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MASS Discussion

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

  1. Lawrence Bevan

    Lawrence Bevan Active Member

    Hi

    everybody have a look at http://www.youtube.com/watch?v=bfXP1D1pGMY&feature=related

    at or around 1minute 45secs we get a shot of the SoleSupport orthotic worn by Mr Roddick with his foot on top. Looks like a pretty regular orthotic to me. Bit of a loss of shape in that subortholene??

    L
     
  2. EdGlaser

    EdGlaser Active Member

    Can you tell me where in Royal Whitman's original articles he describes MASS position or anything like it? I also cannot find where he describes callibration, soft tissue compression, full contact geometry. Maybe Root described it or the great Kirbster himself.

    Of course you can not because they did not. If you know posture controls function then you, Kirby and the gang have obviously forsaken all hope of changing function with your pancakes. Bring in a bigger wedge but don't raise the arch. Not to MASS position because that would be recognizing Glaser's contribution. Are you a complete moron? I listed the arguments Kirby and Ritchie use to discredit me. If you cannot see a personal attack there and Zero substance......you are nuts. Drink more Cool Aid Steve.
    If you cannot see the substance in my response to Simon, you must be blinded by Kevin's brilliance. Open your mind. You are only admitting that I am right.....and hung up on who gets the credit. Petty useless BS for egomaniacs. Get a life.

    Ed Glaser, DPM
     
  3. EdGlaser

    EdGlaser Active Member

    Robert,
    If you spent as much time looking for real answers to biomechanical questions as you do criticizing reflexively things that you have no understanding of, maybe you could learn something. Hung up on credit.....lets just assume that Robert Isaacs actually came up with MASS...it may be your only hope of getting credit for original thinking. I have real work to do. This was a fun diversion. There are plenty of people who want to learn biomechanics because they did not get it in school. Maybe they attended the one lecture per year that Kevin gives at Samuel Merritt. Maybe instead of biomechanics, you want to discuss credentials, wardrobe, religion, newness, or some other slight of hand. I do agree with you that you are NO salesman. Other than your level of stupidity, you have not sold me on anything.

    Ed Glaser, DPM
     
  4. EdGlaser

    EdGlaser Active Member

    The difference is that his orthotic is actually the shape of his foot. Your "regular" orthotic is arch filled which divorces the geometry of the orthotic from the geometry of the foot. Your "regular" orthotic has enough space between the arch and the foot to smuggle diamonds into the country. I know because I travel all over the country teaching and take these "regular" orthotics out of the doctor's shoes and show them where they can stick four fingers between the orthotic and the foot when the foot is in MASS position. What did you expect the orthotic to look like....a fish, a toy train, a car.

    As far as the "loss of shape", that is called plastic deformation or creep (not to be confused with Isaacs who is also a creep). I guess Andy puts them through some real punishment. Just having fun.

    To my knowledge, Andy no longer uses our product. He may be using ICON labs or some French prefab. When he signed with Reebok, sole supports were too aggressive for the curved lasted shoes they make. At one point he used us. Had 20 pairs made. Money talks and he took the endorsement. Que Sera Sera. I wish him luck and am glad that I could help him when I did.

    Ed Glaser, DPM
     
  5. efuller

    efuller MVP

    Ed, you never succesfully defended, in my opinion, your contention that SALRE is a falacy. Your version of the theory may be a fallacy, but that't not what we believe.


    from post # 59 on challenging SALRE

    Ed,

    Thanks for reposting the pdf file in a text form. There are still the same criticisms in multiple places in the post. So, let me know if I miss some of your criticisms.

    Many of the criticisms are straw man arguments. You misstate the premise of SALRE.



    Quote:
    Originally Posted by EdGlaser
    To Kevin, Eric and all following this discussion:
    This thread is called Challenging SALRE . I thought it might be nice to actually challenge it.
    Before I even begin my critique of the SALRE theory, let me discuss Kevin’s and Eric’s answers to my original question. Why does pushing up on the arch, lateral to the STJ axis cause a pronation moment but results in supination?
    Kevin explains that the STJ axis acts like the fulcrum of a see saw and that part of the plantar pressure lateral to the axis is moved more medially when pressing up on the arch, decreasing its lever arm and therefore decreasing the pronation moment.
    If that was true, then Kevin and Eric have a major conflict. Eric says that his arch drops when you push up on it, except when the force is applied at a point medial to his Medially Deviated STJ Axis. When you push up on his arch, it goes down. That is very strange, and I have never seen anyone else exhibit that but Eric is observing it.
    If Kevin’s explanation was correct then the upward force applied to the medial navicular which lies just medial to the medially deviated axis (MDA), would have a similar effect to the upward force applied in the MLA lateral to the axis. Decreasing the net supination moment by offloading forces more medial to the axis.…..causing foot pronation. Again, that is where Eric exhibits supination. Who is right here, Kevin or Eric? You both seem to be on the same side but saying the exact opposite thing. Simon then suggests what would happen if the COP were a arrow instead of the net effect of a widely distributed force and tries to dislocate the navicular or strain the spring ligament to raise the arch.
    Certainly anyone can easily see that pushing up on the arch will raise the arch. In Kevin’s supination resistance test you lift the arch with two fingers. What are you doing? Applying a vertical force to the arch and raising it. What else raises the arch… external leg rotation, windlass, and muscular contraction. I have never seen someone lower the arch by pushing up on it in the closed chain. Whether or not it is hard or easy to resupinate it will always go up when you push it up. This is a pretty easy experiment to do. Take a child and push up on their arch. I just did and it went up. I don’t think that this is a geographical phenomena.

    Ed, this criticism was answered in earlier posts that you have not responded to. There may be a misunderstanding in terminology. I haven't looked at the old post, but I may have said foot pronation when I meant STJ pronation. I was talking about non weight bearing when I said, there are feet with medially deviated STJ axes, that when you push upward on the medial longitudinal arch the STJ will pronate. And I agree with Kevin's comments about shifting the center of pressure. Has that been explained to your satisfaction that we can move on to the next criticism?


    Quote:
    Originally Posted by EdGlaser
    Before I begin my critique, let me separate two things here: STJ pronation/supination vs Foot pronation/supination
    Closed Chain Supination of the Foot (CCSF)….which is a change in POSTURE which involves increasing the height of the MLA. This involves a complex series of bony interactions which reposition bones in all three planes and works around a multitude of axes….most of which are sagittal plane as evidenced by the fact that the foot shortens in supination indicating that it is decreasing the radius of the arc of the MLA . CCSF increases arch height.
    Closed Chain Pronation of the Foot (CCPF)…. which is a change in POSTURE which involves decreasing the height of the MLA. This involves a complex series of bony interactions which reposition bones in all three planes and works around a multitude of axes….most of which are sagittal plane as evidenced by the fact that the foot elongates in pronation indicating that it is increasing the radius of the arc of the MLA. CCPF decreases arch height.
    Open chain STJ pronation and supination which consists of a rotation around a single axis between the talus and calcaneus. When talking of moments and forces it is convenient to oversimplify and reduce the problem to a see saw as you did here and in your article. But that see saw must be triplanar and not its shadow on the horizontal (plantar parallel) plane.
    Closed chain STJ pronation and supination which is specifically the rotation which occurs around the STJ axis during CCSF and CCPF. This is picking our just the rotation of one of the many joint axes and looking only at its individual movement or equilibrium.
    (abbreviations are only meant to save me time….thanks).

    This criticism is essentially saying that SALRE does not pay attention to MASS. This is a classic problem of two people with different paradigms only being unable to see the other paradigm through the lens of a different paradigm. This shouldn't be a problem with us, because we both agree upon Newtonian mechanics. But apparently it is.

