

Walk this way.

Bill

 

No doubt! And no disrespect to all the great people I didn't name. I just think the gap is a little wide thats all.

 

Ok, I'll start

An object at rest will stay and rest, and an object in motion will continue with unchanging motion, unless acted upon by external force.

Marty Feldman?

 

I'd add his others and the work of Hooke, Cauchy and Young too.

 

I actually think that the number of people with a more sophisticated understanding of foot and lower limb biomechanics is increasing year on year, due in no small part to the activities of those willing to share their knowledge and experience in this field and to forums such as this.

 

I think that the word 'dogma' was a bad choice of word on my part (actually I am not sure it ever did describe the views of anyone who was, in any way, involved with the teaching of biomechanics in britain at least). The word got stuck in my head from an earlier posting, as I was scanning this thread. Having gone back to look at it a second time I see that the author had put inverted commas around it.

To know how far we've come needs us to establish a starting 'pont' and and end 'point' (now). As this survey is being carried out in the form of a list (with all its strengths and weaknesses) it would be useful to have a list of contemporary concepts in podiatric biomechanics for comparison with the past and for future comparison.


[B]Contemporary Concepts in Podiatric Biomechanics[/B]

Bill

 

To figure where we are now would require a consensus as to what everyone believes now. Some of us may believe in one paradigm and others may believe in a different paradigm. Some people still believe the Earth is flat. The history of progress of science is an very interesting study. Kuhn's on the nature of scientific revolutions is a fascinating read. We will always be in transition.

Eric

 

Dear Eric,

Nail on the head.

There is no contemporary consensus as there was no historical consensus. I would expect a list of historical concepts to include contradictions, misunderstandings, individual modifications and additions, etc..

If any sense of a consensus emerges in the historical list it should lead to a bit of head scratching. How come we have an historical consensus?

However if it's acceptable to list the historical concepts I would imagine that it's equally valid to create a list of contemporary biomechanics concepts and if it gives a consensus view either the understanding or misunderstanding is perfect or there is a problem?

Bill

 

I graduated in 2006 and was taught most of what you were taught!!

Everything I use I learned in continuing education workshops (including yours Kevin) and seminars or from reading papers and using my own brain to think through a 3d puzzle.

Unfortunately Root and modified root were not just footnotes to show us where we came from.

I learned that if I wanted full marks on a test for a biomechanics question, or a clinical instructor to approve your orthotics prescription, post to calcaneal vertical. Always. They won't mark it wrong. Always use moderate fill. Well most of the time. If it is a severe pronator then you can throw in deeper heel cup and minimal fill. Maybe a skive. Might actually get you a bonus! Or a severe supinator, then flexible shell with maximal fill. And that's all folks! Because we wouldn't want to over-correct. And 10/10 mark is achieved!

Some PURE GEMS

Orthotics work by controlling pronation (or supination, but we don't really understand how to actually achieve that because it's so rare). Pronation is bad.

High arched/supinated feet are really really rare and only need help with shock absorption (accomodative CFO).

Allow 3 degrees of motion (ie possibly even pronate the foot slightly while casting, or don't fully correct them, or post slightly valgus, we MUST avoid over-correcting, they need to pronate that much to shock absorb)

Don't correct more than 4 degrees.
Only correcting me 4 would leave me still in horrible pain and seeking a below knee amputation as orthotics clearly don't work.

Some colleagues are aghast I do not measure to determine my (rearfoot and intrinsic forefoot only, never to sulcus) postings!
We were taught though bisections were somewhat subjective, they are a qualitative and oh so valuable... see above...
We were basically frightened away from anything but calc vertical to avoid "over-correction" as we might cause an ankle sprain.
The forefoot falls in line if you control the rearfoot, some colleagues are still shocked that I order mortons/forefoot varus/valgus extrinsic posts...
Well, they said they make the foot work around the STJ neutral position. Not in it at least, all the time...
Taught many other bits too, or grazed them in a slightly more modern form.

 

That straw man, doesn't make anything that you do right or proven for that matter.

Yawn

Dennis

 

Dennis, is the reason that you keep coming back to the arena is so that you can learn debate tactics? yawn, straw man ( Straw man, there's an icon we need). How is what Kevin said a straw man argument. Those were all things that were taught at the College where Kevin and I were students. A straw man argument is where you misstate your opponents beliefs and then attack those misstatements. For example stating that tissue stress is a paradigm where we just wait for pathology to happen before treating. That's an incorrect characterization of tissue stress. At least use the criticism correctly.

