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MASS Discussion

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Apr 13, 2010.


  1. Members do not see these Ads. Sign Up.
    For those of you non-US podiatrists who may not subscribe to Barry Block's PM News, I thought you might be interested in some of the comments that have been made recently on PM News on the subject of Ed Glaser's "mechanical engineering background" and on his "theory" of maximal arch stabilization with high-arched orthoses Whitman-brace style orthoses. As you can see, at the end of the thread, even Dennis Shavelson gets to take a few pokes at me.

    I really shouldn't be allowed to have this much fun.:rolleyes::butcher::drinks

     
  2. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other thread tagged with MASS Theory
     
  3. Here is the latest two replies from PM News on Ed Glaser and his lab Sole Supports.

     
  4. Graham

    Graham RIP

    It would appear that the MASS needs a biopsy and probable removal!
     
  5. I'm pretty sure producing foot orthoses from foam box impressions is not a fallacy. I made half a dozen this morning. ;)

    Foam casting not well thought of across the pond it would seem?
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    In one of the previous threads about this subject I inquired of Ed if his "truly custom" insoles were in fact the CBAS brand sold to Foot Solutions stores. He admitted it but it didn't appear jump out at anyone else at the time. Drs. Udell and Richie both caught the importance of that one of the major point when considering his real motive; sales. The chiropractic profession has conservatively four times more practitioners than the podiatric profession and far less experience and training in the lower extremity. They comprise a large group of potential unsophisticated adherents to Ed's marketing and Stu's influence as "one of their own". Stu does all of the print marketing to my profession that I am aware of and writes all of the journal papers aimed at them. See:

    http://chiropracticbiophysics.blogspot.com/2009/10/power-of-foot-posture-introduction.html

    http://chiropracticbiophysics.blogspot.com/2010/04/custom-foot-orthotics-are-they-really.html

    Marketing to retail stores a medical device is truly reprobate. These chains constantly sell their wares and negate the necessity of a referral to a licensed and trained specialist. They are staffed with pedorthists who have minimal (at best) education in anatomy, physiology and pathology. I saw a woman recently in my office with a CBAS insole in her shoe who had Rheumatoid Arthritis (undiagnosed) who was told she had metatarsalgia and was dispensed a CBAS insole by one of the same chains that SS markets to and produces their insole for. I did the only appropriate and ethical thing which was refer her out to a foot specialist and a rheumatologist. This does not occur when the shop owner acts as the doctor and dispenses based on greed. Promoting this type of activity is a direct slap in the face of his profession and colleagues in my opinion. My state truly needs orthotic licensure, as does many others.

    I do not know what Stu's bona fides are with regard to foot orthoses but can surmise that his sum experience is based on Ed's teachings and financial interest as an employee of Ed's company.

    The dispensing of "custom made orthotics" in the chiropractic profession is mainly the Foot Levelers brand because chiropractors have been marketed to in a manner that has them believe that there is a connection between the subluxation and the foot by this company. While I do feel that there are certainly alterations in pedal mechanics and gait that can cause lumbosacral symptoms, I do not believe that that design is effective in mediating them. They are 'casted' either from a foam box semi weight-bearing or a ridiculously unsophisticated 'scanner' full weight-bearing (which as we all know has its merits in certain pathologies but does not produce a volumetric negative image of the plantar foot).

    Stu capitalizes on this in his article above "Custom Foot Orthotics: Are they really Custom?". It doesn't take a rocket scientist to portend where he is going with this line of marketing disguised as questioning the other labs methods. The question is what methods does SS utilize to arrive at the correct arch height? In his article he alludes to "Other variables that increase the custom properties of an orthotic include the patient’s weight, the patient’s foot flexibility, and the patient’s activity levels.". No kidding, but what does that have to do with how SS produces a positive model from their proprietary design I would ask?

    The arch height on every one of their devices that I have seen is an extrapolation (to use his own terminology) based on the unusually aggressive height of the medial arch inherent in every one of them. How is that "truly custom"? They appear to negate the increase in arch height by using a flexible subortholene shell which provides less than optimal control. Dr. Gurnick hammers the nail home with thoughts that mirror my own with "the shell length was short and the material was not stiff enough to control the excess midstance pronation enough to induce resupination of the feet prior to late midstance and propulsion." This is the entire paradigm of the SS system, to resupinate the foot during late midstance but I also question the ability of their shells to achieve the major tenet of their marketing.

    I have a lot more to say on the subject but the problem lies in the lack of solid education being afforded my colleagues regarding foot orthoses. Those chiropractors without pedorthic training or some form of additional didactic education should simply refer custom orthoses out to more qualified practitioners rather than reap a profit from the process. They should also question any lab touting a singular, proprietary design based on biased research and marketing with less than solid peer-reviewed research.

    Regards
     
  7. Dr. DSW

    Dr. DSW Active Member

    In actuality, the answer lies in the audience. The less your audience knows about biomechanics, the easier it is to sell your theory. Period.

    I would say that there is a large percentage of the podiatric profession that is not well versed on biomechanics, and I would probably include myself in that group. With some it's simply a matter of a lack of training, with some it's a lack of understanding, with some it's a lack of interest and in some it's a combination of all of the above. (I will use the excuse of a lack of good biomechanical training!)

    Therefore, it's pretty easy to "sell" a less than knowledgeable DPM and even easier to "sell" an even less knowledgeable DC your new product with all it's bells and whistles. That's especially true when all you have to do is use a foam box, vs. a more "sophisticated" method of capturing the deformity/foot.

    Dr. Glaser must be commended for knowing his "audience" and moving in for the kill.

    It's really no different than Walmart marketing the new Dr. Scholl garbage to it's consumers. They see the commercials where you walk up to a shiny, new fancy machine, step on the computer TWO dimensional mat (with your 3 dimensional foot) and lo and behold it magically tells you which Dr. Scholl "module" you need to cure all your foot ailments. You then purchase a piece of flexible crap for $50, that will eventually function as a terrific fly swatter.

    However, Walmart and Dr. Scholl's knows THEIR audience. The uneducated consumer, who is sold on a quick cure for his/her foot problem, without a visit to the doctor, but sees a fancy machine and nice packaging.