    Since you have brought in foot posture, it is fair to criticize it in relation to our current discussion. Hicks described the windless mechanism in terms of arch raising and arch lowering. I like these terms better than foot pronation and foot supination because there is less chance of confusion with STJ pronation and supination. However, we can name all the joints of arch raising and lowering and examine the equilibrium around each of those joints. When someone stands on a MASS orthotic, we should be able to describe how the orthotic applies a moment to each of those joint to raise the arch when compared to when the foot is not on the orthotic.

    Ed, would you agree that arch raising consists of metatarsal plantar flexion, midtarsal plantar flexion, STJ supination and ankle dorsiflexion? Would you add any more joints?


    Quote:
    Originally Posted by EdGlaser
    Comment: Rotational Equilibrium is a simple Newtonian certainty around any axis. It is basic first semester physics. I have no disagreement that it exists around every axis of the body. It is the SAL of SALRE that is questionable.
    Now, to a broader critique.
    In order to evaluate the theoretical model of Kirby, the SALRE theory, you must first look at the assumption it is based on.
    The following assumptions, which are the very heart of this theory, are questionable:
    1. The assumption that the STJ axis is the only relevant axis of motion determining pronation and supination of the foot and that the foot functions as a uniplanar seesaw around it. The foot has many joints that contribute to foot pronation and supination both between numerous bones and between the heel and ground (heel rocker axis) and between the forefoot and ground (MTP rocker axis).

    Ed, SARLE is only attempting to examine moments about the STJ axis. It is using these moments to explain some of the pathology seen in the foot. For example, posterior tibial tendon dysfunction can be explained quite nicely using SALRE. SARLE, is not very useful in explaining 2nd met stress fractures, and we have never said that it was. SARLE is not trying to explain all the moments at all the joints involved in arch raising. That makes this a straw man argument.


    Quote:
    Originally Posted by EdGlaser
    2. SALRE theory further reduces the complexity of closed chain foot function to forces acting on either side of a singular axis’ projection onto the transverse plane. Not using the axis itself, but its shadow in the transverse body plane or plantar parallel position. This makes the axis primarily a frontal plane axis although in actuality it may vary considerably from this plane.

    SALRE does not make the STJ axis a primarily frontal plane axis. This criticism is erroneous.


    Quote:
    Originally Posted by EdGlaser
    3. It also assumes, by omission of any discussion of it, that closed chain foot posture is irrelevant to corrective strategy. The foot, apparently, has only a normal or deviated STJ axis. This implies that foot function is solely determined by a given axis type (ie: Medially Deviated STJ Axis (MDA) = over-pronated foot) which is the transverse plane projection (2D) when the foot is held in the open chain in the “plantar parallel” position. This position involves making the weight bearing surface, without an orthotic, on a plane that would represent the ground or horizontal plane. The foot must usually dorsiflex to achieve this position through the application of pressure on the distal plantar surface of the forefoot. This will necessarily yield a more pronated if not fully compensated posture.

    This is attempt to view SARLE through the lens of MASS. It is essentially saying that SALRE does not work if you ignore posture.

    Moments will be applied to the joints of the foot by ground reaction force regardless of the position the foot is in. You look at the location of the STJ axis in the position which the foot is in. We are making the assumption that in any given position of the foot there will be a unique location of the STJ axis. Then you look at the the three dimensional relationship of the the ground reaction force vector to determine the moment from ground reaction force to determine the moment from ground reaction force.


    Quote:
    Originally Posted by EdGlaser
    4. It assumes that this plantar parallel itself can be accurately and reliably estimated.

    This can be fit into the broad category of criticism of you have to know exactly where the axis is to be able to use SALRE in treatment. For treatment, you do not have to know where the axis is. All you have to do is know which direction you want to change the moment. Then you shift the center of pressure in the direction that you want to change the moment. If the STJ needs to be pronated then you shift the center of pressure lateral, if the STJ needs to be more supinated then you shift the center of pressure more medial.


    Quote:
    Originally Posted by EdGlaser
    5. Another assumption is that the timing of corrective forces is irrelevant, whether they occur at the heel strike or after the foot has fully pronated.

    I don't understand the criticism. The theory can be used all the time. The STJ axis will move with motion of the joints over time. However, the moment at any instant in time will be determined by the location of the axis at that instant in time relative to the location of the center of pressure at that instant in time. For treatment you can change the location of ground reaction force whenever the foot is contact with the ground.


    Quote:
    Originally Posted by EdGlaser
    6. A sixth assumption is that the pronation of the foot (raising and lowering of the MLA) is in a 1:1 relationship with rotation around the STJ axis.

    How is this an assumption of SALRE?


    Quote:
    Originally Posted by EdGlaser
    7. Also it must be assumed that the orthotic correction does not make a postural change in the foot, for the measurements to have relevance. If for example the foot is severely pronated with considerable flexibility, it will exhibit a Medially Deviated Axis in the plantar parallel position, and the most corrective posture for that foot might be 30 degrees higher in calcaneal inclination angle. The location of the STJ axis when fully compensated has little significance compared to the actual 3D triplane orientation of the axis which will contribute somewhat to foot function following corrective orthotic control.
    There are numerous other questionable assumptions but for brevity, I think that these seven may suffice for now.

    I'd like to make three points about your comment.

    The first point is similar to the point mentioned above about having to know the exact location of the axis. You can treat a foot with SALRE by shifting the center of pressure without knowing exactly where the axis. is.

    Second point: You have to apply moments to the foot to achieve a postural change in the foot. Without the orthotic the foot will stand in a certain position. When you stand on an orthotic there will be different forces and moments applied to the foot so that a foot will reach equilibrium in a different position without the orthotic. SALRE can be used to explain how the orthosis can alter the moments applied to the foot to create arch raising. STJ supination is one of the joint motions that occur to create arch rasing. Therefore the orthosis would probably have to add supination moment to create arch raising.

    Third point: Just what motions of what joints allow you to get 30 degree increase in calcaneal inclination angle? Are you saying that you can actually get a 30 degree increase in calcaneal inclination angle. Do you regularly see a 30 degree change in calcaneal inclination angle? Wouldn't this cause a functional equinus.



    Quote:
    Originally Posted by EdGlaser
    Some cut...
    Any argument over the theory and strategy of foot correction should begin with an agreement about the goals of correction. Postural restoration is superior to tissue stress modification whenever foot flexibility allows it. It is also a universally held truth in all of orthopedic medicine that form or posture and function are interdependent and that healthy function is the key to orthopedic health.

    Ed, you have no case unless you can explain, mechanically, why postural restoration is superior to reduction of mechanical stress to a point where there is no pain. Why should postural correction be a goal of therapy?

    Ed, in reading the other comments further in your post, I believe that the responses above have answered those criticisms as well. If you disagree, point out the specific points that you did not feel were answered.

    Respectfully,

    Eric
     
  6. Dear Mr. Ed,
    Thank you for your latest post and fascinating disclosure of your involvement with the Scientology cult. No, I never knew of your involvement with these people. Furthermore, you recall some conversation with a podiatrist who clearly mis-quoted me as labeling you as a Scientologist, since I never knew this story until you spoke up in this forum. How did you ever go from this mis-guided conversation to the assumption that any of us are "religious bigots"?
    Please Ed, are you not getting a little paranoid now?
     
  7. EdGlaser

    EdGlaser Active Member

    Eric,
    This is a very good post.....I appreciate that I can discuss actual biomechanics with you. I think that this post belongs in a separate thread about Defending SALRE. Not one entitled MASS Discussion. I would love to participate in such a thread. I have, as you can see, spent way too much time on the arena today. Your post is well thought out, as usual, since it is a response to something I wrote 16 months ago. Remember, last time I went down this path, Kevin retreated and threatened to abandon the arena. Although I dislike his arrogance, I did not want to hurt Craig or the arena by pushing Kevin off, especially since I am way too busy to take his place.

