Rothbarts insoles

Hi Phil,
I think the truth about how orthoses (or D-pads or anything else you want to put in a pt's shoe) is just too simple for us to take in.
Surely a healthy joint, any joint, works around it's neutral position? Given that, all the bits and bobs we put in shoes probably, the ones that work, simply allow the foot to work a bit more around STJ neutral, and remove some of the compensation the foot/lower limb must make as it adapts to a hard and flat (approx) surface.

The relevance of evolution, (hugely important, and IMO something we as a profession have closed our eyes to and the evolutionary point I make is this:
If our lower limb anatomy has changed very little in 1.6 million years, should we really be accepting that suddenly (in evolutionary terms) our feet have adapted for a hard and flat surface? I have some slides (but no scanner currently so can't post them here) of casts of homo erectus tib/femur juxtaposed with "best match" homo sap tib/femurs. They are much the same, and it took no more than 10 minutes to find them in the bone drawers in the Anthropol Dept at Durham.
This isn't "my" theory. The bones are so similar as to be almost the same.

Where was Root et al flawed?
In supposing the STJ worked around neutral?
Or in supposing we had adaped for life on a hard and flat surface, thereby giving the lie to a bunch of foot "conditions" which, if placed in their proper context (on a mixture of undulating, and soft/hard terrain, where every step is different) are nothing more than mild variations of normal?

As you say, it doesn't affect prescription writing, because your device is an interface between the foot and the hard and flat (approx) surface , but it certainly helps people to understand biomech.
Cheers,
davidh

 

Ian,
Precisely!

 

Mark:

I never said that these proprioceptive insoles never work. I use these concepts of Morton's extension/forefoot varus posting on a few of my patients with good benefit to the patient. My point is that this individual is advocating a type of foot orthosis approach that should not be used for as many individuals as he claims since, when this technique is used inappropriately, it can actually cause harm to the patient.

If you think that what I have said about forefoot varus extensions is ridicule, I would be interested in what you would have said about the comments that I have heard Merton Root, DPM, Bill Orien, DPM and Chris Smith, DPM (three of my biomechanics professors) make when they have told podiatrists in public that they were approaching malpractice by using such orthosis modifications. Very strong words indeed, but I believe that they felt strongly about this because they had seen the harm that these types of orthosis modifications had created for some individuals. These highly respected podiatrists, who taught thousands of podiatrists throughout the States over the past 50 years on foot biomechanics and foot orthoses, had a passion for seeing that their students did the right thing for their patients and caused no harm to them. This passion and fear of patient harm far outweighed any worry about saying something that may have hurt some feelings or may have ruffled some feathers of interested bystanders.

Maybe I am just trying to carry on the tradition from Drs. Root, Orien and Smith of being viewed as being highly opinionated and negative of approaches that we feel are inappropriate and possibly harmful to patients. If I were to let these obvious self-serving promotions of ill-conceived ideas be discussed without me saying something about it, then I feel I would have let the last generation of biomechanics professors down by not carrying on their tradition of warning their podiatrist-students about the possible harm that may come to their patients by using such an approach on most of their patients.

 

I really don't have too much to add on this subject, but do suggest that you all see the following post that Craig submitted on an excellend synopsis on BM's high and low gear transitions...http://www.podiatry-arena.com/podiatry-forum/showthread.php?p=10019&posted=1#post10019 \

I would have to agree very much with Craig and Kevin that in general any varus posting under the medial column is a recipe for disaster. But, there are instances, as Kevin states, that some posting is necesary. In the rare instances with pateints who have a true fixed FF Varus, or an extreme 1st ray fixed elevatus. Howard has suggested in these patients the use of a soft addition or buildup under teh 1st ray to support this position. With a gradual decrease as the potential of that ray eventually plantarflexing does exist.
Very interesting discussion. Nice to see it not breaking down into nastiness yet, hope that continues!
Cheers!
Bruce Williams

 

RE Primus Metatarsus Supinatus Foot

Dear Dr Payne,

Thank you for allowing me to post again on your forum. I note that you posted part of your communication with the Journal of Bodywork and Movement Therapies. I suggest that it would now be appropriate to post my indepth reply that was also published in the JBMT.

regards,
B Rothbart

 

1. You have NEVER been prevented from logging into this site.

2. You initially signed up with two user names (against the forum rules you agreed to when you joined). One was deleted. You have always been allowed to sign in under this user name.