    Dr. Glaser is doing nothing different. He has found his target audience. DPM's and DC's (and stores) that don't understand biomechanics, but are listening to his hype and BS.

    Now for those of you interested, ask Dr. Wedemeyer about my bladder controlled/fluid filled orthoses. These will be the next hot item on the market!!
     
  8. Dr. DSW

    Dr. DSW Active Member

    The above post should say my "urinary bladder controlled fluid filled othoses"!!
     
  9. Ed has finally responded to all the accusations against him and his orthosis lab in the latest set of postings from PM News.

     
  10. Jeff Root

    Jeff Root Well-Known Member

    David, below is a personal reply I received today from a podiatrist who read a posting I wrote on the PM News forum. My initial posting was a direct reply to a podiatrist who had a question concerning orthoses for a symptomatic ice skater (tailor’s bunion with 5th met pain). I will not name the podiatrist who sent this to me, but I think the international podiatry community might be interested in the attitude of some podiatrists concerning prescription foot orthotic therapy.

    He wrote "I suggest you keep your opinions to non medical personnel in non medical venues. Arch supports are at the very distant interest of real DPM's. You may have been able to fool the podiatrist of yesterday, but today we laugh at the idea of an arch support (oh, excuse me, a custom orthotic) for ice skates, high heels and most other conditions. Opinions by even well known arch support believing podiatrists are in conflict with each other and we laugh at those elementary, unfounded beliefs. Please, stay away from opinions that you have a money interest in. It's so obvious. Can't you find a C.Ped, Chiropratic, or PT venue to pedal your wares?"

    What I find so interesting is the fact that if my primary objective was to sell more orthoses, then I would be marketing them to other potential distribution sources. With all due respect to the other specialties mentioned, is there any one of them that receives the same level of education and training with respect to foot orthotic therapy and biomechanics as podiatrists? On the other hand, I believe that attitudes like the one expressed above have the potential to create a new niche if this is any reflection of the future attitude of podiatrists.

    Respectfully,
    Jeff Root
     
  11. Jeff:

    Don't worry, I have quit responding to same podiatrist (RB) due to similar personal e-mails he has sent me. The good news is that now all his e-mails go into my spam box, where his thoughts belong.:drinks
     
  12. Griff

    Griff Moderator

    Slightly off topic from MASS (and possibly worthy of its own thread) but the post above from Dr Ray McClanahan intriuged me so I did look him up as he so modestly suggested. His website confused me a little - he seems to be a huge believer in how we were designed to be barefoot and how orthoses are unnecessary... and of course he has invented the answer to all of our problems (which almost paradoxically he recommends we wear in our shoes). May I introduce 'Correct Toes': http://www.nwfootankle.com/home/toes/101
     
  13. I saw that Too Thanks for finding the link- So tibialis posterior overuse treatment spread the toes. How does that reduce the Subtalar joint pronation moment I wonder?
     
  14. How original! And there I thought nothing could surprise me any more.

    I wonder what the evidence he alludes to is. Perhaps we should ask him.

    Loving the articles

    http://www.nwfootankle.com/home/FootHealth/drill/2/113

    lots of fizzics.

    Apparently arch supports are not arch supports because they only support in the middle instead of pushing in at either end. :drinks
     
  15. Found it


    http://quoindesign.com/nwfootankle/FasciosisTreatment.pdf

    So there you go. Evidence. Abduct the hallux and you release the tension on the flexor retinaculum, the post tib opens blood rushes to the heel and the planter faciosis heals. QED.

    Shame on you all.
     
  16. StuCurrie

    StuCurrie Active Member

    I have to admit that I am continually intrigued by the underlying level of vitriol in these threads and posts. I realize some may feel that it is justified by what is perceived as the clash of marketing with long held beliefs, but I wonder how many other topics raise this level of animosity? I have heard it said, that in few other professional debates would you find the level of ad hominem criticism that hovers around this topic. I might suggest that the debate in the community is so contentious because of the financial interest of all involved, blended into a relative vacuum of evidence and salted with the conflicting outcomes of the treatment in question. Perhaps too, this harrying is a function of the Forum Medium, where people do not know each other all that well on a personal level, and can debate without the normal social deference that happens in face-to-face conversation.

    David, I think we both would agree that any debate between us would result in some wasted breath on both sides, but in the interest of fact checking I would like to answer some of the questions you have posed in your post.

    The practitioner’s prescription, in the form of a cast of the foot in the corrected MASS posture, unaltered by the lab.

    I consider these factors important in the manufacture of a custom device (and I think are saying that you do too), and primarily result in changes to the calibration or flexibility of the shell.

    By extrapolation I was referring to the manufacturing process whereby the final orthotic shape is derived from some piece of data (i.e. plantar pressure data), rather than the volumetric 3D negative of the foot. Extrapolation is not part of the Sole Supports manufacturing process.

    The shell length is made to the proximal met heads of the foot in the corrected Mass posture. On an individual orthotic level it is always possible to have an orthotic that is "not stiff enough" or too stiff even. This is one of the intricacies of designing a custom device and it is not a function of the material only.

    More education and knowledge is always a good thing. I might suggest this statement does not give enough credit to some of your colleagues who do indeed understand the concepts involved.

    I hope that any practitioner adhering to any theory would question that theory as a part of their regular course of self-evaluation.

    There were 3 articles published in JAPMA in 2008 that were sponsored by Sole Supports. This is considered a peer-reviewed journal. Now, a greater debate might ensue about corporation-sponsored research, but research costs money, and in our current system much of that money comes from corporations in the form of donations to University programs. In this case, Michael Pierrynowski is a very highly regarded researcher and leader in the field, his ethics are beyond reproach, and any implication otherwise is misguided.