    I will have to review the whole thread as well as some of Kirby's work. It deserves a thorough and thoughtful response, with references directly to Kevin's writings. I am done for tonight and have a full day tomorrow. But I will respond, hopefully over the weekend. You had 16 monts to formulate this. Many responses come to mind immediately but I want to word them correctly. I think that I can show you that my criticisms have merit. Keep in mind, I am not disagreeing with the physics, just the underlying assumptions. I will respond......in the mean time feel free to move this to another thread. I may even have a 3D animation made to explain my points. You'll notice that I never, in the post you quoted, discussed his wardrobe, religion, credentials, bowel habits, exotic pets or sexual orientation. No personal attacks........substance. It is refreshing. I have the greatest respect for you, Eric. We may disagree but you rise above the irrelevant crap.

    Ed
     
  8. David Wedemeyer

    David Wedemeyer Well-Known Member

    Apparently Ed speaks for Stu? I would also be curious to know how many orthoses Stu prescribed in private practice prior to joining Ed as Director of Research for SS? This is not a sleight; I am merely curious what your background is in the industry? You do not come across many DC’s who spend a great amount of time delving into lower extremity biomechanics and orthoses. Of course Ed figured this out judging by your marketing!

    Before you verbally crap all over me keep in mind that I lay no claim to knowing everything about the subject, but it is something that I provide in my practice every day. I manufacture and dispense insoles for Medicare patients, custom orthoses and bracing devices so I do have some knowledge and background in orthotic therapy. Local physicians are confident enough in my professional abilities to refer their patients over for care; in fact 90% of the orthoses that I dispense are on referral. This is not typical of a C.Ped in a retail store and you well know it, don’t go there. I didn’t arrive here by simply accepting everything that came my way and if I could not get clinical results with a particular design, lab or device it has been abandoned. I did look at the SS system and found it wanting. Period. Your reference now and in the past that I am somehow less than objective and a discerning in my approach and revision of the subject is a completely baseless and anemic argument.

    Copied from:
    http://lowerextremityreview.com/article/active-stance-orthoses-functional-relevance-of-the-arch

    You truly stepped in it in several of your points Ed. I’d like to illustrate just two and let everyone reading decide whether or not you talk around corners and constantly?

    Why would you allude to the SALRE theory as credible in one article (one that promotes your product and it is a product in the end and a proprietary one at that) and then come on PA away from prying eyes and then slam it as "crap"? It is because Kevin enjoys wide credibility as a clinician, researcher, educator and innovator? Your aim by including your product and hypothesis along with his and the other theories is not lost on anyone with any level discernment. Your equivocation of previous statements that are then contradicted and "niced down" to your target market are a nice touch.

    I love this quote because it shows just how ignorant you are of the use of this modification. Kevin advocates using an inverted cast with NO arch fill in every paper that I can recall with these specific criteria on the prescription for many of the pathologies the medial skive is intended to treat. How can you even argue that ALL custom orthoses from competing labs add arch fill or deny that Kevin advocates a high MLA in many orthoses? I presume it is easier to denigrate everyone who counters you or refutes your omniscience than to simply prove your claims with credible, unbiased research. Talk about anecdotal (and paid for)

    Have you ever really looked at other labs casts or is this just speculation on your part to serve your bottom line and include in your marketing? We all have used and probably do use high MLA, no arch fill designs when it is appropriate. What we cannot get our collective heads around is how this works for every foot or how your accommodative material, gait referenced foam box casting blah, blah are the Holy Grail of orthotic therapy( apparently Andy Roddick couldn’t either).

    You have been asked many times how your system mediates very specific conditions that we commonly encounter and have yet to simply address the questions and instead devolve into one of your angry rants, name calling etc. You include terminology such as medially deviated joint axis on the article above as though it is a relevant finding and then call Kevin’s entire theory crap. How can you possibly resolve that discrepancy Ed? Kevin is barely participating in this thread (and Doug Richie hasn’t even posted) and yet you continue to focus on and deride them. That makes you look more like a bully than a professional.

    I suppose if you work backwards with an idea and have a lot of studies to cherry pick from, quote and include in your marketing articles that include the more commonly and widely accepted theories it gives your claims a cleaner feel. It also aids in the appearance that what you are doing is scientific and accepted as well. A sort of credibility by association, but you already knew that Ed. This is especially true if you fund them yourself and include your product in the research. It’s funny that you mention Scientology; much of your marketing did give me that impression because you cannot simply make your claims without comparing your product to competing ideas and tearing them and their creators down. While you criticize others in an aggressive manner you don’t take it yourself graciously.

    If you wish to misspell my name purposely to soothe your fragile eggshell ego Ed, have at it. It is a very childish attempt at denigration. Aim high Mr. Ed
     
  9. EdGlaser

    EdGlaser Active Member

    The doctor I spoke to had no difficulty remembering who told him I was a Scientologist. Certainly a religious bigot would refer to the courses I took as "involvement with the Scientology cult". What cult do you belong to? I get it, its another wardrobe question. Maybe you heard I shaved my head, wore a bunny suit and did chicken sacrifices without the proper credentials. What other BS rumors are you spreading about me? Is academic discussion beyond your capabilities?

    Ed Glaser, DPM

    PS: Sorry, Eric, I cannot let personal attacks to unanswered. It is time wasted that could be spend learning.
     
  10. pnunan

    pnunan Member

    I try to keep an open mind on biomechanics and different points of view. Let me say not one individual theory or person has all the answers. The MASS theory is just that a theory. In the several lectures I have attended I was amazed by several comments by the "founder". One was at a conference where he admitted that he had not done any in shoe studies of his orthotics. The second was the big pillow model of the subtalar joint. We must remember that we are not just looking at bones and joints. There are ligaments, joint capsules, tendons and muscles that can and do effect the function of the foot. Also there are many disease states such as PTTD, RA, Charcot disease etc that effect the structure of the foot. Third was the insistance that the first ray must come down to the ground. Let's see Hicks I believe described the windlass mechanism and Dananberg popularized the kinetic wedge and agressive 1st ray cut out to engage the windlass mechanism. Wait a minute, didn't Root also say place the medial edge of the orthotic lateral to the first metatarsal? Wouldn't this cause plantarflexion of the 1st ray? Fourth, it was implied in early lectures that the "founder" was a mechanical engineer, stating that he studied that subject. Kind of left it up in the air.

    Problems with the MASS theory are with the diseased foot, by that I mean, Charcot, PTTD (chronic) and RA patients. You are going to force their arch up? Probably won't be real tolerable. The bottom line is that MASS is nothing new, it is a combination of several theories and ideas. Yes it is slick marketing. Oh by the way, the Sterling Management courses, knew several people who took them, went to an introductory course myself. The secret is not in giving patients want they really need, the key to success is convincing patients that they really need something, whether it was surgery or orthotics. You had to sell the patient on what really was best for them, whether it was true or not.

    It was either Schuster or Ganley that said you could wad up tissue paper, put it in someone's shoe and a certain percent would claim how wonderful their feet feel. If it works for you and your patients fine, but don't make claims that you have something new, that your theory is the only true way or that you have a product that will really knock our socks off. Seen way too many of those claims that are nothing but pure B.S.

    Patrick J. Nunan, DPM
     
  11. Precisely, so given this variation how can we "calibrate" an orthoses to have an optimal stiffness for all of the various activities?

    Before you start making assumptions about what I do or do not, think or think not let me tell you you know nothing of these. For your information, I measure orthosis stiffness characteristics using both physical testing and finite element modelling. N.B., I do not call this "calibration". What is the optimal stiffness for an orthoses at the medial longitudinal arch section for a 75kg runner?

