Prescribing Orthoses: Has Tissue Stress Theory Supplanted Root Theory?

I see a couple of photo's of the patient within this thread. I've attached them here. To me, it tells me why I like to have a patient in front of me, rather than try to comment on photographs of a patient that I've never seen in the flesh for myself. I don't prescribe foot orthoses via the internet nor telephone and I certainly don't make diagnostic decisions from photographs posted on the internet. What is it that you are trying to say about this patient, Huntybun? Because to me in one photo we have extensor firing and the other we have flexors firing. To me the patient is probably latarally unstable and constantly adjusting muscular activity to maintain balance- like I said- I don't diagnose based on photo's. Yet, you seem to be on a witch hunt here Dr Huntybunty to prove something else? You lost me, why is this important to the debate as to Root being invalid? What is it that you are trying to prove by keeping referring to this? That you don't like Dr Spooner? (I don't think Dr Spooner thinks too much of you either, between me and you).

But you are going there Huntylovey, because you are attempting character assasinations of Drs. Kirby, Spooner and Fuller are you not by:

Your comment above regarding Dr Kirby:

Your constant reference to the same post within this thread made by Dr Spooner;

And:

when Dr Spooner said:

You Matthew Sciaroni DPM replied:

What is it that you were intimating with regard to Dr Fuller here drhunt1?

Then of course we have this gem against me:

Filed away?

Anyway, you might have missed this question Honeybun:

Two further questions:
1) do you own a pass-port?
2) do you own a gun?

 

https://www.youtube.com/watch?v=qdJvgS4CRpI

 

As I recall it appeared to me that when this patient intermittently relaxed their flexors as they must do periodically to reduce fatigue, there was an instantaneous rebound effect that creates very brief dorsiflexion of the lesser digits. This may be due to tension in the dorsal tissue structure such as the ligaments or due to actual contraction of the extensors. If the extensors are firing, they are probably firing to create compression in order to stabilize the MTPJ. The dominate muscle activity is the flexors as evidenced by the contracted digits which are clearly evident even when the digits are not in contact with the supporting surface.

 

Mat

from the pic of ur son, I would describe that as a ff adductus, either way he would be a good candidate for the SDO,

 

Jeff,

I see you complained about someone not getting back to you.

Well, I have the same complaint about you.

tks

 

Dobbs-it appears you may be someone else on this board, n'est pas? One thing is becoming clear to me, though...and that is you're a Brit. They have an attitude that they think they're better than everyone else, and your posts fits that line quite nicely. No...I have never been asked to lecture in the UK or Australia...and if I was ever, I would decline. In the words of Groucho Marx: "I refuse to join a club that would have me as a member". If frequent flyer miles are the sign that you actually know something, than why remain sub-genius and anonymous? If you've ever contributed anything germane or prudent to a discussion, it's news to me...which I've stated repeatedly.

And all you had to do was read my response to Simon to know that lateral instability was my diagnosis...glad to read that my clinical skills are reaching home with you. But I was more interested in your response to Simon whom stated that the pics demonstrated extensor contractures.

As far as Simon and Kirby are concerned...it's their bed that they sleep in...not mine. They have, IMO, "assassinated" themselves...I really didn't have to do too much.

And as far as your last two questions, (totally OT, btw), yes...I'm armed to the teeth. But all one would need to do is look at my profile pic to determine that I'm an avid duck hunter, (wild fowl shooter in British vernacular). You should come out sometime and go hunting with me...it would be a blast!

And I'm currently in the process of obtaining a passport, not for attending boring lecture series abroad, but to take my two sons down to Baja to hunt big game fish. I'm enclosing a couple of OT pics for your amusement as to what I'm writing about. Besides being a magical place, these fish are serious pelagic species...wouldn't you agree? Fighting big fish out of small boats is classic Hemingway material...and my boys are in for an epic ride!

 

Both are ways of looking at the same foot. There will be some overlap because we are both discussing the same anatomy. For example the concept of the partially compensated varus is an observation of the anatomy. That concept will have to be present in any theory that looks at the differences between feet. So, if you just look at the things that describe anatomy, you will not be able to separate these concepts out into separate theories.