3. You posted the same or similar self promotional post 3 times (againist the forum rules you agreed to when you joined). Two of them were deleted leaving one.

4. You have now joined up again using a third user name! (againist the forum rules you agreed to when you joined), but will let it pass this time to get a reply

By all means post your detailed reply and everyone can see and judge for themselves how it failed totally to answer everything I raised.

Please feel free to also respond to Kevin's posts, especially the bit about improving the menstrual cycle.

 

Dear All,
In the interests of the current discussion, attached is the reply from Brian Rothbart to Craig's comment in the JBMT.
Tony Achilles
(p.s. I have no affiliation to either party)

 

Rothbarts

Well, this is fun isn't it!? 700 odd viewings of this debate. Passionately held views surfacing, me being accused of being a snake oil salesman, .....if I'd known this Bx theory was THAT contentious I'd have got involved a long time ago!! In my book, anyone who comes up with a theory that questions the accepted state of things........and gets people so angry that it prompts this level of academic debate not to mention the personal asides then HE HAS GOT TO BE on to something worth trying.
Clive Chapman was a colleague who had his own take on Bx. He tried to demystify Bx....he posted rearfoot values of 10-15degrees regularly. and had a link with a pre fab orthotics firm. People (me included) paid to attend his seminars. People disagreed with him, but nothing like this!

Craig...as Brian is going to post on this site, I'll leave it to him to answer your letter point by point.

Kevin....I'll come clean, I haven't noticed any difference to my menstural cycle through wearing the devices.......and I owe my fine head of hair to them of course! I've never seen a genuine snake oil sales poster...where do I get one.I'll stick it up in the surgery, my patients will think it's a hoot!

So...seconds out........ROUND TWO

Go back and read my last posting. If this is snake oil salesman speak, I don't recognise it. It is a plain statement of why I went to hear Brian speak, and why I tried the devices.

LET ME RECAP........the story so far
1/ Brian has controversial theory. I attend 2 day workshop and decide he's either raving mad or has a point. After second day decide he has a bloody good point that I can use in my practice as a practical tool.
2/ Send off for starter kit, and start to issue devices to "worst" patients in my practice. and to "body aware " pts, and those who are connoisseurs
of orthotics. Those that turn up with a bag full of failed devices.
3/ Results go far beyond my expectations. I've got enthusiastic patients.
4/ After bringing in 4th shipment from States, (each one bigger than the last) I phone Posture Dynamics to see if they have a distributor in Europe as I'm fed up waiting 10 days and paying stupid import duty.
5/ I'm asked if I want to be the distributor for the UK. I said yes because I GENUINELY BELIEVED that this was a useful tool for the profession. And I still do for reasons I'll go into. I freely admit that my enthusiasm for the devices was based solely on the results I saw in my practice.
6/ The results have ranged from nothing short of the miraculous......to "Ithink they're doing me good, but you're not getting them back"
5/ I've had 3 failures in over 100 issues. One patient had had extensive fore foot surgery. She was comfortable in another device I'd made her, and I was trying to get her into a thinner device. One said they made her feet too hot.
One was one of my associates, who is currently doing his Masters in Bx..no go,but as no one on the masters course can sort him out either....?!One fee refund, the other 2 were free hand outs to try. Some snake oil salesman I am
That's it so far. I'm off for a coffee, then back to the meat of this debate.
(pause for suspense to build........................!)

 

I would add some comments about this thread:

1. First of all, Brian Rothbart insoles and theory are more than similar to posturologie. Posturologie http://www.posturologie.com/ is a paradigm developed in France more than 50 years ago for explaining different conditions based on body asymmetries. Just check the website http://www.posturologie.com/posture_normale.html and compare information and diagrams with http://www.rothbartsfoot.bravehost.com/ (plagiarism?)

2. All podiatry theories are flawed according to Karl Popper's falsifiability (http://en.wikipedia.org/wiki/Karl_Popper) but you can accept them as paradigms or theorical models according to Thomas Khun. I suppose it is Dave Smith and Mark Russell were trying to say.