    Yeah, that's fairly straight forward. The problem is, as we know, the foot will not provide an evenly distributed pressure on the orthotic shell during dynamic function. Also we have to make certain guesses to extrapolate dynamic loading onto the shell, so for example, in running we may make an assumption of 2.4 x body weight. We can use in shoe-pressure analyses to get a better understanding of actual dynamic loading and plug this into the finite element models. However, this becomes awkward due to the problems in in-shoe mapping and foot orthoses research- we have a paper accepted for publication in JAPMA on this which I hope will be published soon.
    Look forward to seeing it, as you know I've been using finite element modelling to take into account surface geometry for a number of years now, if there is anything I can help you with let me know. I also use a test jig to make direct measure of foot stiffness variables and try to incorporate that into the model. The problem is, we just don't have an optimal baseline as Robert pointed out.

    Ed, see my answers above. Before you carry on swinging and missing. Whatever you think of me, our thought processes are not a million miles apart (on certain topics).
     
  12. As tempted as I am to come in with my own critisms of Ed's rather long list of contentious and arguable statements, I'd like to try something different.

    There are a few things required for a wholesome and constructive discussion.

    It needs to be on a sufficiently small number of points that everyone can follow. There is SO MUCH here to discuss that inevitably bits will be lost along the way and its well nigh impossible to follow a coherent thread. There can be no reasoned discussion when the topic is ALL of MASS and its founder vs ALL of the rest of biomechanics.

    There needs to be an attempt made by ALL parties to keep their claims / arguments in the realms of the credible and provable. Me saying "MASS is crap" in response to Ed saying "SALRE is crap" is not something which can be debated. It reduces it to "oh no it isn't, oh yes it is".

    Likewise, statements like "Mass works", which with all respect Ed you know there are those who will challenge, need to be the object of a discussion, not a justification for another object. Otherwise we just jump around inside the same argument. To say that Y is true therefore X is also true is only valid does not work unless we all agree that Y is true.

    There is no need (so far as I can see) for the protagonists to respect one another. But there is need to keep the debate on the subject under discussion and not on the individuals discussing it.

    I suggest that we try to "reboot" this thread and start again with one or two discussion points which can be constructively debated, hold our mutural contempt from spilling out into our posts and try to keep the debate relevant and moving.
    No more "Mr Ed" cracks, no more "kirby cool aid".

    I would suggest the calibration issue is a good one to start with.

    Or shall we just keep slagging each other off. I'm fine with that too, I like a good barney!
     
  13. Ed.

    You said
    Let me try to understand you. You are seeking to "match" the ORF (orthotic reaction force) to the force the body applies to the orthotic in a downward direction.

    Obviously the two will always match for as long as the two are in contact (newtons 3rd law). So I still don't fully understand what you are shooting for here.

    I understand the mechanism for your calibration. As simon says there may even be some merit to the idea. What I don't understand is your target. WHY do you want to calibrate your devices?

    Are you seeking to make the orthotic stiffness such that it does not flex at all under that persons "downforce"?
    Are you seeking to make the orthotic stiffness such that it does not flex until a certain load? And if so, what is that load?

    To restate my earlier point,

    Fancy a go at some calm and reasoned scientific debate? Or shall we call each other some more names for a bit ;).
     
  14. Lawrence Bevan

    Lawrence Bevan Active Member

    Ed

    I understand the mechanical term. My thoughts were that Andy Roddicks orthotics had undergone creep because whilst I didnt expect them to be shaped like a train I did expect higher arched. They fitted his arch closely but not to a MASS arch shape hence they must have flattened with use. Interestingly even with the creep they still seemed to be performing with the lower arch shape...

    BTW my "regular" orthotic fits to the arch very closely as well - I'll either have no fill or only a thin fill under the 1st ray only as per the recommendations of Ray Anthonys book "The Functional Foot Orthotic"
     
  15. I know I was the one who said we should not try to discuss everything in one thread, but I feel a point must be made here.

    When we talk about insoles "fitting" the arch, we must state what position the foot is in when we do the comparison.

    Ed talks about big gaps between an orthotic and the foot in mass position. Thats well and good. But that works on the assumption that the MASS position is the RIGHT position. If I put the foot into an even more supinated position (say by putting the foot in MASS then adding a forefoot varus extension to adjust the whole position to a more inverted one) there would be a gap between a MASS orthotic and the foot.

    Ray anthony's book may refer to little fill so that the orthotic closely fits the foot, But that works on the assumption that the neutral position is the right position. They'll be a gap between that insole and a MASS arch but not between that and a neutral one.

    A fully weight bearing system (name escapes me) boasts of how it is the best because the insole is moulded to direct contact with the foot in relaxed weightbearing position. But that works on the assumption that the fully weight bearing is the right position. There will be a gap between that insole and a neutral arch but not between that and a weight bearing arch.

    I suspect ANY insole with an arch will "fit" the foot in one position or other. So the debate about how well it fits (for me) hinges entirely on which position we want it to fit in. Back to the debate about what we are targeting.

    Which brings us back to whether MASS has more merit as a position than any other.

    Its more supinated than neutral.

    Its not the most supinated position an orthotic could acheive.

    So is it the RIGHT position? For everyone? If MASS was better than neutral because it is more supinated than Neutral would a MASS device with a full length extrinsic wedge be better because it is more supinated still (MASS+ anyone?)

    "FIT" is an irrelevant topic unless we know WHAT we are TRYING to fit.

    Regards
    Robert
     
  16. EdGlaser

    EdGlaser Active Member

    If you look at our references, four out of five are in shoe studies. More on the way. The casting repeatability study was not in shoe.

    You must have me confused with someone else. I never heard of the “big pillow model”

    There are conditions where the foot is rigid. Some cases of PTTD, RA and Charcot disease are included. Accommodation is generally misunderstood in Podiatry. Many think that accommodation means soft. What it really is, is a redistribution of plantar pressure (force per unit area) evenly over the plantar contact surface of the foot. It is why we an lie on a bed of nails but not on one nail. Full contact in the MASS position simultaneously dramatically reduces the impact force, and shearing forces while redistributing the pressure evenly over the entire surface of the foot. It is more accommodative than most soft orthotics that have or will have areas bottomed out. Accommodation reduces hot spots. Full contact with NO arch fill at all accomplishes this, making it an excellent choice for RA, Charcot disease and other causes of rigid foot structure. BTW it is also good for high arched feet with Charcot Marie Tooth disease for the same reason. PTTD can also have some flexibility. MASS position never pushes the foot into a position that it cannot easily attain with its existing ROM. The casting technique is in foam which only applies a 1.75psi resistance to compression (that is the foam that we have custom made for us). ROM may and often does change over time which requires either adjustment of arch height (usually up) and or new orthotics. In PTTD as with all of the conditions we treat we give the maximum correction that is possible with that foot without over correcting and causing new problems. It is not perfect and will never be. I like that….it gives us something to study further.

    Early on we used the phrase, “lower the head of the first met” to describe raising the arch; Supination. We did this because of its relevance to forefoot mechanics and ease of understanding. Now we simply call it foot Supination or MASS posture. When you raise the arch to MASS position the first metatarsal declination angle increases to a considerable extent. This does not happen with the kinetic wedge or by placing the medial edge lateral to the first met, as Root did. Digging a hole for the first met to sit in, or raising the ground around it has minimal postural effect. Try it, you’ll see.