Tissue stress theory will use some things that were invented by neutral position theorists. For example, the concept of an intrinsic forefoot valgus post. That concept is very important for changing how the foot is loaded in stance. In tissue stress, we use the intrinsic forefoot valgus post to decrease load on the first ray and increase load on the lateral forefoot. I'll let the neutral position theorists give their reasoning as to why they would use an intrinsic forefoot valgus post. The reasons for using this modification are probably different between the two theories. The indications for using this modification are also probably different between tissue stress and neutral position theory. i use an intrinsic forefoot valgus post when there is eversion range of motion in stance. I assume that neutral position theorists use an intrinsic forefoot valgus post when there is an everted forefoot to rearfoot deformity, unless there is some reason to balance the heel bisection to some other position.

Then there are areas where the two theories are completely separate. For example, tissue stress has no need for neutral position. If you are a neutral position theorist, what would you say to a second year student who asked, "Why is neutral positon important?" Tissue stress can also have a lab make an orthotic without ever using forefoot to rearfoot relationship.

Jeff, I've asked you this question several times. If I sent your lab a cast and asked you for 3mm of intrinsic forefoot valgus post, a heel cup that looks like a 2mm medial heel skive when the anterior edge of the orthotic is on ground, an arch height of 22 mm at the navicular tuberosity and heel cup that was 65mm wide, could you make it?

Another major difference is that tissue stress looks at the foot where it sits in stance. Neutral position looks at the foot where someone thinks it ought to be. When neutral position theorists talk about compensation for deformities they are talking about moving away from neutral. Tissue stress theorists look at the foot after the compensations have occurred and are looking at stress on anatomical structures in resting position.

So the two theories are different. There have to be some similarities because they are trying to describe the same object.

Eric

 

Matt, if you are going to paint people using broad stereotypes you should at least get your stereotypes correct. Americans are much better at having the attitude that they are better than everyone else.

Eric

 

Eric-it appears you haven't traveled enough. Americans aren't better than everyone else...we ARE everyone else...just with a different system. My brother has lived in Cambodia for 25 years...and has been head of AmCham of SE Asia for 20 of those. He's got LOTS of exposure to all types and nationalities...and recently had to get rid of an Aussie attorney/business partner that was worthless...full of beans. He's also had plenty of exposure to Brits throughout his adult life, professionally and otherwise. I stand by my stereotype. Hope this helps.

 

How does someone who doesn't even have a passport become so xenophobic? Weird.

 

Dr, Hunt: I don’t know which is worse, for a supposed man of science: the fact that your stereotypes and prejudices allow you to discard a person’s opinions just on nationality (ad hominem attack btw), or that you base those stereotypes in someone else’s experience, not even yours.
Just by seeing this, even if I had no idea on the topic at hand, I’d have to give credibility to whoever stands opposite to you in the argument.

-------------
PS: Sorry for posting something this empty of content, I guess I woke up in a ****ty mood and had to say something about this.

 

The Duck Hunter`s arrogance, prejudices, disrespect for Dr Evans and other esteemed colleagues have not won him any respect from me or my peers and many have totally rejected his "cure" for GP as a result. Shameful behaviour.

 

