Prescribing Orthoses: Has Tissue Stress Theory Supplanted Root Theory?

https://www.youtube.com/watch?v=QON6SSMLcC8

 

Blinda,

The U.S. is the third largest county in the world and a leader in technology, science and medicine. So I think the fact that TST has not supplanted "Root Theory" (even though there is no such thing as "Root Theory") in the U.S. is significant. The UK ranks 22nd and Australia is the 53rd largest country. The UK population is 20% of the total U.S. population. So in terms of potential patients, I consider that to be significant. And since this thread was started by a podiatrist from the U.S., it is all the more significant.

Have a Happy 4th of July or as we call it in the U.S., Independence Day!

 

Over interpretation of results from a small sample....
Argument from/Appeal to Authority...

Etc etc...

 

No, just sharing our experiences.

 

The USA hasn't been leading podiatric biomechanics research for many, many years. Get over yourself, Jeff. About 46% of USA population hold a passport- do you have a passport, Jeff?

 

Yes I have a passport. WTF does that have to do with biomechanics?

 

LOL! Although Simon doesn't indicate whom is leading the world in biomechanic research, he dismisses the work of US Podiatrists with sweeping generalizations. And who can forget his post on page 2 of this thread, where he actually posted pics of his "contributions"...

http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=359863&postcount=6

I would be embarrassed to post pics of those orthotics...but Simon, obviously, is not. And then he goes on to claim the patient presented with extensor contractures in the pics! Yikes!

The problem with academics, (or those that profess to being in that category), is that while they, (and others) consider themselves at the "top of the tree", they cling to very thin branches with a tenuous grasp...it doesn't take much to shake them free of that position.

Perhaps someone should post the Youtube video of Simon dancing at a conference with his two-tone wing-tips to further demonstrate his contributions towards biomechanics.

 

OT-Happy Independence Day, Jeff...this nations 239 year old celebration of the signing of the Declaration of Independence, thereby telling King George where to stick it.

 

It's as relevent as a "survey" carried out at an American meeting when we are talking on an international forum. When was the last time you were invited to visit Europe/ Australasia to discuss podiatric biomechanics?


Your little world has had it's day.
https://www.youtube.com/watch?v=e-FVQ5rCTWE

 

Perhaps more importantly...when was Simon invited to speak at a US conference? Was that when he broke out in doing the Simon two-step on stage?

 

According to my searches Dr Spooner was last invited to speak in the USA in 2011 at the ACFAOM meeting. He seems to have been invited to speak internationally 3 times this year. I can't find any reference to you being invited to speak anywhere, Drcurrentbun. Neck wound in...?

 

I have been invited but never went due to obligations at my business. But that is totally irrelevant to this discussion. The Western Foot and Ankle Conference is one of the big three podiatry conferences in the U.S. Perhaps you should ask one of the 1200 plus attendees if TST was discussed and how TST has influenced how they practice. Just out of curiosity, how many attendees were there at the recent Biomechanics Summer School that Kevin lectured at?

I find the defensive reaction on the PA to Matt's and my casual poll on TST at the Western very interesting. If you read my post I have admitted that I believe change is needed. So why be so defensive when I discuss the limited impact of TST at the Western? I would think you would view it as an educational opportunity. Instead, you attack the messenger.

 

Why be so parochial? Your country is lagging behind in podiatric biomechanics research. Why should we look to you as our leader?

 

You opinion. What country is the leader in surgical biomechanics? Podiatrists in the U.S. are more and more functioning as foot and ankle surgeons. For better or worse, they are turning orthotic therapy and non-surgical biomechanical intervention over to pedorthists who will likely function in the future like non U.S. trained podiatrist.

 

I forgot to ask since it apparently is a very important question, do you have a passport?

 

How up to date do you feel you are with current podiatric biomechanics outside of the USA? Do you feel you are up to date on world-wide opinion, Jeff? When was the last time you visited Europe or Australasia to discuss current views on orthoses prescription? I'm guessing here, but i suspect the answer you are looking for is... never.

Bless your cotton gussets:
https://www.youtube.com/watch?v=e-FVQ5rCTWE

 

They have this new thing called the internet. And my comments were about the current state of biomechanics in the U.S. The last time I check, I still live in the U.S.

 

And by the way, thanks for reminding me that my passport is about to expire! I need to get on that.

 

I've a passport and have travelled this world all over. You my friend, have never been out of North America, have you?.... but, but, but.. i went to Canada once.... That don't count Rooty. Have you been to... Asia? Africa? Europe?

 

You've never been outside of North America to discuss podiatric biomechanics have you, Jeff? Anyway, avoiding the deflection: how up to date do you feel that you are on current podiatric biomechanics thinking? Do you feel as left behind as you seem to appear?

 

No, what has that got to do with biomechanics? Have you been to the U.S. Dobbs?