    Sincerely,
    Stu
     
  17. Griff

    Griff Moderator

    Heres the link to previous discussion on these articles for those who may have missed it the first time round. (Posts #58 thru #73)

    Prefabricated Vs custom made foot orthoses
     
  18. David Wedemeyer

    David Wedemeyer Well-Known Member

    Jeff,

    Hello and thank you for sharing that and your response. It illustrates a more pervasive problem than the topic itself and that is interprofessional respect and respect for allied health fields. I have witnessed the same disrespect that some surgically oriented podiatrists show for the conservatively focused DPM’s being displayed by MD foot and ankle specialists for podiatrists and so on. It is not lost on me that the more expansive egos favor hurling diatribes at the very methods that they possess no real acumen in or broad understanding of. Isn’t the term for that prejudice?

    The comment that custom orthoses are not medical devices alluded to by this particular person is based on his own myopic view of patient care I would guess and express my own personal horror at. I suppose that the foot plate of an AFO (which is by definition a custom orthosis) is then not a medical device and that conservative intervention is not at all necessary prior to surgically repairing posterior tibial tendon dysfunction? I suppose that all DPM’s, DC’s, PT’s, Orthotists and Pedorthists are charlatans then based on the letter authors comments? Considering that over 90% of the orthoses that I provide that are accompanied by an MD or DPM script and are referred to my office then this particular megalomaniac would really be surprised at how many “medical professionals” are in disagreement with him.

    It is attitudes like this dilute the public trust in and the professional equity of the health arts. He should venture off of his throne and look around at allied fields and what they have to offer and more importantly what is currently being offered by his colleagues. Of course that may not be profitable to his practice or soothing to his expansive ego.

    The comment “Can't you find a C.Ped, Chiropratic, or PT venue to pedal your wares?" is particularly offensive to me professionally both as a practicing chiropractor and a certified pedorthist. Although we are not as well trained as podiatrists in pedal biomechanics and treatment and do not perform surgery, he infers that chiropractors are somehow incapable of the same level of understanding of the subject. We did receive more than enough education in the human anatomy, physiology, biomechanics, pathology and diagnosis to adequately understand the subject. Trust me, no one who ever graduated with a chiropractic degree is a village idiot, our didactic education was just more focused on the human spine. Making the leap to treating the foot conservatively is neither out of our professional grasp nor outside of our license.

    Lastly, judging by the quality and content of that letter author’s syntax and vocabulary I wouldn’t allow him to perform surgery on my enemy’s pet hamster.

    Jeff that may not be a completely unreasonable idea or business decision. Unfortunately, many of your colleagues are completely uninterested in orthoses and biomechanics where it was once a mainstay of the podiatric profession.

    Regards
     
  19. David Wedemeyer

    David Wedemeyer Well-Known Member

    Ah, the Dr. DSW UBCFFO! Our old friend never did make it back here after that discussion did he? I found a pair of his exceptional silicone dandies in my closet the other day and stopped and reexamined them. Same outcome; they're crap!
     
  20. efuller

    efuller MVP

    Another reason that podiatristts don't "understand" biomechanics is they may have been exposed to an incoherent theory. For example, Root theory has two definitions of normal. Forefoot to rearfoot relationship is not a repeatable measurement across practioners. The definition of neutral position of the STJ as not pronated nor supinated is no definition at all. The foot described in the biophysical criterea for normalcy (the "normal foot") is exceedingly rare. I'm sure that there are many other examples in the threads of where there are inconsistancies in the theories that have been taught over the years. It may not be the student that is the problem, but the paradigm that is the problem. In speaking with classmates, and later students, there were many who got good grades yet felt that they did not understand the material.

    There are some very good observations, for example not fully compensated varus that are an excellent explanation of what is seen. Interestingly, you don't need neutral position to explain uncompensated varus. Neutral position just clouds the issue. All you have to do is understand the anatomy.

    Regards,

    Eric
     
  21. Jeff Root

    Jeff Root Well-Known Member

    Eric, in spite of the limitations, the work of Root, Weed, Orien and Hughes turned out some excellent podiatrists and some of podiatry's most highly respected educators. The challenge of today is, what and how should the schools be teaching students? And who will update and revise this information for the students of tomorrow? Who will write the next textbooks for the students so they will have the benefit of an organized education that will lead to them becoming good clinicians?
     
  22. David Wedemeyer

    David Wedemeyer Well-Known Member

    Stu perhaps it is your unwavering adherence to your employer's insulting and ignominious vitriol leveled at Root and other theories presented in your pop can marketing that evokes such responses? At some point one needs to look inward when the diatribes continue to flow in effluence. I am not saying that MASS does not have any merit whatsoever, I simply refute that it is a new design, it is not. I also refute that it is effective for the wide variety of clinical applications you lay claim for and that we see and mediate with orthoses in daily clinical practice. Further after inspecting your devices I am not convinced that they perform as suggested. My experience with your companies product mirrors Dr. Gurnick’s above.

    Your marketing, target audience and self-serving research is what led me personally to be skeptical of the motives of your company. Instead of just presenting his own theories and design to your market, your founder engaged in his own ad hominen assault on Root theory and proposed that everyone else just plain had it wrong and that his new (sic) MASS theory was the panacea.

    Always a pleasure to have you drop in and contribute Stu. Oddly the only time that we see this is apparently when your threat radar is set off by criticism of your product and motives. Could I encourage you to do this on a more regular basis and perhaps open your eyes that there is much to be learned beyond the company that employs you and to heed your own words and question why so many learned practitioners are resistant to the SS design.


    And by prescription do you mean a canned, one arch height design based on your own paradigm or the standard modifications in wide usage such as a medial skive, first ray cutout, inverted cast, shell choice by the practitioner etc? Oh wait, by prescription you mean YOU choose for them. Now that's truly custom!


    Shell flexibility and material properties are an important feature of the comfort and performance of any truly custom device, on this point we agree. You offer one choice, subortholene. Same shell, same flex, same material properties for every patient. I have held a few SS insoles in my hand so I am familiar with your material. I have also witnessed a similar number of failures of your design in my own practice. Almost all of them came from a local large pedorthic chain branded under the CBAS moniker. How you can state that you are committed to patient care and truly custom orthoses and rebrand your devices for sale to retail outlets is beyond me? Apparently others are now seeing this as a major flaw in your mantra that you fund research to validate your paradigm and then on the other hand backdoor your devices into the market through retail pedorthic outlets and the offices of providers with zero training in the subject. Does anyone else see the conflict of interest here?