    I have already beat that to death. My first engineer at Sole Supports, Inc. was Bill Bors. He is our mad scientist. He did not have a degree but I would put his practical knowledge of every aspect of engineering against any MIT engineer graduate. He is a genius. He is an expert on physics, electricity, electronics, welding, plumbing, fluid dynamics, avionics, radio (he holds a very prestigious certification from the FCC), optics, machine language programming, CAD-CAM, building…..I could go on and on…but you get the idea. We also have Matt Moore (and I never looked to see what letters he puts after his name) who is has a masters degree in biomedical engineering from Vanderbilt. Paul Garland (again ? letters) is a brilliant software engineer who helped develop Solid Edge 3D modeling software and taught Programming in various languages at the university level for many years. He has an assistant Kimberly (again letters have little meaning to me) who works full time for us in a virtual office from home in another city. Mark Barber is our milling, prototyping, and sourcing engineer with an ME degree from somewhere. I have seen engineers with fancy letters who were useless and those with no letters who were amazing. Instead of worrying about letters, I consider what they can contribute and then I provide a creative fun environment and watch them invent.


    The casting technique only pushes the arch up to a point where it can be easily achieved at Midstance with the heel and forefoot on the ground.

    What was Whitman’s term for MASS position? Can someone please post a quote from Whitman’s writing where he describes putting the foot into the maximal arch that a person can achieve at Midstance with the heel and forefoot on the transverse plane? If he had a term for this position, please tell me. Did he also compress the soft tissues to get the geometry, as it will be applied to the foot. What was his casting technique? If Whitman came up with exactly the same geometry as MASS lets call it by whatever name he used. That’s fine.

    I am sorry that you, or anyone else had a bad experience with Scientology. I can only comment on my experience. They never told me to sell something, “whether it was true or not.” Of course I was exposed to it over 20 yrs ago and have not been back since. I remember them saying, “Care enough about your patient to make sure that they get exactly the treatment that they need. No more, no less.”
    My point in mentioning it is, all of the irrelevant personal criticisms that Doug Ritchie and Kevin Kirby throw out at me have nothing to do with the validity of my theory. You still are hung up on credentials and newness. Why not discuss biomechanics instead. Not my wardrobe, credentials, newness, religion, motives, business model etc. etc. Whether Kevin and Doug were really the grand marshals of the Gay Pride Parade has nothing to do with their theories. I don’t care if they have sex with chickens…..I like to talk biomechanics.

    Respectfully,

    Edward Glaser, DPM
    CEO Sole Supports, Inc.
    www.solesupports.com
     
  17. EdGlaser

    EdGlaser Active Member

    Sorry, as I said, I have a full day. I will get back to Simon and Robert's questions later.
    Thanks,
    Edward Glaser, DPM
     
  18. Mac

    Mac Member

    Here's a little food-for- thought...

    To state that someone's "theory" is either wrong, a fallacy or that mine is correct, blah, blah, blah is just wrong. My response is, PROVE IT, and this may be possible soon but will take time. As my dctoral advisor once said to me, "opinions are always correct".

    First of all, these are not theories. These are ideas or hypotheses that have come from clinical experience. The fact that they come from clinical experience is great. I wish more of my colleagues interacted with clinicians because the questions that immerge are interesting and clinically relevant. They are all great ideas but need to be tested in a laboratory, quantitatively.

    To date, the only hypotheses that have been repeatedly tested with: 1) custom foot orthoses as an intervention; and 2) that have reported fairly systematic results have investigated the influence of the intervention on ankle moments, impact peak and loading rate in runners. This is evidence that may, one day, eventually lead to a theory regarding the influence of custom foot orthoses on lower extremity kinetics.

    It is only now that we may be able to measure the parameters necessary to test some of the Sagittal Plane ideas/hypotheses, and others. I am excited for clinicians like Dr. Dananberg who can now with the evolution of multi-segment foot models be able to answer some of the questions surrounding their idea.

    Regarding the scientists/clinicians at McMaster University, Pierrynowski is a fine scientist and I respect him, greatly. Trotter was/is his student and I would go easy on criticizing their work. Universities in the past have received funding (or product) from Industry with the best of intentions. Frequently at the University level, they have no idea of the political issues, what is an orthosis and what is an insert, etc.

    We have supplied product for a number of studies because we want to learn more about how custom foot orthoses (from a neutral suspension cast) influence lower extremity dynamics. We have done this with no financial interest in the project but with only interest in scientific integrity.

    Anyway, that's all I'm going to contribute. We should be pulling together to figure out ways to answer some of the questions. My gut tells me (and remember opinions are always correct) that there are aspects of each idea that may eventually prove correct. Others will be refuted. Only time will tell and it isn't going to happen overnight.

    Christopher L. MacLean, Ph.D.
     
  19. Jeff Root

    Jeff Root Well-Known Member

    I’m going to attempt to be careful how I write this because I don’t want to get involved in personal insults or less than professional conduct although I can appreciate the sense of frustration on both sides of the fence. I would however, like to point out that some very meaningful information occasionally comes out of these types of passionate debates. One just has to rummage through the muck in order to find it.

    In Root theory and MASS we have the theory of orthotic therapy and the practice of orthotic therapy. I’m guessing as in the practice of Root orthotic therapy, that MASS orthotic therapy has some who have more success than others as a result of their individual skills and knowledge.

    MASS orthotic therapy requires a different approach (i.e. casting technique, cast preparation, shell configuration, etc.) than Root orthotic therapy. One of the primary claims of the labs that support the use of MASS theory or some variation of it is that traditional Root type orthoses fail because they don’t support the arch sufficiently and as a result, they don’t induce enough re-supination of the foot. The problem is, we don’t know the failure rate of orthoses nor do we know the failure rate of one practitioner or lab as compared to the next. In addition, we don’t always know why an orthosis actually failed so we rely on an assumption or an educated guess. Logic and trial and error are import tools in resolving treatment failures.

    In my lab, I see some practitioners who appear to have outstanding clinical results while others seem to have less than ideal results. I base this comment in part, on the individual practitioner’s rate of return for adjustment and on other feedback we receive at the lab such as their rate of telephone support to address treatment related problems. I also see very different philosophies and approaches by those who are in theory, practicing the same theory.

    I have some very large volume practitioners who use seemingly different approaches (i.e. how they cast or prescribe) but they have few if any complaints and returns. However, I can’t necessarily assume from their lack of complaints that their clinical outcomes or success rates are the same. We just don’t know because we have no scientific means to measure it. The fact that a practitioner or their patient doesn’t complain or return their devices doesn’t necessarily mean that there was treatment success.

    We also need to consider the fact that patient selection is another important variable. Some practitioners are very liberal in recommending custom orthoses to their patient’s while other are more conservative and reserve custom orthoses for more severe pathology. Needless to say, it is much easier to have a higher “success” rate with a less pathological population! It could be argued that some practitioner’s over utilize orthoses and others under utilize them. How does this influence our perception of success, especially at the individual practitioner level? And how does the patient population differ between different specialties? Are chiropractors, PT’s, podiatrists, DPM’s seeming the same patient populations for the same conditions or might there be differences in the pathology they treat?

    I have seen some orthotic labs that appear to do a very good job in manufacturing Root type orthoses while others who do a very poor job. Within the labs that do a good job, there are some very good Root type practitioners and some not so good Root type practitioners.

    There are now several labs that have sprung up as a result of MASS theory. Will the originator(s) of MASS theory be willing to accept responsibility for every lab and practitioner who professes to practice MASS theory, regardless of how they do it? The practice of MASS will ultimately be judged by the average of the labs and practitioners who practice it, not by the individual performance of just one lab. Time will tell.

    Calibration is reported to be very import component in the application of MASS theory. Yet how can labs that practice MASS theory claim to get such good results if they don’t calibrate their orthoses? So how important is calibration. New thread?: MASS labs debate the value of calibration!