When will you learn to defend your position and answer questions about your paradigm? That's another strategy that we use. How do you use foot typing to alter how the orthotic is fabricated for one foot type as opposed to another?

Eric

 

Yawn.

Dennis

 

Lets keep this thread on topic what? We've more than enough threads on FFT.

 

Your posting proves the old adage that Love is Blind Robert.

The love and passion for your work and that of other self proclaimed leaders of Modern Biomechanics professing tissue stress and SALRE and Kevin is so exposed.

My two posts here made absolutely no reference to FFT, as that was my agreement about posting onThe Arena (which you yourself violated by yawning on my recent threads BTW).

A Dennis Shavelson post has become equatable with FFTing but you say there's nothing personal or biased in your bones?

Shame on you yet once again.

Dennis

 

Your posting proves the old adage that Love is Blind Robert.

The love and passion that you and other self proclaimed leaders of Modern Biomechanics professing tissue stress and SALRE and Kevin as leading the way instead of your Newtonian smoke screens is so exposed.

My two posts here made absolutely no reference to FFT, as that was my agreement about posting on The Arena unless violated (which BTW you yourself violated by yawning on my recent threads).

A Dennis Shavelson post has become equatable with FFTing but you say there's nothing personal or biased in your bones?

Shame on you yet once again.

"But love is blind, and lovers cannot see
The pretty follies that themselves commit."
William Shakespeare


Dennis

 

I believe that you are correct not just for tha CCPM but for most of the other schools programs as well in America.

DPM's are being pounded by stale, old technology biomechanics that is no longer innovative.

My question is this, as his sign off on The Arena, Dr. Kirby credentials:
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

as if to intimate that he is having influence on the biomechanics being taught at CSPMSMC.

How can that be explained when contrasted to what you claim to be being taught?

Dennis

 

Well Dennis, my guess would be that the taught syllabus in California, USA has absolutely no bearing on the education one would receive if attending University in Manchester, UK...

 

Actually, if you look carefully you'll see the person I quoted in my post, and thus was addressing, was Eric not you. He was the one who mentioned FFT, I asked him not to. Ironic that you should accuse me of blindly loving "self proclaimed leaders of Tissue stress" when I was actually asking him to cease and desist.

I wasn't even talking to you, yet you take umbrage. That you presume personal attack from that is perhaps less a sign of personal vindictiveness on my part as paranoia on yours?

You have me muddled up with a whole other body. If you look carefully, you'll see I took no part in the yawning nonsense. Seems a poor way to answer a criticism to me. Once again, you're assuming I'm victimising you. I'm really not. :boohoo:

Actually, what you've done here is make that true. An FFT point was raised (by Eric) and I asked him not to. DS is not in this equation at this point. But by claiming victimisation you've presumed that an FFT post is equatable with a Dennis Shavelson attack (which of course its not). The irony is almost tangible.

 

Ian G, Excuse me! I taught in Manchester from 1980-1987, at a time when "Root Biomechanics" was coming and going. I honestly believe that we did our best to untangle to good from the silly (it is not appropriate to call it "bad"). Together with my colleagues of the day, all those years ago, I believe that we looked at "Root theory", saw the good bits and taught it well. We also saw the bits that were, well, lacking in scienctific basis, and did our best to explain this to our students. No offencd meant, you have my word. Rob

 

Hi Rob,

I think you may have misinterpreted my comment and the point I was trying to make. Here was the situation as I saw it:

- Miss B stated she what she was taught at University (Root Theory)
- Dennis made the incorrect assumption Miss B was a US trained DPM
- Dennis then used what Miss B had said as a pathetic swipe at Kevin (see his above post #64)
- I was merely pointing out the geographical distance between where Kevin lives and works, and where Miss B lives and works (and I assume trained) and how Dennis 'blaming' Kevin for what Miss B was taught was nothing short of ridiculous.

I was in no way making any comments on any institution or what they teach (and if it would be considered good/bad).

 

David: you are right here. I misinterpreted Miss B stating:
"I know this is an old thread but I Just wanted to add...I'm not what you would call a 'mature' podiatrist, in fact, I wasn't even born in 1983! But unfortunately a lot of the concepts you outlined are the exact same ones that I was taught. I graduated 2011".