3. I agree with Kevin Kirby regarding the use of validated models and scientific language. Although, I prefer to refer it as biophysics instead of biomechanics (mechanics is only one part from physics) or engineering (we talk about the human body not bridges). If we are not able to start using a scientific language we will can not leave nonsense blablabla.

4. We (I include myself), as podiatrist, have the bad habit to apply every treatment or theory we hear or see in our practice without thinking about its consistency.

5. We forget that feet have flexible arches! like none man have built.

Regards,

 

I have no problem with theory's that question the state of things - I spend so much of my academic life doing just that. We spend a lot of time teaching the students different theroretical approaches and giving them the tools to evaulate different theories. We do not teach them about the topic of this thread (and I do not know of any other podiatry school that does), as its so factually flawed (its not even worthy of being called a theory). I did get one honours student to look into the approach recently, but with the tools they got taught on how to evaluate theories/approaches they quickly gave it a tag very similar to the "snake oil" slang.

The key tool we try to instill in students is the "theroretical coherence and biological plausibility" concepts I often use. The approach of Rothbarts easily fails both.

Anyone can read my letter to the editor and Rothbarts reply and make there own mind up abut the adequacy of the response -- simply restating ones own references that no one can check the veracity of is not a response.

Why has none of the research been published in peer reviewed mainstream scientific or podiatric journals?
Why publish in 2nd tier journals?
Why make so many claims and quote references to support that claim and when you go and check the reference, it dosen't support the claim being made?
Why use references that none of us can check? or use references that are in abstract form that we can not see if the methodology can be reproduced?
Why ignore evidence that actually states the opposite?

I am still waiting for the explanation on the effects on the menstrual cycle.

 

Hi everybody, just spent the last couple of hours reading the whole thread. I have to say that while I automatically come down on the Craig/Kevin side of the fence, there is one small, niggling problem - a lot of people say that they (the insoles) work. This may be simply that, as someone mentioned, propping up the foot with anything relieves symptoms - but a soft 3.5mm wedge under the 1st MTPJ area?? I concur with the thought that doing anything like this will cause FHLimitus and new symptoms, so how does it help? It may well be that you have to pick your patients very carefully in order to see the quoted results or avoid causing long-term damage, but this dosen't seem to be the case. A second point is that anyone who seems to be doing something different is sometimes seen as saying everyone else is wrong and is castigated as a result. I personally have never seen these insoles and feel I need to before I can add anything of any use to this thread. Keep on writing. Sammy

 

I too have spent a couple of hours trying to digest all this. Having not heard of Rothbarts inserts before I was intrigued. I have not seen the inserts and an not sure I want to. My conclusion is that I am more concerned at the blind faith put in what, to me, is a very flawed concept.

 

Primus Metatarsus Supinatus Foot

I have noted a referral to my website using the old address. Below is the updated website URL:

www.rothbartsfoot.info

So many questions have been asked, so many misunderstandings have been generated in some of the postings, that it would be almost impossible for me to answer them all. Instead, I will be conducting a 2 day seminar in England (details to be posted).

As they say, nothing is new under the sun. And that also holds true for my research. The concept of the common compensatory pattern (postural distortions in my terminology) was first introduced by the Osteopath Zink. This is not to be confused with posturology, which does have some commonalities with the CCP, but in practice is very different. I say this with first hand experience. Last year I conducted a 3 month course (endorsed by the Italian Association of Podology and accredited by the Italian Ministry of Health for 50 CEUs) at the Istituto Italiana di Podologo (The Podiatry School in Rome Italy). Some of the matriculants were posturologists and we spent a great deal of time looking at the differences between posturology and biophysics (biomechanics). Is some of my work based on posturology, absolutely. However, more is based on Zinks CCP. Zink argued that the base of support in human motion was the pelvis. I argue that the base of support are the feet. Incidentally my research has been published both in the English (UK) and Italian Podiatry Journals.