 

I have had many conversations with foreign podiatrists. Just had two from Australia visit my lab a few months ago and I just spoke to the only Australian podiatrist attending the Western Foot and Ankle Conference. Do their opinions count? This is a silly discussion. So back on topic, would you agree with the following statement:
It probably is unfair to compare Subtalar Joint Neutral (STJN) Theory of Root et al and Tissue Stress (TS) Theory and say they are unique and separate from each other. The combined works of Root et al formed the basis for much of our thought process in regards to foot structure and the response of the foot to different structural "deformities".

 

Been to the US of A on many occasions, even lived there. The point being, America is not the only fruit. Biomechanics is an international discipline, and you my lovely are lagging behind the rest of the world because you are unwilling to move on. Don't try to influence the international community here with your, "I asked people at the Western..." as if "the Western" has any international recognition... it doesn't... get over yourself. You have no concept of world wide opinion in podiatric biomechanics because you've never been out of North America to glean any opinion. Read the international literature; what does it tell you?

 

Jeff, you've never been to Europe have you? Yes or no will do. Anyway, here's a better question: could I take some undergraduates, never expose them to your father's works and at the end of their degree training have them be able to cast and prescribe efficacious foot orthoses without ever touching on your father's theories- the answer is yes.

Your fire has burnt out, the world has moved on, only in your business are your fathers ideals still important.

 

Anonymous Dobbs (if I were as condescending as you I wouldn't want people to know my real name either) wrote:

To which I replied:

then Simon wrote:

Simon, let me say it again real slowly so you can understand what I said a few post ago to anonymous Dobbs. Noooooooooooooooooooooooooooooo. That means negative. So talking biomechanics in another country is meaningful but talking biomechanics with foreigners in your own country is meaningless? Really?? Interesting that many foreign podiatrists have come visit me at my lab to talk to me about orthotics and biomechanics.

It was once said that if you came from more than one hundred miles away and had a set of slides you were considered an expert. Now you have to fly across the ocean and have a nice PowerPoint presentation and dance and sing on stage to be considered an expert (perhaps in your own mind!). So how many people have considered it worth their time and money to fly across the ocean to pick your brains?

 

Simon and Dobbs, care to answer my question above that you conveniently ignored? Sorry if it happens to be back on topic as I know that distracts you.

 

The sub-genius strikes again. Glad to read that you haven't elevated your position in life, Dobbs...it's comforting to many of us that while the world is in turmoil, you remain at intellectual levels that make morons jealous.

BTW...why not comment on the pics Simon shared with us on page 2, post #6 on this thread...

http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=359863&postcount=6

Do you agree with Mr. Spooner that the pic of the patients' feet demonstrates extensor contractions of the lesser digits? Perhaps you're too busy flying all over the world lecturing to make the defense of "one of your own"...but please entertain us. And btw...did a Brit discover the source of growing pains in children? Or was that an Aussie? And whom resolved the issue that has baffled researchers for decades trying to discover the link between GPs and RLS...was that a Brit or an Aussie? Survey says........neither. That's quite interesting given your sub-genius position about other Podiatrists compared to those here in the States. Perhaps many of us here are too busy in surgery to involve ourselves in biomechanics, (a situation that doesn't complicate your professional existence), but I assure you, that's about to change, Dobbs. And also rest assured, it will have little to do with TST.

 

Dobbs-please make sure that this is written on your head stone. I can see it now: "Here lies a complete, sub-genius boob, but darned if he didn't have a lot of frequent flyer miles"!

 

Originally Posted by Simon Spooner

How up to date do you feel you are with current podiatric biomechanics outside of the USA? Do you feel you are up to date on world-wide opinion, Jeff? When was the last time you viaited Europe or Australasia to discuss current views on orthoses prescription? I'm guessing here, but i suspect the answer you are looking for is... never.

The reason for these differences is that both sides are discussing theory, with a technology that is not backed by science.

If, the theories were discussed with a science d backed technology (e.g. fluid), the language among scientists would be more along the same lines.

Don't you think?

 

Simon and Dobbs, I'm still waiting for your response on the above question.

 

I answered it two days ago:

 

The statement

was written by Kevin Kirby.

Another thing that I learned at the Western Foot and Ankle Conference last month is that CSPM where Eric taught and where Kevin is an adjunct professor was just ranked last in biomechanics amongst all of the U.S. podiatry schools. CCPM which became CSPM was at one time THE podiatry school for biomechanics. So why is the school that is home to TST in the U.S. ranked dead last in biomechanics?

 

Because they are stuck in the past now? Eric no longer works there and hasn't for at least a decade because, and forgive me if I'm wrong Eric, Eric didn't fit the mold of the faculty (Root driven) and Kevin only does a few days each year there. So, perhaps the reason CCPM has fallen behind is because the full-time teaching staff are espousing the same old, same old- why don't you ask the full-time biomechanics lecturers what research they are currently engaged in, and what's on their sylllabus?