    There is also the question of forefoot valgus which I encounter more frequently than true varus in practice. How on earth can the MASS position (which is a varus forefoot attitude cast into the foot) mediate this or most especially the intricacy of both uncompensated and compensated forefoot attitude and produce reliable results. I could conjur up numerous pathologies that many here would disagree your design is appropriate for and yet your one material, one arch, one concept catch all product mediates them all? I feel that due to the inherent degree of compliance of your devices you have simply chosen accommodation over control.


    We agree to disagree that foam box casting is the preferred method for a negative impression. I use foam for diabetics or when compliance (accommodation) is more important than control. I feel that you promote foam as a casting medium because it would be very difficult to get your market to embrace plaster casting, it is time consuming and a messy process. Tom Michaud has been doing some research of foam vs. plaster neutral. Dr. Richie recently published an eye opening study on the two mediums. Your opinion of these would fascinate me.

    Also not every lab extrapolates data and any of the labs that I have used offer a no arch fill option and tight contour to the cast. I use a high arch or inverted cast on certain pathologies so I do have some sympathy for this concept but to suggest that I use ot for every foot is ludicrous.Those labs which rely on imaging and poor imaging at that exist and use algorithms and libraries we are all ware of that. I can name numerous labs which do this but they do not represent the PFOLA standard for a custom device. It is a problem I agree but by knowing how they produce their positive and selecting a quality lab is not a difficult bit of investigation. It makes for a topic for submission to a chiropractic journal and to market to the less sophisticated practitioner but is hardly anything new or newsworthy.


    You cannot turn this around and try to imbue that I have less than the utmost respect for our colleagues who do in fact understand the concepts involved. We both know that there are few in our ranks that focus on this subject. Read my previous post to Jeff Root. The problem is that as a collective group our profession has a very low level of exposure to the subject and companies such as yours promote reductionist marketing to keep it appeal and gain more adherents. It is not a simple concept, but suggesting that you have all of the answers built into one device and method which relies on a corrected casting position not in wide usage is fallacious.


    "If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright. My own footer on all of my posts. Can you really say the same Stu?


    Would you be so kind as to post those studies here for our perusal?
     
  23. Griff

    Griff Moderator

    Here you go David

    Ian
     

    Attached Files:

  24. I think Leslie Trotter earned her salary very well with Sole Supports with doing these papers to show how great Sole Support inserts are.;)
     
  25. Ah yes. They certainly knocked the 3mm open cell foam dead flat insoles (from the Sarah Lee Catalogue if memory serves) into a cocked hat.

    In fact, since that study I've stopped using 3mm flat insoles to treat Plantar Fasciitis altogether. :drinks
    :good:

    When someone comes in and tells everyone else they are doing it all wrong (and in none too civil terms), what response do you expect?

    Hey ho.
     
  26. efuller

    efuller MVP

    Jeff,

    I have tried to be very careful to criticize the theories and not the individuals. My own feet have benefited from the work of the people you mention. That still does not mean that their theories are coherent. They found some things that worked and then tried to explain why they work. They deserve a lot of credit for finding what works and educating people about it.

    What should be taught is an interesting question. Craig Payne wrote about this many years ago. (I can't remember the whole title but it had biomechanics and uncertainty in it.) I recall that some have said that none of those pioneers said that an orthotic "holds" the foot in neutral position. However, there was a post in the last month talking about neutral position cast holding the foot in neutral position. I haven't published the study, but I did look at a series of patients standing on neutral position orthotics and none of them stood in neutral position. We should not be teaching that casting a certain way will hold the foot in a certain position. This is also the problem that I have with the MASS technique. There is a belieft that a piece of plastic under the foot will push the foot into the exact position that the foot was casted in. Yes, the orthotic pushes on the foot, but we should do some engineering anaysis to better assess where we should push. Perhaps that is a topic for another thread.

    Eric Fuller
     
  27. efuller

    efuller MVP

    So, he challenging folks to a debate. We had that debate on this forum. I'm having trouble finding it. That debate should be posted on podiatry management.

    Eric
     
  28. David Wedemeyer

    David Wedemeyer Well-Known Member

    Ian,

    Thank you.

    I have now read all of the studies Stu referenced. I have also carefully considered what Eric wrote regarding criticizing the theories and not the individuals. I am really trying here, but Stu failed to mention Leslie Trotter. Michael Pierrynowski is probably everything that Stu claims and yet I find his omission misleading being that she has a financial interest in the SS company. What is the point of doing research of this type other than to promote your brand? I cannot view any of these studies as anything but another marketing ploy on their behalf. All of their "research" employs the same agenda; to promote his methods, theories and lab.

    Robert,

    The Sara Lee reference evaded me until I read the studies. 4mm open cell spongecake vs. subortholene insoles casted via Rhesus monkeys in a weightless environment with exsanguinated bologna top covers should be the next landmark study

    :rolleyes:
     
  29. EdGlaser

    EdGlaser Active Member

    Kevin, Doug, and their sheeple.

    Please let me summarize:
    MASS Posture theory is correct so therefore one must criticize:

    1. Is it New... or who gets credit for it? I frankly don't care. Whatever contribution I have made to MASS Posture theory.....great. You will notice that MASS is not trademarked.....it is my gift to the science of LE biomechanics. Root said that "(Neutral Position) is what turned out to be the key to my being able to contribute to Podiatry"......and by your own admission, after you learned it from me, Neutral is the wrong position to put the foot in. He was a great man and deserved the title of "Father of Foot Biomechanics". I learned much from Root, Orien and Weed and Sgarlotto as well and many other dedicated researchers. MASS Posture is New, Full geometric contact with the foot in the maximal achievable supinated posture at midstane while the heel and forefoot are still on the ground is New. I can't remember anywhere in Whitman's article where he described any posture like this. Soft tissue compression as a component of casting is not new but we have applied it differently. Calibration of the shell as a function of body weight, forefoot flexibility and momentum is very New.
    And we are coming out with some awesome new technology soon that will blow everyone away. I suggest that people look at our Sole Suports TV channel on youtube, and please subscribe;

    http://www.youtube.com/user/solesupportstv

    Where you will find some of the leaders in our profession talk about their personal experience with Sole Supports, Inc. products.