Do postural distortions have an impact on infertility in women (and urogenital issues in general), absolutely. However, again this is not a new concept. The first paper I read on the subject was published in 1952 By Niceley P. (Urologic symptoms relieved by postural corrections. Journal Int Coll Surg, May 18(3):340-48). Have I personally seen women become pregnant (who were not able to after many years of trying) AFTER correcting the position of the pelvis, again ABSOLUTELY. But again, this is not a new concept. Gynocologist write about the Isthmus block preventing insemination. By reversing the retroverted uterus, the chance of impregnation is improved. Unfortunately, they advocated surgery to reposition the pelvis. I advocate a much less invasive approach - reverse the retroverted uterus by improving the posture. How do we improve the posture? We use proprioceptive insoles. If you think that it is not possible to change posture using proprioceptive insoles, go the the following URL and see for yourself
http://www.rothbartsfoot.info/Infoscientific.html

So, what may seem like a 'wacky' notion, that you can improve the chance of pregnancy by putting something underneath the foot, is not so wacky afterwards.

regards,
Prof Brian Rothbart
Principal Researcher, Diabetic Study, Istituto Superiore di Sanita 2004 - 5
www.iss.com

 

Prof. Rothbart,
Could you please explain further what you term proprioceptive input, in relation to mechanical input, and how your insoles can be shown to determine a change by this mechanism, and not a mechanical one??
regards
Tony Achilles

 

No Sammy, it's not a niggling problem, it's a bloody big problem that questions the status quo. It needs explaining by researchers who have respect for each others views (in public anyway). And after the academic dust has settled......there has to be a use for the research ie a clinical tool that the everyday practitioner can use in his practice to help patients.

We now have in the public domain 1/Brian's original paper 2/Craig's objections3/Brian's replies to the objections. It seems to me that it comes down to two academics totally disagreeing with each other.......but as far as the rest of us are concerned, we can read the papers and make a choice.

Brian's theory stands or falls by the statement that the ontogenetic retention
of talar supinatus results in a STRUCTURAL not POSITIONAL elevation of the 1st met/hallux. At the workshop, he stated that the possible incidence of this in the populace could be as high as 85%. This translates to me that 8 out of 10 patients coming to see you could have this problem. IF HE'S RIGHT.
As far as I'm aware his is the only theory to go back to the embrylogical stage of development.
All I know is that I started to get my patients to stand, put them in st neutral, and measure the first ray defecit. Some were 20mm of the ground. Yes I did say 20mm.

This is where the arguments REALLY start.
These devices are not suitable for every foot type. If you dispense them to patients with LESS than 10mm 1st ray defecit, you'll cause problems. 10mm is the MINIMUN.

These devices are NOT SUPPORTIVE, and they are not orthotics either. The only similarity they have with orthotics is that they re time the gait cycle.

Unless I've completely lost the plot, one of the tenets of Bx still held is that foot should work around STN for optimum function. So, if the hallux is 15mm (common) in the air when the foot is in STN what happens.......the hallux will come down to the ground come what may when that patient starts to walk.......pronating the foot. and bringing the leg/knee/hip into xs internal rotation, and causing the pelvis to rotate forwards. As someone said.....it's not rocket science.
If you put a 15mm wedge under the first ray, of course you'd get problems. Brian's theory states that you put back a THIRD of the deficit....for people who have in xs of a 10mm defecit ONLY.

Brian's theory is that these devices, instead of supporting the foot, stimulate the propriocetive action in the muscles of the foot, and that putting back 30% of the first ray defecit will give a 75% decrease in hyperpronation.(I told you the arguments start here!)

These things do not work when the patient is standing still....they only work on walking. THEY ARE NOT SUPPORTIVE
Theory.......the foot reaches toe off, hits post (under first ray only-NOT 2-5)
ie contacts ground earlier in gait cycle forcing centre of gravity backwards, just like an orthotic does. But also and again the controversial bit, every time the hallux hits the post the proprioceptors fire and send an impulse to the cortex. Result, after a time the brain is re programmed into thinking the ground is higher than it is, muscles in the foot are strengthened, AND IN A LOT OF CASES THE PATIENT CAN DISCARD THE DEVICE AFTER A PERIOD OF TIME. THEY DO NOT HAVE TO BUY INTO THE LIFE STYLE OF PERMANENT DEVICES.

I can hear the howls of anguish now........that's his theory. IT IS A THEORY. All I know as a practitioner, it seems to work, and I haven't jammed a first ray yet. The devices fit in shoes as an added bonus. Thought I'd just mention that!