I'm in full agreement that we need to get away from labels. Root set forth certain hypotheses within the big realm of biomechanics. Most of those hypotheses are still up for consideration. I'm still not sure what TST is as any sort of system. One of the favorite books on my shelf is "A Primer of Orthopaedic Biomechanics" by Cochran. Another is "Biomechaics of Musculoskeletal Injury" by Gozna and harrington. Are either of these texts TST? Who knows. I only try to practicee biomechanics in my daily routine of treating patients. I consider a piece of plastic or cork under the foot to produce pressure at certain points under the foot and produce reactions. Is that TST or is it Root? Do I accept the Root hypothesis? Yes. Do I accept rotational equilibrium around the STJ axis concepts? Yes. Do I accept twisted plate theory? Yes. Do I accept basic functional hallux limitus concepts? Yes. Do I use Richie brace concepts? Yes. Do I take goniometric measurments? Yes. Do I take more measurements than Root proposed? Yes. Have I tried to better define the techniques for improved reliability in goniometric measurements? Yes. Have I done my own work on trying to make better orthotics for diabetics? Yes. Do I use physiotherapy in the course of treating biomechanical dysfunction? Yes. Do I try to devise surgeries for specific biomechanical problems? Yes. As I have heard Kevin discuss his post-graduate training under the disciples of Root, I'm grateful that I didn't get that training program, as his experience seems to be one of constraint of thought.. On the other hand, my post-graduate experience was much more free in that I had the ability to think outside the box. My father was constantly trying to improve on and further develop the principles that Root taught and to incorporate thinking from other disciplines, even trying to include orthodontic principles into his practice.

In summary, anyone who is tying themselves down to any particular theory or system is doing themselves and their patients a disservice by not availing themselves of all the tools that are out there. My goal, therefore, is to have the biggest biomechanical toolbox to best serve the people that want help. One of the things I enjoy about going to an American Society of Biomechanics or an International Society of Biomechanics meeting is that I never hear the terms "Root Theory" or "Tissue Stress Theory". I would urge all who are using the terms "Root theory" and "Tissue Stress Theory" to drop these divisive terms as neither serves the purpose of advancing biomechanical understanding nor in offering the full complement of biomechanical examination and treatment modalities.

One of my favorite sayings is from Dr. Leonard Levy: "Remember we're not treating foot problems. We're treating people who have foot problems."

Daryl

 

Dr. Evans disrespected herself when she held my article and information within to a higher standard than she viewed her own work. That's her problem, not mine. As for the content of my article itself, you can ignore it as you deem necessary...doesn't really matter to me. It just means you're purposely dismissing pertinent information because you place personalities ahead of principles. Shameful indeed.

 

No she critiqued your work because you asked her to, but your big fat ego couldnt take the constructive criticism. That is not how a scientific researcher operates, so people will not take your work seriously. Shame.

 

Thanks for the reply. I have respectfully asked multiple posters here about Simon's pics he presented in post #6 on this thread and their thoughts on his ascertains that they demonstrate extensor contracture. Finally, just above, J.R. Dobbs did...in a backhanded way. Even though he agreed with my early assessment of obvious lateral instability, he refused to answer my original question about how someone who's opinion is so revered overseas can make such a huge mistake...and not have anyone from his part of the globe call him out on it. Reverse xenophobia=protectionism?

 

FYI- I did not "ask her for her critique". I tried sending the link to the last email addie I had for her which no longer worked. I merely wanted someone on this blog to forward that link to her. Some of her criticism was noteworthy, but was overwhelmed by double standards, profound misinformation and rambling attacks on the process, not the content. She even wrote that the editor should be ashamed because of supposed lack of peer review. For someone who's supposedly in the position she finds herself, that's not a good tactic to use.

 

I didn't need to "agree with your assessment of obvious lateral instability" since in the original post Dr Spooner had said:

Stop with your own self-importance, for one minute.

Your "early assessment" is irrelevent because the presenting problem had already been defined, what you have done is looked at a single photo and then decided that because Dr Spooner poked fun at you previously, this would be your opportunity to strike back, but a single photo is not a patient assessment, is it HUnty1.2 and when Dr Spooner presented another photo of the same patient which supported his view, you chose to ignore it. What if Dr Spooner had posted the second photo first? Have you seen or examined this patient for yourself DRHunybunnt?

It's all about the ego with you isn't it- is that why you need the gun?

 

LOL! The British in you is so evident, Dobbs. Pot, kettle, black, J.R...and it appears that your day isn't going well.

Let's revisit the earlier posts in the thread...shall we? Here's my response to Simon, (btw, he never "tore me a new one"...he put me on ignore...after I did the same to him).

http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=359884&postcount=13

Take a hard look at those pics in that post, Dobbs...they could be of the patient Simon discussed in post #6...it's all the same type of presentation. Too bad PhD's can't take radiographs...because a plain film WB lateral of the patient that Simon discussed in post #6, would be quite similar to that in my post #13.