    http://www.youtube.com/user/solesupportstv#p/c/CE901224FEE3B973/5/CwzTR39EIG4

    http://www.youtube.com/user/solesupportstv#p/c/CE901224FEE3B973/3/F2JPxd9q6r4

    http://www.youtube.com/user/solesupportstv#p/c/CE901224FEE3B973/4/ASPuH4nrBu4

    http://www.youtube.com/user/solesupportstv#p/c/CE901224FEE3B973/2/RvE-kkHutuQ

    There is also a series called “Legends in Podiatry”. There is a funny piece where I talk about the moment arms around the sagital plane axes of the foot and their influence on plantar fascial tension. I am costumed as a Giants Coach and speak in a NY accent. There is a lecture that I did at the Miami School Dec 09. I teach regularly at NYCPM, OCPM and occasionally at Temple. Dr. Chip Southerland gives a thoughtful introduction. He is really one of the great minds in biomechanics, surgery and a real humanitarian. We are also doing a documentary on the Yuccatan Crippled Children’s Project (founded by Chip) to help further his humanitarian efforts. (BTW: his book “De Opresso Liber” is a heart pounding adventure…..a real page turner well worth reading, I am ordering his new book on Amazon….can’t wait). Look for more fantastic videos on the Sole Supports TV channel on Youtube coming soon. We have our own TV studio and a full time videographer to help us partner with our clients to bring relief to more of their patients and grow their practices with the use of creative video assets and marketing tools. We don’t just supply orthotics: We help our clients Make more People Better.

    2. What did I wear for halloween or some TV commercials 25 years ago or maybe for the last Relay for Life Cancer benefit we sponsored (where I dressed like a woman)...I have photos but I warn you they are not pretty. Actually those TV commercials were very effective. The public certainly voted on them with their feet by bringing in over 100 new patients per month. Sorry, I never did wear a bunny suit or a clown suit. I did however wear a Tuxedo and do a series called the Podfather. If anyone wants the script I can reproduce it....It was so good that it was played at the CLIO awards. Another series I did was called the Wonderful Wizzard of Gauze. These were professionally costumed and completely sung to the tune of “If I Only Had a Brain”.
    I even occasionally did some impromptu stand up comedy. It was great fun. I am sure some stuck up sourpusses hated my commercials. I hope that they went elsewhere for treatment. I got the fun patients.

    3. Am I a Mechanical Engineer?: NO, I never said that I was. There is no “M.E.” after my name. Where were the real facts to be found….on my CV…. Who wrote that….Let’s see…..could it be myself. Yes.. I now have five engineers who check my math, physics concepts etc. I think I have that base covered.

    4. I sell to Chiropractors. So does almost every lab in the country including Prolabs. We know because we called them and asked them. KLM takes ads out in chiropractic magazines. April 11th Langer, who has been bought by a Canadian lab called The Orthotic Group, hosted a seminar with Dr. Justin Wernick (DPM former owner of Langer and Chief of Biomechanics at NYCPM for about 25 yrs.) and Kim Ross, DC who has long been the spokesman for TOG to Canadian Chiropractors.
    This info does not jive with their web info but it was on the direct mail piece they sent to me. Maybe they fired Wernick or hired him….I have no idea….. http://www.theorthoticgroup.com/TOG-Professionals-Seminars.html
    It looks like they have another DPM….Alan Lustig speaking for them now.

    Does Podiatry own the science of biomechanics? Kirby himself said the only 25% of DPM’s in his estimation were adequately trained in biomechanics. It seems to me that knowledge is not sacrosanct and belongs to who ever wants to know it. Superior patient treatment should be offered to every practitioner for whom it is in his or her scope of practice to prescribe, cast for, dispense and treat with foot orthotics. This is the ONLY right thing to do in the best interest of the public’s health. Why shouldn’t everyone be offered a choice of products to offer their patients. Besides if you thought I was making an inferior product why would you worry? Are you complaining that Foot Levelers sells to chiropractors…..NO……. because you know that MASS theory is correct……otherwise it wouldn’t bother anyone. If MASS theory and posture were so bad, didn’t work so well, then no one would complain about any other profession having it. It is threatening to you because now Chiropractors and PT’s and MD’s are using far better orthotics than you prescribe. You don’t want your patients to have the best orthotics but you sure don’t want anyone else to have orthotics that make yours look sick.

    4. You criticize my business motives. That, you know nothing about. It is very simple: WE MAKE PEOPLE BETTER!!!!!!! I treat my employees like gold. I have a thriving business. Last month we hit another record in sales. I guess your BS is really hurting me…..LOL. I have grown over 50% since your baseless personal attacks began in 2006.

    5. It concerns you that I am profitable. Sorry about that….people like a product that works. The free market votes with its feet. Since you started attacking me I gained and lost the Foot Solutions account. Foot Solutions is a chain of stores that specializes is shoes and orthotics. Each store is required to have a cPed, and many have two or more. So, they are a chain of Mom and Pop cPed shops that offer their service under the franchise name: Foot Solutions. They sponsor podiatric education. Bill Faddock, DPM who has one of the highest pass rates on the cPed exam, does their training. There are still a few cPeds in their system who refuse to use their new ABS (Advanced Biomechanical Support) which is their cheap knock off of our product. One FS cPed owner, who refused to switch recently told me that after three attempts to copy our product he could still not make a second pair that was acceptable to the patient after they received a Sole Supports, Inc. CBAS orthotic. CBAS is no more. The few cPeds that still use us are getting a branded product we call CAST (Custom Arch Support Technology). Although we refuse to compromise our production standards, they are different only in color and marketing materials so as not to threaten docs. As part of the agreement between us and FS either Alyson(our Director of Professional Development) or I traveled to their regions and trained their cPeds. Their cPeds were well trained in MASS technology. As Dave Weidermeyer, DC, cPed points out, cPeds are qualified(according to the law) to cast and dispense orthotics. In some states a prescription is required to establish diagnosis. Again, almost every lab in the USA and Canada will sell to cPeds. I know Prolabs and Paris labs do. Many market heavily to the pedorthic profession. I have often heard podiatrists criticize “The Good Feet Stores” because the “deliver a sub-standard product by untrained staff”. When FS uses CAST orthotics they are delivering a great product with excellent training. If you want to question whether cPeds should be doing orthotics, I suggest you take that up with Weidermeyer and your state legislature.