Now......I'll sit back and wait to be shot down,(I'm the messenger, I'm just using the theory) and then we'll go into the placebo effect and start the arguement about proprioception.......this one will run and run

 

Posturology is not based on biophysics. And biophysics is not only biomechanics, although both terms are used as synonymous. For the study of foot function you need to know about mechanics, electrophysiology, dynamics, trigonometry, etc

The problem with posturology, osteopathy and your work is that they fall on metaphysics. Does they work? Sometimes yes and sometimes not. But, they fail to explain no why they work (it is only a theorical model); they do not explain why they do not work.

As it have been said before, if you create a paradigm you can only explain facts through it. But, if you use biophysics, there is a common language independently from the model.

Thus, you can not compare posturology (metaphysics) with biomechanics (physics). And, from you have said, your work is based (and far than similar) to posturology and osteopathy.

Also, as Craig Payne have said, Why do not publish your work on first line journals?

Finally, I have to say that I agree with you about two statements:

1. The base of support are the feet
2. Weight-bearing asymmetries can cause systemic problems such as cardiovascular problems http://www.cacr.ca/news/1998/9812Schamberger.htm

Regards,

 

One of the truly interesting things about our profession is that we are relatively young (especially when it comes to Bx). At the moment we seem to be somewhere around the adolescent phase - where we are very deeply and passionately committed to our beliefs. We have not gained the benefit of having a long standing theoretical basis from which to argue our practice, just as the adolescent is developing their knowledge and experience base. Therefore, when we fight, we fight like enraged teenagers. And I think this thread is testamony to that!

I would not have it any other way. It is the passion , enthusiasm and motivation of our youth that drives us into the future. So, for this youthful profession, this line of debate is very valuable.

So far I have been delighted by the maths (OK, so I am married to a mathematician - what else would you expect to turn me on!). Keep up the arguments chaps - it is fascinating. Just remember that we are all on the same side.

As an Australian Rock Band called itself - TISM.

cheers

Felicity

PS. TISM - This Is Serious Mum

 

Good on you girl.

These comments re: Osteopaths and lack of their evidence base (and we might as well add in chiropractors). doesn't seem to worry them. They have faith in their theories, patients go to them for help.....even after the recent report in the papers to say that their interventions did little good. All the chiropractors I know however live in bigger houses than Pods do though. (Except me of course, 'cos I sell snake oil on the side!)

 

This reply got lost in all the hullabaloo the other night.

Dave

I think you misunderstand the basic reason for division. The basic idea of dividing something by two means forming 2 parts that together make up the original thing. So dividing by zero would mean you make zero groups and together they'd have to make up the whole thing. That can't be done, because if you say zero groups - and you put them together again - you would still get zero...and not what you started with. That's why dividing by zero is mathematically impossible.

That goes for anything - even if you don't see it as numbers. The thing is though...you can see anything as sets - and numbers are sets too. So even if you were talking about everyday objects like chairs and tables. You could make those into sets; appoint a number to those sets and still add and subtract and do everything you want to do. Simple when you think of it that way, huh?

Now BOT after I catch up with the replies. Hello Felicity - nice to see you chipping in!

Mark Russell

 

Re Proprioceptive Input

Tony,

The research coming out of Europe regarding the regulation of posture via proprioceptive input to the bottom of the foot is vast, however, allow me to quote one of my favorite studies:

Journal of Physiology (2001), 532.3, pp. 869-878
Foot sole and ankle muscle inputs contribute jointly to human erect posture regulation
Anne Kavounoudias, Régine Roll and Jean-Pierre Roll
Laboratoire de Neurobiologie Humaine, UMR 6562, Université de Provence/CNRS, Marseille, France

(You can access the entire paper at the following URL: http://jp.physoc.org/cgi/content/full/532/3/869

To quote their conclusions:

"Mechanical vibration was used as a common tool since it has been clearly demonstrated that, depending on the stimulated body site, it was able to induce oriented postural responses from mainly muscle proprioceptive or tactile origin (Eklund, 1972; Roll & Roll, 1988; Kavounoudias et al. 1998, 1999a)."

If you want a more detailed description, read the entire paper. It is excellent. It also will explain how proprioceptive insoles function (or at least how we THINK proprioceptive insoles function, no one really knows for sure. However, the one thing most of us agree upon (we being the major research facilities looking at this proprioceptive loop) is that these insoles are not mechanical in their action, that is, they do NOT support the foot.