Perhaps CCPM need to take that leap and like I said: take some undergraduates, never expose them to your father's works and at the end of their degree training have them be able to cast and prescribe efficacious foot orthoses without ever touching on your father's theories. Visiting them only to give the historical perspective of "what we used to think".

 

"Didn't fit in" is not what I was told at the Western. CCPM/CSPM became a conduit for Podiatric surgeons...some of THE very best this world has known. The work of the Baja Clinic surgeons should've been published a long time ago, and it's a shame it never has. While most foot surgeries are named after orthopedic surgeons, this is a case where Podiatric surgeons trained at the California school led the world in reconstructive surgery. Thus, the emphasis on biomechanics was lost. Further, the academic retirement of the biomechanic department heads didn't help. It is up to those that graduated from that school to pick up the baton that was passed to us years ago...and that is something I've already done, and plan to do more. The fact that here in the US, people are seeking biomechanic assessments from orthotists, chiropractors and retail stores is proof that US schools have dropped the ball in this regard. Nothing I see coming out of the UK or Australia currently is really changing the hearts and minds of Podiatrists worldwide. While we still argue over simple concepts, the world has moved past our profession. One of my aims is to change that...which I believe I already have. Hope this helps.

 

Matt,

Unless you want to pay for it, I have to ask Tim, the owner of the factory. For me, just cover my expenses.

I don't mind fitting you as long as we get straight certain criteria first

1-you have to respond to the fitting by only 3 criteria

a. it must comfortable to wear
b. it should feel snug or full.
c. you should feel stable.

We can discuss the bio/fluidmechanics as it happens.
What I don't want is for you to tell me that you want to lift or do something specific to a part of your foot with the fluid.--It's hydro-dynamic there is nothing you can do with that Rx. However, if you have an anomoly say like a rigid plantarflexed ray, you could use a small material that might require an old fashioned chiropody technique of additional buttressing and padding. Even just adding a wedge under the MTJ (as long as the fluid absorbs it, will displace more fluid causing a more full feel under the arch, (that's not the way I want to do it) Having creativity with the fluid is a benefit.

Then the only adjustment, is to pronate or supinate the planes of motion. The closer we get to meeting the 3 criteria of the fit, the closer we come to joint congruity through out the gait cycle. Quantifying a Rx has that advantage.

I hope I don't have to answer to you why joint congruity is better? Do I?

To me, this is the difference in bio-mechanical tissue stress. If it's inefficient, TS is higher, if its efficient, the reverse.

After all, there has to be TS regardless of efficiency.

2. You agree to abide by the daily report instructions (I'm sure you could ultimately figure it out on your own, but if I assist you, you'll get it quicker.)--it requires a “daily report” of your proprioceptive sensations.--that's simply how I figure out the next step within1-2 weeks.

Here is where my education and experience comes in handy to assess with you based on the the 7 daily questions you need to answer to obtain the proper fit.

3. We agree you're fit, when we're finished.


I did ask something (and no one seems to answer) and that is, were you able to envision the bio/fluid loading as described in my article?--otherwise, what do you make of it?

btw—do you have a biomech issue?
I also need your wt and shoe size

 

Thanks. Actually, Dennis...I don't have any foot problems. (I'm not like the dentist with bad breath, or the overweight cardiologist, or the opthamologist with coke-bottom glasses, LOL!) My youngest son, however, has a forefoot varus deformity and I'm using him to gauge the effects of different orthotics. I will include a pic of his feet in static stance for your perusal.

 

Matt,

Sorry my post was on the wrong thread. It was for Matt (Ben-Hur)

I can see the deformity on your son's RF. How old is he? is he experiencing any problems?

 

Nope, what you see is that science and research outside of the USA is not changing podiatry within the USA and that the old school isn't convincing the modern student. Hmmm. When was the last time you visitied a podiatric biomechanics meeting in the UK or Australia, Honeybunny? I put it to you that you have never attended a podiatric biomechanics meeting outside of the good ol' US of A, have you? Please state the meetings you have attended in the UK or Australia... None, end of the story book. The problem with biomechanics in the USA, is that they are attempting to teach the same old crap, but to a more critical audience. The world has moved on. Do you hold a pass-port, Honeybunney?

How many of the teachers at the California school hold PhD's? How many are currently publishing research? In the rest of the world, lecturers are pretty much expected to hold or be working toward PhD's and to be actively involved in publishing reasearch in peer reviewed journals. I should be interested to know how many of the biomechanics faculty at California Podiatry School hold PhD's and how many are currently working toward them? How many are actively engaged in research?

Can you list the current biomechanics syllabus at California?

 

What were you told then, Huntybunty?... let's see if you can be man enough to stand up and have your opinions recorded for later use... Is this you: http://abc30.com/archive/6171118/

 

Dobbs-you never fail to disappoint me. Nope...not going there. I'm not Kirby, nor do I abide by character assassinations on public forums that you seem to adore. But your name calling tactics are acknowledged and filed away.

Now...care to comment on Simon's post #6 on this thread and answer my questions to you?