    6. More recently and most annoying is your newest form of personal attack. I was sponsoring a dinner meeting in California recently where I gave my talk. After the meeting one doctor stayed late to ask me some questions. After answering his biomechanical questions, He asked me if I was a Scientologist. Funny question. I asked him where he got that idea. Doug Richie told him. In other words the newest reason why someone shouldn’t give their patients MASS posture orthotics from Sole Supports, Inc. is because of a rumor that is being spread about my religion. I told him that I was Jewish. So was he. It is true that in 1989 I took a course from one of their affiliates, Sterling Management on how to manage a company with statistics. It was a great course and my practice doubled within 3 years (250K to >500K). It doubled without raising my prices or giving anyone treatment that they did not need. I then took some follow-up courses in Nashville at the Celebrity Center there. All in all, I was satisfied with what I learned and felt that it was worth the money. By mid year in 1990 I was finished my courses and have never taken another Scientology course since. I also got some auditing (which is their therapeutic form of self analysis). While I was at the Nashville center, I was taking these self paced courses with a Baptist Minister, CEO’s of large companies and very successful intelligent and highly ethical people. Would I recommend it to anyone? I now know that all of the information is in the books that L. Ron Hubbard wrote and can just as easily be read, a lot cheaper. As far as Scientology is concerned….I am a satisfied customer……but I am still Jewish. I asked the doctor who was telling me this, “What if he told you not to buy from me because I was Jewish? Christian? LDS? Moslem? Hindu? Buddhist? He quickly realized that religious bigotry is not the best basis to make a choice of orthotic labs. In your tireless fight against science, truth and biomechanical understanding, you have reached a new low. You are pitiful. Your intellectual bigotry foreshadows your religious bigotry.

    Anyway. Brett Ribotski has offered us a venue to debate on his website. I have accepted.

    Sincerely,

    Edward Glaser, DPM
    CEO Sole Supports, Inc.
    www.solesupports.com
    ed@solesupports.com
    931-670-6111 x199
     
  30. Is it?!

    Blimey. You never said. Well thats that all cleared up then.

    Don't know what all the fuss was about.
     
  31. EdGlaser

    EdGlaser Active Member

    7. Your fantasy that we have no research. I think that previous posts more than adequately revealed that we have 5 RCT’s published with several more on the way. In addition we have published theory articles in several magazines. I seriously doubt that any orthotics lab does anywhere near the level of research we do. Several research articles have shown quite conclusively that orthotics like the ones you prescribe are about as good as Dr. Scholls in masking symptoms and have little to no kinematic effect. You keep herding the tissue stresses around the bottom of the foot to hide symptoms and I will continue working on changing foot posture and function. Your attempt to discredit Leslie Trotter is especially deplorable. In all my years, I have met few individuals with the moral and ethical integrity of Leslie Trotter, DC, cPed. You are simply not in her league of intellectual ability, integrity or biomechanical knowledge. I am privileged to count her among our most trusted advisors. There is no amount of money that could ever entice Leslie Trotter to compromise her principles…..and Mike Piernowski, pHD is beyond reproach. You are really barking up the wrong tree now.

    8. Sole Supports, Inc. foot orthoses are not immediately comfortable. That is because they apply a corrective force and unless you are numb, you will feel that force. They take a little hand holding while the patient’s biomechanics changes. Rather than giving the patients support for the positive changes that are occurring, you choose to bad-mouth the corrective orthotics and push your Scholl-like tilted pancakes.

    9. The SALRE theory is crap. It is based on a ridiculous assumption that everything revolves around the STJ axis. THAT is not new. You simply walked down the same path as Root. You found a way, the Kirby skive, to add more post while ignoring the arch or posture of the foot. Your great accomplishment was to turn the rearfoot post into a bigger post. What Rothbart did to the forefoot……you did to the rearfoot. You have no scientific justification for your skive or any other mods. Anecdotal evidence and “expert” opinion is all you have. Isn’t it interesting how people often find their own faults in others. Instead of coming up with original thinking, you prefer to take credit for mine.

    Sincerely,
    Edward Glaser, DPM
    CEO Sole Supports, Inc.
    www.solesupports.com
    ed@solesupports.com
    931-670-6111 x199
     
  32. EdGlaser

    EdGlaser Active Member

    You see, this is the kind of useless banter that makes me not want to post on the arena at all. I wish to discuss biomechanics not this BS. :bang: Since you are using my casting technique, I am sure you are getting better results than many others. MASS is correct, you know it. Changing the posture of the foot is the most efficient way of improving function. You just cannot bring yourself to give me any credit for my theories. That's fine.

    Ed Glaser, DPM
    CEO Sole Supports, Inc.
    www.solesupports.com
    ed@solesupports.com
     
  33. My work here is done!!

    No I'm not. I take casts in a very supinated position from time to time but I was doing that before I ever heard of you. You can't "own" a position.

    If you can, I call baggsies on lieing down. If you use my position you admit its the best one (more banter, are you still here?)

    Works for some. Not for most.

    Careful everyone, he's using the jedi mind trick (more banter, you wish to leave, you wish to leave, you wish to leave..)

    :D For real. You think you were the FIRST to think of changing function by changing the posture of the foot. Nobody did this before you. You actually believe that.

    Stop, please, my sides hurt!!! :D:D

    Did you also invent the question mark, the walking stick and the fork?

    Sorry. I just can't take you seriously Ed. I'll leave this one for others to play with.

    To paraphrase Simon, all yours sunbeam. I need to compose myself enough to drive home without crashing.

    Can't bring myself to give you credit for improving function by changing posture. That one will keep me laughing for weeks!
     