The proprioceptive insoles I use are based on a tactile response (not a mechanical vibration as used by Anne Kavounoudias), but the response is identical.

best regards,
Brian

 

Regarding publication

Also, as Craig Payne have said, Why do not publish your work on first line journals?

Regards,[/QUOTE]

Javier.

Do you consider the American Journal of Podiatric Medical Association a major journal? I have published 5 or 6 papers in that journal.

cheers,
Brian

 

Alex,
Is there any evidence to support the 85% with talar supinatus?

Still not quite sure about this issue of proprioceptive, not supportive, as it seems you are providing compensation for primus metatarsus elevatus. (please correct me if I am wrong)

Sorry to open the debate regarding proprioception, but I would regard any tactile input to have a proprioceptive effect and have myself had patients improve function following habituation to an orthosis.However,no correction of a structural abnormality has taken place

I would be interested to know following the removal of the device,whether this 'proprioceptive' alteration is permanent and how it could correct the structural primus metatarsus elevatus described.
respectfully

Tony Achilles

 

Brian,
Thank you for your reply.
However, the study notes vibrative input.
I feel to assume that your insoles create the same response as a vibrating insole, is a large leap of faith.
Could not the same be applied to all insoles??
regards
Tony Achilles

 

Proprioceptive Input

Tony,

Nothing to be sorry about, you are asking very astute and important questions. The pivotal question is, does the insole support the foot or not. If you use an arch support, you are supporting the foot. If you dimension the PCI past 30% of the measured PMs value, you are supporting the foot (in my opinion). I have no doubt (in my mind) that supportive type orthotics also apply a tactile stimulation to the bottom of the foot. However, when you have a PMs foot type, arch supports, rearfoot posts, kinetic wedges, and forefoot posts are counterindicated, and please read that as C O U N T E R I N D I C A T E D !!! Also, please understand in the NON PMs foot type, PCIs are C O U N T E R I N D I C A T E D !!!

Regarding Ingramming (in this case meant to mean reprogramming the cerebellum(?) to maintain the postural correction without a continuous tactile input), the jury is still out on this issue. But this is what I suggest based on my clinical experience: in some of my patients I find they are using their PCIs less and less and still maintaining their level of wellness (when this occurs, it usually takes 3-4 years of using the devices before ingramming is observed). Obviously you are NOT correcting the structural deformity. So how does it work? I suggest it is a function of reprogramming the postural center in the cerebellum (I believe) to maintain the postural correction. Again, no one knows for sure, other than the fact, that it does occur.

Regarding 85% with talar supinatus, no hard evidence to date. Again, just from my clinical experience, the clinical trials we have done (some published) and my experience as an avid embryologist (self trained after my one course in Embryology at the Univeristy of Detroit, and again at OCPM). I believe it is very important to understand the embryological development of the normal foot before you can understand the etiology of the PMs foot. Go to my website at http://www.rothbartsfoot.info/EmbryolWheel.html It presents a visual presentation on this subject (note - most of the material comes from Grays Anatomy).

One thing more about engramming, it is not permanent. If you stop wearing the proprioceptive insole for a period of time (several weeks or more) the engramming effect slowly attenuates.

Thanks for you queries, very stimulating.

Brian

 

Re Proprioceptive Input

You are correct, that would be a giant leap of faith. As I said the Kavounoudias study is one of my personal favorites. However, the literature is replete on this subject.

Dr Fusco (MD researcher in Italy) has investigated tactile insoles, and their impact on posture. Go to the following URL to read her research: http://www.ksitalia.it/engl/2valutazioneStrument.htm

I can give many many more references if you like, however, check out the abbreviated publications that I have listed on the following page (Under Research and Publications): http://www.rothbartsfoot.info/Links.html
Please note, all of these are from other researchers (other than myself).

regards,
Brian

 

Alex can I suggest that you read Tom McPoil's paper on this. Basically he found no relationship between talar head rotation and forefoot position. So if you are correct in that Brian's theory stands or falls on this concept, the available evidence suggests it falls- sorry.

 

In other words since all orthoses provide a tactile input, they could all be termed "proprioceptive". As could socks and shoes. I think this is a none-sense.

 

Javier.

Do you consider the American Journal of Podiatric Medical Association a major journal? I have published 5 or 6 papers in that journal.

cheers,
Brian[/QUOTE]

Can you give the titles and references of these papers please?