Now...what is your assessment of Simon's claim that the extensor tendons are responsible for the contractures?

 

you wanted the link sent to her so she could read it then encouraged her to post her response on the forum, but that not asking for her to critique it?

You didn`t like her response so threw your toys out and deride anyone else that agrees that your article is nothing more than an unscientific observational piece.

 

I sent her the link AFTER the article had been published...that's not a critique, nor was I really asking for it. As I've written before, Angela was closer to the truth in 2003 then she was in 2008. I encouraged her to publish her response on this forum to begin the long overdue discussion...that's all. But her attack against me and the information was above and beyond the pale. Many, if not all, of our more esteemed colleagues I talked to at the Western agree with me. Her rants, double standards and ridiculous assertions needed to be exposed...and they all agreed I did just that. If infection and cancer was such a concern to her...why didn't she mention them in her differential in either article she wrote? If she was adamant about not misleading students in Podiatry, why is she still traveling around the world lecturing on dated misinformation while at the same time dismissing relevant and pertinent information that could change the trajectory of the discussion? Why did she feel compelled to attack the editor and Board of PMM for publishing the article without knowing all the facts surrounding their review process and those I contacted prior to submission? Why did she use a BS link to bolster her objections, when she didn't mention cancer in her articles and missed the target of her anecdotal argument entirely?

Yaaaaawn...off to work.

 

Forum Rules;

I know you`re on your way to Scouseland, Craig....but do we really have to put up with meglomanic, xenophobic posters?

Say `hi` to Jo Hamill from me

Cheers,
Bel

 

[couldn't pass this one up]

So tell me, Ms. Longhurst...do the tirades and attacks towards Jeff Root on this forum constitute xenophobia in your opinion? Does the constant and unwavering assault on Root based biomechanics from your ilk as well as those that hail from the UK demonstrate the same? Does the simple assertion that PhD's are better at information gathering and dissemination of useful information than DPM's fall into that category?

Please.

 

Did I mention you by name?

No thanks.

 

xen·o·pho·bi·a/ˌzenəˈfōbēə,ˌzēnəˈfōbēə/
noun
intense or irrational dislike or fear of people from other countries.

So to answer your questions: No, none of these constitute xenophobia. However, one might argue that you are displaying xenophobia within your question here

 

And while you're at it Craig, does childish name calling add value to this forum and is it consistent with the rules, purpose and intent of this forum?

In six sample posts, Dobb's writes:

Not once I have seen any criticism of or a request for administrative intervention by anyone about this rude, crude and offensive behavior. Don't selectively enforce the rules.

 

Terms of endearment for DRDefencelesssmallbirdshooterwithabigguntomakeupformypersonalshortcomings1 everyone knows we got a thing going on.

 

That's right Jeff, but we'll gloss over the posts where you called me a prick and cast aspersions about my father's social class.

 

You have called me worse things. And some you edited out after your better judgment kicked in. And for the record, I wasn't questioning your social class Simon, I was questioning your professionalism and social behavior. Class has nothing to do with occupation or money.

 

Whatever, you were questioning my father's social standing in a jibe aimed at me. Highly inappropriate. You know it and I know it. The point being he that is free from sin should cast the first stone- and that isn't you, Jeff. Don't play the hollier than thou card.

 

I have no problem with the occasional satire here, but I believe your comments have unnecessarily and significantly added to the volatility of the environment on this forum and particularly in this thread. You are intentionally provoking others in an effort to get an emotional response. You get the response you intended and then others complain and ask for administrative intervention or censorship. I don’t believe this type of behavior is in the best interest of this forum. There is enough debate and emotion even when this thread stays on topic. There does seem to be a double standard. Why was Dr. Shavelson banned? I have no idea because I wasn't following the PA at the time, but how is your conduct helping your profession on this forum? Now your trying to create more debate about hunting and gun ownership. This isn't the place for it.