  34. Ed, we've been around this idea of "calibration" before and I don't recall ever getting an answer from you on how you "calibrate" your orthoses, as I remember it was a "proprietary secret". If by calibration you are referring to a stiffness value for the shell, at what point in the shell are you measuring this and how do you account for the interaction between leg stiffness (Kleg) and footwear stiffness/ surface stiffness to arrive at a net stiffness within a (presumably) optimal range?

    If I want to start using your product, how do I calculate "forefoot flexibility" and "momentum" for an individual and then fill those bits in on the prescription form? They are on the prescription form- right? Moreover, how do you account for variation in "forefoot flexibility" and "momentum" in your "calibration" which will occur when the patient is performing different activities of daily living?

    This is interesting, first we need to know how you are measuring "improving function"; what do you mean by this? Then, we need to think about the term "efficient"? If you could expand on both of these, please.

    Lets say that we put a patient in a pair of your orthoses and it does change "function", and that this change in "function" results in a change in "forefoot flexibility" how does your calibration system adjust to this change in "forefoot flexibility"? If "forefoot flexibility" is an integral part in the orthosis prescription and the "calibration" of the orthosis then surely a change in "forefoot flexibility" would require a change in orthosis "calibration"? Unless of course you can predict the change in "forefoot flexibility" that will occur with one of your devices in a given individual and pre-calibrate the device to account for this? How do you predict the 'calibration" to account for changes in "forefoot flexibility" and of course, "momentum" as the foot's velocity and "forefoot flexibility" changes during the various tasks it undertakes on a daily basis?

    Here's a hypothetical test of Ed's "calibration system": lets say we have two patients with identical foot morphology, we take casts of their feet in the MASS position (which is repeatable- right?), we ask Ed's lab to make devices for each subject, one weighs 60 Kg, the other weighs 90Kg, what would be the difference in the shell thickness/ geometry of the devices that were returned from Ed's lab for these two individuals? In fact, if I took two sets of casts from the same individual, but told "porkies" about the patient's weight, I should be able to carry out this hypothetical in real life and report the results... If I did this several times, I could write it up as a paper and have it published in a journal...
     
  35. EdGlaser

    EdGlaser Active Member

    Robert,
    I would have a battle of the wits with you but I never hit an unarmed man.
    Let's see, what original thoughts have you come up with........nothing?
    Ed Glaser, DPM
    Where exactly is your glass house?
     
  36. I've been reading a book all about fallacy recently. What's the Latin for when one attacks the man rather than engages in the debate, Robert?
     
  37. EdGlaser

    EdGlaser Active Member

    The downward force of the human body is a moving target. There is a range of forces that a person puts through their foot in activities of daily living. Many influences, including those you name have an effect on that force. Of course body weight changes daily, activity level changes, direction of motion, terrain, surface characteristics change. There are too many variables to name. An orthotic also delivers a range of forces in the opposite direction.

    We drill a small rounded hole which we call the calibration reference point at the apex of the arch, which is found using another of our inventions. This is used for repeated measurements to make sure that we are at the same point for each measurement. Do your orthotics have a calibration reference point? Why not? Because you don’t calibrate at all.

    How is calibration done? We put the orthotic in an enclosed container with a digital encoder vertically positioned to be in the calibration point. Incorporated in the container itself is a rubber bladder. As we fill the bladder slowly with air, it first goes in full contact with the shell and then applies a evenly distributed force per unit area over the entire area of the shell. As the shell begins to move we measure the force with an analog transducer. The signal goes through an analog to digital converter and the data is matched with distance every two thousandths of an inch. By taking people of similar weights and varying fore foot flexibilities and visa versa we can solve for two simultaneous algebraic equations.

    Orthotics are not an exact science. We are shooting for a range of forces in the upward direction that most closely matches the range of forces the body puts through the orthotic in the downward direction. Gravity pushes down; it is a pronator. Most of the muscles passing the ankle (except the gastrocsoleus and peroneus brevis) are anti-gravity or supinators. These muscles are loosing their battle with gravity and the foot is degenerating into a Pronated posture. An orthotic is like a plastic spring. It applies an assistive vertical upward force to help these muscles fight gravity. MASS is just the best starting position to apply such a resistive force. It dramatically reduces impact, shearing and full contact allows more corrective force to be tolerated as the force is distributed over a larger area. Force per unit area, pressure is reduced. As I have stated many times, accurate and detailed collection of defect codes turns a lab into a giant experiment. Our returns for too flexible or too rigid is less than 1% and even in both directions. This number reduced by 80% or more when we introduced digital calibration. You talk often about the power of a study being important…..we collect data on 6000+ orthotics pairs per month. Over 12000 pieces of data monthly. With a 6 month, 50% no questions asked return policy we try to encourage our practitioners to return orthotics that were ineffective. We are experimenting with FEA and a whole new kind of calibration that takes into account geometric curvature, but it is still to early to let the cat out of the bag.

    Here is a link so that you can see the calibration machine animation.

    http://www.youtube.com/user/solesupportstv#p/f/7/MjuKQI5-5SE

    So, how do you account for these same forces? Ignore them? Take a SWAG(scientific wild ass guess)? Or does force not matter when you are channeling the great Kirbmeister or consulting Ms. Clea psychic hotline? Maybe it just doesn’t come into play when one is tilting the pancakes.

    Forefoot flexibility is assessed by grading from one to five the ROM of the first metatarsal around a stable fifth metatarsal. We call this the Gib or Forefoot Flexibility test. We have invented two different measuring devices for this and both were found to do no better than the human hand.

    Assessing Foot Flexibility
    Foot flexibility should be assessed before casting. Flexibility must be assessed since this information is essential to custom orthotic design and completion of the design form.