 

Can you give the titles and references of these papers please?[/QUOTE]

Don't worry, beat you to it:
BA Rothbart
Flexible vertical talus syndrome: its relationship to talipes equinus
J Am Podiatr Med Assoc 1974 64: 697-700.

BA Rothbart
Phasic activity of muscles within the lower extremities
J Am Podiatr Med Assoc 1973 63: 129-137.

BA Rothbart
Nomenclature and its importance in modern podiatry
J Am Podiatr Med Assoc 1972 62: 298-302.

BA Rothbart
Metatarsus adductus and its clinical significance
J Am Podiatr Med Assoc 1972 62: 187-190.

BA Rothbart
Clinical treatise on transverse plane dysplasias of the femur and tibia
J Am Podiatr Med Assoc 1972 62: 1-14.

BA Rothbart
Heel spur and heel spur syndrome
J Am Podiatr Med Assoc 1971 61: 186-189.

Which of these publications are relevent to the current discussion?

 

Simon.......no need to apologize. You were very polite. I'll send you a bottle of snake oil. (I'm not going to live this down am I?! I've now received a copy of the snake oil poster posted by Kevin......it's going up in the surgery next week)

As far as your posting....I quote from Brian's published reply to Craig's objections to his theory........"Dr. Payne is correct in that McPoil's (1987) study found no correlation between talarsupinatus and forefoot varum.However McPoil did not evaluate the correlation between talar supinatus and Primus Metatarsus Elevatus".....which is the REAL crux of Brian's argument.

 

But he did measure the relationship between rotational position of the talar head and forefoot position. Since a metatarsus primus elevatus would result in an inverted forefoot postion, you should probably see some relationship, don't you think? Why wouldn't you?

Moreover, as I recall, the only evidence Brian provides for this is an embryologic study from the turn of the 19th/ 20th century- not exactly current

 

References

Don't worry, beat you to it:
BA Rothbart
Flexible vertical talus syndrome: its relationship to talipes equinus
J Am Podiatr Med Assoc 1974 64: 697-700.

BA Rothbart
Phasic activity of muscles within the lower extremities
J Am Podiatr Med Assoc 1973 63: 129-137.

BA Rothbart
Nomenclature and its importance in modern podiatry
J Am Podiatr Med Assoc 1972 62: 298-302.

BA Rothbart
Metatarsus adductus and its clinical significance
J Am Podiatr Med Assoc 1972 62: 187-190.

BA Rothbart
Clinical treatise on transverse plane dysplasias of the femur and tibia
J Am Podiatr Med Assoc 1972 62: 1-14.

BA Rothbart
Heel spur and heel spur syndrome
J Am Podiatr Med Assoc 1971 61: 186-189.

Which of these publications are relevent to the current discussion?[/QUOTE]

 

References

Don't worry, beat you to it:
BA Rothbart
Flexible vertical talus syndrome: its relationship to talipes equinus
J Am Podiatr Med Assoc 1974 64: 697-700.

BA Rothbart
Phasic activity of muscles within the lower extremities
J Am Podiatr Med Assoc 1973 63: 129-137.

BA Rothbart
Nomenclature and its importance in modern podiatry
J Am Podiatr Med Assoc 1972 62: 298-302.

BA Rothbart
Metatarsus adductus and its clinical significance
J Am Podiatr Med Assoc 1972 62: 187-190.

BA Rothbart
Clinical treatise on transverse plane dysplasias of the femur and tibia
J Am Podiatr Med Assoc 1972 62: 1-14.

BA Rothbart
Heel spur and heel spur syndrome
J Am Podiatr Med Assoc 1971 61: 186-189.

Which of these publications are relevent to the current discussion?[/QUOTE]


Simon,

You are quite correct. All those papers were based on Rootian biomechanics (which I was an ardent supporter of during the 1970s).