    Have I seen MASS failure (pun intended!)? Yes. One practitioner who had the devices made for him at a SoleSupports (SS) workshop described it as feeling like he had a gold ball under his arch. Another practitioner who received his orthoses directly at a SS workshop became a Root Lab customer after being treated by me at a future conference. He is extremely happy with the clinical results he gets with Root Lab’s orthoses now. His SS devices had a simulated leather top cover. He has a partially compensated forefoot varus. There was significant evidence of pressure on the top cover at the apex of the medial arch but virtually no contact pressure along the anterior, medial aspect of the device. I made a traditional Root type orthosis that supports his uncompensated forefoot varus and he loves his Root devices. He is an avid runner and has a carbon fiber pair for dress shoes and a hybrid pair made from the same casts for running purposes. For the record, I would never ask this or any practitioner to allow me to run a video of him criticizing my competitor’s product on YouTube.

    I have also met some practitioners who are very satisfied with their SS orthoses for their own feet or in their practices. Some of the SS devices I have seen were very flexible as I expected, and some were surprisingly more rigid than I expected. I have seen some of the devices worn as manufactured and others that required significant modification in an effort to achieve comfort or the desired outcome. Sound familiar?

    I fear that anyone looking for an orthotic panacea will be disappointed. I’m probably not adding much value to this discussion since this is an opinion based commentary, so I will bow out now and let the debate resume!

    Respectfully
    Jeff Root
     
  20. Most of them are! Its just a question of whether the opinion is masquerading as fact.
     
  21. pnunan

    pnunan Member

    Ed,

    You had a foam model (pillow) of a talus and calcaneus and used that as a prop over and over in your early lectures. You also implied whether you intended or not and had people believing you were a mechanical engineer. There are many ways to accomplish your same stated goals from casting. You have the choice to tell the lab not to fill the arch, plantarflex the 1st ray thus raising the arch etc. Again this is nothing new. You have successfully marketed your product, good for you. But I have noticed you truely don't like it when people question your knowledge or theories. I would like a front seat to a debate between you and Doug Richie, Kevin Kirby or many others. I have seen you several times in public and am not impressed with your live presentations. You actually write better than you speak.

    However, you are also guilty of personal attacks on people's integrity. Name calling is never acceptable in a debate, period. If you want a true forum than arrange to have it at a meeting with several well known biomechanists, podiatrists, physical therapists and chiropractors. Stick to facts. There are many ways to help people with orthotics. You nor anyone else has all the answers.

    Patrick J. Nunan, DPM
     
  22. David Wedemeyer

    David Wedemeyer Well-Known Member

    Chris if your comments were directed at my post, point well taken. I did not mean to imply that either researcher had anything but the best intentions. I know neither except by reputation and that reputation I would not challenge. What i was trying to say you put much more eloquently in your last sentence. I won't drone on but I feel that using your brand in the study to promote it rather than seeking the objective that you refer to (scientific integrity) is my tipping point and the source of my frustration.

    Here, here :good:
     
  23. efuller

    efuller MVP

    I agree. However, I was responding to your comment that SALRE was a fallacy. I couldn't let that go unanswered, especially since your criticisms had been answered before.

    Both your statements and my responses were in that thread written 16 months ago. They can be found in the defending SALRE thread from 2008

    Respectfully,

    Eric
     
  24. It's been a while and I'd forgotten your modus operandi Ed. It came back to me with this posting and the hours that have passed and still no response... Yeah, I remember now, you can't respond because you are too busy doing.. insert X. I took the time out of my day to respond to you...

    To re-iterate:

    How do you manage to "calibrate" the stiffness of devices such that they are effective for both walking and running? If we had two patients with identical foot morphology, stiffness etc. (i.e. identical feet), but one patient weighed 75kg and another weighed 95kg what would be the difference in the devices produced by your lab in terms of their physical form, i.e. shell thickness, medial longitudinal arch height etc. ? I might just test this by sending your lab a few casts from the same feet, but filling in a different body weight on the prescription form, assessing what I get back, and maybe writing up, I presume that's ok with you?

    What about if we were making devices for the same individual weighing 75kg, what should be the differences between the devices manufactured for this patient for running versus walking in terms of their "calibration" viz. their physical characteristics?
     
  25. Richard Stess

    Richard Stess Member

    I have been following this conversation for quite some time now and find that it really isn't adding much to the science and art of treating patients. Why would Drs. Kirby or Dr. Richie take the challenge of a debate with Dr. Glaser. I believe they had a debate at the APMA national meeting in Hawaii and it was like watching the Ali vs. Sonny Liston fight.....No contest and one that I would not like to see again. It was ugly!

    Richard Stess, DPM
    VAMC, San Francisco Retired
    STS Company, President
     
  26. If anyone has a bootleg video, audio or transcript of that I'll pay good money to see it!
     
  27. And in your opinion, who came out better in this debate: Kirby, Richie or Glaser? What would add to the "science and art of" treating patients, in your opinion?
     
  28. Richard Stess

    Richard Stess Member

    Both Drs. Richie and Kirby refer to studies in their debates that have been published by legitimate journals and whose papers are reviewed and acceptable to peers who adhere to verifiable criterion. The science and art of patient care are affected when listening to experts whose opinions are based upon what appeas to be reasonable fact and methodology rather than impressions/theory. You ask who won? Not one who requires or suggests that only one lab can produce an orthotic device with satisfactory therapeutic outcomes.
     
  29. EdGlaser

    EdGlaser Active Member

    That is a complicated question. It has many factors. The short answer is that a person gets their orthoses calibrated for activities of dailly living. If they are also a competitive athlete then we ask what sport and position. Then ideally they get a second pair to resist the range of forces that are put through the orthotic during their sporting activities. An example, we made orthotics for a man who won the world’s strongest man competition. He weighed almost 400 and wanted orthotics to work for his deadlift. He was trying to deadlift about 1000 lbs. We needed to calibrate for 1400 lbs. They orthotics seemed hard as a rock. He could not tolerate them to walk around the mall so we made him another pair for his body weight. The reason that this is complicated is because orthotics cost money. Some people participate in several sports. Triathletes for example. Triathletes need at least three pairs. One for bicycling, one for the Marathon and the other for ADL. I tell the patient how much they cost, I recommend they get orthotics for a sport that they are serious about. Some sports have about the same stresses on the foot. ADL and Golf. Running and Soccer are close. I would try to aim for somewhere between the two sports and hopefully have enough overlap. Remember, we are talking about Ranges of Forces, both up and down. As I said, It is like a Venn diagram. How much of the circles are overlapping. Will we always cover every force the body puts through the orthotic…..of course not. Will the orthotic still apply a resistive force to compression…..absolutely. So the foot may fully pronate right through the orthotic sometimes. Then we are dampening the force. The impulse or impact reduces, so that deceleration occurs over a longer period of time. Maybe someday we will have an orthotic with a microchip in it that actually applies some electromagnetic field to the orthotic to instantaneously sense, measure and adjust the force of the orthotic to the downward force of the body. One might even imagine an orthotic with adjustable ribs, or elastic bands that can be adjusted prior to a sporting activity to approximate the range of forces more accurately. I have thought of prototyping such an orthotic but I have to finish one project at a time.


    Exactly what kind of physical testing do you do?

    I am really interested. What measurements have you taken?
    What have those measurements told you about the proper resistive force of the orthotic?
    How many orthotics have you dispensed so far where you have done finite element modeling? Is this past the experimental stage in your lab? We are still working on the 3D modeling of the orthotic and are playing with Pro Engineer (software) to do the FEA. This is over my head and my software engineers are meeting with me about it to decide the direction we should go on this. It is a complex problem. I hope you have solved it.