 

Actually I was disappointed in myself for getting drawn into some of those petty exchanges. Bad on me. Let me ask you this Simon, do you condone all of Dobb's conduct towards Dr. Sciaroni?

 

DRHUNT1 is an ego-manic. He arrived on this forum proclaiming he was the saviour of biomechanics and growing pains, refusing requests of his real name. He has become increasingly hostile to anyone and everyone who dares to question him. In so doing he has made sweeping xenophobic statements, no-one has forced him into this, he has chosen to systematically attack Australian and British podiatry. Despite the fact that he has never been outside of North America and doesn't own a pass-port. He clearly knows very little of podiatry internationally. I have just pulled his leg and mocked his ego along the way.

He needs to take a long, hard look at his attitude. But you are right, I shall take my leave to let his ego shine on unchallenged. I'm sure when the only people writing on here agree with him, he'll be happy.

Wishing you many happy sales.

 

Yes "bad on you" Jeff, loose the hollier than thou stance- please, we've both been around podiatry discussion forums long enough to know the way discussions often go. DrHunt1 has been as much an aggressor as anyone as far as I can see (he's on my ignore list so I don't see all of his posts, only the bits people quote). Just as you sow you shall reap, Jeff. DrHunt1 threatened Kevin with legal action, then repeatedly tried to provoke him; he's been popping at me constantly, Eric, he even had a go at Craig, Dr Evans repeatedly, the Australians, the UK....

 

Why not stay and challenge and debate him in a civil manner? Sell us on your point of view!

 

So I will take your reply as a "yes" that you do condone Dobb's behavior. As they say, politics makes for strange bedfollows.

 

You can take my reply to be whatever you want it to be, Jeff as I said: "just as you sow you shall reap". For the record, Dobbs earlier posts were really funny, then he got a bit too serious for my liking. I preferred it when he was just blatently taking the piss.

Do you condone DrHunt1's behaviour, Jeff? Are "you two in bed together" because it suits your politic?

 

Whether TST has replaced any other theory is open for debate.
What isn't open for debate any more is whether disrespectful name calling has replaced civil academic debate.

Daryl

 

ROFL! You've been exposed, Simon. Funny how you use an alias to further your deceit, while pointing fingers of blame at others for remaining anonymous. You never fail to disappoint, Simon...you're as hypocritical now as you continue to fail to acknowledge a simple mistake you made. Don't worry, Dobbs/Simon...everyone makes them...it's how one handles them that separates us all. You wouldn't have lasted more then 15 minutes being attacked face-to-face with Dr. Harvey, then head of Pediatric Ortho at USC Med Ctr/LACounty Gen Hospital, in front of the patient no less. He would've reduced you to rubble....but more expeditiously than I have here.

Since when did I EVER write that I was going to save biomechanics? Can you refer me to a post where I wrote that? As I remember, the blog members here were attacking some Italian researchers for using the term hyperpronation...and I simply challenged those that mocked the Italians...including you. My!...you would've thought I attempted murder by challenging the powers that be here on this international forum! No, Simon...that's just a bloody excuse for what REALLY bothers you.

I told the blog members that I had resolved this issue of growing pains in children, and I used Root based biomechanics to describe and discuss it. In the article, I took that epiphany one step further to discuss the connection to RLS in adults. This is one of the Big Kahunas in Podiatry...one of the Holy Grail of foot pain, so to "speak". What really bothers you is that it was: 1) written and explained using Root based biomechanic precepts, and 2) it was determined by a Yank.

Patient care, Simon, is not about egos and personal ideologies...it's about treating patients SUCCESSFULLY. I have asked for nothing in return for my extended and not inexpensive efforts...and yet you and yours demean, belittle, denigrate, insult and attack anyone that opposes you, which included me. The problem is, Simon...I have accomplished something that simply cannot be demeaned or ridiculed. Sure, many have tried and, like yourself, still attempt to...but the bottom line is this...I did it, and you didn't.

As far as my stereotypes are concerned...I will take the word of my well-traveled, worldly and experienced brother over ANYONE'S here on this blog. He is right on target...you...not so much. Hope this helps.