Regarding germane publication on my current research in peer reviewed publications (ignoring the paper cited in the Journal of Bodywork and Movement Therapy):

(1) Rothbart BA, Esterbrook L. 1988. Excessive Pronation: A Major Biomechanical Determinant in the Development of Chondromalacia and Pelvic Lists. Journal Manipulative Physiologic Therapeutics 11(5): 373-379.
JMPT is THE major research journal for the American Chiropractic Association (no advertisements and very strict peer review process)

(2) Rothbart BA, Yerratt M. 1994 An Innovative Mechanical Approach to Treating Chronic Knee Pain: A BioImplosion Model. American Journal of Pain Management 4(3): 13-18.
(3) Rothbart BA, Liley P, Hansen, el al 1995. Resolving Chronic Low Back Pain. The Foot Connection. American Journal of Pain Management 5(3): 84-89

The AJPM is a peer reviewed journal (no advertisement).

Currently I have a paper that has passed peer review and set for publication in a n international peer review journal which I will quote once it has been published.

Ok, I am tired. This has been fun but exhausting. I will post again sometime in the middle of next week.

regards,
Brian

 

Re Citations on Talar Supinatus

Simon,

McPoil did not look at Primus Metatarsus Supinatus (I have exchange emails with him). You can not extrapolate or make assumptions from a published paper that did not, at that time, know of the existence of this foot type (my first paper published on this foot type was in 2002).

Regarding references on the embryology of talar supinatus, I have given numerous citations regarding the evidence for the torsion changes in the talar head. However, I think it is only correct, as part of the citations, to credit the FIRST paper published on this subject. It was written in 1906 by a archeologist (Bardeen) who examined over 1000 Egyptian bones (feet) and reported the vast differences in talar torsion. I have also given other references

Strauss WL 1927 Growth of the human foot and its evolutionary significance. Contributions in Embryology, 19:95.

Streeter GL 1945 Developmental horizons in human embryos. In Contributions to Embryology, Vols 21, 32 34, Carnegie Institution, Washington DC
(Streeter was an internationally known embryologist, respected all over the world)

Sewell RS 1906 A study of the astragalus. Part IV Jour Anatomy and Physiology, Vol 40:152

Interesting enough, Grays Anatomy includes much of the work first published by Sewell, Bardeen and Streeter

Cummins H 1929 The topographic history of the volar pads in human embryo. Contributions in Embryology 20:105

Bardeen CR 1905 Studies of the development of the human skeleton. Amer Jour Anatomy 4:265.

Bohm M 1929 The embryologic origin of clubfoot. Jour Bone Joint Surgery (American) 11:2, 229.

Sarrafian Sk 1983 Anatomy of the Foot and Ankle. JB Lippincott, Phil.

These and not to mention my studies.

All these and more were cited in my publications.

Brian

 

I see a solution to all of this. Perhaps Dr Rothbart could provide some samples of his insole system to independent researchers to carry-out some kinematic and kinetic testing? That way we can stop speculating on what they do or don't do to the lower-limb and find out scientifically.

I'm sure Brian that if you a confident in your claims you will have no problem with this as it would provide you with the perfect way of silencing your critics.

What say you?

 

With the exception of Sarrafian (a textbook and as such not a primary source) all of these papers are from the 1st half of the 20th centruy one from the 1940's the rest from the 1920's or earlier. Are there no contemporary sources to support your conjecture? Me thinks our understanding of lower limb function has moved on slightly from then.

 

moreover, the rigour required for scientific publication has changed somewhat since this time of the "gentleman scientist".

 

Current Research

Simon,

This is being done at this very moment. Two large independent research facilities are evaluating my technology. One is funded and starting this May in the United States (a double blind study involving a base of 400 people), another on a smaller scale in England. Before I gave specific details, I need to check with the research facilities and Bjorn Svae before releasing this information.

Brian

 

Re References

Simon,

You are tiring me out. I am not complaining, mind you, it is just I have a long day tomorrow.

Ok, how about two Podiatrists who published in the 1970s discussing the theoretical relationship between talar supinatus and forefoot varum. They are:

(1) Tax HR. Podopediatrics. Baltimore: Williams & Wilkins, 1980.

I think everyone knows who Dr Tax was. He wrote the definitive textbook on children Podiatrics during his time.

(2) Hlavac HF. Compensated forefoot varus. J Am Podiatr Med Assoc 1970;60(6):229-233.

cheers
Brian

 

Brian, I don't mean to bug you. Tax is a textbook- thus secondary source- who did he reference and the Harry Hlavac reference is 36 years old. Moreover, what experimental data did either of these two workers provide to support any claims that you now make?