    Foot Flexibility Test
    1. The patient is seated as in casting. The following instructions are for the R foot (reverse for the L foot).
    2. Cup the back of the R heel with your L hand and invert it. This locks the rearfoot and lower leg to allow testing of the midfoot and forefoot in isolation.
    3. Place your R hand around the medial side of the forefoot, sandwiching the metatarsal heads between your thumb and index fingers, while the L hand maintains the locked rearfoot position. The fingers of your right hand should be on the dorsum of the foot.
    4. Rotate the fore-foot in the directions of inversion and eversion, using the fifth metatarsal shaft as the axis. Apply only moderate pressure at the endpoints of motion.
    5. Estimate the total range of forefoot rotation in the frontal plane, as if there were a goniometer attached perpendicular to the front of the foot. Take care not to add extraneous movements to the foot in other planes (e.g., adduction/abduction). Based on the diagram below, grade the amount of flexibility on a 1 - 5 scale (smaller numbers are more flexible).
    If the range appears to be between cut-off values or you are otherwise uncertain which grade to assign, choose the more flexible rating (smaller number). One reason is that the more flexible ratings yield an orthotic with a thicker shell. It is faster and easier to adjust an orthotic that is too rigid by grinding away excess thickness. An orthotic made initially too thin must be completely re-made. Another reason is that you risk loss of pronation control if the shell collapses slowly over time, due to inadequate rigidity. This is mostly pertinent in the case of average to much more than average pronation and foot flexibility.


    Over time, I like to see that my patients are walking better. Less external rotation of the foot at toeoff (resolve the too many toes sign).
    Can we help them heel strike in a more Supinated foot posture?
    Are they resupinating adequatedly at Midstance to lock the Talus against the calcaneus in the sagittal plane to allow for better propulsion? Are they propelling off of the medial side of their foot at toe-off? Is there functional hallux limitus? These are just a few of the things I look for.
    How do you know that your patients are improving or increasing efficiency? Or are you just concerned with herding the tissue stresses around the bottom of the foot? Yee Haw!


    Good questions. There are many factors that effect the upward force of the orthotic including:
    1. Shell Thickness
    2. Modulus of Elasticity of material.
    3. Length of foot.
    4. Width of foot.
    5. Curvature of the Arch, and lateral side.
    6. Graduation of thickness into the arch.
    7. Heel cup height.
    8. Medial and lateral flanges.
    9. Thickness of the lateral side of the shell.
    10. Shoe resistance.
    11. Shell geometry. Etc. etc. etc.

    One can attempt to calculate them all but it is a Herculean task at best. I prefer to just measure it. Paul Scheerer said, (at one of his lecture I attended) “You cannot improve something unless you can measure it”. He is right. How do you measure the upward force your orthotics deliver to the body?

    Trying to match the forces is like Venn diagrams in math. How much overlap is present? If you feel that you have a better way to approximate the optimal overlap…..please tell me. If you don’t then my way of calibration is the best we have right now. Really, Simon, what measurement do you take? Where is your data? Do you even have a better idea? Do you think that measuring the forces is even relevant? No…..we just need to keep our patients walking flat footed along the peak of a 4-6 degree roof.

    You know. It almost seems like you are trying to learn…..but everyone knows better than that. You already have your mind made up. You have drunk too much of the Kirby Cool-aid. Shoot down anything that disagrees with your deity. While you are taking pot shots at our heels, we are attempting to advance the science of foot orthotics. What have you done original….. made a STJ axis locator to go along with the SALRE theory, which is nonsense. Keep the faith.

    BTW, I would be happy to do this study and compare our accuracy with yours. How do you measure again? Ms. Clea, Simon's on the phone for you again? :wacko:

    Ed Glaser, DPM
    CEO Sole Supports, Inc.
    www.solesupports.com
     
  38. EdGlaser

    EdGlaser Active Member

    Then I guess that you finally understand Kevin Kirby. SALRE is a fallacy and therefore Kevin only engages in ad hominem attacks. Look in the mirror.

    Edward Glaser, DPM

    I usually don't engage in the arena because I have more important things to do. Occasionally it is fun though. I would not have bothered if Doug and Kevin were not slandering me on PM.
     
  39. I believe the Latin is "ad Hominem" Simon. The cockney for the same is shorter and easier to spell though.

    Although interestingly:-

    Which presumably means If I said (hypothetically)
    "Ed is resorting to personal swipes rather than answer the point that changing the posture of the foot to attempt to change function has been around for as long as we've been using insoles because he has a pathological need to believe that he has discovered something new rather than just pimping up a whitman brace."


    That would NOT be an ad hominem because the argument (that he is claiming credit for an old, old concept) stands irrespective of my personal and unflattering view of WHY this should be so and what it makes him.

    Likewise
    "Ed is a cynically trying to take intellectual ownership of casting the foot in a very supinated the position in spite of the fact that it had been around for decades before he came along. This shows him to be a pillock"

    Is NOT ad hominem because again the abuse is ancillary to the argument not in place of it.

    Whereas

    "Ed is a dull, repetitive, cynical, annoying salesman who only comes on here to seek disciples for his system and to gain it disproportionate attention to its merit or the number of people who use it."

    IS an ad hominem because there is no argument, just personal attack. So I'd never just say that.

    Isn't logic theory fun?

    Interesting Idea about the research. You think that if such insoles had their resistance to deformation measured it might produce a graph upon which points for different body masses could be plotted? Might produce interesting data to be sure and would certainly test the claims of "calibration"

    The thing for me is that while calibrating the resistance is all good (and something we all, I suspect, do in some form or other) you rightly point out that we have no baseline for what is most desirable.

    Within the paradigm of the Mass protocol The amount of ORF the device exerts must be more than 0 and less than a theoretically completely rigid device and that there is a target point between these two (lets call it PR for perfect rigidity). We can extrapolate that from the fact that there is a calibration process rather than just issuing max rigidity to everyone.

    A process may have been derived to accurately relate patient details to orthotic rigidity but how was the PR decided? And has it been shown to be better than PR + 5 or PR - 5. And does it take into account all the variables which will affect supination resistance?

    Without accurate calibration we are shooting with our eyes shut. With it we are shooting with eyes open... but at an invisible target. We might know where we are shooting but not where we WANT to shoot.

    Oh and by the by Ed

    This is particularly amusing considering the context. So you WOULD hit an ARMED man then? Most unwise. Depending on the weapon he is carrying of course. Find an axe wielding thug and hit him, you'll soon get the idea.

    :boxing: vs :butcher: = not a great plan.

    Regards
    Robert
     
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