    Force seems to pass like a wave through the foot. We use the F scan in our lab (I know the e-med is better in some ways but the f scan is affordable and gives us a pretty good idea of what is going on). I agree, there are serious problems to solve here. I first shoot for a practical first approximation. Then doing lots of numbers of orthoses, we can judge when an orthotic comes back for warranty, adjustment or recalibration. Was it too stiff or to flexible for the patient’s needs? Unfortunately all this is complicated by perception. Some patients can tolerate great changes with little discomfort or complaint. Others are the princess and the pea. We are always collecting data. Then we choose to look at a particular question and answer it with the data we have. It is a ridiculously large task. That is why Stu Currie, DC is such a valuable asset. He is a detail oriented, scientist. He doesn’t have to agree with me. We are on the same side. Trying to learn more about making better and better orthotics. We are not trying to prove something….we are trying to learn something.

    The first and most important factor in considering the downward force of the human body is weight. If you take the slopes of the force curves of all of the orthotics you do. Each can then be reduced to a single number. You can choose the angle of the force curve from the x axis in degrees or radians, or the Sin, Cos or Tan of that angle, placed on a scatter graph (slope vs weight). You do this for each foot flexibility rating. This is really where a large “n” is critical because there is some subjectivity in the Gib test measurement. We did this years ago. It is time we updated the data…..we will (thanks for reminding me). We found that this formed a hazy line with several outliers. The dots far from the line were warrantees and were eliminated. Using the “trend-line” function on excel we were able to create a linear equation. The fore foot flexibility which is graded on a one to five scale. We just want to know….is the person average flexibility, very rigid, very flexible or on the rigid or flexible side of normal. Then we factor in activity level. If the person is a runner we make it more rigid. Again, very large numbers are needed to cross check the accuracy. Exactly how much is somewhat of an art based on 14 years experience making MASS posture orthotics, and the amount of information that we get from practitioners. We have a large notes section where they give us details to consider when calibrating, diagnosis, activity, sport, position, etc. etc. The more info we get, the better we can nail down the approximate range of forces to resist. We shift the calibration target. This can be done in many ways. Adding weight, moving left or right on the linear equation, changing flexibility. We hope to collect sport and position specific data with our F-scan but as you know there are many complications and assumptions that have to be made. Again, our philosophy is shoot for the best first approximation and then refine it with data as it is collected. We shoot for maximal overlap of the force ranges. Is it perfect?….No. It never will be. Can we and are we continuing to collect data to make it more and more accurate? Yes. Remember we are not shooting for personal fame, credentials or the most peer reviewed articles in publication....we are shooting for making people better with the best orthotic we an manufacture. It is hard to explain the units we use. Since the pressure increases at a fixed rate, and using observations of high speed video of calibration in progress, you can see how the plastic deforms. With the human eye we see that it must deform evenly. Collapse in the front or rear of the MLA is unacceptable….it becomes a display sample. The orthotic will fail so it is useless. Once the orthotic passes that QC (and a good grinder can pass it over 90% of the time, and that’s one hell of a training process), we notice that it deforms in a relatively straight line fashion….much like a spring with a certain spring coefficient. Therefore we can simply count the number of clicks (two-thousandths incriments) that occur to reach a certain pressure. This keeps cycle time within reason for large scale production. Alternatively you can keep take incremental measurements of pressure to reach a certain distance. Both are two sides of the same coin. Temperature of the plastic is another variable we have to deal with. After grinding, the temp may be slightly higher due to friction. We calibrate at room temperature which means that we have to have a temperature controlled environment, HVAC is not cheap in a 40,000 sq ft facility in Tennessee summers. Luckily in the shoe the temp is fairly homeostatic in warm blooded mammals due to ….98.6 degrees. Humans survive in a narrow range of temps….thank god, or the complexity would be overwhelming especially if the temps varied on the surface of one foot or between feet and was unstable. Minor variations occur but again within an acceptable range. Surface geometry is another complicating factor as you noted. You are on the right track….only FEA will yield an acceptable improvement on what we are doing now. I wish Pro E. did not cost 36K with all the modules necessary to do this. We have had it for about a year and are finding that the 3D modeling is a daunting task…..but doable. I hope you have done it….I would pay big for a shortcut. We have been collecting 3D data on MASS position casts for almost five years now and have an incredible amount of data to crunch. Learning this way is an evolutionary process, takes time and tenacity. You may criticize us for not instantly having all of the answers, we don't claim to. You don't have to swim faster than the shark, just faster than the other swimmers.


    I know that. That is why I am so surprised when you jump on the “personal attack” bandwagon questioning my motives, bias, salesmanship, wardrobe, reading, credentials etc. etc. BTW, you can also criticize me for being fat, bald, forgetful, diabetic, having a messy desk and drinking too much coffee. It is beyond frustrating when brilliant academians like you, Kevin and Doug stoop to that. I am truly sorry if I get offensive....I have too many arrows flying at me at once and that is how I react.

    I know that I say that my orthotics are superior. The best in the world. I believe they are for good reasons. Shifting a medical paradigm takes force too.

    I am still waiting for someone to quote Whitman’s exact definition of MASS posture, calibration, soft tissue compression etc. …..straw man argument if I have ever heard one. All higher arched orthoses are not created equal.

    Respectfully,
    Ed
     
    Last edited: Apr 23, 2010
  30. EdGlaser

    EdGlaser Active Member

    Eric,

    With all due respect, and I hold you in the highest regard, although attacking SALRE is fun and an interesting diversion I have little time for it. I feel that SALRE is a myopic approach. Rotational equilibrium is a newtonian certainty. Picking one axis and basing everything on that, as it has been applied in the arena...and I could quote Kevin a hundred times on that both from here and his newsletters, is simplistic at best. Basing treatment protocols on the location of the shadow of the one axis, the STJ axis, in the transverse plane or on the plantar surface of the foot is ludicrous. It leads to bigger posts inside the heel cup without addressing the many other axes of the foot that are affected by postural changes. I am sorry. I just do not have the time to research this again right now. I have a lot going on. Perhaps this summer we can have some fun with this. Right now we are in the middle of an exciting new product launch, a new marketing campaign, a big new research project on outcomes, and this is my busy travel season for lecturing. Next weekend for example I am in California on Thursday, Chicago on Friday, Cincinnati on Saturday. Two of the venues have over 300 attendees. NO, I did not pay to speak as Kevin keeps saying. He is so off base. When I donate my honorariums to research it is because I want to give back. Sometimes I do contribute more money..... the state societies do not seem to mind my support. Maybe they should not accept any money from corporations to support professions that support them. I hope the money is used to do good for Podiatry.

    Ed
     
  31. EdGlaser

    EdGlaser Active Member

    Pat,
    Yes we have a silicone molding lab at Sole Supports. We make those large bones and they are for sale on our website. They are a fantastic teaching tool. Using bones in a demonstration does not imply the non-existance of soft tissues. Soft tissue diagnoses are an important part of my lecture.
    I am sorry if you misunderstood my background. I tell a little about my educational background to explain why I see things differently. If you look at the program for the seminar you will see Edward S. Glaser, DPM. If your understanding, evaluation or comprehension of my theory is dependent on my having an ME degree then you are out of luck. I said nothing untrue....you just assumed wrong. If you have another way to get the MASS geometry with the soft tissues compressed....please tell me. It is one of our research projects. We certainly want to hear about your method. Plantarflexing the first in space has no frame of reference, does not compress the soft tissues, is inacurate and therefore we will not use it because it is not an improvement on what we are currently doing.
    I LOVE people to question my theories.....else why would I take the abuse that is constantly handed me on this site.
    I consider myself a better lecturer than writer but you are entitled to your opinion.