To be that she was American Podistry as I guess I assumed that the Schools involved in the UK, AU and NZ were teaching SALRE/Tissue Stress.

I did not have the right to "blame" Kevin for her education and I apologize to hi for that.

The fact that Miss B was receiving so much misinformation during her education raises a question for me and that is how many graduates of UK, AU and NZ schools have not found The Arena and are therefore "Dummies" as per David?

Dennis

 

I don't think I can speak for Eric, Craig, Simon and others. However, I can speak for myself on how I believe I gained greater knowledge in biomechanics over the 33 years that I have been a podiatry student and podiatrist.

1. I attended every biomechanics lecture given during my four years of podiatry school and took on extra work/projects with the likes of Dr. John Weed, Ron Valmassy and Rich Blake when I was a podiatry student.

2. I worked hard by showing interest in the biomechanics program at CCPM and trying to be as good or better than any of my classmates at biomechanics so I could get the one spot available for the Biomechanics Fellowship from 1984-85 at CCPM. [Sadly, the Biomechanics Fellowship that Rich Blake, Eric Fuller and I all trained in has not been in existence now for over a decade.]

3. I worked extra hours teaching students, doing demonstrations, making foot orthoses and reading every paper and book I could find on foot and lower extremity biomechanics during walking and running at the CCPM library during my Biomechanics Fellowship. I lived and breathed biomechanics nearly every waking hour that year.

4. I asked my most respected Biomechanics Professors questions at every opportunity while I was a student and Biomechanics Fellow at CCPM. I even had one of my professors trying to avoid me every time he saw me in order to keep from having to answer my questions. The squeeky wheel does get the grease in life.

5. Soon after I went into practice, I asked Paul Rasmussen, owner of Precision Intricast Labs, to let me write an informational newsletter on foot and lower extremity biomechanics and orthotic therapy on a monthly basis for his orthotic lab. Since October 1986, I have written a total of 298 monthly newsletters, published three books from those newsletters, will publish a fourth book in early 2014, and will soon be publishing three Spanish translations of those books for Spanish-speaking podiatrists. Doing these monthly newsletters over the past 25+ years has probably been the single most important factor that allowed me to increase my own knowledge. Writing on a subject forces the author to become more knowledgeable on that subject. Guaranteed!

6. Publishing papers and doing research with individuals that had greater knowledge than me in certain areas has also allowed me to learn more and develop greater depth of knowledge of other disciplines.

7. Trial and error experimentation and careful observation of new treatment techniques on my own patients in my private practice has helped me develop new tests and new techniques and theories which have, in turn, benefitted other podiatrists and their patients.

8. Being involved in online discussions on the Podiatry Mailbase and Podiatry Arena on a regular basis also greatly improved my knowledge and sharpened by debating skills. There is nothing quite like learning from the likes of Eric Fuller, Simon Spooner, Craig Payne, Bart Van Gheluwe and Howard Dananberg on a regular basis for the numerous years we have been having these discussions. The education I have received and the friendships that have developed as a result of these online discussions can not be measured in any way but to say these friendships and academic relationships are......priceless!!:drinks

 

Up until that time, I had considered Dr. Weed to be "deity-like", perfect in his knowledge, since he knew so much more than I did and his ideas always seemed to make sense to me. This one incident was profound for me in that the man that I most respected in his knowledge of podiatric biomechanics I now found to be imperfect. This event then led me to start questioning and examining all the other things that had been taught to me by him and my other biomechanics professors.

Now, 23 years later, I realize that this event, was an important part of my education and development as a researcher and educator in foot and lower extremity biomechanics. I began to realize that just because someone I respected greatly said it to be so, didn't mean it was so. I knew I had to analyze my own observations along with my understanding of Newtonian physics to see if what I had been taught still made sense.

These types of lessons are very important for our younger generation of podiatrists so that this profession may remain strong in their knowledge in this most important of fields: podiatric biomechanics. Teaching these lessons is exactly what I am trying to accomplish with this thread.


Mahalo Podiatry Arena,

It is good to know where we have come from but much more fun knowing where we are going.

11. An orthotic is only as stable and energy efficient as the foundation it is placed on.

Mahalo,
Steve

Kingetics- Loving True Actions...TM