    Unfortunately, they will not debate me. Doug wrote to me asking what we should debate....my bunny suit, my credentials? How about biomechanics ONLY.
    Stick to the facts.....from your mouth to God's ears.....Please make it so. From the moment I got on the arena Kevin blasted me on things he knew nothing about. My attempts to have a constructive discussion are thwarted by personal attacks. I am sorry that I react with offensive jabs. Put yourself in my "bunny suit" for a second.
    No I do not have all the answers. Who else is researching MASS besides me and the universities that I sponsor research at? Who is best equipped to answer questions about MASS Posture? What posture do you put the foot in....and WHY?

    Respectfully,
    Ed
     
    Last edited: Apr 23, 2010
  32. EdGlaser

    EdGlaser Active Member

    The only problem is that Doug, Kevin and myself did not debate at all.

    At the Western Congress Doug was the moderator, Kevin, Cheryl (from the CA podiatry school, Chip Southerland and I gave a 15 minute talk (and we were told what to talk about....something like "What influenced your teaching?) and then Doug presented cases and asked for comment. Hardly a debate. Kevin as usual just read a list references for his 15 minutes. Data mining at its best. I think his point was, I am smarter and I have read more than anyone in this room. Congrats on that.
    I tried to present a whole new paradigm and a classification system of postures based on translation of the STJ axis during postural change and the concept of the heel rocker axis as being more important than the STJ axis. Because of the very small moment arm between the STJ axis and force moving down the leg and the very small moment arm between GRF and STJ axis at heel strike compared to the huge moment arms these two forces have at heel strike with the heel rocker axis. And I talked about the merit of early postural intervention, before the foot has collapsed completely as compared with force distribution on the bottom of the foot in a near fully pronated posture.

    At the APMA national Kevin was in Australia with Craig or somewhere else. It was Doug and I with about the same format; except we had 25 minutes. No debate happened. The APMA paid each of us $2500. and travel to Hawaii. I kept the honorarium in this case....that should make Kevin very happy.

    I might have a bootleg tape or two.... What's you bid?

    Respectfully,
    Ed
     
    Last edited: Apr 23, 2010
  33. EdGlaser

    EdGlaser Active Member

    MLA height is determined by the cast only.....Zero fill ever.

    What is the science behind arch fill? Please answer that....and quote RCT's please. The difference in calibration is completely done with shell thickness. All the rest was answered in an earlier post today.

    Respectfully,
    Ed

    PS: I always welcome research and remember turn around is fair play. I would like to measure the calibration on your devices. Maybe you do a better job than we do in calibration. All things are possible.
     
    Last edited: Apr 23, 2010
  34. Ed, if I may, you mention cycling somewhere in a reply to Simon. Something about different device for different activity. From what I can gather no arch fill, very high arch is the type of device you prescribe.

    If you could try and explain how you would prescribe a MASS orthotic for a cyclist as oppossed to a runner in your triathlete example. The biomechanics of cycling and running are very different and to be honest I can´t see a high arch device having any role in changing cycling mechancis and may lead to some issues as well, but you mentioned the example so if you could expand on it ?
     
  35. Griff

    Griff Moderator

    Not the focus of this thread at all but just wanted to say for the record I disagree with this.

    As you were.
     
  36. Jeff Root

    Jeff Root Well-Known Member

    I thought the following comments that were written by Merton L. Root, DPM for the California College of Podiatric Medicine's Newsletter in 1982 in response to an article that appeared in consumer reports might be worth considering. I uploaded a PDF of the full article for those who are interested.

    Respectfully,
    Jeff Root

    "A second major reason for the failure of podiatry to convince the public of the value of its orthoses is that the profession is using gimmicky terminology and attempting to foist it on the public. Terms like "biomechanical imbalances," "optimal functional position," and "rebalance the foot" were used by Consumer Reports as direct quotations from podiatrists. Not one of these terms makes scientific sense, and the public is knowledgeable enough to reject such nonsense.

    Biomechanics, which is a relatively new basic science of medicine, has particular value to podiatry because podiatrists primarily treat problems that are directly or indirectly caused by abnormal mechanics of the foot. Those podiatrists who have little or no knowledge of biomechanics but attempt to convince the public and the profession that they do, are distorting biomechanics, and will eventually destroy it as a valid scientific basis for understanding the foot. The science of biomechanics will continue to grow and flourish in other medical specialties but will die in confusion within the profession of podiatry."

    Some cut:

    "An orthosis that is prescribed to resist specific abnormal forces identified by examination and is designed to promote improved function of the foot is called a functional orthosis. A functional orthosis does not support the arch of the foot. A functional orthosis does not "balance" a foot. A functional orthosis does not hold a foot in any position. A functional orthosis does not accommodate lesions or painful areas of the foot. A functional orthosis only resists abnormal forces and promotes improved foot function."
     

    Attached Files:

  37. Richard Stess

    Richard Stess Member

    Eric, I was in error. You are correct that there was a debate. It was not at the APMA National in Hawaii but rather it was at the Western in Anaheim 2 years ago. I stick to my guns that it was like the Ali vs. Liston fight for those who can remember that far back. It was over in 30 seconds. No contest. It was embarrasing to say the least.
     
  38. Richard Stess

    Richard Stess Member

    Sir:
    I was in the audience at the Western Podiatry Congress two years ago during your discussion and yes your attempt to debate. I must say that in 40+ years of practicing podiatric medicine and biomechanics and having attended countless seminars and meetings have I ever witnessed anything quite like your display. I have never listened to any lecturer attempt to justify his own opinions and belief’s by vigorously discrediting and dismissing others theories. I was surprised by the content of your lecture but more importantly embarrassed by your methodologies. If I were either Dr. Kirby or Richie I would certainly not put myself on the same dais again to have a repeat of such an embarrasing performance.
     
  39. efuller

    efuller MVP

    Ed,
    We are going around in circles. To reiterate: Kevin's rotational equilibrium paper took a three dimensional concept and explained it in a single plane to make it easier to understand. The simplified explanation can be expanded to three dimensions. SARLE explains a lot of pathology. It explains why some feet get posterior tibial tendinitis and other feet get peroneal tendinitis.

    SARLE is not the whole tissue stress approach to the foot either. You can't explain a callus beneath the second metatarsal head with SARLE. However, you can add in first ray stiffness and metatarsal length as things you should be looking at when assessing areas of high stress in the foot. We do that. So, saying "Basing treatment protocols on the location of the shadow of the one axis, the STJ axis, in the transverse plane or on the plantar surface of the foot is ludicrous." is a misrepresentation of what we do and unnecessarily inflammatory.

    Additionally, what is wrong with basing some treatments on the SALRE model. It's pretty straight forward thought process to see posterior tibial dysfunction being related to a medially positioned STJ axis creating a high pronation moment from the ground. The small leverage of the PT tendon in this case will mean that it will have to withstand greater tension to create the same motion or moments. Treatment is based on shifting the center of pressure more medial to decrease the pronation moment from the ground.

    This logic also explains why Sole supports devices work. In most feet, increased pressure from a high arched device will be medial to the STJ axis. In some feet with excessively medially positioned axes, increased pressure in the arch will really hurt. As Jeff Root pointed out, Mert Root didn't like it when people say an orthotic holds the foot in a certain position. I don't like it either. One of the major problems that I have with the MASS approach is that it seems to follow this logic. How does MASS therapy differ its protocol for different pathologies?

    Regards,
    Eric
     
  40. David Wedemeyer

    David Wedemeyer Well-Known Member

    How unbelievably prescient were Dr. Root's comments and predictions here. His portend that other professions would continue biomechanics and that it would die a confused death in podiatry were spot on. Thank you for sharing that Jeff.
    :good:

    Regards,
     
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